November 18, 2013

existential anxiety

     As an inpatient psychiatry service at MD Anderson, we filled a role that is probably a bit different from other inpatient psyche services at other hospitals.  Our consults dealt with two main problems.  The first was altered mental state, usually after surgery.  Take someone at least 60 years old, stick them in the hospital, operate on them and a large portion will have an acute onset of dementia, especially at night.  They're affectionately named 'sundowners' because as the sun sets, the weird behavior begins.  While it is debilitating to the patient and exasperating to the night team, especially the nurses, it's temporary and treatable but that's not what this post is about. 
     The second reason for a consult from our service was what was brilliantly named by the head attending - existential anxiety.  This is not anxiety from someone with an anxiety disorder.  This is not anxiety from someone who is terrified of hospitals.  This is anxiety about dying.  It's not the least bit pathological in my mind.  In fact, it is a completely inherent part of the human condition when one is faced with knowing that death is likely imminent.  How else is one supposed to feel, especially in the younger patients?  What is the "normal" reaction that is expected in a 20 something or a 30 something when faced with such circumstances?  Existential anxiety seems the most appropriate reaction possible.

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