S.

ANTONY GEORGE
B.TH
LAKE VIEW BIBLE COLLEGE & SEMINARY
EXTENSION CENTRE

Crisis counselling
Terminal Illness
A disease that cannot be cured and that is reasonably expected to result in the death of the
person within a short period of time is termed as terminal illness. This term is more commonly used
for progressive diseases such as cancer or advanced heart disease than for trauma. It indicates a
disease which will eventually end the life of the sufferer. Everyone reacts differently to news of a
terminal illness. Some react with fear and anxiety. Many fear pain, abandonment, loneliness, and the
unknown. They may become anxious about their loved ones, unfinished work, or dreams.
Ten Leading Causes of Death in world due to Severe illnesses
HEART DISEASE
CANCER
CEREBROVASCULAR DISEASE
CHORIC LOWER RESP. DISEASE
ACCIDENTS
ALZHEIMERS DISEASE
DIABETES MELLITUS
INFLUENZA AND PNEUMONIA
NEPHRITIS,NEPRITIC SYNDROME,NEPHROSIS
SEPTICEMIA
As an illustration , the terminal illness CANCER has been taken for discussion.
Statistics regarding the terminal illness - Cancer
a) Cancer Patients according to Geographic region

b) Cancer Incidence Rates for the 10 Primary types in U.S (2011)

States Cancer Statistics: 19992011 Incidence and Mortality Web-based Report

c) Frequency of illness in modern culture

These people suffering from chronic diseases if they are not taking proper medical treatment, in due
course their chronic diseases will turn into life terminating terminal illness.

How Social and Economic factors affect health?

Health and health problems result from a complex interplay of a number of forces. These points are
explained in detail below.

Income and social status

There is a close association between income and health so that health improves at each step up the
income and social hierarchy. In addition, societies with a high standard of living in which wealth is
more equally distributed are healthier, irrespective of the amount spent on health services.

Social support networks

Support from family, friends and social organizations is associated with better health. Moreover,
people living in communities with higher levels of social cohesion lend to be healthier.

Education
Higher levels of education are associated with better health. Education increases opportunities for
income and job security and equips people with the means to exert control over their life
circumstances.

Employment and working conditions

Hazardous physical working environments and the injuries they induce are important causes of health
problems. Moreover, those with more control over their work and jobs which involve fewer stressinducing demands are healthier. However, unemployment, particularly if long term, is associated with
poorer health.

Physical environments
The quality of air and water influence the health of populations. So do features of the constructed
physical environment, such as housing, roads and community design.

Source: Federal, Provincial and Territorial Committee Advisory Committee on Population Health (1994).

The Process of Terminal Illness

Most people do not just suddenly become terminally ill. Instead, there is usually some
variation of a series of events or an up and down process that includes many physical changes,
spiritual crises, and virtually all human emotion. The most common initial response to a diagnosis
of life-threatening illness is shock and disbelief. The emotional response is usually complicated by
(1) explanations of the illness given in medical terms that many patients do not understand and (2)
an immediate discussion of treatment options that, again, many patients do not fully understand.
For some, the shock and disbelief never go completely away. After the initial shock, there usually
is a period of turmoil, which includes sleeplessness, difficulty concentrating, and a mix of anxiety
and depression. This acute distress usually diminishes in one to two weeks as treatment of the
disease becomes the major issue.
Problems
For most people, it is not easy to be ill, especially terminally ill. The illness itself brings new and
formidable challenges to life. While some old problems or issues that once seemed important fall
away, other problems or issues that seemed unimportant or forgotten may re-emerge. Among the
more common problems at this stage of life are feelings of grief, loneliness, depression, anger,
anxiety, and spiritual distress.
Helping in the process of grief
Understand that grief is an inevitable and normal part of terminal illness.
Recognize and express the losses inherent in terminal illness.
Explore the losses and their meaning.
Work to resolve conflicts and relationships.
Accept that some conflicts and relationships cannot be resolved.
Explore what is possible for the future.

Helping in the process of lonliness

Be consistent.

Accept imperfections in self and others.

Listen with heart and mind.

Remember that there is more than what can be seen with eyes; the presence of God or
a loved one who has gone on can help more than anybody.

Helping in Depression
Manage physical symptoms.
Rule out external causes, including medications, metabolic disorders.
Maintain hygiene, diet, other (limited) daily activities.
Stay aware of the difficulties inherent in helping when depression is a problem.
Ensure that goals are reasonable.
Allow expression of sadness, guilt, anger and other negative feelings
Be alert for and act on signs of suicidal thoughts

Helping in Anger
Understand the nature and function of anger.
Understand one's own response to anger.
Accept that some anger is inevitable in terminal illness.
Help or allow the verbal expression of anger.
Help identify and deal with the underlying feelings or issues behind anger.
Understand that anger is sometimes justified and appropriate.

Helping in Anxiety
Manage physical symptoms.
Increase patient and family control and involvement in decision-making and care.
The patient and family benefit from exploring the anxious feelings, especially
precipitating and underlying issues.

Emotional and Physical Reasons People May Fear terminal illness/Death

Helplessness

Dependence on others

Mutilation by surgery or disease

Uncontrollable pain

Being unprepared for death

Social Reasons People May Fear Terminal illness or death

Fear of separation from family or home

Fear of leaving behind unfinished tasks or responsibilities

Spiritual Distress
Terminal illness threatens spiritual beliefs and needs in many people, including, at times,
people of great faith. In the physical suffering and loss of hope they wonder what meaning there
is in this. In the isolation of loneliness and lost relationships they wonder where is God and hear
no answer. Spiritual distress is best answered through faith; and if faith seems unreal and too
distant, too difficult to find, then through religion.
For Christians, Psalms are usually a good place to start. Psalm 22 speaks directly to
people who suffer apart from God: My God, my God, why hast thou forsaken me? Psalms 23 and
121 bring back memories and hope: The Lord is my shepherd, I shall not want.. Psalm 23. I will
lift up my eyes to the hills . .. The Lord will guard you as you come and go, now and for
evermore. .. Psalm 121.
Passages from the New Testament that are speak directly to the questions of terminal
illness include: I am the resurrection and the life.. . John 11:25-26 Let not your hearts be
troubled. .. John 14:1-4 O death, where is thy victory? I Corinthians 15:54-56 Our Father who
art in heaven .. . Matthew 6:9-13

Questions Asked by Teminally Ill Patients

Why is this happening to me now?

Why this pain and suffering?

Is there a God? If so, will He be there for me?

Will I have time to finish my lifes work?

The patients may be made to realize the similar situation from the bible and passages can be read
from the Bible to alleviate their fears. Examples like the following can be used.

Psalm 90:12 says, Teach us to number our days that we may get a heart of wisdom..
Numbering our days means thinking about how few there are and that they will end. Paul
used this phrase about grieving without hope in relation to those whose loved ones had
died: We do not want you to be uninformed, brothers, about those who are asleep, that
you may not grieve as others do who have no hope (1 Thessalonians 4:13). There is a
grief at death. But the grief is differentit is permeated with hope. We would rather be
away from the body and at home with the Lord (2 Corinthians 5:8).

Preparing to face the crisis

The patients suffering from terminal illness should be gradually made to understand that
death is inevitable.

Every person dies eventually (Job 14:1-2; Eccles. 3:2; Romans 5:12, 1 Cor. 15:22; Heb.
9:27)

God determines the length of life (Job 14:5).

Mans life seems brief (James 4:14)

People die whether they are godly (Samuel, David, Jeremiah) or ungodly (Pharaoh,
Ahab).

People die at various ages, such as the elderly (Daniel), and the very young (David's

infant child).

People die from a wide variety of causes, such as the effects of aging (Job, David), from
illness or disease (Asa,Herod), from war (Saul, Ahab), and from execution (Agag).

Job references the unrelenting pain he is encountering (Job 6:10 Niv), as does
Jeremiah, who wonders, Why is my pain unending and my wound grievous and
incurable? (Jer. 15:18 Niv).

Stress in the Counseling Profession

Counseling can be a hazardous profession. Some sources of stress for counselors are they
often have a feeling they are not helping their clients. Moreover there is a tendency to accept
full responsibility for clients progress. If there is no visible progress on the part of the client,
the burn-out and stress accumulates for the counselor. Some may feel a pressure to quickly
solve the problems of clients. Having extremely high personal goals and perfectionistic
strivings also will lead to lot of stress. To overcome these factors, counselors need to pick
Jesus as their role model. The salient features of Jesus as a counselor is explanined below.

He didnt see people as the problem, but someone who has a problem

His drive was based on compassion

He accepted people as they were, instead of the way theyre expected to be

He recognized their worth above any rules and regulations and showing them
their worth in Gods eyes

Jesus used discernment to see the real needs of the individual, despite what they
may have brought to his attention

Jesus encouraged people and gave them hope. He did not provide false hope
through minimization or denial

Jesus placed much emphasis on peace of mind through allowing God to take the
burden

Jesus promoted reshaping or refashioning peoples thinking by focusing on the

important issues, or, foundation issues

Jesus spoke with authority, he was not hesitant, backward, or bashful

INSPIRATION FROM REAL LIFE STORIES

The clients need to be inspired by real life stories so that their confidence level is
improved . Some of the real life stories or quotes can be used to boost their confidence
level.

Anna Quindlen (born July 8, 1953) is an American author, journalist, and opinion
columnist whose New York Times column, Public and Private, won the Pulitzer Prize
for Commentary in 1992. Her mother died at the age of 40 from ovarian cancer, when
Quindlen was 19 years old. Her famous quote is Think of life as a terminal illness,
because if you do, you will live it with joy and passion, as it ought to be lived

Steven Paul "Steve" Jobs was an American entrepreneur, marketer, and inventor, who
was the cofounder, chairman, and CEO of Apple Inc. He is widely recognized as a pioneer
of the personal computer revolution. In 2003, Jobs was diagnosed with a pancreas
neuroendocrine tumor. He died of respiratory arrest related to the tumor on October 5,
2011. His famous quote is If today were the last day of your life, would you want to do
what you are about to do today.

Henry Charles Bukowski was a German-born American poet, novelist and short story
writer. Bukowski wrote thousands of poems, hundreds of short stories and six novels,
eventually publishing over sixty books. Bukowski died of leukemia on March 9, 1994, in
San Pedro, aged 73. His famous quote is We are here to laugh at the odds and live our
lives so well that death will tremble to take us.

Prayer:

Father God we come to you in the face of the most difficult news we could hear. We have
heard that word "terminal" and we know that we have to take it seriously. But we
understand ultimately that these matters are in your hand. We ask for your restored health,
if that is not to be then we ask for comfort and peace and freedom from pain. Even as the
outward body may get weak you can provide inward strength. None of us know the number
of our days; so help us to make each day count. Help us to see each day as a gift. This we
ask through Christ our Savior. AMEN.