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Fear Avoidance as the Body’s Defence Mechanism for Death

Received: 19 June 2018    Accepted: 24 July 2018    Published: 28 August 2018
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Abstract

Today within the sphere of chronic pain, the mechanism of fear avoidance is a well-known concept that has been substantiated through international literature in the field. As patients believe that work and physical activity will aggravate their pain, the logical response is to progressively implement avoidance strategies for particular physical movements. This will thus tend to perpetuate a feedback loop: pain - non-confrontation - weakening - pain. In this article, we aim to show that this concept is transferable to the field of serious illness and palliative care, even if the term is used differently on a therapeutic level. The idea of avoidance here relates to death and can be defined in the following way: fear of death/distress - non-confrontation regarding death – life/death instinct ambivalence. Because of this psychological life-saving mechanism, the subject who is ill remains in the stage of life/death instinct ambivalence, in other words, living. The implications of this model for clinical practice are completely new, whether applied at the moment of diagnosis, during the psychological experience that accompanies the illness or even in the aforementioned final phase of life. the mechanism of fear avoidance represents a real life-saving defence, whether from the moment of diagnosis of serious illness, during the psychological process that accompanies the illness, or in the final moment of death, allows the patient to die, psychologically speaking, more comfortably.

Published in American Journal of Psychiatry and Neuroscience (Volume 6, Issue 3)
DOI 10.11648/j.ajpn.20180603.12
Page(s) 61-66
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Diagnosis, Delirium, Fear Avoidance, Defence Mechanism, Palliative Care

References
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[2] Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-a]voidance beliefs – a moderator of treatment efficacy in patients with low back pain: a systematic review Spine J 2014;14: 2358-2678.
[3] Alric J. End of life & Psychoanalysis Death threat and return to desire (Only in French) Fin de vie & Psychanalyse Menace de disparition et relance désirante Montpellier Sauramps Médical 2016.
[4] Amar S. Palliative care support Psychoanalytic Approach (Only in French) Paris Dunod 2012.
[5] Doucet C. Palliative care clinical and death metapsychological problem (Only in French. L’Evolution psychiatrique 2005; 70 605-612.
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[7] Alric J. & all. Stay alive with disease Psychoanalytic approach in oncology and palliative care (Only in French) Clinique psychanalytique en cancérologie et en soins palliatifs Erès 2015.
[8] Rolving N1, Nielsen CV, Christensen FB, Holm R, Bünger CE, Oestergaard LG. Does a preoperative cognitive-behavioral intervention affect disability, pain behavior, pain, and return to work the first year after lumbar spinal fusion surgery? Spine 2015; 40: 593-600.
[9] Andersen TE, Karstoft KI, Brink O, Elklit A. Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury A prospective cohort study Eur J Pain 2016; 20: 1241-52.
[10] Jay K, Brandt M, Jakobsen MD, Sundstrup E, Berthelsen KG, Schraefel M, Sjøgaard G, Andersen LL. Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial. Medicine (Baltimore) 2016 Aug; 95 (34): e3945. Doi: 10.1097/MD.0000000000003945.
[11] Fritz JM, Magel JS, McFadden M, Asche C, Thackeray A, Meier W, Brennan G. Early Physical Therapy vs Usual Care in Patients with Recent-Onset Low Back Pain: A Randomized Clinical Trial. JAMA. 2015; 314: 1459-1467.
[12] Alric J. The appeal to the eternity in the psychic life The death is not in confrontation (Only in French) Alric J & Bénézech JP. La mort ne s’affronte pas…! Montpellier Sauramps Médical 2011 59-69.
[13] Kübler-Ross E. On Death and Dying. Genève Labor et Fides 1969.
[14] Alric J. I am going to live just like that The psychic sufferings of the sick of the cancer: How to recognize them, how treat them? (Only in French) Dudoit E & Ben Soussan P. Les souffrances psychiques des malades du cancer. Comment les reconnaître, comment les traiter? Paris: Springer-Verlag 2009: 35-39.
[15] Laplanche J. & Pontalis JP. The Language of Psychoanalysis Puf 10ème édition 1990: 67.
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[17] Pascal B. Pensées. Edition Brunschvicg (réedition 1965).
[18] Freud S. 1926. Psychanalyse et Médecine Ma vie et la psychanalyse Paris Gallimard 1972: 95-184.
[19] Bénézech JP. Is prognosis ethical? Médecine Palliative 2008; 7: 140-148.
[20] Alric J. Thaveau L. & all. Of already there of the death in the disappearance of the finiteness Psychoanalytic approch in oncology (Only in French) Etudes sur la mort, Thanathologie Les fins de vie Paris: Esprit de temps 2010/2: 30.
[21] Spinoza. Ethics. Trad. A. Guérinot, L’éthique de Spinoza, Paris: Ivrea, 1993.
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Cite This Article
  • APA Style

    Jérôme Alric, Bénézech Jean-Pierre. (2018). Fear Avoidance as the Body’s Defence Mechanism for Death. American Journal of Psychiatry and Neuroscience, 6(3), 61-66. https://doi.org/10.11648/j.ajpn.20180603.12

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    ACS Style

    Jérôme Alric; Bénézech Jean-Pierre. Fear Avoidance as the Body’s Defence Mechanism for Death. Am. J. Psychiatry Neurosci. 2018, 6(3), 61-66. doi: 10.11648/j.ajpn.20180603.12

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    AMA Style

    Jérôme Alric, Bénézech Jean-Pierre. Fear Avoidance as the Body’s Defence Mechanism for Death. Am J Psychiatry Neurosci. 2018;6(3):61-66. doi: 10.11648/j.ajpn.20180603.12

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  • @article{10.11648/j.ajpn.20180603.12,
      author = {Jérôme Alric and Bénézech Jean-Pierre},
      title = {Fear Avoidance as the Body’s Defence Mechanism for Death},
      journal = {American Journal of Psychiatry and Neuroscience},
      volume = {6},
      number = {3},
      pages = {61-66},
      doi = {10.11648/j.ajpn.20180603.12},
      url = {https://doi.org/10.11648/j.ajpn.20180603.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20180603.12},
      abstract = {Today within the sphere of chronic pain, the mechanism of fear avoidance is a well-known concept that has been substantiated through international literature in the field. As patients believe that work and physical activity will aggravate their pain, the logical response is to progressively implement avoidance strategies for particular physical movements. This will thus tend to perpetuate a feedback loop: pain - non-confrontation - weakening - pain. In this article, we aim to show that this concept is transferable to the field of serious illness and palliative care, even if the term is used differently on a therapeutic level. The idea of avoidance here relates to death and can be defined in the following way: fear of death/distress - non-confrontation regarding death – life/death instinct ambivalence. Because of this psychological life-saving mechanism, the subject who is ill remains in the stage of life/death instinct ambivalence, in other words, living. The implications of this model for clinical practice are completely new, whether applied at the moment of diagnosis, during the psychological experience that accompanies the illness or even in the aforementioned final phase of life. the mechanism of fear avoidance represents a real life-saving defence, whether from the moment of diagnosis of serious illness, during the psychological process that accompanies the illness, or in the final moment of death, allows the patient to die, psychologically speaking, more comfortably.},
     year = {2018}
    }
    

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  • TY  - JOUR
    T1  - Fear Avoidance as the Body’s Defence Mechanism for Death
    AU  - Jérôme Alric
    AU  - Bénézech Jean-Pierre
    Y1  - 2018/08/28
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    N1  - https://doi.org/10.11648/j.ajpn.20180603.12
    DO  - 10.11648/j.ajpn.20180603.12
    T2  - American Journal of Psychiatry and Neuroscience
    JF  - American Journal of Psychiatry and Neuroscience
    JO  - American Journal of Psychiatry and Neuroscience
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    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.ajpn.20180603.12
    AB  - Today within the sphere of chronic pain, the mechanism of fear avoidance is a well-known concept that has been substantiated through international literature in the field. As patients believe that work and physical activity will aggravate their pain, the logical response is to progressively implement avoidance strategies for particular physical movements. This will thus tend to perpetuate a feedback loop: pain - non-confrontation - weakening - pain. In this article, we aim to show that this concept is transferable to the field of serious illness and palliative care, even if the term is used differently on a therapeutic level. The idea of avoidance here relates to death and can be defined in the following way: fear of death/distress - non-confrontation regarding death – life/death instinct ambivalence. Because of this psychological life-saving mechanism, the subject who is ill remains in the stage of life/death instinct ambivalence, in other words, living. The implications of this model for clinical practice are completely new, whether applied at the moment of diagnosis, during the psychological experience that accompanies the illness or even in the aforementioned final phase of life. the mechanism of fear avoidance represents a real life-saving defence, whether from the moment of diagnosis of serious illness, during the psychological process that accompanies the illness, or in the final moment of death, allows the patient to die, psychologically speaking, more comfortably.
    VL  - 6
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Author Information
  • Department of Palliative Care, University Center Hospital, Montpellier, France

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