Category Archives: Emotional Care

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

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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

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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.

Grief

“What we must do…with God’s help, is to accept sorrow as a friend, if possible. If not, as a companion with whom we will live for an indeterminate period, for whom we have to make room as one makes room for a guest in one’s house, a companion of whom we shall always be aware, from whom we can learn and whose strength will become our strength. Together we can create beauty from the ashes and find ourselves in the process.”
Elizabeth Gray Vining, 1952, Quoted in PYM Faith and Practice, 2002

Grief, the intense sadness that comes after a loss, manifests itself in many forms, is different for everyone, and often impossible to put into words. Though grief is universally experienced, it can be isolating. Reminding us of our aloneness in how it affects each person differently, it is something that one must go through in one’s own way. It can numb, enrage, or level a person all in one day. It may challenge our faith. Grieving persons may experience anxiety, depression, fear, physical aching, and may feel blindsided, experiencing an intensity of feeling they have never experienced before. Some may experience giddiness, or other seemingly inappropriate emotions. Those who have grieved and who work with grieving people agree, there is no way around it, only through it.

In 1969, Dr. Elizabeth Kubler-Ross identified five stages of grief:

  1. Denial: A sense of unreality, this cannot be happening. One may feel numb, unable to process emotions. This may be a way of helping us cope with loss without being completely overwhelmed.
  2. Anger: One has a sense of unfairness. A person may become angry at the one who died, oneself, family members, or doctors.
  3. Bargaining: This may take place before the loss. Bargaining with God, with family members, with one who is leaving… “I’ll be a better person if…”
  4. Depression: Overwhelming sadness, frustration, hopelessness. People may experience changes in sleep patterns, eating habits, even thoughts of suicide. Always refer to professional help if thoughts of suicide are expressed or suspected.
  5. Acceptance: The loss is accepted as permanent, and thoughts turn to moving on and finding the good in life again. One realizes that life must go on and begins to take steps toward living again. This does not mean the loss is forgotten or that sadness is gone for good, but that we can cope and move forward with living. Some people may become resigned, rather than accepting. This is not the same and may indicate that the person needs further help in coping with their loss.

Though stages of grieving have been identified, not everyone goes through these stages in the same pattern. How then, can we help others or ourselves through the grieving process?

Supporting a Grieving Person:

  • Do not expect people to grieve a certain way, follow a specific pattern, or stick to a timeline of grief. Expectations that grief should end within an allotted time are unrealistic and arbitrary.
  • Validate and accept whatever a person is feeling– numbness, anger, confusion, sadness. Feelings are not right or wrong, they just are.
  • Do not ignore or avoid the loss. If you do not know what to say, just listen and be present. Some people may process their loss by repeating the story. Be willing to listen again.
  • Provide physical comfort and practical support – food, housework, organization, help with childcare, outdoor chores.
  • Empathy, when genuine, can be helpful. Letting a person know that you have experienced similar feelings, if this is true, may alleviate loneliness and provide comfort that this pain will not last forever. However, try to avoid comparisons that set up expectations. Acknowledge that each of you will have a unique experience, but that you will be beside the person no matter what. Again, just listen.
  • Provide information about professional resources, support groups and counseling. Offer rides and support as needed.
  • Seek immediate help if thoughts of suicide are expressed.
  • Listen.

Traumatic or Complicated Grief:

Grief after a trauma, such as an accident, violent, sudden or painful death may be exacerbated by post traumatic stress disorder. There is increasing evidence that in such cases, treating the person for post traumatic stress is important in allowing for a healthy grieving process. Often the focus is on the person who has died or is in intensive care and the trauma to family members is overlooked. A professional evaluation should be conducted to be certain that appropriate treatment occurs.

Grief that is unrelenting, worsens over a long time, or is accompanied by unusual behavior may indicate complicated grief. A professional should evaluate complicated grief.

Blessed are they who mourn, for they shall be comforted.
The Beatitudes

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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

Other Articles/Links:

Journey of Hearts website
Grief’s Journey website
Journey Through Grief Website
The Compassionate Friend: grief support after a child dies

Sources/Further Reading:

Agnes Whitaker, Editor, All in the End is Harvest, an Anthology for Those Who Grieve, 1984, Darton, Longman&Todd, London.

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

Ronna Fay Jevne and James E. Miller, Finding Hope: Ways to See Life in a Brighter Light, 1999, Willowgreen Publishing, Fort Wayne, Indiana.

Lucille Clifton, Everett Anderson’s Goodbye, 1983, Henry Holt and Company, New York, NY. (A children‘s book that captures the stages of grief in beautiful simplicity relevant to any age)

Fred Rogers, Mr. Rogers Talks With Parents, 1983, Family Communications Inc. Pittsburgh, PA. (A parenting book that covers many topics and has a beautiful, simple approach to grief and dying)

Joan Halifax, Being With Dying, Cultivating Compassion and Fearlessness in the Presence of Death, 2009, Shambala Publications, Boston.

Hoarding

“I saw that a humble man with the blessing of the Lord might live on a little…”
John Woolman, 1743, Quoted in PYM Faith and Practice, 2002

Hoarding is a phenomenon that leads to social isolation, depression, anxiety, and reluctance to move in retirement. This reluctance often brings hoarding to the awareness of family and Meeting. By hoarding I do not mean simple clutter; a cluttered home may have piles of stuff here and there that are worked at and diminished from time to time.

Hoarding is a psychological issue that results in stuff everywhere, a home that can’t be walked through, a bathtub full of clothes, all correspondence for the past 20 years in boxes, a dining room table piled so high that no one has ever eaten there, appliances that don’t work and can’t be gotten rid of, half the bed covered with junk mail.

A way to distinguish between clutter and hoarding is the emotional distress or barriers thrown up at the thought of getting rid of anything. For hoarders their stuff is an extension, definition, or protection, of Self and cannot be eliminated. There are YouTube sites with videos of the homes of hoarders, and of the negative results of making a surprise intervention and cleaning the place while Mom is not home.

While hoarding may be treated successfully as an addiction, it is an anxiety based disorder and sometimes requires professional help. There is a network of social workers who specialize in this phenomenon. There are also a few workbooks that can walk the hoarder through making changes in small steps, a process best done with on-site assistance of someone with great patience, which usually means not a family member.

Due to the emotional need for their stuff, hoarders can be extremely reluctant to move. Trudy had severe arthritis but lived in a house with five levels; she needed to be some place that was all on one floor, or with elevators. Her children had shown her attractive places to move to, but she continued to refuse in spite of her constant pain. An Aging Services Specialist worked with Trudy weekly for 6 months, gaining her trust, helping her to decide what she truly wanted to save and what could be gotten rid of, and they worked together on one small area at a time. Once the most important things were boxed, Trudy agreed to move and leave behind the bulk of stuff to be cleaned out after moving. This order of moving first and then getting rid of stuff is more effective and easier on the hoarder than thinking that everything extraneous must go before a move can be contemplated.

The other learning for families or Meetings of anyone reluctant to move is taking the time to listen to the reasons, and then taking those reasons seriously. For Will it was that the house held all his memories of his wife who had died many years before. Offering Will a large box in which he could put the things most central to his memories would allow him a sense of control and respect.

Marta’s need was to know that everything she was leaving behind would go to a home somewhere. First Marta invited family and friends to take what they wanted, and then Marta identified the charity that would receive the proceeds of the estate sale held after the move. Marta’s needs were met and she could move.

However, neither Will nor Marta was a hoarder; both were merely savers. Hoarders need time and expertise to make moving thinkable.

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:

Anxiety and Change
Honoring the Individual Through Validation

Other Articles/Links:

Find Help With Hoarding
National Association of Senior Move Managers

Sources/Further Reading:

David F. Tolin, Randy O. Frost, Gail Steketee, Buried in Treasures, 2007, Oxford University Press, New York, NY.

Including Everyone: Faith Community Care for People with Challenges

Q: Do I show through my way of living that love of God includes affirming the equality of all people, treating others with dignity and respect, and seeking to recognize and address that of God in every person?
PYM Faith and Practice, 2002

Any of us, at any time, may experience a challenge that means we need adaptations to access places, activities, and community that are important to our lives. We are all in some way differently-abled. For some, needs differ only slightly or temporarily from the mainstream, others face lifelong challenges. Creating an inclusive environment supports Friends’ Testimony of Equality and enriches the spiritual community by allowing us to experience the rich and beautiful diversity of humankind. How can a faith community create an environment where everyone fits, all are welcomed warmly, and each person’s needs are considered?

When considering accessibility and community, try to avoid assumptions and always ask a person what they need. Many spiritual groups are eager to address building accessibility, and this is important. (It is difficult to attend an event where one cannot access the bathroom) However, inclusiveness requires sound communication and a welcoming attitude in addition to physical accessibility. Following are some ideas gathered from various Quaker Meeting’s reponses to a Philadelphia Yearly Meeting Care and Aging Survey conducted in 2009 and also from Grounded in God, Care and Nurture in Friends Meetings, edited by Pat McBee. In addition, you may want to contact your regional faith community office, such as your Yearly Meeting, or a local advocacy group for resources and support.

  • Nothing About Me Without Me: always ask people what they need, and how the community can be welcoming and accommodating.
  • Make sure you address a variety of barriers: architecture and communication is accessible, and that your attitude is welcoming.
  • Maintain awareness of local resources, call on them or your regional faith organization (Yearly Meeting for Friends, Area Agency on Aging, advocacy groups) for help.
  • Regularly make any resources known, i.e. financial assistance that is available (funds available through your faith group.)
  • Announce needs for rides, visits, or other support after worship, during events, through phone committee or e-mail lists.
  • Education for the community, on sensitivity and related to specific challenges
  • Maintain contact information for family members or close friends for people choose to share this information. This helps in the event of a crisis or if the group is unable to contact someone.
  • Support caregivers—Clearness Committees and spiritual care as well as practical support such as cooking, cleaning, visits, transportation
  • Provide opportunities for service to the community—a homebound person may be able to serve on the phone committee, for example, or ask homebound members to mentor new or younger attenders
  • Establish a “buddy system” for people who live alone
  • Communicate with people who are unable to attend worship or committee meetings through newsletters, phone calls, website. Web blogs, e-mail, home visits, send photographs or letters.
  • Assess why your members can’t attend. Are people truly homebound, or is it your environment shutting them out?
  • Do you need to work on the environment, communication, or attitudes so everyone is welcomed and included?

“The test of true ‘community’ is not its sighs of pity for its vulnerable citizens, but its acts of acceptance and inclusion.”
Christina Hurr, Superintendent for the Butler County Board of Mental Retardation and Developmental Disabilities, Ohio

“When we learn to be inclusive, we can be a world of shalem, or wholeness, and create a world of shalom, which is peace.”
Rabbi Ted Riter, Temple Adat Elohim, California

“A community that excludes even one of its members is no community at all.”
Dan Wilkins

“You should include everybody, that’s how you stop bullying.”
Buffo, World’s Strongest Clown

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:

Role of the Spiritual Community in Care
Spiritual Approach to Dementia Care

Sources/Further Reading:

Edited by Pat McBee, Grounded in God, Care and Nurture in Friends Meetings, Philadelphia, Quaker Press of FGC, 2002.

That All May Worship – An Interfaith Welcome to People with Disabilities, 2005, National Organization on Disability, Washington, D.C.

Erik Carter, Including People with Disabilities in Faith Communities, 2007, Paul Brookes Publishing, Baltimore, Maryland

Various Meeting’s reponses to Philadelphia Yearly Meeting Care and Aging Survey, 2009.

Quotes from Everyone Is Included