Anthroposophic Therapeutic Speech for Orientation in Palliative Phases of Illness

Dietrich von Bonin

Last update: 22.12.2020

The ability to speak is one of the central achievements of human consciousness and includes speech as self-expression, as a carrier of thoughts and as a means of communication. Speech can also be considered to include pre-verbal and non-verbal communication with gestures and the voice.

Speech as a medium of understanding and orientation is of great importance in phases of palliative care. Accompanying people in this phase often involves reducing or doing without ordinary speech, leaving us with the weight of a few, condensed words. Just as babies start life with one-word sentences, at the end of life there may be a reduction in the abundance of words that can be spoken by and around a person who is preparing to depart.

  • What is essential to the person who is rounding off his or her biography, what still wants to be expressed or experienced? “I realize that I have nothing left to lose and I am endeavoring to free myself from old, entrenched ideas in order to recognize and do what is really important to me.” This journey inward, and then perhaps speaking the discovery aloud, can be accompanied and supported by anthroposophic therapeutic speech. Breathing exercises, vowel exercises and texts that help people to listen to themselves and express emotions can be helpful.

  • In this way, the content of a condensed text – such as a poem or a verse – can shine ever more powerfully through the mediating words and form a silent bridge to the person being accompanied. In this situation, it is especially important for practitioners and family members to pay close attention to the person’s real needs and not to impose texts or content with good intentions. Even the classical exercises of speech formation and therapy are no longer a priority now.

  • On the other hand, it may prove helpful to use the building blocks of speech – sounds and syllables in different modalities – in a receptive manner. These elements of speech can help reinforce a patient’s mindful connection to their body, which is often important on the way to enabling them to eventually detach from it completely. This experience can be supported by having patients place their hands on their abdomen or chest while hearing the gentle sound of M; or by having them feel the flow of breath and accompanying it with a soft F, S, CH or M. Patients can also use their feet to apply gentle pressure against the bed frame or the therapist’s hands.

  • During the preterminal phase, which can last for weeks or months, many people find that important texts and poems begin to emerge from the depths of their memory. The therapist’s accompaniment and additions can be of great importance, especially when only fragments of memory are involved. The therapist can do this by completing text fragments or speaking rhythmically, but as the patient becomes increasingly weak, the texts may be internalized and give way to quieter or even inaudible speech.

  • If the patient is bedridden and has symptoms such as shortness of breath, which often occur in the terminal phase, it has proven particularly useful to perform receptive hexameter on the patient’s legs.

  • In case of painful or spasmodic conditions, it can help to stroke the patient with air sounds such as S or CH. Especially CH can release the breath even without touching and can stimulate it to resonate.

  • In the final phase, many people want to be alone and they seek the right moment from a higher state of awareness. When they leave their body, they leave behind speech, along with vowels and consonants, and they converse with those close to them from within, as if in an inversion.

Research news

Phase IV trial: Kalium phosphoricum comp. versus placebo in irritability and nervousness 
In a new clinical study, Kalium phosphoricum comp. (KPC) versus placebo was tested in 77 patients per group. In a post-hoc analysis of intra-individual differences after 6 weeks treatment, a significant advantage of KPC vs. placebo was shown for characteristic symptoms of nervous exhaustion and nervousness (p = 0.020, p = 0.045 respectively). In both groups six adverse events (AE) were assessed as causally related to treatment (severity mild or moderate). No AE resulted in discontinuation in treatment. KPC could therefore be a beneficial treatment option for symptomatic relief of neurasthenia. The study has been published open access in Current Medical Research and Opinion

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