Coping with helplessness.

Abstract

Part of my assignment as a palliative care psychiatrist involves psychotherapy with severely ill inpatient veterans. One morning each week, my site of operations is a specialized inpatient unit called the community living center. Some of the patients on this unit receive hospice care, while others are designated “end of life.” Although the expectation for the residents of this community is “life at its final stage,” some improve sufficiently to actually achieve discharge. Others remain residents for far longer than the standard “6-month or less” stay. The opportunity is therefore provided for both short-term and longer-term psychotherapy, with adjustment to a hospital existence the common goal. In nearly 4 years of work on this unit, I have come to know a number of men and women. I have approached each patient from the viewpoint of cognitive therapy. A common issue I have encountered is the resident’s inability to continue to do what he or she did previously at a younger age. In some instances, this inability may form the basis for how the resident views his or her identity. Entry into this stage of life often mandates a change. The resident is also required to learn how to live in a space accommodating 20 people, rather than in an apartment for one or in a home for a family. Helplessness comes in a variety of forms, and, for some patients, it may recur over and over again. I met Mr A almost 3 years ago. We worked together for a year in weekly psychotherapy sessions. In many ways, however, our most important work took place recently, nearly 3 years after we first met. But, that gets ahead of my story.