No Sense of Coherence

Abstract

See related article, pages 1447–1453. When making a diagnosis of stroke, a physician should ask the patient how he experienced his deficit. Most patients, if not impaired by speech or memory, will give a straightforward account of their surprising and miserable experience of having felt a sudden motor or sensory loss, distressing weakness, or alarming loss of vision or of coordination. Interestingly enough, many patients also include in their story why they think this has happened to them. Often they report that they had recently endured much ‘stress’, and whatever their own personal definition for this might be, it will often be connected to a life-event, such as loss of job, loss of a spouse, or any other personal unhappy (or, much more rarely, happy) event. Although stroke physicians empathically listen to such explanations by the patient, they do not overtly take these subjective causalities as an indicator of a stroke risk. If stressful events persist, physicians might offer general advice enabling …