Am J Hosp Palliat Care 2016 Feb 7;33(1):93-101. Epub 2014 Oct 7.
School of Psychological Sciences, Monash University, Clayton, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia Cabrini Monash Psycho-oncology, Cabrini Health, Malvern, Australia.
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.