GOT REST?

Photo by Alan Retratos

By Sterling Hawkins, MSW, LCSW-C, LICSW

It's the holiday season, and whether or not you celebrate traditional holidays, there's one thing in common with all holidays. It is a period when no work is done. Work in the way we understand it- A regular activity that one engages in to earn a livelihood. Holidays and how they are celebrated depend on who you are, and what you believe. On a personal level, holidays often allow me to reflect on my relationships with others and places where I enjoy spending time. I've always equated holidays with rest. As a college student, I remember looking forward to winter break, when exams and papers were all done, and I could visit with friends back home, and enjoy seasonal food and drink. But what I remember most were the hours of unstructured time. This meant for at least a week or two, when I was not visiting or socializing with friends, I could sleep whenever I wanted. Strangely, however, once my sleep deficit resolved, I never felt completely rested. It wasn't until years later that I realized that my definition of sleep was too limited. Leave it to me in my ignorance and efforts to oversimplify what for others seemed obvious. I failed then to appreciate the importance of expanding my definition of rest.

 Dr. Saundra Dalton-Smith, a physician and researcher, in her 2021 Ted-Talk explains that my mistake is common. We try and fix an ongoing lack of energy by getting more sleep; only to do so and still feel exhausted. Dalton-Smith identifies sleep as physical rest. And only one of the seven types of rest we all need to remain healthy. The six other types of rest she identifies are mental, sensory, creative, emotional, social, and spiritual. In this article, I only will focus on three of the seven types we typically don't consider when thinking about rest. You may read the entire transcript or view the TED Talk by clicking on the link below.

Sensory Rest

In today's climate of digital connections, those of us who enjoy its modern infrastructure have unlimited access to individuals and information wherever and whenever we choose. Dalton writes "bright lights, computer screens, background noise, and multiple conversations... can cause our senses to feel overwhelmed."   

If you are like me, there are times when you find yourself unable to resist checking email, voice mail, and responding to texts. Sadly, at times, our devices exert more control over us than we should allow. Dalton says we can start to counteract the negative tendencies simply by closing our eyes in the middle of the day for several minutes or intentionally unplugging at the end of every day. These and other mindfulness techniques create moments of sensory deprivation that can begin to undo the damage inflicted by our over-stimulating world. 

Creative Rest 

Have you ever wondered why individuals take sabbaticals? A sabbatical is a break or change from a normal routine away from work. Traditionally, sabbaticals were offered to individuals in academic settings to give professors a year's leave of absence from teaching to pursue research, publish, or time away to engage in professional interests outside of the classroom. The sabbatical by design allowed persons to remain employed and still be compensated during this time.

While Dalton does not use the term sabbatical to describe creative rest, it is implied by her definition. One purpose she says for creative rest is to engage in problem-solving or as a catalyst for brainstorming innovative ideas. In short, inspiration. Dalton comments "Creative rest re-awakens the awe and wonder inside each of us."   While it may be impossible to pursue a year-long sabbatical, it is possible to incorporate aspects that lead to discovery, self-awareness, and exploration in our daily routine.

To dig a little deeper into the origins of creative rest we need to examine the root or context of sabbatical. The word sabbatical can be traced to the Greek word sabbaton which is derived from the shabbath, meaning rest. The Old Testament refers to the sabbath as God’s Day of rest- Genesis 2:2-3. And following Genesis the Sabbath was to be applied to his followers wherein his people were required to rest after six days of work- Leviticus 23:3. Taking a sabbatical has always involved rest for deep reflection, rediscovery, and reimagining. Dalton writes that one way we can practice creative rest is by displaying images of places we love and art that speaks to us in our workspace. It is hard to feel inspired or rested where creativity is lacking.

If you're wondering if taking a vacation will allow you to meet your creative rest requirements, think again. Vacations are primarily for recreation and are typically short breaks that disrupt our regular routines and provide us with distractions and fun stuff to do or see. Oftentimes, vacations by their nature create more stress, because you're painfully aware of their limited duration, and seek to cram multiple activities into a narrow timeframe. In contrast, a sabbatical is usually for one year and geared toward education, learning how to improve one's self, and developing or producing something of worth. Sabbaticals are designed to overcome certain challenges, be they mental, physical, or spiritual that only time and intentionality will resolve.

Spiritual Rest

Spiritual rest according to Dalton is "the ability to connect beyond the physical and mental and feel a deep sense of belonging, love, acceptance, and purpose."   Spirituality encompasses activities that take us outside of ourselves, away from material or physical things, allowing us to embrace the soul or spirit profoundly. No one spiritual practice can claim exclusivity. Prayer, meditation, silence, and the sounds and songs of nature whether produced through voice or musical instruments can create a sensory experience or belief that there exists something greater than us. Spirituality in this context is different from religion which is defined as a set of beliefs or practices shared by a community or group. In contrast, the type of spirituality being implied involves an individual practice used to cultivate and develop a sense of peace and purpose.

In his poem titled “Time Off Work,” the author Carl D’Souza asks a question:

In an ideal joy and happiness society, would every working person get time off work to rest,

to rejuvenate,

to play,

to self-entertain,

to self-educate,

to care for and improve one’s mental health,

to travel and explore,

to do family joy,

to do friendship-joy

to do romance-joy,

to do joy and happiness activities?

In response to D’ Souza’s rhetorical question, we must each acknowledge that our world is not ideal and that there is much sorrow and unhappiness. And forces conspire that compel us to believe that sensory, creative, and spiritual rest are impossible to fully achieve. However, it is rest that brings us closer to the ideal and rest that allows us to practice in the words of Behida Dolic, “Little gestures of the soul” that don’t take an immense amount of energy. Finally, as you pause from work to celebrate, reflect and reconnect, remember to incorporate rituals involving these types of rest into your holiday.

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References:

Dalton-Smith, S. (2021, January). The 7-types of Rest that Every Person Needs [Video]. TED Conferences. https://ideas.ted.com/the-7-types-of-rest-that-every-person-needs/

D’Souza, Carl. “Time Off work”, Hello Poetry.com, https://hellopoetry.com/carl-dsouza/poems/?tab Oct 2021

Photo by SHVETS Productions

By Sterling M. Hawkins, MSW, LCSW-C, LICSW

I’ve been thinking about what matters most at the end of life, and why it matters.  It’s not always what you think.  Most of the things we hold onto both emotionally and physically change throughout our life cycle.  What is well known in the field of aging is that people at the end of life want to feel that their life was complete.  How they go about that is expressed in different ways depending on the individual.  Along the journey toward end-of-life care, we usually accumulate “stuff” that somehow in the beginning seems important, but over time and at the end often changes value.  I believe what becomes important for most, in the end, involves effective communication, care coordination, and physical, emotional, and spiritual support.  So how do we get there?

American physicist, Alan Lightman in his collection of writings titled  “The Accidental Universe: The World You Thought You Knew, writes “ I don’t know why we long so for permanence, why the fleeting nature of things so disturbs. With futility, we cling to the old wallet long after it has fallen apart. We visit and re-visit the old neighborhood where we grew up searching for the remembered grove of trees and the little fence. We clutch our old photographs. In our churches and synagogues and mosques, we pray to the everlasting and eternal.  Yet in every nook and cranny, nature screams at the top of her lungs that nothing lasts, that it is all passing away.” This sentiment echoed by Lightman is acutely evident in death. Death involves a change from a life we know and can observe to what is certain but hidden and unknown. Death involves change.

As Americans, we have a strange relationship with death. We acknowledge it and sometimes even prepare for it. We write and even sing about it. However, few of us welcome it when it comes, if given the chance to do so. Perhaps it comes when life is good, and the summer years of life remain rich and vibrant. Or, before spring has yet to bloom. Or, when autumn leaves fall, or winter’s snow has killed off the maiden grass and the thistle. It always comes.

I had the opportunity years ago to participate in a couple of training programs offered by a hospice organization. What I learned back then helped prepare me for my work today, with those who are in their final years of life. Back then I never gave as much thought to the resistance to death when a diagnosis presented insurmountable challenges for the patients with whom I worked. But now after years of working with the chronically and terminally ill, I see how the subject of death for some patients and their families is terrifying. Particularly for those who were born and raised in the United States. Unlike non-western countries, many Americans have an aversion to death. I believe there are three reasons why this occurs:

[1] We remove death from our lives by avoiding thoughts or conversations about death

[2] We use technological advances to delay death. And,

[3] We separate the dying from society in medical facilities.

As a child, I remember going to funerals when somebody would die that was known to me or one of my parents. On rare occasions, I might get to see the person before they died. If they were sick and, in the hospital, dying at home or in a nursing home, my mother sometimes carried me with her to see them. But in most cases, I just learned about their death from my mother or someone else in the family. In the 1950s and 1960s, health education was severely restricted to those who were not employed in health care. Many physicians and specialists within the medical establishment held a very paternalistic approach to informing their patients and relatives about the nature of their illnesses.  In such instances, I recall the expressions of disbelief and phrases the family repeated as heard from the deceased person’s physicians— “Heart just gave out…, died of pneumonia…, cancer took her…, didn’t take care of himself…” Curious kid as I was, I remember thinking to myself, “what exactly does that mean?” It was only later that I realized the stigma associated with dying without the knowledge or power to change the narrative about what we should know, when possible, prior to death’s occurrence. Being African American and uneducated in most cases during the fifties and sixties meant limited access and disclosure about medical practices from those providing the treatment.   In the 1960s  segregated hospitals were common and legal throughout the United States.  Even in so-called mixed-race hospitals, Black patients were often housed on separate floors.  The notorious Tuskegee syphilis study a government-led experiment on Black males ran from 1932-1972  and killed over 100 men.  People of color were often discriminated against and were restricted from receiving care.  As a result, African Americans are often suspicious when their doctors begin withdrawing medical treatment or fail to disclose the implications of their illness.   Some physicians fail to engage in end-of-life care planning, the discussion that examines a patient’s disease process, and treatment approaches they can choose from, including hospice.  Too often these discussions simply don’t happen and because of the lack of trust, African American patients and their families don’t ask specific questions to become better informed and educated about what choices are available.  The conclusion is that doctors need to clarify what is happening medically for those at end-of-life in terms that can be understood while providing education on what treatment options are available. Such attitudes of racism and discrimination still exist today.  However, with the digital revolution of the 1990s came the opportunity for the public to access health information that was long restricted and available only to Whites.

Working in both hospital and home care settings as a social worker have taught me priceless lessons about accepting my own mortality and the importance of making adaptations to our life instead of alterations that are in the end untenable and do little to improve one’s “quality of life”. 

As I write this, I’m aware that some may argue that quality of life is a relative term. One might say that an alteration for one person may be an adaptation for another. Let me explain.

The modern usage of hospice as a place for and philosophy of end-of-life care began with the work of a British physician named Dame Cicely Saunders. Dr. Saunders began work with terminally ill patients in the London area in 1948. The term “hospice” is defined as a program that gives special care to people who are near the end of life and have stopped treatment to cure or control their disease. Hospice offers physical, emotional, social, and spiritual support for patients and their families.  The main goal of hospice care is to control pain and other symptoms of illness so patients can be as comfortable and alert as possible. It is usually given at home, but may also be given in a hospice center, hospital, or nursing home.

One of the key components of hospice philosophy is the discussion of the goals of care. The topic of goals of care deserves its own article.  But for simplicity, I will cite a few components when discussing goals of care that can be expanded. Tailoring services to match the needs of the last phase of life requires defining that phase in the most relevant ways. Because the phenomenon of a long healthy life followed by chronic and debilitating illness in the last phase is new in human history. We are just beginning to understand the dynamics.

In a White Paper published in 2003 by the Rand Corporation, the following components were said to be integral to adapting health care to those with serious and chronic illnesses in old age:

·        The timing of death remains unpredictable until late in the course of serious chronic illness. Therefore, special arrangements for care near the end of life must be triggered by the severity of symptoms, rather than waiting for a reliable prediction that death is near.

 ·         The major causes of death are all progressive, degenerative illnesses that leave people in fragile health for a long period of time before death. Programs and policies to improve care for chronic conditions need to accommodate the fact that death is the eventual outcome.

 ·         Designing reliable care systems might best build upon the time course and nature of the service needs of a small number of populations, differentiated by the trajectory of disability and symptoms over time, rather than conventional differentiation by care setting (e.g., hospital or home) or diagnosis.

It’s unlikely that such systemic changes will improve health outcomes, so long as the topic of death remains something to be avoided.  However, each one of us can do our part to preserve those aspects of life that death cannot take away. I’d like to suggest five ways we can do this: [1] We can begin by being present with those facing death, wherever they are emotionally and psychologically. What this means is that [2] We must not marginalize their feelings. Equally important is [3] Not ignoring them (the dying).  At times, I still find this personally challenging.  In health care, it is difficult not to develop some emotional attachments with those who receive our services. To avoid these emotions, we sometimes avoid interacting directly with our clients.  Being a part of a healthcare team that offers bereavement care for its providers is helpful if your practice is dedicated to those who have fragile health conditions or are terminal. If you are a behavioral health provider, you should [4] Seek to become knowledgeable about disease processes and their treatments. Ask questions. Read the literature. Stay informed and share information honestly with those who inquire of you. The last thing we can all do to ease anxiety, denial, and depression for those facing death is to [5] Listen more and talk less. I believe this to be essential and one of the easiest ways to connect and engage with those facing death.

Cambridge University philosopher Stephen Cave in his book titled “Immortality: The Quest to Live Forever and How it Drives Civilization” gives a fitting conclusion to the narrative of death, one he calls the “Mortality Paradox”.  He writes, “We are therefore blessed with powerful minds yet at the same time cursed, not only to die but to know that we must…. This is the central theme of philosophy, poetry, and myth; it is what defines us as mortal. Since we attained self-awareness as Michel de Montaigne wrote, ‘death has us by the scruff of the neck at every moment.’ No matter what we do, no matter how hard we strive, we know that the Reaper will one day take us. Life is a constant war we are doomed to lose.”

In our journey toward the end, as healthcare providers,  let’s remember to assist those who are already there watching and waiting for the final chapter to end their life’s story.

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References:

Hospice of Holland Inc. (2019) A Brief History of Hospice. Retrieved on 17 September 2022. Available at https://understandhospice.org/brief-history-hospice/

Lynn, Joanne & Adamson, David M. (2003) Living Well at the End of Life: Adapting Health Care to Serious Chronic Illness in Old Age. Retrieved on 17 September 2022. Available at https://www.rand.org/content/dam/rand/pubs/white_papers/2005/WP137.pdf

Michas, Frederic (2022, March 3) Number of U.S. hospice providers from 2009-2019. Retrieved on 18 September 2022. Available at https://www.statista.com/statistics/339895/number-of-hospice-providers-in-the-us/

Photo By Rod Long

By Sterling M. Hawkins, MSW, LCSW-C, LICSW

When you’re young, you don’t know what your needs are.  You receive the good and the bad of whatever people, parents, siblings, spouses, and friends give to you.   As we grow and mature, so does our understanding of what our needs truly are.  And, at times how dependent we are for having those needs met.  Through experience and by discipline most work to avoid being at the mercy of others who perhaps express similar needs.  They are familiar but strangers all the same and represent an anomaly in ways we don’t want to be treated.  When a parent or guardian cares for you based on how they were cared for at a similar age, in some instances the care may have been perceived as good.  In other instances, deplorable, unsafe, or physically and emotionally harmful.  Subtle at first and over time some needs become more pronounced in older adulthood.  Who will care for me when I am no longer able to care for myself?  And, what will be required of me when others call upon me for help?  We will ask ourselves one or both questions at some point and discover what it means to be a giver or recipient of care.

Caregiving is defined as providing care for the physical and emotional needs of a family member or a friend in their own home.  Caregiving may involve assisting with meals, personal care, transportation, helping with medical procedures, and therapy.  As this definition implies, these activities are usually performed by a family member.   However, in addition to family caregivers, there are also volunteer caregivers, who are usually unpaid and provide companionship, supervision, and assistance with routine and non-medical tasks to individuals in service to their community.  And, finally, there are professional caregivers.  These are individuals who are hired to provide care that may be medical or non-medical in assisting others to live as independently as possible.  Professional caregivers can be hired privately but are usually employed by assisted living or skilled nursing facilities.  One in five Americans (21%) identify themself as a family caregiver.  23% of Americans say caregiving has made their own health worse. And finally, Family caregiving spans all generations, including Boomers, Gen-X, Gen-Z, Millennials, and Silent.

Caregiving is essential to our emotional and physical wellbeing, and while we often consider only services provided by individual caregivers, other entities such as state and local governments, private and philanthropic organizations usually support the family caregiver, enabling them to perform tasks for those who depend on them for certain activities to be met. 

We each come to caregiving with different expectations and responsibilities.  For some, it is a job or duty.  Others choose to serve in this role.   While each caregiving experience is uniquely personal it is a journey that most will travel during our lifetime.

There are many facets of caregiving.  And the literature is replete with information to help guide caregivers as they define their roles and responsibilities, and the intersection of the individual, family, and community systems.  Numerous studies have been conducted on the social and emotional burden placed on caregivers, but few offer strategies on how practically to cope by meeting the spiritual needs of family caregivers.

In the book, titled “Caring for the Spirit of the Family Caregiver- Forty Days of Reflections to Strengthen and Encourage” by Dr. Rev. Beryl Dennis, (Covenant Books Inc., 2020), she examines the role of self-care through a first-person lens, as she gives readers a glimpse of her own story as a caregiver for her parents and how her own faith and practices allowed her to find patience and encouragement associated with that role. 

Dr. Dennis offers the reader a Judeo-Christian approach to caregiving.  However, I believe the problems, principles, and practices are also applicable to non-faith traditions.  I recently reviewed this book and believe it is a good resource for those who identify themselves as a family caregiver.

The material presented is based on her research investigating biblical models of care that help sustain family caregivers spiritually and emotionally.  She speaks to a large audience: Identified family caregivers, those who are associated directly with a family caregiver (other family members, neighbors, friends), and finally community groups who engage with the family member receiving care in collaboration with the caregiver.

The findings from her research revealed that what matters most when addressing the needs of family caregivers is those effective interventions begin with an assessment of a caregiver’s risks, needs, strengths, and preferences.  As a qualitative study, Dr. Dennis completed her research by conducting interviews to answer the question-- “What do family caregivers need to give them spiritual and emotional sustenance?”  

To create a tool useful for caregivers, resources are presented in a 40 Day Devotional guide.  Dennis emphasizes that the roles and responsibilities associated with caregiving often create a “wilderness” effect for the caregiver.  The forty days is more symbolic than literal and represents a “journey we grow closer to God in strength, courage, and faith.”

Each devotion is organized into five categories: Scripture Text, Biblical Models, Theological Reflections, Family Caregiver Insights, and Prayers.  Scripture Texts first identify a caregiving need or problem.  Second, Biblical Models are identified to highlight relatable characters in Scripture.  Third, are the implications that follow from the place and/or circumstances where these characters find themselves.  These serve as Theological Reflections.  Fourth, Family Caregiver Insights examine the practical insights for learning. And lastly, Prayer becomes a personal petition, a psalm, or a lament to God.

The devotionals are divided into topical sections that address common problems associated with caregiving, people written about in Scripture to learn from, and promises God gives to those who believe in divine help.  Principles consistent with humanitarian values and practices address needs that are important for engaging in any difficult and sustainable work.  Having been a caregiver myself at various times throughout my life, I can attest to the value of addressing my own spiritual needs in the process.

I like that the book can be used as both a daily devotional and as a reference for aspects of the caregiving experience.  The prayers are short and simple expressions to God that are written in common everyday language.  What I enjoy most about this book is the way Dennis blends her own experiences with those experiences of the persons she interviewed. The caregiver's insights are personal yet concise. Insights center on the adult child as a caregiver for an aged parent. As this is most common.  The result is a seamless guide that enables caregivers to become stronger and spiritually grounded in their identified role.

In summary, caregiving requires an investment of the self.  This investment is multifaceted and the spiritual component of who we are as caregivers is often ignored.  At times the concern for making a safe and comfortable living environment for the person receiving care creates stress, anxiety, isolation anger, resentment, helplessness, and grief in our own life.  These stressors are sometimes invisible, and at their core are inseparable from our spiritual needs.  Addressing the spiritual needs of the caregiver is foundational to the health (physical, psychological, and social) of the caregiver.  In my own education with family caregivers, I explain that the attention they give themselves can have a positive impact on the person receiving care and the quality of life they experience.

Andrea Wilburn in her recent article titled “Caring for Aging Loved Ones,” best describes this experience. “We are all going through life events for the first time, figuring things out.  Learning how to love in an intelligent connected manner… we need to look out for each other and encourage each other.  These are conversations that we should be having in an openly social affirmative manner.”

My challenge to caregivers is that you need to explore those resources that will best equip you to care for that someone who is depending on you and to identify and develop those spiritual practices that will renew your spirit.

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References

AARP and National Alliance for Caregiving. Caregiving in the United States 2020. Washington, DC: AARP. May 2020. https://doi.org/10.26419/ppi.00103.001

 Wilburn, A. [2022] Caring for Aging Loved Ones. The Good Men Project, Retrieved on 12 July 2022.  Available at https://goodmenproject.com/featured-content/caring-for-aging-loved-ones-kpkn/

Photo by Cottonbro

By Sterling Hawkins, MSW, LCSW-C, LICSW

I attended a conference on suicide last month.  Death by suicide is trending up again following the Pandemic, which started me thinking about those individuals that are considered high-risk and also those without known risk factors. No matter how we define ourselves, our human condition unites us in the ways we experience our internal landscape or the factors that place people at risk for a crisis. The simplest definition of a crisis is— a time of great disagreement, confusion, or suffering.  I believe that it is safe to say that everyone living has experienced or will experience a period of crisis.  While each of us may exhibit a vast array of emotions leading up to a crisis, how we survive in the aftermath has a lot to do with preparation given that crises are a fact of life.

Our capacity for anticipating and interpreting what is happening is key.  Biochemical changes in the brain react to external stimuli and cause us to behave in similar ways at various times.  Adverse historical experiences may also influence what happens leading up to a crisis.  There are other factors as well, least of which involve the misinterpretation of what we witness occurring in our own life or the lives of others we know personally, and how these feelings intersect, change, or remain the same over time.  When we know the science about the mind and body, and how they are designed to function in what can loosely be defined as normal situations, we can then learn to regulate these factors using behavioral and Psychopharmacol interventions.

We live our lives on a continuum.  Drive the body or mind too aggressively in a particular direction and you will experience a crisis.  So, I began by asking the question— What are the drivers that enable us to survive crises for those who may not be suicidal, but are simply stressed, angry, or hopeless?

In not wanting to oversimplify a very complex subject, I will restrict my comments to what I have learned from my own personal experience and in working closely with others.  There are three fundamental and overlapping principles that I have found helpful when it comes to crisis management.  I’ll briefly share each of these. 

Having realistic expectations about yourself and others

Even in the absence of illness and disability, we are challenged.  We each have expectations for ourselves and others.  At times it’s easy to follow the momentum of what worked well for us in the past.  Success and accomplishments eventually do wane.  Having realistic expectations essentially means not being afraid to ask yourself questions and being willing to re-evaluate your worldview, values, and personal beliefs.

 Choosing a proper point of reference

Being able to live with a positive outlook means accepting your strengths and your weaknesses while making improvements wherever possible but recognizing that not everything circumstantially may change.  The concept of having a transcendent versus imminent point of reference becomes critical.  It is known that anything belonging to our material world can be damaged, destroyed, or taken from us.  So, when loss, sickness, or death occurs we have nothing left apart from the memory of what was. A belief in God or something outside of the “self” that transcends our material world is a rational way that gives our life meaning and purpose and balances individual potential with our human tendencies toward failure, and those influences in our life over which we have no control. 

 Being patient and allowing certain others to help you.

Our individual blueprints are under constant revision.  Too many suggestions from too many sources create enormous mental and physical pressure that will paralyze your personal growth and development in the areas you need it the most. So, when seeking help, carefully reach out to those who know you best and care about you. Reach out to those persons who are willing to be truthful and make sacrifices without bargaining or secondary gains.  Certain outcomes following a crisis may teach you things that will enrich your life.  In the moment, all may seem hopeless.  However, our reference point is often the equivalent of viewing a single frame from a full-length film.

 “THIS EXPERIENCE TAUGHT ME THAT AT TIMES THERE ARE NO VISIBLE INDICATORS.”

In the late 1980s, I received a letter from the mother of a friend and former college classmate named Sandy.   For several years after graduation Sandy and I kept in touch by writing letters and using 60-minute cassette tapes to document the stories occurring in each of our lives for the other to listen to.  These tapes we would send each other every two or three months cataloged the highs and lows in our lives and our shared faith.  I had not heard from Sandy for almost 6 months after writing to him the previous summer when the letter from his mother arrived.  I was a stranger to her.  We had never met.   She began by congratulating me on my new job which she apparently learned about from the letter that I had sent to Sandy the previous year.  She then told me that Sandy had committed suicide and that he had been sick on and off and that he suffered in the end. 

After working through the grief, I couldn’t seem to shake how if I had known Sandy was ill, I could have supported him emotionally, and perhaps he would not have ended his life.  I struggled to identify missed cues and questions I failed to ask.  This experience taught me that at times there are no visible indicators.  Particularly when geography is a barrier.  Was it just complacency, assuming everything was fine, or a comfortably loose connection? 

Back then there was no social media, no Facebook, Instagram, or Snapchat.  So often, the lives of friends and families remained shrouded in mystery until we could see them in person.

Had I known Sandy was ill I would have traveled up north from Florida where I was living at the time to see him.  I would have done whatever I could to let him know I was there for him and try to keep him from sinking emotionally past the point of rescue.  I would have tried to help him not to escape the sorrow but tried to support him while embracing it. His mother’s letter was brief because to her I was a stranger known only through the letter I had written.  She had no obligation to express more details.  The weight of her son’s death I am certain was made even heavier as she penned her reply to me.

Expressing compassion toward those who suffer in the midst of their darkest night is something we must always be willing to do.  To ask challenging questions without judgment or denial we must accept the fact that we too are just as vulnerable in certain ways at certain times.  And, that those in crisis require of us the capacity to love.

There’s more of course to crisis management and intervention than just these three approaches.  This is simply a primer for anyone considering what insulating strategies aid in preparing for and coping well in the aftermath of an emotional crisis.

In the words of Jordan Peterson— “There are so many ways that things can fall apart or fail to work altogether, and it is always wounded people who are holding it together.”

Photo by Mike Jones

By Sterling M. Hawkins, MSW, LCSW-C, LICSW

Time is a constant that's bought, borrowed, and lost. We experience it as moving fast or slow, but never at a standstill. I first knew I wanted to work with older adults in my mid-twenties. When I entered graduate school to pursue my Master's in Social Work, I could have selected several age groups as a focus. However, I chose to focus on older adults. Perhaps because as a child, I was constantly around older adults and have vivid memories of seeing family members and acquaintances' age and the challenges they each faced in the process. And secondly, my desire to help seniors achieve their best life.

This month I reviewed the topic of Gerontological Social Work. To help me do this, I selected the book titled "The Practice of Social Work With Older Adults: Insights and Opportunities for a Growing Profession" by Mary Kaplan, MSW (Health Professions Press Inc., 2020). The author is a licensed clinical social worker who has worked in health care and geriatrics for over 40 years as a clinician, administrator, educator, and community activist. She is retired from the University of South Florida School of Aging Studies, has authored five books, and is an international speaker.

This book examines the challenges encountered in the practice of geriatric social work. In this concise work of roughly 200 pages, the author takes a vast topic and distills it into four main sections: [1] The Development of Geriatric Social Work, [2] Basic principles that social workers and other health care practitioners should be aware of when working with older adults, [3] Issues and Challenges in Late Life, and [4] Geriatric Social Work: Settings and Opportunities. Kaplan provides readers with illustrations using her own practice experiences and real-life client stories in each chapter. In her Epilogue, she gives an appraisal of the future for those interested in pursuing a career in geriatric social work. I selected this book because I am a geriatric social worker and had the opportunity to meet the author in 2019. I believe the book captures the essentials required to practice successfully with older adults.

In highlighting some aspects of the book that make the case for required knowledge for those working with older adults, Kaplan, in Chapter 2, defines the characteristics of older adults by citing general stereotypes and differences that often exclude the diversity of seniors, differences in the aging process, and the factors that influence how seniors are treated. Here she examines Sex and Gender, Health and Functioning, and the Influence of Culture and History on Older Adults.

In Chapter 6, Kaplan addresses the Mental Health of older adults, and in Chapter 7, Mental Competence. These two chapters contain a wealth of information and provide the reader with common types of mental illnesses found in older adults, in conjunction with vital diagnostic criteria and corresponding treatment interventions. I like that she identifies Mental Health Assessment Tools that aid practitioners in performing a standard mental health assessment. A Mental health diagnosis cannot be discussed without examining the concept of Mental Competence. In the chapter on Mental Competence, Kaplan identifies how Dementia ( the loss of memory, language, problem-solving, and other thinking abilities) corresponds with principles of decisional capacity and how determining mental competence and capacity in older adults can be tricky. Kaplan discusses the role of guardianship and several types often used by state courts that define the scope and powers for appointed guardians who assume decision-making responsibilities in caring for older adults.

Each chapter of the book begins with Key Points that provide the reader with what's important to know about the chapter. And at the end of each chapter, Kaplan provides Chapter Notes that reference her citations. I like how the author blends a macro view of each aging topic with her personal stories that illustrate the micro complexities of working with older adults. The book delivers on its aim to highlight the practice of working with older adults by examining the social demographics of aging, sticking to a fundamental approach, and presenting an honest appraisal of the challenges and rewards of working with this population. The text should be considered a standard for every social work student entering the field of Aging. The book has helped me remember what can easily be forgotten, even by seasoned professionals when working with seniors in sub-specialty settings.

Social Workers who work with older adults can and do help them improve their quality of life. Kaplan's lived experience, and extensive research is a testament to investing in the lives of those who may be looking back more than they are looking ahead. The good news is that each of us can practice more effectively with older adults by becoming more knowledgeable about the challenges and rewards of making a difference in the lives of older adults that we encounter, regardless of our area of practice. 

Photo by Cup of Couple

By Sterling M. Hawkins, MSW, LCSW-C, LICSW

Mental health therapists are struggling. The struggle is to balance the process of being broken while becoming whole. Being a mental health provider does not exempt me from this struggle. What is true for the masses is true for practitioners as well. Mental health providers understand the dual nature of humanity— that we are complex creatures with immense capacities for love and hate. There is such a thing as righteous hate when it comes to racism, sexism, and social injustice. But if we allow our treatment efforts to correct, mitigate, and resolve those prejudices and injustices to turn us toward personal hate, we risk endangering our clients and ourselves. Allow me to explain.

When working with clients, I sometimes use Cognitive Restructuring. In this process, thoughts or beliefs associated with anxiety, fear, or depression are replaced with thoughts or beliefs related to confidence and strength. For most therapists, anger is an all too familiar emotion we encounter in practice. Occasionally, for therapeutic reasons, we may encourage some of our clients to become angry, but more often than not, we try to get clients to address what is beneath or at the root of their anger. It is generally agreed within the mental health community that anger is rarely, if ever, a primary emotion. However, we sometimes unintentionally transfer our anger onto clients when their trauma becomes a catalyst. In our present climate of racially motivated violence and hate, I find cultivating a sense of strength and wholeness into the lives of my clients an ongoing challenge because every issue has the potential to become politicized in ways that at times cause me to lose sight of what's essential. Clients sometimes fail to identify the primary emotion fueling their anger, particularly when harmed. When this happens, feelings of devaluation, powerlessness, and rejection usually result. The danger for us as therapists is that we may fail to assist clients properly in alleviating their emotional pain. Some of us go to great lengths to justify our client's anger, and yet their anger remains.

As therapists, we sometimes unconsciously reflect back to our clients our own distressing emotions stemming from similar experiences from our past in reaction to something the client says or does. This concept is called "counter-transference." Likewise, clients' words and actions can also stem from their past experiences and emotions. This concept is referred to as "transference." Transference comes in various forms that time will not allow me to delve into. However, not all transference is negative. Particularly when we as therapists are able to recognize when it occurs. At times it can be educational. At other times it is used to exercise empathy. The challenge for us as therapists is to remain self-aware throughout the process and not react to what our clients are transferring or projecting onto us.

In not wanting clients to feel distressing emotions of fear and hurt, we sometimes reflect to them our anger as a means to keep their more vulnerable feelings at bay. While engaging in psychological defenses such as blame or criticism provides a temporary escape and release for the anger, it often fails to break the vicious cycle and restore harmony and trust that most of us deeply crave. A noted theologian once remarked— "the natural religion of every human heart is self-righteousness." That is to say, we are all seeking vindication from someone or something to become whole, but first, we must be broken.

In the book titled "A Tale of Two Cities, "the author Charles Dickens presents a fictional narrative based on factual history. It was written in 1792 at a time like now when socio-economics and political forces created today's version of "cancel-culture." The aristocracy had gained increasing political and economic strength and used this strength to oppress the commoners. The result was a growing sense of anger and hatred by the commoners towards the aristocracy.

In the story, Charles Darnay, a young French aristocrat, sees this oppression and relinquishes his titles, property, and French citizenship; he moves to England and is accused by England of being a French spy. He was jailed, tried, but acquitted because of conflicting statements given by his accusers.

Another central character, Sydney Carton, a shrewd young barrister present at Darnay's trial, asks him afterward if it was worth almost losing his life and giving up his titles and possessions only to be accused of being a spy. Carton is depressed and doesn't like Darnay. And although they share a close physical resemblance, Darnay's actions and demeanor are of a quiet yet assertive disposition. These character traits remind Carton of everything he is not. Carton admits that he is a drunk and has no hope of improving his life but does want to learn what possessed Darnay to relinquish his wealth and privilege in exchange for a meager living among the working class. As an educated trial attorney, Sydney Carton has strong opinions about himself and the ambition of others in an environment of political corruption and his own sense of powerlessness against injustice.

This is an example of positive transference by Charles Darnay because he is not reacting negatively to Carton's impression of who and what he believes Charles Darnay represents in terms of political influence and wealth based on past experiences. Carton's initial approach toward Darnay is mild cynicism. Darnay doesn't fit the stereotype of an aristocrat, and Carton is perplexed.

Another character in the story and adversary of Charles Darnay is Madame Defarge. Defarge owns a tavern in France and is a revolutionary driven to annihilate all French nobles, of which Darnay is now only by birth. While exiled in France, Darnay is not forgotten by those who seek revenge against him because of his family's history. Madame Defarge's sister, we learn later in the story, was raped and murdered by aristocrats. While those responsible are presumed dead, Defarge will not rest until all aristocrats are killed. Defarge's retribution cast a wide net that resulted in many deaths. However, Madame DeFarge's hate eventually costs her her life.

Defarge's angered response- (killing all the aristocrats) against the unlawful death of her sister is an example of negative transference. It is because her anger has been transferred and projected onto an entire class of people whose wealth has made them despicable without determining individual culpability.

In the end, through a series of events and against the warnings of friends and associates, Charles Darnay leaves England to return to Paris to help a friend. Once in Paris, he is captured, jailed, and convicted by Revolutionaries in a kangaroo court because of his own ancestry. The fact that he had relinquished all of his privileges associated with nobility and has witnesses at his trial from England, among them Sydney Carton, who testified on his behalf, proved futile. Darnay was sentenced to death by the guillotine. Years had passed. Sydney Carton was now a close friend of Charles and his wife, Lucie. The couple also had a young daughter.

Seeing the plight of his friend Charles Darnay, Mr. Carton saw an opportunity to prove himself worthy of love. While in Paris with Darnay still imprisoned, Carton determines to intervene on Darnay's behalf. In the end, Sydney Carton is revered by his associates and especially Charles and Lucie Darnay. In the end, Sydney Carton sacrificed an irrevocable possession--his life. I will leave it to you to discover how he does this.

Several characters in this romantic drama face unenviable choices and the opportunity to exercise retribution for the atrocities they suffered unjustly. They, however, evaded sinking to the depths of their captors who, unlike them, allowed their hatred to grow into a blood-thirsty rage.

A Tale of Two Cities reflects societal values that parallel with those ethics and values governing our practice: The Importance of “Human Relationships” that emphasize the understanding that relationships between and among people are meaningful and that our efforts should always seek to restore, maintain, and enhance the well-being of individuals, families, and communities. And, along with the importance of Human Relationships, "Social Justice" that ensures all people everywhere have equal access to the resources and opportunities they require to meet their basic human needs.

In "A Tale of Two Cities," we learn that much of the developed world exists as a polarized world. While the goal of therapy is to reduce the suffering or distress of our clients, we must be careful in our efforts not to inflict more pain into the lives of our clients while attempting to relieve their suffering. I believe the message for us is this— "Don't let the darkness overcome you." If you believe that virtue exists and good exists and that in the end, good always triumphs over evil, it is your responsibility and mine to point others, which includes our clients, toward good wherever we find it, consistent with moral values that restore social accountability.

As we begin this year, we each will have opportunities to expose evil, practice good, and be examples for those who remain in darkness. And, to remember the words of philosopher Fredrich Nietzsche— "Whoever fights monsters should see to it that in the process [they] do not become a monster. "

Photo by Patrick Hendry

By Sterling Hawkins, MSW, LCSW-C, LICSW

Several nights ago I watched the Netflix documentary “14 Peaks: the quest to climb the world’s highest mountains in less than a year.” The film was released in November and chronicles the expedition of Nirmal Purja, a 38-year-old Nepali, mountain climber, former British Army Gurka, and Special Forces officer who embarks on a seemingly impossible quest to summit all fourteen of the world’s 8,000-meter peaks in seven months.

A newcomer to the world of high altitude climbing, Nirmal, who goes by Nims for short, discovered his love for climbing in 2012 when making a trek to Mt. Everest while on military leave. Against his family’s urging to remain in the military, Nims left military service and began seeking sponsorship to complete his mission to focus the attention of the world on the Nepalese Sherpa community. The Sherpas serve as elite guides and expert explorers and earn their living hosting expeditions for mountain climbers who come from around the world to the Himalayas to test their skill and endurance against the most majestic and deadliest mountains on the planet. Sherpas risk their lives each year, are underpaid, and lack recognition within the international climbing community. Nim’s expedition sought to change this by highlighting the invaluable service Sherpas provide to climbers at all skill levels.

The expedition, dubbed “Project Possible.” becomes a catchphrase for every obstacle and challenge Nims and his team face throughout the mission. Nims set 6 world records while completing this project and successfully accomplished what most in the climbing community said was impossible. Nims says “It’s about achieving the impossible in life, you just need to have a vision.”

As I reflected on this documentary, I asked myself the following questions: What keeps me going when I’m emotionally and physically drained? And, is it possible for me to refuel, recharge, and refresh while completing my own objectives? 2021 has required each of us to dig deep mentally and tap into our physical and emotional reserves in unique ways we are unaccustomed to. As I pondered these questions I identified three things that have helped me this year and thought I would share them with you as we approach 2022.

Acknowledge the Challenge

Before setting out on any mission you first have to decide what the mission is going to be and determine if you have the tools and resources needed to accomplish your goals. Perhaps you are already involved in a project or on a mission that has stalled, and you desperately need the motivation or essential resources to complete your mission successfully. In the film, the first thing Nims does is examine what he wants to do. He answers the question “what” before he attempts to answer the question of ‘how”. If we’re honest, most of us spend far too little time thinking about what it is we wish to accomplish at the micro-level. Looking at your tasks incrementally before you initiate them will help you to identify the best methods to navigate obstacles and avoid burnout or failure.

Embrace your Vulnerability

The second thing you can do to increase mental and physical stamina on any given task is to embrace your vulnerability. What this means simply is that you accept certain limitations as non-negotiable while leveraging your resources and strengths toward those aspects of the project that will yield the best returns for the amount of effort you put forth. What this looks like will depend a lot on your personality type and what methods you apply in solving specific problems that you encounter in the process. Nims is very ambitious and an over-achiever by nature who had already accomplished a rather impressive track record while serving in the Special Forces of the British Navy. He was no stranger to what others called impossible. In 14 Peaks Nims was simply facing new challenges that required him to assess what he thought was possible using his own definitions while not allowing others to completely define what they believed he should or shouldn’t attempt as it related to the mission.

An example of this was Nim’s decision to use oxygen when climbing at an altitude above 26,000 feet, referred to by climbers as the “death zone” where the lack of oxygen can quickly cause what is known as altitude sickness, which can result in headache, nausea, vomiting, rapid heart rate and if left untreated, death. There is a decades-long debate about using oxygen when climbing at altitudes above 26,000 feet among purists in the climbing community. Nims made the decision early to climb with bottled oxygen to ensure that his efforts were not compromised by the unexpected. Altitude sickness can occur at any time on any high-altitude climb. Even among professional climbers. Therefore, Nims chose to use oxygen, so as to not jeopardize the mission or the members of his Team. Besides, he had nothing to prove. Two years earlier he had climbed and summited K2 without the use of oxygen. The decision to use oxygen on this mission allowed Nims to lead while maintaining his pace with the rest of the team.

Build a Support Network

This I believe is the most important of the three strategies. When we build a support network it enables us to remain objective by giving us a panoramic view of whatever we are attempting, by allowing us to harness the collective wisdom of others who may approach circumstances and situations differently than we would. And, by enhancing our options and increasing our intellectual and emotional capacity we are able to endure and push through roadblocks and challenges that could sabotage our mission. Attempting any challenge in life that poses a high risk requires you to face the possibility of undesirable outcomes. The recognition of failure, loss, and even death is a reality and an occupational hazard for some. For others, it is a chosen lifestyle. For those who risk their lives because it is their job and those who risk their lives for sport, the same dynamic is at work. Each is motivated by the desire to overcome challenges and excel in what they do. In the scientific community, this phenomenon is referred to as “hormesis” and is defined as the adaptive response of cells and organisms to moderate and intermittent stress. In laymen’s terms, something that could significantly impair or even kill you in high doses can make you stronger in low doses. If we apply this biological concept to everyday lives, in our work, in our family life, or in recreational activities, theoretically we should improve and grow stronger over time.

So what does this have to do with building a support network? Everything. Having a support network is like having a testing ground. It enables you to try new things take calculated risks you would be unable to take if you were trying something new on your own. Most importantly, a support network or team creates a safety net that allows you to grow, adapt, change, and develop your skillset. One of the side-effects of growth involves feelings of uncertainty, anxiety, and just plain fear.

During the filming of 14 Peaks, Nims is asked what made him different from others unwilling to attempt this type of expedition? His answer surprised me. he answered-- “I have no fear.” I turned this over in my mind baffled, but think I now understand what he means. What he was saying I believe is that he has respect for the forces in nature that could kill him and would not focus on those forces in a vacuum. He would rely on the knowledge and expertise of each personally handpicked team member to supplement his own knowledge deficits to make what seemed impossible, possible.

New York Times columnist, Carl Richards, several years ago wrote about the feeling of being in, just a little over his head as a source of motivation in his work. He wrote that while it seems counterintuitive— “there’s something about a sink or swim environment that excites me.” And, that trying new things often forces you to face a steep learning curve. The very act of taking on something new helps us to become better at work overall. He emphasizes that this approach requires moderation. He writes— “you can’t spend your whole life in the deep end, as this is a recipe for drowning. Muscles get tired. So just like physical exercise, you have to take breaks. You have to calibrate the stress and rest cycle of any entrepreneurial or creative work. He concludes that the tangible benefits that come from stepping outside our comfort zone, is that you can become more excited about your work which is a surefire way to improve performance.

To conclude, recognizing your need for fuel in daily life involves each of these practices: Acknowledging your challenges, Embracing your vulnerabilities, and Building a support network. Your need for fuel in daily life may be less challenging than it was for Nims and his team, but no less important. Recognition for most of us requires us to acknowledge and accept what our physical body most needs. Simply planning to get a good night’s sleep and to exercise. Or, stopping to eat lunch. We must fight the temptation to skip or defer these health practices. Rest, exercise and nutrition increase your body’s immune response and fuel efficiency by giving it what it needs to run longer without the need for chemical stimulants and energy boosters. This by far is the best way to guarantee you never run on empty. A good support network can help build accountability between its members and ensure that everyone is working to overcome the mental and physical challenges that result from working on lengthy projects that come with inevitable setbacks and risks.

Running out of fuel for high-altitude climbers means more than fueling to meet a deadline, delivering a product or service on time, or losing to other competitors. Running out of fuel could literally cost them their life. Building reserve and maintaining it involves continual conservation of your physical, mental, and emotional energy. You have to decide what’s best and remember what things have made it difficult for you in the past, causing you to become apathetic or disillusioned with your objectives. Fuel economy whatever your mission involves each of these three elements and more. Make them a part of your pre-check list before beginning your next project.

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References:

Clarke, G., Jones, T. (2021, November 29 ) 14 Peaks: Nothing Is Impossible. Retrieved from https://www.netflix.com/title/81464765

Lawrence, A. (2021, December 3). 14 Peaks: the quest to climb the world’s highest mountains in less than a year. The Guardian. https://www.theguardian.com/sport/2021/dec/03/nirmal-purja-mountaineer-14-peaks-documentary

Richards, C. (2016) The Paradox of Finding Motivation Through Fear.  New York Times.  Retrieved on 4 December 2021. Available https://www.nytimes.com/2016/04/12/your-money/the-paradox-of-finding-motivation-through-fear.html

By Sterling Hawkins, MSW, LCSW-C, LICSW

In March, we reached the one-year mark of living through the Pandemic. In a state of uncertainty when the lives of thousands were lost during the initial spread of Covid, I found myself thinking about letting go. Less than a year earlier I had sifted through the remaining contents of my mother’s personal effects after my wife and I had cleaned out my mom’s studio apartment following her death. Those items that survived the first purge ended up in my basement. The photographs, books, kitchen utensils along with her personal files, linens, towels, and other items. After sifting through photographs and old funeral programs of other deceased family members and friends, some I filed neatly away. These were items I wanted to keep because they preserved the memory of the person. A similar event occurred in 2005 after my father’s death. And, before that in 1998 after my grandmother’s death. The process of discovery, discarding, and donating items enabled me to create emotional bookmarks and helped me to detach from things that served no practical or emotional need other than it was owned by a family member now deceased.

Over the past year, I’ve reflected on these events and my own accumulation of stuff that I now consider non-essential. Back in March, I stumbled across an article in the New Yorker Magazine by Ann Patchett titled “ How to Practice.” In the article the author tells the story of her own journey into discovery, discarding, and donating that was prompted by the death of Kenneth who was the father of her closest childhood friend, and how this served as an inspiration to reassess her attachment to some of her own possessions and let them go. Patchett describes the attachments we forge with things over time and how many of those attachments in the end no longer serve to define us in the way we want to be known.

In thinking about ” How to Practice” I’m reminded of the awkwardness often felt when examining the accumulation of things that are far removed from our daily existence. “Bookmarks” as I often refer to them or “snapshots”, represent a part of the past, evoking pleasant and sometimes painful memories. I believe Patchett in describing her experience reminds us of several things when reflecting on our relationship with personal possessions.

• Our life is a collection of the things that define us but often these things along with their definitions change over time.

Most of what we possess is useful only for a limited time. We form attachments to objects in a similar way we do with people. We spend time with our things. Clothing universally is something that we can become attached to. I remember owning a full-length salt and pepper tweed coat that I purchased at a second-hand thrift shop as a college student. The look and feel of it made me want to wear it, whenever the temperature dipped below fifty degrees. And, wear it I did for many years long after under-grad and graduate school I still had the coat and even obtained a piece of silk to hand-sew a new lining. Eventually, the exterior became shabby with age forcing me to accept the fact that the coat had served me well but needed to be let go as seams separated and buttonholes widened from frequent wear. This was not the only winter coat I owned. However, it was the only one that I felt attached to.

• Who will want what we leave behind after our death?

In the article, Patchett recounts how Kenneth the father of her friend left detailed instructions regarding those items he willed to family and friends. “Tavia got the fourteen-inch All-Clad covered saute’ pan, Therese got the extensive collection of light bulbs, Tavia got the blue wool blanket, Therese got the midsize dehumidifier. The list went on and on: art, artifacts, household supplies. Since neither Tavia nor Therese [Kenneth’s daughters] had space for more than a few mementos, they decided to sell most of their inheritance and split the proceeds equally.” I believe we each must accept the fact that sometimes we over-inflate the value of the things we own. Perhaps not intentionally, but because it somehow serves to satisfy our need to preserve their value even after we’re no longer around to celebrate the original joy we received from owning them. Often, such items hold only a sentimental value that is personal, and one that is rarely transferrable.

• Imagining one’s own death as a spiritual practice to detach from possessions that no longer define us.

I’m reflecting on my history and my attachment to things I’ve collected over the years that hold some sentimental value, but mainly take up space. These items have no monetary value. The few items that do, I have contemplated placing on Craig’s List just to ease my conscience for reasons like Tavia and Therese wanting to exchange them for money that I can use to buy something else more relevant to my present life. I sit and look at old books that line my shelves written by little-known authors whose names I’ve forgotten. Incomplete sets of china and a few paintings by artists passed down and lost to antiquity. Files of papers from classes I enjoyed writing as a student that survived multiple moves cross country, and posters from my teenage years that remain secure in a mailing tube. Imagining that I will relinquish such attachments when I die forces me to accept that these things hold meaning only because I have attached meaning to them. If this sounds familiar, questions we should be asking ourselves are: Do I feel burdened by keeping these items? If your answer is yes it’s important to know why you feel this and what type of burden is placed on you. Do these items limit the physical or emotional enjoyment of your living environment (home or work)? Why do I feel the need to keep certain items? And, would I feel shame or a sense of betrayal towards someone for relinquishing items given to me by another person even if they are no longer alive or connected to my present life? Do I feel the need to keep things because of the good memories attached to them? And, finally, Do I use or display these possessions often enough to make keeping them worthwhile? Answering such questions while acknowledging our eventual death weakens the bonds our possessions have on us. In letting go, we accept the natural progression of time and that our relationship with the things we own often changes along with us.

• Embracing the emotional fallout of letting go.

The process of detaching from items we own is ladened with emotion. Emotions we are unaccustomed to feeling and ill-prepared to navigate as we begin the complex process of letting go. Patchett writes, “ I started in the kitchen, a room that’s friendly and overly familiar. . . I filled the laundry basket with the things I didn’t want or need and carried those discards to the basement. I made the decision to wait until we’d finished with the entire house before trying to find a place for things we were getting rid of. This was a lesson I’d picked up from my work: writing must be separate from editing, and if you try to do both at the same time nothing will get done. . . What I had didn’t surprise me half as much as how I felt about it: the unexpected shame that came from owning seven mixing bowls, the guilt over never having made good use of the electric juicer my mother had given me, and strangest of all, my anthropomorphism of inanimate objects.”

In this instance, I believe Patchett’s self-assessment is not so strange and that thinking of objects as possessing human traits is linked to a greater tendency to acquire and save things. People who have emotional attachments of this type might feel responsible for their possessions, particularly when given by a loved one, where they see them as objects that have been entrusted to them as caretakers.

The strong attachments, we form with things are often endowed with qualities that are rooted in our imagination of what we want them to be and not necessarily what they are. We create stories both real and imagined about those objects and their relationship to us and to other people and places. All of these things combine to create a powerful narrative where we find it difficult to write the final chapter. It’s the process of writing this epilogue to complete the narrative, and the myriad of stories we create for our possessions that makes letting go so painful.

• Tools for transitioning into Adulthood.

Children often get attached to objects. It’s not uncommon for some children to have a favorite toy, a blanket, or stuffed animal. For these kids, those objects represent much more than the material from which they are made, but something that signals safety and reminds them of the person who gave it to them. As we age however according to Dr. Kiara Timpano an assistant professor of psychology at the University of Miami, the immediate need for those objects often declines, but that doesn’t mean that the attachment to them declines. “When a kid grows up, he might not need his teddy bear to calm him during a thunderstorm, but that doesn’t mean it’s not still important to him. It may be important because of the history and memories it represents, and because it’s been in his life for so long that it serves as an extension of himself.”

Patchett in describing her experience in detaching from a house filled with memorable objects writes- “I had miscalculated the tools of adulthood when I was young or had I miscalculated the kind of adult I would be.” This seemingly innocent reflection on her part creates a paradox that many of us face as we age. We often become someone different than who we imagined ourselves to be when we were young.

I agree with Patchett’s observation but question whether we truly “miscalculate” the tools of adulthood. I think what more accurately occurs is that objects that tend to be associated with a particular phase of life are carried with us past the point where they serve the practical needs associated with that particular developmental phase as was noted by Timpano.

Though attachment to objects seems universally human, people vary widely in what they get attached to and why. Researchers Mihaly Csikszentmihalyi, Ph.D., and Eugene Halton, Ph.D. in their book— “The Meaning of Things: Domestic symbols and the self” said that there are differences of age and gender regarding the things we get attached to. During his interviews, from the 1970s, he noted that men were more likely to pick objects related to hobbies, while women often chose family heirlooms. And, older people tended to point out photos, while teenagers more frequently chose electronics. In the Forty years since that research was published, I believe little has changed. With these general categories, it’s easy to see how one can move throughout their life toward objects with ever-increasing attachments- from a distant observer to a casual interest to a hobby and finally a die-hard devotee.

The practice of letting go is a challenging one. And, it’s a task that most of us will confront at some point in adulthood. The challenge is that we must examine our relationship with our material things. Things that we associate with our identity and help to define who and what we are known for.

How to Practice: Patchett concludes is about “starting to get rid of my possessions, at least the useless ones, because possessions stood between me and death. They didn’t protect me from death, but they created a barrier in my understanding, like layers of bubble wrap, so that instead of thinking about what was coming and the beauty that was here now I was thinking about the piles of shiny trinkets I’d accumulated. I had begun the journey of digging out.” In this context, Patchett uses the term "practice" as a metaphor for spiritual discipline and preparation. And, as a reminder that each of us must practice and prepare for that time when it comes.

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References:

Beck, J. 2014, December 10). For The Love of Stuff https://www.theatlantic.com/health/archive/2014/12/for-the-love-of-stuff/383592/

Patchett, A. (2021, July 22). How To Practice https://www.newyorker.com/magazine/2021/03/08/how-to-practice

By Sterling Hawkins, MSW, LCSW-C, LICSW

It’s hard to talk about suffering without acknowledging that it is a deeply personal and subjective experience. Having spent many hours with people in the midst of suffering as well as experiencing my own grief, I have come to believe one thing. Suffering is unavoidable and how we suffer can either make us stronger or destroy us completely. My purpose in writing this article is not to quantify or compare the experience of those suffering but, to examine how suffering can and often does make us more genuine and tolerant. How do you handle suffering? This is a question that forces itself upon us. Our responses cover a vast array of emotions that either help or hurt us amid our suffering. Nassim Nicholas Taleb author of “Antifragile” believes that suffering at its best should make us stronger and better than if we had remained untouched by adversity. Whenever I suffer, I ask myself one question- “why”? Suffering’s design can provide us with enormous resources which allow us not just to endure suffering but to actually grow stronger through the experience. Suffering teaches us about who we are and how we process the material world and our relationship to it. 

Sociologist, Ron Anderson, Ph.D. in his book titled “Human Suffering and Quality of Life” Has developed a taxonomy of suffering, a framework that makes it easier to think about suffering and to measure it. He comments: “people think about suffering in very different ways depending upon their backgrounds in religion, local culture, and unique personal experiences.” He expands on this concept in the first chapter- Frames for Thinking About Suffering. In it, he identifies three types of suffering: Physical, Mental, and Social Suffering. Anderson draws some interesting parallels about how we think and experience suffering from a phenomenological perspective. He concludes in his first chapter on “Conceptualizing Human Pain and Suffering” that “Human suffering can only be fully understood from the accumulation of knowledge about its causes, context, and results. Suffering is so broad that knowledge is needed from many disciplines, including the humanities, social sciences, biological sciences, and professional health care. However, discerning the mutual interplay between suffering and the quality of life depends largely upon knowledge and tools from within social science research.”

This phenomenological perspective interests me as it relates to creating a sense of contentment, that equates with acceptance of one’s own life given our effort to avoid suffering. It’s difficult to define what makes suffering acceptable or tolerable, because of the unique personal experiences cited in the research literature which form the definition. Insulating factors such as feeling loved or acknowledged and supported while undergoing suffering increases tolerance for individual suffering. These insulating factors at times are elusive and may change over time. Given the limits of a single discipline to answer the question of why we suffer, I believe a philosophical understanding may be helpful when paired with cognitive-behavioral approaches to aid in mitigating the undesirable effects of one’s suffering experience. 

19th Century Philosopher Arthur Schopenhauer (1788-1860) believed that as humans, we live in a world of endless suffering. In his book “On the Suffering of the World” he writes “We are like lambs in the field, disporting themselves under the eye of the butcher, who chooses out first one and then another for his prey. So it is that our good days we are all unconscious of the evil Fate may have in store for us— sickness, poverty, mutilation, loss of sight, or reason. “ Schopenhauer was a pessimist and paints a terse sentiment of this life. He believed that the only way to find a tranquil and peaceful existence is to come to terms with a principle he referred to simply as “Will” a mindless, non-rational impulse at the foundation of our instinctual drives and fundamentally the foundational experience of life itself. 

Philosopher Fredrick Nietzche (1844-1900) like Schopenhauer rejected the idea of orthodox religion as a basis for determining the cause of suffering. He shared with Schopenhauer the belief that the world of individual existence is essentially a world of suffering, with one difference- that suffering was metaphysically necessary for us to conclude that there are other more valuable experiences to which suffering gives rise to. Nietzche nonetheless was not anti-religious. He simply saw religion as an important construct that can be used to address the problem of suffering. In other words, Nietzche believed the problem of suffering in the modern world was not about defending religious belief or explaining the existence of evil, but a matter of finding creative sources of meaning in a nihilistic world. He differed from Schopenhauer in that he was less accepting of what was observed in suffering and more interested in why suffering occurred. Nietzche saw the “Will” not as a mindless, non-rational impulse, but a force that could make suffering purposeful.

One of the keys to suffering well involves “Right-Thinking” which simply put is an ability to hold beliefs and opinions that are sensible, and that most others agree with. So, how does one engage in right-thinking? Starting with the idea that suffering is a natural consequence of living in a material world with normal bodies that become weak, and that fail, and function with less ease and precision than when they were young. And, that our minds and emotions are prone to conflict through miscalculations and misinterpretations of what we see and feel when observing our actions and the actions of others. 

Holocaust survivor and psychiatrist, the late Viktor Frankl in his book titled “Man’s Search for Meaning” observed the following- “The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity - even under the most difficult circumstances to add a deeper meaning to his life. It may remain brave, dignified, and unselfish. Or in the bitter fight for self-preservation, he may forget his human dignity and become no more than an animal. Here lies the chance for a man either to make use of or to forgo the opportunities of attaining the moral values that a difficult situation may afford him. And this decides whether he is worthy of his suffering or not. Such men are not only in concentration camps. Everywhere man is confronted with fate, with the chance of achieving something through his own suffering.” Frankl’s observation implies that there is a moral element and purpose to suffering, and accepting this may be the first step to resolve or at best ameliorate suffering’s worst effects. According to Frankl, who we become at the end of our suffering can be and often is redemptive. Consequently, the “why” so often posed while suffering expresses a desire for meaning rather than for an explanation.

Frank Ostaseski, co-founder of the Zen Hospice Project on Suffering writes- “Suffering is about perception and interpretation. It is our mental and emotional relationship to what is first perceived as an unpleasant or undesirable experience. Our stories and beliefs about what is happening or did happen shape our interpretation of it. When things don’t go according to plan, some people believe that they are helpless victims or that they ‘got what they deserved.’This leads to resignation and apathy. When we get caught in anxiety and worry about what might happen in the future, it can quickly proliferate into a web of fear that is not easily corralled. . . Suffering is falling in love and then becoming complacent. Suffering is not being able to connect with our children. . .Thinking that life is moving by too fast or too slow. Not getting what you want, getting what you don’t want, or getting what you want but fearing you will lose it—all of this is suffering. Sickness is suffering, old age is suffering, and so is dying.”  These are all types of suffering that most can relate to.

I’ve been learning how not to look at the condition of my life to reliably give me what I want for some time. Although, I still nostalgically relive periods in my life that were ideal and made me happy. I no longer believe that such conditions that occur throughout one’s life can be sustained no matter how great the effort. Yet, I can’t help but long for those ideal conditions to remain when they occur.

In the International Journal of Existential Psychology and Psychotherapy Louis Hoffman, Ph.D., and Janie Paige, B.A. discuss The Varieties of Suffering and their Clinical implications. They conclude that All emotions [even suffering] at their base are normal and potentially beneficial. Many psychological problems are rooted in the lack of acceptance of normal emotions, and that for many clients their difficulty in responding to normal emotions can create larger difficulties and more disruption to their life. They provide several examples of how this concept is observed that I will summarize.

Grief- is a normal reaction to loss yet there are forces in society that interfere with healthy grieving. Many who grieve losses are given messages from others: family, friends, religious leaders, and co-workers that discourage healthy grieving. Even in health care often medication is given to create a numbing effect. Returning to the emotion and engaging in the grieving process is an essential component in the move toward restoring psychological well-being.

Staying with Emotion- Research supports that when clients stay with their emotions and explore them, they can have a powerful and healing effect and allow individuals to develop insight into their emotional patterns. They do emphasize that for this type of therapy to be effective, assessing the client’s resiliency, support, and coping resources before engaging in such an intervention is essential.

The Interpersonal Emotions and Healing - After client factors, relational factors are the most important element in the healing process. Being in a relational context with a therapist who has developed the use of presence, empathy, and authenticity can in itself be healing and empower other therapeutic interventions making them more effective.

Creativity and Meaning- Diamonic influences are those emotions and thoughts that occur as something natural within the person who experiences them and have the potential to consume their whole personality. Emotions such as anxiety and anger are said to have strong daimonic potential. Daimonic emotions can be responded to destructively or constructively, in a manner that promotes well-being. Healthy responses to the daimonic are rooted in creativity.

I will conclude with a brief excerpt from an interview with, British author Katherine May, where she discusses her most recent book titled: “Wintering the Power of Rest and Retreat During Difficult Times.” I believe she captures the essence of how we should all suffer. She recently commented- Life is fundamentally cyclical. . . and if we can truly grasp and believe in how fleeting life is, how delicate, how subject to powers beyond our control, that we can begin to set our minds to a better way of living within it, that isn’t tormenting itself with trying to grasp onto things that cannot be grasped and trying to assert ourselves in places that is completely meaningless to do so. “ She goes on to read a portion from the book - “Plants and animals don’t fight the winter; they don’t pretend it’s not happening and attempt to carry on living the same lives they lived in the summer. They prepare. They adapt. They perform extraordinary acts of metamorphosis to get them through. Wintering is a time of withdrawing from the world, maximizing scant resources, carrying out acts of brutal efficiency, and vanishing from sight; but that’s where the transformation occurs. Winter is not the death of the lifecycle, but it’s a crucible.   

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References:

Anderson, R. E. (2013). Conceptualizing Human Pain and Suffering [E-book]. In Human Suffering and Quality of Life: Conceptualizing Stories and Statistics (SpringerBriefs in Well-Being and Quality of Life Research) (2014th ed., pp. 8–23). Springer. http://users.soc.umn.edu/~rea/documents/Preprint%20of%20Human%20Suffering%20SpringerBrief%20v5%2013june13.pdf

Carlisle, C. (2012, November 12). Evil, Part 5 Making Sense of Suffering. The Guardian. https://www.theguardian.com/commentisfree/2012/nov/12/evil-making-sense-of-suffering

Frankl, V. E., & Allport, G. W. (2000). Man’s Search for Meaning (4th ed.) [E-book]. Beacon Press. https://www.goodreads.com/quotes/706756-the-way-in-which-a-man-accepts-his-fate-and

Hoffman, L., & Paige, J. (2017). Varieties of Suffering and Meaning: Clinical Applications. International Journal of Existential Psychology and Psychotherapy, 7(1), 7–9. https://www.meaning.ca/web/wp-content/uploads/2019/10/228-13-549-2-10-20180905.pdf

On Being [onbeing.org programs]. (2021, January 21). On Being with Krista Tippett Katherine May How ‘Wintering’ Replenishes [Online forum]. Https://Onbeing.Org/Programs/Katherine-May-How-Wintering-Replenishes/. https://onbeing.org/programs/katherine-may-how-wintering-replenishes/

Ostaseski, F. (2017, July 14). What It Means to Suffer and Why It’s Important. Https://Observer.Com/2017/07/What-It-Means-to-Suffer-Why-Its-Important-Resistance-Pain-Emotional-Mental-Health/. https://observer.com/2017/07/what-it-means-to-suffer-why-its-important-resistance-pain-emotional-mental-health/

Wicks, Robert, "Arthur Schopenhauer", The Stanford Encyclopedia of Philosophy (Spring 2019 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/spr2019/entries/schopenhauer/>.

By Sterling Hawkins, MSW, LCSW-C, LICSW

It is a new year, and still little has changed, at least on the surface. Our nation continues inching toward recovery from the COVID-19 Pandemic, which at present has claimed over 340,000 lives. We have a vaccine, but some scientists have already expressed concerns about viral evolution and the virus's ability to mutate and adapt over time, calling for new anti-viral protocols. Our economy too, in the wake of COVID has suffered, causing many to lose their jobs or, close their businesses altogether without the benefit of a second stimulus. Others, living in the margins, cannot afford their rent, pay for auto and home loans, groceries, and medical bills. In times such as these, the gaps widen between what we believe and what we hope for. Many of us last year, depending on our experience, remain skeptical and take a nuanced approach in forming our expectations for the New Year.

2020 has reminded everyone that it's often difficult to make sense of what happens to us or why. Even when we understand the "how" the absence of a rational "why" erodes our faith in people, systems, and sometimes our belief in God. Especially in an atmosphere of risk and betrayal. It is a reminder that faith, defined as- the confidence or trust in a person, thing, or belief not based on proof alone, may provoke doubt in a world that seems random and cruel. You may say that faith is unimportant when discussing economics, politics, science, or psychology apart from religion. However, before drawing your conclusion it is important to remember that true faith is always rooted in reason. Reason can be defined as the cause, explanation, or justification for an action or event. There is a close connection between reason and faith. I believe you cannot have one without the other. Most of us reason and form judgments apart from facts unconsciously all the time. This process of reasoning is known as inductive reasoning. Inductive reasoning aims to develop general theories based on specific observations. For example, economic downturns in the U.S. often are followed by an economic recovery. Therefore, we should expect an increase in economic stability moving forward. Or, every year in the U.S. between June and November, Atlantic coastal weather patterns produce hurricanes. Therefore, hurricanes will most likely occur between June and November. And finally, every family in a small suburban city knows someone in their neighborhood who lost their job at the city factory when hundreds were laid-off. Therefore, everyone in the city is unemployed.

What should be immediately evident from these examples is that most things we believe in are not empirically verifiable. As it relates to the current state of our nation, we believe specific policies and practices should be instituted to define civil society but fail to agree on which policies and best practices are responsible for outcomes experienced by members of society. Regardless of your worldview faith can never be divorced from reason. To say that truth is only intelligible through reason is itself a statement of faith. Each of us exercises a good amount of faith to believe our worldview and sustain it. To be committed to truth means looking where the evidence that supports your worldview doesn’t fit, is flawed, or doesn’t make sense. You may say, how can I possibly believe that faith is better than doubt? And, I say it is an act of faith to aspire to our most celebrated ideals like “life, liberty, and the pursuit of happiness” as found in the Declaration of Independence. We may all agree that COVID is neither political nor religious, but it is sad to see how many people made it so.

What 2020 has forced all of us to do is to sit still. And, in our stillness, we are forced to consider our politics, our science, our economics, and our religion. And, most importantly, how each of these influences our relationships. That is we must consider their influence on how we relate to others, our spouses, our families our jobs, and the larger society. For many, changes brought about by the Pandemic have strengthened those relationships and our values. This past year has raised our appreciation and compassion for others and our awareness as to why various people and things occupy an important place in our lives. Others in hindsight may find that the people, possessions, and activities which occupied their lives in a pre-pandemic state are no longer a worthy investment of their time and effort. Perhaps you have suffered immeasurably over the past year and are beginning the New Year with an emotional deficit. Emotionally in the red and lacking faith that your life and your relationships will improve. You are questioning, how can faith make a difference for me? The answer is in "Hope". I said previously that true faith is always rooted in reason and that reason is itself a statement of faith. This brings us to hope. I believe hope too, must be joined with faith and reason. Writer, Sharon Blake persuasively defines hope and explains the relationship between faith and hope and why both are essential to living life and engaging with the world successfully. She says "Hope is an optimistic attitude of mind based on an expectation or desire. Faith says it is so now and hope says in the future it could happen . . . Hope seeds planted in one's life can be the catalyst for the roots and the foundations of one's faith walk. . . Hope speaks for the future and faith for the now in life."

This was brought home to me in a quote I read the other day circulating on social media which reads:

Every minute someone leaves this world behind. We are all in "the line" without knowing it. We can never know how many people are before us. We can not move to the back of the line. We can not step out of the line. We can not avoid the line.

So while we wait in line:

Make moments count.

Make priorities.

Make the time.

Make your gifts known.

Make a nobody feel like somebody.

Make your voice heard.

Make the small things big.

Make someone smile.

Make the change.

Make love.

Make up.

Make peace.

Make sure to tell your people they are loved.

Make sure to have no regrets.

Make sure you are ready.

Author: Marianne Baum

The Old Testament patriarch Job gives readers a similar reflection:

" Mortals born of woman are a few days and full of trouble. They spring up like flowers and wither away; like fleeting shadows, they do not endure. . . A person's days are determined. . . and have set limits he cannot exceed." Job 14:1,2, 5.

So as we turn the page on another year I encourage you to not take 2021 for granted. Many lost their lives in 2020 who given a second chance would have embraced the sobering reality of how fragile life is. And, how all of us are waiting in line uncertain of our turn. In 2021 dare to discover hope.

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References:

Blake, S. [2017] Hope vs Faith or Faith and Hope, The Huffington Post, Retrieved on 20 December 2020. Available at https://m.huffpost.com/us/entry/8907892/amp

New International Version. Biblica, 2011. BibleGateway.com, www.biblegateway.com/versions/New-International-Version-NIV-Bible/#booklist.

Wehner, P. [2017] How Can I Possibly Believe That Faith Is Better Than Doubt? , The New York Times, Retrieved on 21 December 2020. Available at https://www.nytimes.com/2017/12/25/opinion/faith-christmas-religion.html