FW: It's very common, but there hasn't been good systematic investigation. In one new study on adolescent suicide, investigators looked at the family and found many traumatic losses. There's a whole decade of research on substance abusers and their self-destructive course. The families are just littered with highly traumatic losses that are unmourned. Two factors are at work. One is that some losses are more traumatic than others, like witnessing the murder of your parent. If on top of that, the family can't help you process that loss, it's doubly likely that it's going to reverberate and have consequences in later relationships.
PT: How do these things show up in relationships and how do you know it's a loss issue?
FW: That's where you have to be attuned, and why I always do a genogram in clinical work.
PT: Could you explain what a genogram is?
FW: It's an intergenerational family diagram that shows who's who in the family, the significant events, births, losses, and their timing. A child born around a significant loss may have a special role to replace a person who was lost. I pay particular attention to past losses and their connection to the person who's coming in for help.
For example, a man came in for help around the breakup of a relationship. Previously married and divorced, now turning 40, he was desperate for a meaningful commitment and children. What was blocking him, he told me, was that he had a mother with a very controlling personality. He had done a lot of work in prior therapy to find a woman who would not be like his mother. I explored his family origin to shift from viewing his mother as a controlling personality--that was just something inherent in her personality--to understanding the context of the behavior he experienced as controlling.
It was only through talking with his older sister that he learned that his father had had a serious heart attack when he was around five. The physician had told the father, "You have to drastically alter your life if you want to live." But he loved adventure, risk-taking, dangerous sports and travel, and was a workaholic. He was also a man who didn't want to admit vulnerability again. So he turned over the control of his risky behavior to his wife.
All the son knew growing up was that his mother was very controlling of his father, and he feared he might marry a woman who would control him the same way. It was important for him to understand that the mother's controlling behavior kept his father alive and the family intact. This knowledge shifted his perception of his mother, of women, and of himself, and gave him a contextual view of the dilemma in the family. It's a classic example of the indirect effects of loss or threatened loss that can block a person from intimacy.
PT: The family tremendously shapes loss and one's reaction to it and that in turn shapes what happens to the family.
FW: Trying to protect one another, the family blocks communication about what they're frightened of, often about an impending loss. What I see too often is that somebody becomes symptomatic. A child develops a behavior problem. Families set up such rules to protect one another, but ultimately they're doing themselves a disservice. After the fact they come to me with regrets: "There were things I wanted to say. things I wanted to do." Or, "I wanted to respect my mother's need not to talk? so none of us talked about it."
PT: How do you help them speak?
FW: I urge a conjoint life review, where family members sit down together towards the time of death, review their life, and hear each other's perspectives. It's a wonderful time for things like, "Well I never knew you felt that way," or "Is that why you got angry?" or "I didn't understand." It's a chance to go back over old business. I like to track the family development, have the parents in to talk about the courtship, the birth of the children, the different transitions in the family, its high points, and the painful moments. Too often, after death, individuals are struggling in their heads with, "I wish I had asked him this," or "I never knew my mother, I only knew her as a parent to me," or "We had a terrible fight and didn't speak for years and then my sister died and there was never a chance to make up."
When there hasn't been a reconciliation, a person tends to carry the loss with him and often has conversations in the head--"I wish I had said"--that keep him caught in the past, unable to move on.
PT: Loss is a process. What are the kinds of challenges,that occur in this process and what are the tasks that need to be done? What things can families do that are helpful?
FW: The first is acknowledgement of the reality that loss is impending or has occurred. It isn't just that daddy went away and we don't know when he's coming back, but that daddy died.
PT: Perhaps we should go back a step, if the loss is impending. How does one say to a father, "Daddy, you're dying"?
FW: That's the problem--we don't do it. We have social expectations that inhibit us from saying the "D" word, and we keep thinking, "I shouldn't say 'are you dying' or 'you may die soon.'" Perhaps it's partly the fear that if I say it out loud he may think I want it to happen, or if I say it out loud maybe it'll happen sooner. It's kind of a superstitious belief.
Tags:
1990s,
60s,
aids crisis,
business loss,
chicago center,
coming to grips,
cutting edge research,
death,
dying process,
economic climate,
economic uncertainty,
family,
family health,
genogram,
hara,
largest population,
loss,
marano,
multinational corporations,
population group,
trauma,
University of Chicago
