“Hey This Feels Real Homey”

 
 
“Hey This Feels Real Homey” Keeping Company with One Who is Dying Contour Drawing and Scribble Drawing for Self-Care Introduction Frank Ostaseski, founding director of the Zen Hospice in San Francisco, has made some helpful suggestions for those of us offering companionship to someone approaching death. "Have confidence in the healing power of human presence. Particularly in the final days, slow down and leave room for silence...Create a calm and receptive environment. Honor the spiritual dimensions of dying. Let go of control and be willing to acknowledge ignorance in the face of this extraordinary mystery (2000).” This presentation explores the use of the image-making process when sitting with someone who is terminally ill. It is my own personal journey as an artist, therapist and sister - in the face of my brother’s imminent death. My belief and my hope are that this kind of art-making can be offered to caregivers, friends and families of those who are ill and/or in the dying process - as a means of self-care. End of Life Care Twenty-one years ago my father died alone in a hospital bed with little control in his final weeks. He was frightened, confused and angry. His health had deteriorated so fast that my family was unprepared and bewildered. The prevailing experience was one of powerlessness. There was no mention from medical staff that there might be another way to die. No one in my family knew enough to ask. This was in 1981, in the relatively early days of the hospice movement in the US (**History of Hospice Movement). It wasn’t until eight years later (1990) while taking a graduate class on death and dying that I learned about hospice care, offering another way to die (*Hospice Concept). At the time, I was awaiting acceptance into a Masters in Social Work program and quickly contacted a local hospice to become a volunteer. The training was illuminating and enriching. I embraced the philosophy of patient centered care, vowing that (hopefully) no one I loved would have to die without some measures of comfort and control. The realization of that promise to myself came twenty years later. My brother David had been diagnosed with Bladder Cancer in 1996. After four years of enduring all sorts of treatments, at the age of 47, he was given just weeks to live. He lived five weeks. I spent four out of the five weeks with him. Ten days at my home in California, where he and his fiancee married in my backyard, and the last three weeks in Massachusetts, where I came to their apartment daily to offer my care and support. Neither the sun nor death can be looked at steadily. La Rochefoucauld Why the Need for Art-making? My brother David had always been an extraordinarily verbal person. During high school he was alternately voted: ”Class Chatterbox,” “Class Clown” and “Life of the Party.” Professionally he had become a successful stand-up comedian and a motivational speaker. In the last two months of his life, the cancer had progressed in such a way that speaking was an uncomfortable burden. In addition, he and his new wife were developing boundaries of intimate sharing. It became apparent that my brother was choosing not to share candidly with me (as he previously might), anything that he had not yet shared with his partner. While their love for one another appeared to provide an oasis of joy, it also seemed to have created a kind of intoxicated denial, which limited focus on his coming departure. All of the above made for substantial adjustment on my part. Art-making became my companion in the midst of his pending death and newfound silence. It enabled me to channel my emotions and accept his choices. Through this method of self-care, I was able to be present for my brother (and myself) in a very profound way. TWO ART PROCESSES Through the use of basic art materials, I was able to access and express portions of my inner self that I was reluctant to acknowledge or share. Both the scribble technique and contour drawing require minimal space, equipment, artistic skill, or lengthy instruction. Yet the results can provide great comfort and containment in the presence of the inevitable unknown.  CONTOUR DRAWING (modified) I had been exposed to contour drawing as an art student in the 1980’s (Nicolaides, 1969). After reading Bob Ault’s book, Drawing on the Contours of the Mind (1985), in 1998, I became intrigued with the idea of doing contour drawings. But it wasn’t until February of 2000, while watching my brother try to sleep after his last chemotherapy treatment, that I actually felt moved to do such a drawing. Feeling so helpless in the face of his suffering, it seemed a perfect match, to symbolically hold him with eyes, pencil and paper. While Ault’s stated benefits refer mostly to self-portraits, I found much that concurred with the modified contour drawing of a loved one. Ault explains that contour drawing can be less demanding than other kinds of art making, as there is a reduction of judgement about drawing skill. The method offers time to let down your guard, rest your defenses, and collect your thoughts. There can be an increase in openness, honesty, relaxation and self-reflection (1985). However, perhaps because you are drawing what you see rather than what you think you know, there is a greater confrontation with the reality of the present moment. I found this confrontation provided me with a kind of intimacy and presence of mind I was longing for with my brother. Note: pure versus modified contour drawing: In a pure contour drawing one does not look back at the paper once drawing has started. With modified contour drawing, one can refer back to the paper to select a new starting point once an individual line has been followed to its conclusion. Materials white (or light) paper on a pad, board or table for stability standard lead pencil pencil sharpener colored pencils for coloring-in later Guidelines Sit in a manner that allows you to visually focus on your subject, while drawing with pencil on paper - outside of your direct vision. Study your subject. Notice prominent lines in the figure. Choose one to start with. Place pencil down on paper at point where line appears to begin. Very slowly, as your eyes follow the line on the subject, move your pencil across the paper. Vary the pressure you place on the pencil, depending upon the strength of the line you are seeing on your subject. When you have reached the end of a line, you may glance back at the paper to locate a new starting point. Relax, there is no hurry, nothing to achieve. Allow your attention to rest on your subject, to become absorbed in the detail of the line you are drawing. Let go of concerns - if any, for results of the drawing itself. SCRIBBLE DRAWING I had used the scribble technique for years before learning of its origins. During this painful, confusing and yet precious time with my brother it seemed a natural place to turn. Florence Cane has written about the ability of the scribble technique to free the individual from the inhibition of getting started and to elicit impromptu imagery (1951). Her sister Margaret Naumberg employed the scribble technique as a means of evoking images from the unconscious (1966). The method is noted for fostering expression of inner thoughts and feelings, with results offering a wealth of personal meaning (Montgomery & Oster). Michael Hanes points out how the non-threatening quality of the scribble technique encourages self-assurance (1995). Materials oil sticks “Craypas” paper – 60lb or above (black or white) turpenoid and stiff brush (optional) Journal and pen for writing (optional) (Markers, pencils, paints or pastels, can be used instead.) Guidelines Choose an oil stick - whatever color grabs you. Hold the oil stick with your non-dominant hand while keeping the paper in place with your dominant hand. Start at any random spot on the paper. Gently close your eyes and make one continuous line on the paper. Stop when ready. Open your eyes. Take a look at the paper, turning it in all four directions. Notice if any shape, image or design suggests itself to you as you look at it. With your eyes open, use the full range of colors available to you, jump right in and begin bringing to life the suggested imagery. Blending of colors can be accomplished by simply placing one color on top of another, and/or smudging with fingers. A third option is to use a little turpenoid with a medium stiff brush. If concerns about meaning or talent emerge just notice them… It can help to label them: such as…”I can’t draw” “I’m not good at this sort of thing.” = judgement. Then just let it go. It may be valuable to write (in the same or separate journal) loosely, freely, honesty about the experience of doing a scribble drawing when complete.  Potential Benefits to Caregiver Who Engages in Art-Journaling: Physical activity, something to do, sublimation Self-nurturance, comfort, relaxation Centering, containment, focused attention Self-awareness, self-reflection, collecting thoughts Inner-dialogue with imagery Vacation from rumination Confrontation with death Accepting contradictions Holding on and preparing to let go Documentation - a piece of history Control: choices in the art-making Expressing the unspeakable Embracing present moment reality honestly Sense of connection, intimacy with self and loved one Reverence, devotion Holding and caressing through the materials Reduction of judgement re: drawing skill Increased confidence Ritual before sleep  Potential Benefits to the Dying Person - When Caregiver Engages in Art-Journaling: Relief (caregiver is self-nurturing) No expectations to do or say anything Loving presence, peaceful energy Joy (life), beauty Shared time, familiarity Being cherished Non-physical caress Expression of love Safety, comfort, compassion “I am here for you” “Your silence is okay with me” “I’m here if you want to talk” “I really see what you are going through” “There is no place I would rather be” “You don’t have to worry about me” This existence of ours is as transient as autumn clouds. To watch the birth and death of beings is like Looking at the movements of a dance. A lifetime is like a flash of lightening in the sky, Rushing by, like a torrent down a steep mountain. - Buddha *The Hospice Concept? Hospice is a concept of caring derived from medieval times, symbolizing a place where travelers, pilgrims and the sick, wounded or dying could find rest and comfort. The contemporary hospice offers a comprehensive program of care to patients and families facing a life threatening illness with a limited life expectancy. Hospice is primarily a concept of care, not a specific place of care. Quality rather than quantity of life is emphasized. Hospice emphasizes palliative rather than curative treatment. Palliative care is the active, total care of patients whose disease no longer responds to curative treatment, and for whom the goal must be the best quality of life for them and their families. Professional medical care is given. The focus is on controlling pain and other symptoms, easing suffering and enhancing the life that remains. Psychological and spiritual aspects of care are integrated to enable patients to live out their lives with dignity. Hospice affirms life and regards dying as a normal process. Hospice neither hastens nor postpones death. Hospice provides personalized services and a caring community so that patients and families can attain the necessary preparation for a death that is satisfactory to them. Those involved in the process of dying have a variety of physical, spiritual, emotional and social needs. The nature of dying is so unique that the goal of the hospice team is to be sensitive and responsive to the special requirements of each individual and family. Although most hospice patients are cancer patients, hospices accept anyone regardless of age or type of illness. These patients have also made a decision to spend their last months at home or in a homelike setting. (Adapted from Hospice Net http://www.hospicenet.org)  **Early Hospice History in United States 1963: Hospice was first introduced in this country when Dame Cicely Saunders, who was in the process of establishing St. Christopher's inpatient hospice in London, visited Yale University. Her lecture on the concept of holistic hospice care to medical students, nurses, social workers, and chaplains included photos of terminally ill cancer patients and their families that dramatically showed the differences between before and after symptom control. This contact set off a chain of events, which resulted in the development of hospice care as we know it today. 1965: Florence Wald, then Dean of the Yale School of Nursing, invited Saunders to become a visiting faculty member of the Yale School of Nursing for the spring term. 1968: Wald took a sabbatical from Yale to work at St. Christopher's to learn everything she could about hospice. 1969: A book based on more than 500 interviews with dying patients was published, titled On Death and Dying. Written by Dr. Elisabeth Kubler-Ross, it identified the five stages through which many terminally ill patients progress. The book became an internationally known best seller. In it Kubler-Ross made a plea for home care as opposed to treatment in an institutional setting and argued that patients should have a choice and the ability to participate in the decisions that affect their destiny. 1972: Kubler-Ross testified at the first national hearings on the subject of death with dignity, conducted by the US Senate Special Committee on Aging. In her testimony, Kubler-Ross stated, "We live in a very particular death denying society. We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality. We should not institutionalize people. We can give families more help with home care and visiting nurses, giving the families and the patients the spiritual, emotional, and financial help in order to facilitate the final care at home." 1974: America's first hospice, The Connecticut Hospice, Inc., in Branford, Connecticut, began providing in home hospice services. National Cancer Institute (NCI) funded Connecticut Hospice for three years to develop a national demonstration center for home care for the terminally ill and their families. 1978-1980: Additional hospices received contracts from NCI. 1978: A US Department of Health, Education, and Welfare task force reported, "the hospice movement as a concept for the care of the terminally ill and their families is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs. As such, it is the proper subject of federal support." 1979: The Health Care Financing Administration (HCFA) initiated demonstration programs at 26 hospices across the country to assess the cost effectiveness of hospice care and to help determine what a hospice is and what it should provide. 1980: The W.K. Kellogg Foundation awarded a grant to the Joint Commission on Accreditation of Hospitals to investigate the status of hospice and to develop standards for hospice accreditation. 1986: The Medicare Hospice Benefit made permanent by Congress. States were given the option of including hospice in their Medicaid programs. (Adapted from Hospice Net http://www.hospicenet.org) REFERENCE LIST Ault, B. (1985). Drawing on the contours of the mind: The psychotherapeutic use of contour drawn self-portraits. Cane, F. (1951). The artist in each of us. London: Thames and Hudson. Carbonetti, J. (1999). The yoga of drawing: uniting body, mind and spirit in the art of drawing. New York: Watson-Guptill. Cassou, M., Cubley, S. (1996). Life, paint and passion: reclaiming the magic of spontaneous expression. New York: JP Tarcher. Edwards, B. (1979). Drawing on the right side of the brain: a course in enhancing creativity and artistic confidence. Boston: Houghton-Mifflin. Furth, G.M. (1981). The use of drawings made at significant times in one’s life. In E. Kubler-Ross (Ed.), Living with death and dying. New York: Macmillan. Hanes, M.J. (1995). Clinical application of the scribble technique with adults in an acute inpatient psychiatric hospital. The American Journal of Art Therapy, 12(2), 111-117. Kramer, E. (1971). Art as therapy with children. New York: Schocken Books. Montgomery, S.S., Oster, G.D. (1996). Clinical use of drawings. New Jersey: Jason Aronson Inc. Naumburg, M. (1966). Dynamically oriented art therapy: Its principles and practices. Chicago: Magnolia Street. Nicolaides, K. (1961). The Natural Way to Draw. Boston: Houghton Mifflin. Ostaseski, F. (Writer). How to be with a dying person. WNET New York: PBS. www.thirteen.org/onourownterms Rubin, J. A. (1987). Freudian psychoanalytic theory: emphasis on uncovering and insight. In J.A. Rubin (Ed.), Approaches to art therapy: theory and technique. New York: Brunner/Mazel. Singh, K.D. (1998). The grace in dying: a message of hope, comfort, and spiritual transformation. San Francisco: HarperCollins. Winnicott, D. (1971). Therapuetic consultations in child psychiatry. New York: Basic Books. SKYLIGHT-STUDIO.COM Jill Fitzgerald, LCSW, ATR, CT Skylight Studio & Therapy Office 10567 Oak Creek Drive Lakeside, CA 92040 jfitzart@skylight-studio.com (619) 561-1882 http://www.hospicenet.orghttp://www.hospicenet.orghttp://www.thirteen.org/onourowntermshttp://www.thirteen.org/onourowntermsmailto:jfitzart@skylight-studio.comshapeimage_2_link_0shapeimage_2_link_1shapeimage_2_link_2shapeimage_2_link_3shapeimage_2_link_4

Keeping Company with One Who is Dying

In loving memory of

David Michael Fitzgerald

March 21, 1953 – March 16, 2000

By Jill Fitzgerald, LCSW, ATR, CT


The video above and the “booklet” below were created in 2001 to highlight the benefits of using art-journaling to enhance the experience of caregiving a loved one who is dying. 


Jill has presented this work nationally for the American Art Therapy Association (AATA) (2001), the Association for Death Education and Counseling (ADEC) (2003) and the Northern California Art Therapy Conference (NCATA) (2005); as well as locally in numerous workshop settings.


Special Thanks to Michael D. Bell whose love and technical support make all things possible - or so it seems...xo