Article
Change
Mental Health
4 min read

Don't try and cope on your own

The company of those who care helps when handling traumas.
a man in a wheelchair sits in a subway station holding a sign reading 'seeking human kindness'.
Michael, Boston, 2018.
Matt Collamer on Unsplash.

I did a horrible piece of training at the weekend. You have to do a lot of continual learning if you’re a counsellor, and some of it is hard going. This particular session (with Cruse, a national bereavement charity) was about self-harm, and it contained sheets and slides and lists of the ways in which people hurt, damage and punish themselves. Usually as a way of expressing another kind of pain or because it’s the only thing they can control in a chaotic world. Six hours of it, on Zoom. 

All of us have topics that we struggle with – areas that we find difficult to contemplate – and self-harm is one of mine. It is so far from my own experience of reality that it makes me feel square and naïve and overprotected, and every part of me revolts against it in some way. How terrible that people who are already suffering can only find relief by inflicting further harm on themselves! And some of the injuries are so grievous. Mortifyingly, my main reaction on this occasion was an urge to put my fingers in my ears and tell everyone to STOP IT... not just the trainer, but the poor souls involved in hurting themselves too. Training can be humbling, in the way it reveals the limits of your own compassion to you.  

Clearly though, telling people to ‘stop it’ is not an option, however you might feel! So what to do? 

Christianity, usefully, offers quite a lot of different options for coping with difficult life stuff, so I started considering some of these as I attended to the trainer. The peaceful, thoughtful series of Lent reflections I’ve been listening to recently, for instance… might they help? Um no, not suitable really. Too meditative. You can’t ‘gather the scattered pieces of your consciousness and centre them on God’ when someone is talking about teenagers cutting themselves in ‘risky places, or too deep’ I found. Tranquillity of mind is too passive a response.  

So then I thought about people talking sometimes of being able to hand over their troubles to Christ. He ‘takest away the sins of the world’, as the communion service puts it... his arms are open and he is God, so he can bear the weight. But that didn’t work either. Too mystical. It felt as if action was required, not meek handing over of sorrows because I couldn’t bear to contemplate them. I don’t think we’re meant to dodge responsibility and simply go, ‘Ugh, you have these ones Lord because I don’t want them’.  

So, I sat there writhing inwardly and feeling sweaty and miserable and wishing I was somewhere else. 

This kind, accepting, unshocked conversation was immensely comforting and reassuring, I found. There was safety in it, and daylight, and hope. 

But then I started wondering how everyone else at Cruse copes with such things. I began looking at the other faces on my screen… the 21 of my colleagues who were also attending the training, almost all of them volunteers.  

There was the strong, calm face of Manju, an Indian doctor lady, and Suki, a smiley gappy-toothed African lady, who both work on the triaging team, assessing callers as they come in and assigning them to helpers. There was Richard the First and Richard the Second, both white, one younger than me, one older, both friendly and knowledgeable and kind. There was Naga, a retired nursing sister who looked Scandewegian, and Christina, ditto – except she’d been a teacher. And Nick, not much more than a teenager by the look of him, and Sat, a big Brummie taxi driver in a turban. William looked as if he might be an academic, with his leather elbow patches, and Keith had his sound off due to the presence of a large cat on his desk, which leaned over periodically to miaow into his mike. Lots of others too. 

And suddenly I realised that there was my answer: all those good people, giving up their Saturday because they cared. Listening to stories of suffering because they wanted to understand better, in order to be able to help – to do something for the broken and the sad among us. 

That’s the presence of God, surely: that an army of people turn out, day in, day out, to do things simply because they are good. There is no payment, no special recognition. They have to listen to some very difficult things and contemplate darkness that they wouldn’t necessarily in their own lives. But there they all were that morning, one small group among thousands of others all over the country no doubt – ready to serve, and cheerful and friendly and attentive. 

They talked matter-of-factly about cases they’d encountered and situations which can lead people to injure themselves, and about self-harm as a phenomenon in certain social groups. About how it can be treated, about how it can heal and disappear with the right care and compassion. About how sometimes it can even be preferable to other alternatives. It is much easier, for example, to stop self-harming than it is to recover from an eating disorder. 

This kind, accepting, unshocked conversation was immensely comforting and reassuring, I found. There was safety in it, and daylight, and hope. A feeling that even if someone is suffering, there are others who are able to meet them there, to keep them warm and hold them up. That people do act as the hands and feet of God actually sometimes, regardless of creed or faith or fallenness. 

Looking at them all I felt so much better… and that if they could do it, I could. We only need to work in company together and our collective strength will keep us all afloat, rescuers and rescued alike. ‘Be not afraid’ the Bible says over and over again. It is very much easier not to be, when you’re not trying to be brave by yourself. 

  

Article
Ageing
Care
Change
5 min read

Delicate, fragile, frail: how we cope when we age

The insights and analogies that help.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

An old woman wearing a shawl looks pensive.
Valentin Balan on Unsplash.

“Who could dissect a portion of the human frame without marvelling at its delicacy, and trembling at its frailty?” mused preacher Charles Spurgeon in the nineteenth century. Songwriters, artists, authors and surgeons alike are fascinated by frailty. Within, beneath and beyond that fragile frame though, could there be a deeper reality, waiting to arise – and endure? 

Fragile Lives is the ‘heart-stopping memoir’, operation by operation, of heart surgeon Professor Stephen Westaby. “The finest of margins,” he writes, “separates life from death, triumph from defeat, hope from despair – a few more dead muscle cells, a fraction more lactic acid in the blood, a little extra swelling of the brain. Grim Reaper perches on every surgeon’s shoulder.” 

To what shall we compare this fragility of frame? - which means we can shatter sudden as glass, our “breath becoming air” in the blink of an eye? (Paul Kalanithi, a young neurosurgeon, called his memoir When Breath Becomes Air as he fought his own battle with cancer). A snowflake? A spider’s web? A butterfly wing? In Dutch still life paintings, the transience of life is variously depicted in dry, fallen withering petals, rotting fruit, and a glass vessel, like a vase. At some funeral services, it is said that we are made from dust, and to dust we shall return. Elsewhere in the Bible, we are likened to a mist that appears for a little while and then vanishes, or to a flower that withers away, a fleeting shadow that does not endure. Our days are a mere handbreadth, our life but a breath, writes one Bible songwriter. 

Medics talk more commonly of frailty than fragility – and it’s not just a byword for old age. According to the British Geriatrics Society, not all old people live with frailty; not all people living with frailty are old, though age is a recognised risk factor, with nearly 40 per cent of adults aged 85-90 being frail. Described as a vulnerability to external stressors which can result in sudden marked deterioration in function, frailty might feature as a combination of falls, immobility, delirium, incontinence, and increased side effects of medications, suggesting the body is struggling to cope. “A minor infection or minor surgery results in a striking and disproportionate change in health state – from independent to dependent, mobile to immobile, or lucid to delirious,” writes a team of doctors in The Lancet

Frailty is a sign of advanced biological rather than chronological age. Often, it’s an unwelcome term, with consultant physician Patricia Cantley noting that, “from a patient or relative’s point of view, the word frailty seems to be at best somewhat vague and at worst, derogatory and demotivating”. She prefers to talk in terms of paper boats. Picturing young healthy patients as little tugboats of wood and steel, built to withstand storms, she likens the frail patient’s clinical situation to a paper boat, which can sail the sunny seas, but is soon buffeted and may be brought down by ‘medical winds’. 

Encompassing also psychological and cognitive symptoms alongside the physical, frailty is not a fixed state, nor is decline in mind and body inevitable once frailty begins. Seen increasingly as a dynamic spectrum, reversal of frailty is sometimes possible; the paper boat being, to a degree, storm proofed and made to chart a different course. According to Dr John Travers, professor of public health at Trinity College, Dublin, twenty minutes of daily exercise can reverse physical frailty and build resilience in over 65-year-olds, while others suggest that movement based mind-body therapies such as tai-chi and yoga can strengthen both mind and body. Could there also be something of a spiritual strengthening in the frail patient? As the body decays and declines, could the soul, the spiritual self, enlarge, emerge and ultimately endure as life ebbs away? This was certainly the sentiment of Paul, one of the early church leaders, in the Bible, who, after much suffering, wrote: “Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day…we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.” 

Her late Majesty Queen Elizabeth II was seen on our television screens to diminish physically in her last days, her purple hands, tiny frame and walking cane causing concern among viewers. She was, at her funeral, described simply as “our sister Elizabeth”, her small coffin dwarfed by pageantry and a crowd of 2,000 including presidents and kings. And yet, the former Moderator of the Church of Scotland has revealed that she talked much of her Christian faith in her dying days, while her funeral was an explosion of scripture, hymns and sermons that expressed the strength of her personal faith. “It was her way of eloquently, beautifully and powerfully speaking to me and 4.1 billion other people of her Christian faith,” writes Pastor Skip Heitzig. For me, the funeral brought to mind the tides (continuing with the theme of the sea). As the tide recedes, the waters move away from the shore, in what is known as an ebb current. As the tide rises, water moves toward the shore in a flood current. As our Queen’s life ebbed away physically, her spiritual self arose, roaring like a mighty flood. Ocean motion, in currents, waves and tides, is driven by the sun, moon and the planets. Our late Queen also looked upwards, to her God, for spiritual succour that would turn life’s ebb to a soul-flood.  

Hymnwriter Timothy Dudley-Smith sought a similar exchange, from the physical to the spiritual, the mortal to the immortal, in yet more words about boats, in his hymn “My boat so small”, based on the Breton Fisherman’s Prayer. 

“Adrift when strength and courage fail, O Spirit, breathe to fill my sail” 

And, happily, he trusts a safe voyage, finishing with - “My voyage done, all trouble past, to haven bring my soul at last.” 

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