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Hope, help, and humor when facing a life-threatening illness
Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in
My father, Morty Sosland, MD, was a psychiatrist in a community health setting when he was diagnosed with amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease) in April 2020. He continued to work until February 2021 and credits his ongoing resilience to what he refers to as “the 3 Hs”: hope, help, and humor. Although he can no longer speak, I was able to interview him over the advanced technology that is text messaging.
Sarah: Hi, Dad.
Morty: It’s Doctor Dad to you.
Sarah: I guess we are starting with humor, then?
Humor
Research has demonstrated that humor can have serious health benefits, such as decreasing stress-making hormones and altering dopamine activity.1 For individuals facing a life-threatening illness, humor can help them gain a sense of perspective in a situation that would otherwise feel overwhelming.
Sarah: I feel like a lot of the humor you used with patients was to help them gain perspective.
Continue to: Morty
Morty: Yes. I’d have to know the client well enough, though—and timing is important. My patients would come to me with a long list of challenges they had faced in the week, and I would say, “But besides that, everything’s good?”
Sarah: And besides the ALS, everything’s good?
Morty: Exactly. I’d also use magic or math tricks to make kids like coming to therapy or to reinforce important concepts.
Sarah: How has humor helped you cope?
Morty: Thinking about things in humorous ways has always been helpful. I used to say my Olympic sport was walking to the dining room with my walker. Unfortunately, I can’t do that anymore, so now my Olympic sport is getting out of bed. It’s a team sport.
Sarah: And that’s a good segue to…
Help
Countless studies have shown the impact of social support on health. Good social support can increase resilience, protect against mental illness, and even increase life expectancy.2 Support becomes even more critical when you are physically dependent on others due to illness.
Continue to: Sarah
Sarah: Was it difficult for you to accept help at first?
Morty: I would say yes—but at the same time, I accepted it because the illness was so shocking. I learned early on this was a fight that my family would also fight alongside me.
Sarah: I remember you would quote Fred Rogers.
Morty: Actually, it was Fred Rogers’ mother. She would tell her son during hard times, “Look for the helpers. You will always find people who are helping.” Helpers can be family members, friends, doctors, and aides, as well as others who have the same illness.
Hope
In the face of all life’s challenges, hope is important, but in the face of a life-threatening illness, hope must be multifaceted.3 In addition to hope for a cure, patients may focus their hopes on deepening relationships, maintaining dignity, or living each day to its fullest.
Morty: Early on in this illness, I chose to set a positive tone when I told people. I would say I have the top doctors and there is more research now than ever. Years ago, I wrote a children’s book with the mantra, “I say I can, I make a plan, I get right to it and then I do it.”4 My plan is to be around for at least 30 more years.
Sarah: Do you think it’s possible to hold acceptance and hope at the same time?
Morty: Acceptance and hope are not easy, but possible. I get down about this illness. In my dreams, I walk and talk, and most mornings I wake up and see my wheelchair and I think this is absurd or a different choice word. But I focus on the things I still can do, and that gives me a feeling of hope. I can read the latest research, I can enjoy moments of laughter, and I can spend time with my family and close friends.
1. Yim J. Therapeutic benefits of laughter in mental health: a theoretical review. Tohoku J Exp Med. 2016;239(3):243-249. doi:10.1620/tjem.239.243
2. Ozbay F, Johnson DC, Dimoulas E, et al. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35-40.
3. Hill DL, Feudnter C. Hope in the midst of terminal illness. In: Gallagher MW, Lopez SJ, eds. The Oxford Handbook of Hope. Oxford University Press; 2018:191-206.
4. Sosland MD. The Can Do Duck: A Story About Believing in Yourself. Can Do Duck Publishing; 2019.
Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in
My father, Morty Sosland, MD, was a psychiatrist in a community health setting when he was diagnosed with amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease) in April 2020. He continued to work until February 2021 and credits his ongoing resilience to what he refers to as “the 3 Hs”: hope, help, and humor. Although he can no longer speak, I was able to interview him over the advanced technology that is text messaging.
Sarah: Hi, Dad.
Morty: It’s Doctor Dad to you.
Sarah: I guess we are starting with humor, then?
Humor
Research has demonstrated that humor can have serious health benefits, such as decreasing stress-making hormones and altering dopamine activity.1 For individuals facing a life-threatening illness, humor can help them gain a sense of perspective in a situation that would otherwise feel overwhelming.
Sarah: I feel like a lot of the humor you used with patients was to help them gain perspective.
Continue to: Morty
Morty: Yes. I’d have to know the client well enough, though—and timing is important. My patients would come to me with a long list of challenges they had faced in the week, and I would say, “But besides that, everything’s good?”
Sarah: And besides the ALS, everything’s good?
Morty: Exactly. I’d also use magic or math tricks to make kids like coming to therapy or to reinforce important concepts.
Sarah: How has humor helped you cope?
Morty: Thinking about things in humorous ways has always been helpful. I used to say my Olympic sport was walking to the dining room with my walker. Unfortunately, I can’t do that anymore, so now my Olympic sport is getting out of bed. It’s a team sport.
Sarah: And that’s a good segue to…
Help
Countless studies have shown the impact of social support on health. Good social support can increase resilience, protect against mental illness, and even increase life expectancy.2 Support becomes even more critical when you are physically dependent on others due to illness.
Continue to: Sarah
Sarah: Was it difficult for you to accept help at first?
Morty: I would say yes—but at the same time, I accepted it because the illness was so shocking. I learned early on this was a fight that my family would also fight alongside me.
Sarah: I remember you would quote Fred Rogers.
Morty: Actually, it was Fred Rogers’ mother. She would tell her son during hard times, “Look for the helpers. You will always find people who are helping.” Helpers can be family members, friends, doctors, and aides, as well as others who have the same illness.
Hope
In the face of all life’s challenges, hope is important, but in the face of a life-threatening illness, hope must be multifaceted.3 In addition to hope for a cure, patients may focus their hopes on deepening relationships, maintaining dignity, or living each day to its fullest.
Morty: Early on in this illness, I chose to set a positive tone when I told people. I would say I have the top doctors and there is more research now than ever. Years ago, I wrote a children’s book with the mantra, “I say I can, I make a plan, I get right to it and then I do it.”4 My plan is to be around for at least 30 more years.
Sarah: Do you think it’s possible to hold acceptance and hope at the same time?
Morty: Acceptance and hope are not easy, but possible. I get down about this illness. In my dreams, I walk and talk, and most mornings I wake up and see my wheelchair and I think this is absurd or a different choice word. But I focus on the things I still can do, and that gives me a feeling of hope. I can read the latest research, I can enjoy moments of laughter, and I can spend time with my family and close friends.
Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in
My father, Morty Sosland, MD, was a psychiatrist in a community health setting when he was diagnosed with amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease) in April 2020. He continued to work until February 2021 and credits his ongoing resilience to what he refers to as “the 3 Hs”: hope, help, and humor. Although he can no longer speak, I was able to interview him over the advanced technology that is text messaging.
Sarah: Hi, Dad.
Morty: It’s Doctor Dad to you.
Sarah: I guess we are starting with humor, then?
Humor
Research has demonstrated that humor can have serious health benefits, such as decreasing stress-making hormones and altering dopamine activity.1 For individuals facing a life-threatening illness, humor can help them gain a sense of perspective in a situation that would otherwise feel overwhelming.
Sarah: I feel like a lot of the humor you used with patients was to help them gain perspective.
Continue to: Morty
Morty: Yes. I’d have to know the client well enough, though—and timing is important. My patients would come to me with a long list of challenges they had faced in the week, and I would say, “But besides that, everything’s good?”
Sarah: And besides the ALS, everything’s good?
Morty: Exactly. I’d also use magic or math tricks to make kids like coming to therapy or to reinforce important concepts.
Sarah: How has humor helped you cope?
Morty: Thinking about things in humorous ways has always been helpful. I used to say my Olympic sport was walking to the dining room with my walker. Unfortunately, I can’t do that anymore, so now my Olympic sport is getting out of bed. It’s a team sport.
Sarah: And that’s a good segue to…
Help
Countless studies have shown the impact of social support on health. Good social support can increase resilience, protect against mental illness, and even increase life expectancy.2 Support becomes even more critical when you are physically dependent on others due to illness.
Continue to: Sarah
Sarah: Was it difficult for you to accept help at first?
Morty: I would say yes—but at the same time, I accepted it because the illness was so shocking. I learned early on this was a fight that my family would also fight alongside me.
Sarah: I remember you would quote Fred Rogers.
Morty: Actually, it was Fred Rogers’ mother. She would tell her son during hard times, “Look for the helpers. You will always find people who are helping.” Helpers can be family members, friends, doctors, and aides, as well as others who have the same illness.
Hope
In the face of all life’s challenges, hope is important, but in the face of a life-threatening illness, hope must be multifaceted.3 In addition to hope for a cure, patients may focus their hopes on deepening relationships, maintaining dignity, or living each day to its fullest.
Morty: Early on in this illness, I chose to set a positive tone when I told people. I would say I have the top doctors and there is more research now than ever. Years ago, I wrote a children’s book with the mantra, “I say I can, I make a plan, I get right to it and then I do it.”4 My plan is to be around for at least 30 more years.
Sarah: Do you think it’s possible to hold acceptance and hope at the same time?
Morty: Acceptance and hope are not easy, but possible. I get down about this illness. In my dreams, I walk and talk, and most mornings I wake up and see my wheelchair and I think this is absurd or a different choice word. But I focus on the things I still can do, and that gives me a feeling of hope. I can read the latest research, I can enjoy moments of laughter, and I can spend time with my family and close friends.
1. Yim J. Therapeutic benefits of laughter in mental health: a theoretical review. Tohoku J Exp Med. 2016;239(3):243-249. doi:10.1620/tjem.239.243
2. Ozbay F, Johnson DC, Dimoulas E, et al. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35-40.
3. Hill DL, Feudnter C. Hope in the midst of terminal illness. In: Gallagher MW, Lopez SJ, eds. The Oxford Handbook of Hope. Oxford University Press; 2018:191-206.
4. Sosland MD. The Can Do Duck: A Story About Believing in Yourself. Can Do Duck Publishing; 2019.
1. Yim J. Therapeutic benefits of laughter in mental health: a theoretical review. Tohoku J Exp Med. 2016;239(3):243-249. doi:10.1620/tjem.239.243
2. Ozbay F, Johnson DC, Dimoulas E, et al. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35-40.
3. Hill DL, Feudnter C. Hope in the midst of terminal illness. In: Gallagher MW, Lopez SJ, eds. The Oxford Handbook of Hope. Oxford University Press; 2018:191-206.
4. Sosland MD. The Can Do Duck: A Story About Believing in Yourself. Can Do Duck Publishing; 2019.
5 Ways to quiet auditory hallucinations
Cognitive-behavioral therapy (CBT) can help patients cope with auditory hallucinations and reshape delusional beliefs to make the voices less frequent.1 Use the following CBT methods alone or with medication.
1. Engage the patient by showing interest in the voices. Ask: “When did the voices start? Where are they coming from? Can you bring them on or stop them? Do they tell you to do things? What happens when you ignore them?”
2. Normalize the hallucination. List scientifically plausible “reasons for hearing voices,”2 including sleep deprivation, isolation, dehydration and/or starvation, extreme stress, strong thoughts or emotions, fever and illness, and drug/alcohol use.
Ask which reasons might apply. Patients often agree with several explanations and begin questioning their delusional interpretations. Your list should include the possibility that the voices are real, but only if the patient initially believes this.
3. Suggest coping strategies, such as:
- humming or singing a song several times
- listening to music
- reading (forwards and backwards)
- talking with others
- exercise
- ignoring the voices
- medication (important to include).
Ask which methods worked previously and have patients build on that list, if possible.
If a patient hears command hallucinations, assess their acuity and decide whether he or she is likely to act on them before starting CBT.
4. Use in-session voices to teach coping strategies. Ask the patient to hum a song with you (“Happy Birthday” works well). If unsuccessful, try reading a paragraph together forwards or backwards. If the voices stop—even for 2 minutes—tell the patient that he or she has begun to control them.3 Have the patient practice these exercises at home and notice if the voices stop for longer periods.
5. Briefly explain the neurology behind the voices. PET scans have shown that auditory hallucinations activate brain areas that regulate hearing and speaking,4 suggesting that people talk or think to themselves while hearing voices.
When patients ask why they hear strange voices, explain that many voices are buried inside our memory. When people hear voices, the brain’s speech, hearing, and memory centers interact.5
That said, calling auditory hallucinations “voice-thoughts,” rather than “voices,” reduces stigma and reinforces an alternate explanation behind the delusion. As the patient begins to understand that hallucinations are related to dysfunctional thoughts, we can help correct them.
1. Rector NA, Beck AT. A clinical review of cognitive therapy for schizophrenia. Curr Psychiatry Rep. 2002;4:284-292.
2. Kingdon DG, Turkington D. Cognitive-behavioral therapy of schizophrenia. New York: Guilford Press; 1994.
3. Beck AT. E-mail communication.
4. McGuire PK, Shah GMS, Murray RM. Increased blood flow in Broca’s area during auditory hallucinations in schizophrenia. Lancet. 1993;342:703-706.
5. Sosland MD, Deibler MW. Temple University Psychosis Group. 2003.
Cognitive-behavioral therapy (CBT) can help patients cope with auditory hallucinations and reshape delusional beliefs to make the voices less frequent.1 Use the following CBT methods alone or with medication.
1. Engage the patient by showing interest in the voices. Ask: “When did the voices start? Where are they coming from? Can you bring them on or stop them? Do they tell you to do things? What happens when you ignore them?”
2. Normalize the hallucination. List scientifically plausible “reasons for hearing voices,”2 including sleep deprivation, isolation, dehydration and/or starvation, extreme stress, strong thoughts or emotions, fever and illness, and drug/alcohol use.
Ask which reasons might apply. Patients often agree with several explanations and begin questioning their delusional interpretations. Your list should include the possibility that the voices are real, but only if the patient initially believes this.
3. Suggest coping strategies, such as:
- humming or singing a song several times
- listening to music
- reading (forwards and backwards)
- talking with others
- exercise
- ignoring the voices
- medication (important to include).
Ask which methods worked previously and have patients build on that list, if possible.
If a patient hears command hallucinations, assess their acuity and decide whether he or she is likely to act on them before starting CBT.
4. Use in-session voices to teach coping strategies. Ask the patient to hum a song with you (“Happy Birthday” works well). If unsuccessful, try reading a paragraph together forwards or backwards. If the voices stop—even for 2 minutes—tell the patient that he or she has begun to control them.3 Have the patient practice these exercises at home and notice if the voices stop for longer periods.
5. Briefly explain the neurology behind the voices. PET scans have shown that auditory hallucinations activate brain areas that regulate hearing and speaking,4 suggesting that people talk or think to themselves while hearing voices.
When patients ask why they hear strange voices, explain that many voices are buried inside our memory. When people hear voices, the brain’s speech, hearing, and memory centers interact.5
That said, calling auditory hallucinations “voice-thoughts,” rather than “voices,” reduces stigma and reinforces an alternate explanation behind the delusion. As the patient begins to understand that hallucinations are related to dysfunctional thoughts, we can help correct them.
Cognitive-behavioral therapy (CBT) can help patients cope with auditory hallucinations and reshape delusional beliefs to make the voices less frequent.1 Use the following CBT methods alone or with medication.
1. Engage the patient by showing interest in the voices. Ask: “When did the voices start? Where are they coming from? Can you bring them on or stop them? Do they tell you to do things? What happens when you ignore them?”
2. Normalize the hallucination. List scientifically plausible “reasons for hearing voices,”2 including sleep deprivation, isolation, dehydration and/or starvation, extreme stress, strong thoughts or emotions, fever and illness, and drug/alcohol use.
Ask which reasons might apply. Patients often agree with several explanations and begin questioning their delusional interpretations. Your list should include the possibility that the voices are real, but only if the patient initially believes this.
3. Suggest coping strategies, such as:
- humming or singing a song several times
- listening to music
- reading (forwards and backwards)
- talking with others
- exercise
- ignoring the voices
- medication (important to include).
Ask which methods worked previously and have patients build on that list, if possible.
If a patient hears command hallucinations, assess their acuity and decide whether he or she is likely to act on them before starting CBT.
4. Use in-session voices to teach coping strategies. Ask the patient to hum a song with you (“Happy Birthday” works well). If unsuccessful, try reading a paragraph together forwards or backwards. If the voices stop—even for 2 minutes—tell the patient that he or she has begun to control them.3 Have the patient practice these exercises at home and notice if the voices stop for longer periods.
5. Briefly explain the neurology behind the voices. PET scans have shown that auditory hallucinations activate brain areas that regulate hearing and speaking,4 suggesting that people talk or think to themselves while hearing voices.
When patients ask why they hear strange voices, explain that many voices are buried inside our memory. When people hear voices, the brain’s speech, hearing, and memory centers interact.5
That said, calling auditory hallucinations “voice-thoughts,” rather than “voices,” reduces stigma and reinforces an alternate explanation behind the delusion. As the patient begins to understand that hallucinations are related to dysfunctional thoughts, we can help correct them.
1. Rector NA, Beck AT. A clinical review of cognitive therapy for schizophrenia. Curr Psychiatry Rep. 2002;4:284-292.
2. Kingdon DG, Turkington D. Cognitive-behavioral therapy of schizophrenia. New York: Guilford Press; 1994.
3. Beck AT. E-mail communication.
4. McGuire PK, Shah GMS, Murray RM. Increased blood flow in Broca’s area during auditory hallucinations in schizophrenia. Lancet. 1993;342:703-706.
5. Sosland MD, Deibler MW. Temple University Psychosis Group. 2003.
1. Rector NA, Beck AT. A clinical review of cognitive therapy for schizophrenia. Curr Psychiatry Rep. 2002;4:284-292.
2. Kingdon DG, Turkington D. Cognitive-behavioral therapy of schizophrenia. New York: Guilford Press; 1994.
3. Beck AT. E-mail communication.
4. McGuire PK, Shah GMS, Murray RM. Increased blood flow in Broca’s area during auditory hallucinations in schizophrenia. Lancet. 1993;342:703-706.
5. Sosland MD, Deibler MW. Temple University Psychosis Group. 2003.