Education And Debate Coping With Loss Coping with loss

Blindness and loss of other sensory and cognitive functions

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1160 (Published 11 April 1998) Cite this as: BMJ 1998;316:1160
  1. Roy G Fitzgerald, associate clinical professor of psychiatrya,
  2. Colin Murray Parkes, consultant psychiatristb
  1. a Thomas Jefferson University, Philadelphia, PA 19107, USA,
  2. b St Christopher's Hospice, London SE26 6DZ
  1. Correspondence to: Dr Fitzgerald

    This is the fifth in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice

    Series editors: Colin Murray Parkes and Andrew Markus

    Sensory and cognitive functions enable us to orient ourselves in the world; they make us aware of dangers and rewards; they mediate many sources of pleasure and of pain; and they are the means by which we receive messages from others. Anything that seriously impairs sensory or cognitive function is bound to have profound psychological effects, not only on the person who is affected but also on family, friends, workmates, and caregivers.

    Summary points

    Sensory and cognitive defects disable all who come into contact with them, including doctors

    Fear, frustration, and grief are natural reactions in patients and their carers

    Denial of loss commonly impairs rehabilitation

    Anticipatory guidance and support after the loss can reduce long term problems

    Sensory and cognitive losses disable the doctor as well as the patient. When we attempt to communicate with deaf people, their deafness renders us dumb. Blindness in our patients deprives us of the ability to use non-verbal communication. An aphasic person effectively teaches us what it feels like to be deaf. The brain damaged patient makes us feel stupid. We experience the same frustration as they do and some of the same pain.

    Problems with communication

    The situation is particularly hard when the circumstances demand sensitive and empathic communication, for it is this very subtlety that is most difficult to achieve. The fact that, unlike the patient, we can escape from the frustration—by escaping from the patient—encourages us to do just that. We do our duty, inform them of the help that is available, then leave it all to them. We give up trying to communicate, avoid interaction, and inadvertently indicate that we wish they …

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