Is it Depression or Natural Grief?
Whether it is the loss of vibrant health through illness or someone to death, grief is woven into the experience. The question is; are we comfortable enough to companion this organic process or do we sometimes try to medicate and treat it like something to be fixed or controlled?
My dear friend Rose, who is in the final stage of her life, shared a recent frustration. Her chemo is no longer working to control the pain and the hospice/palliative care team has come on board to help with her end of life comfort care. She loves the team members and can see they have the highest intent for her well-being. Rose feels safe and seen by them and knows they are doing the best they can with the medications available. We have talked about the fact that end of life pain management is an art needing constant refinement as the body progresses to death. She understands this but has an incredibly sensitive constitution and is feeling the effects of the more potent meds quite dramatically. The steroids, as expected, are miraculous for inflammation and her back pain, but causing her some anxiety. She just finished a round of palliative radiation to tackle and shrink the culprit which is a tumour in her spine. This treatment is also designed for better pain management. Rose is very conscious and observant and finding the sensations of the new medications cascading through her body unique and so foreign to what she is used to. The narcotics are making her "feel a bit off”. She is learning to adapt to her body’s needs and the constant new normal for pain management. Rose is finding this next stage difficult to come to terms with but is doing her best to surrender to the dramatic changes her body is now going through.
A few weeks ago the palliative doctor prescribed an anti-depressant because her moods have varied since taking the stronger drugs. At first she was upset, the last thing she wants is another medication thrown into the already varied mix!!! So she sat with the question of depression. Is she depressed or naturally grieving the changes that come with a dying body which in turn affect all the dimensions of one’s being? We had a long talk about it.
Despite the pain, Rose went on an Alaskan cruise a number of weeks ago with a friend and has been out frequently to social events as well as local mini-trips to visit friends. Though independent, Rose is not afraid to reach out for help and is honest with her needs. Our conversation helped her explore the surfacing emotions more fully. At this time she has chosen not to take the anti-depressant. She is already adjusting to the new approach to pain management and now coming to greater terms with the fact her body is actively dying. Rose said that this is a new and curious experience as well. Different physical sensations are now at play than what she is used to; the body slowly shutting down and losing its baseline life force.
In my former role as Program Director for a hospice society I attended a number of different palliative medical rounds on a weekly basis. Sometimes I would gently challenge the doctors and other team members when the topic of grief vs. depression would emerge in dialogue around patient care. They can look very similar in expression. The on-going question is do we really need to medicate the varied moods at end of life or find a better way to companion the grief? Often the challenge for the health professionals is not their level of compassion, but the time needed to provide this extra support and the lack of resources to help with the psycho-social needs of patient and family. In some cases medications can be incredibly helpful. Sadness is clearly a normal thing when preparing to say good-bye to loved ones and a body is becoming frailer; not functioning in the same way. Fear and anxiety are also normal when the patient doesn’t know what to expect next and are vulnerable to extreme pain issues. All need extra attention and added TLC. Death is on the horizon.
Dr. Alan Wolfelt runs the Center for Loss in Colorado and is known internationally as an author, bereavement counsellor, and educator. Over the years he has taught me a great deal about companioning those during vulnerable times. Many who offer services in the end of life field have been influenced by his work and writings. I love his philosophy and approach to care!!!
Here is a link to a provocative article he wrote about companioning vs. treating. https://www.centerforloss.com/wp-content/uploads/2015/10/Introduction-to-Companioning-the-Bereaved-by-Dr-Alan-Wolfelt.pdf. The basic tenants are expressed below.
Eleven Tenants of Companioning the Bereaved
by Alan Wolfelt, PhD., C.T.
Tenant One: Companioning is about being present to another person’s pain; it is not about taking away the pain.
Tenant Two: Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.
Tenant Three: Companioning is about honoring the spirit; it is not about focusing on the intellect.
Tenant Four: Companioning is about listening with the heart; it is not about analyzing with the head.
Tenant Five: Companioning is about bearing witness to the struggle of others; it is not about judging or directing these struggles.
Tenant Six: Companioning is about walking alongside; it is not about leading.
Tenant Seven: Companioning is about discovering the gifts of sacred silence; it does not mean filling up every moment with words.
Tenant Eight: Companioning is about being still; it is not about frantic movement forward.
Tenant Nine: Companioning is about respecting disorder and confusion; it is not about imposing order and logic.
Tenant Ten: Companioning is about learning from others; it is not about teaching them.
Tenant Eleven: Companioning is about compassionate curiosity; it is not about expertise.