We have probably felt demoralized at certain points in our lives:
- receiving a "Needs Improvement" on an annual evaluation from your supervisor/manager/boss despite putting in long hours on big work projects
- seeing "Not Pregnant" yet again on the pregnancy test months after you first started attempting to start a family
- stepping on the scale and seeing that you have once again regained the ten pounds you worked hard the last two months to lose
- losing all your belongings, mementos, and important documents in a massive flood
Demoralization is a sense of despair, helplessness, or meaninglessness with both an inability to cope and an uncertainty of the path one should take. It is feeling like one has no control of a situation, thinking that there is not anything they can do to achieve their goals or change the outcome.
It can be normal to feel demoralized when feeling extremely overwhelmed, such as when given a life altering medical diagnosis, a succession of bad news, an unexpected shortened prognosis, or disfiguration or significant debilitation caused by illness or its treatment.
A person who feels demoralized may not feel that there is any point in attempting to move forward or may not know how to move forward. They may not engage with the people around them, and they may not engage in their medical care. "What is the point of working with physical therapy? I'll never get out of this hospital."
Unlike depression or anxiety, demoralization cannot be treated with medication, though a person experiencing both depression and demoralization would most likely benefit from medical treatment of the depression.
The following are suggestions on how you could help a loved one who feels demoralized or helpless*:
1. Be present as much as possible.
Close relationships with family, friends, or other forms of social support are important in helping a person feel less isolated and in helping them draw on their reserves of resiliency. Be present for your loved one as much as you possibly can without it negatively impacting your own physical, emotional, social, or financial health. "I drop by every other day to check on her, and I try to cheer her up. If she's really not in the mood, I at least make dinner for her and we'll eat together before I leave."
2. Actively listen to what seems to be causing your loved one's distress.
Is your loved one despairing obtaining any relief from unrelenting nausea or pain? Is your loved one despairing setbacks in their wound healing? Is your loved one despairing a succession of bad news - from news that they lost their job, that their best friend was severely injured in a motor vehicle accident, and now that their cancer has returned? Sometimes, you may find that you can potentially take action. Other times, you may find that your loved one is despairing a situation that has no straightforward or easy fix. These conversations may be the hardest for you to sit and be present for, but your active listening may be the best step for helping your loved one regain a sense of control or purpose. "She said my sitting with her helps her feel better, that she's processing while she talks out loud."
3. Reassure your loved one that their reaction to what they are dealing with is normal and human.
Validate your loved one's emotions (read Step 5 in Post 17: How to Discuss Serious, Difficult, Hard to Hear, Bad News in Six Steps). Let them know that they do not need to feel embarrassed or ashamed about feeling helpless, defeated, or incompetent during this difficult time and that these are normal, common, human emotions. "He's always been practical. I thought anybody would feel the way he's feeling, so I didn't know that he felt so embarrassed for feeling like he can't cope. I tell him now that what he's feeling, anybody would feel in his situation."
4. Ask about and attentively listen to what your loved one considers their values and their strengths.
Many people find meaning in their accomplishments and link their identities to their roles in life. They can lose their sense of purpose when they can no longer rely on these accomplishments or roles. Reminding your loved one of who they are as a person, of their values and their strengths, may help them find new purpose or meaning in their illness. "She's a very nurturing person, and it sounds like it was so hard to have others take care of her after the stroke. When we started buying house plants for her to care for, it's like she started becoming more like her actual self. The plants are thriving, and she's thriving."
5. Remind your loved one about previous coping strategies that they could potentially fall back on.
People go through multiple difficult times in their lives. How did your loved one get through previous hard times? What gave them the strength to move forward? Was it relying on their faith, talking with their best friend, journaling, hiking through the woods, or taking care of a beloved dog? "I know her dog saved her. She said when her daughter died, she was thinking about 'ending it.' But caring for her dog got her through that period."
6. Help your loved one set achievable goals and take action, even if it is just a first step.
Actions that will help your loved one regain some sense of control, value, or purpose could range from helping them obtain all the information they need to fully understand their condition to helping them reconnect with their coping strategies. If your loved one feels lost and is uncertain about what direction to take with their medical treatment, you might reassure them, "We'e going to make an appointment with the specialist and give them our list of questions" or "We're going to ask the hospitalist to consult the palliative care team to help us figure out next steps (read Post 44: When a Palliative Care Consult Could Help - Eight Hospital Scenarios)." If your loved one is demoralized from not being able to use the bathroom on their own due to pain, you might say, "We'll keep working with the oncologist to get you better pain control. You deserve better quality of life than this." "The doctor said we could cut down on flare ups and hospitalizations if she stopped smoking, so we set a date to start weaning the cigarettes. I bought gum; that worked for her last time. And we vowed to stay away from casinos for a while. I'm coming up with places we can hang out where she won't feel tempted."
7. Get help for your loved one if you feel overwhelmed yourself.
During this time that you are actively providing support, you should take care that your involvement does not negatively impact your own health and your own relationships with other family members, friends, and work colleagues. Attempting to support a loved one who is demoralized and having difficulty engaging with you (and anything and anyone else) can be overwhelming, especially if you yourself are trying to process grief, sadness, anger, or guilt. Instead of becoming frustrated with your loved one, consider seeking help - from your loved one's primary care physician, palliative care physician, social worker, chaplain, counselor, psychologist, or therapist - for your loved one. "I could tell I was changing - not in a good way, snapping at my kids, having trouble sleeping, making careless mistakes at work - and that I couldn't be her entire support system. It was hard to admit that I wasn't enough, but I'm glad that I did. I don't feel so alone and stuck now that she's also talking to a therapist."
Sometimes a loved one may experience depression, anxiety, spiritual distress, and/or anticipatory grief [read Post 35: Grieving Loss (and Change) That is About to Come - Six Coping Suggestion] in addition to demoralization. If you are unsure and you have any concerns that your loved one could be suffering from depression or anxiety, urge them to get evaluated as soon as possible by their healthcare provider, even if you have to hold their hand to pull them to the office so to speak.
It is very difficult to witness a loved one feeling helpless. If you ever find yourself in such a position, I hope the above suggestions help you and your loved one navigate to a place where both of you can feel more in control of your future.
* modified from Jacobsen JC, et al. Demoralization in Medical Practice. Prim Care Companion J Clin Psychiatry 2007;9(2).