Stressful life situations of duodenal ulcer patients and the role of the medical social worker.
A study was undertaken of the stressful life situations of 87 duodenal ulcer patients (50 Indian and 37 Black males) and a control group of 75 non-ulcer patients (43 Indian and 32 Black males). The majority of the control group were orthopaedic patients selected on the grounds that they were not hospitalised for a psychosomatic complaint. The group emerged, however, as highly stressed in relation to possible work and income loss, because of their injuries. The duodenal ulcer and non-ulcer groups were similar in many demographic details and in several stressful life situations. There was a significantly higher reporting of stress in family life, in the work situation and as a result of the illness itself, by duodenal ulcer patients compared with the controls. The initial hypothesis that there would be more areas perceived of as stressful in the case of duodenal ulcer patients than controls was confirmed in the study. A minor hypothesis that there would be cross-cultural differences in the perception of stress was also confirmed. The follow-up study of Indian duodenal ulcer patients demonstrated the development of an "illness career" consisting of a periodic response to stress with onset or recurrence of duodenal ulcer symptoms accompanied by changes in the individual's family system. Minuchin's (1978) concept of enmeshment or disengagement in family systems was found to be applicable to the duodenal ulcer patient. The symptom served to maintain family homeostasis by transforming family conflict into care and concern, or by legitamising the under-functioning of the sick person. The role of social work intervention in relation to duodenal ulcer disease was explored through the establishment of a medical social work programme at the Gastro-Intestinal Unit, King Edward VIII Hospital, Durban. It was shown that the psychosocial aspects of duodenal ulcer disease must receive attention, together with medical treatment, if comprehensive patient care is to be achieved. Intervention should emphasise self management of stress through behaviour modification and cognitive restructuring. Family therapy is essential in cases where the symptom has a function in the family system. Many systems are involved in the aetiology and treatment of duodenal ulcer disease. A general systems approach is therefore useful in promoting a holistic view of the person and the illness.