Transcript Slide 1

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 sledgedrivers 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
Questions
The problem saturated story
/ The story of need
Who am I?
The story of the past
Where have I come from?
Where am I going?
The clouded future story
How will I get there?
What challenges do I have
to face?
The re-interpreted story of
the past
What help do I need?
The imagined story of the
future
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
Character: Stability & Direction
The “unseen” in our lives gives stability and
direction
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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
Behaviour
Inner person
•Values
•Beliefs
Life skills
•Emotions
•Thoughts
Inner Person
“Change of heart”
Source of life
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”
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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
Integration
Health
Disintegration
Sickness
SPIRITUALITY
FAITH
GOD-IMAGES
MEANING
PURPOSEFULNESS
Growth
Change
A Model for integration
Culture
Society
Helping
Professions
Scripture
Faith
Documents
Healing
Care
Individuals
and families
The faith
community
Phases of
disease
Emotional
experience
Human need
Focus of
counselling
Spiritual focus
1. Diagnoses
Denial, fear,
anxiety
Security
Empathy
God’s
compassion
(Trust)
2. Symptomatic
phase
(Health
impairment – Still
functioning)
Isolation,
loneliness,
mourning
Connection
Communication &
relationships
Belonging to a
healing
community,
acceptance
Guilt (Internal &
External) remorse,
anger
Forgiveness
Restitution
Reconciliation
(with self,
others and
God)
3. Severe health
impairment –
functioning
severely
impaired)
Self-rejection,
depression,
hopelessness,
worthlessness
Dignity
Hope and
meaning
A hopeful and
meaningful life
4. Terminal phase
Wasting away,
uncertainty, fear
Peace and
acceptance
Letting go
Peace
5. Bereavement
Sadness and
longing, anger,
depression
Grieving the loss
Acceptance of
loss, continuing
with life
Comforting
PHYSICAL PROGRESSION OF DISEASE
PHYSICAL PROGRESSION OF DISEASE
Emotional
Needs
Denial, anxiety, fear
Security
Spiritual
focus
God’s compassion
trust, commitment to support
“Being”
focus
Empathy, assurance of God’s
love
PHYSICAL PROGRESSION OF DISEASE
Emotional
Needs
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
Emotional
Isolation, loneliness mourning,
losses, guilt (internal, external),
anger, remorse
Needs
Contact with others, forgiveness
Spiritual
focus
“Being”
focus
Belong to a ‘community’,
acceptance, reconciliation
(self, others, God)
Communication, strengthen
relationships, restitution
PHYSICAL PROGRESSION OF DISEASE
Emotional
Needs
Self rejection, hopelessness,
worthlessness, depression
Value, respect, dignity
Spiritual
focus
A hopeful and meaningful life
“Being”
focus
Finding hope and meaning
PHYSICAL PROGRESSION OF DISEASE
Emotional
Fragile, uncertain, extreme fear
Needs
Peace, acceptance, security
for those left behind
Spiritual
focus
Peace, assistance succession
planning
“Being”
focus
Support “let go”
PHYSICAL PROGRESSION OF DISEASE
Emotional
Needs
Sadness, longing, anger,
depression
Grieving the loss, care for those
left behind
Spiritual
focus
Comforting
“Being”
focus
Continuing with life
Caring for life (Practical, emotional, relational)
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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
influence
Circle of
concern
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)