In the dynamic silent space where a diagnosis of cancer or a life-limiting illness settles, the world divides into a stark sense of ‘before’ and ‘after’. Quite unexpectedly, the once open road of the future has become suddenly seized by an intense preoccupation with uncertainty.
There is growing acknowledgment that the passage of the ‘sick’ body is not just a medical one but a profound and intensely personal one which holds a mirror up to us and our world. Consequently, the confrontation is often challenging with capacity to shake one’s sense of identity to the core. Because of this, the foundations of our relationships, our appreciation of what it means to be alive and to live, is swiftly brought into sharp focus and called into question. Inevitably, this can force a series of honest conversations with oneself, the kind which you wished you could have with your doctors, your children, your loved ones, and into the soul of what truly matters in the end.
Given the prevalence of cancer and life-limiting illnesses, it is rare to meet someone whose life has been untouched by some kind of significant or enduring serious health challenge. As a result of working for many years as a psychotherapist within oncology and palliative care I have been privileged to work with individuals and families facing these immense challenges, many of whom lives were irrevocably changed because of it. Accordingly, I have needed to explore my own relationship to both living and dying and have learned so much as a result. I have been alongside others as they too have turned towards some of lifes most painful and uncomfortable questions while simultaneously being gifted with the sheer beauty and vitality of being mortal.
The Courage to Care
In the West, we have systems that allow medicine to work tirelessly seeking to heal the body. Likewise, the physician’s instinct, trained to fight and to fix, is to keep offering more treatment—more surgery, more chemotherapy—even when the probability of a good outcome is infinitesimally small. Having delivered communication trainings to medics on ‘Breaking Bad News’ I am very aware that many physicians share, often apologetically, how ‘terrible’ they feel they are at having ‘hard conversations’, expressing fear of extinguishing hope while simultaneously struggling to concede defeat and being confronted by their own sense of helplessness against the unfolding trajectory.
Yet the necessary focus upon the physical dis-ease can come at the expense of the attention to the care required by our souls and psyches. In essence, the true courage for the physician is not the heroic acts nor promise of interventions that offer more time, but the courage to let go. Wherein the willingness to put aside our own limitations and limited capacity for being with our own helplessness and to sit down with the ‘patient’ – the human being whose body carries the illness, and to pose and ponder…..
The questions that really matter:
- “What are your biggest fears and what is most important to you for the time you have left?”
- “What is the minimum quality of life you would find acceptable?”, and
- “What might you be willing to sacrifice for more time?”
Ultimately, there must be a significant shift from the medical imperative (“What can we do?”) to the human imperative (“What do you want to live for and how do you want to live?”) and acknowledged as being a sincere and generous act of care, and one which grants greater permission to the patient to exercise choice.
Similarly, when we ponder and allow ourselves to recognise and value the very things that make life worth living— a small choice, a routine comfort, a beloved companion, we exercise the fundamental right to live a life that feels like our own. That is to say, the dignity of choice and the feeling of purpose and what matters allows us to not just live as some sort of survival, but to prioritise what makes it ‘my’ good life all the way to the very end.
The Finite Horizon: The Clarity of a Shortened Life
Psychological research demonstrates that our priorities change profoundly when our time horizon shortens. For instance, many of my clients would describe their experience as being one of “now staring at the ‘clock’, as opposed to being out of view”. Consequently, the priorities and the complacency we live by when time is taken for granted shifts dramatically when our finiteness comes sharply into view. In particular, our attentional focus may contract beautifully to the immediacy of the present, to our most cherished relationships and to our ways of being and showing up in the world.
The beautiful truth of love and connection become illuminated and the central currency of a finite life. Notably, many will stop worrying about their career legacy or meeting new people; instead, they seek and cherish time with their children, their oldest friends, a comfortable chair, a favourite view and remaining our self for as long as is possible.
Perhaps a heart-rendering truth to confront in a culture where the pursuit of ‘goods’ or status or even ‘self-actualization’ is abruptly exposed as missing the point. When all the noise, the busyness falls away, what remains is the simple yet sometimes paradoxically painful, irreplaceable joy of being loved and loving well. Accordingly, this is one of the gifts I have been honoured to learn from those who have opened to facing their proximity to death, and for all of us, no matter our age, an invitation to take heed of where we may best invest our precious time.
This final, beautiful choice— particularly where family and loved one’s also have the courage and grace to support it, can mean that even in the face of inevitable loss, we can co-create and co-author moments and chapters defined by meaning, love, and self-possession, rather than fear and intrusion.
Whether time is relatively long or short, the space and support of the often-transformative power of psychotherapy, and specifically an approach like Deep Brain Reorienting (DBR), becomes can be an essential lifeline through difficult times.
The Invisible Wound
While the focus of a life-limiting illness understandably homes in on the physical—the scans, the treatments, the prognosis, the practical and logistical needs of these hijack attention, silently stealing the space needed for the inner story to be voiced and heard.
From diagnosis to the repeated painful and invasive moments surrounding treatment, the difficult conversations and interactions, or the lack of tender care or support, land as seismic emotional shockwaves, generating what become the invisible and complex tapestry of invisible wounding:
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Trauma:
From the moment of diagnosis through the intrusive and sometimes painful medical procedures and the terrifying unknowns being registered by the body and mind as profound threats, and can lead to symptoms of anxiety, depression and Post-Traumatic Stress Disorder (PTSD) and exacerbate existing issues.
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Grief and Loss:
Physical health issues impact upon our lifestyle and capacities. There can be a process of needing to grieve for the life that was, the loss of certainty, the loss of plans and dreams, the changes of the physical body or its functioning, the scars, the shifting roles within family, friendships and work, the loss of autonomy and freedom as we had once known
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Existential Dread:
Being confronted by the vulnerability and fragility of our physical body can simultaneously bring us face to face with our own mortality. This confrontation can bring rise to a fear so deep and pervasive that it can feel unbearable and unending, often manifesting as panic, fear, sleeplessness, and the anguish of isolation and aloneness.
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Relational Strain:
‘Ill bodies’ rarely happen in isolation, we inhabit lives that we share with others and the shift in needs and dynamics, our coping styles and ways of managing can place pressure on intimate relationships, it can change family dynamics, and can leave the individual feeling profoundly misunderstood, feeling burdened and alone, even when surrounded by love.
DBR: The Sanctuary in Which We Orient Towards
While support groups and coping strategies can be invaluable lifeline’s, the intense nature of one’s own experience often require something more personal. This is often where people turn towards specialised psychotherapy – understandably the need for this is not about fixing the disease, but about treating the terror, processing the trauma, and making space for being with the hard questions and conversations that can’t yet be had elsewhere, and for the beauty of the true needs and song of the self to emerge.
In the therapeutic space, there is no need to maintain a facade of unrelenting optimism but rather co-create a sanctuary for honesty. Where the painful shock and shocking pain of aloneness, isolation, abandonment, injustice and the betrayal of one’s body can gradually be turned towards. Where anger, fear, shame, despair, and sadness may be felt, named and affirmed. A critical step toward finding a path through and beyond whatever lies ahead, and even the possibility of more ease and spaciousness, even a different sense of vitality breaking through, as each step is taken.
Ill-health: A Portal to the Unresolved Past
While talking therapies provide a safe container for talking, sometimes the sheer intensity of the trauma and fear associated with illness can catalyse older wounds and make talking alone too challenging.
A wealth of research illustrates the direct correlation between early life adverse experiences and poor outcomes for adult health. Instead of this being the case of ‘if’ it is more likely we need to ask ‘when’ will older memories or wounds surface, even where they may have been secured out of reach for decades.
The often-felt paradoxical combination of the past coalescing with what is presently unfolding day-to-day, can be overwhelming but at the same time can give rise to a sense of greater urgency – a need to listen to and respond to the siren calls to address what lies within. Ill-health can ironically present as a portal to attend to not only what is arising in relation to one’s physical health, but also to deeper unmet needs as patterns from unresolved past issues continue in their unrelenting impact upon one’s capacities in the present – and thus the future, unless we attend.
Deep Brain Reorienting (DBR): A Compass for the Nervous System
Despite having trained in many trauma modalities, the relatively new, yet incredibly potent DBR proffers much hope for deep healing and transformation, and by means which are often described as relatively gentle. Furthermore, DBR seeks to prioritise mitigation against overwhelm as much as possible.
Developed by Dr. Frank Corrigan, DBR is deceptively simple, yet very nuanced. DBR is underpinned by neuroscience and seeks to address the core of traumatic responses. In contrast to therapies that focus upon thinking, analysing, or catharsis involving upper brain levels, DBR focuses upon the subcortical midbrain and brainstem —the oldest and most primordial part governing our immediate survival responses and the very substrates of the background feelings of ‘me’.
DBR: the Unique Emphasis upon First Attending to Shock
When we receive frightening or horrifying news, or endure painful and distressing treatment regimens, our brain will naturally orient towards the threat. However, this orientation towards the threat, for example, orienting to ‘the sound of the needle being unwrapped’, is not only going to happen on the first occasion of this happening, but perhaps also to the second, the seventeenth or the seventieth. Moreover, the instantaneous orientation ‘towards the sound’ may be instantly followed – within milliseconds by shock – a hollowing, emptying, sudden wave of coldness, a moment of stopping, recoil or bracing. To clarify -the shock response is designed to bring arousal and wakefulness into the system so that we can respond – and this can happen so fast that it may not even be consciously registered.
Oftentimes, people will describe such moments saying things like: “When I heard those words/saw the look on his face… it was like time stopped… it was like my stomach dropped… my breath got taken away…like sounds got muffled…’” . At the same time, what might be experienced as a fleeting moment, may be dismissed as being unimportant, though the impact lingers.
The orienting towards what is happening, what we have heard, seen, and the initial and fleeting shock responses arises often before your conscious mind can process what has happened or is about to happen. Notably, when something shocking or horrifying arises in the present, whether a micro shock or one that is more significant – it can tap into a history of unresolved and unprocessed shock, and stir up what has been held and trapped deep inside, perhaps for many decades.
DBR, Healing The Consequences of Unresolved Shock
In DBR, it is hypothesised (because of the underlying evidence from research) that it is this unprocessed shock that can bring rise to the many painful and challenging symptoms – insomnia, rumination, generalised anxiety and the myriad of symptoms that are listed and labelled by other diagnosis – PTSD, BPD, DID etc etc.
In DBR, we gently and precisely turn to those moments that have captured the attention of the brainstem, “the moment of hearing the dismissive tone”, “seeing that look on his face”, so that we can pick up on the very first moments of what arises at the level of the brainstem when the body has registered something is about to ‘go wrong’. We then elicit the sequence of what follows to promote the innate healing to flow – dissipating underlying shock sequences that may link back to much earlier life experiences. Gradually we reorient towards what was once too unbearable, perhaps too horrifying or painful to turn towards at the time, and when the system instead became overwhelmed by the subsequent affective and defensive responding.
Why DBR? The Mind-Body Connection
Many might not consider psychotherapy when life has been overtaken by ill-health as they may not consider its usefulness in terms of being able to directly affect the ‘ill body’. While at times this may be true, the long-standing tradition and ancient knowledge of Eastern ways is gradually being validated by the ‘science’, and in the West there is now an increasing recognition and appreciation of the vital importance of the mind-body connection. The ways in which we carry and respond to the emotional and psychological impact of ill-health, alongside the need to be with the physical elements of what is unfolding – a considerable strain on a system that is already enduring a lot.
The Unique Power of DBR for 'Dis-ease'
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Addressing the Pre-Affective Shock:
The diagnosis itself can be an overwhelming shock as too are the often many aftershocks that arise during subsequent treatments. DBR can help dissipate unprocessed shock energy which in turn helps us to process the subsequent affective and defensive responses and to orient towards and process underlying core pain.
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Easing Procedural Trauma:
Medical treatments—surgeries, biopsies, IV insertions, radiation—can be traumatic, even when necessary. DBR may help the nervous system process what can often be distressing and painful events, making it less likely that the sight of a hospital or the smell of antiseptic will trigger a panic attack or deep emotional dysregulation when these still must be faced.
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Reducing Anticipatory Anxiety:
The fear of the next scan, the next blood test, or the next painful side effect can dominate life. By working at the deep brain level, DBR often lowers the baseline of anxiety, creating more space and freedom in the present moment, even where medical uncertainty remains.
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Connecting to the Core of Self:
By gradually dissipating and calming the deep, defensive structures, the armouring that has been held for decades, supporting what lays underneath to be oriented towards and processed, DBR can support the system to return to a state of greater internal stability and connection and even a sense of reconnection with our “true north”. The stiller, more spacious and dynamic quietness of being, separate from the illness. This essential capacity of Self can be vital in supporting clarity, helping in decision making, communicating needs, and for being able to access the internal reservoir of vitality – a different connection to our life force to what we have known before.
In essence, DBR isn’t about changing the facts of the illness, but it can dramatically change how the body and mind carry and turn towards that reality, and what the presenting ill-health chapter may be eliciting from our histories. It can support the system to move from a state of high alert and survival mode to a state of greater ease and more spacious balance.
Finding Meaning and Presence in the Midst of Uncertainty
The more significant purpose of undertaking therapeutic work is not with a view to heal the illness, more an opening to heal in other ways. To reconnect with our inner reservoir of stillness and peace, promoting a deeper quality to the experience of life—a life lived with presence, dignity, tender care, and a sense of meaning, regardless of prognosis.
Healing in this way may include:
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A Shift in Focus:
Energy previously consumed by anxiety and rumination becomes available for connection, creativity, and simple enjoyment. Preoccupation and suspended waiting, transform into turning towards ‘life’ and its meaning to us.
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Reclaiming Narrative:
Like an external force, illness can hijack the story and steal our identity. DBR can help to reclaim and redefine how we move forwards – the once experienced blocks and obstacles can be relinquished, and a new opening to life dawns – the shift can be immensely empowering.
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The Power of Connection:
As wounds heal, capacity to connect with loved ones deepens. Discovery of our true voice enables needs to be communicated, connecting more fully with ourselves, with others and the world – more embodied, more here – more now.
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Discovering Existential Meaning:
Confronting the fragility of our lives often provokes terror, while simultaneously being a profound catalyst for growth. It can clarify what truly matters and DBR becomes a space in which rather than wrestling with the big questions, the answers organically emerge. Gratitude for what is, and how it will be, and our legacy, whether through words, love, or the quiet and simple example of how one chooses to live regardless of remaining time may be discovered.
The Sacred Dimension of DBR
For those facing life-limiting illnesses, particularly where time is known to be foreshortened, such work can take on an added, sacred dimension: about living well to die well, facilitating our ending transition. In resolving old hurts, finding as much peace with one’s life as is possible, and approaching what is to come with as much humility, love and grace as is possible. And with humility, this can so often feel like the most important therapeutic work of all.
For anyone whose life is affected by serious illness, tendering to the care of your heart, your mind, your soul, is vital.
The aloneness, the sadness, the angst, the intrusive memories of treatment, are not failures of character; they are the natural and to be expected responses of a human being under extraordinary duress. While medical care of the body is essential, it remains incomplete without attending to the wounds of the heart, mind and soul – and vital to our healing.
A Plea to Attend to Wholeness
For anyone whose life is affected by serious illness, tendering to the care of your heart, your mind, your soul, is vital.
The aloneness, the sadness, the angst, the intrusive memories of treatment, are not failures of character; they are the natural and to be expected responses of a human being under extraordinary duress. While medical care of the body is essential, it remains incomplete without attending to the wounds of the heart, mind and soul – and vital to our healing.
Seeking a skilled, trauma-informed therapist—one who understands the unique challenges of health-related trauma and perhaps even specializes in methods like DBR (or approaches such as EMDR or Somatic Experiencing, focusing upon what is happening in higher levels of the brain) to support trauma processing —is a powerful act of self-care. Rather than being a sign of ‘not coping’ – it is more a profound declaration and willingness, sometimes even a deep sense of calling, to turn towards your inner life and your dignity, no matter what is happening in your body.
The path is unchartered, it can be difficult and painful but possible with Deep Brain Reorienting to turn towards, to dissipate and transform what is being held, and perhaps been trapped for many decades. It is possible to navigate the storm, to reconnect with your inner compass that remains steady, true, and deeply connected to the core of who you are.
The goal is not to eliminate pain, but to make room for joy and presence alongside the pain. And that, in the face of life’s greatest challenges, is a triumph of the human spirit.
Next Steps
If you are interested in exploring how Deep Brain Reorienting or trauma-informed psychotherapy can help you or a loved one, please contact me, or reach out to an approved practitioner. There is support available, you do not have to walk alone in the storm.
There are many services and charities that support with enduring and life-limiting illness – the list below is far from exhaustive.
