by Kristen Tobias, M.A.
Dr. Ellis routinely acknowledged that we all possess the innate capacity to think both rationally and irrationally—it is part of the human condition. In addition to the influence of biological predispositions and early life experiences, there may be critical phases of the human lifespan wherein we become more susceptible to thinking irrationally and thereby disturbing ourselves. The midlife crisis, and the more recently popularized quarter-life-crisis, quickly comes to mind. The type of contemplation inherent to these life phases may be associated with activation of irrational beliefs about where one should be and what must happen. Perhaps less appreciated is the notion that similar demands seem to arise in the context of an acutely limited lifespan, either related to aging or in the context of a terminal illness.
A recent discussion with colleagues centered on the idea that unresolved interpersonal relationships can contribute to the development of depression in those who imminently face death. A normative response to death and dying is a reevaluation and reorganization of priorities. Increased emphasis may be placed on penitence, reconciliation with friends or family, and reestablishment of social ties. But what happens when the desire to make these relational changes is elevated to a demand? Individuals may think that they must restore peace, or that they should undo hurt, or that others must be receptive to attempts at reconciliation. And reformation may include an urgency…it must happen before it is too late.
The problem with unresolved or terminated relationships is that they involve another individual who has their own unique thoughts and feelings about the estranged relationship. The person’s hurt, pain, or anger may preclude a willingness to reconcile. What happens when a person facing death continues to demand that a relationship be different than it is? It isn’t hard to see how depression arises from this type of thinking. We can also surmise that a depressed person is less likely to effectuate reconciliation compared to a person that is sad, but not clinically depressed.
How might we best challenge demands during end-of-life care? A functional dispute may be most appropriate. Validation of the strong preference could be gently emphasized as we point out the damaging consequence of a demand for reconciliation. Recognition of the present proximal influence of thinking on emotion, as opposed to the historical (distal) event (i.e., the estrangement), may help to change depression into sadness. It seems that logical and empirical disputations may also be applied in a sensitive manner that acknowledges the gravity of the situation. For example, the negotiation of awfulizing might be more challenging to navigate in this clinical population.
Accepting an unfortunate reality does not meet resigning to this fate or passive acceptance of this fate, but will help us to not experience an unhealthy negative emotion. The absence of depression will put us in a better position to navigate a meaningful apology and help to ensure that we have done everything in our power to restore a relationship.
Quality of life becomes paramount during end-of-life care. In an attempt to ease suffering, other unhealthy negative emotions such as guilt, shame, and hurt might be transformed into healthy negative emotions such as remorse, regret, and disappointment, respectively. REBT can be a mechanism for meaningful change as individuals navigate this important phase of life and their unique circumstances.
