Working Through
Grief, Loss and Depression with |
| Joan sat in a chair in our office.
She had been crying for about 15 minutes, and her eyes were
swollen and red. Unlike other times, however, she made no effort
to hide her tears or to stop crying. After a time had passed she said,
What is there after the tears? It's funny. When I first came
here, I worried about myself because I never felt anything, never
cried. Now I wonder if I'll ever stop." Joan had been in
therapy for approximately a year and a half. Initially she had
entered therapy because she had read an article Jane had written
on children of alcoholics and had recognized in herself many of
the characteristics, including frequent depressions, difficulty
in intimate relationships, overpowering feelings of guilt and
shame, difficulty expressing feelings, and poor self-esteem. She
was a dance instructor, had a lot of students and yet experienced
feelings of failure in her occupation. She states that she often felt
like an observer in life, numb, not knowing what she felt in many
situations. She was afraid of conflict and spent a good deal of
time pleasing other people, yet not knowing what she believed
about anything. During her first year of therapy, she talked a
lot about what it was like growing up in an alcoholic family. She
often talked about extremely painful situations in her childhood
without connecting to her own emotions. Joan often talked to me
about feeling that there were many different parts of her at war
with each other. She was an extremely creative person, and Jane
asked her to draw herself. She drew three pictures. The first was
of a tiny little girl huddled in the corner, afraid and shaking
with tears in her eyes. The second was a picture of a very angry
girl, furious at the first and trying to hurt her. The third was
a picture of a very calm and beautiful ballerina with very slight
smile. When Jane asked who was the strongest of these three, she
said, "Well, it must be the girl that's
angry at the other one, or the ballerina. It certainly wouldn't
be that terrified child because I have been trying to get rid of
her all of my life."
Joan creatively depicted through her art what many children of alcoholics feel: a part inside that is a child who never went through developmental stages, a child who very early felt fear and sadness in her/his alcoholic home, a child who never cried the tears nor told anyone the fear because of the unspoken loyalty in the family. The angry child represented depression, that punitive part of adult children that feels deeply and profoundly unlovable, the part that will not allow them to experience their own fear, the part that feels extremely guilty and responsible for their parents' problems. They think the alcoholism in the family is their fault. The ballerina represents the fifty-year-old, five-year-old: the survivor, the perfectionist, the constantly hyper vigilant part of the self, the person who remains constantly in control, the compulsive striver, the overachiever, the workaholic, the adaptive part of self that presents to the world a picture of stability, pleasing, and achievement. Like Joan, many adult CoAs are admired, are envied, are successful, and yet, no matter how many rewards or how much applause is given, they never feel a sense of self-worth. Inside they experience emptiness and a powerful self-alienation. Children of alcoholics tend to have great empathy for other people and feel deeply the pain of others, and yet display very little compassion for the child within themselves. It was important in the therapeutic process for Joan to realize that behind the mask of strength was the stronger self, the child of the past. It was important for her to get to know that child, to cry with that child, to attain for herself again a freedom and spontaneity through the process of mourning, and to end what Alice Miller called, the courtship between grandiosity and depression"; to experience, through the mourning process, the deep pain of abandonment that was once felt; and to attain again, rather than emotional constriction, the freedom to experience a full range of emotions. Perfectionism, over achievement, compulsive care-taking and pleasing in the adult child is often a defense against the intense pain of childhood loss. often that loss consists of whole developmental periods-loss of childhood, loss of self. There is a great deal of pain in the realization that an alcoholic family is a battlefield that makes a child 'afraid to walk without stilts" [Miller.] George Vaillant, in his book, The Natural History of Alcoholism, states that often living with alcoholism is second only in stress to being in prisoner camps in World War II [Vaillant]. When an individual lives with an air raid a day, chronic stress becomes normal. In order to protect the ego from the disintegration resulting from that degree of trauma, individuals have to adapt with massive uses of denial and repression. It is difficult for an adult, but if that person is a child living with the constant unpredictability of an alcoholic family, he/she has to put so much energy into just surviving that the developmental process is put on hold. The child survives through the use of denial, hyper vigilance, and psychic numbing. Because so many adult children from alcoholic homes show survival skills and characteristics similar to individuals who have survived the trauma of war, clinicians in the field, such as Timmen Cermak, M.D., see the survival characteristics of adult children as a variant of post-traumatic stress disorder [Cermak]. A clinician in Seattle, Jean Burgan, created a story which helps us understand the necessity for the development of hyper vigilance, denial, and repression in children from alcoholic homes. This is the story of one day in the life of a little girl from an alcoholic home. The little girl gets up in the morning at a normal time. For most five-year-old children, that is about seven or eight o'clock. Her mother had been up drinking late the night before and is still in bed when the child wakes up. The little girl waits patiently downstairs. Her mother wakes up at around eleven o'clock and comes into the kitchen. Because she drank heavily the night before, the little girl's mother has a hangover. She is feeling sick and irritable. The last thing in the world she wants to contend with upon arising are the needs of a little girl. The little girl walks into the kitchen and says, Good morning, mommy, I've been waiting for you to get up. I'm hungry, can I have some lunch?" The mother pushes her away and tells her that she does not want to be bothered. The little girl walks away feeling that she has done something wrong. Five-year-olds do not understand hangovers. They believe they are magicians and responsible for what goes on around them. The child feels that she has done something wrong. Mother reaches for the vodka bottle, then the tomato juice and makes herself a Bloody Mary. She drinks it and makes another. A little while later, the little girl returns to the kitchen and tries again. "Good morning mother. You look beautiful this morning. I don't want to bother you, but I'm really hungry, I’d like some lunch." Because mother has had a couple of drinks, she now reaches a stable blood alcohol level. She is no longer irritable. She no longer has a headache, and she is feeling normal. She turns to her daughter and says, Good morning honey. Certainly you may have a sandwich. What would you like? Bologna and cheese, peanut butter and jelly, liverwurst?" It does not occur to the little girl that mother's new behavior is because she has had something to drink. Instead she feels that she must have done it right this time. She leaves the kitchen knowing that her sandwich will be made and feels happy. Mother continues to drink. When she returns to the kitchen a little while later, her sandwich has been made and is on the table. Her mother has now had enough to drink to be on the rising side of a blood alcohol level. She is at what is called star time": she is feeling high and on top of the world. The little girl goes to sit down at the table and the mother runs and picks her up and covers her with wet, slobbery kisses. She says to her daughter, You're the best little girl in the world. This afternoon, I'm going to take you downtown and buy you a 10-speed bike." The little girl doesn't understand that her mother's new behavior is because of further drinking. She feels a vague discomfort because of the wet, slobbery kisses. She doesn't understand why. What she thinks is that she has done something right. She has pleased her mother, and she is going to be rewarded with a brand new bike. After she has eaten her lunch, she goes out to play while her mother continues drinking in the kitchen. When she goes back into the kitchen later in the afternoon, mother has had enough alcohol to be on the falling side of an alcohol curve. She is at this point, snarly, angry, drunk. The little girl runs up to kiss her mother and says, mommy, are you ready to go and get the bike?" Her mother pushes her away saying, What are you talking about, you little brat. You're always asking me for things, Get out of my sight." The little girl still does not understand that her mother's change in behavior is because of alcohol. She feels that she had done something terribly wrong to disappoint her mother. She feels sad and leaves the kitchen, crying. The little girl sits on the porch, trying to understand what it is she has done wrong, trying to figure out what she is going to say, trying to figure out how to make her mommy happy. Mother continues to drink, and when the little girl comes back into the house an hour later, she finds her mother passed-out on the kitchen floor. Most adult children of alcoholics that we have treated, remember the first time they found their parent passed-out. They report the terror of that first occasion, because they thought they had found their parent dead. This little girl is not living in a safe and consistent home. She is living in a war zone where her mother changes constantly from hour-to-hour, depending on the amount of alcohol she had ingested. The little girl does not relate to a stable mother. She relates to five, depending on the degree of inebriation. She learns very early to stay out of her mother's way during that hangover state and to get reasonable needs met when her mother is not drinking or has a stable blood alcohol level. She learns to get unreasonable needs met when her mother is at 'star time", and she learns to stay out of her way when she is snarly, angry, and drunk. When she is an adolescent, she might take her mother's keys or steal money out of her purse when she has passed out. What she learns most is that there is something wrong with herself, and she learns to be afraid of her environment. She represses the first time she saw her mother drunk on the kitchen floor because it is too painful to remember. She develops a fantasy mother in her mind who shows her love, because developing children cannot tolerate abandonment. She learns to be hyper vigilant and constantly aware, in order to survive. The massive life energy that is necessary to maintain this hyper vigilance and denial causes an arrest in emotional development. She becomes fifty at five, and her own development is put on hold. Like a soldier in a war zone, she learns that chronic trauma is normal, and in order to survive, she learns to repress emotionally and to deny what is experienced as constant danger. She detaches emotionally and develops emotional constriction, rather than spontaneity. She learns either to stay out of her mother's way or to constantly take care of her mother and always be good. She feels deeply and profoundly unlovable, and learns like the ballerina, that she is only acceptable when performing or doing. The price children pay in an alcoholic home for being thirty at five, is often to feel developmentally that they are five years old at age thirty. The family is the arena for both growth and healing of its members. One of the most important and vital tasks of the family is to provide a haven from the stressors of the outside world. If the boundaries that separate the family from the world are either too rigid or too lax, the family within those boundaries will become impoverished and devitalized. In an alcoholic home there is often little interaction between members and the outside world. In a healthy family, each parent is an individual, and the parents together are the sources of nurturing, protection, and learning for the children. The parents have a boundary around their relationship which allows the child the freedom to develop normally and allows children in the family to form their own unit of support. In an alcoholic family, because of the constant need for survival and hyper vigilance on the part of the children, normal development does not occur, because the focus of the parents is not on the developing needs of children. The focus is on alcohol. The children learn that their needs cannot be met and so alter their needs accordingly, which leads to a consistent over-control of self. Because the child has to constantly be aware of the parent's needs, feelings, and behavior in order to survive, the child loses concept of self and develops chronic over-responsibility for others. The parent's needs become the children's needs. The parent's wishes become their wishes. The parent's sadness and grief become their sadness and grief. Rather than fostering the development of healthy individuals, the alcoholic family fosters enmeshment or extreme detachment. Children from alcoholic homes learn very early that they cannot trust their environment. They learn to control their needs, and they learn to trust only themselves. They become chronically counter-dependent because dependency means pain and feared loss of self. This rigid counter-dependence was dramatically exemplified by this adult-child story. was at a picnic with a group of friends on a hot July afternoon. One of my friends had a Siberian Husky, and I noticed the dog was hot, so I gave him a partially full carton of ice cream. A few minutes later, I inadvertently stepped on the ice cream carton on my way to the picnic table. The dog growled and bit my bare foot. I looked down to see my foot covered with blood. I became temporarily confused and didn't know what to do. I walked into the house, turned on the cold water in the bath tub and tried to stop the blooding. I watched the icy cold water run over the wound, but the blood didn't stop. I tried to think of how I was going to get myself to the hospital. A friend had followed me into the house, and I looked up at her perplexedly and said, 'I don't know how I'm going to drive myself to the hospital.' She was shocked at my reaction. She said, There are 20 people here. Somebody will drive you to the hospital.' What was most shocking to me was that it had never occurred to me to ask for help. It wasn't that I thought about it and decided not to. It just never occurred to me." Children from alcoholic families never learned the ABC's of feeling. The only way they could survive was to constrict themselves emotionally. Because the focus was on alcohol, there was no network in the family that supported affect or communication. There was no place where it was safe enough to work through feelings. The permission to feel and the degree of allowable catharsis is always directly proportional to the amount of support to work through feelings. Children of alcoholics do not begin to work through delayed grief and loss until they feel safe enough and have enough support to do so. They need to feel safe enough in the therapeutic setting to go back and walk through the trauma. it takes a long time (in the therapeutic setting) for the adult child to feel safe enough to begin the grieving process and it is absurd to talk about short-term treatment with adult children of alcoholics. For adults, who as children learned not to trust, it takes time to develop a trusting relationship. The first year or year-and-a-half of therapy often focuses on relationship building. The adult child needs to test the safety of the therapeutic relationship, and to develop the sense of supportive environment necessary to begin the grieving process. Those therapists who talk about treating children of alcoholics in ten sessions are actually talking about education. They provide an intellectual framework and cognitive understanding of what has happened, but not the structure of a safe environment to work through long-term grief. Alice Miller states, The opposite of depression is not joy, but spontaneity" (Miller). Spontaneity is the ability to experience the full range of emotions, and in order for this to occur, adult children need to work through the grieving process. Working through grief allows for the independence of mastery of the self. The process of grief work in therapy is as Freud called it, the process of repeating and working through" (Freud remembering, with the support of the therapist, the day the child found mom on the kitchen floor, waling through the trauma, experiencing the feelings, developing empathy and connection with that child of the past. It is important for adult children of alcoholics to recognize that their defenses were once friends that protected their ego from the devastating pain that could not be experienced in childhood, but that those defenses later became barriers to their experiencing the fullest range of emotional relationships as adults. The by-product of delayed grief is emotional constriction, and the reward for working through the grief process is the freedom of choice, spontaneity, and the ability to experience the rainbow of emotions between the stark black and white that they have learned to feel as children. Chronic, unresolved grief shows itself in many forms:
Stages in recovery for adult children involve acceptance, grief, and integration which leads to behavior change. One of the mistakes that is made in programs designed to give education only, is the expectation of behavior change before the mourning or grieving process. Many adult children whom we have treated have gone through many programs like Assertiveness Training repeatedly and experience consistent failure because they cannot operationalize in their lives the skills that they have been taught. Behavior change occurs only after the trauma has been repeatedly walked through and the grief has been fully experienced. Education concerning the characteristics of adult children of alcoholics is important in the therapeutic process, because it normalizes what is often considered abnormal. It allows adult children to see themselves as survivors who developed defenses to protect themselves in an abnormal family. Cognitive understanding provides a framework and structure to work through the grieving process, but education alone is not an end in itself. Education is instead a life raft" to retreat to an occasion when the pain and sadness feels like 'too much." Education is an aid in pacing grief, not a replacement for mourning. The freedom that is gained through the process of mourning is the freedom of choice. Many adult children of alcoholics suffering from delayed grief have lived in the prison of a never-ending cycle of disappointment, repression of pain, depression, workaholism, frantic push towards success, and disappointment again. The applause and rewards are never enough, never felt. Alice Miller talks about the emptiness and loneliness of the illusion of touch through achievement:
Through the process of mourning, adult children of alcoholics experience the pain of the illusion of the (ppy child of the past" while also reclaiming the empathy for the child inside that really was. If the therapeutic environment is supportive to the process, the adult child will enter into the full experience of mourning which will eventually lead to integration and the freedom to reconstruct their life rather than to a life controlled by the pain of the past. For many, the repression of unresolved grief has not only meant denial of self, frequent depressions, and massive guilt, but also the illusion of control. Many have repetitively entered relationships that are punitive and lack nurturing, yet feel helpless to separate from them because of a sense of desperation they could not understand. Many have worked around the clock, becoming stimulus junkies" who could not relax and live their lives except through mazes of deadlines and goals. They experienced the feelings of loneliness even when surrounded by others. They have developed caseloads rather than friendships and allowed relaxation only through illness. They constantly confronted, in attempts to relax, the rigidity of that master inside, depression. There are no shortcuts in the treatment of delayed grief. Grief can be experienced only by an individual in therapy when the relationship with the therapist is experienced as safe and supportive; only then can the process of remembering begin, walking with direction back through the trauma and working it through. Grief is the pain that heals itself if the individual experiencing it or others do not get in the way. "What is there after the tears?" The experience of grief allows for the reclaiming of history, of family, of the child of the past. It allows for the ability to reclaim the choices of the present, the memories of the past, and the dreams of the future. It allows the freedom spontaneously to experience joy, sadness, anger, success, loving and being loved, and to live a life of balance and of choices with the freedom to say yes" or no" without the terror of feared abandonment. Through grief comes the realization that the pain of abandonment took place in the past, and there is nothing that can be done in the present that will change that loss. After the tears comes the freedom to experience the rainbow of emotions which exist between the painful world of darkness and the illusion of a bright fantasy world that never was. REFERENCES
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