Thursday, July 24, 2008

Nouwen and the Birds...

Excerpt from "Seeds of Hope: A Nouwen Reader". Chapter entitled "Celebrating Humanness"

the Birds and I Genesse Abbey, June 13, 1974

This morning, Father John explained to me that the killdeer is a bird that fools you by simulating injury to pull attention away from her eggs which she lays openly on a sandy place. Beautiful! Neurosis as a weapon! How often I have asked pity for an unreal problem in order to pull people's attention away from what I didn't want them to see.

Sometimes it seems that every bird has institutionalized every one of my defense mechanisms. The cowbird lays her eggs in some other bird's nest to let them do the brooding job, the Baltimore oriole imitates the sound of more dangerous birds to keep the enemies away, and the redwing blackbird keeps screaming so loud over head that you get tired of her noise and soon leave the area that she considers hers. It does not take long to realize that I do all of that and a lot more to protect myself or to get my own will done. Genesse Diary

I find this to be an interesting commentary on people and the defense mechanisms we use. Often we want something done, but we aren't willing to do the work to get there. Or in the case of some patients I have met, they do not or are not able to take responsibility for their own actions. The illness is the result of someone or something else. That may be true, but in the meantime, this is where we are... let's work with that. Blaming someone else for our problems and trying to figure out why or how, sometimes this doesn't help us at all. We end up wallowing in our own misery and at times, this exasperates the situation (and the other people around who are trying to help.) I have a few patients who are "labelled" (for lack of a better word) as "non compliant". This means that they have come to our hospital saying "I need help. Please help me to fix this issue." But when told a treatment plan or when the "plan" doesn't fit their criteria, they don't follow the "prescription". They want help, but not in the way that we have to offer it. Very frustrating at times.

The complication is that often the non-compliance is a result of denial or non-acceptance of the situation that they are in. True. Some times we will wallow in our misery and pain. True, sometimes this is warranted. However in the case of a health issue, this may not be good. Rather time is not always afforded to allow the person to process at their speed.

This afternoon, I was talking to 2 family members of a "new" patient. *New to me* One I had met a few times before, and so we had a good rapport. They had worked in the health care field and hence had some understanding of the kind of issues that occur from non-compliance. The other person, I had only met this afternoon. They didn't come to the hospital very much as per the non-compliance being a large part of a relationship dynamic causing frustration and burnout for this individual. They mentioned that when the patient smartens up (my words) and gets a transplant then maybe they will stop whining about their problems and life will go back to the way it was. The health care knowledgeable family and I explained this person that getting a transplant is not like waving a magic wand. Instead, it is a means to living longer (temporarily) just as certain medications and treatments were. Kidney disease can be chronic, and when it is, it can be considered terminal at times. Freud said that from the moment we are born, we begin to die. This is a fact that we all must face, just some people must face it sooner. That can be a factor of the non-compliance. They aren't ready to consider death as a possibility. It would likely overwhelm and cause depression. "Why bother to live for today if I might die tomorrow?" But then we might all think that eh?

The birds and their "defense" mechanisms. Sometimes, people use these defense strategies so that people don't see the thing the birds are trying to hide. Sometime we people are the birds. We are trying to distract our fellow cronies from seeing the flaws, our perceived failures, and other times, we are trying to distract ourselves from seeing our own flaws and perceived failures. It is too overwhelming at times. Sometimes these "defense mechanisms" are warranted, but to persist too long can damage our emotional and spiritual health.

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