Journaling as a Practice

Journaling is a form of expressive writing (meaning writing which focuses on one’s emotions and experiences rather than structure, grammar, punctuation, etc)¹ which can help aid in the meaning-making process while providing several other benefits, such as decreasing depressive symptoms,² improving happiness,³ and even reducing signs of illness.⁴ This kind of writing allows us to better understand and create meaning in our lives by making us recall experiences and more closely analyze our emotions surrounding these events.⁵ As Kane explains, “writing helps to organize thoughts, facilitate integration, and helps individuals accept their own experiences and put them into context.”⁶ Anyone in a patient’s community can journal. Having a group of people intentionally focusing on expressive writing as a form of meaning-making helps result in a shared meaning, which becomes a unique central point of connection for the community (see the “Collective Soul” section). Particularly at the end of life, journaling is an impactful, accessible method of meaning-making which can involve as many people as would like to participate.

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Patients

There are many ways to approach journaling, and none of them are “wrong.” Though what follows will suggest several methods of journaling, all of these are adaptable to any circumstance. What matters is that you journal in a way that allows you to reflect on and understand the meanings in your life.

Use pen and paper. Writing longhand removes the most distractions and promotes focused thought, which produces more of the benefits cited for journaling. ⁷
Identify your values and write about them. Think about where your values came from, where they have taken you, and how they influence your thoughts and actions now.
Write about your relationships with people, whether your family, friends, healthcare providers, acquaintances, or complete strangers.
Write about your story of loss, from either first or third person. Writing in the third person has been shown to be especially helpful to analyze the symbolism in your own life. ⁸ This loss can be about anything, but it may be particularly helpful to focus on your end of life. You can also write in the third person for any other topic, though it has been especially helpful when writing of loss.
Think of the things you are grateful for and write about them consistently. Forming a habit of writing about gratitude has been shown to decrease depressive symptoms, ⁹ increase happiness, ¹⁰ and even reduce symptoms of illness. ¹¹ Even without making this a habit, gratitude helps us form meaningful attachments to what is good in our lives.
Think of the things you are not grateful for--pain, stress, despair, conflict, and so on. Studies have found that expressive writing about distressing events correlated with improved meaning making and less intrusive thoughts, which are unwanted, negative thoughts interrupting daily life. Writing about less distressing events still leads to meaning making, but does not lower the occurrence of intrusive thoughts. ¹² So, any form of expressive writing, such as journaling, can help with reflection on meaning, though directly addressing distressing thoughts and events leads to a healthier mindset following the writing.
Write as much as you can about anything. The topic does not matter, so as long as you begin and writing. Let your initial thoughts carry you to new places and explore those new places without feeling a need to structure your thought.
“Challenge yourself to write about something that made you stop and ask a question. It could be anything—a building you pass on the way to work, the way something functions, a story you heard about on the radio. Write about it. Why does it make you feel curious? What questions do you have about it?” ¹³

Write about things you are grateful for, things you are not grateful for, or anything that comes to mind. You can structure your writing or let your mind carry your thoughts to new places. There is no “wrong” way to write and make meaning.

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Caregivers

For yourself:

Caregivers experience high rates of burnout, commonly associated with symptoms of depression, anxiety, fatigue, and so on. Journaling has been shown to help alleviate these symptoms, as well as foster the meaning-making process. Here are some ways you can journal to create more meaning in your life as you face stressful circumstances.

Use pen and paper. Writing longhand removes the most distractions and promotes focused thought, which produces more of the benefits cited for journaling.
Identify your values and write about them. Think about where your values came from, where they have taken you, and how they influence your thoughts and actions now.
Write about your relationships with people, especially your relationship with your loved one facing the end of life. But also write about your relationships with your family, friends, acquaintances, or complete strangers.
Write about your story of loss, from either first or third person. Writing in the third person has been shown to be especially helpful to analyze the symbolism in your own life. This loss can be about your loved one’s dying process, your grief, or any other struggle you may be facing in your life. You can also write in the third person for any other topic, though it has been especially helpful when writing of loss.
Think of the things you are grateful for and write about them consistently. Forming a habit of writing about gratitude has been shown to decrease depressive symptoms, increase happiness, and even reduce symptoms of illness. Even without making this a habit, gratitude helps us form meaningful attachments to what is good in our lives.
Think of the things you are not grateful for--pain, stress, despair, conflict, and so on. Studies have found that expressive writing about distressing events correlated with improved meaning making and less intrusive thoughts, which are unwanted, negative thoughts interrupting daily life. Writing about less distressing events still leads to meaning making, but does not lower the occurrence of intrusive thoughts. So, any form of expressive writing, such as journaling, can help with reflection on meaning, though directly addressing distressing thoughts and events leads to a healthier mindset following the writing.
Write as much as you can about anything. The topic does not matter, so as long as you begin and writing. Let your initial thoughts carry you to new places and explore those new places without feeling a need to structure your thought.
“Challenge yourself to write about something that made you stop and ask a question. It could be anything—a building you pass on the way to work, the way something functions, a story you heard about on the radio. Write about it. Why does it make you feel curious? What questions do you have about it?”

Write about things you are grateful for, things you are not grateful for, or anything that comes to mind.

You can structure your writing or let your mind carry your thoughts to new places.

Consider spending extra time on the relationship you have with your loved one and your feelings surrounding caring for them.

There is no “wrong” way to write and make meaning.

For your loved one:

Everyone needs to make meaning throughout their lives. But at the end of life, the importance of meaning-making becomes pressing. For your loved one in this circumstance, it is important to help them through this process by gently encouraging them to embark upon the meaning-making journey. Here are some ways you can bring up and explain journaling as a practice for meaning-making to your loved one.

Bringing up a shared experience (event, relationship, etc) which was meaningful to youand transition to a conversation about how journaling about that event has helped you. You can suggest to them that, though their experience will necessarily be unique from your own, it could help them understand their lives and suffer less, whether that suffering is spiritual, mental, or physical.
Show them this website and help them navigate it!

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Community

For yourself:

Seeing a loved one dying can bring up feelings of depression, anxiety, fatigue, and so on. Journaling has been shown to help alleviate these symptoms, as well as foster the meaning-making process. Here are some ways you can journal to create more meaning in your life as you face stressful circumstances.

Use pen and paper. Writing longhand removes the most distractions and promotes focused thought, which produces more of the benefits cited for journaling.
Identify your values and write about them. Think about where your values came from, where they have taken you, and how they influence your thoughts and actions now.
Write about your relationships with people, whether your family, friends, acquaintances, or complete strangers. You may want to spend some extra time writing about your relationship with your loved one at the end of life.
Write about your story of loss, from either first or third person. Writing in the third person has been shown to be especially helpful to analyze the symbolism in your own life. This loss can be about your loved one’s dying process, your grief, or any other struggle you may be facing in your life. You can also write in the third person for any other topic, though it has been especially helpful when writing of loss.
Explore your life and imagine yourself in the role of a caregiver or in the place of your loved one at the end of his or her life. Write about this and think about being in their place would impact your life as it is now.
Think of the things you are grateful for and write about them consistently. Forming a habit of writing about gratitude has been shown to decrease depressive symptoms, increase happiness, and even reduce symptoms of illness. Even without making this a habit, gratitude helps us form meaningful attachments to what is good in our lives.
Think of the things you are not grateful for--pain, stress, despair, conflict, and so on. Studies have found that expressive writing about distressing events correlated with improved meaning making and less intrusive thoughts, which are unwanted, negative thoughts interrupting daily life. Writing about less distressing events still leads to meaning making, but does not lower the occurrence of intrusive thoughts. So, any form of expressive writing, such as journaling, can help with reflection on meaning, though directly addressing distressing thoughts and events leads to a healthier mindset following the writing.
Write as much as you can about anything. The topic does not matter, so as long as you begin and writing. Let your initial thoughts carry you to new places and explore those new places without feeling a need to structure your thought.
“Challenge yourself to write about something that made you stop and ask a question. It could be anything—a building you pass on the way to work, the way something functions, a story you heard about on the radio. Write about it. Why does it make you feel curious? What questions do you have about it?”

Write about things you are grateful for, things you are not grateful for, or anything that comes to mind.

You can structure your writing or let your mind carry your thoughts to new places.

Consider spending extra time on the relationship you have with your loved one and their caregiver(s). Put yourself in their shoes and examine how you may feel if you were them.

There is no “wrong” way to write and make meaning.

For your loved one:

Here are some ways you can bring up journaling as a practice for meaning-making to your loved one.

Use your own experience. Talk about the ways journaling has helped you and suggest to them that, though their experience will necessarily be unique from your own, it could help them understand their lives and suffer less, whether that suffering is spiritual, mental, or physical.
Show them this website and help them navigate it!

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Healthcare Team

For yourself:

There are many reasons for healthcare professions, ranging from physicians, to nurses, to chaplains, and so on, to focus on meaning-making. For example, physicians experience high rates of burnout. Meaning-making practices, such as journaling, have been shown to reduce symptoms associated with burnout. Further, as a member of a healthcare team, you often communicate with people who are at the end of their lives. This circumstance makes it pressingly important that you know how to communicate with people through the language of meaning-making. To do this, you must be able to partake in the process yourself. The more well-versed you are in the language of meaning-making (which you achieve through regular practice), the better you will be at communicating with and helping patients in the patient’s own meaning-making process. Journaling can help you in this process, and is a practice which works well as a habit. Here are some ways you can journal (though you can adapt as you see fit):

Use pen and paper. Writing longhand removes the most distractions and promotes focused thought, which produces more of the benefits cited for journaling.
Identify your values and write about them. Think about where your values came from, where they have taken you, and how they influence your thoughts and actions now.
Write about your relationships with people, whether your family, friends, patients, acquaintances, or complete strangers.
Write about your story of loss, from either first or third person. Writing in the third person has been shown to be especially helpful to analyze the symbolism in your own life. This loss can be about any struggle you may be facing in your life, though focusing on the loss you feel with the dying of a patient may be particularly helpful. You can also write in the third person for any other topic, though it has been especially helpful when writing of loss.
Consider writing about being in your patient’s shoes or being your patient’s caretaker. How would you feel if you were them?
Think of the things you are grateful for and write about them consistently. Forming a habit of writing about gratitude has been shown to decrease depressive symptoms, increase happiness, and even reduce symptoms of illness. Even without making this a habit, gratitude helps us form meaningful attachments to what is good in our lives.
Think of the things you are not grateful for--pain, stress, despair, conflict, and so on. Studies have found that expressive writing about distressing events correlated with improved meaning making and less intrusive thoughts, which are unwanted, negative thoughts interrupting daily life. Writing about less distressing events still leads to meaning making, but does not lower the occurrence of intrusive thoughts. So, any form of expressive writing, such as journaling, can help with reflection on meaning, though directly addressing distressing thoughts and events leads to a healthier mindset following the writing.
Write as much as you can about anything. The topic does not matter, so as long as you begin and writing. Let your initial thoughts carry you to new places and explore those new places without feeling a need to structure your thought.
“Challenge yourself to write about something that made you stop and ask a question. It could be anything—a building you pass on the way to work, the way something functions, a story you heard about on the radio. Write about it. Why does it make you feel curious? What questions do you have about it?”

Write about things you are grateful for, things you are not grateful for, or anything that comes to mind.

You can structure your writing or let your mind carry your thoughts to new places.

Consider spending extra time examining the relationship you have with your patient and his or her caregiver(s). What would it be like for you to be them?

There is no “wrong” way to write and make meaning.

For your patient:

Here are some ways you can bring up journaling as a practice for meaning-making to your patient

Use your own experience. Talk about the ways journaling has helped you and suggest to them that, though their experience will necessarily be unique from your own, it could help them understand their lives and suffer less, whether that suffering is spiritual, mental, or physical.
Show them this website and help them navigate it!

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Collective Soul

With each member of the “collective soul” embarking upon the meaning-making process through the practice of journaling, you can build a common language which allows more connection and openness throughout this process. With every person contributing their own unique meaning to the conversation, you as a group can achieve a “shared meaning” that everyone can connect to and through.

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