MARY ANN COHEN, M.D. HENRY W. WEISMAN, M.D. A biopsychosocial approach to AIDS Dr. Cohen is director of consultation-liaison psychiatry and Dr. Weisman is associate director of consultation-liaison psychiatry. both in the departments of psychiatry and medicine. Metropolitan Hospital Center. New York Medical College. Reprint requests to MaryAnn Cohen. M.D.. 220 West 93rdSt.. New York. NY 10025. ABSTRACT: The severe and devastating illnesses that comprise acquired immunodeficiency syndrome (AIDS) undennine coping capacities and increase the sense of alienation and expendability. A comprehensive program proved necessary to coordinate services and educate staff members, and has been organized in the form of a Multidisciplinary AIDS Progam (MAP). The goal of the program is to improve care of the person with AIDS by means of a biopsychosocial approach. A comprehensive team approach, the Multidisciplinary AIDS Program (MAP), has been developed at Metro- politan Hospital Center. a 600-bed municipal hospital, in order to im- prove the care of the person with AIDS by means of a biopsychosocial approach'" to the multiple aspects of AIDS-an approach that views these individuals as deserving coordinated care and treatment with dignity. Addi- tional goals of the program have been to diminish the patient's sense of alienation and expendability, to im- prove communication, and to further staffeducation. Alienation and expendability The MAP has involved approximately 300 persons with AIDS and AIDS-re- lated complex (ARC). Of these, 70% were intravenous drug abusers, 22% were gay or bisexual men, and the re- maining 8%, both men and women, had contracted their illnesses from other sources. They were followed for an average of ten months. and for the duration of the illness, whenever pos- sible. A consistent theme of alienation and expendability' was evident. Many persons with AIDS have been given overt and covert messages by employ- ers, families, and communities that they are unwanted. Many had isolated themselves and felt unloved, unwant- ed, and expendable even before devel- oping AIDS. Some were subjected to discrimination because they were members of risk groups initially asso- ciated with AIDS. Intravenous drug abusers may be depressed and self-destructive indi- viduals who have effectively severed the bonds that linked them with their families and communities. Because of their antisocial behavior, they may have incurred the anger of their loved ones and spent time in prison for crimes associated with buying or sell- ing drugs. The gay or bisexual men who are admitted with AIDS may have had recent losses so that they too feel isolated and alienated or rejected. They may have maintained contact with friends and family without in- forming their families about their ho- mosexuality. A mother may learn on the same day, that her son is gay and has AIDS. One mother reacted to this with hostility and openly maintained a prayer vigil outside the intensive care unit, praying that her son would die because of the shame he had caused her. APRIL 1986· VOL 27· NO 4