A serious illness takes its toll on more than the body, it can cause emotional upheaval for patients and their families.

Until recently, many Bermudians were simply patched up by a medical doctor and sent home to recover mentally as best they could without the right psychological support.

That is why Bermudian Dr. Sue Adhemar, after raising four children, decided to go back to school to become a charter psychologist with a speciality in health related issues.

She received her Bachelor of Science degree from the University of Liverpool in England, and her Master?s degree and chartership from the University of Wolverhampton, also in England. ?I made a point of doing health psychology, because I knew that there was a huge gap here with regard to health issues,? said Dr. Adhemar.

One of her particular interests is cardiac rehabilitation, although she is not limited to this.

?I was lucky enough to work with some of the leading chartered psychologists in the United Kingdom in one of the finest cardiac units in Merseyside, England,? she said. ?I help clients come to terms with emotional distress, deal with the psychosocial issues and look at the impact on the family. I try to make a person?s rehabilitation part of a holistic process. Many people think recovering is just about getting into the gym and building yourself back up, but there is always an emotional side to how anything impacts on us.?

Dr. Adhemar knows well what a heart attack can do to an entire family, because her own father died of a heart attack when she was little. ?I have a family history of heart disease,? she said. ?I lost my father when I was seven-years-old. I know and understand the impact on a family.?

She said, unfortunately, her family never received any psychological help, and they were the worse off for it.

?I don?t think they managed very well,? she said. ?My mother didn?t cope very well. I think without psychological intervention most people learn to manage with whatever they have, but it just takes so very long.

?It makes the whole trauma process extended. Psychological support helps to minimise the damage. In some instances, all you can do is damage limitation.?

She said it is important that the patient?s family also get support. ?Sometimes, if you have a family situation where they have been traumatised by what has gone on, they are not in a position to offer support to the patient,? she said. ?They are too close and they have their own needs so it is very difficult.

?Everybody needs for their needs to be met and that can cause a lot of problems. So there is a lot of family work that can be done.?

Dr. Adhemar said the family?s cultural background also needs to be taken into account because not every culture responds to a situation in exactly the same way. ?The client?s cultural background is inextricably linked to the person. That is one of the advantages of psychology. We are trained culturally and it is a very important issue in psychology.?

Dr. Adhemar originally trained as a nurse and worked for a long time in her former husband?s medical office.

She now has her own office with Benedict Associates, and also does house-calls or goes to a patient?s hospital room. Her services are covered by insurance. ?I am happy to go to doctors? offices, or to the patient?s home, if necessary, because some people are not mobile. If you have a bilateral amputee, for example, it is a big struggle for them to get into an office. I think it is kinder to see them where they are available.?

She said that many people go abroad for treatment, and find psychological support out there, but when they return to Bermuda it is abruptly cut off unless they seek psychological support from a general psychologist or counsellor.

?If they go to someone with a background in health psychology, it is quite helpful,? she said. ?When something happens such as a one-off heart attack we don?t have established coping methods to deal with that. The impact is enormous, and it can be very disempowering. You just cope in the best way you can. If someone doesn?t have good coping methods or support then the impact is quite traumatic; a heart attack is a life threatening event, after all.?

She said many people are frightened after a heart attack and feel anxious that it might happen again. The fear makes many people very cautious when resuming their previous activities. Dr. Adhemar?s aim is to take psychology into the community and make it an integral part of Bermuda healthcare.

?When something is a life changing event then you deserve to have the same support emotionally as you do physically,? she said. ?There is a mass of research to suggest that learning how to manage problems effectively, reduces the impact overall on the patient.?

In addition to cardiac work, she has also worked with diabetic patients to help them manage their illness. She also enjoys doing life span development and organisational psychology.

?It is about giving people skills to manage, sometimes, quite normal things that happen in their lives that can have a negative effect,? she said. ?It is about getting coping skills and instilling good self-management.

?If you keep on doing what you are doing you are going to keep on getting what you get. If you are giving someone skills to make effective changes in their lives then everything is so much happier and more comfortable.

?I usually work as a team with a patient,? she said. ?They know themselves better than anyone else. For the vast majority of people it is not the people that are difficult it is their circumstances. The client may think they are reacting in an unusual way, but usually they are just coping in the best way that they can which for them feels inadequate.?

She said in the past, some people recovering from a heart attack were sent to a mental hospital for psychological help because they were fearful of having another heart attack.

?It isn?t always necessary for someone to be referred to secondary mental health facilities for their normal reaction to a serious health problem,? she said. ?It doesn?t help them. In fact, it just retraumatises them.?