Grief: Cognitive and Emotional Challenges. By Michael Church

NOTE: This entry does not refer to any particular person or to any particular group, and the example is a composite from multiple cases.

Katrina’s 20-year-old son, Trevor, had been diagnosed with terminal cancer when he was 10.  By the time he was 18 he was also diagnosed with a drug addiction. By the time Trevor was 20, Katrina, married with a child younger than Trevor, had spent the past decade believing it was her job to keep him alive, even though – as early as 14 – he told her many times he did not want to live any longer. His actions were very self-sabotaging, and he was brought into the hospital many times very close to death, resulting from drug use, lack of exercise, poor eating habits, and refusal to adhere to medical recommendations. All led to a rapid decline in his physical and cognitive health, while his tolerance to drugs grew greatly over the years, as he increased dosages to get the “high” he craved. He told his mom that the only time he felt okay was when he was on drugs.

One night he overdosed and died just before his 21st birthday. It was never clear if the overdose was intentional. Katrina was plunged into guilt; she blamed herself for not being there with him when he died, and obsessed about how she could have saved him once again. Although she admitted feeling some relief that the family suffering was over, even this relief added to her guilt: “What kind of mother would be relieved by her child’s death?” she lamented. Her guilt grew into serious depression and she began psychotherapy.

Katrina had to face and accept several harsh realities, especially that her son did not value his life and there was nothing she could do to change that. His cancer and drug addiction were consequences of many factors that were beyond her control. She felt guilty she had not insisted on chemotherapy, even though doctors said that chemo would not work. It was a terrible decision to be confronted with, but Katrina and her husband did the best they could at the time. She needed to accept that she did what most parents would have done in similar circumstances.

Katrina was still mothering Trevor during his late teens, and he had not made any fundamental or positive changes to help himself. As a matter of fact, he deteriorated during these years even while many medical and mental health care providers and facilities did their best to improve the quality and quantity of his life. The bottom line was, he did not care. He believed his pathetic state of living could not change for the better, and his drug habit fostered a self-fulfilling prophecy. He had been telling his mom for years – in actions and words – that he was not afraid of death and did not want to live, and she somehow denied the significance of these statements. His mom became collateral damage even though he probably survived longer because of her heroic efforts.

Katrina entered therapy to help reinvent herself with renewed purpose and goals. She worked to close the gap between cognitive and emotional acceptance. As is commonplace, she accepted Trevor’s death rationally before emotionally. At first, she made the mistake of trying to control her feelings, even to the point of refusing to cry or talk about her loss. Unfortunately, these actions extend suffering and delay acceptance. With the help of her therapist, Katrina was able to learn how to use action to facilitate emotional acceptance. She stopped blaming herself and trying to control her feelings. Instead, she focused on controlling her actions and letting natural healing take its course. It takes a lot of time and effort to reach emotional acceptance of many harsh realities of life, and there is no timetable or road map to follow. Every situation is unique and must be handled creatively and courageously.

She progressed with letting go (acceptance) because she was willing to talk about and face her loss. She developed a legacy for her son, did not avoid going to his room, looked at his videos and pictures, visited his grave site regularly, talked about him with family and friends, and joined a support group for grieving parents. Most importantly, she let herself grieve in her own way.

 Katrina knows there will always be an emptiness in her heart for her son who is not at the table, but she is no longer mired in the stages of grief. She is living more fully and reveling in her role as grandparent and the success of her surviving child. Her relationship with her husband is healthy and stable, and they are looking forward to a future with renewed energy and meaning.

Katrina’s case reveals some important lessons about the need to synchronize emotional acceptance with rational acceptance, particularly when personal loss is involved. That is, you need to behave in ways congruent with facing the reality of a situation, and focus on living in the present. Life is for the living and that is what those you leave behind would want. In so many important areas of life, when it comes to enhancing your confidence and self-esteem to face challenges and overcome fears, there is no substitute for facing and acting in ways to better those psychological states.

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