Translated material
Accepting the diagnosis
Models are always beautiful, logical, one stage follows another, everything is ordered... But in reality, as a rule, everything is chaotic, inconsistent and not so attractive. Any counselor who works with people who are diagnosed, especially with terminal illnesses, is trained in a model of accepting the diagnosis.
Elisabeth Kübler-Ross created her model based on her many years of experience working with people with cancer. Now this model is widely known: Shock-Denial-Anger-Bargaining-Depression-Acceptance , and is used in completely different contexts, incl. as the “Bad News Acceptance Model” or the “Change Acceptance Model.”
The main task of a consultant is to be with a person at each stage, to help a person be more aware of what is happening to him, to his feelings, and to accompany him in working with these feelings. And, under no circumstances, do not force a person’s movement from one stage to another.
The problem with the existence of HIV-negatives among people diagnosed with HIV is the lack or poor support in the process of accepting the diagnosis.
The existence of internalized stigma regarding one's HIV status or other people living with HIV is also a consequence of insufficient support in accepting the diagnosis. Moreover, the person himself may feel that he has accepted his diagnosis. But if he constantly expresses sarcasm and demeaning “jokes” to other people living with HIV, or engages in self-destructive, potentially dangerous behaviors, then this suggests that at a deep level, acceptance of the diagnosis has not occurred. The dynamics between internalized stigma, acceptance of diagnosis, and cultural trauma surrounding the HIV epidemic are complex and internally contradictory.
Or the so-called could have happened. "false diagnosis" For example, when a person begins to take therapy not for himself, but for the sake of others: partner, children, parents. The fact that a person begins to take therapy is already very good and valuable in itself - it is important to remember this. But the fact that a person’s internal focus is shifted from himself to others contains the potential for breakdown. For example, a partner leaves, children or parents argue and stop communicating - if a person was treated for their sake, then in this situation his motivation disappears and there is a risk of him stopping therapy.
Both people with a diagnosis and counselors often forget that accepting a diagnosis is a non-linear process and depends on many factors. It would seem that the person has plunged into a state of deep depression, which, theoretically, should indicate that the next stage should be acceptance, but time passes and acceptance does not occur. But the point may be that the person did not express his anger - in his picture of the world it is impossible to feel and express anger, and the person suppressed this feeling in himself, drowning it out with a resolved feeling - sadness. But anger has not disappeared anywhere; it remains in the person’s unconscious and prevents acceptance of the diagnosis. A person can jump from stage to stage, return to those stages that, it would seem, he has already passed. And this takes time for each person.
It is also not often said that adaptation to a diagnosis is a spiral-shaped process (and is similar, in this sense, to the spiral of the cycle of changes by Prachaska and di Clementi): some problems are solved, new ones appear, the emergence of which is influenced by the context and quality of a person’s life. And all the questions related to accepting the diagnosis, which, it would seem, the person has already answered for himself, may appear again. For example, due to the need to talk about your HIV status with the parents of a new partner (or this partner himself). Or the need to go to a country and find out that the laws of this country in one form or another restrict the entry of people with HIV into its territory (there are currently 48 such countries in the world). Or due to interruptions in therapy. Or fatigue from therapy... But you never know why a person might think about his diagnosis again. After all, in fact, every morning, looking in the mirror or automatically taking morning therapy, a person goes through his entire path of adaptation to the diagnosis.
And it’s good if a person has the opportunity to go to a psychologist who understands this process. But, unfortunately, even in state AIDS centers, seemingly qualified psychologists do not always understand the individual dynamics of a person. Yes, and not every person is ready to go to a psychologist. Yes, of course, doctors, to the best of their ability, contribute to the process of making a diagnosis, but, nevertheless, doctors have completely different tasks.
Therefore, a person can be helped in this process by unqualified but professionally trained counselors, peer counselors and support groups, since it is absolutely important not to be alone with your feelings and not to be isolated. By the way, the very reluctance to go to a support group for people living with HIV may also indicate that a person is having problems accepting his diagnosis. It is unqualified professionals who most often take on the psychological support of people with a diagnosis. And this is a recognized international practice - support from the community. WHO and UNAIDS emphasize that people who receive support from lay counselors, peer counselors and are integrated into their community are better able to cope with their diagnosis and have higher life satisfaction.
The model only helps a little to understand what happens to a person’s feelings. But the model does not say that this happens only one way and no other way. And each person’s path to accepting their diagnosis is unique. And it is not easy for anyone. But if a person has a support system of loved ones, counselors, community, and is not isolated, then this process is much easier.
And, of course, what was written above applies not only to the process of accepting an HIV diagnosis, but also to other, not only diagnoses, but also life circumstances.