To ask is to believe that somewhere there is an answer. ~~ Jonathan H. Sacks, PhD
Fear of dying is an existential experience for everyone. It is a common denominator in the human condition. All of us experience it from time to time. It is further provoked by the dying and loss of the loved one. Watching the dying person raises this fear to a recognizable level. What will I do without my loved one? How will I survive? Am I strong enough to make the change and remain sane? Will I die, too? The fear can take at least several forms: fear of actual physical death, and fear of annihilation of the self (“going crazy”). 1 Just as anger can be frightening, fear can turn into anger and rage. The fear must be managed so that it does not spiral completely out of control – something it threatens to do. Defenses against fear may take many shapes. Among the easiest and most primitive defenses is plain denial: “It won’t happen to me.” 2 As every thinking person knows, internal dialogs – conversations with oneself – are not always rational. “Don’t believe everything you think” is a psychological imperative. That is necessary but far from effortless.
A physician, an anesthesiologist, provides a bold and anguished description of fear. He documented his own feelings when his wife developed breast cancer. His words are poignant, keenly distressed. It is raw fear, the instant wish to deny/repress, the what-if’s, sense of helplessness, questions of self-preservation.
“I opened up the radiology images on the computer, and then I saw it. My wife had breast cancer. At that moment, my world crumbled. I felt trapped. I wanted to run out of the operating room and scream…I wanted it to be a dream, a bad dream. But it wasn’t…I wanted to do something, anything to make things better. But despite my eight years of medical training, and three years of experience in private practice, I could not actively heal my wife. And I felt helpless…I never acknowledged to myself how scared I really was…I repressed all my fears. What might happen if the cancer came back [after successful surgery]? What if it metastasized? How would I raise our girls alone?
I started having trouble sleeping, and I noticed many new physical symptoms – muscle fatigue and weakness, numbness and tingling in my fingers and arms, and palpitations… I became convinced that I had either multiple sclerosis or ALS…
[He eventually found relief by talking about these fears and anxiety in highly focused discussions.] I learned to recognize the symptoms of anxiety, and by simply recognizing its existence, the anxiety no longer controlled me and my [physiological] symptoms subsided.” 3
Talk, introspection, and insight. Those were the healing powers for the caregiver.
This doctor-caregiver’s report is a good reminder of the mind-body connection. Anger is not the only emotion capable of producing alarming physiological symptoms when allowed out of control. Fear can do that, too.
From ancient times to the present day, much has been written about defense mechanisms against fear of dying and death. The writings amount to lessons in self-preservation. Each has his own nuanced ideas and insights. Fear strips away the bearer’s sense of worth and dignity and reduces him to feelings of inferiority, helplessness, and worthlessness. Everyone must find a way to survive in good health. Perhaps he follows the suggestions of others, or he creates his own path, or both. Once again, there is no recipe, no how-to formula, no one-size-fits-all.
The fearful caregiver craves a return to stability, to emotional balance. A new level of equilibrium is sought: adjustment or adaptation. The word “acceptance” could be added here. However, there is no such thing as “acceptance” of death. So don’t worry if you can’t get there from here. The word was poorly chosen. An adjustment may be made to account for death. We may adapt to the concept of a finite lifetime. We may resign ourselves to our fate as humans. However, we do not “accept” the idea of our own death or the death of our loved ones. The idea of acceptance is based on denial. It implies perfect control over, and suppression of, the self-preservation instinct. We have no such perfect control. We do not “accept” death. We do not receive it willingly, favorably, or with approval. Acceptance is then ultimately incapable of relieving death fears. 4
Something emotionally adaptive and stabilizing is gradually achieved. It is a situation in which things once again happen as the caregiver thinks they should, and there are no harmful changes. With effort, it becomes a new reality. That takes time and patience and hard work, grief work. It takes sympathetic support from others, a harmony of feelings, as well as inward focus on calming the anguish and uproar. Of course it can be done. Fear of dying does not go away. It does come back, but under far better control. We do not need to be perfect to be good. Appreciation of life is decidedly heightened by the experience. That is the reward. The controlled comeback is a distinct demonstration of the strength of the bereaved caregiver, his resilience and his ability to grow. Strength and growth.
- One respected professor thinks of it – and teaches it – this way: “A distinction is made between fear of the process of dying, and fear of death itself and what may come when one is dead.”
Shelly Kagan, PhD, Open Yale Courses, Phil 176, Lecture 22: “Fear of Death”: Yale University, 2013. — http://oyc.yale.edu/philosophy/phil-176/lecture-22
However, the fear of death of the self is omitted from this suggested framework. The death of the self is a vital concept in any discussion of death fears.
- “Repression” may be a more appropriate term than “denial.” For a complete, formal definition and explanation of these complicated mechanisms of defense, see:
Anna Freud, The Ego and the Mechanisms of Defense, New York: International Universities Press, Inc., 1946, pp. 45-57.
- Scott Finkelstein, MD, “Being a caregiver has made me a better doctor,” blog: KevinMD.com, 17 May, 2013.
- For notable further discussion, see: Bruno Bettelheim, PhD, Surviving and Other Essays, New York: Alfred A. Knopf, 1979, pp. 5-6.
Dr. Bettelheim was a child psychologist, Holocaust survivor, genocide scholar, and psychoanalyst.
Image credit: www.thescrambler.com — Dale Chihuly’s glass ceiling
Tags: #fear #eol #hpm #GriefWork #resilience #growth
Rea Ginsberg is a retired director of social work services, hospice coordinator, and adjunct professor of clinical social work. She can be reached on LinkedIn and on Twitter @rginsberg2.
Becoming what might have been
Solitude is fine but you need someone to tell that solitude is fine.
~~ Jean-Louis Guez de Balzac, Dissertations (1665)
An ancestral insight: We Need Others
Childhood bereavement changes the course of the future. All bereavement transforms the survivor’s future. Parent-loss in childhood is especially powerful because of the child’s immature, undeveloped psychological defenses and his status of enormous dependence.1
Customarily, parents make a fundamental promise to their children, to take care of those children throughout their period of need for parental care. This promise sounds like “forever” to the child. He firmly assumes its truth. It is comforting and reliable. The parents are seen as infinitely trustworthy. Most children find it impossible to picture a world in which such a parent no longer exists.
When the promise proves false and the parent dies, the child suffers more than one loss:
1. The promise of “forever” feels like a lie, a betrayal;
2. The parent disappears permanently and the child feels abandoned;
3. The child may also feel outraged that the lost parent would commit the crime of abandonment;
4. The child often engages in active search behavior, believing consciously or unconsciously that death is a reversible condition and that the beloved dead parent is retrievable;
5. When search fails to reunite, some feelings of helplessness and hopelessness are inevitable;
6. The grief of the remaining parent may make him unavailable to support the child for critically important periods of time;
7. The remaining parent may not be able to grieve adequately or empathize with the child’s feelings of loss, leaving the child to feel a partial loss of this parent as well;
8. The remaining parent may hold unrealistically high expectations for the younger child’s understanding of death, leaving the child with feelings of heightened confusion, humiliation, and outright anger;
9. The child may fear that this parent will also die;
10. The child may lose self-esteem, believing himself guilty for the death of the deceased parent;
11. The child may become fearful of his own supposed omnipotence; that is, he fearfully presumes the death is caused by a flash of his angry wish for it;
12. The child may worry that he himself will also die soon and for uncontrollable and incomprehensible reasons;
13. The child may wish to die in hopes of reunion with the lost parent in the world of the dead;2
14. He may regress, behave in more infantile ways, and become fearful of being alone; the child’s age matters, here and elsewhere;
15. Many children temporarily lose their physical health because of (a) high-stress factors such as sudden and unwelcome alterations in customary routines, change of caregiver(s), sleeplessness, and disrupted eating patterns/appetite loss; (b) generalized anxiety caused by separation from the deceased parent;
16. Additionally, take into consideration the rudimentary defense system of the child, his immature personality; defenses are mental processes which attempt to exclude unwelcome information.
It is like the perfect storm to produce ambivalence, anger, self-reproach, and fear, tinged with suspicion, lack of trust, and a cynical worldview. Heredity proposes; development disposes.3 Some researchers would suggest that these combined factors approach the level of toxic stress on the child’s developing brain.4
The nature of bereavement is composed of intricately interconnected interwoven parts. It is complex. Many common characteristics certainly are shared by those who grieve. Yet, different people may respond to loss in widely varied ways, depending on the specific circumstances and personality of each.
In some grieving children, the undeveloped Self soon becomes enveloped in skepticism of others’ motives. The child questions if others will also lie and die or otherwise disappear. Trust is difficult to reestablish and achieve. This wary view of others tends to widen, to expand, to eventually include the whole human world. It may affect every corner of the child’s life. It can easily last a lifetime if not confronted and treated.5
Suspicion is defensive. It becomes a magic trick for the child. It is his effort to protect himself from the grief of even more losses. It works for him, but it arrests significant aspects of his further psychosocial development. It places a purposeful but ultimately unhealthy – if not useless – barrier between himself and all others. In this way, it inadvertently heightens his grief and isolation.
In short, suspicion is a problem-solving effort. The problem is pain from grief. The solution is avoidance of more grief pain. Suspicion becomes the route to avoidance. This suspicion is harmful.
Potential goes unfulfilled. What might have been self-actualization is forestalled. The child’s true and highest potential for healthy psychosocial growth is restrained by mistrust. It is submerged, hidden in a morass of suspicion. As he moves into adulthood, mistrust remains a prominent factor in his relationships with others.
He inspects others’ reliability intently for “proof” that his mistrust has merit. He convinces himself that his often-mistaken perception is accurate and that mistrust was warranted. Suspicion is frequently confirmed, according to his judgment. Virtually no one escapes his flawed scrutiny. The closer the relationship, the more the mistrust comes to the fore. For him, intense closeness equals the excruciating pain of loss; therefore, early and extreme investigation of others is required. Even the grieving child himself does not recognize his positive growth potential. He is too busy wielding the long sword of his self-protective mistrust. Also, this mindset often affects intellectual development adversely. The adult stays stuck in his past, in his grief-laden childhood. The past is certain prologue.6
This is the disappearing Self that grief can produce. It is tragic and lonely. It is tragic because true and deep closeness to other people cannot usually occur. Then, the consequential accompanying growth and sense of safety are largely blocked. Grief imprisons the mind. It is lonely because parent-loss feels lonely beyond comprehension, and the healing work of grief has not been accomplished. The experience of “feeling good” again is missing.7
Healthy, wholesome growth is not lost, however. It is only hidden. Grief can be treated by people who care, people who are not necessarily/only licensed professional counselors and therapists. Once upon a time, friends and other important acquaintances (e.g., teachers and spiritual leaders) did this for one another. Psychotherapy was later called “the purchase of friendship.” Of course, sensitive family members also helped each other.
Even the most grieved and untrusting of people can reemerge from their disappeared state of mind. People are resilient; foster it, promote it, nurture it. Give sorrow words. Talking helps coping. Tell the truth and answer the questions. “Some research suggests that people recover from traumas faster simply if they can talk about them.”8 Make promises and then keep them; it builds confidence and trust. Support groups may also assist. Grief work matters.
.”…he who remains passive when overwhelmed with grief loses his best chance of recovering elasticity of mind.”9
Healing work takes some encouragement and gentle support from others who know how to listen and when to respect silence. It takes showing up, being there, being available and reliable and stable. It takes patience and lots of repetition. Progress does not travel in a straight line. It takes compassion, if not empathy as well. H. D. Thoreau wrote, “Could a greater miracle take place than for us to look through each other’s eyes for an instant?”
The warmth of thoughtful kindness and honest reassurance go a long way in combating suspicion. The qualities of sincerity and freedom from deceit have remedial power. Self-respect and inherent dignity are enhanced in the presence of others who care; human relationships are central to strength and growth. And it may take a village, a community of support, to help in healing the wounds of childhood. A strong support system eases the pain and provides relief. All of this can transform lives. It gives Hope.
It is worth the effort, the energy and determination. It is also the healer’s finest legacy, the mark he leaves on others’ lives.10 That is incentive enough for him to proceed. What counts is the courage to continue.
Potential unbound from bonds of mistrust and unprocessed grief is possibility finally on the way to realization.
It is never too late to be what you might have been.
~~ George Eliot
————- ————- ———— ————- ————-
End Notes, in other words:
1. “When his parent dies, a child finds himself in a unique situation because of the special nature of his ties to the deceased. An adult distributes his love among several meaningful relationships – his spouse, parents, children, friends, colleagues – as well as in his work and hobbies. The child, by contrast, invests almost all his feelings in his parents. Except in very unusual circumstances, this single relationship is therefore incomparably rich and intense, unlike any close adult relationship. Only in childhood can death deprive an individual of so much opportunity to love and be loved and face him with so difficult a task of adaptation….The death of a parent engenders a longing of incomparable amount, intensity, and longevity.”
Erna Furman, A Child’s Parent Dies: Studies in Childhood Bereavement, New Haven and London: Yale University Press, 1974, p. 9.
In this context – that of a child losing his parent – it is also interesting to note that the words “bereave” and “rob” stem from the same root. The child is bereaved, deprived, robbed of his parent.
2. “Since children have greater difficulty even than adults in believing that death is irreversible, hopes of reunion with the dead parent are common. They take one of two forms: either the parent will return home in this world, or else the child wishes to die in order to join the dead parent in the next.”
John Bowlby, Attachment and Loss: Volume III: Loss: Sadness and Depression, New York: Basic Books, Inc., 1980, p. 354.
3. Sir Peter B. Medawar (1915 – 1987; winner of the Nobel Prize in Physiology or Medicine, 1960)http://www.nobelprize.org/nobel_prizes/medicine/laureates/1960/medawar-bio.html .
4. Center on the Developing Child, Harvard University, 2016: “Early experiences affect the development of brain architecture, which provides the foundation for all future learning, behavior, and health….Adverse experiences early in life can impair brain architecture, with negative effects lasting into adulthood….The interactions of genes and experience shape the developing brain…Ultimately, genes and experiences work together to construct brain architecture.”
Center on the Developing Child, ibid: “The future of any society depends on its ability to foster the healthy development of the next generation. Extensive research on the biology of stress now shows that healthy development can be derailed by excessive or prolonged activation of stress response systems in the body and brain. Such toxic stress can have damaging effects on learning, behavior, and health across the lifespan.”
5. “Whether an author is discussing the effects of loss on an adult or a child, there is a tendency to underestimate how intensely distressing and disabling loss usually is and for how long the distress, and often the disablement, commonly lasts. Conversely, there is a tendency to suppose that a normal healthy person can and should get over a bereavement not only fairly rapidly but also completely….I shall be countering those biases. Again and again emphasis will be laid on the duration of the grief, on the difficulties of recovering from its effects, and on the adverse consequences for personality functioning that loss so often brings. Only by taking serious account of the facts as they seem actually to be is it likely that we shall be able to mitigate the pain and disability and reduce the casualty rate.”
John Bowlby, Loss: Sadness and Depression, op. cit., p.8.
6. This mistrust and suspicion is not paranoia, nor is it paranoid personality disorder. It is strong fear caused by the unresolved grief from childhood. It might be called “pseudo-paranoia” because of the suspiciousness involved. In its strictest psychodynamic sense, paranoia is different. It is a psychotic (severe; schizophrenic) mental disorder characterized by the slow deterioration of personality and involving delusions of persecution (“someone is plotting against me”) and grandeur. Auditory hallucinations may also be present.
7. How long does it take to recover from grief? Maybe two weeks. So say the American pundits. Maybe a lifetime. So say the bereaved, those who have loved and lost. They know better. They know best. They are the folks “on the ground,” the real people in actual distress.
Does the mourner “recover” or does he heal into growth and greater strength? Who cares to look inward for insightful answers? Self-examination is a bold, brave act. Not everyone has that daring. The resulting Self-awareness hurts a lot sometimes, for the sake of increased peace and joy in living and loving – feeling good in a whole new way, because death changes the minds of those who live on.
“Feeling good is hard to describe and define, but is readily recognized. It is characterized by pleasure in living, is often accompanied by a heightened sense of bodily and mental well-being, by an ability to extend oneself to others and to initiate and enjoy harmonious interactions with them, by an ease and comfort in giving to and taking from life what it has to offer, and by being creative in thought, word, or deed, however humble a form it may take. Feeling good is usually experienced in more simple or complex ways at all levels of development…It is a treasured feeling, sorely missed when absent.”
Erna Furman, “On Fusion, Integration, and Feeling Good,” The Psychoanalytic Study of the Child, New Haven: Yale University Press, 1985, Volume 40, pp. 81-82.
8. News Release, Stanford University News Service, 8/29/1994,
http://news.stanford.edu/pr/94/940829Arc4145.html (We have known this literally for many centuries. Modern research confirms ancient wisdom, now with interesting scientific explanations.)
9. Charles Darwin, The Expression of the Emotions in Man and Animals, quoted in John Bowlby, Loss: Sadness and Depression, op. cit., p. 345.
10. “We never know the good we do, still less the chain of consequences to which it gives rise. But this is the only legacy worth leaving: the trace we leave on other lives, and they on others in turn. Sometimes a single act…can reverberate in incalculable ways.”
Rabbi Lord Jonathan H. Sacks, To Heal a Fractured World: The Ethics of Responsibility, New York: Schocken Books, 2005, p. 236.
Sacks’ website: http://www.rabbisacks.org
Frequently, this is also the start of a virtuous circle of caring.
* * * *
We Need Others.
The act of listening can transform a life.
* * * *
Image credit, top: “Figures and dog in front of the sun,” 1949; Joan Miro, Spanish painter/sculptor, 1893 – 1983; www.brisasptso.org
Image credit, below: www.humblepiety.blogspot.com
Tags: #eol #hpm #children #toxicstress #mistrust #feelinggood #growth #friendsandfamily #supportsystem #compassion #griefwork
Becoming –The birth of the Self
Rea Ginsberg is a retired director of social work services, hospice coordinator, and adjunct professor of clinical social work. She can be reached on LinkedIn and on Twitter @rginsberg2.