HOSPICE CARE: UNDERSTANDING MENTAL HEALTH, RELATIONSHIPS AND INTIMACY

When someone is no longer able to engage with the world in the way they previously did, perhaps after the diagnosis of a life-limiting illness or taking on caring responsibilities, the impact on mental health and personal relationships can be huge.

“So many thoughts and feelings emerge after a diagnosis which can impact how you relate to yourself and others,” explains Cat Aird, Counselling Manager at ellenor.

Grappling with emotions, trauma, life changes and shifting roles can affect every relationship we have with others, whether romantic, sexual, professional or with our family and friends. Even our casual interactions with other people, like joking around, can become more complicated following the diagnosis of a life-limiting illness, perhaps because you’re approaching them with a sense of handling them with care.” says Cat.

“People think that grieving starts with dying.  But it can start at the point of diagnosis,” says Cat.  “From the moment someone is diagnosed, quite often, the whole family begins to grieve in different ways.”

From the loss of a future you might have planned, to loss of independence, to death itself, each stage is a different grieving process, Cat continues. Emotions can be an absolute rollercoaster as we grieve different losses and adapt to new things.”

For those with partners or spouses, there can be another kind of loss as romantic or sexual intimacy can also be affected by the shifts in their roles, caring responsibilities and self-esteem: “If you have a romantic partner, and you feel overwhelmed by a constant state of stress and anxiety, is sex likely to be the first thing on your mind? You might be overwhelmed with all these feelings and fears that take precedence,” explains Cat. “This could be perceived as rejection, or as a loss of romantic interest or desire. It’s not always as simple as that.”

But a loss of intimacy and emotional connection can offer a sense of grief in itself and some couples find it difficult to explain that loss to one another. Patients might start to associate touch with medical care, and people with caring responsibilities may forget that casual, loving touch is still important to many people.

“Someone might think, ‘I want you to give me a kiss and a cuddle because you love me and you find me attractive, not because you think I’m fragile and you want to look after me’. Sometimes this isn't a conscious process at all, but that underlying feeling can affect how we react to others. For example, if someone withdraws their hand from a loving touch, they may not be consciously thinking 'you're only touching me because you're taking care of me' but that feeling might be lurking under the surface. It is their response to that feeling, as opposed to the touch, that may cause that withdrawal,” says Cat.

“If they feel they’re not being touched as much in that intimate way, and if that is something they want and need, it can impact on self-esteem. Physical changes can also impact a person’s self-esteem especially if they feel that they don’t recognise themselves anymore. If they lack confidence and don’t feel attractive, it can be hard to believe someone else might find them alluring.

Although generalising isn't necessarily helpful, if we look at stereotypical roles, someone who may have always been the ‘strong one’ or the ‘breadwinner’ in their family may find it tough to admit that they’re scared and that they need support, especially if they don’t want those around them to see what they perceive as weakness, or if they feel like they are letting others down (even though they aren’t). Someone who might have always taken on more caring roles may find it difficult to accept that help.

Talking is key, suggests Cat. But so is listening and understanding: “Sometimes it’s not about fixing, resolving or doing. Sometimes the most helpful thing of all is just listening, understanding and being there; it can be helpful for someone to just feel 'heard' without judgement.”

Some conversations can be harder than others. Trying to talk to children about death when they might not understand illness or the finality of dying can be complicated and upsetting. Talking to a partner about missing touch and intimacy might feel trivial compared with treatment or financial conversation. But if emotions are swirling and you don’t know how to approach these discussions, speaking to a professional can help.

“Quite often, conversations feel more difficult when we think about them. Having these conversations can lift so much weight off a person's shoulders.” observes Cat.

“A huge part of the counselling process is about creating a safe and non-judgmental space where a person can talk freely about anything that they wish to explore. In Counselling, you build a relationship with your counsellor to explore things in a way that feels safe. It can help you to realise that it is okay to feel everything you feel, and you'll hopefully start to feel far better for understanding why you feel that way instead of just beating yourself up for feeling it.” 

If you are interested in receiving Counselling, you can self-refer by calling 01474 320007 and speaking to a member of the Clinical Admin Team.