To the Editor.
—An essay in the March 11, 1992, issue of the Journal of the American Medical Association1 deserves further discussion. It describes a man who resisted surgery for his mature cataracts, underwent a personality change for the worse after the surgery was eventually performed, and then committed suicide.I believe this patient had an extreme example of what may be termed refuge blindness.As physicians, we assume that our patients share with us certain basic attitudes about health and illness. Good health is desirable. Illness or disability is bad and should be prevented, cured, or ameliorated. This is our world picture.There are patients who do not live in this world. These patients are neither demented, mentally retarded, nor psychotic, but their failure to comply with medical advice meant to save or restore sight is so blatant, so bizarre, and so seemingly irrational that we are puzzled and
Fishman RS. Refuge Blindness. Arch Ophthalmol. 1993;111(2):163-164. doi:10.1001/archopht.1993.01090020017009