Author Archives: Meg Reber

Depression

Q: How does our community support people who are overwhelmed by emotional challenges?

Q: Am I a listening, caring presence for others when they are experiencing troubling times?

A Time of Loss and Change: depression is not a “normal part of aging” just as it is not a normal part of our development at any age. In older adulthood and at other times in our lives where we are facing loss, isolation or change, we may be at higher risk of depression. Loss of loved ones, roles, home or community ties, or physical changes can increase risk for depression. Men especially are more at risk for depression as they age, and suicide rates increase dramatically for men over 65, even more so for those with a history of depression.

Signs of depression include:

  • Sadness: grief as a natural response to loss is different from depression. Unexplained, unrelenting sadness or grief that never lets up is a sign of depression.
  • Expressions of Feelings of Loss of Self-Worth: a person may feel they are a burden, life has lost meaning, they cannot do things they were once able to do.
  • Withdrawal and Isolation: a person may avoid visits with friends, or avoid coming to Meeting.
  • Avoidance of Activities that were once loved: a person stops doing things that were once important to them.
  • Changes in Sleep Patterns: extreme fatigue, insomnia.
  • Changes in Appetite: usually weight loss, but some people may eat more to try to replace lost energy.
  • Fixation on Death, Suicidal Thoughts: consult a professional if a person expresses thoughts of suicide.
  • In older adults and others, depression may also manifest itself as hopelessness, helplessness, increased irritability, anxiety, forgetfulness, unexplained physical complaints. Symptoms such as confusion, forgetfulness, or paranoia may be similar to signs of dementia or other illness. A professional evaluation will help discern the root cause of the symptoms so that appropriate treatment can be determined.

“The remarkable discovery we can make is that love has not deserted us, and that it is available to us now in a new way.”
Margaret Torrie, 1975, PYM Faith and Practice

How can I help? A person with depression needs professional care. Friends can help by encouraging one to seek professional care and by being a caring presence.

Overwhelmed by symptoms of hopelessness and confusion, compounded by the stigma placed on mental illness, often a person who is depressed does not recognize their symptoms and cannot take action to get help. They may also feel ashamed or embarrassed. Let the person know they are accepted and supported, and learn about your local resources and refer to professionals.

  • Validate Feelings: respect and validate the person’s feelings. When a person’s feelings are validated, they feel valued. This contributes to healing and opens the doors for communication. See the Quaker Aging Resources article on Validation.
  • Walk Beside the Person: even if they say “I don’t want to,” let them know that you want to spend time together. If you are rejected, suggest another activity—visit pets, children, a garden. Walking and other exercise can help alleviate symptoms of depression. Mental health research shows that spiritual support, helping a person to find meaning and purpose, assists in recovery. Just listening goes a long way.
  • Don’t give up: continue to let the person know you care. Let go of expectations and understand it is the illness that is keeping the person from calling you back or taking you up on that potluck supper. Enlist the help of others and continue to encourage your Friend to accept professional help. Call your regional faith group office for assistance, especially if reluctance to seek care or accept medication is a concern.

Seek help immediately if thoughts of suicide are expressed or suspected.

National Suicide Prevention Lifeline 1-800-273-TALK (8255)

LINKS TO MORE INFORMATION: Click on the blue text below to be directed to outside websites that offer additional information on this topic. The websites will open in a new window, when you are done, simply click out of that window and you will be back on this site.

Other Articles/Links:

Counseling For Friends in Philadelphia Yearly Meetings
Helping Older Adults with Depression
Mental Health America 1-800-969-6642

Sources/Further Reading:

Edited by Patricia McBee, Grounded in God: Care and Nurture in Friends Meetings, Philadelphia, Quaker Press of FGC, order this book from quakerbooks.org

Deborah Morris Coryell, Good Grief, 2007, Healing Arts Press, Rochester, Vermont.

Rosalynn Carter, Helping Someone with Mental Illness,1999, Three Rivers Press, New York, NY.

Brian Quinn, The Depression Sourcebook, 2000, Lowell House. Los Angeles, CA.

Care of the Caregiver

“…the Latin root of the word “comfort” means ‘with strength’ rather than ‘at ease.’”
S. Jocelyn Burnell, 1989, Quoted in PYM Faith and Practice, 2002

S. Jocelyn Burnell made this observation in writing about pain, but it applies as well in considering the challenges of caregiving. Caring for another, whether because of physical illness, emotional, behavioral or cognitive challenges, is not easy. However, it can be an opportunity for personal growth and self-discovery. Through caregiving, one may discover one’s own gifts of compassion, patience, love and perseverance. However, even for the most joyful caregiver, there can be times of frustration and stress. Spiritual communities can be a vital resource for people facing the challenge of caring for a loved one. We can all benefit from understanding the signs of caregiver stress:

  • Feeling frustrated, irritable, angry, or sad, especially unrelenting
  • Changes in sleep pattern—having trouble falling asleep or not wanting to get out of bed
  • Increased or decreased appetite
  • Loss of interest in activities, withdrawal from friends and/or family
  • Getting sick more often than usual
  • Exhaustion
  • Making unreasonable demands on yourself—feeling you are the only one who can take care of the person
  • Feeling you want to hurt yourself or the person for whom you are caring

Some of these symptoms of caregiver stress are very similar to those of depression. A person who is overwhelmed taking care of others may not recognize that he or she needs help. Others may need to be attentive and take action to support the caregiver.

Q: How do we support caregivers who may be overwhelmed by the chronic needs and concerns of family and friends?

It is natural for the person in need of care to become the focus of a community’s concern. However, families and loved ones acting as caregivers may need spiritual and practical support just as much as the person who is ill. Here are some ways you can help caregivers:

  • Take a proactive approach to reaching out to caregivers. Often people will be hesitant to ask for help but will accept support if asked.
  • Be prepared to offer specific suggestions for how you can assist.
  • Offer individual support and a listening ear.
  • Provide Clearness Committees or other opportunities for discernment to assist families in making decisions about care, housing and other concerns. Remember that caregivers may be too busy or overwhelmed to think of this: make a point to remind people of the opportunity.
  • Help the caregiver with chores, meals, childcare, transportation, or any number of practical needs. This can give the caregiver a break, or provide peaceful time for them to be with their loved one without the burden of worrying about work undone.
  • Keep information on hand about local resources or where to find out more, such as your county Agency on Aging.

Download this article in pamphlet form

LINKS TO MORE INFORMATION: Click on the blue text below to be directed to outside websites that offer additional information on this topic. Articles from this site will open in the same browser window/tab. Articles from other websites will open in a new window; when you are done, simply click out of that window and you will be back on this site.

More articles on this website:

Depression
Grief

Other Articles/Links:

Children of Aging Parents
caring.com
Caring Today
National Care Planning Council
When Siblings Step Up article from the Wall Street Journal

Sources/Further Reading:

Cappy Capossela and Sheila Warnock, Share the Care, 2004, Fireside, New York, NY

James E. Miller, When You’re the Caregiver, 1995, Willowgreen Publishing, Fort Wayne, Indiana.

Anxiety and Change

Anxiety is a normal reaction to stress and affects all of us at one time or another: we are anxious about speaking in public, apprehensive about going to the doctor, and may worry obsessively while waiting for the results of a medical test. Some anxiety is healthy – it can keep us vigilant about things that are important for our well-being, compel us to move forward with our lives and inform us of a concern we need to address. However, anxiety that overwhelms one, making it difficult to function, may indicate an Anxiety Disorder.

Specific anxiety disorders affect 11% of people over the age of 55, but only a small percentage receive evaluation and treatment. Also, an estimated 17-21% of people over 55 have symptoms of anxiety that do not meet the criteria of a specific anxiety disorder. “Due to the lack of evidence, doctors often think that [anxiety] is rare in the elderly or that it is a normal part of aging, so they don’t diagnose or treat anxiety in their older patients, when, in fact, anxiety is quite common in the elderly and can have a serious impact on quality of life,” says researcher Eric J. Lenze, M.D.

Older adults are more likely to be facing enormous changes, loss, illness, or dementia that can cause or exacerbate anxiety. Conversely, when one is very anxious one may become forgetful or confused. Although it is usual for anxiety to increase with major life changes, anxiety that disrupts a person’s usual activities can and should be evaluated and treated.

Anxiety disorders are among the most treatable of illnesses, and include panic disorders, post traumatic stress disorder, social anxiety, and generalized anxiety disorder. Treatments vary and include medication, cognitive behavioral therapy, desensitization and relaxation techniques, yoga and exercise, and natural remedies.

“Facing the future, even with a sure faith, is not easy. I am cautious at every step forward, taking time and believing I shall be told where to go and what to do. Waiting patiently and creatively is at times unbearably difficult, but I know it must be so.”
Jennifer Morris, 1980, PYM Faith and Practice 2002

Symptoms of Generalized Anxiety Disorder:

  • Excessive, ongoing worry and tension
  • An unrealistic view of problems
  • Restlessness or a feeling of being “edgy”
  • Irritability
  • Muscle tension
  • Headaches
  • Sweating
  • Difficulty concentrating
  • Nausea or other stomach problems
  • The need to go to the bathroom frequently
  • Tiredness and being easily fatigued
  • Trouble falling or staying asleep
  • Trembling or tingling feelings in limbs
  • Being easily startled

As this list shows, the symptoms of anxiety often mimic symptoms of physical illness and vice versa. An evaluation by a doctor or mental health professional can help sort out the cause of one’s symptoms, allowing proper treatment.

How can we help? A spiritual community can provide spiritual support so that the whole person is addressed in the healing process.

  • Challenge stigma and fear of mental illness by educating oneself and others
  • Establish a climate of safety in your community for those with differences or facing major life changes.
  • Always ask. Let the person know you are there to help, and ask what they need. One would not question talking to a person about help they need related to physical illness.
  • Quaker Meetings may offer Clearness Committees for Friends or caregivers experiencing anxiety.
  • Remember that feelings are real to all of us. Regardless of how unrealistic a fear may seem, validate the person’s feelings. (See Quaker Aging Resources brochure on Validation)
  • Provide reassurance, but try not to belittle the person’s fear, and remember they may need to work in small steps.
  • Encourage but do not push a person with anxiety.
  • Refer to professionals. Encourage Friends to see their doctor and/or seek counseling.
  • Offer to walk beside the person on this journey. Even simply accompanying the person to an appointment can support and validate their care.
  • A very small group or individual visit can provide spiritual support if the person has trouble attending worship. If necessary, meet without the person to pray or hold them in the light, and let them know you are doing so.
  • Encourage physical activity, which has the capacity to alleviate anxiety. Offer to take a walk or a yoga class together.
  • Encourage professional help and provide information about your local resources.

“True silence is the rest of the mind; and is to the spirit, what sleep is to the body, nourishment and refreshment.”
William Penn, as quoted in PYM Faith and Practice, 2002

Download this article in pamphlet form

LINKS TO MORE INFORMATION: Click on the blue text below to be directed to outside websites that offer additional information on this topic. Articles from this site will open in the same browser window/tab. Articles from other websites will open in a new window; when you are done, simply click out of that window and you will be back on this site.

More articles on this website:

Care of the Caregiver
Honoring the Individual Through Validation
Spiritual Approach to Dementia Care
Spirituality and Change
Stigma

Other Articles/Links:

Anxiety and Depression Association of America
Mental Health Ministries

Honoring the Individual Through Validation

“And thou, faithful babe, though thou stutter and stammer forth a few words in the dread of the Lord, they are accepted.”
William Dewsbury, 1660, Quoted in PYM Faith and Practice, 2002

Validation therapy, developed by Naomi Feil, works from the belief that there is a reason behind the way people behave and what we communicate. When we validate, rather than judge one another, we honor the unique spirit within each person.

Each of us has a collection of experiences and emotions that inform how we respond to a situation. Naomi Feil developed techniques for using Validation Therapy to converse with people who are experiencing later stages of dementia. These principles and techniques are useful for relating to one another with compassion and empathy at any point in our lives and in a manner that is consistent with Friends’ belief that there is that of God in every person.

Principles of Validation *

  • All people are unique.
  • All people are valuable.
  • There is a reason behind behavior.
  • People must be accepted, not judged.
  • Painful feelings that are expressed and validated will
  • diminish.
  • Painful feelings that are ignored or suppressed will gain strength.
  • Empathy builds trust, reduces anxiety, and restores dignity.

Simple Ways to Help:

  • Avoid advice, testing, and correction – it may only frustrate the person and make it more difficult to communicate.
  • Focus on feelings instead of facts.
  • Reflect back to the person what they have just said to you, without judging their feelings.
  • Consider what might be behind this person feeling upset or anxious and try to respond with empathy to their feelings by imagining their reality.
  • Accept repetition. If someone has dementia, is grieving or distressed, they may not remember your prior conversation; they may need to repeat themselves to process emotions.

This scenario gives examples of some ways you can communicate with someone with dementia, using Validation techniques:

I was having lunch with my old friend Sarah. When I arrived she seemed uncertain who I was. I felt sad that she could not remember me, but I knew she couldn’t help it. I put out my hand and said “It’s Ella and I am so glad to be having lunch with you today.”

Sarah was anxious after lunch and said she needed to get home before her children were dropped off by the school bus. Our kids are all grown with children of their own, but her worry was real. “Yes, it is does seem close to that time of day. Your family knows where you are and everyone is being cared for.”

Sarah asked about her children a few more times while we were waiting for the bill, but seemed to calm down when we left. On the trip home, she focused on everything there was to see along the way. Back at her apartment, she didn’t look for the children. We looked at some old pictures, and laughed.

“Our life is love, and peace, and tenderness; and bearing one with another, and forgiving one another, and not laying accusations one against another, but praying for one another, and helping one another up with a tender hand.”
Isaac Penington, 1667, PYM Faith and Practice, 2002

*adapted from Naomi Feil, The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer’s -Type Dementia, 1993 http://www.vfvalidation.org

Download this article in pamphlet form

LINKS TO MORE INFORMATION: Click on the blue text below to be directed to outside websites that offer additional information on this topic. Articles from this site will open in the same browser window/tab. Articles from other websites will open in a new window; when you are done, simply click out of that window and you will be back on this site.

More articles on this website:

Allowing Yourself to be Cared For: Autonomy, Interdependence and Interrelationship
Care of the Caregiver
Including Everyone: Faith Community Care for People with Challenges
Spiritual Approach to Dementia Care

Other Articles/Links:

Validation Training Institute

Sources/Further Reading:

Naomi Feil, The Validation Breakthrough, 2002 Health Professions Press, Inc., Baltimore, Maryland.

Advance Directives

“…living close to physical death (our own and that of others), we come to recognize death as a natural and often welcome event. Yet another movement of growth into the fullness of the knowledge of God.”
Margaret McNeill, 1990, PYM Faith and Practice, 2002

If you are 18 and over and wish to have a say about what may happen to you if you become unable to speak for yourself, you need Advance Directives. Advance Directives include a Health Care Proxy, Living Will, Power of Attorney, and a will. Towards the end of life, one needs a Do Not Resuscitate (DNR), and some states may have other forms as well.

A Health Care Proxy allows a person to choose whom they want to make their decisions for medical care when they are not able or no longer want to. It also provides space to say exactly what those decisions would be. Your state may have one online. It allows you to make your choices and remain in control. Parents will not necessarily be deferred to by doctors for an adult child (18 and over), especially if the parents are divorced and not in agreement.

Living Wills also are tools to express your medical decisions, but they do not have the power of law behind them that a Health Care Proxy does. They do give additional opportunity to be clear about your wishes. They can also be found online.

A Power of Attorney (POA), or a Springing or Durable POA covers non-medical decisions that may need to be made when you are no longer able, such things as paying the bills, choosing a long term care facility, doing the taxes. Be sure that your form is the most current one accepted by your state. A springing POA is one that only goes into effect when you no longer can take care of business yourself; a durable POA remains in effect when you are no longer able. Some states websites provide them online, or they may be purchased at a business supply store.
Wills are not magic: doing one will not make you die, despite what many Friends have only half jokingly told ARCH program facilitators. Children will need someone to care for them, if the parents are no longer able and you want to be the person choosing, rather than having the decision made by the court, or by a family argument. Wills can clearly make your wishes known about what to do with the stuff, the cash, and who or how that is decided, and thus prevents those ugly family fights that result in siblings becoming estranged. If you do not have a will the state may decide how much of your estate goes to your children and how much to your spouse. The three previous items do not need a lawyer, a will does.

DNR and other state forms are available to complete towards the end of life. Your state’s Do Not Resuscitate form is online. It prevents you from having your heart or lungs restarted when you no longer want that to happen. In many states, even if you have a DNR, when someone calls the paramedics they will, by law, resuscitate you. If this is not what you want, ask the people who are likely to be with you just to hold your hand. Your state may have other forms you can fill out with your doctor telling what treatment you do and do not want at the end of life, and the doctor signs and dates each section. Having this conversation with your MD can help your decisions and informs your doctor, since these directives can be enforced by law.

A File of Life is a plastic bag with a red sticker on it kept on the refrigerator door, and a matching red sticker goes on the front door. Inside the bag is a copy of your proxy statement and a form with all your medical information. Paramedics will recognize the sticker on the door and will grab the bag and take it with you to the hospital.

Once you have filled out all of these, give a copy of each, except your will, to your family, your health care proxy and all your doctors and discuss what exactly your decisions are. Your lawyer keeps the original of your will. Do not keep any of these in the safety deposit box, which will be sealed at your death, preventing your loved ones from being able to get them for several weeks.

Consider having a conversation in your faith community about planning for very serious illness or the end of life. Exploring these issues in a supportive environment can help people address their values and emotions while making informed decisions. Both NYYM and PYM offer free Advance Directives workshops to Meetings in which we provide such forms, discuss the issues and do a whole lot more. Friends find this workshop to be actually enjoyable as well as informative, and not gloomy. To schedule a workshop for your Meeting contact your Yearly Meeting office.

Download this article in pamphlet form

LINKS TO MORE INFORMATION: Click on the blue text below to be directed to outside websites that offer additional information on this topic. Articles from this site will open in the same browser window/tab. Articles from other websites will open in a new window; when you are done, simply click out of that window and you will be back on this site.

More articles on this website:

End of Life Decision Making and Quaker Testimonies
Green Burial and Other Options

Other Articles/Links:

Minute from Northern Yearly Meeting about preparing for death
Download your state’s Advance Health Care Directives
Legal Guide for the Seriously Ill

Sources/Further Reading:

Hank Dunn, Hard Choices for Loving People: CPR, Artificial Feeding, Comfort Care and the Patient with a Life-Threatening Illness, Fifth Edition (ISBN 978-1-928560-06-7)

Elizabeth Gray Vining, Facing One’s Own Death, 1979, Spoken Essay for the Committee on Worship and Ministry for Philadelphia Yearly Meeting.

Lucy Screechfield McIver, A Song of Death, Our Spiritual Birth: A Quaker Way of Dying, Pendle Hill Pamphlet 340, 1998, Pendle Hill, Wallingford, PA.