THE WIDESPREAD development of critical care units in general hospitals during the past decade has produced many benefits for the seriously ill and injured. Among the less heralded of these has been the sharpened focus of attention on altered states of consciousness, emotional reactions, and behavioral patterns of the critically ill.1 Psysicians and nurses are called on to appraise and evaluate cognitive clarity, feelings, and behavior of patients. The importance of the patient's previous life experiences, coping style, and personality assets and vulnerabilities serve as the basis for planning and implementing treatment programs in such intensive care facilities.2 Physiologic and psychologic adaptive patterns in the face of stress are part of a unitary response to challenge, and both reflect subcortically centered systems of defense.
Approach vs Avoidance Patterns
Hess,3 as early as 1925, pointed out that an animal's reaction to environmental challenge is importantly reflective of the