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

How to Argue

As a marital and family therapist, I sometimes consider it my job to help people to have a good old-fashioned argument. It’s no easy matter, as there seems to be a real knack to getting it right.

Not all families argue but it can be a helpful way of maintaining closeness. It helps people to regulate negative emotions and allows opportunities for family members to feel heard and accepted.

If you grew up in a family where the smallest thing could result in a full blown fight or if you rarely saw anyone in your family get angry, then this article might be for you.

It will look at common and unhelpful conflict styles and will suggest ways in which we can win arguments without letting our relationships lose out.

Volcanoes, Gas Tanks, Tortoises and Hedgehogs.

Every one uses different styles of dealing with anger. I have divided these different styles into categories.

Volcanoes:

A volcano stores up anger, resentment and bitterness until it all get’s too much to control and the volcano has to blow. This can be pretty explosive leaving both the volcano and other members of the family stunned and hurt.

Volcanoes learned a long time ago that the best way to deal with a problem was to keep perfectly calm. This approach can be highly successful at work and in many situations at home.

However the mounting tension can be exhausting. Family members may also be unaware that anger is building up leaving the volcano feeling misunderstood and frustrated and adding further to their anger.

Gas Tanks:

Gas Tanks tend to carry a lot of volatile material around with them and can explode with the slightest spark. They can be very sensitive to having their feelings, hurt or ignored and have found in the past, that the only way to address hurt, fear or sadness is by losing their temper.

If you live with a gas tank, you may find yourself feeling anxious not to hurt or offend in any way. You may also find yourself treading on eggshells a lot of the time.

Hedgehogs:

Hedgehogs are good at not exposing any part of themselves that feels vulnerable. They have learned as children that expressing their feelings can be dangerous and can lead to rejection or abandonment.

The trouble is that hedgehogs can be extremely prickly to the touch. If you live with a hedgehog, you may be used to getting your feelings hurt. It is unintentional but can be experienced as sarcasm, the cold shoulder, insensitivity, or humiliation.

Tortoises:

Tortoises plod away and take everything in their stride. They have a tough outer shell and seem to be immune to feelings.

If you live with a tortoise you may feel lonely and ignored. You may feel misunderstood and wonder if they really care. Paradoxically their outer shell is there to protect them from caring too much.

A vicious circle can develop where family members take pot shots at the tortoise in order to make them react. However this can only make them retreat further into their shell.

Of course this is an over simplification. In fact there are crossovers between the styles and we often find ourselves adopting more then one in family arguments.

The trouble is that each style feeds off the other. They are self perpetuating, leaving family members caught in escalating conflict or bitter withdrawal.

How not to be a volcano, gas tank, hedgehog or tortoise.

We have all caught ourselves, or someone we love using these argument styles. However it takes a great deal of tolerance in a relationship to endure this for long.

John Gottman has done a thorough study of happy couples and has noted that happiness in relationships is not found through avoidance of arguments but in the adherence to certain unwritten rules.

It’s not whether you argue but how. With this in mind, I have extrapolated some ground rules for family conflict.

Win/ win

Many people think that in order to win an argument, someone else has to lose. In fact the win/lose approach often results in both sides losing. Arguments can become entrenched, leaving people feeling exhausted and hopeless about finding a solution.

Instead of being on separate sides, therefore, try to imagine that you are looking for a way back on to the same side. If you allow your loved won to win you over with their argument, it is very likely that they will do the same for you.

Lids with safety valves.

Gas explosions are never helpful in arguments so try and put a lid on it. If you feel like a volcano and can sense the pressure building up then release it gently and effectively using assertiveness and empathy. If you are about to blow then use time out.

Assertiveness

Be assertive. There is no need for profanity, insults or abusive tactics. Try not to make the argument about the other person or point the finger of blame. Focus on what happened, how you feel and why this is so important to you.

Empathy

Arguing without empathy is a bit like shaving with no sense of touch. Without empathy, how do you know how sharp your words are and how hurt your loved one feels? Arguments can escalate so easily without this essential ingredient.

Take time out

If you become too agitated then take time out. Acute stress makes it hard for us to think clearly. So if your temperature goes up, or you hear the blood pounding in your ears, take a break.

Notice if you are hungry, or tired. This can greatly affect your ability to keep a lid on things. You may find it helpful to eat something or have a sleep. Writing your thoughts down in a letter may help you to calm down.

Useful links

http://www.canadianparents.com/article/seven-secrets-to-a-happy-marriage

http://www.gottman.com/?gclid=CMzFnp7k_aQCFaP92AodZVC2hg

http://www.suite101.com/content/resolving-conflict-a214421

http://www.suite101.com/content/overcoming-conflict-avoidance-a52146

http://www.suite101.com/content/arguing-positively-a91233?sms_ss=email&at_xt=4cc9a5a3e27b2c76,0

http://www.suite101.com/content/four-negative-behavior-patterns-in-marriage-a231804?sms_ss=email&at_xt=4cc9a2eeb9e423a4,0

Play, Family Life and Emotional Well Being

As children go back to school and homework agendas take the place of the carefree, less structured weeks of summer. I ask if we shouldn’t be allowing more time in our family lives to play.

Play is often ignored by adults, who may see it as pointless. Yet play is satisfying, pleasurable, fun. It is an intrinsic part of childhood and a child's natural medium of self expression. Play is often how children make friends, forming relationships that often span years.

Through play, children learn to be themselves. They explore aspects of their personality, they develop skills which make them feel good about themselves. What we know is that when engaged in play the child often becomes so engrossed as to lose awareness of his/her time and surroundings becoming immersed in an imaginary or symbolic world.

Play starts with a relationship. Between mother and infant, mirroring smiles and gurgles lend movement and sound to a time-honored dance. In this early play, children learn that they are lovable and special, that others are loving, caring and trustworthy, that the world is an exciting place to explore. As children develop, games become more elaborate including face making, role playing and physical games.

It is a safety mechanism to let off steam. Through play a child can express his anger whilst feeling safe from retaliation. 

For many families, play introduces humor at times of severe stress. It helps them cope with irritability, sadness and even fear. It has the potential for parents and children to build deeper connections with each other through laughter, imagination, and creativity.

"Play stirs things up, [states professor and psychotherapist Catherine Ford Sori] gets families …trapped in their left brains to use the creative spontaneous and playful aspects of their right brains". Play allows family members to see things from different angles, to explore new roles for themselves, to approach family problems with greater flexibility and maturity.


I don’t know when we lose our ability to play but maybe our children have something to teach us after all.

References

Sori, C.F. (2006) "Engaging Children in Family Therapy" Routledge: Taylor and Francis Group