UAMS Pastoral Care & Clinical Pastoral Education

Dementia
A fraying narrative of one’s life,
echoing in gestures, glances, laughter’s balm.
The self is not erased but refracted,
like a familiar song on the radio
heard through static.

Memory becomes a shoreline eroded by waves,
names, places, stories,
all washed out to sea.

What remains are lived moments,
echoes faint, distorted,
like a song half-sung.

It’s just moments now.
They don’t join up.

_____________________________________________________________________

When I wrote Dementia, I was thinking about how a life begins to loosen its hold on itself. Not suddenly. Not all at once. More like a well-read novel whose pages are coming apart, caught by the breeze, drifting in the air.

A fraying narrative of one’s life,
echoing in gestures, glances, laughter’s balm.
The self is not erased but refracted,
like a familiar song on the radio
heard through static.

So much of who we are is held in the stories we tell ourselves. We live inside those stories, and in many ways, they look after us. We weave the tapestry of our lives with the threads of lived experience, moments spun together into something that feels meaningful and fits us well.

With dementia, those threads begin to unravel, and life begins to fray at the seams.

But what I have noticed, what I wanted the poem to honor, is that the person does not simply disappear overnight. It is an insidious unraveling, slipping in like nightfall, on slippered feet.

A person loses clarity, like a picture out of focus. The self becomes refracted, broken into fragments of fractured light. You can still recognize them in a characteristic smile, in the way they reach for your hand, in laughter that comes unexpectedly in what seems a moment of true connection. But like the ocean, such moments ebb and flow.

It reminds me of what John O’Donohue wrote about presence, how the soul is not confined to the thinking mind, how there is a deeper knowing that lives in the body, in feeling, in connection. When memory unravels, something more elemental begins to surface.

Words fade.
Yet gestures speak.
Stories disappear.
But emotion remains.

Memory becomes a shoreline eroded by waves,
names, places, stories,
all washed out to sea.

The Courage to Know and to Become Oneself: A Psychodynamic Journey

“We make out of the quarrel with others, rhetoric, but of the quarrel with ourselves, poetry.” - William Butler Yeats

The psychodynamic approach begins with a simple but unsettling realization: we are often strangers to ourselves. We do not fully know the person we see in the mirror.

We tend to think of ourselves as rational individuals, fully aware of why we think, feel, and act as we do. The psychodynamic tradition, however, suggests that much of human experience lies beyond our conscious awareness. Hidden from view lies a deeper psychological world shaped by hidden desires, unresolved conflicts, fears, memories, and relational patterns. These dynamics influence us long after we believe we have moved beyond them. From this perspective, what we observe outwardly reveals only a fraction of the inner life shaping our behavior.

The Foundations of Depth Psychology

The psychodynamic approach emerged primarily through the work of Sigmund Freud and was later expanded by thinkers such as Carl Jung and other depth psychologists. Although the theory has developed considerably over time, it continues to rest upon Freud’s central premise: we are influenced by unconscious processes outside immediate awareness.

The psychodynamic perspective suggests that early relationships leave enduring emotional impressions. Early experiences of attachment, love, rejection, approval, shame, and abandonment become integrated into the very fabric of our developing personality.

These formative experiences continue to influence how we:
• Seek connection and manage vulnerability
• Respond to conflict and interpret the world
• Navigate present encounters through past expectations

In this sense, the past remains active within the present. The self is not a fixed identity fully known to itself, but a deeply layered reality. Operating out of sight is an inner world of emotional associations that, while they appear irrational on the surface, make sense within the deeper logic of the psyche.

Conflict, Defense, and Meaning

Central to psychodynamic thought is the idea that each of us experiences internal conflict. We carry competing desires, fears, values, and emotional needs that are not easily reconciled. Because some emotions feel threatening to our sense of self, we develop defenses against them.

These defense mechanisms protect us from psychological pain, yet they distance us from greater self-awareness. We may:
• Intellectualize the grief of rejection rather than feel it directly
• Project unwanted feelings onto those around us
• Bury painful memories beneath busyness, perfectionism, or withdrawal

The psychodynamic approach does not view these responses as moral failures. Instead, it sees them as attempts by the psyche to preserve stability during emotional difficulty. Behavior is rarely meaningless. Recurring, self-defeating patterns reveal tensions within our inner world that have not yet been fully understood. In this view, all behavior carries meaning, even when its purpose lies outside conscious awareness.

The Role of Relationships and Growth

The psychodynamic tradition also emphasizes the phenomenon of transference. Each of us carries emotional expectations formed in early childhood into present encounters. Feelings once associated with formative figures may be unconsciously projected onto partners, friends, authority figures, and therapists.

In therapy, the relationship itself becomes a space where these longstanding relational patterns emerge and can be examined with greater clarity. Rather than focusing only on symptom reduction, psychodynamic therapy seeks a deeper understanding of the person’s emotional inner life.

Growth involves:
• Developing robust self-awareness
• Learning to tolerate emotional truth
• Entering relationships freely rather than repeating unconscious patterns

At its core, the psychodynamic approach is concerned with the lifelong task of becoming more fully oneself. Such self-understanding requires courage. Genuine self-knowledge often brings us into contact with uncertainty, vulnerability, grief, and contradiction. Yet it is precisely through this process of reflection and encounter that a more integrated sense of self becomes possible.

In this sense, identity is never fully given to us in advance; it is something we continually discover.

“We know what we are, but know not what we may be.”
- Hamlet

📣Maternal mental health matters!
PRI's Tracey Carey, RN, discusses our Women’s Mental Health Program with Arkansas Governor Sarah Huckabee Sanders today at the Women’s Health Expo at War Memorial Stadium, sponsored by the Arkansas Department of Health.

UAMS - University of Arkansas for Medical Sciences Women's Mental Health Clinic is here for you, no referral needed (pregnancy through 12 months post-partum as well as pregnancy planning). Call 501-526-8201 or visit: uamshealth.com/location/womens-mental-health-clinic/

Nurses Week is a reminder of the professional dedication that nurses bring to our patients and their loved ones every single day here at UAMS Medical Center. It is a time to pause and recognize the profound impact nurses have on lives, and to say, sincerely, thank you.

In her opening comments, Susan McDougal, director of the UAMS Pastoral Care Department, reflected on the enduring legacy of Florence Nightingale:

As we mark more than two centuries since her birth on May 12, 1820, Florence Nightingale stands as a towering figure in the annals of nursing, revered as the progenitor of modern nursing practices.

Born into privilege, Nightingale defied convention and family expectations when, at the young age of 16, she felt called to alleviate the suffering of those less fortunate.

Leaving behind the comforts of her wealthy upbringing, she pursued nursing education in Germany before embarking on a transformative journey to Turkey. There, amidst the chaos of war, she selflessly tended to the needs of thousands of sick and wounded soldiers.

In 1860, Nightingale established her own School of Nursing, a bastion of progressive ideals that transcended mere physical care. She passionately advocated for the holistic well-being of patients, recognizing the intrinsic link between physical and mental health—a radical notion for her time.

A trailblazer in every sense, Nightingale championed the revolutionary idea that healthcare is an inalienable human right, a concept ahead of its time.

Blessed with intellect, bravery, and unwavering determination, Nightingale earned the endearing nickname "Lady with the Lamp" for her nocturnal rounds, bringing solace and comfort to patients in the dimly lit corridors of the hospital.

Throughout time Nightingale's tales of valor served as beacons of instruction and inspiration. Though, true courage, she believed, resides within the depths of each nurse's soul.

Undoubtedly, Nightingale would look upon the UAMS nurses with immense pride, witnessing in them the same indomitable spirit and selfless courage that defined her own noble endeavors. Indeed, they are the embodiment of everyday heroes, their dedication and compassion lighting the way for generations to come.

At the conclusion of the celebration marking the start of Nurse’s Week, clinical pastoral training residents participated in the blessing of hands.

UAMS Psychiatric Research Institute

Therapy as a Resource for Personal and Professional Wellness:

Conversations about clergy wellness often highlight the importance of exercise, time spent with family, recreation, and rest for maintaining a balanced life and reducing stress. Yet therapy is seldom encouraged unless a clergy member is perceived as impaired. Experiencing moderate depression, chronic stress, or ongoing personal conflict does not indicate incapacity; it reflects the realities of what it means to be human. Challenges such as strained relationships, unresolved family issues, or emotional burdens are all areas where therapy can and does provide meaningful support.

As a CPSP Diplomate in Clinical Pastoral Supervision, I regard therapy not as a red flag but as a constructive form of self-care and a way to remain grounded in both one’s personal and professional life. It fosters self-insight, which in turn enhances one’s capacity to relate to others, whether patients, congregants, or colleagues, with greater empathy and understanding. Prolonged stress can leave even the most resilient individuals feeling overwhelmed or discouraged, and emotional or spiritual isolation can intensify those experiences.

Therapy, whether individual or group-based, helps counteract that isolation. It creates space to process difficult issues, restore a sense of purpose, and strengthen one’s sense of self.

A good friend of mine, Bill Zeckhausen, a psychotherapist who is now deceased, reflected on his experience facilitating small groups for clergy. He noted that many participants were able to work through both professional and personal conflicts within a supportive community. Some continued that work through individual, couples, or family therapy. Notably, they often spoke openly about seeking therapy, not with embarrassment, but as an intentional step toward growth and greater fulfillment in life.

Join us for the annual History of Medicine and Science Lecture! This year, we’re excited to welcome Dacre Stoker — great-grandnephew of Bram Stoker — as our guest speaker. A Canadian author, he has co-written best-sellers Dracula the Un-dead and Dracul, continuing the legacy of the iconic gothic classic. Discover the medical connections behind Dracula. This free event is open to all.

Register here: https://medicine.uams.edu/neurosurgery/events/history-of-medicine/

UAMS, University of Arkansas Launch Six-Year Bachelor’s to Medical Degree Program - UAMS News LITTLE ROCK — The University of Arkansas for Medical Sciences (UAMS) and the University of Arkansas, Fayetteville (U of A) recently announced plans for a new accelerated six-year Bachelor of Science to Doctor of Medicine (BS-MD) program, creating a direct pathway for exceptional students to progre...