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The Life Tapes and Symbolic Immortality Review
Introduction
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An Existential Intervention for Cancer Patients That Increases Family Social Support and Symbolic Immortality with a Brief Existential Intervention for Cancer Patients and Their Families (Existential - dealing with existence - life and death).
The Life Tapes Project (LTP) helps bring families closer together by increasing communication and also acts as an existential intervention, leading to a greater sense of legacy, meaning of life, and increased self awareness. It involves the symbolic immortality that is an aspect of existential coping and social support factors, which benefit patients and their families and meet patient and family needs.
Introduction
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A diagnosis of cancer poses a powerful threat to the emotional equilibrium of both patients and families. It poses an existential threat, coupled with the fear of arduous treatments and possible painful decline, which haunts both patients and families despite the current improved effectiveness of treatments and the prospects of improved survival. With the possible prospect of dying, isolation becomes especially distressing (Yalom, 1980). A key role of both family and medical team is to provide a supportive environment for the patient to live and confront the potential reality of death. Often, communication paralysis and denial exist; although, often, family members want to talk freely.
In order to address the psychological needs of patient and family, adjuvant cancer supportive programs have been developed both locally and worldwide. Often, these address the existential needs and concerns of patients and families. The LTP was created as one of these interventions to help bring families closer together, as well as act as an intervention, leading to a greater sense of meaning, self awareness, identity and connection for the patient. Speigel and Bloom found that expressiveness in an open forum of group support helped patients improve adjustment. The quality of family support is very important to decrease distress and support immune function. Helping to allay patient fears about illness and its affect on themselves and their family members is another benefit of supportive care.
The LTP has proven to be a suitable way of addressing these issues, which enhance both social support and help in understanding existential factors that may underlie some of the psychological benefits of family support. This existential coping has been exemplified in a concept called symbolic immortality. In 1977, using audio taping of family histories, we showed benefits for family cohesion and support through improved communication. Cancer was viewed as a life-changing event, happening to the entire family not simply the affected individual. The life tape interview also promoted meaningful self-reflection and the mutual sharing of authentic emotions ensconced in the history and legacy of the family.
Symbolic Immortality
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Being conscious of our own mortality is a fundamental aspect of being human, with the consequent anxiety we all attempt to manage - to a greater or lesser extent - across the span of our lives. Yalom, discussed our approach to life being tied to our relationships and to our philosophy about death. Successfully confronting death will enhance our appreciation of, and satisfaction with, life.
Robert Jay Lifton, 1979, 1996, and Becker in 1973, discussed our propensity to identify with things greater and more enduring than ourselves in the form of symbolic immortality. Lifton recognized our connection to an enduring human reality. He described five domains: Biological and bio-social, religious or theological, creative, nature, and transcendental.
The LTP interviews are most closely related to the biological and creative domains, reflecting a continuous chain of life, where values, achievements and philosophical thoughts are passed on to future generations. Thus, some important part of the individual continues to exist symbolically, even after death.
Symbolic Immortality in the Biological Domain
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Symbolic immortality in the biological domain is found in the continuity of family across time - through one's family and subsequent generations and in the sense that our lives are reflected in the continuation of our thoughts and values in our family, children, and grandchildren. Thus, cultural traditions are continued in future generations, identified in the chain of predecessors and in the children and generations to come. Traditions, values and a sense of common heritage, as well as political beliefs, and even humor continue beyond the mortality of a single family member. These become symbolic as part of the family culture, and their continued existence in others contributes to the sense of symbolic immortality.
In the LTP interview, a discussion of family genealogy and history about one's forbearers, as well as one's family, are discussed.
Symbolic Immortality through Creativity
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In the creative domain, symbolic immortality is readily apparent in great works of art, such as the Mona Lisa, or literature, music, or science that will last many generations beyond the creator.
Although few people will be known by their works, most of us will leave a creative mark on the world through unaccountable human interactions that fill our lives and in particular by "every day offerings of nurturing or even kindness - in relationships of love, friendship and, at times, even anonymous encounters. Indeed, any form of acting upon others contains important perceptions of timeless consequences." (Lifton, 1996, pg. 22)
Thus, through living, one can make a lasting difference in the lives of others as a form of symbolic immortality in the creative domain. This could be exemplified during an LTP interview, when patients recall their proudest moments or acts of kindness or selflessness. A person in the room during an LTP interview, who is a recipient of such a kindness, can experience the impact of human kindness, which promotes appreciation, as well as being taught something about being a model he hopes to emulate. Also it could be exemplified by how the patient has coped with cancer and expressing and discussing feelings about dying.
This kind of symbolic immortality through creating changes in others can also contribute to bio-social symbolic immortality. Also, passing down lessons learned through one's life struggles or experiences can add to the family heritage. This is also reflected in the way a patient has lived with cancer and how behavior and values affect the survivors. It also reflects how a patient can serve as a model to others in the family and how to face and hear about dying and death. It helps counteract fears and also helps family members counter their sense of helplessness and loss at the prospect of their loved one's death. This has become one of the strengths of the LTP interview process - that is - to think of oneself as if a piece of me becomes a part of one's family history.
Using Symbolic Immortality to Facilitate Family Social Support
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- Social support and working together to improve family relationships through making a life tape can contribute to the feelings of immortality by identifying family ties and through acts of loving support. This helps manage existential anxiety stirred by a threat to loved ones (Speigel, 1993) and leads to increased support of the patient while increasing their own sense of well-being and appreciation of life. Relationships between patients and family members are strengthened through improved communication and emotional support, decreased isolation and existential anxiety, with greater feelings of closeness and involvement.
- The patient's relationship to the sense of his or her own self and life is deepened in the form of greater life meaning and satisfaction, self-understanding, and symbolic immortality.
- It can lead to an evaluation of end-of-life issues, such as a sense of closure and anxiety about death and dying.
- Possible changes in quality of life, mood, social support and post-traumatic growth related to cancer have been noted in the LTP.
Results of the Life Tape Project
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- 1. 90% of patients reported important benefits from the interview in these categories:
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a. Leaving a legacy and passing on values to family was most frequently cited
b. Increases in self-reflection and self-understanding
c. Quality of social support: sharing feelings, fears, love and appreciation - least reported benefit.
d. Helps overcome hurdles to effective communication by gathering loved ones together for an LTP discussion.
e. By expressing concerns and affection, the patient receives support from the family, which the patient desires most
f. The patient learns the family can handle the current problems
g. The experience of existential isolation is one distressing effect countered by social support
- The LTP works as:
- An existential intervention in the face of mortality through the creation and awareness of symbolic immortality.
- Improving psychological well-being through existential adjustment.
- Facing existential concerns, which are prominent in the minds of cancer patients.
- Patients and health care practitioners alike confront existential issues of being alive when we come face-to-face with the prospect of death.
- Concerns are universal and normal and do not negate the importance of understanding how human beings strive to cope with them.
- Those of us who help others face death, can begin to get a deeper grasp on the fundamental challenge and facilitate the natural process that helps patients transit this phase of life.
Currently, (for those in the San Francisico Bay Area) the life tape interview is a free, 1.5-2.0 hour videotaped interview of a cancer patient and his or her family, including the life history, family history, and vital episodes in the family's life, as well as the legacy of the patient and family. The impact of the cancer on both patient and family is discussed, as well as anxieties, fears, and apprehensions.
Conclusion
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- LTP provides the opportunity for cancer patients to reflect on their lives.
- To gain perspective.
- Find meaning.
- Reveal themselves to others.
- Face the issues and meaning of mortality in the presence of family and loved ones.
- Family members are given the opportunity to express their feelings to the ill family member.
- Provide patients a sense of what will remain with their families after they are gone.
- Provide a sense of symbolic immortality while offering a concrete example of how to be supportive of a loved one.
Thus, the taboo about discussing death may be broken, and the door is opened to greater communication and decreased isolation. The LTP provides a guided opportunity for self-exploration and revelation, pulling for the best responses in the cancer patient's most important support system. For health care professionals, it provides an opportunity to understand their own and others' struggles to manage anxiety about mortality. It also provides a venue to understand what the patients are going through and to better help meet their needs. It promotes the sense of dignity and closure, as well as being a venue for hospice and palliative care communications - a key for psychological well-being in the face of death (Chochinov, 2002).
It is of interest that even a solo interview has been shown to provide the opportunity to reflect on life, and the resulting tape or DVD is also a remembrance for friends and family. The act of reflection helps to bring a sense of meaning and closure for patients. Thus, it affords an opportunity to identify, strengthen or reaffirm a connection with the value of our lives and lessens the anxiety and alienation that so often accompanies an awareness of mortality. By choosing to prepare a legacy that will remain after one has died, one is often affirming what matters in one's own life - both in the content and the chosen audience for the life tape.
The LTP offers the person with a life-threatening illness the opportunity to leave a gift to family and friends, enhance the sense of control and increase the support provided. Preparation of such a legacy involves both a confrontation with death and an enhancement of life.
First appeared March 18, 2006