The response to stress.

The normal response to stress can be understood in terms of periods of outcry, denial, and intrusive thoughts leading to working-through to completion. The general physician who understands this pattern can assist the patient through the denial phase by encouraging ventilation and through the intrusive phase by providing structure, advice, and medication to temper the painful feelings. With such assistance, most patients can integrate the stress event into their lives, with the duration of response related to the severity of the stress. A year of stress response after the death of a loved one is common. Psychiatric referral is indicated if the stress response seems unduly prolonged, has lead to maladjustive reactions, is disproportionate to the actual loss, or threatens to overwhelm the person.