The Struggle for Life: A Psychological Perspective of Kidney Disease and Transplantation (Praeger Series in Health Psychology)

Colin Baigent, BM BCh, MA, MSc, Reader in Clinical Epidemiology a [MEDLINE LOOKUP]

In the preface to this book, the authors challenge the reader to approach the subject matter with a fresh perspective. There is, they say, no place for the quantitative tradition when assessing psychological problems among patients with kidney disease. Complex emotional states defy classification by reference to quantitative psychology, and must instead be understood in the context of each particular patient's worldview. That sort of understanding comes only from talking to patients, and not from getting them to fill in questionnaires. It was in order to make this point forcefully that the authors, who run a psychosocial support service for kidney patients in Glasgow, Scotland, decided to write this book describing their own practical experience. They hoped that, by bridging the gap between psychotherapeutic and clinical services, others would try to create similar types of support for their own patients. Will they succeed?

Since the target audience is transplantation team members, the book begins with useful background material, including an outline of psychotherapeutic theory as it relates to chronic illness, and a short section on psychoanalysis. After this, however, the authors hit their stride, and we have chapters on a wide range of "human dilemmas," among them medical noncompliance, grief, abnormal body self-image, substance abuse, debt, depression, anxiety, and sexual problems. In each area, the authors explain why, in relation to these problems, dialysis and transplant patients ought to be considered sui generis and argue that much of the related psychological literature on other chronic illness (eg, cancer) simply misses the point. They explain, for example, that transplant patients frequently see themselves as the recipient of a "gift," and feel pressure from within to do something "special" with their lives. This aspiration is difficult enough if we are healthy, but many such patients have experienced years of poor health, perhaps even reduced cognition, and the inevitable result includes a range of consequences from depression and reduced self esteem, through to relationship difficulties and suicide. Each chapter gives us several vignettes from the authors' own experiences, together with a transcript describing how they tried to help, often with some success. Even as one steeped in the so-called quantitative tradition, I was impressed by the skill involved in trying to realign patients' expectations of their postmorbid lives, or in helping them to come to terms with their limitations, or in helping to ease their feelings of isolation. For me, these accounts were the most worthwhile part of the book: they remind us, above all, that health professionals have first of all to be human beings to connect with patients' experience of illness.

In spite of my enjoyment of much of the book, however, I fear it will be less widely read than it should be. Quite simply, for a book that aims to win over clinicians to the cause of psychotherapy, it seems to be too long. Busy physicians, surgeons, and other health professionals who are chronically short of time may lose patience with much of the supporting quantitative material on psychotherapeutic research and the sections on theory. It is a pity that the authors did not stick to their guns about the value of the oral tradition in this context. For the selective reader, however, reading of the transcripts of the psychotherapist's art will be rewarded by a rare insight into the emotional world of transplant or dialysis patients. In that respect, the authors may prompt others to explore how such a service might be provided in their own practice, and this can only be a good thing for present and future patients.

Publishing and Reprint Information TOP

aUniversity of Oxford, Clinical Trial Service Unit, Harkness Building, Radcliffe Infirmary, Oxford, United Kingdom UK
Copyright © 2004 by National Kidney Foundation, Inc.
doi: 10.1053/j.ajkd.2004.05.015
July 20, 2004

This book may be useful for patients and support groups as well as physicians, surgeons and perhaps nurses.

I found the transcripts interesting as we deal with similar patients in my work as a transplant coordinator. I congratulate the authors for this work.
March 10, 2004