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March 17, 1999

Clinical Crossroads: A 29-Year-Old Man With Multiple Sclerosis

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(11):985-987. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-11-jbk0317

To the Editor: I read with interest the case of Mr J, the man with MS.1 The article emphasized the medical aspect of the disorder and provided important updates on its etiology, genetics, and treatment. However, the potential psychological toll of Mr J's MS should not be neglected. For approximately 10 years, I have provided both individual and group therapy to patients newly diagnosed as having MS. Consistent with the psychological research and clinical literature, I have observed several sources of significant stress for patients with relapsing-remitting MS, including ambiguity of health status (frightening ordeal of not knowing whether their relapsing-remitting MS will deteriorate into secondary progressive MS); the terrifying prospect of possible future cognitive impairment; feeling that others cannot appreciate their medical struggles because they often look healthy apart from perhaps a slight problem in gait; work stress (the threat to their family's economic security and difficulty planning ahead in terms of career goals); and the sense of body betrayal (particularly for persons heavily invested in their physical appearance and activity). Exacerbations are frightening and discouraging times, and produce oppressive feelings of distress. Adaptational crises often occur at times of medical change (eg, when a cane or a wheelchair become necessary). I have heard patients accuse family members who are trying to plan ahead (eg, moving from a 2-story home to a 1-floor ranch-style house) of anticipating the worst possible medical outcome for them.

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