Helen was considering suicide when her daughter, Gail, asked me to
come to her house. Gail was shocked to discover Helen was hoarding
her pain pills with the intent to accumulate enough of them to end
Helen had been diagnosed with ALS, a progressively debilitating and
usually fatal illness. As a long-time trauma counselor, I had
frequently worked with people who had terminal illnesses and it was
always a challenge. Helen surprised me though. Her suicidal thoughts
were not because of her own future; her fears were for her husband,
who was performing more and more caregiving tasks. Helen was afraid
that her long-term illness would have a crushing effect on her
husbandís health and spirits. Helen had nursed her first husband
though his long and ultimately fatal illness so she knew exactly
what Frank would be up against in his attempts to care for her as
the disease took its toll. Helen felt so strongly about this
that she preferred to be dead rather than cause her husband, Frank,
I soon discovered that the roots of Helenís concern could be found
in an event that had happened more than ten years earlier. Although
Helen loved her first husband dearly, the five years she spent
caring for him after his stroke left her exhausted and feeling
alone. She had given up her job to nurse him, a job she loved
dearly. She had wanted to care for him at home and kept him there
even when he expressed a willingness to move to a nursing home.
Helen remembered only too well the moments of exhaustion,
frustration, and even resentment as her own life had been eaten up
by the need to provide full-time care. She didnít want Frank to
endure such pain although he was insisting that he wanted to provide
all her care himself.
What else could she do, Helen wanted to know. She didnít want to
face the time when he might resent the sacrifices he would have to
make. Most of all, she felt her exchange with him would be out of
balance and this feeling was at the core of her desire to die.
Already Helenís disease had robbed her of almost all of her mobility
and she knew that at the rate it was progressing, she would be
unable to talk before another year was up. When Helen expressed her
regret that she hadnít taken the overdose of pills already, I knew
she needed help quickly.
My years of working with terminally ill people had taught me that we
might need a two-pronged approach in handling this situation.
Certainly I needed to talk to Frank about allowing Helen to move to
a nursing home when the appropriate time came. We needed to help him
understand that Helen did not want to see him so overburdened with
her care that he was suffering, too. We also needed to find a way
that Helen could exchange with Frank so that she could contribute
something to his wellbeing.
Helen was a good person who had spent most of her life helping
children as a teacher. Like most of us, she wanted to give as well
as take in life. Her mind was still intact even while her body was
being destroyed by her illness. None of us wants to be put in a
position when we can only take and no longer give in life. It was
very noble and loving of Frank to want to care for her at home, but
he needed to acknowledge her spiritual and emotional needs as well
as her physical ones. And he needed to confront his own needs as
As I interviewed Helen with an eye toward what she might be able to
do that would be helpful to her husband, I learned that Frank had
experienced a very difficult childhood that he was reluctant to
discuss. Part of his reason for insisting that Helen remain at home
throughout her illness was that he had been abandoned by his mother
as a child and he perceived leaving Helen in a nursing home as a
form of abandonment. One of the few abilities Helen still had was
her ability to speak and to listen. With her agreement, I taught her
some simple techniques to help Frank. These techniques, which are
similar to physical first aid procedures, teach lay people to
provide effective emotional first aid to friends and loved ones.
Helen was an apt pupil and learned the techniques quickly. Using
them, she was able to encourage Frank to talk about childhood
experiences and discover some of the decisions he had made at the
time when the events had occurred.
One of Frankís many realizations was that he had made an important
decision at the age of nine. Feeling bereft by his motherís
desertion, Frank had vowed that he would never be a person who would
walk out on someone else. He also realized that this decision had
caused him to hang on to relationships in the past long past the
point where it benefited him or the other person. It was a
tremendous relief to Frank to be able to have conversations each
evening where he remembered his childhood and talked out all those
times in the past. Equally wonderful was the effect it had on Helen.
She felt able to be useful and enjoyed so much watching Frank
experience relief and genuine happiness. With the return of this
feeling of usefulness, her suicidal thoughts vanished.
I had planned, once I had helped Helen find a way to feel useful
again, to speak with Frank about taking actions that might be needed
to lighten his load as a caregiver. I found, however, that
there was no need to do this in the end. The coupleís close
communication had helped them work out a plan for Helenís care.
Frank had realized that the most important moments of the day were
the ones when they were talking on a deep spiritual level and he
continued to talk to Helen even after she had lost the ability to
speak. At Helenís funeral, Frank described those conversations as
some of the happiest moments of his life.
What does this story have to do with those of you who are providing
care for someone who has lost their mental abilities? Itís wonderful
when the person you are caring for has the ability to help you, too,
because it gives tremendous happiness to someone who is very ill to
still be able to feel useful. But that isnít possible when the
illness has stolen their ability to think clearly or communicate
fully. Almost all caregivers find that the illnesses they must deal
with every day remind them of earlier events in their lives when
they suffered other losses or traumas. That fact, plus the fears
engendered by the loved oneís illness, makes a caregiver a prime
candidate for some emotional first aid. Just as physical first aid,
in the form of CPR, can save a life, so emotional first aid can make
a life worth living. Pick a friend from a support group who is
willing to work at learning a few simple techniques and pair up to
help each other out. By taking turns asking and answering the
questions in the procedure below, you can each provide tremendous
help and support to the other. What follows is just one of the
simple techniques available. Try it out with a friend or loved one.
Directions: Take turns with your partner asking and answering the
set of questions below. As you ask the questions, follow these few
simple rules: listen, donít talk; be compassionate, not critical;
show great interest; be persistent; acknowledge responses with a
simple ďokĒ or ďuh huh.Ē
Recall a time when you were unable to help
someone. Tell me about it. Did you make any decisions at that
Recall a time when you succeeded in helping someone. Tell me
about it. Did you make any decisions at that time?
Recall a time when you did not receive
effective help. Tell me about it. Did you make any decisions at
Recall a time when you received effective
help. Tell me about it. Did you make any decisions at that time?
If you would like a copy of The
Emotional First Aid Manual, send a request to Innovations Press at
P.O. Box 4800, Mission Viejo, CA 92690 or order online at
www.innovationspress.net. If the cost of the book ($19.00) is
prohibitive, let the publisher know, as funds have been donated to
provide copies to anyone who cannot afford one.
Janet Buell has spent over 25 years doing full-time trauma
counseling and is certified by the International Association of
Trauma Counselors. Janet is the author of seven books including the
recently released ďThe Emotional First Aid Manual.Ē She has also
been a caregiver..
Contributing authors to the book include psychiatrist Dr. Frank
Gerbode, psychologist Dr. Robert Moore, and past president of the
International Association of Trauma Counselors Dr. Will Foreman.
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