I was on the brink of marriage, and as happens in our culture I was praised for not missing a beat. I was in a very heavy internship at Yale. I took off a few days for the funeral, then went right back. Everybody said, "You're terrific, so resilient." our society likes winners; there's no legitimization of a time to mourn or grieve, or a time out from moving forward.
PT: We don't have an attitude that permits us to deal with loss in a way that is going to help us move forward?
FW: The myth is that once you grow up and leave home, you're not very deeply connected to your parents, and you're not supposed to be. Then people are often surprised at how strong their emotions are about the connections with their aging parents. If you're an adult and a parent dies, people just expect you to go on with your life; it's not a big deal. In fact it is a very big deal. Launching is our landmark of reaching adulthood. You're supposed to leave home, be emotionally independent. If a parent is terminally ill at that time, it's much harder to come together.
Also, in general our culture has always discouraged the showing of grief publicly. We think back to the funeral of J. F. Kennedy, and Jacqueline Kennedy being praised for being so stoic. The model of the ideal mourner is one who doesn't show grief, keeps a stiff upper lip. We tend to not legitimize the need to be sad.
PT: Is there growing recognition that we have to give loss its due?
FW: Some things, particularly the AIDS crisis, have forced us to do so. Whole communities are dying; particularly in gay communities, people are dealing not with one loss but with many losses. Also, the baby-boom generation is reaching midlife, with aging family members, and dealing with questions of how long do we prolong treatment attempts of terminal illness, when does life end? For the first time, we're coming to terms with our own mortality.
In addition, our ways of dealing with loss have been gendered. Women carry all of the emotions around; real men don't show any emotions, they don't let their guard down. Many men are starting to challenge that, coming into touch with feelings that they've been cut off from, relationships with their fathers. They're recognizing that the stuffing of emotions in life has kept them remote from intimate relationships.
PT: So no matter how much men pursue intimacy, keeping a stiff upper lip about loss is actually going to keep them from achieving intimacy in relationships.
FW: A good example is a couple that came to our outpatient clinic a few years ago. A working-class couple had lost their only child, a son, at 21 or 22. The husband brought the wife in for help with her depression; he would sit out in the car and wait. The therapist suggested that perhaps he could benefit from treatment as well, to which he replied, "I'm functioning fine, I go to work every day, she's the one, please help her." And in fact, it is usually the women who seek treatment for depression or other complications of loss.
But the danger is that if women get the treatment, men are then left without any chance to let down their guard and begin to experience their own loss. After all, it was his only child and his only son, too. If we had just agreed to individual therapy for her, the couple's relationship would have grown increasingly distant.
PT: Why?
FW: When they first came in he was avoiding her; he was avoiding her pain in order to protect himself. I felt it was very important for him to be in the room even adjunctively, without defining him as a patient, so that he could share in the grief process, even though it was directed more at her. And in that process they could begin to comfort each other.
Some studies show a high rate of divorce following the death of a child. Couples are at risk when they wall off from one another because they can't tolerate the pain of the shared grief. They feel it will overwhelm them. If a couple can come together in their grief and comfort and support each other, and if the one who's uncomfortable with the grief can let down and begin to be in touch with that, not only will each individual benefit but the relationship will be strengthened.
PT: But it's usually the man who can't be emotional because of the cultural rules.
FW: In the case of a child brought in with garden-variety behavior problems, we took a recent history of the family and found that the father had been diagnosed with a brain tumor about seven months ago. He had surgery, was told it was malignant, is on chemotherapy, and went back to work the next week. The family is living with a life-threatening situation that carries a very poor prognosis, and all communication in the family is blocked because the father wants to tough it out: "I had my surgery. I don't want to talk about it. I'm just going on with my life." In deference to the father, the mother keeps a veil of silence. But every night the son secretly prays for his father. He has no way to express his feelings with the family.
PT: Let's look at losses other than death. Right now, people in America are feeling a lot of anger over the loss of the American Dream. We're not only in a recession, people are realizing it's not going to be better tomorrow. They've lost hope. To what extent is the prudent reaction to reality a loss of hope?
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