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Psychodynamically oriented authors have made significant contributions to thinking about the care of individuals afflicted with fatal illness. By now, Kubler-Ross's (1969) work on the psychological adaptations made by the terminally ill and the defences used by them in coping are so well known that they have permeated the popular consciousness. Shelley Taylor (1989), in writing about coping among patients afflicted with breast cancer, identified three principal emotional tasks facing these women: the need to maintain a sense of control, to maintain positive self-esteem, and the quest for a sense of meaning in the illness. Such contributions to the understanding of psychodynamic experiences of terminally ill people help those providing clinical care to have a deeper empathy towards their patients.
For those stricken by the AIDS epidemic, the task of psychological adjustment is like the adaptation to other life-threatening illnesses, while in other ways it is different. For any human being suffering from a particular sickness, his or her experience is shaped not only by the disease's physical course, but is also embedded within the socially constructed meaning of having the illness. Susan Sontag (1989, 1978) has written about the specific cultural meanings of tuberculosis and cancer as well as AIDS. AIDS patients experience a unique social stigma due to its prevalence among particular segments of society such as gay men, intravenous drug users, and the urban poor. This stigma creates an aura of shame around the illness, which compounds the physical suffering caused by the disease itself. Ironically, the epidemic arises at a time when psychiatry and psychoanalysis have as fields critically re-examined their traditional assumptions associating one of the affected groups—homosexual men—with psychopathology. However, despite the scientific re-evaluation of this issue, ignorance about homosexuality and irrational bias persist within the mental health professions as well as