Experiences of selves in isolation: A psychodynamic approach to the care of patients being treated in a specialized medical hospital unit 1

Abstract

In this paper, I explore the emotional experiences of patients who are nursed in physical isolation in a specialist general hospital. I begin with a description of a subjective experience that occurred while I was in a session with a patient. My own inner psychic state led me to think about what the patient might be feeling and it became the basis for the subject of this paper.With reference to the work of Daniel Stern, Thomas Ogden and others I discuss the possible effects of a serious physical illness and its treatment on the patient's sense of self and bodily continuity. Insight into the mental, physical and emotional processes that may affect these patients can help the counsellor to work with the kinds of anxieties that arise and provide the emotional containment needed. The patients written about in the three clinical examples were all in-patients being treated for leukaemia. The ideas explored here can also apply more broadly to include other seriously ill patients needing intensive medical treatment in hospital.

Cancer du sang et secteur protégé adulte : premières investigations pour une recherche–action

“…Le cas de Mme M. illustre comment l'épuisement peut conduire d'une passivité tolérée à un état de passivation insupportable en ce qu'il ramène le sujet à un état de détresse aiguë comme le décrit également J. Parkinson ou encore D. Ibled [6,21]. L'intervention psychologique était une nécessité absolue pour éviter un effondrement psychique majeur.…”

“…Reste que nous ne savons pas ce que sont devenus les patients après leur sortie et si l'intervention de la psychologue a pu avoir un effet durable. Cette question est d'autant plus importante que plusieurs auteurs ont souligné un risque d'aggravation de la détresse psychique à la sortie de l'hôpital [6,21]. Sensibilisées à cette question, nous l'avons mise au coeur de la recherche en cours, dont le protocole est basé sur une comparaison entre deux groupes de patients : l'un suivi durant l'hospitalisation uniquement, l'autre durant plusieurs semaines à domicile après sa sortie.…”

Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective

“…Whereas little is known about the experience of isolation in BCUs (both immunocompromised patients, placed in protective or reverse isolation, and patients with infectious diseases, placed in source isolation), studies of other medical isolation settings have examined the demands and stressors on isolated patients (Catalano et al, 2003;Collins et al, 1989;Gammon, 1998;Gaskill et al, 1997;Jones, 2010;Knowles, 1993;Linda Barratt et al, 2011;Parkinson, 2006;Purssell et al, 2020;Rees et al, 2000;Shaban et al, 2020;Vottero & Rittenmeyer, 2012). The outbreak of COVID-19 has led to increased interest in the negative consequences of (prolonged) isolation of highly infectious patients (Hossain et al, 2020;Shaban et al, 2020).…”

Experience of adults and children in hospitals

“…Sensing a lack of identity and confidence in who they truly are, those individuals might then feel disorganised and disengaged (Parkinson, 2006). Indeed, the lingering, long-term psychological effects such as anxiety, depression and post-traumatic stress disorder have been recognised to commonly occur in response to critical illnesses (Eddleston, White, & Guthrie, 2000;Mayou & Smith, 1997;Scragg, Jones, & Fauvel, 2001).…”