THE PSYCHOSOCIAL SETTING OF THE DEVELOPMENT OF LEUKEMIA AND LYMPHOMA

I will describe some psychological and social experiences of men and women developing the leukemia and lymphoma group of diseases. I will deal with this somewhat circumscribed, but at the same time heterogeneous, group of diagnostic categories together, fully aware of the diversity of pathological manifestations. These diseases may be considered as reticuloendothelial disorders and are described by many as neoplasltic, and therefore can come under scrutiny at this conference. Three separate studies have been carried out during the past I5 years in association with members of the Hematology Unit of the Department of Medicine at Rochester, in particular Dr. Lawrence Young, Dr. Scott Swisher, and Dr. Stanley Troup. The patients to be considered at this time were all adults, age 20 and above, and include one series of 16 men,’ another of 32 women2 and more recently a second series of 61 men. The initial study carried out many years ago included 16 consecutive male patients admitted to a general hospital with the diagnosis of leukemia or lymphoma. Eight were leukemia and eight were lymphoma. Ages ranged from 25 to 77 years with a median of 49 years. All of these men were white except for one negro. These initial observations indicated that the men developed the manifest disease in a setting in which they were experiencing a loss of personal and emotional support incident to separation from a mother figure such as the wife or the actual mother usually by death. They were also adjusting to a variety of concurrent losses of self-esteem related to some injury, operative procedure, retirement or change of work. There was no common personality type or conflict situation evident in these men and no consistent pattern in their past adjustment. The symptoms leading up to the recognition of lymphoma or leukemia and manifested in the course of the illness frequently included anorexia, nausea, vomiting, pain and varying degrees of anxiety reaction and depression. The observations suggested that the symptoms could be related to the patient’s psychological distress as well as to the leukemic or lymphomatous disease and that the development of the manifest disease might be in some way related to the individual’s particular response to the psychosocial situation. A second, more systematic study included 32 women, studied by one and usually three or more open-ended interviews. Nineteen had various types of leukemia and 13 had various types of lymphoma. Ages ranged from 20 to 71 with a median of 42 years. All were white. Thirty of these 32 women had developed their symptoms or unpleasant affects in the wake of experiences that were interpreted as personal losses or interpersonal separations of meaningful significance in view of the associated emotional distress. In FIGURE 1 are shown the individual cases, the 12 categories of losses or separations, including death and threat of death or separation from the mother, death and threat of death or separation from the father, and death, threat of death or separation from the husband, threat of death or separation from the children, and death of other significant adults. Also listed are the experience of the menopause, a loss or change in home, and loss of work. During the four-year prodromal period, 16 of these women had experienced three or more of these types of losses, nine had two, five had one. As indicated previously two of the women had no