Abstract
This chapter will deal with topics related directly to attitudes to cancer and other diseases; the nature, sources, and extent of these attitudes both in the medical profession and in the general population.
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References
Attitudes to Cancer
Dargent, M., (1962). La cancérophobie. Acta Un. int. Cancr. 18, 709. 476 cases of cancerophobia, one third of which were neurotic, two-thirds had a normal fear. Only 3.5% of the 476 in fact had a neoplasm.
Dargent, M., and Vauterin, C. (1961). La cancérophobie. Sem. Hôp. Paris. 37, 2417.
Donaldson, M. (1955). Cancer: The psychological disease. Lancet i, 959 and later correspondence.
Donaldson, M. (1958). Early diagnosis of cancer. A psychological problem. Lancet ii, 790. “Although true cancerophobia is rare, both personal apprehension (which can be prevented by education) and impersonal cancer apprehension (‘f ear of creating fear’) are almost universal.”
Levine, G. N. (1962). Anxiety about illness: Psychological and social bases. J. Hlth hum. Behav. 3, 30. National sample of 2970. Cancer more feared than polio, cerebral palsy, arthritis, birth defects and T. B. Positively correlated with fear of cancer were the factors: knowing a victim, knowledge about the disease, perceived prevalence, perceived expensiveness of treatment. Negatively correlated with fear of cancer are education and possession of adequate community medical resources.
Nunnally jr. J. C. (1961). Popular conceptions of mental health: Their development and change, New York: Holt, Rinehart & Winston, Inc., p. 62. Incidental to the author’s examination of attitudes to mental health, he found that methods for treating cancer aroused the most anxiety when compared with methods for treating broken bones and mental illness.
Samp, R. J. (1962). Physician poll on cancer preventon. Opinions and reactions of over 1,400 Doctors. J. Amer. med. Ass. 179, 1001. Evidence that “generally the ideas of preventing cancer seem novel, ineffective, and speculative” to doctors.
Thomas, A. (1952). Typical patient and family attitudes. Publ. Hlth. Rep. Wash.) 67, 960. The author highlights the psychosocial, informational and experiential factors in a person’s reaction to terminal cancer. A person’s attitude to cancer will, in turn, affect that of other patients and families.
Wakefield, J., and Davison, R. L. (1958). An answer to some criticisms of cancer education: A survey among general practitioners. Brit. med. J. i, 96. The Authors found no cancerophobia resulting from an intensive cancer education programme.
World Health Organization (1964). Prevention of cancer. Wld. Hlth. Org. techn. Rep. Ser. 276. “The warnings that cancer education might create cancerophobia have proved a myth” (p. 31).
The Doctor Looks at the cancer program (1956). J. Amer. med. Ass. 160, 1171. An editorial review of a report of National Opinion Research Center interviews with 500 physicians, named by their patients as family doctors in an earlier random sample study of adult U.S. population. Study indicates that the “average physician strongly endorses the American Cancer Society’s injunction to ‘go straight to your doctor at the first sign’ of any of the ‘seven danger signals.’ “ Despite minority criticism, “great majority of practicing physicians in the United States regard the major voluntary health agencies as useful allies in the continuing fight against ignorance and disease.”
Major public oplaion surveys on cancer
(N.B. The dates refer to publication: in each instance the survey was carried out earlier.)
Argentina
Seeber, A. B. de S., Public opinion on cancer in Argentina. U.I.C.C. Bull. 2, No. 4, 3, (1964).
Australia, Perth
A social survey of community attitudes to cancer. Cancer Council of Western Australia 1966.
Canada
Phillips, A. J. Public opinion on cancer in Canada. Canad. med. Ass. J. 73, 639, (1955).
Phillips, A. J., and Taylor, R. M. Public opinion on cancer in Canada: A second survey. Canad. med. Ass. J. 84, 142 (1961).
England, Manchester
Paterson, R., and Aitken-Swan, J. Public opinion on cancer: A survey among women in The Manchester Area. Lancet ii, 857, (1954).
Paterson, R., and Aitken-Swan, J. Public opinion on cancer: Changes following five years of cancer education. Lancet ii, 791, (1958).
Women’s knowledge of and opinions on cancer. An Interim Pilot Survey for the Manchester Comittee on Cancer (Manchester: Derek Roe Associates Ltd.)
Italy
Morandi, G., Vivori, C. e Mengon, M., Le conoscenze e gli orientamenti del pubblico in tema di tumori maligni [Public opinion and knowledge about cancer]. Riv. med. Trentina 1, 69, (1963). (Italian text.)
Poland
Sawicki, F. Opinia publiczna o nowotworach [Public opinion about neoplastic diseases]. Zdrow. publ. 12, 599, (1963). (Russian and English Summaries.)
United States of America
Summarized in 1956 and 1964 (below).
Horn, D. et al. Public opinion on cancer and the American Cancer Society: A report of a national Sample Survey. New York: American Cancer Society Inc. 1956.
Horn, D., and Waingrow, S. What changes are occuring in public opinion toward cancer: National public opinion survey. Amer. J. publ. Hlth. 54, 431, (1964).
Other references
Amer. Cancer Soc. (1964). The public’s awareness and use of cancer detection tests. A Survey for the American Cancer Society. (Gallup Organization, Inc. Princeton, New Jersey.)
Cartwright, A., and Martin, F. M. (1958). Some popular beliefs concerning the causes of cancer. Brit. Med. J. ii,592.
Cartwright, A., Martin, F. M., and Thomson, J. G. (1958). Public opinion concerning tuberculosis. Med. Off. 99, 73.
Kegeles, S. S., Kirscht, J. P., Haefner, D. P., and Rosenstock, I. M. (1965). Survey of beliefs about cancer detection and taking Papanicolaou tests. Publ. Hlth. Rep. 80, 815. Behavioural scientists at the University of Michigan School of Public Health, analysing a national probability sample of whom 884 were women, confirm earlier reports that low socio-economic groups and women over 65 are least informed of the value of cervical tests. Those who know the benefits of tests tend to have them more regularly. The authors feel tests should be the subject of education at the time when women visit physicians and clinics. Physicians must explain to women the importance of these tests as they give them and must emphasize the benefits of early diagnosis. A greater mass information effort is needed.
Levine, G. N. (1962). Anxiety about Illness: Psychological and social bases. J. Hlth. hum. Behav. 3, 30.
Toch, H., Allen, T., and Lazer, W. (1961). The public image of cancer etiology. Public Opinion Quarterly 25, 411.
Wakefield, J., and Baric, L. (1965). Public and professional attitudes to a screening programme for the prevention of cancer of the uterine cervix. Brit. J. prev. soc. Med. 19, 151.
Davison, R. L. (1965). Opinion of Nurses on cancer, its treatment, and its curability. Brit. J. prev. soc. Med. 19, 24.
Horn, D., and Solomon, E. S. (1957). Perception of the seven danger signals. Mimeo: American Cancer Society, Inc.
Horn, D., and Solomon, E. S. (1957). The impact of a health education program. Mimeo: American Cancer Society, Inc.
La Pointe, J. L., Wittkower, E. D., and Lougheed, M. N. (1959). The psychiatric evaluation of the effect of cancer education on the lay public. Cancer (Philad.) 12, 1200.
Levine, G. N. (1962). Anxiety about illness: Psychological and social bases. J. Hlth. hum. Behav. 3, 30.
Pratt, L., Seligmann, A., and Reader, G. (1958). Physicians’ views on the level of medical information among patients. In: Patients, physicians and illness, ed. by Jaco E. G. (Free Press of Glencoe.)
Pratt, L., Seligmann, A., and Reader, G. (1958). Physicians’ views on the level of medical information among patients. Also in Amer. J. publ. Hlth. 47, 1277 (1957).
Samora, J., Saunders, L., and Larson, R. F. (1962). Knowledge about specif ic diseases in four selected samples. J. Hlth. hum. Behav. 3, 176.
Delay studies
[For studies included in the extensive reviews by Kutner et. al. (1958) and Blackwell (1963) a reference only is quoted. Other studies are briefly annotated.]
Aitken-Swan, J., and Paterson, R. (1955). The cancer patient: Delay in seeking advice. Brit. med. J. i, 623.
Alvarez, W. C. (1931). How early do physicians diagnose cancer of the stomach in themselves? J. Amer. med. Ass. 97, 77.
Bard, M., and Sutherland, A. M. (1955). Psychological impact of cancer and its treatment: IV. Adaptation to radical mastectomy. Cancer, (Philad.) 8, 656. The authors consider the “anticipatory stage”, in which the person suspects that something is wrong and that it might be cancer. The influence of fear and possible delay are discussed.
Bar-Moar, A., and Davies, A. M. (1960). Delay in diagnosis and treatment of cancer of the digestive tract. Haref uah, 59, 319.
(Hebrew Text). 201 consecutive cases from The Rothschild Hadassah — University Hospital 1955 — 1958. Analysed according to site and responsibility for delay. 17% of the Patients delayed less than two months, 23 % more than a year. The percentages for doctor — delay were 50 % and 13 % respectively.
Blackwell, B. L. (1963). The literature of delay in seeking medical care for chronic illnesses. Health Education Monographs. No 16. Most of this review is taken up with a consideration of cancer delay, since little has been done in other fields. It is divided into sections dealing with separate aspects of delay: existence and length of delay; site of the cancer; delay as related to personal, physical and social attributes; psychological factors associated with delay; personality of the delayer; and factors which lead to seeking care. The remainder of the work is devoted to what little has been done with respect to other chronic illnesses and psychoneuroses.
Boyce, F. F. (1953). Certain preventable errors in the diagnosis and management of carcinoma of the stomach and the lung. Ann. Surg. 137, 864.
Brindley, G. V. (1937). Carcinoma of the rectum: Factors affecting its cure. J. Amer. med. Ass. 108, 37.
Burdick, D., and Chanatry, F. (1954). Central New York Surgical Society Survey on Breast Carcinoma, 1920 to 1952. Cancer, (Philad.) 7, 47.
Byrd, B. F. (1951). Fatal pause in diagnosis of neoplastic disease in physicianpatient. J. Amer. med. Ass. 147, 1219.
Cobb, B. (1959). Emotional problems of adult cancer patients. J. Amer. Geriat. Soc. 7, 271.
Cobb, B., Clark, R. L. jr., Mcguire, C., and Howe, C. D. (1954). Patient — responsible delay of treatment in cancer: A social psychological study. Cancer, (Philad.) 7, 920.
Cooper, W. A. (1941). The problem of gastric cancer. J. Amer. med. Ass. 116, 2125.
Cooper, W. A. (1952). Patients, physicians and gastric cancer. J. Amer. med. Ass. 150, 688. Of 687 cases (for the years 1932–1951) patients delayed for an average of eight months. There was little improvement in the decades before and after 1940. The average delay after consulting a doctor was four months. Patient-delay has its origins in ignorance, fear, and false hopes. Fundamental in this respect is the individual’s reaction to illness in general.
Diddle, A. W. (1950). Genital cancer among women: Factors affecting its control in an urban population. Amer. J. Obstet. Gynec. 59,1373.
Drellich, M. G., Bieber, I, and Sutherland, A. M. (1956). The psychological impact of cancer and cancer surgery: Vi. Adaptation to hysterectomy. Cancer 9, 1120. Delay is the result of fear of losing the highly-valued organ (the uterus), without which the patient feels she cannot continue in her at present adjusted and satisfying life. When the symptoms or disease are seen as a greater threat than the operation and its consequences, then she will seek treatment promptly. When operation and losing the organ are seen as a greater threat than the disease or its symptoms, she will delay.
Dublin, L. I., and Spiegelman, M. (1947). The longevity and mortality of American physicians, 1938–1942. J. Amer. med. Ass. 134, 1211.
Dublin, L. I., Spiegelman, M., and Leland, R. G. (1947). Longevity and mortality of physicians. Postgrad. Med. 2, 188.
Dublin, L. I., and Spiegelman, M. (1948). Mortality of medical specialists, 1938— 1942. J. Amer. med. Ass. 137, 1519.
Flowers jr. C. E., Ross, R. A., and Pritchett, N. L. (1958). Delay by physician and patient in the diagnosis and treatment of pelvic cancer. Sth. medical J. (Bgham, Ala.) 51, 1497. 191 cases were studied: of 131 cases of carcinoma of the cervix 70 (54 %) showed no symptoms, but of the remainder 16 % (21 cases) of the patients delayed, 30% (37 cases) of the physicians delayed. For carcinoma of the endometrium the figures were 16 % and 20 % for patient and physician delay respectively. 75 % of the cases of carcinoma of the vulva and vagina delayed. Delay in diagnosis could have been reduced in 64 % of the cases by annual examination.
Goldsen, R. K. (1963). Patient delay in seeking cancer diagnosis: Behavioral aspects. J. chron. Dis. 16, 427.
Goldsen, R. K., Gerhardt, P. R., and Handy, V. H. (1957). Some factors related to patient delay in seeking diagnosis for cancer symptoms. Cancer (Philad) 10, 1.
Gray, D. B., and Ward, G. E. (1952). Delay in diagnosis of carcinoma of the stomach. Amer. J. Surg. 83, 524.
Graziani, E. C. (1955). Quoted lrn: Causes of delay in diagnosis of cancer. J. Amer. med. Ass. 158, 968. A study of one thousand patients in Peru. The figures for delay were fairly close to those in other countries. The main difference was that more responsibility for delay lay with the patient and less with the doctor. Ignorance was the most important cause of patient delay.
Hammerschlag, C. A., Fisher, S., De Cosse, J., and Kaplan, E. (1964). Breast symptoms and patient delay: Psychological variables involved. Cancer (Philad.) 17, 1480. Sample of forty-one patients. Tested two hypotheses: (1) that people with more sharply (subjectively) defined body boundaries would delay more, and (2) that a person who habitually employs the defence-mechanisms of denial or repression would delay more. The first hypothesis was supported, the second was not. The authors suggest that those who have a well-defined body boundary “feel more secure about their bodies, less threatened by its symptomatic alteration, and, therefore, had less need to seek immediate assistance”. Furthermore, it was suggested, they delayed even more because they were less willing to enter into a submissive, dependent relationship such as exists between patient and doctor, or in a hospital. The authors suggested that one implication of their findings is that emphasis on the personal responsibility of the individual will be most effective (if not essential) in educating such people (delayers) to seek treatment early.
Harms, C. R., Plaut, J. A., and Oughterson, A. W. (1943). Delay in the treatment of cancer. J. Amer. med. Ass. 121, 335.
Henderson, J. G., Wittkower, E. D., and Lougheed, M. N. (1958). A Psychiatric investigation of the delay factor in patient to doctor presentation in cancer. J. psychosom. Res. 3, 27. One hundred cancer cases, each involving a delay of three months or more. Studied by means of a” combination of non-directive and mildly directive interview techniques”. Reasons for delay were considered in relation to a large number of factors: (1) connected with the physician; (2) connected with the disease. Significant ones were — minor symptoms overlooked, previous contact with cancer (increased delay), reason for initial contact with the doctor; (3) connected with the patient, that is, attitudes to health and medical care, and personality characteristics (4) connected with cancer education. Delay is not in the main due to ignorance. The authors conclude by discussing the importance of the form that an educational campaign takes: mere presentation of facts is not sufficient. The use of fear as a basis of cancer propaganda is seriously questioned. The importance of personality and interpersonal relationships is emphasized, as also are general medical attitudes. Finally, the physicians own interpersonal relationships and attitudes are considered.
Howson, J. Y. (1948). Observations on the delay period in the diagnosis of pelvic cancer. Med. Clin. N. Amer. 32, 1573.
Howson, J. Y. (1948). Pelvic cancer delay. The Organization and Observations of the Philadelphia Committee for the Study of Pelvic Cancer. Amer. J. Obstet. Gynec. 55, 538.
Howson, J. Y. (1950). Five Procedures and Results of the Philadelphia Committee for the Study of Pelvic Cancer. Wis. med. J. 49, 215.
Howson, J. Y., and Montgomery, T. L. (1948). An attack upon the delay period in the diagnosis of pelvic cancer. Trans. Amer. Ass. Obstet. Gynec. 59, 97.
Howson, J. Y., and Montgomery, T. L. (1949). An attack upon the delay period in diagnosis of pelvic cancer. Amer. J. Obstet. Gynec. 57, 1098.
King, R. A., and Leach, J. E. (1950). Factors contributing to delay by patients in seeking medical care. Cancer (Philad.) 3, 571.
King, R. A., and Leach, J. E. (1951). Habits of medical care. Cancer (Philad.) 4, 221.
Kutner, B., and Gordan, G. (1961). Seeking care for cancer. J. Hlth hum. Behav. 2, 171.
Kutner, B., Makover, H. B., and Oppenheim, A. (1958). Delay in the diagnosis and treatment of cancer: A critical analysis of the literature. J. chron. dis. 7, 95.
The authors distinguish between delay and procrastination. Delay can be unavoidable or avoidable. Only avoidable delay can be truly called procrastination; it is a failure to seek medical attention once the symptoms appear and are recognized as significant. The distinction made here is (a) between biological onset and first appearance of symptoms, and (b) between this appearance and the patient’s recognition of a legitimate medical complaint. To distinguish thus between causes of delay (insidious nature of the disease, failure to appreciate the significance of the early symptoms of cancer, and the true procrastination) is important in constructing hypotheses regarding delay and in understanding variations in behaviour within and between populations.
The authors make a very extensive review of earlier studies dealing with:(1) The prevalence of delay on the part of both patients and doctors. (2) Duration of patient-delay and doctor-delay. (3) Reasons for delay considered under several headings: patient-delay (knowledge of symptoms etc., psychological factors); physician-delay (failure to examine, diagnostic failure, wrong treatment or advice, medical attitudes and beliefs, insensitivity to the medical problem and to the patient, pessimism etc.).
The discussion points out some of the major inadequacies of the studies reviewed, and calls into question the vast majority, since they “neither provide for individual differences in the basic reasons for promptness and delay, nor for individual differences regarding the site, symptomatology, and severity of the disease and the symptomatic onset”. Finally, the authors consider some of the problems which their review of the literature on delay has shown to be in need of further research.
La Cour Andersen, J., and Stakemann, G. (1962). Cause of delay in diagnosis and treatment in carcinoma of the cervix. A study of 888 cases from 1958–1960. Dan. med. Bull. 9: 117. Of the cases studied 43 % were found to be in Stage 1, 24 % in stages III or IV. This was regarded as being due to the lack of symptoms in many cancers and to delay by the patients. The proportion of early cases has improved since 1942 when compared with pre- 1942, but there has been little improvement in the past two decades.
Lawter, D. E. de (1948). Culpability for delay in management of cancer. Med. Ann. D. C. 17 342. (Abstracted in J. Amer. med. Ass. (1948), 138, 777, No 1498.)
Leach, J. E., and Robbins, G. F. (1947). Delay in the diagnosis of cancer. J. Amer. med. Ass. 135, 5.
Makover, H. B. (1963). Patient and physician delay in cancer diagnosis: Medical aspects. J. chronic Dis. 16, 419. Discusses several aspects of delay, many of which are dealt with in F et al. (1958), of which article Makover was a co-author.
Miller, N. F. (1940). Carcinoma of the body of the uterus. Amer. J. Obstet. Gynec. 40, 791.
Miller, N. F. (1943). A consideration of certain factors pertaining to the control of carcinoma of the cervix. Amer. J. Obstet. Gynec. 46, 625.
Miller, N. F. (1948). Carcinoma of the uterus, ovary and tube. J. Amer. med. Ass. 136, 163.
Miller, N. F., and Henderson, C. W. (1946). Corpus carcinoma. Amer. J. Obstet. Gynec. 52, 894.
Pack, G. T., and Gallo, J. S. (1938). The culpability for delay in the treatment of cancer. Amer. J. Cancer 33, 443.
Robbins, G. F., Conte, A. J., Leach, J. E., and Macdonald, M. (1950). Delay in diagnosis and treatment of cancer. J. Amer. med. Ass. 143, 346.
Robbins, G. F., Macdonald, M. C., and Pack, G. T. (1953). Delay in the diagnosis and treatment of physicians with cancer. Cancer (Philad.) 6, 624.
Rosser, C., and Kerr, J. G. (1939). Cancer of the rectum in young persons. J. Amer. med. Ass. 113, 1192.
Scheffey, L. C. (1953). The delay period in the diagnosis of pelvic malignancy. Obstet. and Gynec. 1, 554.
Segschneider, P. P., and Rieden, H. G. (1960). Zur Verschleppung des Kollumkarsinom. [Delay in the diagnosis of cervical carcinoma.] Zbl. Gynäk. 82, 1449. Reviews 1996 cases in years 1949–1959. Delay in diagnosis for more than 4 weeks was the patients’ responsibility in 74.5 % of the cases, and the doctors’ in 27 %, There was delay in 80.6 % of the cases (German text).
Shands, H. C., Finesinger, J. E., Cobb, S., and Abrams, R. D. (1951). Psychological mechanisms in patients with cancer. Cancer (Philad.) 4, 1159.
Simmons, C. C., and Daland, E. M. (1920). Cancer: Factors entering into the delay in its surgical treatment. Boston med. surg. J. 183, 298.
Simmons, C. C., and Daland, E. M. (1924). Cancer: Delay in surgical treatment. Boston med. surg. J. 190, 15.
Stearns, H. C. (1950). Discussion of Diddle, A. W.: Genital cancer among women, factors affecting its control in an urban population. Amer. J. Obstet. Gynec. 59, 1381.
Stepanov, V. M. (1959). Causes of delayed treatment of cancer of the tongue. Vop. Onkol 5, 216. [Russian Text] 183 cases. 73 % of patients consulted a doctor within one month, but only 1.8% were admitted to hospital during first month, 26.1 % in first three months, 29.7 % in first five. Causes of delay: (1) faulty diagnosis, 78 %; (2) insufficient awareness of cancer among the population 11 %; (3) insidious course of the disease 11 %.
Sugar, M., and Watkins, C. (1961). Some observations about patients with a breast mass. Cancer (Philad.) 14, 979. A study of 50 patients prior to final diagnosis in order to discover why they delayed. Briefly stated, the conclusions were that cancer patients delayed and were depressed. Delay was not associated with knowledge of cancer symptoms nor was it caused by fear of what would be found. The non-delayer tended to show anxiety, while the delayer exhibited depression and little fear. By comparison, the patients who in fact had benign lesions were anxious and did not delay.
Taylor, S. G., 111, and Slaughter, D. (1952). The physician and the cancer patient. J. Amer. med. Ass. 150, 1012. This is the sixth of a special series of articles on cancer. In it the authors discuss the improvement brought about by propaganda in bringing the patient to the doctor earlier.
Titchener, J. L., Zwerling, I., Gottschalk, L., Levine, M., Culbertson, W., Cohen, S., and Silver, H. (1956). Problem of delay in seeking surgical care. J. Amer. med. Ass. 160, 1187.
Youngman, N. V. (1947). Psychological aspects of the early diagnosis of cancer. Med. J. Aust. i, 581.
Abrams, R. D., and Finesinger, J. E. (1953). Guilt reactions in patients with cancer. Cancer (Philad.) 6, 474. Sample of 60 unselected cancer patients. Attitudes of patients and doctors were studied by interviewing. Patients need to find a cause for their illness: 93 % of the patients showed feelings of guilt, due mainly to cancer being looked upon as unclean. Medical staff, too, showed special attitudes concerning cancer. Guilt feelings were responsible for (1) delay, (2) emotionally negative attitudes or feelings, and (3) patients’ inability to communicate. The authors conclude by considering measures taken to relieve the feelings of guilt.
Adsett, C. A. (1963). Emotional reactions to disfigurement from cancer therapy. Canad. med. Ass. J. 89, 385. This article summarizes conclusions from studies contained in this section of the present bibliography.
Aitken-Swan, J., and Easson, E. C. (1959). Reactions of cancer patients on being told their diagnosis. Brit. med. J. i, 779. 231 selected cancer patients were told their diagnosis. Between a week to a month later their reactions to being told were checked: 66 % were glad to know the truth, 7o disapproved, and 19% denied they had ever been told. None of the 35 family doctors who were asked reported any undesirable effect caused by the patients having learned the diagnosis.
Bard, M. (1952). The sequence of emotional reactions in radical mastectomy patients. Publ. Hlth. Rep. (Wash.) 67, 1144.
See Bard and Sutherland (1955) below, and Sutherland (1959).
Bard, M., and Sutherland, A. M. (1955). Psychological impact of cancer and its treatment: IV Adaptation to radical mastectomy. Cancer (Philad.) 8, 656. See Sutherland (1959). Of special interest in this study is the consideration of the significance of the breasts and their relation to the individual woman’s femininity. No generalizations can be made about the response of an individual to cancer of the breast and mastectomy; each case must be considered in the light of the individual’s adjustment to the important areas of life (death, sex, family etc.) and the values she has concerning them.
Bellak, L. (Ed.) (1952). Psychology of physical illness: Psychiatry applied to medicine, surgery and the specialities. London: J. & A. Churchill Ltd., New York: Grune & Stratton Inc. (Chapters of particular interest are annotated under entries for Meerloo and Rosen).
Brant, C. S., Volk, H., and Kutner, B. (1958). Psychological preparation for surgery. Publ. Hlth. Rep. (Wash.) 73, 1001. A study of 50 patients. There is a need to deal with the anxieties surrounding the pre- and post-operative periods. Recommendations are made.
Cobb, B. (1959). Emotional problems of adult cancer patients. J. Amer. Geriat. Soc. 7, 274. 40 patients. 3 major categories of stress:(1) the meaning of cancer for the individual; (2) the change from active to passive life; (3) separation, temporary or permanent. The doctor-patient relationship is considered in the light of these stresses.
Drellich, M. G., Bieber, I., and Suther-Land, A. M. (1956). The psychological impact of cancer and cancer surgery: VI Adaptation to hysterectomy. Cancer (Philad.) 9, 1120. See Sutherland (1959). This article is of special interest for consideration of the psychological significance of the uterus.
Dyk, R. B., and Sutherland, A. M. (1956). Adaptation of the spouse and other family members to the colostomy patient. Cancer (Philad.) 9, 123. See Sutherland (1959).
Gerle, B., Lunden, G., and Sandblom, P. (1960). The patient with inoperable cancer from the psychiatric and social standpoints. Cancer (Philad.) 13, 1206. 101 cases. Deals with the question of telling the patient his diagnosis. Found that fear of death does not seem to be the main cause of worry, but rather the pain associated with cancer.
Greene jr. W. A., Young, L. E., and Swisher, S. N. (1956). Psychological factors and reticuloendothelial disease: II Observations on a group of women with lymphomas and leukemias. Psychosom. Med. 18, 284. The authors found that the predominant emotional reaction was shame and not guilt. They suggest that this may be a characteristic response to this type of cancer as opposed to neoplasms.
Janis, I. L. (1958). Psychological Stress: Psychoanalytic and behavioral studies of surgical patients. New York: John Wiley & Sons Inc. Evidence from three sources: intensive case-studies of thirty patients, a second study by means of questionnaires of several hundred recent surgical cases, and the psychoanalysis of a patient who underwent surgery. The work aims firstly to bring out the theoretical implications of the surgical situation by an examination of the way people respond to stressful events in their lives. The second aim is to emphasise the practical implications, especially those concerned with (a) medical management, which must take into account the needs of the patients, (b) the better prediction of how a patient will tolerate stress, and (c) effective psychological preparation for surgery. One of the main findings was that someone faced with the threat of mutilation or death will revert (regress) to the emotional responses employed and found satisfactory in stress situations of early childhood. The other major finding was that post-operative reactions will depend on pre-operative anxiety. The most extreme emotional disturbance will appear post-operatively where the patient has had very high or very low anticipatory (preoperative) fear. Those who exhibit a moderate (medium) degree of pre-operative fear exhibit least post-operative disturbance.
Kline, N. S., and Sobin, J. (1951). The psychological management of cancer cases. J. Amer. med. Ass. 146, 1547. The author considers whether a patient should be told the diagnosis, and types of reaction to knowing that he has cancer — flight from the disease, over-reaction to, and obsessive preoccupation with the disease.
Kutner, B. (1958). Surgeons and their patients: A study in social perception. In, Patients, Physicians and Illness, ed. by E. G. Jaco. Glencoe (Ill.): Free Press. In the course of an excellent article the author deals with (1) the interpersonal relationships in surgery; (2) some social and psychological needs of surgeons: the operator’s role; and (3) the social and psychological needs of patients: the meaning of surgery, social traumata of operations, the search for meaning, psychological preparation, the perception of the surgeon’s role, and the implications for medical education and research.
Meerloo, J. A. M. (1954). Psychological implications of malignant growth: A survey of hypotheses. Brit. J. med. Psychol. 27, 210. Hypotheses put forward by the author deal with: psychosomatic aspects of the disease, fear of cancer created by propaganda, the psychological impact of surgical lesions, and the psychological problems of the investigator. Also considered are the psychological mechanisms of fear, frustration and denial at work in the doctor and patient when confronted with the possibility of cancer.
Meerloo, J. A. M., and Zeckel, A. (1952). Psychiatric problems of malignancy. In: Psychology of physical illness: Psychiatry applied to medicine, surgery, and the specialities, ed. by L. Bellak. London: J. & A. Churchill Ltd.; New York: Grune & Stratton Inc. This short but useful chapter deals with the patient’s attitudes concerning malignancies and the emotional significance they and the site of the malignancy have for him. The importance of the attitudes of the doctor and of the patient’s family is also discussed.
Menzer, D., Morris, T., Gates, P., Sabbath, J., Robey, H., Plaut, T., and Sturgis, S. H. (1957). Patterns of emotional recovery from hysterectomy. Psychosom. Med. 19, 379. 26 patients studied. Found that a crucial factor associated with post-operative reaction was the habitual way the patient handled fear and other difficult life situations prior to operation. Also of importance was the patient’s attitude to femininity.
Meyer, B. C. (1958). Some psychiatric aspects of surgical practice. Psychosom. Med. 20, 203. Considers the psychological characteristics of the patient and situation prior to surgery; pre-surgery psychological manif estations; the post-operative period; psychological and therapeutic aspects of mutilation; the patient-surgeon relationship.
Orbach, C. E., and Sutherland, A. M. (1954). Acute depressive reactions to surgical treatment for cancer. In: Depression, ed. by P. H. Hoch and J. Zubin. New York: Grune & Stratton. See Sutherland (1959).
Renneker, R., and Cutler, M. (1952). Psychological problems of adjustment to cancer of the breast. J. Amer. med. Ass. 148, 833. The dual psychological conflict confronting a woman with breast cancer arises from the need for adjustment to breast mutilation, and the need for adjustment to invasion of her body by a potentially deadly disease. The emotional meaning that the breasts have for a woman is important.
Rosen, V. H. (1952). Psychiatric problems in general surgery. In: Psychology of physical illness: Psychiatry applied to medicine, surgery and the specialities, ed. by L. Bellak. London: J. & A. Churchill Ltd. An excellent chapter dealing with the threat of danger involved in surgery, the emotional responses to danger, the process of undergoing surgery, and various specific aspects of surgery, such as chest surgery and amputation of a limb.
Ross, W. S. (1965). The climate is hope — How they triumphed over cancer. New York: Prentice-Hall, Inc. Not a research work, but throws interesting light on the attitudes to cancer of those treating it — and suffering from it. (See further entry in Chapter 12).
Shands, H. C., Finesinger, J. E., Cobb, S., and Abrams, R. D. (1951). Psychological mechanisms in patients with cancer. Cancer (Philad.) 4, 1159. An important article dealing in some depth with the integration by the individual of the distressing information that he has cancer. The processes and levels by which this is achieved, the part played by defence-mechanisms and by pain are discussed, as is the doctor-patient relationship. Adaptation to the new situation will result in the reduction of anxiety; adaptation should be aimed at, even though much distress may be involved in the process.
Sutherland, A. (1952). Psychological impact of cancer surgery. Publ. Hlth. Rep. (Wash.) 67, 1139. See Sutherland (1959).
Sutherland, A. (1956). Psychological impact of cancer and its therapy. Med. Clin. N. Amer. 40, 705. See Sutherland (1959).
Sutherland, A. M. (1959). Psychological impact of cancer and its therapy. In: Cancer, vol. 6, ed. by R. W. Raven. : Butterworth & Co., (Publ.) Ltd. In this article Sutherland summarizes many of the general findings of his own and his co-workers’ studies. The experience of having cancer is a special and severe form of stress involving the threat of death, or of mutilation, or of both. Many fundamental, underlying, emotionally-charged convictions are brought to the surface in a cancer patient. The experience of having cancer cannot be separated from the experience of its therapy, and each type of operation has its own special problems (see the separate articles in this bibliography). The ill-effects of the stress caused by threat of death or mutilation consequent on surgery are produced mainly in four ways: (1) by disrupting or threatening to disrupt a major pattern of adaptation to life; certain organs (e.g. sexual) often play an important part here; (2) by activating a system of beliefs, assumptions, values and other notions which become explicit determinants of action (e.g. concerning the function of a particular organ); (3) by attacking an organ whose function has been guiltily maintained throughout the patient’s life; and (4) by constituting one more serious difficulty in the life of a person already overloaded with frustration and sorrow. All the individual’s behaviour is geared to minimizing the disruption of established patterns of adaptation to life as he sees it. These patterns include activity, beliefs, values, orientations etc.; physical organs play a greater or lesser part in this adaptation, and so threat involving these organs will result in the use of mechanisms of defence proportional to the perceived disruption and possible loss. This view of the behaviour of the patient is considered in the various conditions of the pre-operative, surgical, reparative and post-operative phases.
Sutherland, A. M., and Orbach, C. E. (1953). Psychological impact of cancer and cancer surgery: 11 Depressive reactions associated with surgery for cancer. Cancer (Philad.) 6, 958. See Sutherland (1959).
Sutherland, A. M., Orbach, C. E., Dyk, R. B., and Bard, M. (1952). The psychological impact of cancer and cancer surgery: 1 Adaptation to the dry colostomy; preliminary report and summary of findings. Cancer (Philad.) 5, 857. See Sutherland (1959).
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Cobb, B., Clark, R. L., Mcguire, C., and Howe, C. D. (1954).
Goldsen, R. K. (1963).
Goldsen, R. K., Gerhardt, P. R., and Handy, V. H. (1957).
Henderson, J. G., Wittkower, E. D., and Lougheed, M. N. (1958).
Hochbaum, G. M. (1959). What they believe and how they behave. Int. J. Hlth. Ecluc. 2, 43.
Järvinen, K. A. J. (1960). Physical activity of patients after the onset of acute cardiac infarction. Brit. med. J. i, 922.
King, R. A., and Leach, J. E. (1950).
Kutner, B., and Gordan, G. (1961).
Rosenstock, I. M., Derryberry, M., and Carriger, B. K. (1959). Why people fail to seek poliomyelitis vaccination. Publ. Hlth. Rep. (Wash.) 74, 98,
Sugar, M., and Watkins, C. (1961) .
Titchener, J. L., Zwerling, I., Gottschalk, L., Levine, M., Culbertson, W., Cohen, S., and Silver, H. (1956).
Wittkower, E. D. (1949). A psychiatrist looks at tuberculosis. London: The National Association for the Prevention of Tuberculosis. More details of the papers for which only the authors are quoted above are given in the list of references at the end of Chapter 2.
Apple, D. (Ed.) (1960). Sociological studies of health and sickness. New York: McGraw-Hill Book Co.
Bruhn, J. (1962). An operational approach to the sick-role concept. Brit. J. med. Psychol. 35, 289.
Caudill, W. (1953). Applied anthropology in medicine. Chapter in anthropology today: an encyclopedic inventory, ed. by A. L. Kroeger. Chicago: University Illinois Press.
Freeman, H. E., Levine, S., and Reeder, L. G. (Eds.) (1963). Handbook of medical sociology. New Jersey: Prentice-Hall.
Hollingshead, A. B., and Redlich, F. C. (1958). Social class and mental illness. New York: John Wiley & Sons.
Jaco, E. G. (Ed.) (1958). Patients, physicians and illness: Sourcebook in behavioral science and medicine. Glencoe (Ill.): The Free Press.
Mechanic, D. (1962). The concept of illness behavior. J. chron. Dis. 15, 189.
Parsons, T. (1952) The social system. London: Tavistock Publications. (See also chapter in Jaco 1958).
Paul, B. D. (Ed.) (1955). Health, culture, and community. New York: Russell Sage Foundation.
Pearsall, Marion. (1963). Medical behavioral science: A Selected bibliography of cultural anthropology, social psychology, and sociology in medicine. Lexington, Kentucky: University Kentucky Press.
Polgar, S. (1962). Health and human behavior: Areas of interest common to the social and medical sciences. Curr. Anthropol. 3, 159.
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Stoeckle, J. D., Zola, I. K., and Davidson, G. E. (1963). On going to see the doctor, The contributions of the patient to the decision to seek medical aid. J. chron. Dis. 16, 975.
Susser, M. W., and Watson, W. (1962). Sociology in medicine. London: Oxford University Press.
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Committee on Public Education of the Commission on Cancer Control. (1967). Attitudes to Cancer. In: Public Education about Cancer. UICC Monograph Series, vol 5. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-88006-3_2
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