Let me say at the outset the reason for being a medical doctor or any other healthcare providers to make an accurate diagnosis and organize a treatment plan. Furthermore, many if not most patients feel a sense of relief that their problem and both a name called a diagnosis and it can be treated. What is often not recognized is that very diagnosis and the treatment leads to damage to the patients’ ego ideal.
What is an ego Ideal? It is how people aspire to see and feel about themselves-their bodies and their minds. A Psychiatric Glossary fifth edition defines ego ideal as “The part of the personality the aims and goals for the self; usually refers to the conscious and unconscious emulation of significant with whom one has identified. The ego ideal emphasizes what one should be or do in contrast to what one should not be or not do (APA 1980, page 35). In other words, we view ourselves as active, likeable, complete and normal. Yes, many of us would like to see ourselves as brilliant, talented, great athletes and heroes but we can accept that we are not.
But, having just been given a diagnosis and prescribed a treatment and/or a mediation, people feel a sense they are not perfect, not totally healthy and not completely complete. Hence, persons must and do wrestle ambivalently with the diagnosis and treatment. On one hand there is relief that there is diagnosis and a treatment but the pains they are not perfect. So patients experience, if even not express, feeling s of annoyance, alienation and sadness at the situation.
There are the stories of the patients who feel fine going into the doctors’ offices only to be perplexed when they discover they have hypertension. Or teenagers who has just been diagnosed as Type I diabetes. They often have several bout of treatment in an intensive care unit before they accept the need to take insulin.
The bottom line is that clinicians need to recognize the grieving process perhaps very sublime of what the diagnosis and treatment mean to the patient. They can listen and hear the patients’ concern. And by doing so can validate the patients’ emotions about their diagnosis and treatment.