Emotions and illness.
AIM: This paper discusses issues central to emotional expression in illness. Its aim is to challenge the psychopathological paradigm currently utilized within healthcare and propose an alternative model based on healthy emotions. BACKGROUND: Emotions are important to human survival. It is argued that most patients will have an emotional response to their illness but anxiety and depression are unlikely to be representative of most patients experience. The paper focuses on two important negative emotions, fear and sadness, and their psychopathological associates, anxiety and depression. Problems of diagnosing anxiety and depression in practice are highlighted. It is contended that emotional reaction to illness is normal and that emotions expressed are likely to hold clues to individual adaptation. It is argued that in health care, emotions should be assessed as healthy reactions to a survival threat and merit study from this perspective if we wish to understand individual patient illness reaction and adaptation better. Literature from cardiology is used to illustrate clinical problems. RATIONALE: Given the present knowledge of emotions, it should be possible to utilize emotion theory as a paradigm for studying human reaction to illness. This in turn could help shape studies on adherence and adaptation. CONCLUSION: The reaction and experience of patient illness is unlikely to be understood through the psychopathology paradigm. A better understanding of patient reaction to their illness is more likely to emerge through the study of basic emotions during acute life-threatening episodes.