Live Until You Die

I have been working for over a decade now helping people with serious illness “live until they die.” My work focuses on the cognitive model of therapy, which points to the thoughts that people have and the response people make to them. When an event like a serious medical illness strikes, I believe that we all have catastrophic thoughts: “Uh, oh, this could take my life,” or something similar. The story, however, does not end here. Rather, it begins here. If an individual focuses on, magnifies, or thinks more about this thought, it can dominate cognition. If, however, the individual disputes this thought and applies his or her energies elsewhere, the thought often has little effect. I believe that this approach can be taught to a person suffering from serious illness. By applying the cognitive model at the proper time, he or she can avoid the cognitive consequences of focusing on an undesirable outcome. I pair this with consideration of one’s life stage. I believe that a diagnosis of cancer (as one example) can usher in a new life stage. It is typical of a new life stage that a person spends time thinking about what he or she can and cannot do at this time. Once again, if the focus is set on what one can no longer do, there are negative consequences. A healthy focus considers what an individual can do now. The usual emphasis on avoiding cognitive errors remains a part of any cognitive therapy: polarization, personalization, and overgeneralization. Does the individual think typically in terms of black and white? Does he or she always put himself/herself in the center of the screen? Does one (often) correct assumption lead to a whole raft of related ideas, many of which have no validity? The person confronting serious medical illness, and many people dealing with the changes wrought by increasing age, retain an identity that relates to an earlier time of life. They do not update that “identity pie” to reflect their current reality. Doctors and lawyers, for example, continue this view of themselves long after they have retired from doctoring and lawyering. For many people, this approach lends itself to a brief therapy interaction. Many patients want this interaction to take place with their providers. However, many providers either do not talk much with their patients or do not see this aspect of doctoring as one of their roles. This lack of physician-patient interaction has made room for a psychiatrist with a specific task as a member of a treatment team. Typically, the therapy is short-term and complements the interaction of the patient and his or her physician. At times, however, the relationship is long-lasting, the patient’s personality is unyielding, and the transaction continues for quite a while. I met Mr A more than 3 years ago. We continue to meet regularly, and we each believe that benefit continues to accrue.