Presentation on theme: "LOSS, DYING & DEATH: FACILITATING MEMORY WORK Listening to and telling Stories of the heart LOSS, DYING & DEATH: FACILITATING MEMORY WORK Listening to."— Presentation transcript:
LOSS, DYING & DEATH: FACILITATING MEMORY WORK Listening to and telling Stories of the heart LOSS, DYING & DEATH: FACILITATING MEMORY WORK Listening to and telling Stories of the heart
The experience of illness Ivan’s turmoil started with his first visit to the doctor, who tries to evade the truth with vague comments. The doctor said that this and that symptom indicated this and that was wrong with the patient’s inside, but if this diagnosis were not confirmed by analysis of so-and-so, then we must assume such-and-such. If then we assume such-and-such, then... and so on. To Ivan Ilyich only one question was important: was his case serious or not? But the doctor ignored this misplaced inquiry Leo Tolstoy, The Death of Ivan Ilyich. 1960:127).
The experience of illness Tolstoy portrays the actual crisis of illness as follows: Everything in the streets appeared depressing to Ivan Ilyich. The sledge- drivers looked dismal, so did the houses, the passers-by and the shops. And this pain, this dull gnawing ache that never ceased for a second, seemed, when taken in conjunction with the doctor‘s enigmatical utterances, to have acquired a fresh and far more serious significance. With a new sense of misery Ivan Ilyich now paid constant heed to it. (1960:128).
The experience of illness Ivan’s wife makes him feel that his condition is his own fault and that he irritates her. This now is the deepest pain in Ivan’s suffering. And he had to live thus on the edge of the precipice alone, without a single soul to understand and feel for him. (1960:132).
The experience of illness Tersely Tolstoy summarises the suffering of illness: What tormented Ivan Ilyich most was the pretence, the lie, which for some reason they all kept up, that he was merely ill and not dying, and that he only need stay quiet and carry out the doctor‘s orders, and then some great change for the better would result. But he knew that whatever they might do nothing would come of it except still more agonizing suffering and death (1960:142)
“If you want to know me, you have to know my story, for my story defines who I am”
The narrative paradigm revisited A “Story” is: Events Linked in sequence Over time According to a plot As a guide, I want to help the person to: Tell their story Discover the plot of the story Identify unique outcomes in their story Develop this into a new story This training will empower you to: understand and tell your own life story better help others to tell their stories decide on new outcomes for their own stories help others to change a problem saturated story into a growth directed outcome.
The narrative paradigm revisited Focus The problem saturated story / The story of need The story of the past The clouded future story The re-interpreted story of the past The imagined story of the future Questions Who am I? Where have I come from? Where am I going? How will I get there? What challenges do I have to face? What help do I need? What will it be like when I get there?
The narrative paradigm revisited Three narrative tools The “not-knowing” position Participative active listening Conversational questions
10 Character: Stability & Direction 10 The “unseen” in our lives gives stability and direction
A Spiritual Model The Lord says: ”I will condemn those who turn away from me and put their trust in human beings, in the strength of mortals. He is like a bush in the desert, which grows in the dry wilderness, on salty ground where nothing else grows. Nothing good ever happens to him. Jeremiah 17:5-6
A Spiritual Model The Lord says: But I will bless the person who puts his trust in me. He is like a tree growing near a stream and sending out roots to the water. It is not afraid when hot weather comes, because its leafs stay green. It has no worries when there is no rain; it keeps on bearing fruit. Who can understand the human heart? There is nothing else so deceitful; it is too sick to be healed. I the Lord, search human minds and test human hearts. Jeremiah 17:5-10
A Spiritual Model Circumstances Source of life Behaviour Inner Person “Change of heart” Inner person Values Beliefs Emotions Thoughts Life skills
Confrontation of world view Four experiences are predominant in serious illness: The impact of loss; The expression of extreme emotions; Destructive patterns of thinking; Severe doubt and despondency.
Confrontation of world view Core assumptions in a person’s conceptual system are disrupted in serious illness: The world is benevolent; Events in the world should be meaningful; The self is positive and worthy. (I therefore don’t deserve it); God is fair and in control (How can He allow this?)
The predicament of being ill: The suffering in suffering Illness as a functional need ( redundancy ) Illness as a relational predicament ( isolation and rejection ) Illness as a physical predicament ( pain ) Illness as an existential predicament ( meaninglessness and despair ) Illness as a psychological predicament ( torment/distress ) Illness as a religious predicament ( doubt and a crisis of faith )
“Toxic faith” Conditional love; Instant peace; Guaranteed healing; Salvation by works; A vengeful God; Biblicism.
Questions Is it possible to live meaningfully with vital hope, despite suffering, sickness and death? Can affliction be experienced as a challenge and a task to be wrestled with and worked through? Is it at all possible that ministry to the sick can create a zest for life and a sense of victory?
The health-Illness polarity Health Sickness Growth Change IntegrationDisintegration SPIRITUALITY FAITH GOD-IMAGES MEANING PURPOSEFULNESS
A Model for integration Individuals and families Scripture Faith Documents Culture Society Helping Professions The faith community Healing Care
Phases of disease Emotional experience Human needFocus of counselling Spiritual focus 1. DiagnosesDenial, fear, anxiety SecurityEmpathyGod’s compassion (Trust) 2. Symptomatic phase (Health impairment – Still functioning) Isolation, loneliness, mourning ConnectionCommunication & relationships Belonging to a healing community, acceptance Guilt (Internal & External) remorse, anger ForgivenessRestitutionReconciliation (with self, others and God) 3. Severe health impairment – functioning severely impaired) Self-rejection, depression, hopelessness, worthlessness DignityHope and meaning A hopeful and meaningful life 4. Terminal phaseWasting away, uncertainty, fear Peace and acceptance Letting goPeace 5. BereavementSadness and longing, anger, depression Grieving the lossAcceptance of loss, continuing with life Comforting
PHYSICAL PROGRESSION OF DISEASE
EmotionalNeeds Spiritual focus “Being” focus Denial, anxiety, fear Security God’s compassion trust, commitment to support Empathy, assurance of God’s love
PHYSICAL PROGRESSION OF DISEASE EmotionalNeeds Spiritual focus “Being” focus Turmoil, fluctuating emotions Responsible living, guidance support when needed Strengthen faith and relationships, finding and living a vocation Companionship and guidance
PHYSICAL PROGRESSION OF DISEASE EmotionalNeeds Spiritual focus “Being” focus Isolation, loneliness mourning, losses, guilt (internal, external), anger, remorse Contact with others, forgiveness Belong to a ‘community’, acceptance, reconciliation (self, others, God) Communication, strengthen relationships, restitution
PHYSICAL PROGRESSION OF DISEASE EmotionalNeeds Spiritual focus “Being” focus Self rejection, hopelessness, worthlessness, depression Value, respect, dignity A hopeful and meaningful life Finding hope and meaning
PHYSICAL PROGRESSION OF DISEASE EmotionalNeeds Spiritual focus “Being” focus Fragile, uncertain, extreme fear Peace, acceptance, security for those left behind Peace, assistance succession planning Support “let go”
PHYSICAL PROGRESSION OF DISEASE EmotionalNeeds Spiritual focus “Being” focus Sadness, longing, anger, depression Grieving the loss, care for those left behind Comforting Continuing with life
Caring for life (Practical, emotional, relational) To place the individual in his world To clarify the present state of one’s affairs To promote self-awareness and self-image To determine the influence of one’s background To guide the individual to take an overview of his life To help one understand one’s legacy from the past To clarify values and priorities To explore internal sources of identity (e.g. beliefs, values, interests, worries and ambitions) To identify personal strengths, handicaps, joys and sorrows To identify physical, social and emotional obstacles To initiate decision-making and problem solving To create a vision and a future in spite of a life threatening disease
Caring for life (Spiritual) God’s compassion and our security Experiencing connection and belonging to a healing community Forgiveness and reconciliation The dignity of a meaningful and hopeful live Finding peace and acceptance Positive living with life threatening disease
Re-active / Pro-active engagement Circle of concern Circle of influence
The mind-body connection Pain is perfect mystery, the worst of evils, and when excessive, overturns all patience. (Milton) Our greatest enemy is not disease, but despair! (Anon)
Bereavement Types of bereavement: That suffered by the dying person himself; Loss through sudden, unexpected death – e.g. a motor accident or heart attack; An expected death, but unprepared for either due to lack of time or to an inability or a refusal to enter into any conscious anticipatory grief work; An expected and long prepared for death. The grief is being worked through and one of two things may occur: mourning may be completed pre-death, whereupon the mourners withdraw their emotional investment from the dying one, leaving him/her isolated; grief-work is partially done and this is helpful to the bereaved after the death. The bereavement after a suicide, which is placed separately from (2) (loss through sudden death) because the grief-work is so much more intense, and there are other qualitative differences. Grief at the loss of a body part, a marriage, significant work, a home, etc.
Bereavement and life maps Facilitating acceptance of the reality of the loss that will or has taken place. Creating a framework for the need to live with memories of the deceased. Facilitating the need to bring feelings into the open, to be understood and dealt with and to gain insight into strange feelings Creating a context for finding meaning To remain in touch with one’s own sense of integrity. Creating a network that support growth
Caring for life A Companion in the life journey. Caring for life is an attempt to create a paradigm shift in care giving from a predominant focus on our “knowing and doing” functions to our “being” functions. DJ Louw (Cura Vitae, 2008:7)
“Being” hope and healing Being hope and healing is about a theology of life and the healing of life from the viewpoint of Christian spirituality. It is about how new life in the risen Christ and the indwelling presence of the Spirit can contribute to the empowerment of human beings. It is about hope, care and the endeavour to give meaning to life within the reality of suffering, our human vulnerability, and the ever-present predicament of trauma, illness and sickness. DJ Louw (Cura Virae, 2008:7)