Dignity Therapy

Terminal illness often undermines a patient's sense of dignity and leads to depression, anxiety, a sense of hopelessness, and feelings of being a burden to others. One technique, however, “dignity therapy,” seems to alleviate some of these symptoms. A recent program on NPR brought it to my attention.

Dignity therapy is an intervention with the terminally ill who, in guided conversations with trained interviewers, speak of what’s most important to them. Patients are encouraged to tell their life stories and to talk about their feelings, their memories, and their hopes for their descendants. Transcriptions of their conversations are then edited and presented to the patients, who have an opportunity to correct or otherwise change them, and the patients can then bequeath the final versions to their loved ones.

The interviewers ask about the patient’s life as a whole. “Tell me a little about your life history, particularly the parts that you either remember most or think are the most important.” Responses are followed up by other questions such as “When did you feel most alive?” “Are there specific things that you would want your family to know about you and are there particular things you would want them to remember?” “What are your most important accomplishments, and what do you feel most proud of?” “What have you learned about life that you would want to pass on to others?”

The dignity therapy technique was first reported by Harvey Max Chochinov , a psychiatrist at the University of Manitoba, and his colleagues in the Journal of Clinical Oncology in 2005. The researchers, who employed the procedure with 100 terminally ill patients, half from Canada and half from Australia, found that after the therapy, a majority of patients reported a “heightened sense of dignity” and a “heightened sense of meaning,” and reported less suffering compared to the level present before the intervention.

One doesn’t need to be terminally ill in order to suffer a loss of dignity, as I’ve found in my own hospitalizations, in which I’ve often felt as though I were being processed along an assembly line of patients, an impression fortified by our being all dressed alike, in identical ill-fitting, unflattering hospital gowns. How much worse must these feelings be when, terminally ill, your strength is depleted and your dependency greater. It stands to reason that you will be bucked up when a professional shows an interest in you not as a collection of symptoms or as the host of a disease but as a person with a unique life story. And if you do not believe in an afterlife, the annihilation you face may seem not so terrible if you can leave something behind, a testament of what has been most important to you.

It struck me as I read about this technique, that one shouldn’t wait until one is terminally ill before preparing such a legacy. Not all of us will be terminally ill. We may drop dead from a heart attack or a burst aneurysm. We may be run over. We may be shot by a jealous lover. We may, in other words, die with no warning whatsoever.

I was reminded of this recently when, during a family dinner at a Chinese restaurant in Chelsea, my brother slumped in his seat, unresponsive. My quick-thinking daughter called 911, and he was taken to NYU Medical Center, where his vital signs returned to normal levels. He had suffered a “vasovagal episode” brought on by having to stand for four hours at the opening of an art show in which his wife had participated. But as I looked at him slumped in his restaurant chair, horrified at the thought that he might be dead, the brevity and uncertainty of life never seemed clearer.

So, people, if you want to leave a written legacy for your loved ones, don't wait until you’re terminally ill. But, I must admit, this is advice I won’t take myself. Since I’m not going to be hung in two weeks, to steal from one of Johnson's aphorisms, my mind is not sufficiently concentrated. Besides, I’m too busy having a good time.

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