Approaching Mortality

How do you understand what is happening to you?

What is your worst fear?

What is most important to you?

What sacrifices are you prepared to make?

In recent months, I have been providing a counselling service to patients and family members at a local hospice and I recently came across this book:

“Being Mortal: Illness, medicine, and what matters in the end” by Atul Gawande

I was so struck by the humanity and experience of the writer that I was wondering if a review of its contents might be useful for some of my readers. 

Who might benefit from this book?

Anyone living with life threatening illness, living with someone with a life threatening illness or working in palliative care.  Anyone who is mortal.

What are the main ideas?

Modern medicine struggles to deal with mortality. For this reason, it runs the risk of neglecting care at the end of life.

However Atul Gawande argues that, in life, endings can be more important then the countless moments that come before.

In end of life care, endings matter. This is true for both the one with a life threatening illness and for those closest to them.    

Gawande suggests that being mindful of endings eases or limits suffering by supporting individuals to:

·      Negotiate over-whelming anxiety about death, about suffering, about loved ones and finances.

·      Reach acceptance of the limits and possibilities, leading to a greater sense of empowerment.

·      Share memories, pass on wisdom and keep sakes, settle relationships, establish legacies, make peace, ensure that those who are left behind are ok. 

·      End on their terms

Difficult conversations

Gawande advocates courage in having difficult conversations with individuals and family members.

"I am worried"

He argues that facts can be daunting and confusing. According to him, people are more interested in the meaning behind the facts. He suggests that the words “I am worried that the illness is still there” convey more then any medical detail.

 The most important questions

How do you understand what is happening to you?

What is your worst fear?

What is most important to you?

What sacrifices are you prepared to make in order to hold on to what is most important?

It seems as if these questions cannot be asked too early or too many times.

Time has a habit of altering all answers and everyone, without exception, has a habit of moving unconsciously through life and of limiting the choices that they make about how they live.

These ideas will be all the more meaningful to those amongst us with a heightened sense of their mortality. If this describes you, then you might appreciate this book.

Supportive links

http://www.counselling-directory.org.uk/counsellors/rachel-lewis

http://www.macmillan.org.uk

https://www.alzheimers.org.uk

http://www.amazon.co.uk/Being-Mortal-Illness-Medicine-Wellcome/dp/1846685826/ref=sr_1_1?ie=UTF8&qid=1454602807&sr=8-1&keywords=atul+gawande

Cognitive Behaviour Therapy: What is it and how does it work?

“The mind is its own place, and in it self can make a Heaven of Hell, a Hell of Heaven.”

~John Milton, Paradise Lost

Many of you reading this blog will hear a ring of truth in the quotation above. Perhaps you are plagued by negative thoughts that circle almost constantly in your head. Perhaps moments of creeping anxiety or even sheer panic make your life unliveable.

CBT (Cognitive Behaviour Therapy) was devised to get to the heart of each individual’s personal hell. It provides a method of changing the way we look at things and of changing our experience of life as a whole. I use it to work with anxiety where it has shown to be a useful approach.

Its central philosophy is that beliefs about ourselves, about others, or about life in general have a direct impact on what and how we feel and on how we behave. CBT describes how this can create a kind of a feedback loop, where a person’s beliefs and their physiological, emotional and behavioural responses all interact with each other in ways, which perpetuate and maintain the problem.

Imagine for example that you are walking into a bar one day and a man turns to look at you. What do you think?

“He’s noticed how I look.”

“What does that guy want with me?”

“This does not look like a safe bar.”

“That guy must be waiting for someone. He must have wondered if I was that person walking in”

On the surface, it’s impossible to judge which of the above thoughts might be true. However they each reveal something about our general outlook towards life, towards others or towards ourselves.

Supposing one were to think “He’s noticed how I look.” This thought may come from a variety of different outlooks. Someone, for example, who generally sees the world as an unfriendly place might be prepared for the possibility that others will laugh at him. If he then goes out and sees people looking at him, he might automatically think that they are judging him.

At this point there is often a physical response. The person might go red, they might feel a lump in their throat, a tightness in the chest, or feel short of breath. Their heart might pump harder. They might shake or sweat. They might experience stomach pains or a sense of unreality. This in turn emphasises the impression that others are looking and leads to feelings like, embarrassment, shame, anxiety, sadness or anger.

In response, he might start a fight or duck into a corner. He may attempt to deflect attention by having a loud conversation with the bar man. According to CBT, the way we behave in response to these events only goes to reinforce the beliefs that caused such a reaction in the first place.

It sparks a vicious cycle that can lead to spiralling negative thoughts and escalating psychological and physical discomfort.

Although we all have beliefs that guide our general outlook in life, we are rarely aware of them. This is because they are always acquired when we are very small and don’t have the language to question them.

So they get hardwired to a part of the brain, which operates automatically. CBT is about gaining control through finding these beliefs and making them conscious.

Cognitive behaviour therapists help their clients to examine their beliefs either through carefully devised questions or through behavioural experiments.

Behavioural experiments involve exposure to the events that elicit the discomfort. The theory goes that by facing up to our beliefs in a concrete way we reach parts of the brain that other therapies can’t reach rewiring our belief system and creating possibilities for long term positive change.