Psychiatric Considerations In Rheumatoid Arthritis

Abstract

Since it is apparent that disruption of a meaningful relationship with resulting emotional trauma frequently precedes an attack of arthritis, the first task of therapy from the psychiatric point of view will be to restore the patient’s sense of security. This can be done by establishing a positive contact with him, which may follow easily as a corollary of the usual medical treatment, especially if the disease is acute and hospitalization is necessary. This contact does much to gratify dependent needs by attention to the patient’s comfort through medication and nursing care. It is possible that some of the spontaneous remissions of the disease, so characteristic in the early stages, have some bearing on the patient’s ability, with the aid of his contact with the doctor, or through other means, to restore his sense of security by replacing the disrupted relationship with another. Such a substitution for the lost relationship cannot be considered in any sense to constitute a “cure” from the psychologic standpoint. In carefully chosen cases it is feasible to attempt by means of psychotherapy to resolve this peculiar dependent relationship on the physician. In view of the depth of the psychopathology, which has its roots in the very early life experiences of the patient, this will be a lengthy process. Efforts of this sort would seem to carry a possible favorable prognosis in those patients who are treated early in the course of the disease before extensive, irreversible joint damage has occurred. However, the remissions that are observed in rheumatoid arthritis late in the disease give a clue that psychotherapy may occasionally be useful in such cases as well. At any rate it is logical in patients highly vulnerable to stress to resolve psychic conflicts as fully as one attempts to treat physical and dietary defects.