To say to someone, "You're dying aren't you?" or "Are you dying?" or "Do you think you're dying?" may help that person feel more comfortable. Often there's tremendous relief when the person who's dying can now say it out loud. What he may say is, "Yes, but I didn't know if you realized it," or "I didn't want you to feel worse by talking about it." Everybody avoids talking about it because they're afraid they're all going to break down in tremendous grief or it will be too painful for others. If there were a single message, it's for people to take that risk to talk about the unspeakable together.
PT: You're saying it's not bottomless.
FW: That's right. It's the fear that there's no bottom to it. Taking the risk to talk more directly should begin with the hypothetical: "Have you ever thought about What if?" It's also important to get clear medical information. Is the patient dying or could he live for years? Is it a one in a hundred chance the patient is dying; is it three months or three years? Doctors are often unclear in their diagnosis, but there are probabilities and it's important to know them .
Families have a lot of trouble with ambiguity. Where there is a lot of ambiguity around loss, there's more depression and inability for the family members to master the situation. PT: What must families communicate in loss situations?
FW: There has to be permission to tolerate different expressions of grief. One person may yell and scream, another may cry for weeks and weeks. Another may walk around numb and the grief surface three months later.
A father may be angry at his son for using drugs and overdosing; that anger is part of his grief. Or, even though her parent didn't choose to leave, a daughter's experience is one of abandonment. It's important to check with one another. Everyone's got feelings of regret, and it's helpful to hear, "Oh I didn't know you have regrets too." Often I'll track families through the last week or last day together. I'll ask, "Is there anything you wish you had done differently," to help them come to terms with the fact that you can't do everything perfectly.
In the case of a shameful death like a suicide, there's a tendency to distort what happened. The more distortion there is--covering it up, pretending it was an accident, distorting the facts--the more over time the cover up and the secrecy set up walls that keep people from being able to really be close again. often they can't reconnect until they're able to let down the' barriers and say, "Here's the truth," "What really happened," or "Let's talk about how we really feel about this." It's important to know what happened and how it happened, as well as the meaning given those events. The more we understand what happened, the more we can make sense of the loss.
PT: Is there always the need to make sense out of the loss?
FW: There's a human need. Some people make sense out of it through their religious affiliation: it may be God's will, or that God understands even though we can't. One family that experienced the death of a child shared the belief that the child was so special God wanted him.
It is necessary to explain death to children, to help them understand very simply from early on. Kids are highly sensitive to the intensity of feelings in the family and they try to construct meaning out of what's going on. They'll either construct their own fantasies or come out of the experience with a belief that death is so horrible it can't be spoken about. That will create a catastrophic fear of loss.
PT: So it actually magnifies their fear, perhaps a generation later.
FW: Yes, and the same is true of divorce or abandonment, which are also forms of loss. One of my clients was a woman whose child was stealing money from her. When I asked about her family, she said, "Well my father just left one day when I was about four, and so I grew up with my mother. It was never talked about. My father came to my graduation because somebody else was graduating; he didn't even recognize me." Tears came to her eyes, and I asked, "What was the legacy of that for you now?" She said, "I've lived with a constant fear that our family will fall apart and my husband will just leave me and I won't understand why." She carries a legacy in part because her father left but in part because no one helped her to understand the circumstances of his leaving. The legacy is a global apprehension that at any time a husband may leave. Just in case, she squirrels away money.
PT: How did you get interested in loss?
FW: In my family of origin my mother had traumatic loss experiences that she kept to herself over the years. She had lost her father as a teenager just after she left home and never had a chance to say goodbye to him. Many years later her mother died and once again she wasn't told until after the funeral. I realized that she carried around with her this unfinished business. I was aware from early on what can happen if your relationships with family members end without you having a sense of resolution. PT: What did she carry around with her? How did you observe it?
FW: There was a quiet sadness. Then, when my mother died, I was in my 20s and in social-work school. Though I had read the developmental theory of Erik Erikson and others about the tasks of young adulthood and later life, it was clear to me that they didn't fit together.
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