Sep 13, 2011

NPR: Dignity Therapy for the Dying, A Chance to Rewrite Life

Can telling the story of their lives help the dying?  Yes and no, which should come as little surprise, given how varied the situations, responses, desires, and lives of those who are dying turn out to be.  It depends very much on what we mean by “help,” what the process of telling the story of one’s life is intended to do, and how involved of a process the “telling” becomes.

Virtue Ethics, by the very structure of the actual moral theories that comprise that approach — going beyond merely holding that virtues (lasting developed habitual dispositions) are good things and vices bad, and even beyond shifting from evaluating actions alone to evaluating persons and their characters — understands and teaches that one of the key questions for Ethics is generically “What is a good life?” and more specifically:  “What is a good life for me?”  “What is a good life for this or that person?”

One asks such a question not just to decide whether something is bad or good, but to make progress in rightly understanding this tricky, slippery, deceptively simple question.  As one continues to ask it — to examine human nature or one’s own life, one’s character and relationships, the narrative history of one’s choices and consequences, regrets and successes, realizations and setbacks — one can make progress, attain better perspective, rework one’s priorities and preferences.

That is a central goal and activity for those who adopt the Virtue Ethics approach — ranging from Greek philosophers like Plato, Aristotle, and their followers down to the present, philosophers formed by and expressive of other cultures like Confucius and those working in the long (neo)Confucian tradition, religious thinkers who straddle philosophy and theology, like the monk John Cassian, Saint Augustine, Saint Thomas Aquinas, even the recent Popes John Paul II and Benedict XVI.  You have to look long and hard and deeply at lives in order to assess them rightly, in order to figure out how best to reshape your own or those of others.

Dignity Therapy is an approach that fits in with these reflections.  Developed by a psychiatrist, Harvey Chochinov, out of his own practice with dying people, it originated with an insight that people needed to assert to others, to make sense of, who they were, what their identity and meaning were.
… he did study after study trying to tease out exactly what troubled people most about dying. What he found was that what people found most assaulting and annihilating was this idea that who they were would completely cease to exist after their death. And so Chochinov decided to do something about it. “If the idea of having something that will outlast even you matters for patients that are near the end of life, then we need to do something that will create something that will last beyond … the patient” …
This is admittedly a different motivation for sustained and systematic scrutiny of one’s life than the motivation Virtue Ethics would bring.  The psychotherapy is aimed principally at helping them come to terms with their own coming death (for what this means, measurably, see here).  Virtue Ethics is aimed principally at improving one’s moral life, relationships, appreciation of goods, and making progress towards the ultimate good for human beings.  But, Virtue Ethics and certain kinds of psychotherapy can — and long have — function as complements to each other.

How does it work?
[What] Chochinov decided to create was a formal written narrative of the patient’s life — a document that could be passed on to whomever they chose. The patients would be asked a series of questions about their life history and the parts they remember most or think are most important. Their answers would be transcribed and presented to them for editing until, after going back and forth with the therapist, a polished document resulted that could be passed on to the people that they loved.
Notice that this is a structured, iterative process — insight and reflection — even more or less faithful reconstruction of the past — takes time, as has to occur piece by piece.

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