Lessons from a dark part of ancient history

In 536 AD, a lot of the world was completely dark for 18 full months. This sounds bonkers but it’s true! The sun was literally blocked by some kind of weird fog so that crops failed and people subsequently went hungry and died. This fog blanketed the Middle East, Europe, and parts of Asia. It was huge and devastating and completely bewildering (one imagines) to the people who did not see the sun for more than a year.

I first heard about this story over a year ago but I think about it frequently. What must it have been like to be those people, covered in darkness for months and months, with no apparent rhyme or reason? What did they tell each other? What did they tell their children? How long did their hope last, if it lasted at all? I think too, about how utterly alone they were. There was no way to communicate with people beyond their borders, so each little hamlet and town must have thought they were totally alone in the dark.

While we may not be in literal darkness, many of us feel that way at this moment in time. There is so much ambient grief and anxiety and distress, it’s difficult not to feel it seeping into you. The usual coping skills are harder to access at times like these. Everything feels harder, actually. It’s hard to feel so overwhelmed by the state of the world and the winter and illness and anxiety and and and. We are all, collectively, overwhelmed by darkness.

However, unlike the people in 536, we are not alone in our distress. We are not isolated in our tiny towns, wondering if the world is ending or if we’ve been cursed. We can reach out to each other and get support, even if there are no quick fixes or easy answers. We are not alone; you, reading this, are not alone. We can find the light by being with each other and seeking joy in the darkness.

Meeting Resistance

I met with a lot of resistance when I worked in hospice. I had plenty of patients who didn’t want to sign a Do Not Resuscitate form, for instance, or who didn’t want to take the medication that would keep them comfortable. Sometimes it was frustrating but for the most part, I accepted that resistance as part of the job. After all, people were literally dying. Who was I to tell them how to live out the rest of their lives? I remember once, at a consent signing, the son of a patient told me that his father “wasn’t handling his death well” and I thought… Well, he doesn’t need to; it’s HIS death. I wasn’t particularly troubled by those moments in that job because the big picture was so very big. Death has a way of throwing things into a very clear perspective.

But now I’m not a hospice social worker anymore. Now my job (a lot of the time) is to help people make changes to their behavior so that they have less stress, less depression, less anxiety, and better health. I feel pressure from the doctor who makes the referral and pressure from the patient who says, this is bad, fix it. And in these sessions, when I meet resistance, I struggle.

I’ve been trying to use motivational interviewing because a lot of what I’m meant to do is help people focus on behavior change. When using motivational interviewing with a patient, the clinician is supposed to keep in mind the stages of change. The first stage is pre-contemplation. Basically, these patients aren’t ready to make any changes. Even if they know they should quit smoking/lose weight/take their medication/you name it: they aren’t there. Sometimes the goal with these patients is just to help them identify what the consequences will be if they don’t take any action. Sometimes they don’t come back. It’s one of the basics of social work, right? MEET THE CLIENT WHERE THEY ARE.

But sometimes I really resist that!

This has been bugging me because I recently met with a patient who shot down everything I said. Every. Single. Thing.  I tried to join him with empathy. I reflected back to him what he was saying to me: job too stressful, health too difficult to manage, lack of social support. I tried to listen for change talk; when he said that he knew he couldn’t continue the way he was going, I seized on that like a drowning man grabs a life preserver. But he wasn’t having it. The session can be boiled down to me saying, “So what about…” and him saying, “nope, won’t work.”

In the end, we were both frustrated. He had started the session telling me that he didn’t think I could help him and honestly, my delicate ego had been marching around my mind the entire time, telling me I COULD help him and I WOULD! But at the end of it, we hadn’t moved much. He was resistant to me and I was resistant to him and we were both stuck.

This is one of those things that keeps coming up for me, however many years into my social work career: dealing with the impulse that screams PLEASE LET ME HELP YOU. It’s disappointing to me when the patient doesn’t want to do anything to change their circumstances. But why is that? Why do I want it more than the patient? Why do I measure my competence as a clinician through how a patient responds in one half hour session? If I’m being generous to myself, I can say it’s because I became a social worker to help people; I want people to leave the session with a plan to feel better. Less generously (but no less true), I let my delicate ego make me think I can save everyone, even people who didn’t ask for it. I’m resistant to their resistance and that’s just not going to work.

So I’m taking a deep breath and stepping back for a second. Pre-contemplation just is; same with resistance. I don’t have to move anyone forward. I don’t have to have any goal except for the goal the patient has given me. I can let my expectations go and get back to hearing what the patient in front of me is saying. And sometimes it may be, “I’m not ready.” And my response has to be, Ok. Tell me more about that.