She kissed him goodbye at the front door that morning, handed him his lunch sack, and watched him drive away, not knowing that three hours later his company service truck would be t-boned by a drunk driver, killing him instantly. More than a year later, sitting in my office, determined not to break down, swatting away the few tears that squeak out without her consent, she is unwilling to take a tissue until I invite her to do so. “The tissues are included,” I casually joke. They always smile when I say that, and then they take a couple of tissues, which they promise themselves they won’t use. “I hate crying,” they usually say. Or, “I’ve cried so much, I can’t believe that I have any more tears left.” The pool of tears is bottomless, until the day when there are no more tears. And, then, they usually say, “I can’t cry anymore. At first I couldn’t stop, now I can’t cry.” “You’ll cry, again. Trust me. There’s more where those came from,” is my usual response. Why will there be more tears? Because there is no such thing as new grief. Grief is like Velcro: each old loss simply attaches itself to the next loss, until, like a daisy-chain, there is a trail of losses, culminating in the newest loss. Unresolved losses accumulate, they do not disappear.
“How much better would it have been if she had entered therapy a year earlier, before the statute ran out, before she accepted their settlement, and before I could help her find the strength to fight?”
I’ve been in the field of psychology for 35+ years and in the field of grief and loss for 15+ years, however, I didn’t start my career in grief and loss issues. I began as the co-founder, and executive director, of a rape crisis center. At the time, I did not recognize the loss issues that I was witnessing in the victims’ lives. Rape was a violent, psychically devastating, life-altering event in the woman’s life (and occasionally in a man’s life), and in time that made me a de facto traumatologist, though no one referred to themselves that way in the mid-70’s. It didn’t take long to notice that rape victims had very often been childhood incest victims. And it didn’t take much longer before the question, “Were you incested or sexually abused as a child?” found its way onto the patient intake form. In time, it became a psychological given, if we define a given as something that we expect and are surprised by its absence, rather than by its presence. In short, there is a pre-conditioning, a pre-disposition, to rape that is put into motion by the presence of incest or childhood sexual abuse. The teenage or adult woman frequently makes less than self-affirming choices in her decision as to who to allow physically near to her and under what circumstances. To be more specific, “cultivated” to live without boundaries or a clear sense of self, she allows strangers too close; “cultivated” to be accommodating and helpful, she responds to rapists’ appeals for help (aka “the Good Samaritan ploy”); and “cultivated” to keep quiet and keep secrets, she finds she has no voice when she most needs one.
Early therapy results helps build strong coping mechanisms to deal with the stress of a lawsuit
So, what does this have to do with grief or loss issues?
In a nutshell, any trauma costs a person dearly. The price is paid over and over, again, by the person trying to live under the weight of their experience. And what is the price? Loss. What does the incest victim lose? They lose the opportunity to grow up in a family where they are loved and cherished, or at a minimum, to feel safe and taken care of. Their world view is transformed from “it’s a pretty decent place,” to “the world cannot be trusted, and neither can people.” How does that play out in their adult life? The attachment issues find their way into adult romantic relationships, and for that matter, into friendships. “If I can’t trust my incesting father (or grandfather, uncle, brother) not to hurt me, how can I trust you?” Or, conversely, growing up without love and a full-enough sense of self, she needs to be loved and will settle for any man who will love her, regardless of how bad he may be for her. Stuck in a bad marriage or a relationship in which she feels insecure, she does not heal from the past, but, instead, carries the woundedness with her one day at a time, from one relationship to another. Lacking self-esteem, she is afraid to pursue her dreams, if she has any. Or, over-achieving to feel better about herself, she sacrifices parts of herself to accomplish the title on the door, the pieces of paper on her office walls, and has sparingly few photographs to scatter around the room. Some come out of their childhoods as fighters: no one will ever use them ever again. Others come out avoidant of all confrontation, fearful of the consequences of standing up for themselves, and unwilling to upset the apple cart. Peace at any cost, avoiding chaos at all costs, ends up costing dearly. And, what of drugs and alcohol? Does she succumb to the numbing powers of drugs, or does she mask her pain with alcohol? Or food? Does she try endlessly to fill a hole deep inside of her that cannot be filled with food? Probably, probably, and probably, though not definitely.
[MEDICATION ERRORS: DO NO HARM]
Are there no healthy survivors of childhood abuse, or adult rape?
That depends on how we define healthy. If we mean that the person’s life is working well-enough for them, that they feel some sense of accomplishment in their work or career, feel some sense of love for and from others, have a few supportive friends, and have chosen a partner who is nice-enough and loving, then, yes, there are healthy survivors. However, that does not mean that they do not experience the longterm effects of loss: that haunting feeling that something is missing; the core of loneliness that cannot be completely filled; the college they did not attend because it was too far away, or too big, or too demanding….and they were afraid or didn’t have the self-esteem to believe that they could hold their own academically. Perhaps they settled for being a Certified Nursing Assistant, instead of becoming the nurse or midwife they had aspired to become. Perhaps they married for a sense of safety, and volunteer as a teacher’s aide, instead of becoming the teacher they had once aspired to become. Under-employed, under-paid, and under-potentiated, she convinces herself that life is working for her. In her quiet moments, which are few and far apart, she thinks, maybe, just maybe, she might go back to school after the kids grow up and she’ll earn that nursing degree, or that teaching certificate, or start her own clothing store, or, or, or….
[GRANDMA FELL & BROKE HER HIP: IS IT TRAUMA, FRAGILITY OR NEGLIGENCE?]
Sudden death, and traumatic death, are the most difficult kinds of death with which to cope.
Maybe, like the previous patient mentioned at the beginning of this article, she kissed him goodbye at the front door that morning and identified his mangled body three hours later. With no time to adjust, the unexpectedness, the suddenness of it, confirms her view of the world as being an unsafe place. Now, alone in the world, a single parent, under-employed, under-paid, and under-utilized, she is financially and emotionally under-prepared to live life without him. He was her safety net; and no matter how many holes there were in the netting, he was, at least, someone who cared. Not only does she have to figure out how to live her life without him, and how to do the jobs that he did (e.g., pay the bills), she has to figure out how to fill the roles he filled in her life (e.g., rescuing hero). Most likely suffering from anxiety, maybe even panic attacks, and grappling with her own mortality issues, she is certain that she is having heart attacks; and the sleepless nights don’t help. And, she must do all this while fighting a lawsuit for wrongful death, assuming that she is comfortable with confrontation, and has the strength and ability to fight.
“He was only 55 and his life was only worth $100,000.”
The average person has a tendency to minimize the impact of the loss, typically saying something as insensitive as, “Well, the money will go a long way toward helping her to overcome her grief.” No, it won’t. It will help her to live a decent life, assuming that unlike my patient, the company carried sufficient insurance on its employees, the employee opted for life insurance as one of their benefits, and that she did not trust the company to take care of her. After all, hadn’t her husband worked there for 35 years? Weren’t they family? By the time she was sitting on my office sofa and I asked if she had a good attorney, it was too late. She received a little bit of money: he was 55+, his life expectancy wasn’t extraordinary, and the drunk driver had no insurance to speak of. She received something in the ballpark of $100,000. It was enough to keep the house for a year, to pay monthly bills, to pay off the credit card that she used to bury him, and to pay for some therapy. It was not enough to return to college and earn a degree that would help her to rebuild her life and fund her retirement. Now, under-employed, under-paid, under-potentiated, and grief-stricken, she slogs through every day, wondering why Life is so cruel, God is so absent, and she is so empty.
She attended a free grief group, but that didn’t help. She saw an inexperienced therapist at a community-counseling center, who clearly did not have any training in grief, and that didn’t help. The truth of the matter is that she can’t afford the kind of therapy that she needs: long-term, committed to working through the previous losses so that we can clean up the most recent loss, all while trying to help her figure out how to get through every day. She needs a very experienced therapist, who specializes in grief. Why? Because she has specialized needs: sudden grief, unresolved prior deaths (aka compounded unresolved grief), childhood incest, and teenage rape. I reduce my fee and she gets the therapy that she needs.
Eighteen months later she is grateful: her life is her own for the first time, she understands why she made the life-altering choices that she made, she is looking forward to her future with optimism, and she is taking a couple of classes to upgrade her skills. And, she is angry that she wasn’t more of a fighter: she now realizes that she walked away from confrontation, that she has lived her entire life avoiding confrontation, that she allowed the company to take advantage of her, and she sees clearly how her childhood pre-disposed her to be complicit in her own victimization. Resolved to be no one’s victim, ever again, she leaves my office stronger than when she walked in. How much better would it have been if she had entered therapy a year earlier, before the statute ran out, before she accepted their settlement, and in time to be encouraged to hire a good attorney?
[THE COST OF LOSS FOR ATTORNEY PUBLICATIONS]
There is no such thing as new grief.
That is, until one gets the help that they need to resolve old traumas and old losses, and have the opportunity to mourn their losses. The widow does not cry just for the loss of her recently deceased husband, she cries for the loss of her childhood, her dreams, her potential, her future self, and the choices that altered her life. She cries for what the marriage woulda, coulda, shoulda been; and she cries for what her life coulda, shoulda been. She cries for her regrets. She cries for her lost husband, her lost marriage, and her lost future with him. Once, again, trauma has changed her life, irrevocably.
At the beginning of therapy, she posits, “He’s dead and money won’t bring him back.” In the middle of therapy, she queries, “Granted, there were no guarantees handed to us upon birth, but, c’mon, was it supposed to be this hard?” By the end of therapy, she wishes, “I’d met you sooner. God knows what my life would be now that you’ve made me strong. NOW I could handle dealing with a lawsuit. Oh, well. Lesson learned.”
Albeit, too late.
Written by: Thanatologist, Grief and Loss Expert Witness No. 3712
About the author:
Expert Witness No. 3712 is a practicing Marriage and Family Therapist in Southern California. Her doctorate is in Pastoral Ministry, with a specialization in interfaith chaplaincy. She holds a masters in Psychology, with an emphasis on Marital and Family Therapy; and a masters in Counseling Psychology, with a specialization in Grief and Loss Issues. She is nationally certified in Thanatology (the study of death, dying, and bereavement). She served for many years as a therapist and an interfaith chaplain in hospice, working with the dying and the bereaved.
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