Psychological counselling in the medical setting – some clinical examples given by patients with tinnitus and Ménière's disease

Abstract

The implicit basis for most investigations of hearing disability and handicap seems to be that the loss of hearing or the impairment in itself gives rise to all the individual's problems. Prior to the consultation several important events take place; for example the individual's emotional interpretation of the symptom, causes and future perspective of the illness process. A vigilant or defensive response to the onset of Ménière's disease may lead to a complicated state of dysfunction and a hindrance for psychological adaptation. Focused interviews including patients with Ménière's disease showed that the memories of the first vertigo attack were so strong, that even when years had passed, the patients found it painful to talk about the traumatic event. This state of affairs is not uniqe for the hearing related disorder; someone who is suddenly being injured, or taken ill, often needs time and support to deal with the events taken place, and this way slowly regain the psychological strength it takes to go back to a relatively normal life. The specific problem that compells a person to consult a specialist for a distressing tinnitus might be a crushing anxiety; not over a feared physical disease, but over the risk of suffering a mental breakdown. Therefore, it is a necessity to comprehend tinnitus distress from a deeper psychological perspective, particularly in the therapeutic interaction with patients who have chronic, painful symptoms. A strictly medical model will neither help us move the patient in the direction of insight into his or her general state of mind and health, nor towards insight into the interplay between this state and the suffering.