Managing existential angst whilst working with chronic illness and or disability

Soon after completing my Royal National Institute for Blind People’s accreditation for working with sight loss clients, I became an emergency mental health practioner. In this article I describe my experience of working with this client group and reflect on the emotional difficulty of supporting clients with chronic illness who have also been negatively affected by COVID lockdown measures. 

From the onset, when we talk about mental health and illnesses we automatically begin to use language that elicits a theory of lack and disorder that needs to be treated and remedied. From a phenomenological perspective even person centred practioners and positive psychologists are prone to measuring outcomes in a way that creates a desire and expectation to improve the client’s well-being to an acceptable degree. As therapists that is what we want, we want to alleviate and where possible eliminate the psychic pain, change problematic behaviour and ensure that our clients leave the room with a sense of healing and restoration. How might we then manage the existential angst that usually accommodates working with a client who has an illness that is treatable but problematic, incurable and or debilitating?

Existential angst is the dread commonly associated with philosopher  Søren Kierkegaard (World Library Foundation 2020). It is the terrifying fear that accommodates the lived experience of ‘being’ in the world, understanding one’s own sense of permanence and transient qualities. Put another way, it is the awareness of one’s own fate  a fear of death that is often heightened by sickness, acts of terrorism, hate, abuse and oppression. Anything that presents a felt threat to one’s existence. As children we often begin to developed an understanding of life and death, the need to survive. We often notice small injustices in the classroom when someone is given the tambourine and not us or we miss out on playtime for talking but our classmate does not. Over time perceived threats to our personhood evolve as we are exposed new realities of life, e.g.  we are passed over for promotion despite being a great therapist. Similarly, in practice we may wrestle with a deep intrenched feeling of unfairness or fear of annihilation, when a client suffers a medical crisis.   

Hearing clients detail how their sight has deteriorated, their inability to exercise, or the sadness accompanied by the loss and longing for simple pleasures such as seeing the colours of a rainbow on a wet but sunny day-can be heart breaking for me. I find myself pondering and asking “why something as terrible should befall someone who is young and otherwise has their whole life ahead of them” or feeling lost for words as an elderly person is passed over for a new treatment which, is given to a younger person.

How do I overcome this? I manage my angst by remembering why I work with this client group. I call upon that feeling I get when I recall a client laughing and thanking me for making his day. I do what I can to feel grounded in the present sometimes that means stretching before logging my notes or mentally ticking off all that I  am grateful for.

This is not easy when I understand the varying degrees to which individuals have experienced an increased awareness of their  mortality by this year’s strain of corona virus. It has been targeted almost universally by the shutting down of  entire towns, states and countries. An incredibly unstable time for all but more so for those who already had to struggle to participate in society. For some all and nothing has changed, their access to support has been made even harder, they have become even more isolated, there are small moments of recognition and understanding of what life is like for them daily for those now unable to go and do as they please. I encourage my clients to express themselves as best as they can. We think about practical steps that can be taken whilst, sitting in silence digesting and accepting their limits and mine in making life different for them. I thank them for their time and when we hang up I reflect on life in its fullness. The hardships as well as the charm and ability to be satisfied with the best that there is at this time. Remembering that the best that I can offer is a willing heart to empathically listen and respond to the client with an honest appreciation of what I can do psychological to support them.

Useful articles

Brett & Kate McKay (2018) Sources of Existential Angst in A Man’s Life, Action, Featured, Life Purpose.

Matthew Temple & Terry Lynn Gall (2016). Working Through Existential Anxiety Toward Authenticity: A Spiritual Journey of Meaning Making. DOI: 10.1177/0022167816629968. Last accessed 23/10/2020

World Heritage Encyclopedia (2020) Existential Dread. DOI: WHEBN0000238101. Last accessed 23/10/2020

Written by Sasha McBean.

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