Social Work in Health Care
ISSN: 0098-1389 (Print) 1541-034X (Online) Journal homepage: http://www.tandfonline.com/loi/wshc20
FROM LIFE TO DEATH Josephine A. Lockwood MD To cite this article: Josephine A. Lockwood MD (1978) FROM LIFE TO DEATH, Social Work in Health Care, 4:1, 81-84, DOI: 10.1300/J010v04n01_08 To link to this article: http://dx.doi.org/10.1300/J010v04n01_08
Published online: 12 Dec 2008.
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Date: 29 June 2016, At: 07:17
FROM LIFE TO DEATH
Downloaded by [Boston University] at 07:17 29 June 2016
Josephine A. Lockwood, MD
The medical literature has been replete with publications concerning "the dyingpatient." Of late, one is impressed with the numerous seminars that have occurred in many, if not most, major teaching centers focusing on "the dying patient." Each publication and each seminar attempts to bring greater understanding of the psychological problems with which patients are confronted as they face each day in the process of life extension to the point of death. After having attended many such symposia and after having read extensively about management of families and patients termed "dying," it has been my overall impression that this total concept is counter-life thinking. The processes and dynamics pointed out are those of stepwise adjustments to life rather than death. The reality is that this adjustment is limited, and therefore the patient's time clock requires resetting, as do the goals, expectations, and time clock of medical and paramedical staff. I think it can be readily accepted that a patient is truly "dying," in the context in which this expression is usually used, if that patient is comatose or totally withdrawn and unable to respond to surrounding environment. ~ y i n in g itself can only be thought bf as a process and continuum. I t has been stated that the onset of dying. - bedns - at the moment that growth ceases, which would place t i a t time period some place in the adolescent phase. Needless to say, one's everyday experiences are not spent thinking about the shortening of life by each day lived. Rather, one would hope that each day would be accepted as lifeper se with inner development, a consequence of the acceptance of that life throughout its entire span up to and through those phases of chronic illness that will ultimately lead to death. I t has been stated, "He who fears the experience of dying is unpre pared for the process of living." In so thinking, one accepts as part of life the concept of death. One incorporates all phases into one's own b e ing and thereby potentiates great& insightsmintothe real meaning of each moment's relationshi~sand ex~eriences.If one thinks in terms of dying patients, one's teniency, w i e attempting to explain medical
a
Dr. Lockwood is Associate F'rofessor of Clinical Medicine and Community Preventive Medicine. New York Medical CoUege, and Medical Director, Home Health Agency. Metropolitan Hospital Center. 1901 First Avenue. New York. New York 10029.
'
Downloaded by [Boston University] at 07:17 29 June 2016
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SOCIAL WORK IN HEALTH CARE
care maximally to all patients, is to transmit an attitude of despair to a patient undergoing such an experience. At no time, save when patients are comatose, is any patient without hope, nor should any medical staff person be without hope. The phrase "dying patient" suggests that analogy may be made to an oft-quoted phrase in the writings of Alexandre Dumas, "All ye who enter here, leave hope behind." I would like us therefore to turn our attention to living patients in the process of dying. Such process may span 30 years or 3 hours. In each situation those who have contact with the patient are capable of bringing renewal of hope in that moment of experience together. This is not to say that one denies the existence of serious illness and life-threatening situations, but that one realistically approaches them with the patient and deals with the patient directly. That moment's experience represents a "lifetime" experience in that very moment. Reality must be part of life experience and preparation for tomorrow, the next month, the next year, or the next 10 years and must be ongoing. The greatest development in this area will be internal development with which the patient can be helped by the understanding of medical care persohnel. Dr. Adriaan Verwoedt (1976),in a publication on clinical aspects of aging, has noted that "a number of aged individuals tend to withdraw from reality and to retreat into their inner selves in order to live out their memories. A withdrawal into fantasy is the final outcome of a long process-a process which frequently begins with the experience of significant losses." The fact that such occurrences are noted in aged and chronically ill individuals is an indication that lack of external stimuli, the multiple losses that these patients undergo, and insecurity concerning their own acceptance by neighbors, relatives, and medical staff result in such withdrawals and regression. The ultimate end to this withdrawal would be termed "advanced senile regression." Such a situation would once more represent death, but in a patient who continues to have life processes working. That such a thing can happen is a reflection of the society in which we live or the manner in which we care for the elderly and chronically ill. We might define the stages of living as follows: (a)from birth to adolescence; (b)from adolescence to "adult"; and (c)adult living to death. Reviewing each of those three phases, one can note that if we were to plot the total process, we would be put on an upswinging line for Stage 1 (representing birth to adolescence, physical growth). For Stage 2 we might indicate a plateau or cessation of physical growth, that is, maintenance and stability. For Stage 3 we might represent a slope downwards. When further analyzed, the three stages examined from the innergrowth aspects (i.e., the psychological development of the individual) appear entirely different. Stage 1 would represent some upswing, Stage 2 a more marked upswing, and Stage 3 a significantly more
Josephine A. Lockwood
83
marked upswing. I t is clear that the more experiences one incorporates into one's life. the more meaningful that life will become, and the more one will contribute to other indiaduals and to society as a.whole. LIFE-A TOTAL CONTINUUM
Downloaded by [Boston University] at 07:17 29 June 2016
By thinking of patients in all phases of life as living patients in the process of dying, regardless of the degree and rapidity of advance of disease, we conceptually can bring about the following:
1. Continuing hope with reinforcement day by day. 2. Acceptance of naturally occurring physical and psychological events, thereby diminishing fear and allowing enjoyment of each day's life experience. 3. Professional attitudinal changes so that patients are treated with hope, dignity, and without fear on the part of professional staff in forming relationships despite the personal threat to them at the loss of the patient cared for. .4. Family attitudes and ability to work with patients will be enhanced. Fears will be allayed. I t will become clear that there is nothing ominous about the process of aging and about the degenerative processes associated with chronic disease entities. 5. Patients' attitudes will also be changed so as not to fear rejection, suffering, and isolation. Patients will be able to continue to bring positive forces to their immediate and adjacent environments. They will think of themselves as alive and vital to all those with whom they come into contact. In each situation in which a patient is felt to be "a dying patient," I have observed fears and changes in attitude to the detriment of the patient on the part of the patient, family, professional staff, and friends. CONCLUSIONS "What are you?-I am old." A booklet published by the State Communities Aide Association (1975) bears the above title. I t indicates that the question asked of so many, "What are you?" "Who are you?" can be answered in a multiplicity of ways. One will say "I am a salesman"; another, "I am a housewife"; still another, "I am an artist"; and another, "I am a bank teller"; and still another, "I am old." In the mind of that patient is the fear that just ahead lies the label "senile." The booklet referred to notes that "senility is an invention of modem Western society and is one of the most damaging selffulfilling prophecies ever devised. There is evidence that senility is
ISSN: 0098-1389 (Print) 1541-034X (Online) Journal homepage: http://www.tandfonline.com/loi/wshc20
FROM LIFE TO DEATH Josephine A. Lockwood MD To cite this article: Josephine A. Lockwood MD (1978) FROM LIFE TO DEATH, Social Work in Health Care, 4:1, 81-84, DOI: 10.1300/J010v04n01_08 To link to this article: http://dx.doi.org/10.1300/J010v04n01_08
Published online: 12 Dec 2008.
Submit your article to this journal
Article views: 6
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=wshc20 Download by: [Boston University]
Date: 29 June 2016, At: 07:17
FROM LIFE TO DEATH
Downloaded by [Boston University] at 07:17 29 June 2016
Josephine A. Lockwood, MD
The medical literature has been replete with publications concerning "the dyingpatient." Of late, one is impressed with the numerous seminars that have occurred in many, if not most, major teaching centers focusing on "the dying patient." Each publication and each seminar attempts to bring greater understanding of the psychological problems with which patients are confronted as they face each day in the process of life extension to the point of death. After having attended many such symposia and after having read extensively about management of families and patients termed "dying," it has been my overall impression that this total concept is counter-life thinking. The processes and dynamics pointed out are those of stepwise adjustments to life rather than death. The reality is that this adjustment is limited, and therefore the patient's time clock requires resetting, as do the goals, expectations, and time clock of medical and paramedical staff. I think it can be readily accepted that a patient is truly "dying," in the context in which this expression is usually used, if that patient is comatose or totally withdrawn and unable to respond to surrounding environment. ~ y i n in g itself can only be thought bf as a process and continuum. I t has been stated that the onset of dying. - bedns - at the moment that growth ceases, which would place t i a t time period some place in the adolescent phase. Needless to say, one's everyday experiences are not spent thinking about the shortening of life by each day lived. Rather, one would hope that each day would be accepted as lifeper se with inner development, a consequence of the acceptance of that life throughout its entire span up to and through those phases of chronic illness that will ultimately lead to death. I t has been stated, "He who fears the experience of dying is unpre pared for the process of living." In so thinking, one accepts as part of life the concept of death. One incorporates all phases into one's own b e ing and thereby potentiates great& insightsmintothe real meaning of each moment's relationshi~sand ex~eriences.If one thinks in terms of dying patients, one's teniency, w i e attempting to explain medical
a
Dr. Lockwood is Associate F'rofessor of Clinical Medicine and Community Preventive Medicine. New York Medical CoUege, and Medical Director, Home Health Agency. Metropolitan Hospital Center. 1901 First Avenue. New York. New York 10029.
'
Downloaded by [Boston University] at 07:17 29 June 2016
82
SOCIAL WORK IN HEALTH CARE
care maximally to all patients, is to transmit an attitude of despair to a patient undergoing such an experience. At no time, save when patients are comatose, is any patient without hope, nor should any medical staff person be without hope. The phrase "dying patient" suggests that analogy may be made to an oft-quoted phrase in the writings of Alexandre Dumas, "All ye who enter here, leave hope behind." I would like us therefore to turn our attention to living patients in the process of dying. Such process may span 30 years or 3 hours. In each situation those who have contact with the patient are capable of bringing renewal of hope in that moment of experience together. This is not to say that one denies the existence of serious illness and life-threatening situations, but that one realistically approaches them with the patient and deals with the patient directly. That moment's experience represents a "lifetime" experience in that very moment. Reality must be part of life experience and preparation for tomorrow, the next month, the next year, or the next 10 years and must be ongoing. The greatest development in this area will be internal development with which the patient can be helped by the understanding of medical care persohnel. Dr. Adriaan Verwoedt (1976),in a publication on clinical aspects of aging, has noted that "a number of aged individuals tend to withdraw from reality and to retreat into their inner selves in order to live out their memories. A withdrawal into fantasy is the final outcome of a long process-a process which frequently begins with the experience of significant losses." The fact that such occurrences are noted in aged and chronically ill individuals is an indication that lack of external stimuli, the multiple losses that these patients undergo, and insecurity concerning their own acceptance by neighbors, relatives, and medical staff result in such withdrawals and regression. The ultimate end to this withdrawal would be termed "advanced senile regression." Such a situation would once more represent death, but in a patient who continues to have life processes working. That such a thing can happen is a reflection of the society in which we live or the manner in which we care for the elderly and chronically ill. We might define the stages of living as follows: (a)from birth to adolescence; (b)from adolescence to "adult"; and (c)adult living to death. Reviewing each of those three phases, one can note that if we were to plot the total process, we would be put on an upswinging line for Stage 1 (representing birth to adolescence, physical growth). For Stage 2 we might indicate a plateau or cessation of physical growth, that is, maintenance and stability. For Stage 3 we might represent a slope downwards. When further analyzed, the three stages examined from the innergrowth aspects (i.e., the psychological development of the individual) appear entirely different. Stage 1 would represent some upswing, Stage 2 a more marked upswing, and Stage 3 a significantly more
Josephine A. Lockwood
83
marked upswing. I t is clear that the more experiences one incorporates into one's life. the more meaningful that life will become, and the more one will contribute to other indiaduals and to society as a.whole. LIFE-A TOTAL CONTINUUM
Downloaded by [Boston University] at 07:17 29 June 2016
By thinking of patients in all phases of life as living patients in the process of dying, regardless of the degree and rapidity of advance of disease, we conceptually can bring about the following:
1. Continuing hope with reinforcement day by day. 2. Acceptance of naturally occurring physical and psychological events, thereby diminishing fear and allowing enjoyment of each day's life experience. 3. Professional attitudinal changes so that patients are treated with hope, dignity, and without fear on the part of professional staff in forming relationships despite the personal threat to them at the loss of the patient cared for. .4. Family attitudes and ability to work with patients will be enhanced. Fears will be allayed. I t will become clear that there is nothing ominous about the process of aging and about the degenerative processes associated with chronic disease entities. 5. Patients' attitudes will also be changed so as not to fear rejection, suffering, and isolation. Patients will be able to continue to bring positive forces to their immediate and adjacent environments. They will think of themselves as alive and vital to all those with whom they come into contact. In each situation in which a patient is felt to be "a dying patient," I have observed fears and changes in attitude to the detriment of the patient on the part of the patient, family, professional staff, and friends. CONCLUSIONS "What are you?-I am old." A booklet published by the State Communities Aide Association (1975) bears the above title. I t indicates that the question asked of so many, "What are you?" "Who are you?" can be answered in a multiplicity of ways. One will say "I am a salesman"; another, "I am a housewife"; still another, "I am an artist"; and another, "I am a bank teller"; and still another, "I am old." In the mind of that patient is the fear that just ahead lies the label "senile." The booklet referred to notes that "senility is an invention of modem Western society and is one of the most damaging selffulfilling prophecies ever devised. There is evidence that senility is
