End of Life and the Search for Meaning
The search for meaning
Many, if not most, terminally ill patients experience a crisis of meaning as they approach the end of their lives. They are often racked with feelings of inadequacy and regret. Torturing themselves with existential questions focused on “What did I accomplish?”, “What did I really do with my life?” or “Did my life have any meaning?”
This type of existential crisis can be very difficult to dislodge, and these doubts can seriously diminish the quality of the patient’s remaining life. Rather than using their time to connect with others and say goodbye, they are caught in a cycle of feeling worthless and depressed.
Dignity Therapy was developed specifically to help terminal patients escape this paralyzing and demoralizing loss of meaning. Recently developed by Max Chochinov, MD a Canadian psychiatrist, Dignity Therapy focuses on helping end of life patients to review their lives, identify those moments or themes which they consider to be the most meaningful, and documenting this “legacy”.
"Dignity therapy can bring comfort and enable a sense of meaning and purpose for someone with life-threatening and life-limiting conditions and allow them to feel that their words will transcend even beyond their death," says study Chochinov.
Cheryl Nekolichuk, PhD, a psychologist at Grey Nuns Community Hospital in Edmonton, Canada, wrote "Dignity therapy is a very effective way for patients to find some meaning and purpose at the end of life and it provides an opportunity for them to share their life story and experiences with family members.”
What Is Dignity Therapy?
In Dignity Therapy, the therapist asks the client a series of questions about their life. Helping the client to define who they are, who they have been, and what message they want to pass down to the generations that follow. Together they create a tangible document, the “legacy” that can be passed down after they are gone. This document can take many forms, e.g. writing, video, photo collage, etc.
As they work through the document creation process, the therapist helps the client identify feelings and ideas that they have left unsaid to the people in their lives (alive or dead). The therapist then supports them in communicating with their loved ones, as a means of achieving closure and opening up communication.
The document serves many purposes. “…to apologize for opportunities that were squandered or record biographical information such as the derivation of a daughter's name," Chochinov says. "When you read these documents, you want to walk away and say 'I understand.'"
Formalizing an ancient tradition
In many ways Dignity Therapy has been part of the end of life process since the beginning of time. There is an undeniable desire to get closer and know the dying loved one a little better as their time approaches. We sit by their side, and go through their memories, and let them tell us what has been memorable and meaningful.
But, Dignity Therapy provides a structure to this process, that is especially useful if the individual is lost in a crisis of meaning or is depressed, or whose family relations are too stressed to allow for the supportive and open communication needed to create the patient’s true legacy.
Donald Schumacher, PsyD, president and CEO of the National Hospice and Palliative Care Organization, a nonprofit group in Alexandria, Va., says that this type of therapy should be offered to all patients with terminal illnesses.
"It is very useful and helpful, and this study does point out very dramatically that people in last stages of life can benefit," he says. "The feeling had been that if you don't have a long time to be in therapy, it won't be helpful, but that is not true."
Dignity therapy "will help patients complete some of their life work and can go a way to healing familial relations that might be undone."