A Review of the Construct of Demoralization

History, Definitions, and Future Directions for Palliative Care

Brooker, Joanne BSc, GradDipComp, GradDipPsych, PhD
Robinson, Sophie BPsych
Kissane, David W. MD, MPM, FRANZCP, FAChPM
Burney, Susan BA, GradDipCounsPsych, MHlthSc, FAPS PhD

¹School of Psychological Sciences, Monash University, Clayton, Australia
²Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
³Cabrini Monash Psycho-oncology, Cabrini Health, Malvern, Australia

David W. Kissane, FRANZCP, MD, MPM, FAChPM, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Level 3, P Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3186, Australia. Email: [email protected]

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

American Journal of Hospice & Palliative Medicine 33(1):p 93-101, February 2016. | DOI: 10.1177/1049909114553461

Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.