Resurfacing Experiences: PTSD and Compassion
Sometimes due to illness, dementia, or life circumstances, symptoms of PTSD will return to prominence in older people. Mrs. M, an 89-year-old woman, was a survivor of the Siberian death camps of World War II. When she had to come into transitional care within a local long term care facility, she found herself lapsing into depression as memories and flashbacks of her years in the death camp resurfaced.
When I went to see her, she told me that due to the chronic pain recovering from surgery and to the necessity of being away from home among strangers, she found herself feeling frightened, lonely, and worried, much like she had felt when she and her family were forced onto the cattle cars that transported them to the camps. She was desperately trying to retain her hopes of returning home to her husband, who needed her to care for him, but her own recovery was slow, keeping her in the rehabilitation facility.
I shared with Mrs. M the story of Viktor Frankl, how he had been at the Auschwitz camp at the same time that she was in Siberia. I told her how, from his witnessing and suffering, a belief emerged that people are able to survive nearly anything when they have a purpose and meaning for their survival.
Then I asked Mrs. M, “What was it that you were able to do, that you survived Siberia when so many did not?”
She reflected upon this for a few moments. She then looked at me and said “Compassion. It was compassion that let me survive that horrible place.”“How was that?” I asked.
She then explained to me that there was another young girl there (Mrs. M was 14 when taken prisoner) who was intensely agitated because she was so terribly infested with lice. She had horrible sores on her head, and the blood would run down her face from the wounds created from her scratching and the biting of the bugs.
“I told her,” said Mrs. M, “that the only way to help this is to brush your hair every day! I taught her how to care for her hair. That was all I could do. I think it was the compassion I felt for her, and for everyone else, that helped me survive.”
I suggested to Mrs. M that she could draw upon these same feelings and skills to help her cope with being away from home and the pain and work of recovery. She agreed. Within two weeks, she went home. Before she left the nursing home, staff reported that her coping had improved, as had her mood. She was observed engaging in conversations with others more often, and assisting some of the residents in their daily routines.Spiritual Fitness
This story beautifully illustrates the post-traumatic growth described by Baumgartner and Crothers, where some people, despite trauma and suffering, recover and even surpass their levels of previous functioning by developing and growing in other areas of their lives.
I believe that one of the cornerstones for the development of Spiritual Fitness is the ability to move beyond one’s basic needs and wants to serve something greater than one self. Spiritual growth can occur during periods of trauma and hardship. According to Frankl, people need a sense of purpose and meaning in life to sustain them. When this purpose and meaning is reignited, the quality of life for an elder and/or caregiver can be significantly improved. Even people who are unable to do much any more can serve by accepting gracefully the service of others, recognizing that their needs give others purpose and meaning.
Making Sense of Loss and Suffering
For those who are grieving serious losses or adversity I often employ another concept in Dr. Frankl`s work:
D = S – M → Despair equals suffering without meaning.
When people can find some meaning in their suffering, they can avoid falling into despair, and they can find strength and resolve to overcome the suffering. When people feel there is no meaning, they succumb to despair and hopelessness.
Striving for IntegrityThis ties in with the last stage of Erik Erikson`s theory of psycho-social development, Integrity vs. despair. Often elders spend much time and attention reviewing their lives. They contemplate the choices they made, both what worked and what did not. They often appear to review the challenges in their lives systematically, attempting resolution.
Those who are able to reflect upon their lives and come to accept themselves and the various choices they made with compassion and forgiveness will often move forward toward feeling at peace with themselves and others, achieving Integrity.They can be fairly happy with themselves and feel that their lives were well-lived, despite the mistakes. Often they will say that the mistakes yielded great learning leading to a greater good.
Those who fail to make this journey or who do not come to forgive themselves will often fall into Despair. They may become weighed down with sadness or bitterness, feeling that it is too late and too much damage has been done. Often they find themselves in an endless loop of remembering and condemning themselves or others, further escalating the suffering. They see no meaning in the suffering, but they continue to wallow in it. Couple this with multiple losses which occur more frequently and rapidly in the elder years, and you have people that require treatment for a major depressive disorder and may be at risk of suicide.
Helping Elders Move Toward Integrity
By contrast, elders can find their days imbued with meaning and purpose achieved through life reviews that focus on resolution, forgiveness, and celebration. Reminiscence can occur in group settings or pairings, in which memories are shared through storytelling, mentoring, and friendships. Losses, the death of family, friends, and fellow residents, even their own mortality can be made more meaningful through sharing their insights and wisdom.Dr. Alan Wolfelt speaks of a narrative support that can be provided to someone who is grieving. He calls this companioning. Through sharing, people are supported as they move through their grief journeys. Growing one’s spirit and then ensuring that the wisdom gleaned throughout a lifetime is passed on is among life’s most powerful and spiritually enlightened activities, Dare I say, it is a moral, ethical, and spiritual responsibility that anyone can achieve.
Exercises for Spiritual Fitness
Elders and their caregivers can find great spiritual growth and contentment in the winter of their lives with appropriate tools and support. Here are some activities that can help elders exercise for spiritual fitness:
- Gratitude Letter: Write a letter to someone who made a difference in your life, whom you never properly thanked. Letters may even be to people who are already dead.
- Three good things: Keep a journal and record daily three good things that occurred or that you appreciated and why they were meaningful to you.
- Life review: Allow yourself to revisit the more difficult times in your life. Explore all the strengths, skills, and insights that you developed as a result of the challenges. What good came of these? What did you learn? Were you able to pass this learning on to others? How has your learning served you and others?
- Reminiscence Groups: Participate in reminiscence groups sharing the various joys and hardships in your life. Listen attentively to the stories of others. Further your capacity for compassion and acceptance.
- Grieving: All losses involve grief. Be willing to cry, honor, and let go a little bit each day. Don’t hold on to the sadness and loss. Embrace and nurture the love and memories instead. Be a witness and companion to someone else who is grieving.
- Mentoring: Mentor someone. Allow someone to mentor you. Remember it is an act of generosity to receive.
- Serving Find something to do that will benefit others. Be a good listener, offer a warm touch, recognize the humanity of the people that serve you.
- Forgiveness: Forgive yourself and others. Be willing to let go of old grudges and live with greater love and freedom. “Holding on to resentments, is like taking poison and waiting for the other person to die.” (author unknown).
- Prayer and meditation: I have often heard that Prayer is speaking with God, and Meditation is listening. Taking time to quiet your mind and connect with your innermost self grows your capacity to live in a peaceful, grounded, and loving place.
Using some of these exercises to reflect, share, and forgive, even people with great physical and mental limitations can find meaning in the suffering that comes from the multiple losses of aging.
In future articles, I will explore exercises that contribute to emotional, social, familial, and physical fitness.
Baumgardner, S. and Crothers, M. (2009). Positive Psychology (Value Pack w/MySearchLab). Upper Saddle River, NJ. Pearson Education, Inc.
Britton, K. H. (2012). Life stories of the oldest old. Positive Psychology News Daily.
Frankl, V. (1959). Man’s Search For Meaning. New York: Simon and Schuster.
Santrock, J (1997). Life-Span Development 12th Ed. McGraw-Hill.
Seligman, Martin (2002), Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. New York: Free Press.
Seligman, M. E. P. (2011). Flourish: A Visionary New Understanding of Happiness and Well-being. New York: Free Press.
Wolfelt, A. D. (2006). Companioning the Bereaved: A Soulful Guide for Counselors & Caregivers. Fort Collins CO: Companion Press.
Elderly People Sign courtesy of Ethan Prater
Male head louse courtesy of Gilles San Martin
Hands that have lived courtesy of United Nations Photo
After dinner courtesy of alex@Tlön
Mi abuelo courtesy of Mario Izquierdo
Sharing memories courtesy of Maureen Marsh
Such inspiring tips and stories. There was a point in my life that I wanted to give up, and believing that there was no God after all. It’s a good thing that my family was there to support me, and not to lose hope.
Excellent and moving piece Diana. Thank you. Making such concerns central rather than peripheral to social care is the huge challenge.
Powerful and touched me ti my core. This is one to be printed out for those days that seem too much. Diana, you outdid yourself. Many thanks!
Hi Louise – thank you for your kind comments. I am delighted that you found the article helpful! May you never loose hope again!
Hi Angus – Thank you so much for your compliments! You are so right about the challenge! Bringing about change starts with conversations. Just start talking! Little seeds will be planted.
Thank you Judy! Such high praise! I am glad that it was moving for you!
Very nice, Diana. If only it had come out a few days earlier! I had just finished teaching a class on spiritual fitness, which is always a bit challenging. I’m not always confident my students walk away with something concrete they can do to enhance their spiritual well-being. If I may use your article next time, I think it will help.
By the way, I noted that your topics of interest match the US Army’s five domains of fitness: emotional, social, familial, physical, & spiritual. Just a coincidence?
Thank you so much for your interest! I would be delighted to have you pass this on to your students. Please let me know if you need more material. Kindly email me to let me know who and where you are teaching??? I would be happy to help. In regards to the US Army – there is no coincidence! Please see “The Intersection of Positive Psychology and Geriatrics” It is the first article in this series and introduces the concept of Geriatric Fitness Training – inspired and based on the Solider fitness.