Abstract
In conversations with the terminally ill, it is always noticeable how much these patients hold on to images, wishes, and future perspectives that embody something unreal, utopian, and illusionary for outsiders. It seems like an illusionary misjudgment of reality. This adherence to apparent illusions has a high significance for patients, and an external assessment, from the point of view of an alleged certain reality and so-called common sense, does not do justice to this phenomenon. Whether denial of the incurability of a disease is useful or harmful to the patient is a controversial issue. From a psychoanalytical point of view, the fantasies of inviolability and immortality are regarded as necessities of life. The physician should recognize denial as a protective illusion and avoid forced confrontation with reality. Patients often oscillate between the illusion of immortality and acceptance of the reality of cancer leading to death. The doctor should make the patient feel supported by an empathic relationship to him/her, so he/she is able to at some point let go and find peace.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Literature
Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, et al. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167:453–60.
Bakitas ML, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer. JAMA. 2009;302(7):741–9.
Fallowfield LJ, Jenkins VA, Beveridge HA. Truth may hurt but deceit hurts more: communication in palliative care. Palliate Med. 2002;16:297–303.
Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet. 2004;363:312–9.
Freud S. Civilization and its discontents. Oxford, England: Hogarth; 1930.
Freud S. Reflections upon war and death. In: Rieff P, editor. Character and culture. New York: Collier Books; 1963. p. 107.
Saunders C, Sykes N. The management of terminal malignant disease. London: Edward Arnold; 1993.
Singer AE, et al. Symptom trends in the last year of life from 1998 to 2010: a cohort study. Ann Intern Med. 2015;162(3):175–83.
Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. NEJM. 2010;363:733–74.
Tolstoy L. The death of Ivan Ilyich. UK: Penguin Classics; 2016.
Zimmermann C, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Fritzsche, K. (2020). The Terminally Ill and Dying Patient. In: Fritzsche, K., McDaniel, S., Wirsching, M. (eds) Psychosomatic Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-27080-3_18
Download citation
DOI: https://doi.org/10.1007/978-3-030-27080-3_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-27079-7
Online ISBN: 978-3-030-27080-3
eBook Packages: MedicineMedicine (R0)