Psychological problems of general hospital patients are related to physical illness and disability, and/or physical disorder produced by affective distress. The typical emphasis on psychopathology during academic training, and the orientation towards psychiatry during internships maladapt clinical psychologists for work with such patients. This argument is supported by diverse illustrations: psychological disturbance in pregnant women, psychological problems of patients in intensive care units, the inappropriateness of a psychopathological approach to the psychological aspects of coronary heart disease, and the adaptive value of denial in some instances of physical illness. Psychological reactions to medical conditions can be understood better in terms of developmental crisis. Implications for training are mentioned.
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