CONCLUSIONS: A NEUROPSYCHOSOCIAL MODEL
Although all the diseases introduced and described in the preceding chapters have their own pattern of symptoms and prognostic character, they each present for the person with the disease a crisis of adaptation. This process of adjustment affects not only the patient, but also those who live in their personal psychosocial community. The assaults that such diseases make on the minds and bodies of those who are afflicted are profound and distressing. Much of what is written about the consequences of the diseases focuses on deficits and disabilities, and on the negative impact on caregivers and families. Yet despite the stress of coping with progressive incapacity, many caregivers and persons with the disease respond to the challenges and restructure their lives in a host of resourceful ways. In this final chapter, the focus is on the process of adaptation.
A key to the understanding of the effects of a neurological disease for any individual person, is recognition that this necessitates consideration of the unique circumstances that apply to that person. These circumstances include the particular constellation of symptoms and other clinical features of the disease seen not only from the clinician's perspective, but also from the viewpoint of the patient. Understanding patients' views of their disease, however, involves making explicit the meaning they ascribe to their symptoms and their personal response to the consequences and prognosis of their disorder. Furthermore, every person who contracts a chronic disease has their own set of competencies, weaknesses, resources, and coping skills. These premorbid factors will help determine response to the onset and progress of the disease on the part of both patients and caregivers. Taking account of the way in which each patient has their own unique psychosocial environment is also important. They have a life beyond the clinic that moderates the malignancies of the disease in a variety of relevant ways. The process of adaptation will be facilitated by support from the patient's and caregiver's network. Finally, it is important to remember that the disease process is rarely static. Adaptative tasks differ as the disease progresses.