As I read “The Five Invitations” by Frank Ostaseski, I feel inspired to share my thoughts on emotional self-regulation and how this impacts palliative care. Ostaseski is a physician and a medical director of the Zen Hospice Project in San Francisco, and he shares what he has learned about life through his time walking side by side with death. In Chapter 10, The Raging River, Ostaseski shares his practice journey and how grief can be complicated by how people have historically learned to process emotions.
We have three ways we can deal with emotions: repress, express, and contain. One thing I have discovered, and others have corroborated anecdotally and academically, is that emotions are going to come out one way or another. If we hold them in, we may manifest the feelings in unintended ways including somatization. Sometimes it seems easier to engage in what’s called a “spiritual bypass” or “emotional bypass” where we short-change our emotional process in exchange for a false sense of comfort. Expressing emotions can be helpful at times, but at other times we can stay stuck in our narrative and swirl around in the trauma.
The idea of “containment” as described by Ostaseski posits that we embrace the feeling while not letting it become us. Grounding, being aware of how the feeling shows up in our bodies and noticing without judgment are all ways to contain our feelings. It’s like holding a snowflake, looking at all the unique facets, and allowing it to dissipate on its own. I have other metaphors, but since we are getting snow right now, it’s the one that comes to mind. With containment we minimize the potential for acting out in response to emotion. Containment leads to emotional self-regulation and awareness of ourselves in our body and in our environment.
When my 14-year-old son Jacob was younger, he would frequently become overwhelmed with emotion. Frustration, anger, sadness, fear, anxiety would all bubble up like a geyser at Yellowstone National Park. I found that I was emotionally activated by his strong emotions, and because he was my son, I wanted to shelter him from the pain. Being a parent brings out the most powerful protective instinct I have ever experienced. But I realized this was a terrific opportunity for growth for both of us.
After I engaged in my own mindfulness practice and was self-regulated and intentional with Jacob, I was able to provide guidance for his emotional reactivity. I taught him to think of emotions like clouds. He became aware of them, watched them float by, let them pass, and be present for the time they were with him. Although at times when he is hungry and tired, he may have more emotional reactivity, in general he is able to be aware and purposeful. As a parent, my gift to Jacob is to help him cope with a sometimes unfair and challenging world.
In palliative care, we see the spectrum of unfair and challenging situations. And we also experience the range of intense emotions from patients and their loved ones. When we’re paying attention, we can see people who have trauma and have not learned self-regulation. Without mindful practice of how we show up in the world, children without self-regulation become adults without self-regulation. The only thing we have control over is how we show up in the world, and we can hopefully serve as a guide to those who have not had healthy role models around emotional self-regulation.
The following is information on Ostaseski’s book if you would like to read more:
The Five invitations: What Death Can Teach Us About Living Fully – by Frank Ostaseski | Frank Ostaseski
Ostaseski, F. (2019) The Five Invitations: Discovering What Death Can Teach Us About Living Fully. Flatiron Books: New York.
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