Læknablaðið - 01.06.1961, Síða 35

LÆKNABLAÐIÐ
67
after the acute manifestations
of illness have disappeared. At
a later date should the sources
perpetuating tlie stress not be
resolved, we might expect an-
other outbreak of a stress dis-
ease.
Selye’s work on what he calls
the general adaption syndrome,
a sequence of organic responses
to continued and mounting
phvsical and/or emotional trau-
mata, clearly shows, as does our
newer knowledge of A.C.T.H.
and cortisone, that the disap-
pearance of the acute phase of
an illness does not realljr mean
cure. More accurately we can
speak only of a reversal of di-
rection, i.e., from continued
moving toward recurrent epi-
sodes of acute illness and
chronic progressive destructive
disease, to moving toward in-
creasing physical and psychic
health. For tliis to occur, the
whole life plan of the individual
must be modified. This includes
both a physical and emotional
reorientation. It means helping
a person so arrange and live
his life that the stress level over
time becomes steadily lower.
Modern medicine, in its con-
cept of prognosis, is now mucli
closer to the concept of prog-
nosis in more advanced think-
ing in psychotherapy. In taking
into account the whole notion
of stress, the focus of modern
medicine has become that of
the whole human being in the
totality of his living. Also, such
a concept of prognosis is closely
connected with the notion of
objectives in therapy. Prognosis
will vary with our therapeutic
objectives. They in turn will be
determined by a patient’s assets
and liabilities, physical and
psliychological, his life circum-
s.tances and the availability of
time and finances.
Our objective may have to
be limited to symptom or
psychiatric syndrome relief, or
social rehabilitation. Briefly
stated, tliis meáns to help a per-
son over the acute phase of his
illness and to bring him to, a
state approximating what had
been obtained before he had his
acute outbreak. Such a person
isn’t ever his „old self“ again,
because he has been changed
bv his acute illness. What is
more, he isn,t as „good as new,“
and he isn’t „cured“. Our ob-
jective might be to attempt to
lower the level of physical and
psychic tension so tliat there is
less danger of further episodes
of mental illness. Hopefully his
patterns of living will become
so changed that his tension level
continues to decrease. As we
are lielping him move in this
direction, he will be moving to-
ward greater physical and
psycliic health. What is impor-
tant is that we make as com-
plete a survey as possible of an