What Do We Owe to Those Who Are Dying?

A friend of mine has a relative in the final stages of dying; some of his difficult interactions with this relative (not an immediate family member) have stirred thoughts about our obligations to and expectations of those who are dying.  I’d like to talk about two related aspects of the issue:  First, to what degree do we conceive of old age/death as a kind of second infancy that changes all the rules?   And second, are people in the final stages of dying exempt from the expectations we usually have for other people — such as consideration, fairness and reciprocity — and do their needs always trump our own?

I’ve known clients with parents who expected them to sacrifice their lives entirely in order to care for them in the final stages of dying.  Some of these parents had done reasonably well in their parenting role; others had been entirely deficient and then became infantile and demanding when forced to confront their mortality.  What comes to mind is the Biblical commandment to “honor your father and mother.”  I’ve always found it relevant that the Bible does not says you should “love” your parents; rather, you should accord them a certain level of respect, given that they brought you into the world and reared you.  But what are the limits of “honoring”?  Does that mean you must take care of them during their dying months, even to your own detriment, even when they did a miserable job taking care of you when you were small?  How does forgiveness come into play, and are some failures unforgivable?

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Self-Love and the Sense of Well-Being

I’ve been struggling with this term self-love which seems to be gaining currency of late.  Given that I have no problem with words like self-respect, self-esteem and self-hatred, it might seem surprising that I resist the idea of a love for the self.  My threshold obstacles to accepting it are two-fold:  an overlap with the concept of narcissism, and my aversion to some New Age, wishy-washy formulations that focus on love to the exclusion of other darker emotions.

As I often do with problematic words, I start with a dictionary definition from Merriam-Webster.

Self-love:  love of self
a:  conceit
b:  regard for one’s own happiness or advantage

There’s the first of my problems — definition 1(a) places self-love in the realm of narcissism; definition 1(b) hints at a kind of ruthlessness.  From this point of view, self-love doesn’t appear to be a positive attribute; self-love verges on egoism and selfishness, overemphasizing the wishes of the individual to the disadvantage of other people.  My impression is that the meaning of the word is currently undergoing an evolution, however, largely inspired by developments within New Age thinking. Check back with Merriam-Webster in ten years and you’ll find an additional definition.

I did a little online research about other conceptions of self-love and came across the following, from a website called Inner Self:

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The Interpretation of a Dream

I’ve read and taught Freud’s The Interpretation of Dreams several times; it’s fascinating and beautifully written, a ground-breaking work that brought dreams from the realm of superstition and divination into the world of “science”.  On the other hand, while I admire Freud’s insight and careful demonstration of his ideas, I find his stipulation that dreams represent wish-fulfillments too limiting.  In my experience, dreams represent all sorts of things about ourselves and our states of mind.  When dreams become the subject of a psychotherapy session, associations are crucial, of course, just as Freud instructed; but they may sometimes be those of the therapist, based on familiarity with the client — as I hope the following interpretation of a dream will show.

This session dates back several years.  My client Ryan was at that time in his late 30s, living with another man in his first stable, long-term relationship.  Although Ryan and his partner Seth were nearly the same age, Ryan thought of him as quite a bit older, mostly because Seth seemed more professionally secure and responsible.  In his earlier relationships, Ryan had always looked for someone to “take care of” him, someone he idealized and expected to be a sort of all-gratifying parent.  Because they were based on fantasy rather than reality, these relationships naturally lasted only a short time.  Ryan and Seth had been living together for two years at the time of this dream; while their relationship retained some of the features of Ryan’s earlier brief liaisons, he had come a long way in becoming more personally responsible:  he carried his own weight financially and had grown quite serious about developing his career.
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A Hiking Meditation

We’re in Colorado now for the summer, and last weekend, we took our first hike.  Because my mind is prone to chatter at such times, I try to turn these hikes into a kind of walking meditation:  focusing on my breath, my bodily sensations and the natural beauty here in the Rockies.  I would say that I was successful in reaching silence about 5-10% of the time, and not for sustained periods.  In part, this is just the way my mind works; “thinking” has always been one of my primary defense mechanisms, and it’s deeply ingrained in my neural pathways.  Also, because I’m so focused on writing this blog, in my thoughts I’m continually composing descriptions of what I notice, putting my observations into words that I can later post.  Last week’s hike was no different.

At the same time, those brief periods of quiet during the hike helped to calm me, after the stresses of the week.  I also made some interesting observations about why and when I found it more difficult to achieve quiet.  It gave me some insight into the origins of defenses and their connection to pain.  While in my case, it had to do with physical pain, there’s also a relationship between defense mechanisms and emotional/psychic pain.  These ideas connect to some thoughts concerning helpless I put forward in my post about post-traumatic stress disorder.

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Pride and the Healing of Shame

Because I write and think so much about the psychology of shame and its toxic effects, I’m often asked about overcoming shame, to explain how one “recovers” from shame, or whether I have any guidance about “healing shame.”  My answers in the past have felt inadequate to me, but a recent session with a long-term client helped me bring my thoughts on this issue into focus.

Stan, a middle-aged married man, has struggled with unbearable shame for most of his life and has relied on the typical defenses against shame described in earlier posts.  In particular, he relies on blaming as his primary mode of defense.  For example, he often rants in silence against his wife whenever they have a disagreement:  he’ll mentally complain about her behavior with a sense of grievance, blaming her for the argument.
This has been a life-long pattern in his relationships.  Behind his defensiveness, he has suffered from the sense that he’s emotionally damaged in some fundamental way.

During the economic downturn, Stan suffered some reverses in his business that have placed a great strain on his family, largely shifting the financial burden of supporting them onto his wife’s shoulders for the time being.  She hasn’t criticized him for what has happened nor complained about the weighty responsibility she now must carry.  She recognizes that the economic downturn wasn’t his fault but Stan nonetheless feels humiliated and defensive.  It taps into a lifelong feeling that he is damaged and ineffectual.

Recently, Stan has remarked on his wife’s increasing moodiness.  Even the smallest things seem to set her off; when they re-connect at the end of their work day, she instantly launches into an account of all the things that irritate her about her job.  She strikes him as angry.  Because he feels ashamed about his limited inability to contribute financially, he tries to be as supportive as possible but finds these “bitch sessions” increasingly difficult to bear.

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