Do Good to Feel Good, Part II

Now I'd like to play a couple rounds of Devil's Advocate.

Let's put it on the table. Is there such thing as too much giving? After all, some of us are already helping people. All. The. Time.

We volunteer at the retirement home, we bake for the neighbors. Perhaps we run a little NPO on the side that distributes funds and clothing, or join every other community hesed committee, or run off to a wedding hall in the middle of the night to pick up and distribute the leftover food.

Or maybe we do some or all of the above, PLUS we've found our life's calling in one of those pointedly-named Helping Professions --as a social worker, therapist, nurse or charity office manager. What could be better? We are assured an opportunity to help others, every day, and often in the most moving and meaningful ways. We take care of others' bodies and souls. We sooth mental anguish and relieve financial burdens, advocate for the disenfranchised and restore human dignity. We do all of this without pitying or patronizing.

So is there such thing as helping too much? We love our life's work because it is life-giving, meaningful, significant. We believe our professional role is right and yes, a kind of moral obligation. But we often resent the conditions: Low pay, little recognition, case overload, stressful work environment.

I'm thinking about yet another phenomenon. How do you do it, how can you work here, with such sick kids? someone will query in admiration. Kol haKavod (Bravo!), that's amazing! They don't get it. I can do this work because love this work, and when I'm doing it, my life feels meaningful and significant.

The problem comes later, when I get home. Sometimes it hits me, how sick those kids really are, and I am exhausted. Weighing me down are all the patients I didn't have time to work with. The parents I didn't get back to. That uncomfortable exchange with a short-tempered staff member. The feeling of being constantly on call -- encouraging, empathic, organized and authoritative -- but not too authoritative. These things can all but wash out the day's many successes.

Worse, I often find myself unable to regroup and focus by the time I've finished my commute home. My own kids need me. They need someone to give them lunch and watch their gymnastics practice and blows their noses and help with their math homework. They don't feel my own need to go to the bathroom and then sit down for five minutes, alone, over a hot drink. Whatever went on in my day until now is completely irrelevant. They expect focused, energetic Mommy, ready to go and full speed ahead.

The work itself is not the problem, it's maintaining my strength to give and give, all morning and afternoon, and then give again into the evening. It's keeping up the required enthusiasm at home to do all the day-to-day tasks, with the patience my kids deserve from me.

Sometimes I fantasize leaving for a well-compensated, "normal" office job, or locking myself away in my studio, "arting" around all day. I imagine opening a small craft business, or private therapy work with a limited number of clients. But getting down to it, I know I would only do such a thing if I were to reach the conclusion that the price had gotten too high, that I could no longer keep up both ends of the giving spectrum, and that giving at work was always at the expense of giving at home.

And here's where I have to admit it. For all its difficulties, hospital work gives me a sense of status and accomplishment that, for whatever reason, I cannot always seem to muster at home. Maybe that's the fallout for some of us girls who grew up in the Seventies on Sesame Street and Free to Be... You and Me. Or maybe it's just that at work, I'm an experienced professional, a figure of authority, a source of knowledge and understanding, while at home, I'm "just" Mom.

Their only Mom. Full speed ahead.

Keep the balance,

ALN

____

For more on why we help one another, this is another interesting NYT piece, especially the part about the role of the sclera (whites of the eyes) in human altruistic behavior.

Do Good to Feel Good, Part I

Here it is (again), this time via the NYT: Scientific evidence that giving works.

And let's face it, we know this. We all know it, from the inside. Giving promotes health. Thinking about others promotes health. (Thanks again, Prof K, for your insightful reminder).

The article's examples there are numerous. Here's a personal favorite:

An array of studies have documented this effect. In one, a 2002 Boston College study, researchers found that patients with chronic pain fared better when they counseled other pain patients, experiencing less depression, intense pain and disability.

Anyone who has been chronically ill, or who has spent time among the chronically ill, will readily note that a sick person does not want to be the focus of people's help and attention all the time; she wants to listen to others and be there for them. In other words, she wants to feel normal, and being able to help others restores our sense of normalcy.

Unless you're a celebrity, being the constant focus of others is not a normal state of existence. I'm not convinced it does much good for celebrities either, with their constant complaints of telephoto lenses sneaking ou from behind the trash cans, and all those pop songs lamenting the paparazzi. But heck, it's a living.

Turns out that being stuck in your own misery can lead to somatic harm.

By contrast, being self-centered may be damaging to health. In one study of 150 heart patients, researchers found that people in the study who had more “self-references” (those who talked about themselves at length or used more first-person pronouns) had more severe heart disease and did worse on treadmill tests.

I believe it.

I don't usually do this, honest, but I'm even going out on a limb and referencing Dennis Prager's take on happiness, flippant as it sounds, since I think he's got something too.

(I do take issue with his use of the term moral obligation. I don't usually view the use of antiperspirant as a moral obligation either.... a social obligation, maybe, but moral? An exception might be when working with people, such as those on chemo, who may be exceedingly disturbed or nauseated by strong smells. And on Egged buses during the summer months -- OK, that might just be a moral obligation).

Call it CBT, call it common sense, call it a serotonin-inspired warm fuzzy feeling -- the evidence has long been out there. Actions determine mood, and not the other way round.

Keep the balance,

ALN

Receiving is Giving, Part 3

The Unacknowledged Thank You.  Many years ago, when I was still a beginning therapist in the hospital, feeling like a very small cog in a very big wheel, I worked with a little girl I'll call N.  N was extremely familiar with the hospital, having "recovered" from a life-threatening illness only to endure recurrent long-term hospitalizations for the ongoing, irreversibly damaging side effects inflicted by the original treatment.  At first, I intensely disliked N.  Her voice was whiney, her face scarred, her body misshapen, and her behavior ungrateful and dismissive.  After years of being in "the system," N and her mother knew everyone, in every relevant department.  If one physician or nurse said No, they would work their way up the chain until they got to someone who would give them a Yes, in writing.  Then, only then, would they praise that person up the wazoo, while cursing all the rest.

Many of our school staff members worked with N throughout her hospitalizations, and I myself worked with her over a period of seven years.  At first her artwork was perseverative, lacking creativity and originality.  She stuck with variations of the same image, drawing it over and over, in different media, sizes, and colors, but always sticking with the one theme she knew and loved and could trust to stay consistent in her rocky world.  Even as N grew, reached majority and was transferred to the adults' unit, we continued our regular art sessions, until slowly, she began to branch out and blossom.  She began asking me to teach her new art  techniques.  She requested additional images to study and work from, until reaching a point where she rarely returned to her earlier, repetitive theme.  She began to feel better physically, and worked feverishly through an endless list of staff members and friends for whom she prepared thoughtful gifts in the form of her own original artwork.

All the while, N tended to express her wishes to me in the form of commands, with the please added on as an afterthought, an external politeness she was taught would work to get her what she wanted.  Bring me this, Get me that, Maybe you could buy such-and-such a kind of [very expensive] paint?  On occasion, she did remember to say thank you.  Despite this, I grew to feel close to her and appreciate many of her positive characteristics, and and I looked forward to our sessions.

Throughout the years, N was the beneficiary of many expensive and scarce medical treatments that the hospital went out of its way to provide.  On the last day of her hospital stay (after which she was released to live at home and continue her treatment as an outpatient) the hospital staff held a party for her, during which she and her mother distributed cards and gifts to every last medical staff member and social worker in the room.  

At the time I felt it ironic and insulting that among all her acknowledgements, there was no mention whatsoever of me, who was present at the party, nor of any of the many additional school staff members who had accompanied N throughout all those years.  Nothing.  Not even a thank you.

At first I didn't know how to interpret her behavior.  I thought, Could she really have forgotten all of our time together, all the work she had done, and how much meaning it held for her?   Did she really think it was of that little value?

Then I stopped to think.  As a form of closure, I went over my session notes.  I talked to colleagues.  I did some research on the psychological implications of  showing, or not showing, appreciation within the therapeutic relationship.  All of this helped me make sense of N's behavior.  N and her mother, were simultaneously furious at, and indebted to, the medical establishment, whose original treatment had "caused" her handicaps, and whose later treatment had, at least partially, redeemed her from them.  This family had always made their way through the system by showing people genuine gratitude, contaminated by their feelings of anger at the system which was responsible for all of this in the first place.*

N's involvement with the hospital school, on the other hand, was a perk, an option, a factor she did not associate directly with her medical condition or its treatment.  By extension, it remained an element of her hospital stay for which she could choose to show appreciation, or not.  We were one body within the hospital to whom N did not owe the debt of her life.  In that light, I now understood just what our role was.  We were the only form of hospital  "treatment" she could like or dislike,  thank or not thank, accept or reject.  And she had chosen, for all that, to accept us.  What bigger thanks could we ask for?

Keep the balance,

ALN

_____

* I do not mean to suggest malpractice on the part of the hospital.  The side effects that afflicted N were the unfair and unpreventable results of the life-saving  treatment she received for an illness she suffered as a young girl.

Receiving is Giving, Part 2

This is a tough one, yet another of those therapy issues with no clear-cut answer:  the subject of thank you's.*

I used to feel really uncomfortable when a patient, or more likely, his parent, thanked me after a session.  They don't owe me that, I would squirm and tell myself.  I'm just doing my job.  

What flawed thinking, on many accounts.  Here's why:

Giving Strengthens.  Human beings were not created to receive without giving, and no one in her right mind would choose a position of constant receiving, nor the sense of powerlessness, hopelessness and utter dependency that would follow.  One of the first phrases my kids ever uttered was Self.  SELF!  and with good reason.  By learning to express their own independence, my kids were strengthening themselves and their feelings of independence and humanity.

Receiving is Giving.  I addressed this a bit in my original post.  For hospitalized children, and especially their parents, saying thank you is one way they can give, in a setting where they are constantly on the receiving end:  Countless medicines to fight the disease and the pain;   Food delivered on a tray;  Clean sheets with the hospital's name printed on it.  Even every-day tasks, the ones that characterize a "normal" life -- such as cleaning the floor, cooking pasta, folding shirts -- are no longer an option.  To this add endless non-profits and tzedakah organizations who, despite the most wonderful intentions in the world, sometimes increase the families' feeling that, yet again, they are the objects of someone else's generosity.** 

 

A simple thank you is a way of giving, of re-establishing feelings of identity and wholeness, and of expressing love for self and others in the form of gratitude.  To accept a straightforward thank you with honest appreciation is to move toward restoring the balance between giving and receiving.

I'd Like to Hear It.  As for the professional, it's nice -- maybe even necessary -- to hear thank you for one's efforts, at least some of the time.  Who, after all, doesn't want to be thanked, even while she's punching a clock?  Work is work, and seeking some sort of recognition or appreciation, in addition to a salary, is nothing to be ashamed of.  For most of us it would be false modesty to deny this.  When I came to that new understanding, it became so easy to hear thank you, smile and reply "Your welcome," sometimes followed by, "it's my pleasure" or even, "Thank you too, for sharing your ideas with me."

Yes, there is a hospital story to go with all of this, but that'll have to wait for a later post...

Keep the balance,

ALN

_____

*For those of you wondering why I suddenly have so much time to post, it's becauseI have been stuck at home with the flu for three days.  I'm already feeling much better, but it's too much of a risk for kids with low blood counts to be exposed to my viruses.  At one good thing is coming out of it... I have time to write.

** No wonder so many families, upon finishing treatment, run to establish an NPO of their own, in a worthy and understandable effort to reestablish the sense of give-and-take equilibrium they felt prior to their experience with illness, as well as trying to help others benefit from the "insider" knowledge they have gained.

Receiving is Giving

When we first moved into our little community, some eight years ago, I spent quite a few weeks feeling really lonely.  We knew only one family in the neighborhood.   Our first-born was a year old, and so that natural, time-proven way of meeting the neighbors (that is, through your kids), was not such an option.  It was the height of summer, and even Shabbat was not the greatest opportunity to get to know people, since so many of them were away.  I began to feel like a real outsider.

When did I feel it the most?  It doesn't sound nearly half as ironic now as it did then, but here it is:  Nobody ever came over asking to borrow something.  No one knocked on our door for a cup of flour, an egg, a bag of milk.  Nothing.   For weeks.  

I felt so out of it.  So, well, useless.  People were coming to meet us, offering us help, even inviting us for meals, and that was certainly nice, and appreciated.

But who wants to be on the receiving end every time?

And then, one day.... one of our neighbors came over, apologizing.  Could she borrow a cup of flour?  

Are you kidding?!?!  

I was so excited, I could've hugged her.  (I know, that would have completely confused her).  She had no idea what a huge thing she was doing for me, asking to borrow something, because it wasn't the asking that mattered, it was the giving.  She was giving me, a new person on the block, the chance to be on the giving end, to feel like I (finally) had a role in the community.  A small role, but it meant everything to me.

I work in the hospital with really sick kids.  I wish there was something I could do to make them well, or better yet, to have kept them from getting sick in the first place.  But I know I can't.  I can only try to help them get through their illness with as much strength and love as possible.  And I can do this with the complete awareness that their existence as sick children is the very thing that allows me to do my job, and to give to them.  Their act of receiving my help is, in essence, a very great act of giving.  

No one wants to feel like they are constantly on the receiving end, even (especially?) children. Maybe this type of work has really driven that point home for me... so much so, that I'm constantly reminding the kids I work with, how much they give me, how much I appreciate their willingness to share with me, to learn, to express themselves honestly, even when the subject matter is often painful, frightening, and threatening.

RivkA, I know that you -- and everyone who loves you -- would never, ever choose the circumstances surrounding your "new" role, of helping people to give.  But it is one of the most important roles in this world, and I wish you courage and strength of every sort as you continue to cross all the challenging bridges that come your way.

Keep the balance,

ALN