The social trauma of treatment resistant tuberculosis

The treatment of a man named Xiang for Treatment Resistant Tuberculosis (TRD) was previously reported within the scientific Journal of Bioethical Inquiry.  Xiang’s direct medical expenses were quoted to be in excess of $250,000 and his inability to pay for those expenses and further support his non-custodial family seemed to be the main issues up for debate. However, it is relatively common amongst the physical sciences to ignore the influence of psychosocial factors on physical health and continued medical treatment. Dr Halovic drew attention to this limitation and suggested a treatment framework that evaluated Xiang as a complete person with his own thoughts, perspectives and feelings of his TRD treatment and the traumatic influence of his treatment upon his social relationships, such as his family and employers.

Tuberculosis is transmitted from person to person through air-born particles. Xiang was therefore being treated in quarantined isolation where communication was limited to medical staff and even then, communication was difficult due to cross language difficulties and infection prevention procedures. Cut off from his family, Xiang eventually lost contact with them. Additionally, his employer could no longer retain his employment because there was no foreseeable end to Xiang’s TRD treatment. Xiang was consequently disconnected from his social relationships, which have been found to prevent the effects of trauma on physical and mental health. Xiang was also likely disconnected from his very identity as a hard working family man. In essence, Xiang’s sense of purpose and connection with his world had been severed with limited ability to change this outcome in the foreseeable future. It is completely understandable if Xiang internalised his social failures as personal failures and, without the benefit of continued social support to ward off this destructive process, further mental health degradations are likely.

The reported medical expense of $250,000 for Xiang’s treatment was therefore likely underestimated when taking into account the additional treatment for the associated psychosocial symptoms. However, it is known within the scientific literature that psychotherapy is a cost-effective treatment and reduces the overall financial burden on health care services. People who utilised psychotherapy have been shown to have less use of healthcare resources and stricter adherence to medical treatment procedures; both are relevant in Xiang’s case. Furthermore, a strong and valued therapeutic relationship could potentially act as a proxy relationship for Xiang in the absence of his family and occupational relationships. Reconnecting Xiang with his world and his own feelings of self-worth would likely prevent the deterioration of his mental health and the effects it has on his TRD treatment. Furthermore, the isolation that Xiang is forced to endure would not prevent Xiang’s access to psychotherapy as there is a growing body of evidence that shows that psychotherapy can be effectively administered through e-therapies; psychotherapy able to be administered through web-based technologies such as Skype and internet communities.

Shaun Halovic
Westmead Psychotherapy Program, Sydney University, Sydney, Australia



Effective Therapeutic Relationships Using Psychodynamic Psychotherapy in the Face of Trauma : Comment on “The Ethics of Isolation for Patients With Tuberculosis in Australia”.
Halovic S
J Bioeth Inq. 2016 Jan 15


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