Death, Dying and Psychological Health
Dr.Amanpreet Kaur, Ph.D., M.Phil. in Clinical Psychology*
Dr. Elisabeth Kübler-Ross once stated in one of her books,
“Dying is nothing to fear. It can be the most wonderful experience of your life. It all depends on how you have lived.”
The quote looks astounding on surface level, however; to practice it in real life is a challenge in itself. Death and Dying is a morbid area which society fears to talk about. Moreover, as part of the society whenever we face life and death situations, our denial for death creates different levels of anxiety within us. We behave like children who cover their eyes in a game of hide-and-seek and think that no one can see them.
Death is a vast mystery, however there are two things we can say about it: It is certain that we will die, but it is uncertain when or how we will die.
Our denial of death and anxiety related to our societal beliefs about death leave us with paradoxical experiences, which can be both rewarding as well as challenging at a personal or professional level.
Aspects related to death and dying could not only affect the individuals providing care but more specifically persons living in the end-of-life situations.
I worked in the area of cancer palliative care as part of my Ph.D. in Clinical Psychology from NIMHANS, Bangalore. I specifically worked closely with professional care providers working at cancer palliative care centres (both hospice and hospitals) in Bangalore. As part of my thesis, I explored the challenges and needs of the cancer palliative professionals, and pilot tested the tailor-made Mindfulness Integrated intervention program developed for enhancing their psychological health. (see article Mindfulness as a form of self-Care in End-of-Life Care, in this blogpost)
The major concerns of professional care providers centered around the theme of death and suffering of their patients and their families. Witnessing and handling death and dying as a professional in a palliative care setting is challenging as it reminds one about his/her own or significant others’ mortality. Since compassionate care giving is an essential component in palliative care/hospice care, the staff has a unique challenge of coping with loss on a regular basis.
We do talk about needs, challenges and self-care strategies for cancer palliative patients and their family members.However, we fail to recognize and appreciate the grief reactions of the professionals taking care of them.
This topic is close to my heart both at a personal as well as professional level. I have myself experienced death and bereavement at a stage and age not usually known for existential crisis. I lost my grandfather towards the end of my first year of graduation, just two days before my final exams. He was healthy and I saw him dying suddenly and leaving all of us forever. I still remember the details vividly, I couldn’t cry and that time I didn’t know what to do or how to react. I was there as a ‘strong girl’ who supported all other family members who were grieving naturally. Least did I know the after effects of these complications. I moved back to my home environment where I felt emotionally safe, engaged myself in working hard for exams and told myself ‘Nothing has happened. Everything is fine’ (pigeon closing eyes). After exams ended, I observed some changes in my sleep, appetite and ability to remember things. I started talking about my experiences with family and friends, writing about the same, visited the holy places, practising gratitude, accepting the fate, paying tribute to the one I lost and started reading books on spiritualty. I had more time with myself and for myself and I realized the importance of reflections and putting things in perspectives.
It took some time for me to understand what grief is and how important it is to share one’s thoughts and feelings with others. I have observed the changes in my outlook towards death and openness towards discussing the taboo topic over a period of time. Although it is nothing like what patients go through during cancer or the anticipated death expected by the respective families. It definitely shakes one’s belief of immortality and evokes various psychological reactions. I have come to realize and respect that all of us react differently, take different spans of time to heal, and there is no one way one recovers. Though there are stages of grief but we all take different trajectories towards recovery and healing.
The modern day society is not capable of handling the existential issues, as these topics are considered important for only those who are going through the suffering or the ones seeking spirituality. Leave apart the ones undergoing suffering or impending death, their carers specially the young professionals working in cancer palliative care are quite ill-equipped to handle their own grief because they do not have the facility/time/orientation to take care of their own mental health. And more often, senior professionals distance themselves from such difficult emotions or psychological hardening takes place for them. That’s one way of coping with loss and negative emotions on a daily basis.
Poor self care, poor awareness, running on automatic, with given work related hazards could make these professionals really vulnerable for various psychological disorders and poor overall well-being.
In my study, majority of the participants were seen to have high burnout and high emotional distress (related to loss and suffering of patients at workplace). These findings highlighted the need for individuals and organisations to look after the carers who provide care. Though, what I experienced can’t be equated with others’ feelings, what I understood from reading different articles, theories and listening to narratives, that the answer lies in ‘self-care’.
Self-care is crucial for health care workers too and this can range from lifestyle management to following clinical models of mindfulness. ( see article , Mindfulness as a form of self-Care in End-of-Life Care)
* Dr.Amanpreet Kaur, Ph.D., M.Phil. in Clinical Psychology*
Clinical Psychologist and working as Research Fellow (mental health) at George Institute for Global Health, India