Article
Change
Mental Health
1 min read

Removing pain’s barriers to healing

How do we open the window to let the air in?
A window sheds light through locked bars into a dusty and dark room,
Denny Müller on Unsplash.

One of the trickiest situations you can encounter if you’re a counsellor is having a client you can’t reach. They sit there in front of you, pain in their eyes, but somehow every approach you make meets with resistance. It’s like trying to touch someone through a closed window – you can see them, but you keep bumping into the glass. 

I have two at the moment. One is Cypriot; I’ll call her Androulla, and she scares me rather as she is a doctor and never smiles and knows everything. ‘Yes, I have tried that,’ she says. ‘Yes, I am familiar with that book/ line of thinking/ philosophical method – it hasn’t worked for me.’ 

And I know that we’ve found the poisonous plant in the heart of her heart and pulled it up by the roots. I am as sure as I can be that she will get better now.

Yet she is dreadfully sad. Her mother died out in Cyprus, and she couldn’t get there in time. Her grief is eating her. She glares at me, desperate to be helped but bristling with gun turrets. Hmm. 

Eventually I remember something Jane Goodall said. Jane Goodall is one of the world’s wonderful people… her work with chimpanzees back in the 60s dramatically changed our relationship with animals, and she still travels the world at the age of nearly 90 encouraging young people to take action on climate change. In her lovely Book of Hope she describes how when she’s completely knackered or stuck with something, she sort of hands herself over to an outside power. ‘I just relax and decide to appeal to the source of hidden strength,’ she writes. ‘There’s a wisdom that’s far, far, far greater than my own.’ When she surrenders in this way, she often gives her best lectures she says.  

I think I might give it a try with Androulla. As a gradually-learning-to-be-more-trusting Christian, it seems most appropriate to follow in the footsteps of St Francis. So just before our next session I shut my eyes and say, ‘Help Lord, I don’t know what to say to her. Please take over and use me as a channel – she could really do with your peace and grace, and I seem to be in the way’. I’m quite a controlling person normally so I feel a bit reluctant… but if it works for Jane Goodall and for St Francis, I’m not going to argue! 

To my surprise, I find myself asking Androulla what her understanding of the word ‘mercy’ might be – not a very usual counselling question. Even more surprising, her eyes fill with tears and suddenly she says that the last time she saw her mother, she told her she hated her, and had a physical fight with her and hurt the skin on her old arms. Crying properly now, the poor woman says she doesn’t deserve forgiveness after that, and I find myself telling her how mercy sees everything with utter clarity and loves and accepts it whatever is deserved or not deserved. And I know that we’ve found the poisonous plant in the heart of her heart and pulled it up by the roots. I am as sure as I can be that she will get better now. 

Something compassionate has breathed on these locks, and the stuck windows have suddenly yielded and opened to let the air in. 

Then today the same thing happens again – with Bella, my other client who cannot forgive herself, in this case for the fact that her violent alcoholic husband drank even more after she finally left him and died of organ failure in a homeless shelter. We’ve gone over and over her guilt for weeks, and she has remained shiny and brittle and artificially bright and fine. We’ve got nowhere. Until now. ‘Dear Lord,’ I say before I ring her, ‘help me find a way through to her. Let me remove myself and all my assumptions, so that your healing can flow through to her and give her some rest.’ I do my best to relax into our conversation, just to let what wants to come, come. And out of nowhere, I am suddenly inspired to ask her whether she’d feel guilty if her husband had died of some terrible illness like cancer. 

‘No,’ she says. 

‘Well… you’re a medical secretary. You’ll know better than me that alcoholism is an illness,’ I say. 

There’s a very long silence. 

‘Doesn’t that mean you’ve both been suffering from this terrible illness?’ I ask eventually. ‘Dave because it drove him crazy and then killed him; you because it blighted your life, and is blighting it still? Isn’t it time you said, “No, enough!” to this pestilence?’ 

I can see it in my mind’s eye, the alcoholism, like a swarm of red locusts or a scarlet dragon, devouring both Bella and Dave. I don’t feel that’s an image I came up with, it’s just there in my mind. I can feel this lodging in Bella’s mind too… a whole new way of thinking, a great big shift in emphasis, a transfer of responsibility from her to the monster. 

I don’t know whether the idea is fully rooted yet, whether we can rely on it to grow and flourish and bear good fruit. But I sense that it is at least planted and watered. A bit more sunshine, some careful tending… and probably a lot more trusting would seem to be the way forward. 

It’s not in the training manual, this technique. You won’t hear the British Association of Counselling and Psychotherapy recommending that therapists hand themselves over to Jane Goodall’s ‘outside power’. But something compassionate has breathed on these locks, and the stuck windows have suddenly yielded and opened to let the air in. 

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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