A Novel Use of Dignity Therapy

To the Editor: Dignity therapy is a brief psychotherapeutic intervention for terminally ill patients (1). In this therapy, patients generate a document to pass on to loved ones that contains details of the patient's life, life lessons, and declarations of affection. Clinicians help create such documents by recording the patient's story over several interviews and then transcribing and editing the patient's words. We report the case of a 55-year-old man with severe mental illness who participated in dignity therapy while awaiting transfer to a state hospital.

Case Report

“Mr. J” is a 55-year-old man with schizoaffective disorder and multiple psychiatric hospitalizations who was admitted for worsening paranoia and agitation. Despite stabilization with medications, he continued to require hospitalization because of his poor self-care, and he was referred to the state hospital.

While awaiting transfer, Mr. J worried that he would never spend meaningful time with his adult children, and he agreed to undergo dignity therapy to tell his life story to his children. He was too paranoid to participate in a recorded interview, but he agreed to write his story following the prompts in the dignity psychotherapy protocol (1), which contains questions about life history, dreams, and accomplishments. He wrote his own answers in a simple, grammatically incorrect style, but one of the authors (J.D.A.) typed up his words, edited them, and reviewed them with him. Mr. J focused primarily on the births of his children and the course of his illness, and he concluded by expressing his love toward his children. He distributed 10 copies of his story to family and friends. He reported that dignity therapy had “restored hope” and enabled him to communicate better with his children, who stated that they could now better understand their father.

Discussion

In this case, dignity therapy helped a patient with a debilitating mental illness face a negative life event much in the way it helps those facing terminal illness. In palliative care, dignity therapy has helped patients achieve a greater sense of purpose and will to live and reduced their suffering and depressive symptoms (1). Such gains would be beneficial for individuals with chronic mental illnesses, who have often suffered many personal losses and have low quality-of-life scores (2). Dignity therapy, along with other forms of psychotherapy (3), has the potential to improve patients' personal narratives, and future research to adapt dignity therapy for people with mental illness may increase patients' self-worth and coping abilities.