THE PSYCHOSOCIAL SETTING OF THE DEVELOPMENT OF LEUKEMIA AND LYMPHOMA
THE PSYCHOSOCIAL SETTING OF THE DEVELOPMENT OF LEUKEMIA AND LYMPHOMA
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白血病和淋巴瘤发生的心理社会背景
DOI：
10.1111/j.1749-6632.1966.tb45428.x
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发表时间：
1966
影响因子：
5.2
通讯作者：
W. A. Greene
中科院分区：
文献类型：
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作者：
W. A. Greene
我将描述一些男性和女性患白血病和淋巴瘤疾病的心理和社会经历。我会对此有所局限，但同时又不同，将一组诊断类别放在一起，充分认识到病理表现的多样性。这些疾病可能被认为是网状内皮细胞疾病，被许多人描述为肿瘤性疾病，因此可以在这次会议上进行仔细的审查。在过去的15年里，与罗切斯特医学部血液科的成员一起进行了三项独立的研究，特别是劳伦斯·杨博士、斯科特·斯威舍博士和斯坦利·特鲁普博士。目前要考虑的患者都是20岁及以上的成年人，其中包括一组16名男性，另一组32名女性2，以及最近的第二组61名男性。许多年前进行的最初研究包括连续16名被诊断为白血病或淋巴瘤的男性患者住进一家综合医院。8人是白血病，8人是淋巴瘤。年龄25~77岁，中位数49岁。除了一名黑人外，所有这些人都是白人。这些初步观察表明，这些男子在经历失去个人和情感支持的情况下患上了明显的疾病，这些情况是由于与母亲的形象，如妻子或实际的母亲分离，通常是由于死亡。他们还在适应与受伤、手术、退休或跳槽相关的各种同时出现的自尊丧失。在这些男性身上没有明显的共同人格类型或冲突情况，在他们过去的适应中也没有一致的模式。在病程中表现为食欲减退、恶心、呕吐、疼痛以及不同程度的焦虑反应和抑郁。观察表明，这些症状可能与患者的心理痛苦有关，也可能与白血病或淋巴瘤疾病有关，而明显疾病的发展可能在某种程度上与个人对心理社会状况的特殊反应有关。第二项更系统的研究包括32名女性，通过一次通常是三次或三次以上的开放式访谈进行研究。19人患有各种类型的白血病，13人患有各种类型的淋巴瘤。年龄20~71岁，中位数42岁。他们都是白人。在这32名女性中，有30名在经历后出现了症状或不愉快的感觉，鉴于相关的情绪困扰，这些经历被解释为个人损失或有意义的人际分离。图1显示了12类损失或分离的个案，包括死亡和威胁死亡或与母亲分离、死亡和威胁死亡或与父亲分离、死亡、威胁死亡或与丈夫分离、威胁死亡或与子女分离以及其他重要成年人的死亡。此外，还列出了更年期、失去或改变家庭以及失去工作的经历。在四年的先兆时期，这些女性中有16人经历过三次或更多这种类型的丢失，九人经历了两次，五人经历了一次。如前所述，其中两名女性没有
I will describe some psychological and social experiences of men and women developing the leukemia and lymphoma group of diseases. I will deal with this somewhat circumscribed, but at the same time heterogeneous, group of diagnostic categories together, fully aware of the diversity of pathological manifestations. These diseases may be considered as reticuloendothelial disorders and are described by many as neoplasltic, and therefore can come under scrutiny at this conference. Three separate studies have been carried out during the past I5 years in association with members of the Hematology Unit of the Department of Medicine at Rochester, in particular Dr. Lawrence Young, Dr. Scott Swisher, and Dr. Stanley Troup. The patients to be considered at this time were all adults, age 20 and above, and include one series of 16 men,’ another of 32 women2 and more recently a second series of 61 men. The initial study carried out many years ago included 16 consecutive male patients admitted to a general hospital with the diagnosis of leukemia or lymphoma. Eight were leukemia and eight were lymphoma. Ages ranged from 25 to 77 years with a median of 49 years. All of these men were white except for one negro. These initial observations indicated that the men developed the manifest disease in a setting in which they were experiencing a loss of personal and emotional support incident to separation from a mother figure such as the wife or the actual mother usually by death. They were also adjusting to a variety of concurrent losses of self-esteem related to some injury, operative procedure, retirement or change of work. There was no common personality type or conflict situation evident in these men and no consistent pattern in their past adjustment. The symptoms leading up to the recognition of lymphoma or leukemia and manifested in the course of the illness frequently included anorexia, nausea, vomiting, pain and varying degrees of anxiety reaction and depression. The observations suggested that the symptoms could be related to the patient’s psychological distress as well as to the leukemic or lymphomatous disease and that the development of the manifest disease might be in some way related to the individual’s particular response to the psychosocial situation. A second, more systematic study included 32 women, studied by one and usually three or more open-ended interviews. Nineteen had various types of leukemia and 13 had various types of lymphoma. Ages ranged from 20 to 71 with a median of 42 years. All were white. Thirty of these 32 women had developed their symptoms or unpleasant affects in the wake of experiences that were interpreted as personal losses or interpersonal separations of meaningful significance in view of the associated emotional distress. In FIGURE 1 are shown the individual cases, the 12 categories of losses or separations, including death and threat of death or separation from the mother, death and threat of death or separation from the father, and death, threat of death or separation from the husband, threat of death or separation from the children, and death of other significant adults. Also listed are the experience of the menopause, a loss or change in home, and loss of work. During the four-year prodromal period, 16 of these women had experienced three or more of these types of losses, nine had two, five had one. As indicated previously two of the women had no