Sandra Farago Magrini Ribeiro
The emotional dimension of life standard
Divisiio de Psicologia do Hospital
das CUnicas da FMUSP
Since m aking origin, the study of life standard has been of great concern to scientists, how ever the expression "life standard" started to be used as of 1975, according fo Sptizer. In form er studies the concern w ith life standard could
be found in several w ays since "state of health" w as defined, in 1947, by the W orld H ealth O rganization. It assim ilated the health definition in the B ritish C onstitution w hich stated: "H ealth is not only the absence of infirm ity and disease but also a state of physical, m ental and social w ell-being".
A ttem pting to define, constitute and quality life
stan-dard, one could verify that not only health but also dicision m ay intervene in the union of body and m ind, hum an rela-tionships, identity, ability to create, decide and control of the individuals. W hen this stucture is jeopardized, the individual colapses, becom ing alienated.
O n the order hand, w hen including everything in the psychology dom in one "evenctually creates a gap that ren-ders false guarantees of control of experiences and facts, such as it occurs in a serious disease), w here people have, in fact, little or no control at all".Sontag.
B etw een 1977 and 1987 a significant num ber of publi-cations focused m ethods to evaluate life standard. In these studies as w ell as in later ones, this variable has been alw ays associated w ith physic, phychic and social issues.
The approach to these studies had changed som e w hat.
In m ost cases, the questionnaires w ere developed in areas re-lated to m edical know ledge and recently they have been lim i-ted to diseases or even to specific differences of specialty, such as it occurs w ith oncology that refers in different w ay to breast, head or neck cancer. Estevez adm itted other factors in addition to those abovem entioned, such as the factor cost and benefit, not only the financial aspect of the treatm ent but also a possibility of a productive use of those m aterials for those w ho participate in the patient treatm ent process.
C reating m ethods to assess, in a scientific form , life stan-dard has been pointed out in form er studies, how ever there are still m any controversies in the aspects "Q U A LITY " and Q uantity.
In 1895, in one of his studies entituled "Project", Freud
tried to study psychologic topics using a quantitative approach, and he stanted: "since recognizes only quantity, how ever w e
cannot use this notion in em otional dim ension, w icvh can be observed not by the "quantity"in outer w orld but by the qual-ity w e achieve w ith the relations in outer w orld.
Estevez proved to be able to co-ordinate the life stan-dard question including all its aspects, such as: life style, life
goal and life reality.
W e studied patients subm itted either to vascular sur-gery or plastic sursur-gery in the H ospital das C linicas da FM U SP. In m ost cases, the studies w ere prospective, using sim ilar appraisel instrum ents such as: 1. specific questionnaire in sem i-oriented interview s: 2. tw o reliable and sensible tests,
the H um an Figure D raw ing (H FD ) M achover, The C row n-C risp Experim ental Index test (C C EI).
W e tried not to outline personality aspects, but to ob-serve proup characteristics.
In prelim inary studies w e observed that patients sub-m itted to low er lisub-m b revascularization felt an opressive w orld, w ith very few perspectives and lack of confidence in social
contacts, due to the perm anent threat of the disease and the suffering of other patients. These patients experienced lossdue to constant physical changes, professional alterations (retire-m ent) and the absence of a life project. In addition to those
difficulties they see ked inner aids in oder to defend them -selves such as: phobia, obsessiveness and hysteria.
In patients w ho had am putation at the thigh level, altough regression, attem pt to refrain agressiveness, lack of confidence to interact in the social environm ent opressure feeling, w hich w as dem onstrated by physical signs m ore significant in de-pression and obsessiveness and phobia as a self defense.
B y studying a new group w e observed patients w ith
in-term ittent claudication of low er lim bs after one year of treat-m ent. W e evaluated aspects related to their life standard and their em otional dynam ic, individual and characterization. In the first phase, the studies show ed that the results w ere statis-tically significant applying the C C EI test: signs of phobia, hysteria and depression, A nxiety w as the only significant trait in the fem ale group. These results w ere confirm ed by the H FD ,
th at in ad d itio n , sh o w ed sex u al im p o ten ce, lack o f co n fid en ce in
so cial co n tacts, in tro v ersio n an d d efen se b y retractio n ,
ag ressiv en ess th at m ad e th em su rv iv e (w h ich w as also o n e o f th e
ch aracteristics o f an h y p erten siv e in d iv id u al), lack o f co n fid en ce
w h en facin g n ew situ atio n s, n arcissism an d eg o cen tricity .
T h ese asp ects o f life stan d ard m ay also b e stu d ied in
th o se w h o are n o t sick , su ch as th e life stan d ard o f w o m en
w h o w ere su b m itted to rh y tid o p lasty . W e v erified th at in th is
g ro u p th ere w as a search to im p ro v e life stan d ard th ro u g h
su rg ery . W e u n d ersto o d th eir d ifficu lties in th e p ro cess o f ag
-in g -in w h ich b o d y sch em a d id n o t co rresp o n d to th eir b o d y
im ag e. D esp ite th eir so cial co m m u n icab ility , d ecisio n p o w er
ad ap tatio n an d m an ip u latio n . T h ey u sed an o b sessiv e d efen se
w h ich allo w ed to co n tro l an x iety , d ep ressio n an d b alan ce to
face su rg ery . It rev eals to b e th e m easu rer b etw een b o d y an d
m in d , an d th e h y steria th at in crease th eir v alu e in th eir fem ale
sig n s. In th e seco n d p h ase o f th e stu d y , six m o n th s after th e
su rg ery , th o se sam e w o m en w ere o n ce ag ain in terv iew ed w ith
resu lts in th e C C E I test ten d in g co n sid erab ly to an x iety , o b
-sessiv en ess, d ep ressio n an d h y steria. O n ly d u e to th is resu lt
co u ld o n e state th at th ere w ere n o g ain s in th e L S o f it, b u t
m o st o f th eses w o m en referred to th e ad v an tag es su ch as;
feel-in g b etter w ith th em selv es, im p ro v em en t in afecctiv e
rela-tio n sh ip s, so cial clim b in g , im p ro v em en t in p ro fessio n al life,
am o n g o th er asp ects d iscu ssed .
In a n ew g ro u p o f w o m en w h o w an ted to b e su b m itted
to red u ctio n m asto p lasty , th e asp ects related to life stan d ard
w ere also related to en v iro n m en t, w ith ab sen ce o f co n fid en ce
in so cial co n tacts asso ciated w ith th e sex u ality p ro b lem s.
T h ese w o m en , sp ecially b ecau se o f th eir ag e, eco n o m ic an d
p ro fessio n al p o sitio n h ad stro n g er em o tio n al su p p o rt th an
th o se alread y m en tio n ed . S ix m o n th s after th e su rg ery th e m o st
relev an t facto r w e fo u n d w as th e im p ro v em en t reg ard in g d
e-p ressio n , w ich rep resen ted a co n sid erab le im p ro v em en t in th e
life stan d ard o f th is g ro u p (u n d er stu d y ).
S tu d ies ab o u t life stan d ard are n o t o n ly lim ited to tran
s-late ch an g es reg ard in g p h y sical, p sy ch o lo g ic an d so cial
as-p ects, b u t also to reas-p resen t th e p o ssib ility to im p ro v e th e
rela-tio n sh ip b etw een th e d o cto r an d h is p atien t, w h ich m u st n o t
b e v iew ed o n ly as a d isease carrier.
