Eddy M. Elmer: Death and regression to childhood

Death and regression to childhood

Outline for seminar given to Gerontology: Death and Dying

Eddy M. Elmer

Simon Fraser University, September 2000

Part I

Introduction

In this presentation, I will try to conceptualise the dying person's feelings, thoughts, and actions as regressions to an original childhood state. I offer this idea as others have been offered—to help us appreciate the variety and complexity of reactions toward impending death. This appreciation can in turn help us avoid the uni-dimensional perspectives on death and dying which can impede effective caregiving. My conceptualisation is not meant to be applied to all dying persons; just to some. Since it may seem that by describing another "theory" I am simply adding to the many artificial views of death and dying, I should note that my personal bias is that these ideas should be used not so much to help us come to terms with death and dying, but to help us adjust to and sit comfortably with the ambiguity and elusiveness that characterises it. This is invaluable in assuaging the anxiety that distracts dying persons, their families, and their caregivers from making decisions, offering care, and grieving.

What is a "regression to childhood?"

"Regression" is actually a term used in psychiatry (which is traditionally psychodynamically-oriented). It is a label for one of several "defence mechanisms"—unconscious tactics it is said we employ to cope with unpleasant, unwanted, or unacceptable thoughts and emotions. I "regress" when as an adult I resume behaviours that were in some way psychologically adaptive during childhood. Examples could include:

pouting, crying
whining
excessive complaining
"guilt-tripping"
name-calling
blaming
denying personal responsibility
oral behaviours: excessive eating, smoking, nail-biting, lip-biting, etc
anal-expulsive and retentive behaviours: lack of hygiene, cleanliness; disorganisation; excessive rigidity, stubbornness, inflexibility, perfectionism
malingering; self-mutilation

see Frayn¹ for detailed examples and case studies

Are defence mechanisms in general effective?

In most cases, they are considered primarily adaptive, since they are the ego's reasonable compromise between satisfying basic drives and co-existing in a civilised society. Sometimes, however, defences can precipitate maladaptive "disorders" (eg anxiety, depression, eating disorders, vaginismus, schizophrenia, dissociative disorders, nightmares & night terrors). It can be said that the psychiatric disorders themselves are defence mechanisms "in disguise" (depression, for instance, can be considered a form of "protective cocoon"). Yet why would anyone, unconsciously or not, adopt behaviours that could evolve into such seemingly maladpative behaviours?

defence mechanisms are first and foremost protective mechanisms; in the context of death and dying, denial and repression are common defences in Western society (see Kalish²)
while they may cause us great pain and difficulty (depression is not fun), we somehow decide that the affect associated with the thoughts and feelings we are trying to expel from consciousness are by far more uncomfortable (eg I would rather be fatalistic and pessimistic about life and slip into a depression than try to reconcile with the fact that death exists)

Why regression?

some people experience significant death anxiety and death fear; these feelings are perceived as so uncomfortable that we seek a potent defence—many of us ask what more potent defence is there than (unconsciously) behaving in ways that kept us feeling safe and protected in what we later discovered, and still cannot fully accept, is a harsh world?
whether this anxiety or fear is adaptive or maladaptive; healthy or unhealthy; natural or socially bred; or reasonable or excessive is of little importance in this context, because as long as fear and anxiety are subjectively unpleasant responses, at least some people will strive to deploy whatever defences they can

Part II

Conceptualising death and dying as a regression

Generally, regression is seen in a negative light, as underscored by a description from the American Psychological Association: "A return to earlier, especially to infantile, patterns of thought or behavior, or stage of functioning, eg, feelings of helplessness and dependency in a patient with a serious physical illness."³

This process in a negative sense

Regression as promoting "excessive dependence" (see Boiffin⁴; also, Coppola et al. attempt a program to alleviate regression and dependence in an institution for the elderly⁵)
Regression in effort to relinquish any further responsibility for one's life and death
Regression as distraction from impending death
Regression as narcissistic denial and invincibility
Regression as retribution against caregivers
Regression as enactment of the death instinct; if interested in this concept, see Lowental⁶

The dangers of regression

Elmes and Barry⁷: extreme, but instructive examples of narcissistic regressive behaviour
it can also be easy to re-adopt the childhood misperception of invincibility, which I think might ultimately disappoint and thus frustrate and upset the dying person who will inevitably once again be confronted with impending death
narcissistic behaviours may also, of course, hasten death (eg ignoring medical advice)

This process in a healthy, positive sense, which we should attempt to facilitate

I suggest that, ironically, regression can be a way of achieving the growth and healing that caregivers ought try to facilitate for the dying person
this growth can be facilitated by helping the dying person regress to childhood thoughts, feelings, and behaviours; Pecci suggests techniques for reframing the dying person's "emotional field" by facilitating a regression to early childhood experiences, the birth experience, or past lifetimes, and thus opening the door to healing⁸
Bienenfeld also conceptualises the non-pathologic side of regression⁹
constructive and adaptive benefits of regression:

Finally living freely and unencumbered, as one was meant to (consider Willa Cather's novel, The Professor's House)
Increasing one's sense of generativity (the birth experience and death juxtaposted at one point in time), thus increasing one's sense of continuity in time
An opportunity to see one's life as a whole, which can be anxiety-relieving

The relation to Carl Rogers

Rogers' unique approach to personality and psychotherapy can be used to explain the benefits of regression¹⁰
active denial of various experiences and associated affect causes discrepancy between one's view of self and actual experience; this provokes maladaptive anxiety
perceptual self-integration is key to reducing this anxiety
allowing for "unconditional positive regard" and fostering an environment in which the dying person is free to think, feel, and say whatever she wants without feeling shunned, may help her integrate death fear into her awareness, thus reducing anxiety
I add that allowing for the free expression of regression might also facilitate this perceptual integration, especially if regressive transferences are useful in restructuring earlier losses (see Frayn¹¹)

Some possible implications for caregiving

Support, not suppress, the presence of regressive behaviours
Allow yourself to become party to some of the transferential regressions (see Frayn¹² and Sobel¹³)
Encourage regressions to childhood emotions (perhaps through play or art)
Encourage regressions not so much for the sake of "insight" (which can be construed as an assertion the dying person is somehow "crazy"), but for the sake of perceptual integration
According to Rogers, we all have an innate capacity for this perceptual integration, and will accomplish this integration by ourselves, without any intervention—therefore, as we learnt at the beginning of the course, simply being there with a dying person and making no effort whatever to "make things better" is the best care we can offer

¹ D.H. Frayn, “Regressive Transferences: A Manifestation of Primitive Personality Organization,” American Journal of Psychotherapy, 1990, 44:1, 50-60.

² R.A. Kalish, Death, Grief, and Caring Relationships (Monterey, California: Brooks/Cole, 1985), pp. 84-86 and 98-100.

³ American Psychological Association, Thesaurus of Psychological Index Terms (Washington, DC: APA, 1994).

⁴ A. Boiffin, “Major Regressions,” Psychologie Medicale, 1989, 21:8, 1087-1090.

⁵ D. Coppola et a., “Developing a Sense of Community: A Programming Approach for Institutionalized Elderly,” Activities, Adaptation and Ageing, 1990, 14:3, 17-25.

⁶ U. Lowental, “Dying, Regression, and the Death Instinct,” Psychoanalytic Review, 1981, 68:3, 363-370.

⁷ M. Elmes & D. Barry, “Deliverance, Denial, and the Death Zone: A Study of Narcissism and Regression in the May 1996 Everest Climbing Disaster,” Journal of Applied Behavioral Science, 1999, 35:2, 163-187.

⁸ Ernest Pecci, “Opening the Way to Healing," The Journal of Regression Therapy, 1997, 2:2, 105-107.

⁹ D. Bienenfeld, “The Two-way Street: Aspects of Regression in Psychotherapy with Aging Patients,” American Journal of Psychotherapy, 1985, 39:1, 86-94.

¹⁰ C.R. Rogers, “Some Observations on the Organization of Personality,” American Psychologist, 1947, 2:358-368.

¹¹Frayn "Regressive Transferences"

¹²ibid.

¹³ E.F. Sobel, “Countertransference Issues with the Later Life Patient,” Contemporary Psychoanalysis, 1980, 16:2, 211-222.

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Eddy M. Elmer