Lesson 9: The Past and How Much it Matters

& The Keeper of the Meaning

Attention

Our past and our present coexist.

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Identify connections between early childhood environment and mental health
• Identify ways in which people can rewrite their life story
• Reflect on the historical perspective of the "Mental Health System"

Teaching

Reading

Read Chapter 5 - The Keeper of the Meaning in Vaillant

Erikson

Long ago Erik Erikson posited that early developmental challenges (such as Trust vs. Mistrust, Autonomy vs. Doubt, etc.) which resolved on the "positive" side made it more likely that later stages will be "positive" as well...so, we might say, the person who developed a strong sense of "Trust" in the earliest years, is more likely to have "Integrity" in late life.

In the Vaillant study early environments were assessed with the following:

• Warmth and stability of home atmosphere
• How warm and encouraging (i.e. conducive to basic trust) and how conducive to autonomy, initiative, and to self-esteem was person's relationship with is mother?
• With his father?
• Did he have siblings? If so, did he enjoy supportive relationships with them?
• Would the rater have wished to grow up in that home environment?

As we read Vaillant's accounts of good and bad childhoods, we have to consider some of the childhoods of the clients we serve in the Mental Health field. Sadly, many of these childhoods lack the very substance of what is being assessed in the questions above.

Yet there seems to be some hope. Old age can be a time to rewrite your own history. Indeed, "restorying" is one of the hallmark stages in the counseling/recovery process. It is not so much forgetting the past as much as it is rewriting its meaning.

Working with Family Members and Caregivers (including other professionals)

What the field of Mental Health brings to the situation is a deep understanding of cultural factors associated with the expectations of aging.

When we think of aging person we rarely come up with the picture painted by the symptomatology indicated above. In addition, based upon individual cultural expectations, some of these behaviors may be quite upsetting.

Some of the cultural aspects of aging we contend with when we are working with others include:

• Beliefs about aging and the role of older people
• Beliefs about memory changes with aging
• Religious beliefs and cultural norms
• Size and location of racial/ethnic communities
• Availability of family and other caregivers
• Perceived burden
• Availability and accessibility of culturally appropriate health care services

Our role may be to help everyone orient towards these factors and needs in managing the care of individuals who are manifesting these symptoms.

We may, for example:

• Teach family members about the disease and how it progresses
• Provide materials to dispel myths associated with aging and memory
• Identify cultural and religious needs in a family to caregivers and decision makers
• Help professionals understand the limited availability of some family members
• Help caregivers identify and contend with the real burden of caring for another individual

The Keeper of the Meaning

We can sometimes perceive our "self" as being comprised of three "selves". Our true self (who we truely are), our ideal self (who we want to be), and our public self (who we present to others in social situations). As we age our three "selves" become more "integrated". Older adults care less about what others think of them and have come to terms with the limitations of an ideal self, and thus they are who they are. Anyone who has an older adult person in the household or who works at a long term care facility knows exactly what this refers to.

There is an internal process by which women begin to take on more "male" characteristics of assertiveness and power while men tend to take on more "female" characteristics of nurturing and caring. Some of this is a result of hormonal changes in an individuals biological systems, part is due to a person's environment and a part is due to a person accepting him or herself as their true self. As such, older adults "are who they are" and they can be time capsules of knowledge regarding what things were like in their lifetime and they are keepers of "meaning" from the broad perspective of having been there, having lived those experiences and survived each and every one.

In the world of mental health I have come across individuals who are "keepers of meaning" due to their long lasting relationship with the mental health system itself! That particular set of mental health treatment institutions and services has changed dramatically over the years but the individuals are still in the mental health system receiving services. What historical perspective these individuals have on the "system" itself.

This lesson has you using an app called My Wonderful Days. It is a journaling app. It allows you to write information about your day or things you have to do in a narrative form. There is a $2.99 version but I am only asking you to load the free version which allows you to make limited entries in a month. I felt this app connected to the idea of keeper of meaning since so much of what we know from our pasts comes from what people wrote down. In the past the matriarch of families wrote down events in the back of the family's Bible, a diary or other important book. Now as we enter the age of technology, with everyone having a phone or other device at their fingertips how will the way we document our family history change? My Wonderful Days https://itunes.apple.com/us/app/my-wonderful-days/id434356065?mt=8

Assessment

Lesson 9 Discussion (online course only)

Think about who is the keeper of meaning in your family. Share your experiences with this person and how they have helped to preserve the family history. Now think about your current or future clients, who may not have had someone who was the keeper of meaning of them. How do they preserve their family history? Their family history, potentially like yours, may be full of abuse, addiction and heartbreak. How might you help them to become a keeper of meaning for themselves?