Patients as Health Producers: The Psychosomatic Foundation of Lifestyle Medicine

Abstract

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Clinical Characterization of Demoralization

“…Time devoted by the physician may yield a redefinition of symptoms without challenging the reality of suffering, clarify previous iatrogenic misunderstandings prompted by discrepancies among physicians, underscore the value of self-management, and promote enhancement of a healthy role [40]. Unfortunately, current health care trends privilege expensive tests and procedures and tag the time devoted to the interaction between patient and physician as lacking costeffectiveness, while the reverse is true [41]. The diagnosis of demoralization in a medical patient may mandate such attention.…”

“…If priority is given to this latter clinical situation, on the basis of its development according to stages [22] and macro-analysis [37], suggestions for modifying lifestyle may be the initial treatment of choice [21][22][23]. Such treatment, based on homework assignments, would pertain more to the domains of lifestyle medicine [41,42] than those of psychiatry and clinical psychology.…”

“…An impressive body of evidence has linked the progression of severe medical disorders to unhealthy lifestyle behavior [26], and the importance of promoting lifestyle modifications is increasingly recognized in clinical medicine [41,42]. However, health promotion entails considerable difficulties in its application.…”

“…However, health promotion entails considerable difficulties in its application. Lifestyle modification focused on weight reduction, increased physical activity, and dietary change is advised as first-line therapy in a number of medical disorders, yet the success rate of enduring changes is exceedingly low, particularly when long-term outcome is considered [41,42]. A major difficulty is represented by the prolonged effort that is required, with frequent discouragement and frustration when unavoidable drawbacks occur [41].…”

“…Lifestyle modification focused on weight reduction, increased physical activity, and dietary change is advised as first-line therapy in a number of medical disorders, yet the success rate of enduring changes is exceedingly low, particularly when long-term outcome is considered [41,42]. A major difficulty is represented by the prolonged effort that is required, with frequent discouragement and frustration when unavoidable drawbacks occur [41]. A clinical state of demoralization may emerge during treatment of conditions such as type 2 diabetes and overweight/obesity [42,53,54], and the successful clinician is the one who recognizes and alleviates demoralization while treating the patient.…”