Terminal illness and suicide

Case vignette: Henry, age 19, has been under medical care struggling for 5 months with a non-Hodgkin's lymphoma that has been resistant to treatment. Proven chemotherapy protocols have failed to sustain a remission, and it is evident that his condition is terminal, although not immediately so. When not in temporary remissions he is in extreme pain. The quantity of analgesic medication needed to control the pain also leaves him feeling, in his own words, "too snowed out to do anything." During his last hospital admission, a week ago, he had talked obliquely about ending his life when signs of another painful relapse become evident. Today he appeared in the outpatient clinic, although he had no appointment scheduled. He sought out several of the people who had cared for him over the past few months to thank them and to "say good-bye." He gave some prized personal possessions to one or two of the staff with whom he felt especially close. As this was happening, some of the staff members realized that Henry had a sufficient stock of narcotics at home to end his life. Our commentators are Sanford Leikin, MD, and Richard A. McCormick, SJ.     

The impact of illness on the family and the family's impact on illness

This paper discusses the influence that familial relationships can have on illness and the way in which illness can impact on the functioning of the family system. Developmental phases of illness, the family life cycle and chronic illness are all examined in relation to the family and it's functioning. The way in which health behaviours are adopted within families, and behavioural and genetic predispositions to illness are also discussed.     

Organizational downsizing and stress-related illness

Epidemiological evidence of physical correlates of stress for midlevel workers threatened by organizational restructuring, reorganization, and downsizing was obtained for seamen in the U. S. merchant fleet, an industry which has lost 75% of its jobs in a working lifetime. Illness reports of 22,763 seamen were analyzed to ascertain the relationship between job-related and situational stress factors and the occurrence of eight stress-related diseases (cardiovascular disease, hypertension, heart attack, psychoneurosis, suicide, peptic ulcer-gastritis, arthritis, and asthma). Rank difference was revealed as the primary determinant of disease occurrence rate. The licensed group, midlevel managers in both deck and engine departments, showed a significantly higher percentage of stress related illness than did the unlicensed group. Licensed deck personnel showed higher rates of cardiovascular disease, heart attack, psychoneurosis, suicide, and asthma. Licensed engine personnel showed higher rates of heart attack and asthma. Explanations for high stress levels among licensed personnel center around declining job opportunity due to downsizing and end-of-career anxiety. Other factors include the burdens of supervisory responsibility in an era of eroding management authority, accommodation to technological and situational change, and general aging of the merchant marine workforce.     

Personality and resistance to illness

Personality was found significantly to mitigate the illness-provoking effects of stressful life events. Two groups of executives had comparably high degrees of stress over a 3-year interval, as measured by the Holmes and Rahe Schedule of Recent Life Events. One group (n = 86) suffered high stress without falling ill, while the other (n = 75) reported becoming sick after their encounter with stressful life events. Illness was measured by the Wyler, Masuda, and Holmes Seriousness of Illness Survey. Discriminant function analysis supported the prediction that high stress/low illness executives show, by comparison with high stress/high illness executives, more control, commitment, and interest in change as a challenge.