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Listmembers, Though nothing that I write below has not been written before, I felt the need to say it again. So there we go. Some comments on the Psychosocial Factors in Treating PD. Quote >>>>Individuals with this disorder frequently had significant levels of >>>>disability, a potentially frightening image to an observer. Such memories >>>>may affect the patient's mental model of Parkinson's disease, as they may >>>>initially perceive it as a disabling and untreatable illness. Which it still can be. Stressing too much that PD, if treated, is not disabling, may protect starters, but can be a nuisance for those, who are disabled. People telling me they did read or did see something about PD on television and it can be cured now by a simple surgery and why I haven't go for that yet, are not helpful to me. >>>>Previous studies have suggested that patients with Parkinson's disease >>>>have a specific premorbid personality and coping style. The point here is that one can question when the patient was pre-morbide. We know PD needs many years before the stage is reached, that it can be diagnosed, but that does not exclude it does already have its influence. Another and I feel yet more important reason why this statement has to be questioned, is the fact that many PWP's do not or only partially express their feelings with mimicry or body language. For other People it look like they don't have those feelings. The social consequences of that can hardly be overscored. In my opinion an expert should know about the intuitive way people judge other people and the near impossibility to go beyond this intuition even with the help of conscious knowledge. So even if the sentence about the pre-morbid personality is partially true (which is not sure), in my opinion an expert who writes about it should always stress that if one's emotions are not visible that does not prove they don't exist. The only emotion a PWP seems to have is anxiety or nervousness, which is a wrong but often made interpretation of tremor. >>>>identical twins discordant for the illness, the twin with >>>>Parkinson's disease was more anxious than the undiagnosed sibling. >>>>Patients with Parkinson's disease have often been described as tense, >>>>overcontrolled, and having a perfectionist character style. >>>>For patients with Parkinson's disease who have an obsessive-compulsive >>>>personality type, their coping style is often reflected by an obsession >>>>about their medications. In particular, such patients are often fanatical >>>>about the time they take their medications. Such compulsion about the >>>>pills and the 'clock' needs to be recognized as that patient's particular >>>>attempt to cope and to retain control of her/his environment and circumstances. We know how much disbelief PWP's have met in hospitals when they stressed the importance of the exact timing of their medicines Whether true or not one should not write about this without mentioning that in later stages of PD a great precision about times may be mandatory even when the patient seems to be obsessive and compulsive. >>>>Some patients tend to withdraw from activities due to embarrassment about >>>>their symptoms, especially tremor. In the early stages of their illness, >>>>some patients are afraid to let others know that they have Parkinson's >>>>disease, and they devote significant effort to hiding their symptoms. >>>>Attempting to conceal symptoms can lead to increased anxiety, which in >>>>turn can cause an increase in the symptoms of Parkinson's disease. Here too the whole burden of things that go amiss in the relation of a PWP with the social environment, is laid on the PWP. The embarassment that is mentioned is not only that of the PWP. The social environment may demand things, that can not be met by a PWP. For example: living in a culture where much smiling is mandatory, not being able to smile has far reaching consequences. It is well-advised to try to explain things, but it does not always help. Reading this article, it was again clear what makes self-help groups so usefull. It is the absence of patronizing that only patients or caregivers manage to have. Ida Kamphuis, 53/13 Holland