Chronic Fatigue - Patient and Family Responsibilities
This is a chapter from Chronic Fatigue Unmasked, Gerald E Poesnecker
Patient and Family Responsibilities
As I indicated in an earlier chapter, few conditions in medicine require of the patient such a large responsibility for recovery as does Adrenal Syndrome. Undoubtedly, this is one of the major reasons it is so ignored; few practitioners are willing to spend the necessary time and effort to program, manage, and constantly encourage these patients so that they are capable of carrying out their own parts of the cure. Only the Adrenal Syndrome patient can obtain ultimate control of the condition. The physician can provide a certain portion of the treatment. His part is necessary and vital, but by itself is not sufficient for the total correction of the ailment. Full recovery from Adrenal Syndrome is possible only if the patient assumes his part of the responsibility. If he does not, all help will be slow, arduous, and incomplete.
If this book succeeds in helping the myriads of patients who suffer Adrenal Syndrome to successfully understand the nature of the condition itself, the book will have fulfilled its purpose. Prior to the issuance of this work, all that was available was the twenty-seven page chapter on stress and hypoadrenalism in It's Only Natural. (1) All new Adrenal Syndrome patients in our Clinic were told to read that chapter two or three times before their next appointment. I felt that was the only way they could achieve any semblance of understanding of their situations so that I would be able to help them. This understanding is still an absolute essential for patient care. For current Adrenal Syndrome patients, I, of course, require this text. Whenever they feel depressed or have doubts about their condition, I encourage them to read and reread the exposition of Adrenal Syndrome herein.
Steps in the Patient's Recovery
There are five important steps which the patient must take to help himself in overcoming this condition:
The patient must fully understand the character and nature of the problem.
The patient must accept the fact that he is a victim of Adrenal Syndrome; not only must he accept this fact in his mind, but also
in his heart and soul, so that he has no doubt at all that this is the problem and that he must face it squarely.
The patient must evaluate his entire life-style in light of Adrenal Syndrome.
The patient must correct his life-style so that he can produce the amount of stress reduction that is required in his specific case.
The patient must realize the necessity of, and embark upon, a program of stress reduction that will continue the rest of his life.
Step 1: Understand the Problem. Everything a patient does in his life—be it work, rest, exercise, sleep, eat, enjoy entertainment, take part in any form of activity—helps either to strengthen or to weaken the adrenal glands. Therefore, it is imperative that the patient know as much as possible about every factor, variation, or nuance that might affect him on the road to recovery. My own work, which extends over a quarter of a century, has been a constant investigation of each and every physical, mental, and emotional facet of life that may, in some way or another, help support or injure the adrenal function. I have placed as many examples of these stresses in this book as possible.
Each bit of understanding and information the patient can glean about his problem increases his chance for a rapid and uncomplicated recovery. If questions and doubts arise, the patient is able to return to this text to search for an answer. If a patient has a thorough understanding of his condition, as presented here, he should meet few situations in his existence which he cannot understand and explain. Doubt, fear, and depression arise more from not understanding the real nature of the condition than from any other single factor of Adrenal Syndrome. If a patient has a set of disturbing symptoms, but knows what bodily function is not operating properly and what has caused the malfunction, together with what he must do to alleviate it, a great amount of stress and worry is prevented, and treatment of the condition can progress unhindered. On the other hand, if a patient is having difficulties which he cannot explain or understand, thoughts start passing through his mind that the difficulty might be this disease or that disease; these fears create stresses which produce more symptoms which lead the patient further down a destructive path and can create a serious setback to the improvement of his condition.
The first step on the road to recovery, therefore, is to understand and comprehend basic adrenal reactions. It is a step ignored by too many patients. A good coach in any endeavor always spends a great
deal of time acquainting his student with the so-called "basics" of the game, for he knows that in the long run this knowledge usually means the difference between success and failure. Such instruction is usually dull and those involved are often not eager to follow the program, but it is the only road to real accomplishment. The best advice I can give patients is to return to this text and read and reread it until the fundamental nature of the condition is well understood and its various ramifications become as well known as the letters of the alphabet.
It is not always easy for the Adrenal Syndrome patient to comprehend his condition as readily as a more stable person might, because the nature of Adrenal Syndrome causes mental clouding, poor concentration, and inferior memory retention. Therefore, it is necessary for the Adrenal Syndrome patient to spend much more time going over this knowledge to absorb it, but with persistence he will always succeed.
Step 2: Accept the Condition: Step one, patient understanding and comprehension, is relatively easy to explain to the patient and the instructions for its fulfillment are rarely misunderstood. Unfortunately, this cannot be said of step two: patient acceptance of the condition. This point can present a hurdle that is the most difficult part in the entire treatment of Adrenal Syndrome.
For treatment of Adrenal Syndrome to proceed as quickly and as fully as possible, it is vitally important that the patient direct all his energies toward helping himself to overcome the difficulty. The only way that we can help him marshall these energies is if he is positive about what is wrong with him, if he accepts this fact fully and, therefore, is completely motivated to help the doctor overcome his malady. Unless this can be done, recovery will be unnecessarily slow and probably incomplete. Recovery from Adrenal Syndrome always proceeds in direct proportion to the amount of patient acceptance achieved.
If the above statements are true—as they are—and assuming that the average patient is at least reasonably intelligent, one might readily ask why we have so much trouble obtaining patient acceptance. If this acceptance is essential for the well-being of the patient, why cannot the patient recognize this and do all that is necessary to help the doctor aid him in his recovery from this condition?
To understand the patient's difficulty, let us reconsider the nature of the condition, the nature of the Adrenal Syndrome patient, and the advice of the various physicians the patient may have consulted
before us. Most of these patients have been diagnosed as neurotic or just plain lazy. Most have fears that some strange, undiscovered disease is gradually eating away at their vitals. When the symptoms of the condition are under control, it is easy for a patient to be logical and reasonable and accept the possibility that he may have Adrenal Syndrome. However, when in the still of the night some of the more bizarre symptoms of this condition occur, it is extremely easy for fear and apprehension to creep into the patient's consciousness or for words of a physician who once pronounced him emotionally unstable to come vividly to mind. Doubt builds on doubt, and by morning the patient can have himself thoroughly convinced that he is mentally unstable or a victim of some incurable disease.
On the opposite side of the ledger, for individuals whose symptoms are not as severe as some it is difficult to accept the fact that they have a condition as complicated as Adrenal Syndrome, since the early manifestations are relatively mild. They want to believe either that they are only overworked or that all they have is a virus.
Step 3: Evaluate. It is necessary for the Adrenal Syndrome patient to go on a true austerity program as far as the expenditure of his own neuroglandular energies is concerned. As he is able to adjust his life-style to conserve these energies as much as possible, he will be able to rebuild the general adaptive mechanism and pay off his past bodily debts. When these are paid off and the neuroglandular mechanism is brought to a state of optimal functioning for this individual patient, his austerity program, i.e., his life-style, can be liberalized to a maintenance schedule. However, he must be careful that he does not once again overextend himself and produce more debts—the practice which had previously brought him into such a poor state.
All patients ask how much they must adjust their life-styles. The answer is at once simple and immeasurably complex. They must adjust their life-styles sufficiently to produce the necessary stress-reduction on the neuroglandular system to allow it to regenerate. Exactly what this means for an individual patient depends on three factors: First, on the extent of the drain on the neuroglandular system; second, on the present life-style of the patient; and third, on the types of treatment the patient is able to obtain for his condition. After analyzing these three elements, we are able to help the patient in the evaluation of his life-style changes.
For example, the young minister from Pittsburgh, mentioned earlier, obviously was an Adrenal Syndrome patient. His condition had become so severe that he had fainted in the pulpit while
delivering a sermon. This reaction occurred because of lowered blood pressure and a deficient amount of oxygen available to the brain. At times he became so weak that he had to spend two or three days flat on his back in bed before he could carry on with his work. He was, however, as are so many Adrenal Syndrome patients, a definite overachiever. As soon as he was able to get out of bed, he was out working on church duties, giving lectures in different parts of the country, attending parishioners, and planning new projects. Since he lived about six hours from our Clinic, it was not possible for him to see us frequently. Every attempt was made to find a physician in his local area who was knowledgeable about Adrenal Syndrome. As reported, those who would accept him as a patient seemed to have little knowledge of Adrenal Syndrome, and those who were knowledgeable refused to accept him as a patient. Since clinical treatment of any significant magnitude seemed out of the question for this patient, a radical change of life-style was essential if improvement was to be obtained. He had to give up as many of his external church duties as possible and delegate wherever possible his internal church duties. Eventually, once he was able to regenerate his system, he could gradually return to his various duties. However, I do not believe that, even under the best circumstances, he should ever return to the full intensity of activities that he fulfilled when I first saw him. Admittedly, such an opinion is not what a patient wants to hear. In fact, this patient has had a difficult time accepting Adrenal Syndrome. Nature has a way of helping truth, however, and once he fainted during church services, he had little choice but to accept the condition.
In a similar case, a patient called on me, describing in great detail all her symptoms, each one of which led to the same conclusion, Adrenal Syndrome. She mentioned that while she wanted to come to our Clinic for treatment, it was going to be difficult for her because she was, at that time, holding down three jobs and was working seven days a week. I remarked that her situation would probably be quite easy to help; all she had to do was to give up at least one of her jobs and use that free time to come to see us at the Clinic. I advised her that, in fact, unless she did, there was probably little that I or anyone could do to help her.
Another patient whom I had been treating for some time, achieved good progress up to a point, but could not progress beyond a certain plateau. Review of her treatment program showed she was receiving all of the remedies, following the proper diet, and getting her proper treatments at the Clinic. Only one thing remained for her to do: Change her life-style sufficiently to reduce stress further because she
was, as I had told her, still putting out more energy every week than she was producing and, therefore, creating an ever increasing debt rather than building up a reserve in her energy bank. I learned later that she had been active in certain church activities which, while she enjoyed them, were not an absolutely essential part of her life. She gave up these activities and, within two weeks, started to improve again and has continued that improvement. Eventually, as her neuroglandular mechanism strengthens, she can again include these extra church activities in her life. However, had we not analyzed her life-style and changed it at the time we did, she would undoubtedly still be floundering in her recovery and wondering why she did not make the improvement we had promised her.
Step 4: Reduce Stress. Once the patient has adequately evaluated his life-style, he can correct his way of living and begin the accomplishment of stress reduction. In regard to this point, one is constantly reminded of the familiar biblical phrase, "The spirit is willing, but the flesh is weak." It is one thing for a patient to evaluate his life-style and realize what changes must be made, quite another for him to institute these changes and live up to these changes until proper improvement has been attained. For instance, the young Pittsburgh minister, while obviously aware of the measures necessary for alleviation and correction of his problem, was anything but eager to make those changes and was actually strongly opposed to such changes. Well motivated to work for his ideals and life objectives, he had a strong sense of duty and responsibility to those who were dependent on him. He was willing to make almost any sacrifice except that which would entail a change in his basic life-style. In fact, his resistance was such that he altered his life-style only when his symptoms became so severe that he could not physically continue.
A long-time professional acquaintance of mine, Dr. Henry Linke, often said "The way a patient has lived is what has caused the problem he now has. To help the problem, we must change his life-style. You cannot ultimately do one without the other." Dr. Linke told me that over thirty years ago, and each passing year has reaffirmed the truth of his statement.
These first four points of patient responsibility are interdependent. Before a patient is able to change his life-style, he must understand his condition and, therefore, have a reason to change. People do not make changes without a reason or purpose. Once a patient understands his condition, it is easier to accept the difficulty and realize the only way to overcome it is to make the necessary changes in life-style. He must then, with the aid of his doctor, plan these
changes and, again with the help of his doctor, carry out the alterations which are essential to his ultimate recovery.
Step 5: Continue Stress-Reduction Activity. Once changes have been instituted and the patient is on the road to recovery, he must consider establishing within himself a never-ending evaluation of the stresses to which he is exposed. Stress is an integral component of life without which life would be nearly valueless. The various stresses of living prompt us to all forms of activity which produce every known improvement and man-made beauty in the world about us. In some individuals, however, an overabundance of stresses can exhaust the neuroglandular mechanism. Adrenal Syndrome patients must be careful to avoid an abundance of stress; they must shun those stresses which are, by their nature, worthless or useless. We refer to such stresses as worry, anxiety, judgment of others, or paranoic-type fears. These stresses have no redeeming features except that by learning to eliminate them we grow stronger and wiser.
Probably the most common question asked me by those with Adrenal Syndrome is, "Will I ever be normal again?" The answer I give is, "There is no such thing as a 'normal' person. We are all crippled to a lesser or greater degree from birth. We all come into the world with the combined heredity of our mothers' and fathers' ancestors, none of whom were normal and, therefore, there is no way that they can create a totally normal child. Your problem happens to be a weakness in the neuroglandular mechanism. Luckily, it is one which we understand; one which we can control; and, in most cases, one which we can correct. It is necessary, however, for you to live more carefully in regard to the various stresses of life than the so-called average individual, somewhat in the same way that the individual who has inherited a mild diabetic condition must watch his diet so that he does not ingest too much sugar. As long as he watches this factor, he can live a relatively normal life. If you, the Adrenal Syndrome patient, learn to control and moderate the various stresses upon your whole being, you, too, can live a relatively normal life."
When an Adrenal Syndrome patient says he wants to be "normal" he means what he believes is normal. He really does not mean what would be his own normal state, but what he sees as normal for some other person or for people in general. If a blind person is sick and we help him get well, he does not expect to see again, he only expects to have the additional ailment corrected. This is not true of most Adrenal Syndrome patients. They want us not only to return them to their normal state, but also to make them "see again," i.e., they expect us to help them overcome the neuroglandular weakness which is their congenital due.
We attempt to do this, not by returning these patients to normal, but by encouraging them to a state of supernormal. They must work to obtain a greater control over their lives than the average person, for only in this manner will they achieve their desires. My college football team had a one-eyed quarterback who was good enough to become nationally famous. He put forth much greater effort than most to reach his goal, with his disability, since he lacked depth perception. However, he did not bemoan his fate. He persisted and outpaced all his two-eyed competition for the position. So must the Adrenal Syndrome patient. In the last analysis, how productive, creative, or normal a life the Adrenal Syndrome patient lives is entirely up to him. To succeed, he must follow as fully as he can the five tenets laid down in this chapter. He must fully understand his condition, must have a complete acceptance of the condition, must evaluate the stresses upon him and his general life-style, must correct these stresses as necessary, and must be eternally vigilant in evaluating the emotional stresses that may come to him during the rest of his life. He does not need to stay away from all stresses, but all unnecessary stresses should be reduced to a minimum so that his energy can be conserved for those activities and emotional situations which are truly beneficial and productive to him on all planes of his existence.
What Every Family Should Know about the Person with Adrenal Syndrome
Almost without exception, the average family and friends of the Adrenal Syndrome patient unwittingly do everything they can to worsen the condition. The harder they try to be helpful, the more injurious become the results of their efforts. There are several simple reasons for this paradox, the most common being that almost all obvious or so-called "gut" reactions toward the Adrenal Syndrome victim are invariably incorrect. The advice, be it professional or amateur, which would fit most persons with symptoms similar to those displayed by the adrenal case are completely ineffectual and usually detrimental to the progress of the Adrenal Syndrome patient. Unlike the true neurotic or basic nonachiever, the adrenal victim wants nothing more than to be able to do all the things his friends and relatives are extolling him to do. The fact is, he is physically incapable of accomplishing these tasks and will remain so until the basic underlying condition is remedied.
The patient with this problem is usually intelligent, highly motivated, responsible, with a great desire to achieve. The difficulty is that he has neither the glandular nor the nervous strength to carry out these desires and ambitions. The fact can create in him a large and often conflicting group of emotional and personality frustrations. Put yourself in his place for a moment and perhaps you will see the sense of frustration which is produced by this condition. You are an individual of intelligence and character. You have desired to do useful and productive things with your life and yet every time you attempt to do something, you become more and more exhausted. Every attempt at productive activity is met with strange nervous anxieties or, as one patient put it, "agitated depression." The only thing that even remotely seems to help is rest and withdrawal from all the fascinating events of life. You are like an athlete who is trained to run the hundred-yard dash, but who collapses after a few yards each time he attempts to run. Soon you stop trying and wonder if there is any sense in training or in trying to accomplish anything because fatigue, anxiety, and failure have become the essence of your existence. Here, of course, is where your friends and family come to your aid. They entreat you: "Now, come on, don't be lazy. Keep going, keep trying." They tell you: "It's all in your mind. Tell yourself you are going to succeed and you will." You consider that perhaps they are right, and so you try harder. The harder you try, the more you stress your weakened glandular system and the more rapidly you fail. The more admonitions and encouragement of this kind you receive from your family and friends, the more guilt you accumulate when you are not able to accomplish. The greater the guilt, the greater the stress; the greater the stress, the less you can accomplish; the less you accomplish, the more you are admonished; the more you are admonished, the greater the guilt, and so on.
In this fashion, well-meaning friends and family members hasten the development of this disease. In fact, from my many years in treating this condition, I have concluded that the most difficult to resolve and the most prolonged of all stresses imposed on the Adrenal Syndrome patient are those by friends and family who are truly trying to be helpful. The ironic saying comes to mind: "With friends like these, who needs enemies."
I wish in no way to be harsh or unfair to the family and friends of the Adrenal Syndrome patient. These patients are the most misunderstood of all disease victims in America today. How can their loved ones comprehend their problems when not even one in a hundred doctors understands them?
A large part of my time and energy in treating Adrenal Syndrome patients is devoted to counseling their family and close friends.
Oftentimes only by enlisting their help am I able to resolve a difficult case. When properly motivated, no other group of people can have such a beneficial effect on the victims of this condition.
What Family and Friends Can Do
Understand. The foremost effort that friends can make to help these patients is to understand as thoroughly as possible the nature and character of the disease. To accomplish this end, I suggest that they read this text thoroughly, not just once, but two or three times until the words are engraved on their consciousness and the spirit of the work itself becomes a part of their being.
There are times, unfortunately frequent in some cases, when Adrenal Syndrome patients can be nearly insufferable. At such times it requires the consciousness and personality of a saint to live with them. Only if the healthy friend or family member is permeated with an understanding of the nature of the Adrenal Syndrome experience can he develop the compassion and understanding necessary to help his poor friend or relative on the proper path to improvement and recovery. One who would be of help to these individuals must be able to push aside his own feelings and personal needs as much as possible and learn to say and do those things which are most inclined to produce improvement for the sufferer. There are those who are not willing to undertake such a task upon themselves and many divorces and broken relationships occur because of Adrenal Syndrome. Interestingly, most persons with chronic Adrenal Syndrome tend to marry partners with strong adrenals. This can be true even though the marriage takes place long before real adrenal symptoms manifest. In this way, one partner is steadfast when the other becomes erratic. While such a relationship helps to stabilize a marriage, it does present a problem in that it is difficult for the stronger partner to understand the weaknesses of his or her spouse since he or she has not experienced similar symptoms. This chapter is intended to help remedy this misunderstanding.
I am often asked: "How can I develop this understanding and compassion, Doctor, when the patient seems to do everything he can to upset me?" The answer I give in my office consultations is this: "Suppose you get on a bus and are about to put your token in the meter. Someone enters the bus behind you and steps on your foot while something he is carrying hits you in the shin. Your shin hurts and your foot is sore. You turn around in great anger ready to read the riot act to this inconsiderate, clumsy individual. Upon turning around you find that the object which hit your shin was a white cane
and that the individual you are now addressing is wearing dark glasses and is obviously blind. What happens to your consternation and anger? Immediately, they are brushed aside by understanding. You step out of the way and say to the individual, 'Oh, I am sorry, was I in your way? Please let me help you to a seat.' Which you do. The shin still hurts, your foot is still sore, but your feelings of anger are entirely dissipated and replaced by those of compassion and helpfulness all due to the fact that you have a different understanding of the incident after seeing the individual. The events have not changed from the first insult to your body, but your comprehension of what caused the events has changed completely, and so has your attitude. Thus, it can and should be with your attitudes toward your Adrenal Syndrome friend. He is, as it were, emotionally and physiologically blind. He is not able to change many of his actions; he does not hurt you or anyone intentionally. He is driven to these acts by pressures so great, so difficult to control that even a seraphim would be sorely tired."
There is a Buddhist saying of which I am often reminded in my treatment of the adrenal case: "To know all is to forgive all." If we knew and understood what goes on inside the mind of the adrenal patient, we should be able to forgive him and work to help him on his path back to a productive existence.
Encouragement. Another important step friends and relatives can take to help the Adrenal Syndrome patient toward his recovery is to encourage him. One of the basic characteristics of this disease, particularly in its chronic form, is that of discouragement and depression. It seems to the adrenal patient that life is without joy or purpose, that there is no help, and that he is destined to remain forever in the anxious morass of despondency and depression in which he finds himself.
Sermons and admonitions do not help him; encouragement does. Friends should let him know that they understand his problem, that they appreciate his suffering; but that with the proper treatment and care he will improve. They should let him know that although he will have ups and downs—for this is the nature of the condition itself—he must not give up but continue his treatment until his efforts are rewarded. There is no end to the value of encouragement for the Adrenal Syndrome patient, no end to the need for constant assurance that he is going to get better. In the early stages of treatment, especially for the patient with the chronic form, he has little else to fortify him. His treatment, of course, is helpful, but in the beginning this is directed toward building basic adrenal support and
has little effect on his immediate sense of well-being. In fact, early treatment can make the patient feel more tired than previously because the adrenal is resting in its effort to rebuild itself. Encouragement and hope are the mainstay of help at this time. When friends and relatives ask what they can do to help the new Adrenal Syndrome patient, I reply that there are three things which they should give in full measure: encouragement, encouragement, and more encouragement.
Reinforcement: "Let Thine Eye Be Single." Another vital factor, to which friends can contribute, is treatment reinforcement. The Bible says: "Let thine eye be single." To succeed, it is necessary to look in one direction, take one way, use one path. Only by directing all the forces and energies of the patient along one line can he accomplish his goal. This is important in treating all Adrenal Syndrome patients, but absolutely essential in chronic patients. Once I have accepted a patient, I attempt to make my treatment plan as clear as possible to friends and relatives close to the patient, so that they can offer their support for this treatment. At no time should the adrenal patient have the slightest doubt that the treatment he is receiving is anything but the best available. Doubt creates negative thoughts and these thoughts depress the neuroglandular system in such a manner as to make progress difficult.
Because of the lowered blood pressure and, therefore, lowered nutrition and oxygen available to the brain of the Adrenal Syndrome patient, he has difficulty making decisions and discriminating among types of therapy. He is easily lead from one path to another if some outside influence works to move him in that direction. Like all sufferers of chronic diseases, he is hoping for a miracle. There are no miracles in Adrenal Syndrome cases, only specific hard work which eventually succeeds in overcoming the condition.
Once a patient has started on a particular plan of treatment, it is incumbent on true friends to help support him in this plan of treatment. The patient should be entreated to continue the chosen treatment plan.
If friends or relatives have any disagreement or apprehension about the type of treatment the patient is receiving, they should discuss this situation with the doctor, never with the patient. If those close to the patient are in disagreement with the treatment, it might be best for the patient to go to another physician. There is little use in a doctor's going all out to help a patient if his efforts are constantly subverted by the patient's friends and family.
In Adrenal Syndrome treatment, the doctor must work diligently
to build the patient's confidence in the therapy and in his, the physician's care. Only in this manner will the patient receive the full value of the treatment given. Anything that family and friends do to disturb this confidence can be injurious to the patient and severely slow recovery. Little of this depreciation of the patient's treatment stems from maliciousness or attempt to hurt the doctor-patient relationship, I realize. Most of it comes from a sincere, but misguided, effort to help the patient. Frequently, friends bring the patient newspaper or magazine articles which discuss problems similar to that from which they think the patient is suffering. Usually, these are about conditions which produce symptoms similar to those of the patient's, but which are not related to the patient's own situation. This type of reading produces in the patient, who is unwise enough to peruse them, a sense of confusion. The patient begins to question his doctor's care and to doubt the benefit of his treatment. This confusion, unless rapidly corrected, may act to eat away at the progress made and prevent future improvement.
I do not wish to intimate that the therapy outlined here is the only possible therapy to help these patients, or that I alone have all the answers for this condition. Patients may be helped in many ways. I have attempted to bring together the best methods I know to form a complete treatment for this most difficult disease. I know that other dedicated doctors also do a good job with these patients, for there are "many ways to skin a cat." However, in skinning a cat, it is best to choose one way and not try two or three simultaneously. Once the patient and his family have chosen a method of therapy, they should stick with it and not confuse the patient by suggesting other doctors or other treatments. Should any treatment not fulfill the doctor's stated goals, the patient has the right to discuss the future with the doctor, and if the prognosis does not seem favorable, that patient may wish to look elsewhere. If the patient or family and/ or friends lose confidence in the doctor, another must be sought. While in treatment with any physician, however, the best chance of success is by full faith in his care. Again, "Let thine eye be single."
Consideration of Other Factors. While the foundation of friends' help to adrenal patients is supported by the three great pillars already mentioned—understanding, encouragement, and reinforcement —several other considerations should be mentioned. When a patient's condition is severe enough to require his staying at the Clinic, we usually do all we can to isolate him from adverse influences. Frequently, our main reason for suggesting a patient stay at the Clinic is to remove him from the home environment which aggravates his condition. The patient's efforts to keep in touch with those at home often defeat our treatment plan. The patient sometimes behaves like a narcotic addict in relation to his previous situation. He knows that every time he contacts "the folks at home," they are likely to say things which can trigger old reactions which are detrimental to his recovery. Yet his connection with family and friends is so strong that he continually contacts them even though it devitalizes him, both physically and emotionally.
I have found two solutions to this situation. First, I often explain to friends and relatives the character and nature of the condition and what they must do to be of valuable service to their loved one's recovery. Usually this explanation is helpful and sometimes works very well, but frequently family members are unwilling to cooperate or are simply incapable of understanding the situation. In these instances, and in cases in which friends or relatives do not come for consultation, we insist that a patient not contact his friends and relatives until the negative contact can be controlled by the patient's improved physical condition and understanding of his emotional stresses and sensitivities. With great reluctance do I impose such a blackout, it being far more advantageous to the patient and to me to have the help and encouragement of those at home, but in many instances I am left with no other alternative.
A Few Precautions. Even when family and friends are understanding, knowledgeable, and sympathetic, they should consider a number of important factors involved with patient contact.
All phone conversations should be brief, preferably not over five minutes. Lengthy phone conversations have a deceptive effect on the mechanism of the Adrenal Syndrome patient and can exhaust much more rapidly than direct conversation.
No more than two or three friends and relatives should visit at one time. Most Adrenal Syndrome patients are adversely affected by crowds, particularly visitors the patient does not know well or for whom he feels he must put on a "front." Even old friends should not stay too long (an hour is sufficient) to prevent a drain on the Adrenal Syndrome patient. These precautions are most important when the patient first enters the Clinic. However, as the patient improves, such precautions may be relaxed. A patient may be set back several days in recovery by a visitation of well-meaning friends who wanted to come and cheer him.
I am often asked by persons who sincerely want to help, "What do we talk about with these patients?" Admittedly, this is a difficult point because some patients are very sensitive. If the conversation
centers on the patient and his condition, he might feel he is being patronized. On the other hand, if talk is about the things that are going on at home, he may become depressed and despondent because he wishes he could do these also, but cannot. (Remember, I said that these people are difficult to please.)
A few suggestions may help. First, let the patient talk. Let him tell about the things which are now important to him. What is he finding out about himself and about others'? Let him tell about his plans for the future. In other words, take a lead from the patient. If he brings up a subject, discuss it—but watch carefully how he reacts. If he becomes quiet and withdrawn, if his eyes start to look somewhat vague and glassy, he is being exhausted, and it is time to change the subject or, if no improvement occurs with a new subject, time to leave. Visiting a chronic adrenal patient is like having lunch with a tiger. It can be done, but it is challenging and one must constantly be on guard. When the patient's eyes look glassy, it's as if the tiger were swishing his tail; it is time to leave.
Making Decisions. Though difficult, it is necessary for the Adrenal Syndrome patient, at times, to make decisions. To the patient, with his oxygen-poor brain, molehills easily assume the size of mountains. However, certain family affairs sometimes require a decision by the patient. All such situations must be handled with great care and delicacy, for the patient often has difficulty understanding the exact significance of many of these arrangements. He will frequently lean too far to one side or the other. That is, he may worry unnecessarily over a simple, uncomplicated arrangement in an attempt to make decisions which are not necessarily related to or concerned with the basic problem. Or, on the other hand, he may continually ignore an important project which has to be completed within a certain period of time and which requires some decision from him for its completion.
In these situations, the family should explain the situation to his doctor as thoroughly as possible and then abide by the doctor's suggestions as to how to approach the patient. Such instances happen in our Clinic with great regularity and usually, if the patient is approached in a knowledgeable manner, the situation is resolved without great difficulty.
Children. Patients with children present unique problems. When it is necessary to bring a young mother into the Clinic as an inpatient, we must consider what to do with her children. Occasionally an infant is brought into the Clinic with the mother. Most school-age children are left at home, under the care of the father, grandmother,
or friends. While I do not believe in separating mother and child, in certain severe forms of Adrenal Syndrome there is no alternative.
Depending on the age of the child, he should be taught as completely as possible the nature of his mother's problem. No fanciful stories should be made up, as these can cause severe problems at a later date. Almost any child, from the age of four up, can be told what is "wrong with Mommy." The condition can be explained in language that a child can at least accept, even though he cannot fully understand. If there is real difficulty toward this end, the doctor should speak with the child. In my practice, I do this repeatedly, and often I am able to enlist better cooperation from the children than I can from many of the adults. Children should know that the Adrenal Syndrome patient needs understanding and encouragement from them as much as from any other family member. A child's words of encouragement can be of great help to a loving mother.
While most of the foregoing discussion applies particularly to severe Adrenal Syndrome cases who come as Clinic inpatients, the same information is helpful for those who remain as outpatients. In some ways, the aid and cooperation of friends and family is even more important in these cases, because while the inpatient's family contact is only intermittent, the outpatient's family contact is constant and, if poor in support and encouragement, the stress produced can be severe and unremitting.
Laws of Vibration. We have spoken in this chapter and elsewhere of the vibratory states that exist around these patients. Perhaps a word of explanation would help to understand more fully what is meant by "vibratory states." By its atomic nature, all life puts out certain emanations which we know as vibrations. They have various effects and purposes, most of which are not necessary to mention here. The human being is no exception to this rule. In fact, since the human body is a heat-producing structure with electromagnetic and chemical reactions going on by the billions every second, it produces a strong vibratory or electromagnetic field about itself. This field is effected by the basic electromagnetic and chemical structure of the body, by foods we eat, by the character of our elimination, by the thoughts we think, by the emotions which are prevalent within us, and even by our future aspirations as they affect the physical, mental, and emotional components of our bodies. We all know people whom we instantly like and feel comfortable with. We also know people who leave us cold or unsettled and whom we would just as soon not see again. In these instances, we are affected by the aggregate of their vibratory forces in conjunction with our own. In the first case, the individual's vibratory forces are such that they reinforce and strengthen our own, while in the second, exactly the opposite effect is produced. This response is particularly strong in those with Adrenal Syndrome. If they are around persons who are understanding and supportive, they can be swept along on this support, and great improvement can be brought about in their cases. If there are persons about the patient whose vibratory elements are antipathetic, the results produced are detrimental and the patient's progress can be impeded by these forces of unsympathetic vibrations. It is not even necessary for those around the patient to communicate disapproval. The mere presence of a person who is not understanding, harmonious, and encouraging can be and usually is, injurious to the patient's progress.
Relatives form an important—even a vital—part of recovery. If they do their task—as the doctor does his and the patient cooperates— there may be complete assurance that the patient will be returned to a vital, productive existence.
In a few rules, the best route for family and friends to take to help the Adrenal Syndrome patient are: First, and by far the greatest, be understanding. The more these key people understand the patient's condition, the more they can say and do the correct thing at the correct time. Second, this knowledge must be put to good use in the form of encouragement they give the patient along the way of his long and arduous road to recovery. He needs encouragement in the same way that a woman in love wants to hear the words, "I love you." A woman can never be told "I love you" too often, nor can the Adrenal Syndrome patient or friend be given too much encouragement. Even if you have told the patient an hour before that he is going to be all right, tell him again because it is on these words that he must live during an important part of the therapy program. Last, friends should help him keep his eye on his goal; do not let him wander into different pathways. It is easy for him to wander, because his journey is often long and, as on all long journeys, he begins to wonder if he has taken the right road. Let the patient know that he is on the right road and that he must continue on it to the end. If there is any doubt as to any part of his treatment, friends and family should have him speak to his doctor, or do it themselves. Unless the physician has the patient's confidence and the family's cooperation and assistance, recovery from Adrenal Syndrome is almost impossible. The doctor can and must do a great deal in the treatment of these patients; however, he is capable of accomplishing the full task only with the help of the patient's friends and/ or relatives and, most important, with the cooperation and efforts of the patient himself.