Coping with Serious Illness: Danielle Chammas and Amanda Moment
Nov 21, 2024
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Danielle Chammas, a psychiatrist and palliative care physician at UCSF, and Amanda Moment, a palliative care social worker at Brigham and Women's Hospital, delve into the multifaceted world of coping with serious illness. They discuss the nuances of coping strategies, highlighting how humor and art can aid emotional expression. The duo emphasizes the importance of understanding patients' coping mechanisms and maintaining their psychological integrity. They also touch on the significance of empathetic communication and the need for a collaborative approach in patient care.
Coping with serious illness is complex, as strategies may be deemed adaptive or maladaptive depending on individual circumstances and context.
Humor can serve as a powerful coping mechanism, helping patients confront their illness while fostering deeper connections during difficult conversations.
Deep dives
The Role of Humor in Coping with Illness
The podcast discusses a patient encounter where a young man with terminal cancer utilized humor as a coping mechanism. He engaged the hosts with dark humor and jokes, surprising them with his levity in the face of his illness. This humor served not as a denial of reality but as a way for him to confront the gravity of his situation, as he stated that his story wouldn't end well and thus chose to find joy in the moment. By allowing humor into their interaction, the hosts were able to establish a deeper connection with the patient, ultimately reaching profound discussions about his illness.
Understanding Coping Mechanisms
Coping is defined as the ways individuals manage their reactions to stressors encountered in their lives, especially concerning serious illnesses. It encompasses a broad range of behaviors and can manifest in both adaptive and maladaptive ways, which the hosts clarify as healthy and unhealthy coping. They emphasize that it is essential to assess how coping methods serve the patient, as there are no absolute rights or wrongs in coping strategies. The discussion reveals that even behaviors typically viewed as maladaptive can have a protective function during challenging periods for individuals.
The Complexity of Coping in Context
The conversation highlights that coping mechanisms can shift depending on the context, such as the specific illness situation or personal circumstances. Each patient may have different coping styles that are effective or ineffective at various times, illustrating the dynamic nature of coping. They discuss how understanding the cultural background of patients can also shape their coping, illustrating that practices like denial may not always be inappropriate in certain contexts. The importance of recognizing the multifaceted layers of coping enables caregivers to provide empathetic and tailored support.
The Importance of Formulation in Patient Care
The podcast emphasizes that clinicians must engage in formulation—the process of understanding the 'why' behind a patient's coping behaviors—to provide effective care. Holding space for patients to explore their coping styles involves understanding their personal narratives, motivations, and fears. The hosts advocate for an approach that prioritizes the patient's psychological integrity while assessing how coping strategies serve their emotional needs. This patient-centered perspective ensures that dialogues around coping lead to meaningful therapeutic interactions, facilitating better health outcomes.
Denial. Substance use. Venting. Positive reframing. Humor. Acceptance. All of these are ways we cope with stressful situations. Some we may consider healthy or unhealthy coping strategies, but are they really that easy to categorize? Isn’t it more important to ask whether a particular coping behavior is adaptive or not for a particular person,in a particular time or situation?
We are going to tackle this question and so many more about coping on this week's podcast with Dani Chammas, a recurring GeriPal guest, psychiatrist, and palliative care doc at UCSF, and Amanda Moment, a Palliative Care Social Worker at Brigham and Women's Cancer Center. There are so many take-home points for me on this podcast, including this one on a framework for assessing coping in serious illness:
nonjudgmentally observe their coping
wonder about the impacts of their coping
prioritize helping patients maintain their psychological integrity
mindfully think through how we can serve their coping in ways that they can tolerate, always calibrating based on the person, the moment, and the setting in front of us.
Here are some more resources we’ve discussed in the podcast