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Romanian Neurosurgery (2012) XIX 1 

 
 
 

Psychotherapy of hospitalized patients - between option and 
necessity  

Virginia Rotărescu2, Alexandru Vlad Ciurea1 

1University of Medicine and Pharmacy “Carol Davila”, Clinical Emergency 
Hospital “Bagdasar-Arseni”, Bucharest, e-mail: rsn@bagdasar-arseni.ro 
2Clinical Emergency Hospital “Bagdasar-Arseni”, Bucharest  
 Telephone: 0040722516345, e-mail: virginia.rotarescu@gmail.com 

 

Abstract 
The existence of reciprocal psyche-soma 

influence requires a double   relationship, 
medical and psychological; the 
consequences of poor communication 
include noncompliance to treatment and 
malpractice legal actions. This paper 
provides explanations which necessarily 
require psychosomatic approach of each 
patient, the patient reacting massively in 
psychological plan. Delimitation of 
competence of various specialties is only for 
the benefit of the patient, who will be 
investigated and treated according to 
custom issues (“There are no diseases, only 
ill people”), imposing thus the integration 
of the psychologist in the therapeutic team.  

Keywords: neurosurgical, 
psychotherapy, patient, quality of life, team, 
multidisciplinary 

 
The concept of “health genesis” and 

maintaining the health triggered the self-
care movement connected with the 
consumption in other areas of life. Due to 
the improvement of means of investigation 
and to a more profound specialization, the 
hospitalized population is less willing to 
accept the treatment in a passive and 
uncritical mode; worldwide, there are 

registered increases in malpractice disputes 
that presses the hospitals and doctors to 
inform well the patients about their disease 
and treatment. This turns the patient from 
reactive into proactive and triggers its 
interest of asking questions in which to be 
responded by providing comprehensive and 
relevant information, feeling the need of 
self-assessment of alternatives. The 
psychological support strengthens the 
therapeutic act and can use means under 
the form of beneficial association to 
medication effects, but also under the form 
of remodeling some harmful behaviors for 
health and generating recurrence.   

Man has the power to overcome the 
instinct and the desire, as well to overcome 
the motivation of obligation and duty, that 
I. Kant called “rational will”.  

 By the power to regulate his own 
behavior and to be responsible for his 
actions, the man gets the right to autonomy, 
whose value is inherent, intrinsic and 
infinite. 

 The responsibility for his own decision 
may cause anxiety or may fail to 
childishness, but will never be compatible 
with passivity. 

Recently, the sociologists have suggested 
that the current psychological environment 
from hospitals may be harmful to human 
health. Thus, many people are terrified by 



 
 
 
 Virginia Rotărescu, A.V. Ciurea          Psychotherapy of hospitalized patients 

 
 
 

hospital because they associate it, on the 
one hand, with pain and death, and on the 
other hand they find the clinical 
atmosphere as frightening and 
decentralized; some people become angry 
in hospitals because they are restricted and 
infantilized by the system, while others 
become dependent and helpless, unable to 
make efforts to self-help in their own 
treatment.  

The question that must be asked is: 
“Why are so many people stressed by the 
hospital environment?” 

First of all,  patients are often very ill 
when they are hospitalized and the disease 
itself alienates and disorients. The illness 
produces changes in relations with the 
patients themselves, with their own bodies 
and with others. The concern that his own 
body became object of observation, that the 
symptoms may become worse, confusions 
regarding the present; uncertainty about the 
future undermines the ability to engage in 
planning, to feel competent, to make 
decisions, to engage in activities. 

These aspects of experiencing disease - 
disorientation, isolation, suspension of 
normal activities, inability to communicate 
at a normal level - are often accompanied by 
strong emotions such as fear, but also other 
variables and problematic psychological 
symptoms.  

Dr. Albert Schweitzer said in his book 
“Out of my life and thought” (Norman 
Cousins, 2011, p.188) the conviction at the 
time that “if he ever recovered he would 
never forget his own feelings while ill”; he 
would try as a doctor to give at least as 
much attention to the psychology of the 
patient as he did to a diagnosis.  There is a 
“fellowship of those who tolerate the mark 
of pain” and those outside this fellowship 
have great difficulty in comprehending 
what lies behind the pain. “I know, that 

during my own illness in 1964, said 
Norman Cousins in his book Anatomy of 
an illness (2011, p.188-189), my colleague 
patients at the hospital would talk about 
matters they would never discuss with their 
doctors. The psychology of the seriously ill 
put barriers between us and those who had 
the expertise and the abilities to nursing to 
us. I became convinced that nothing a 
hospital could provide in the way of 
technological marvels was as helpful as 
atmosphere of compassion”. (p.190)  

The stressful examinations or surgeries 
and, especially, its results can cause 
insomnia, nightmares and, in general, 
inability to concentrate; the hospital care 
can be very fragmented so that the patient 
may have contact with 30 different people. 
Often, doctors have little time to waste with 
patients so that they may receive conflicting 
information as their search goes to 
everyone, including acquaintances, friends 
or other patients.  

“The central question to be asked about 
hospitals - or about doctors for that matter-
- is whether they inspire the patient with 
the confidence that he or she is in the right 
place; whether they enable him to have 
trust in those who seek to heal him; in 
short, whether he has the expectation that 
good things will happen” (Cousins, 2011, 
p.191) 

The hospital is today a very complex 
organization, incorporating both historical 
trends as well as current innovations. 
Sociologists have always been fascinated by 
the hospital's functions because there are so 
many and varied: it is a care facility, a 
treatment center, an institution of learning, 
research center and laboratory. Due to the 
need of diagnosis and treatment there are 
necessary different perspectives of approach 
and specific professional skills. The need of 
integrative approach (bio-psycho-socio-



 
 
 

Romanian Neurosurgery (2012) XIX 1 

 
 
 

axiological) of the man explains the 
inclusion of elements of psychology in the 
composition of medical act, emphasis on 
psychology today based on recent notions 
of psycho-neurophysiology, endocrinology 
and immunology (Dănăilă&Golu, 2000, 
Taylor, 1986). Medical model based strictly 
on biological dimensions and with a 
reductionist character is outdated today 
because the doctor's role is limited to 
correction of some organic and functional 
disabilities by pharmacological or surgical 
ways; the diagnosis itself is determined less 
by historical data obtained from patients, 
being based more on imaging means and 
biochemical investigations. 

The recent Western models, in which 
therapists work compulsory in team using 
“linked discipline”, require specialists in 
psychotherapy, psychologists, 
physiotherapists or even internists with 
studies in psychology to investigate and 
solve the problems of patients with 
psychosomatic pathology. Also in our 
country, the interference zone between 
medicine and psychology begins to create a 
theoretical base and an application area 
which leads to optimization of medical act 
and to a worthy position of the human in 
pain (Ciurea & col., 2007; Rotărescu & col., 
2007, 2006). 

Dual relationship between doctor and 
patient - medical and psychological - and 
the reciprocal influence between psyche 
and soma necessarily impose the 
psychosomatic approach to any patient and 
of which objectives must be accepted by all 
doctors because the patient reacts massively 
in psychological plan (Enătescu, 1981). The 
delimitation of the competence of various 
specialties is only for the benefit of the 
patient, who will be investigated and treated 
according to custom issues (“There are no 
diseases, only ill people”), imposing thus 

the integration of the psychologist in the 
therapeutic team (Iamandescu, 1997). 

The clinical observations has managed to 
bring in the center of medical debate a 
number of psychological factors that 
participate directly or indirectly, to the 
onset and rhythm  of the disease (going up 
to complications or death), often being 
factors of resistance to treatment or, on the 
contrary, it may increase. Consideration of 
these factors is not only a goal but an 
absolute necessity in the medical economy.   

Regarding the nature of suffering for 
which the patients present to medical 
consultation, on statistical level was set a 
percentage of  30% - 40% as functional 
disorders, often psychosomatic (as an 
expression of acute or chronic stress) which 
by misinterpretation, may lead to extremist: 
either ignore of organic causes, or disregard 
the psychic factor and excessive use of  
medical assistance. Even modern surgery, 
characterized by the speed of the exercise as 
well as by increasing the quality of life of 
the person who had been operated, is 
threatened by ignoring the existing 
psychological factor in any doctor-patient 
relationship; taking into account this factor 
will help the surgeon to grasp a series of 
features in which the operator act is 
accomplished  - with repercussions on the 
psyche of the patient - but also with a series 
of positive implications of psycho-therapy 
attempts or in postoperative recovery 
dynamics. 

The psychologist will make a thorough 
examination, for information purposes, to 
assess how accurately the current mood is, 
personality type, ego strength, will and 
rationality potential deficit caused by the 
disease. It will work towards inferiority 
complex to prevent and avoid breaking the 
attitude of social contacts (obviously, 
especially to marrowy patients). 



 
 
 
 Virginia Rotărescu, A.V. Ciurea          Psychotherapy of hospitalized patients 

 
 
 

With the transition from normal to 
pathological, a change is being made in the 
balance of the personality and of the general 
mode of reporting and integration of the 
patient in the environment in which the 
patient is able to overestimate, 
underestimate or correctly evaluate their 
physical and mental possibilities, depending 
on its cultural level, previous to sickness 
emotional condition, hopes, promises, 
duration and degree of illness. In such 
situations, it becomes very important how 
the subject uses his self-image, especially in 
terms of feasibility when it comes to 
ranking or reshaping, the patient should 
review his future plans. 

Mental disorder and disorientation will 
be the starting point of the first neurotic 
symptoms against which the doctor and 
psychologist must take immediate attitude 
for the recovery in time of the patients. The 
psyche deteriorates in the same time with 
the body and the motor rehabilitation, 
without a psychic one, give insufficient 
results; this is one of the reasons why the 
psychological study of the patients and their 
mental rehabilitation becomes a first order 
importance, being even harder to 
accomplish.  

Most of us recognize that medicine is 
both art and science, and the most 
important knowledge to be learned or 
passed on in medicine is how the mind and 
body can invoke the hidden resources to 
cope some extraordinary challenges.  

Building trust in the relationship with 
your body, is strengthened the conviction 
that the human mind can discipline the 
body, they can set goals, may in some way 
understand the capabilities and the decision 
to go forward. “However, some experts do 
not know enough to give a verdict - 
condemning a man - and need more 

attention to what they say to the patients 
they may be believed and that could be the 
beginning of the end”(Cousins, 2011). 

All this arguments, sustained in this 
work, are strongly confirmed by the 
European Norms for Medicine in the 
affirmation of obligatory being there of the 
psychologist in the medical team. This data 
are officially confirmed like imperative 
necessity to the Neurosurgical Commission 
from the Governmental Department of 
Health (Ciurea A.V.). 

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