Patient perspective and self-help

Effective adaptation to PD demands that patients and their caregivers elabo rate coping strategies that empower them and promote a more salutary orient ation to formidable psychosocial difficulties and thus, perhaps, blunt or p revent depressive responses. Patients and their loved ones should be encour aged to seize the initiative in terms of promoting an acceptable life-style : in short, "breaking through" rather than "breaking down," The notion of a "healthy" PD patient is not necessarily a contradiction in terms if the pa tient and family can be encouraged to view organic disease as a learning op portunity, continuing to find meaning in Life despite the inevitable threat s to identity posed by PD (e.g., loss of work). PD patients and their famil ies may benefit by grieving (over a finite interval) or observing other rit uals associated with universal life changes, These adaptive processes shoul d be promoted in the context of a trusting physician-patient alliance that addresses both the biochemical foundations and adverse psychosocial consequ ences of PD; the latter problems require that the clinician or nurse furnis h both education and emotional support. Three well-established phenomena fr om the depression literature must be combatted: a normal depression reactio n associated with the failure to attain closely held life goals; outer locu s of control, in which PD patients may perceive that the disease is dictati ng their existences; and learned helplessness, which may result when coping behaviors are not positively reinforced.