(p. 171) Resilience, Transcendence, and Spirituality
■ To work toward resilience and transcendence
■ To understand the importance of spirituality and personal growth
■ To review the program
■ To plan the next steps
■ Hester’s parents got divorced when she was only 3 years old. Her dad disappeared completely and her mom drowned her sorrows in vodka and cigarettes. When Hester was 11, she was sexually molested by a male relative of a neighbor who was supposed to be keeping an eye on her. When she was 17, Hester got mugged and still has the scar from where her throat was nearly cut. At 37, she found a lump in her breast and was told it was cancer. She had a mastectomy and chemotherapy. Today, at the age of 49, Hester is the Executive Director of a very successful non-profit agency that provides mental health care to adolescent girls at risk and pairs them with a “big sister” to help them grow and thrive. Her agency has helped over 150 girls graduate from high school and move on to college. As she looks ahead, she hopes these girls will pass the gift on to their daughters and their daughters’ daughters. When a local reporter asked her how she could personally come through so much and still give so much back, Hester answered, “My wounds are my strength. Without them, I’d never realize how important it is to feel loved.” ■
(p. 172) Resilience and Transcendence
Resilience is roughly defined as the capacity to succeed despite the odds. It is the ability to bounce back despite substantial injury. Resilient individuals have often endured great hardship but have managed to pick themselves up, dust themselves off, and continue forward on their journey. Transcendence takes resilience one step further: not only does the individual survive the hardship, but they are able to learn and grow from that hardship in a way that makes them a better or stronger person. Stories abound of individuals who have grown from injuries or disabilities, or even from learning they are terminally ill. They may no longer be “able-bodied” in the traditional sense but they have become “able-hearted” or “able-spirited”—an accomplishment far more valuable than mere physical functioning.
Ways to Promote Resilience
Given your illness, you may not feel particularly resilient. You may often feel tired, in pain, or just overwhelmed with the daily tasks of coping. Fortunately, there are ways that you can become more resilient.
Find a place of refuge or sanctuary.
Everyone needs a “space” to get away from the stressor(s) that is challenging his ability to cope. That place might be a physical location such as a garden, beach, church, or friend’s house. It might also be a mental space where you can go to find rest and relaxation—e.g., meditation, guided imagery, etc.
Remember that all things come to an end. Good things end, but so do bad things. Pain does not last forever, nor does suffering. You can probably recall very good and very bad times in your life. In the midst of those times, change might have seemed impossible. But the situation did change. Things always change, even if we can’t see how at the moment.
Believe in control.
Although some things are out of your control, you often have more influence than you believe you have, even if it only means controlling your mood and not the situation. You can manage how you think about a situation. You can control whom you do (p. 173) or don’t talk to about the situation. You can control how you choose to cope with an unchangeable situation. Regardless of what comes your way, you always have some element of control.
Draw on the power of relationships.
It is difficult to bear life alone, but with support, we can bear almost anything. Support can come from family, friends, pets, or our sense of spirituality. Remember not to be a “lone ranger.” Ask for help and accept it gratefully.
Find the “why.”
Suffering without a sense of meaning or purpose is perhaps the worst suffering of all. Search for the reason why you should pick yourself up and continue forward. The “silver lining” of your chronic illness might be the opportunity to grow close to loved ones and carefully prepare for handing things off to the next generation.
Find a role model.
It is hard to know how to move forward if you have never seen anyone do it before. Support groups offer a good way to see how others are coping. Inspirational stories and biographies are another good way to see how others have coped or transcended adversity (see suggested reading list in the Appendix).
Use a “perspective meter.”
Suffering is relative to the individual. It arises from the perception of what you have lost. You may be so engrossed in your losses that you forget to look at the bigger picture. What gains are still in your life? What gains might be around the corner? If you look at the sum total of your life, what are things you can still savor?
Don’t take it personally.
Everyone gets sick and everyone dies. Everyone. If you are lucky, you get some advanced warning and are able to prepare for your death. You may have been given the opportunity of appreciating your last days instead of having them end abruptly (as in a sudden accidental death). You have every right to feel a wide range of emotions, but what is happening isn’t a personal attack on you. What is happening isn’t a cosmic injustice or crime. It is sad and it is difficult but it is a natural part of being alive. Let others share this important time with you. It is your time to be center stage.
(p. 174) Spirituality and Growth
Many see spirituality as an important tool for growth and transcendence. Serious illness often activates questions of spirituality regarding ultimate meaning, purpose, and even beliefs about what happens after we die. Spirituality, however, doesn’t necessarily refer to a particular religion or set of beliefs. In the broadest sense, it refers to thinking about issues larger than us—i.e., issues about meaning, connection, purpose, and value. It’s up to you to decide if spirituality is important and, if so, what form that spirituality might take.
Remember that the end of life can be just as special and spiritually meaningful as the beginning. It’s a time to resolve old conflicts, a time to make peace with yourself and your environment, a time to fully realize what’s important and what isn’t. Being sick often brings things into focus. Although we all must die, being sick makes our mortality seem more real and our life more precious. An ending seems like it may be within sight. As one patient said, “If you go to a play but don’t know when it ends, would you pay attention? I think I see the ending and I’m glued to the stage.”
The following questions are meant to guide and provoke thought. Remember there are no “right” answers.
1. Is spirituality important to you or your family?
2. What are your spiritual beliefs?
3. What are your spiritual practices?
4. Do you have a spiritual counselor, priest, or clergy? Where do you go for spiritual guidance?
(p. 175) 5. What gives you a sense of strength or meaning?
6. What effect will your illness have on your spiritual practices or beliefs?
7. How will your spiritual practices affect your health or health behaviors?
8. What are some of the larger questions you’ve been thinking about since you became ill?
9. What do you think happens after you die? Is there anything you need to do to prepare for that?
10. How can others help you maintain your source of spiritual strength and meaning during this illness?
(p. 176) Spiritual Growth Items
You may want to include some spiritual growth items on your lists of short- and long-term goals. Remember spirituality can include communion with nature, appreciation for science and mathematics, or whatever larger-than-life system you see as worthy of awe. Spiritual practices can include prayer, meditation, music, communion, fellowship, being in nature, etc. Although spirituality can be practiced alone (as with prayer or meditation), belonging to a spiritual community can accomplish the goals of both spiritual and social connections.
Recap and Summary
In short, the organization of the program was as follows:
Sessions 1—3: Stress and Coping—stress, breathing, cognition and habits of mind, appraisals, ways of coping, problem solving, A-B-C-D excercise
Sessions 4—6: Mood Management (Depression, Anxiety, Anger)—activity scheduling, relaxation, acceptance, forgiveness
Sessions 7—8: Social Supports—types of support, support networks, communication, listening, assertiveness, conflict resolution, negotiation
Sessions 9—11: Quality of Life—symptom management, end-of-life tasks, goal-setting, legacy projects, spirituality, looking forward
You are not expected to have become an expert in any of the skills presented by the end of this program. However, at this point you should be able to identify fruitful areas where you can work for greater mastery.
Program Feedback and Planning Next Steps—Action Plan
The following questions will help you evaluate your experience in this program and develop an action plan.
(p. 177) 1. What is the single most important, memorable, or useful thing you learned from this program?
2. How will your participation in this program continue to affect you?
3. Are there any concepts, ideas, or other areas of importance that the program didn’t cover or maybe didn’t spend enough time on?
4. If you could do this program all over again, what would you change about it? What would you do differently?
Use the My Action Plan form at the end of this chapter to develop a specific approach to continue learning, growing, and developing your self-management skills after today’s final session. Although you have already established short-, medium-, and long-term goals, this plan will specify what strategies you would like to use on a regular basis. Over the past 10 sessions, you have learned many strategies to identify, monitor, and manage stress, mood, relationships, and medical symptoms. You probably prefer some strategies over others; choose whatever works best for you and include these as part of your action plan. Be sure to reflect on your answers to the program evaluation questions.
Described next are some additional ideas you may want to include in your action plan.
(p. 178) Keeping a Journal: Three Variations on a Theme
It is a long-held belief that expressive writing such as keeping a diary or journal can promote health, and research is starting to prove it. In most versions, you are asked to write about an emotionally charged event for 15-20 minutes—e.g., write about an event that really upset you, detail what happened, why you think it happened, how it affects your life, etc. Specific instructions and variations can be found in Pennebaker’s book, Writing to Heal (2004).
A second variation provides a more focused and mood-uplifting journal format that influences selective attention and promotes savoring. Do this every day over the next several weeks to see how it affects your mood. At the end of each day, take about 10-15 minutes to answer three questions. You might want to jot down your answers for today now. Notice any impact this has on your mood.
1. What surprised me today?
2. What moved me today?
3. What inspired me today?
A third variant of the journal combines journaling with creating an end-of-life legacy project. You can combine journal entries (written or electronic) with poetry, art work, old photos, or MP3s of favorite songs, etc. The journal can be a collaborative effort with loved ones or be passed on as a gift for others to enjoy. The goal is to be creative and expressive while savoring positive memories and improving mood.
(p. 179) Letters to the Medical Team
The idea of gratitude or “fan” letters was presented in Session 10. As mentioned earlier, these letters can be shared or they can be saved as a collection of memoirs. Consider whether there are any medical professionals to whom you would like to write a letter to express your appreciation.
End of Program
Congratulations on completing the program! Though this signals the end of scheduled therapy, you will continue to improve your quality of life and grow as a person. Be sure to keep practicing and building on the new skills you have learned. The Appendix includes a brief list of books you may enjoy as part of your self-study, as well as information on helpful Web sites and organizations. You may consider setting up a “booster session” with your facilitator. Be sure to ask for additional assistance if you should need it in the future. Best of luck on the rest of your journey!
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