Survival by Machine: The Psychological Stress of Chronic Hemodialysis

Abstract

The prolongation of life by artificial means is a compelling topic for the physician who treats patients with chronic hemodialysis. This paper discusses the stresses, losses, and restrictions which dialysis imposes upon the patient, his family, and other caretakers. Examples of psychological reactions to such circunistances are given and major conflictual problems are described. The role of dependency and independence in chronic illness, the use of denial as a major defense mechanism, alterations in body image, attitudes towards life and death are all discussed in terms of the psychological reactions to the stress of hemodialysis. The problem of suicide is illustrated with a variety of forms it takes in these special patients who depend upon mechanical devices for their very existence. Some of the moral, ethical and economic problems of patient selection for hemodialysis are indicated and briefly examined.

Psychiatric disorders and large interdialytic weight gain in patients on chronic haemodialysis

“…Depression is linked in the psychodynamic literature with a response to a loss. End‐stage renal disease patients have experienced multiple losses: loss of kidney function, occupational function and status within the family, mobility and physical function and capacity, and cognitive abilities 24,25 . Therefore, they have a sustained diminution in sexual desire and function.…”

Social networks and social support: living with chronic renal disease

“…(For an indepth discussion of the changes in life-style imposed by dialysis see Refs. [12][13][14][15]. The most common psychological problem experienced by dialysis patients, in part due to the losses that they confront, is depression [14,15,29].…”

“…A number of studies have shown that there is a correlation between social support provided by family members and a patient's adjustment to dialysis [ 14,15,38] . Specifically, there is some evidence that a family's attitudes might be a determining factor of the success or failure of home dialysis [14].…”

Changes in medical problems and use of medical services following psychological intervention.

“…Modern medical and surgical treatments may prolong life but may have iatrogenic psychological complications. This is illustrated by depression during chronic hemodialysis (Abram, 1970;Ziarnik, Freeman, Sherrard, & Calsyn, 1977) and following open-heart surgery (Kimball, 1969). Furthermore, the medical outcomes of such interventions have been shown to be influenced by the psychological response to the interventions (Kimball, 1969;Ziarnik et al, 1977).…”