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A group of seven asthmatics were identified from family practice, following administration of a questionnaire, as expressing feelings of stigma or pessimism concerning their condition. They were interviewed in depth, using interpretive research methods, concerning their experience of asthma. Interpretive research uses qualitative methods to explore the emotions, feelings and meaning of the event of interest. All the interviews were transcribed verbatim by the principal researcher and analyzed by the technique of immersion and crystallization. The picture of asthma that emerged for the participants in this study gave rise to the concept of a dynamic model to illustrate their asthma experience. The model showed asthma as a continuum from diagnosis to final acceptance. The transition phase included a need to integrate knowledge, experience and self-awareness before progressing to acceptance and control. A mentoring relationship greatly facilitated resolution of the transition phase. Progress along the continuum was accompanied by diminishing fear. Another important theme to emerge was the fact that tiredness and physical limitations were common feelings, irrespective of the severity of the asthma in medical terms. The implications of this research for health workers is that they have much to contribute in assisting asthmatics to gain control over their condition, particularly in respect to understanding what knowledge concerning their condition is relevant to asthmatics and in understanding the potential benefit to asthmatics of a mentoring relationship.
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PMID:The experience of asthma. 152 73

To evaluate perceived discrimination against cured cancer patients in the work force in Montreal, in 1982-83 we surveyed 101 cured cancer patients and 101 control subjects who had never had cancer and who were matched for age, sex and neighbourhood of residence. In addition, 24 of the cured patients were randomly selected and paired with cancer patients with a poor prognosis who were matched for age and sex. Discrimination was slightly more common among cured patients (18%) than among control subjects (15%), and 21% of the cancer patients with a poor prognosis reported discrimination. Analysis of the comparisons between the cured and control groups indicated no statistically significant differences. The cured cancer patients reported the following problems faced by cancer patients returning to work: fatigue (30%), absenteeism (14%), psychologic problems (12%), social stigma (12%) and discrimination by an employer (10%).
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PMID:Perceived discrimination against cured cancer patients in the work force. 382 27

"It is in the healing business that the temptations of junk science are the strongest and the controls against it the weakest." Despite their subjective nature, these syndromes (particularly MPS) have little reliability and validity, and advocates paint them as "objective." Despite a legacy of poor-quality science, enthusiasts continue to cite small, methodologically flawed studies purporting to show biologic variables for these syndromes. Despite a wealth of traditional pain research, disciples continue to ignore the placebo effect, demonstrating a therapeutic hubris despite studies showing a dismal natural history for FS. In reviewing the literature on MPS and FS, F.M.R. Walshe's sage words come to mind that the advocates of these syndromes are "better armed with technique than with judgment." A sympathic observer might claim that labeling patients with monikers of nondiseases such as FS and MPS may not be such a bad thing. After all, there is still a stigma for psychiatric disease in our society, and even telling a sufferer that this plays only a partial role may put that patient on the defensive. Labeling may have iatrogenic consequences, however, particularly in the setting of the work place. Furthermore, review of a typical support group newsletter gives ipso facto proof of this noxious potential. The author of a flyer stuffed inside the newsletter complains that getting social security and disability benefits for "the invisible disability" can be "an uphill battle. But don't loose (sic) hope." Apparently the "seriousness of the condition" is not appreciated by the medical community at large, and "clinician bias may well be the largest threat," according to Boston epidemiologist Dr. John Mason. Sufferers are urged to trek to their local medical library and pull four particular articles claiming FS patients have more "stress," "daily hassles," and difficulty working compared with arthritis patients. If articles can't be located, patients are told to ask their lawyers for help. Although "Chronic Fatigue Syndrome" and FS are not considered by everyone to be the same malady, the "National Institute of Health (sic) has lumped these two conditions together. This could work in your favor." (A U.S. political advocacy packet is available for $8, but a list of U.S. senators with Washington, DC addresses is freely provided.) These persons see themselves as victims worthy of a star appearance on the Oprah Winfrey show. A sense of bitterness emerges; one literally bed-bound Texas homemaker writes in Parents magazine that "Some doctors may give up and tell you that you are a hypochondriac."(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Fibromyalgia syndrome and myofascial pain syndrome. Do they exist? 764 31

Primary monosymptomatic nocturnal enuresis (PMNE) is often not openly discussed in Asian societies. We report the parental view of PMNE in Singapore, its impact on patients and their families and the traditional beliefs and its influence on subsequent management. A screening questionnaire was used in evaluating 30 children enrolled in a clinical trial on the use of oral Desmopressin for the treatment of PMNE. Primary monosymptomatic nocturnal enuresis was familial in 56.7% of patients. Fifty per cent of them were previously unevaluated. Earlier remedial attempts included bedtime fluid restriction and voiding (100%), incentive measures (43.3%), traditional practices (26.7%), punishment (20%), drugs (16.7%), psychotherapy (100%) and bladder training (3.3%). Perceived causes of PMNE were maturational delay (50%), deep sleep (50%), familial (43.3%), behavioural problems (43.3%) and excessive fluid intake (26.7%). Reasons for seeking treatment included restricted outdoor activities (90%), parental fatigue (86.7%), disrupted sleep for the household (46.7%) and fear of underlying pathology (26.7%). Perceived adverse effects on patients included social stigma (83.3%), disrupted sleep (33.3%) and impaired school performance (13.3%). Primary monosymptomatic nocturnal enuresis can thus be a chronic distressing problem in Asian communities.
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PMID:Primary monosymptomatic nocturnal enuresis in Singapore--parental perspectives in an Asian community. 920 70

The Self-Appraisal Questionnaire (J. C. Coyne & M. M. Calarco, 1995) was used to examine how primary care and psychiatric outpatients with recent or past major depression appraised their prospects and structured their lives. They were compared with nondistressed and distressed primary care patients. Both depressed groups scored higher than the nondistressed patients for Lack of Energy, Management of Burden on Others, Need to Maintain a Balance in Life, Fear of Taking Risks, Imposition of Limitations on Life, and Sense of Stigma. The distressed group fell between the depressed psychiatric and the nondistressed groups, and generally did not differ from the depressed primary care group. Past depression did not explain differences associated with more recent depression and distress. Distress entails a need to manage its effects on others, but depression in psychiatric patients may produce a more profound reorganization of self-concept, relationships, and coping.
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PMID:Effects of recent and past major depression and distress on self-concept and coping. 950 41

Chronic Fatigue Syndrome (CFS) is characterized by debilitating symptoms including persistent or relapsing fatigue. As a result of CFS, some individuals experience significant stigma that is attached to this illness. Many medical professionals are skeptical of the validity of the illness, and employers often fail to appreciate the seriousness of the symptoms. Although negative attitudes greatly affect the lives of individuals with CFS, there is presently no measurement of attitudes toward this illness and people who have CFS. The purpose of the present studies was to create a scale that measures attitudes toward individuals with CFS--the Chronic Fatigue Attitudes Test (CAT)--and to assess the scale's reliability and validity. The 13-item scale was created using several constructs outlined in the literature regarding negative attitudes toward people with CFS, disabilities, and AIDS. Theoretical implications of the findings and the utility of the CAT are discussed.
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PMID:The development of the Chronic Fatigue Syndrome Attitudes Test. A psychometric analysis. 1062

The formal beginnings of psycho-oncology date to the mid-1970s, when the stigma making the word "cancer" unspeakable was diminished to the point that the diagnosis could be revealed and the feelings of patients about their illness could be explored for the first time. However, a second stigma has contributed to the late development of interest in the psychological dimensions of cancer: negative attitudes attached to mental illness and psychological problems, even in the context of medical illness. It is important to understand these historical underpinnings because they continue to color contemporary attitudes and beliefs about cancer and its psychiatric comorbidity and psychosocial problems. Over the last quarter of the past century, psycho-oncology became a subspecialty of oncology with its own body of knowledge contributing to cancer care. In the new millennium, a significant base of literature, training programs, and a broad research agenda have evolved with applications at all points on the cancer continuum: behavioral research in changing lifestyle and habits to reduce cancer risk; study of behaviors and attitudes to ensure early detection; study of psychological issues related to genetic risk and testing; symptom control (anxiety, depression, delirium, pain, and fatigue) during active treatment; management of psychological sequelae in cancer survivors; and management of the psychological aspects of palliative and end-of-life care. Links between psychological and physiological domains of relevance to cancer risk and survival are being actively explored through psychoneuroimmunology. Research in these areas will occupy the research agenda for the first quarter of the new century. At the start of the third millennium, psycho-oncology has come of age as one of the youngest subspecialties of oncology, as one of the most clearly defined subspecialties of consultation-liaison psychiatry, and as an example of the value of a broad multidisciplinary application of the behavioral and social sciences.
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PMID:History of psycho-oncology: overcoming attitudinal and conceptual barriers. 1191 37

Since 1988, when the term chronic fatigue syndrome (CFS) was coined, considerable discussion has occurred about stigma associated with this diagnostic term. In particular, patients with CFS have felt that this term trivializes the serious nature of this disorder. A Name Change Work group, appointed by the CFS Coordinating Committee, developed an umbrella term: chronic neuroendocrineimmune dysfunction syndrome (CNDS), and proposed that there would be sub-types under this term, one being CFS. The present study examined attributions of this new umbrella term when compared with CFS. Nurses and physician assistants (PAs) were presented a case study of a patient with symptoms of CFS. They were told that the patient had either "chronic fatigue syndrome," "chronic neuroendocrineimmune dysfunction syndrome," or "chronic neuroendocrineimmune dysfunction syndrome, which had formerly been called chronic fatigue syndrome." The different terms led to different attributions, with PA respondents rating the "CNDS" label as more severe. Results suggest that a more medical sounding term (CNDS) may lead to attributions that this syndrome is a more serious, disabling illness. The policy implications of these findings are discussed.
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PMID:Chronic fatigue syndrome versus neuroendocrineimmune dysfunction syndrome:differential attributions. 1518

Impulsive behavior is a common source of stigma. The authors argue that people often stigmatize impulsive behavior because they fail to appreciate the influence visceral impulses have on behavior. Because people tend to underestimate the motivational force of cravings for sex, drugs, food, and so forth, they are prone to stigmatize those who act on these impulses. In line with this reasoning, in 4 studies, the authors found that participants who were in a cold state (e.g., not hungry) made less favorable evaluations of a related impulsive behavior (impulsive eating) than did participants who were in a hot state (e.g., hungry). This empathy gap effect was tested with 3 different visceral states--fatigue, hunger, and sexual arousal--and was found both when participants evaluated others' impulsive behavior (Studies 1 & 2) and when participants evaluated their own impulsive behavior (Study 3). Study 3 also demonstrated that the empathy gap effect is due to different perceptions of the strength of the visceral state itself. Finally, Study 4 revealed that this effect is state specific: Hungry people, for example, evaluated only hunger-driven impulses, and not other forms of impulse, more favorably.
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PMID:Evaluating Eve: visceral states influence the evaluation of impulsive behavior. 1760 90

Continuing advances in antiretroviral therapy are increasing survival and longevity for people living with HIV. However, factors related to depression and suicidal ideation associated with aging and HIV may mean that the synergistic effects of aging with HIV could place many adults at undue risk for these conditions. Such factors include ageism and stigma, loneliness/decreased social support, neurological changes, declining health, fatigue, changes in appearance, and financial distress. Potential interventions that address these factors are needed to abate depression and prevent suicidal ideation. Nurses are in key positions to identify and intervene with HIV-infected and aging patients who may be at risk for depression and suicidal ideation.
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PMID:A model of suicidal ideation in adults aging with HIV. 1876 45


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