Hypnotherapy in Later Life: Part 6

by | Dec 14, 2019 | Active Aging | 0 comments

Conserving Identity

When we are young, we respond “policeman” or “nurse” or “astronaut” when asked “What do you want to be when you grow up?” For many of us, it’s not until almost mid-life that we might realize that we didn’t understand the question. “Being” is about character. We should have said “intelligent,” “honest,” “respected,” or “caring.”

Character is critical to social connection, which comes with vulnerability to our intimates. Sometimes that vulnerability is physical: after a full day, a construction worker needs food and rest. For an attorney, the needs may be emotional: peace and warmth. When restored, a protector may curl up with a book or knitting, while the adventurer seeks the company of friends at the pub or mall.

Knowing our needs and preferences, our partners can contribute greater variety and depth to our experiences – or disrupt our plans and upset our well-being.

The Ericksons’ Stages of Development map our social development. As success is not guaranteed, each stage represents a psychological crisis. The resolutions (the “Success/Failure” columns in the table) control many aspects of our character. Trust is the foundation of honesty; mistrust foments lies. Autonomy, initiative and industry feed intelligence; shame, guilt and inferiority undermine the search for experience and knowledge.

Age Partner Success Failure
0-1 Mother Trust Mistrust
2-3 Parents Autonomy Shame
4-5 Family Initiative Guilt
6-12 School Industry Inferiority
13-22 Peers/Father Identity Role Confusion
23-35 Lover/Spouse Intimacy Isolation
35-55 Workplace Generativity Stagnation
55-65 Society Integrity Despair

Ideally, we would be allowed to linger in each stage until the crisis was resolved successfully. In reality physiology and social norms push us forward. If we haven’t evolved a stable social identity in our teen years, still we must leave the family home, often necessitating moving in with a lover or friends (intimacy). Any bond will fray as we continue to try out adult personalities, forcing our intimates to adjust to our new preferences and priorities. The alternative is to allow others to make choices for us, swallowing our frustration until we find an opportunity to change our living circumstances.

The problem with the second outcome is suggested by the “organic language.” “Swallowing our frustration” reflects a hesitancy to express our needs to our intimates. The latent psychological conflict is transferred to muscles in the throat and jaw, manifesting in eczema or teeth-grinding. These are often recognized only when the “body syndrome” becomes a recognized medical condition, but in fact most of us carry unresolved crises in our body.

This is the context we carry with us when entering Joan Erickson’s ninth stage of development: what we do, our character, and the physical side-effects of unresolved crises. In that ninth stage of development, the first (what we do) is suddenly undermined, threatening the foundation of our character.

To understand this point, consider an Asian child, eating with chopsticks while kneeling on a mat on the floor. In kneeling parents come down to the child’s level, increasing the sense of connection. Now imagine a move to America and the ridicule of peers who see the child fumbling with a knife and fork. Confidence and self-esteem are undermined, restored every night when eating again with family.

In counseling retirees to continue to learn, experts recognize the danger posed by the interruption of our daily routine. The brain is designed to learn, but also to unlearn. Maintaining neural circuits requires energy, and when our priorities change (for example after a successful dating life results in marriage), underutilized circuitry is slowly dismantled to support circuits that bring success in our new situation. In retirement, continued learning helps us to maintain our identity.

In counseling those diagnosed with dementia, Dr. Dan Nightingale proposed a relationship between doing (outer rectangle) and identity (inner rectangle). To preserve identity, he proposes that we focus learning on activities that support our most valued character traits. The process defines a “Strategic Action Plan” that is negotiated by the patient with caregivers and peers. For a detailed case study, see “A Clinician’s Guide to Non-Pharmacological Dementia Therapies.” The book includes vignettes that describe the resuscitation of lives upended by dementia.

Inevitably, however, the disease progresses. As the social identity and cognition are conditioned on physical survival, the brain’s reduced capacities become focused progressively on bodily functions. The degraded conscious mind no longer accurately explains the environment, driving anxiety and fear. Here hypnotherapy has a special role to play: the trusted therapist takes over the executive functions of the brain, in suggestions explaining how the beloved should act to avoid conflict with their caregivers and community. With positive feedback, fear and anxiety recedes, leaving more resources for socialization and reason.

Still, the circle of engagement continues to narrow, and the stress stored in body syndromes eventually comes to the fore. Rumination on traumas may take place, sadly more pronounced after language skills have declined. A detailed history of life trauma is essential in diagnosing these episodes and providing therapy to relieve them. Again, see Dr. Nightingale’s book.

Part 1 || Part 5

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