“U” is for Understanding

In the A,B,C’s for Living Well, understanding has many dimensions and applications. This word has a complicated and mysterious etymology that includes both Old English and Latin. Scholars cannot agree on exactly what the “under” is all about as a prefix, as the root meaning of “under” is beneath or below. Also, the “stand or standing” means to occupy a place. Taken together, their literal meaning would be “to occupy a place beneath”. Following those ancient definitions, I can see a link to humility, drawn forth from humus (a Latin word meaning “grounded” or “from the earth”). To practice understanding then, has an element of humility; an important practice for everyone.

Looking a little deeper, the verb understanding means to “perceive the intended meaning, to comprehend” (Are you understanding my proposal?) As an adjective, it means “to be sympathetically aware of other people’s feelings; tolerant, forgiving” (I had hopes that the caregiver would be more understanding.) It also has several meanings as a noun, one of which is: “sympathetic awareness or tolerance” (We can diffuse this situation through understanding and compassion.) Note that in two of these dictionary descriptions of the word, sympathy and tolerance are present, indicating kindness or a forgiving attitude, both of which are forms of humility.

Connection with others can be achieved through the application and practice of understanding and its close companions, humility, empathy, and kindness. Understanding can mend broken relationships, instill peace amid chaos, provide kindness and comfort where there is suffering, and expand self-awareness which in turn encourages personal growth and deepens relationships of all kinds. Seeking to understand relationships and scenarios that play out within families, neighborhoods, communities, in nature, and in the greater world comes easily for those born with a natural proclivity for empathy. Humility, understanding, and kindness can be cultivated through service to others, sincere practice, and self-reflection.  

Yet, true understanding can be difficult if perceptions or opinions are diametrically opposed, or if there are insurmountably prohibitive language or cultural barriers that would block an exchange of understanding. Similarly, some individuals may suffer from empathy deficit disorder (EDD) or narcissistic personality disorder (NPD). Those conditions may make it difficult for individuals to understand perspectives other than their own. Sharon Begley’s book, Train Your Mind, Change Your Brain, offers a remarkable look at the brain’s neuroplasticity as well as strategies for retraining the brain toward compassion and empathy.

When actively caregiving for another (child, spouse, companion animal, friend, elderly parent, etc.), understanding can make or break an interaction. A whole new level of understanding may be needed when caregiving for someone who is medically vulnerable, in mental or physical decline, or has a life-limiting illness. In that case, the patient may not be willing or able to navigate the experience in a way that makes sense to the caregiver. Their choices for pain management, surgery, rest, or therapeutic interventions may differ greatly from the choices a caregiver would make. In this circumstance, empathy, respect, and willingness all come into play.

In the 1970 hit song by Joe South these lyrics are about empathy: Walk a mile in my shoes, just walk a mile in my shoes. And before you abuse, criticize, and accuse, just walk a mile in my shoes. Caregivers cannot know exactly what a care recipient or patient is experiencing, perceiving, or feeling. They can guess. They can ask. They can theorize or postulate, but since everyone is unique, it is difficult to truly understand what the patient may be facing and why they make certain choices.

In a similar way, patients cannot always truly understand what their caregivers are going through! Family caregivers often feel overwhelmed as they juggle their “day job” with providing care. This is especially true if the caregiver also serves as the power of attorney for health care decisions. Patients with serious illness often must reserve most of their energy for their own processes, and may appear to lack empathy, care, or kindness for caregivers. In reality, they may just be feeling too unwell to extend kindness or to have the energy for understanding. The idea of walking a mile in the other’s shoes, or simply imagining trading places for a bit can help to increase empathy and understanding for both parties.

Caregivers can also increase their understanding of patient needs and feelings through the practice of deep listening and the non-violent communication (NVC) process developed by Dr. Marshall Rosenberg. Listening to understand a patient’s discomfort often gives way to mutual solutions that will not only ease a caregiver’s burden, but also empower the patient to participate in solutions that bring comfort. Some examples to ask the patient are:  Would you be willing to:

  • talk with a counselor about your anxiety?
  • try a new physical therapist?
  • try the new chemotherapy protocol?

Patients can also ask their caregivers:  Would you be willing to

  • go to counseling with me the first time?
  • include me in the interview process for a new physical therapist?
  • support my choices about chemotherapy?

Being willing to do something doesn’t mean it has to happen, or that it will happen. It does, however, open the door for conversations and problem solving with a focus on patient needs as well as caregiver capabilities. On hearing the answer to questions like this, follow up by saying: Can you say a little bit more about that? I really want to understand.

I recall a time when a patient in our care was in tremendous pain and opposed to narcotics for pain relief. The patient was becoming angry with family caregivers who offered pain relieving drugs. Family caregivers were struggling to reconcile what they perceived as the patient’s stubborn behavior. They were upset, distraught, and felt helpless in the face of the patient’s suffering. Guiding a conversation using the NVC process, we were able to ascertain that the patient had a history of narcotic addiction and worried about making a spiritually excruciating decision to “break sobriety” in final days. It had been the patient’s long kept secret. Disclosure evoked deep empathy; the family understood this anguish and were able to discuss acceptable pain management strategies. Peace was restored; comfort given.

Family and professional caregivers are bound to honor, respect, and uphold patient wishes in final days. Even in the most communicative and copacetic families, a care recipient’s health care choices or final wishes may seem impossible for caregivers to understand or agree with. A simple action to take is to outline choices and inform caregivers about those choices ahead of a crisis. We recommend writing things down! The Five Wishes, is a living will with heart and soul. This booklet style living will is a legal instrument in most of the United States and is available in 30 languages! This document can help spark conversations between patients and caregivers to ensure a clearer understanding about final wishes and how to carry out instructions for those wishes.

Feeling truly heard and understood is a comfort in any circumstance. It is especially so when we are ill, injured, or disabled for any reason. Attending a support group offers many obvious benefits (i.e., reduces feelings of anxiety, depression, loneliness, isolation, or feelings of being disbelieved or judged). Group members help each other through direct exchanges of empathy, sharing common concerns, goals, and insights. There is true understanding because they are “walking a mile in one another’s shoes”. Sharing at that level is uplifting, healing, and affirming. My recent direct experience in such a group leaves me feeling humbled and grateful. A feeling of being understood by group members contributed greatly to my improving health. If you, or someone you care for has an acute or chronic illness, please consider a support group. There are many to choose from for a variety of conditions. Several are virtual and work well for medically vulnerable or homebound folks.

In conclusion, to truly understand another’s perspective can be difficult, but not impossible. It takes willingness to explore the other’s views for true understanding. One way to explore is to “walk in another’s shoes.” Once understanding is gleaned, forgiveness, humility, and other forms of supportive care are possible. For those with medical or other challenges, the feeling of being understood is palliative. It can reduce suffering and provide comfort. It can be so uplifting as to spark a cascade of healing hormones, like oxytocin, endorphins, and serotonin that in turn leads to feeling comforted, cared for, and well.

I’m wishing everyone a healthy dose of understanding and being understood today! If you want to read a little bit more about understanding, I think you will enjoy this post from The Daily Stoic, “Will You Understand, or Be Understood?”

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