Long-term adjustment, prognosis, and death in irreversible diffuse obstructive pulmonary syndromes.

Abstract

Forty subjects with severe debilitating irreversible diffuse obstructive pulmonary syndrome were studied over a 4-year period. They were found to utilize denial, repression, and isolation to protect their failing respiratory systems from environmental inputs. Failure of these defenses led to physiologic and psychologic deterioration. Psychosocial assets were found to be as important as the physiologic assets in the treatment of these patients. Patients with high psychosocial assets were found to be more effective in protecting themselves from dangerous symptoms or behaviors and were more likely to proceed with realistic, appropriate treatment programs. The probability of dying was increased in the presence of both low psychosocial and low physiologic assets. Dying was found to be a specific goal-directed adaptive behavior which was reported as being comfortable and relatively devoid of threat. Emotional upsets accompanying death were largely related to problems with family, friends, and hospital staff.