Monday, November 26, 2012

To Life!

Recently I was one of three women who took a fourth out for dinner for her ninetieth birthday. We ate in an elegant restaurant befitting the celebration of achieving such a milestone. Friends for almost twenty years, we basked in the warmth of good wine, great food and, most importantly, our close and enduring friendships. 

At sixty-six I was definitely the baby of the crowd. One of the other women was about to turn eighty, the other was almost seventy-two. All of us still work as psychotherapists and psychoanalysts, actively seeing patients and very involved in our professional lives. We were all widowed or divorced. However the ninety year old is newly involved with a man she thinks she might be comfortable spending the rest of her life with, while the seventy-two year old recently began living with a man who will most likely be the love of her life.

Love, work, friendships. That’s my prescription, not only for reaching older age, but doing so with exuberance, joy, and fulfillment. And it turns out that my prescription is supported by research published in The Longevity Project: Surprising discoveries for Health and Long Life from the Landmark Eight-Decade Study (Hudson Street Press, 2011). Drs. Howard S. Friedman and Leslie R. Martin found that people who felt loved and cared about reported a better sense of well-being, while the clearest health benefit of social relationships came from being involved with and helping others. That description certainly fit the four of us! 

I have to say, however, that even as a child I was learning how to live life as a fulfilled older person for “old people” were never “old” to me. My grandparents worked for most of their lives, stayed actively involved in politics and the world around them, and exuded strength and fortitude. In fact, when my grandmother died at eighty-one, I was shocked. It was almost as though a part of me believed she was immortal. My parents were also excellent role models when it came to aging. My mother lived to be one month shy of her ninety-ninth birthday and, until she was ninety-four, had never been in a hospital except to give birth to me. She worked well into her seventies and the summer before she turned ninety she went on three trips – a land tour of Alaska, a trip through Ireland, and a walking tour of the Swiss Alps. My father, a very intelligent man, died at age eighty-six, never having lost a brain cell. Although he had retired years before, he wrote plays and books practically until the day he died.

So sixty-six doesn’t seem at all old to me. I have had my share of difficulties over the past seven or eight years. My husband, with whom I had a story-book relationship, has been dead for five years. He was twenty-one years my senior, so I always knew that I would survive him, not that the knowing made his loss any easier. He was also ill for several years before his death, so I watched my strong, powerful, competent husband, deteriorate bit by bit before my eyes. Was it difficult? Most definitely. My mother began to fail as well, so I was faced with seeing them both decline simultaneously. I did continue to work during this time, finding that seeing my patients and dealing with their pain, was a welcome respite from my own anguish.

I also began writing about my experience, chronicling the ups and downs of my husband’s struggle with both metastatic prostate cancer and heart disease. Sometimes it felt like a relief to put it down in words, almost as if I was ridding myself of the horror. At other times, it felt tortuous and I wondered why I was subjecting myself to such self-inflicted pain. I wondered if I would do anything with these pages. I didn’t know. I couldn’t think beyond getting my husband past the next day, the next crisis. Eventually my husband who had fought and fought and fought to hold onto his life, to not leave me, said, “It’s enough, already.” He went into hospice. Thirty-six hours later he was dead and I was a widow.

Through the haze of my grief, I took refuge in my work, my family and my friends. I don’t know how I would have survived without them. The telephone was a lifeline. I don’t think I made too many middle of the night phone calls, but it was comforting to know that I could. And my work? Once again it provided a welcome relief from my own pain. Many, although not all, of my patients knew about my husband’s illness and death, opening up a new arena that had to be dealt with and explored. To me, there is nothing more fascinating that the inner workings of the mind, both my patients and my own: trying to grasp, to understand, to find new meaning and greater freedom.

And then there were those pages. What was I going to do with them? Did I have a book in me? Did I want to open up the specifics of all that pain? The time my husband had a heart attack after his first chemotherapy treatment and the cardiologist advised contacting his children. The time he suddenly couldn’t walk and then three days later he magically could. The time he fell and hit his head and a subdural hematoma was added to his laundry list of ailments. Was I ready to tackle all that?

But if I wrote a book, I didn’t want to deal only with the last several years. There was so much more. There was the serendipity of meeting my husband in the first place – my walking up a friend’s newly built steps leading to talking with the carpenter who built them leading to his referring me to the man, my future husband, who would remodel my small home on a lake outside of Ann Arbor, Michigan. There was our falling in love – two people with vastly different backgrounds – my husband from a poor, rural, uneducated, unsophisticated family and myself from a middle-class intellectual background from New York City. We couldn’t have been more different, and yet we were so very alike. And our relationship grew ever closer through the years. His sparkling blue eyes lit up when they saw me. I would melt into his arms feeling safe and protected. If I was going to write, I had to write about these years as well.

And so I did. My book and my sixty-seventh birthday should arrive around the same time in March.

Love, work, friendship, new challenges, new skills, new frontiers. Definitely the way to stay vibrant, to know and feel and believe that age is all relative. Years of my life await me. I plan to make the most of them. And to have many more dinners with my three close, and very precious, friends.  

Friday, October 26, 2012

When Times Collide

Last night I received an email from Jane Dobija, a writer friend of mine from California asking how I was doing, now three days after the fifth anniversary of my husband’s death. I wrote back that I was starting to come back to myself. I went on to say that this had been a particularly difficult anniversary because the days of my husband’s birthday, October 14, and his death day, October 24, corresponded to the days of the week five years earlier. As a result, much to my surprise, I found that those days, as well as the days in between – his entering the hospital, his consent to a “do not resuscitate” directive, various medical procedures, and his entering hospice – all rolled through my mind as though I were watching a movie, bringing the experience back to life in a way that felt far too real and immediate.

In her response, Jane wrote back, “Important experiences, recent and past, merge at various junctures.” She was, in essence, saying that the intensity of my experience of both the past and the present converged on these similar, though not identical, days. 

Probably because I was shifting away from my preoccupation with my husband’s death, I saw her comment as expressing a truism that ranged far beyond my experience of vividly reliving my past trauma in the present. I read it as the underpinning of one of the most powerful forces that shapes our being in the world, transference, our tendency to see the present through the lens of our past.

Transference is a term first introduced by Freud. At that time, it was used more narrowly to explain how the patient came to see the analyst as important figures in his or her earlier life, particularly parents. Transference was then seen as being confined to the treatment room and was basically considered a one-way street. The patient transferred onto the analyst. If the analyst happened to transfer his or her image of early caretakers onto the patient – called countertransference – that was considered pathological, something the analyst needed to understand and curtail.

There is no question that transference does occur in the treatment room. Just yesterday I had an exceedingly anxious patient I will call Rebecca come into my office wringing her hands, saying that she knew I was angry with her. I was surprised. As far as I knew, I was aware of no such feelings. Psychoanalysis has progressed sufficiently from the time of Freud that I also knew I couldn’t dismiss her perception of my being angry without further exploring both her feelings and mine. After all, analysts have an unconscious just like everyone else, so I might have feelings that were out of my awareness. Proceeding with an open mind, I asked why she thought I was angry with her.

“Because I had to change my appointment time. And when I called to ask you to change you sounded mad at me. But I couldn’t help it! I’d had this gynecology appointment for months and I’d forgotten about it and if I had to change that appointment it would have been another three months! I’m sorry. I know it was irresponsible of me. I should have looked, but I just can’t think straight these days!”

So what is going on here? And what is going on inside me? Recollecting my patient’s phone call, I do not remember my feeling at all angry. I tend to be a flexible therapist who will accommodate my patients’ requests as best as I can, as long as I do not feel that they are chronically demanding or unreasonable. On the other hand, listening to this patient’s explanation of why she experiences me as angry with her, I do find myself a bit impatient and exasperated. We have worked for months on her consistent self-effacement and her tendency to blame herself for anything and everything, a legacy from her critical mother who demanded nothing less than perfection. I also wonder if she has the unconscious wish to provoke me into being the angry mother with whom she is so familiar. But I’m getting ahead of myself.

“Rebecca,” I say, “As far as I know I wasn’t at all angry with you. You’ve rarely asked to change appointments and when you have your requests have been entirely reasonable and it wasn’t as though your request inconvenienced me in any way. Are you sure that you didn’t experience me as angry, even though I wasn’t?”

“Well if I experienced you as angry, that’s all that matters! Don’t you always say it’s my feelings that matter?”

So here we are, at an apparent paradox. Yes, Rebecca’s feelings matter. They most definitely matter. But just because they matter, doesn’t mean they reflect an actual reality, assuming we can ever know reality apart from our own subjectivity. I would say that Rebecca has just had the experience my writer friend described, a juncture of past and present experiences. Because Rebecca grew up with a highly critical and demanding mother, when she made a request that felt entirely reasonable to me, her own past history – her own fear and guilt and anger – made it impossible for her imagine that I could respond in an accepting manner.

So, yes, Rebecca’s feelings matter and in this case they matter because they help to shed light on the lens through which she sees the world – a place where any request, however minor, will be received with anger or rejection.

To demonstrate how this juncture of past and present experience is not confined to either patients or to the consulting room, I’d like to turn to an incident that occurred for me many years previously. I had had an argument with my niece and, quite out of character for me, I hung up on her. I felt guilty, tried calling her back, but she refused to speak with me. I asked my husband if he would please do me a favor and call my niece and explain to her that I was experiencing a lot of pressure right now and that I really didn’t mean to yell at her or hang up on her and that I would like to make amends.  My husband complied and did as I asked.

Listening to him say exactly what I had asked him to, I found myself becoming furious at him. Insightful enough to know that my reaction was completely irrational – after all he was repeating word for word what I wanted him to say – I asked myself what was going on. The answer was crystal clear – I was experiencing an intersection of past and present junctures. Outside my awareness, I had asked my husband to say the same words to my niece that my mother used to say to me after my father had verbally exploded in some extreme, out of control manner. I was furious at my father for his explosion - as well as terrified – and wanted nothing to do with him. My mother would come beseeching me to make peace, unable to understand my fear or accept my anger. I would then feel angry with her, just as I now did with my husband. The words and the feelings were the same. What my unconscious didn’t know was that the time was different. “Important experiences, recent and past, merge at various junctures.”

Sunday, October 14, 2012

The Anniversary Clock

At least twice every day, I drive by Lynn University just a few blocks from my home. For the past several weeks, that means I drive by the countdown to the third presidential debate that will take place at Lynn on October 22, 2012. 40. 39. 38. … 24. 23. 22. And so on. I could do without that glaring, twice-daily reminder. For me, October 22, 2012 means something quite different. It is the fifth anniversary of my husband’s death. I have my own internal countdown. I don’t need one staring me in the face day after day as a grim reminder of the reality I know all too well. This year, October 22 even falls on a Monday, the same day of the week that George died. I know I’ll work that day, as I did through much of his illness and soon after his death. As a psychologist and psychoanalyst, I find that listening to the struggles and heartaches, as well as the joys and triumphs of others, often helps remove me from the pain of my own life. 

When I come home after that long day I’ll probably be more aware than usual that George won’t be there to greet me. The door between the garage and the house won’t be open. He won’t be standing there with his sparkling blue eyes and welcoming smile. There won’t be a delicious meal cooking on the stove. There will be no George on that day, just as there hasn’t been for the previous 1827 days, including the two leap days. It actually has been longer since George was able to greet me at the door, his body debilitated by metastatic prostate cancer, heart disease, and chemotherapy for almost two years prior to his death. Then I’d go to him, sitting in his chair in the living room. His eyes weren’t quite as bright, but his face still lit up when he saw me, he’s arms open, proclaiming my homecoming the best time of his day.

Do I need an anniversary to remember all this? No, not at all. George is with me every day. I remember his courage, his strength, his fortitude, and his sometimes maddening stubbornness. I remember the man who loved me with every fiber of his being, who was always my champion, always in my corner. I remember walking hand in hand along the Seine, putting up tents in Botswana (the only time in my life I ever camped), and scuba diving in countries like Palau and Yap, places I had never even known existed. He opened new worlds for me and for that I feel tremendous gratitude. But mostly I remember sitting close to him on the couch or eating on our outdoor patio. I remember the depth of our love and, yes, the indescribable pain of his loss.

There’s not one way to deal with the anniversary of a death. There’s no such thing as a right way. I know from myself, my patients, and my friends, that people handle anniversaries differently and that every anniversary is in itself, different. The one universal is that anniversaries cannot be ignored. Even if you think you have forgotten, that date remains emblazoned in your unconscious. You can distract yourself, occupy yourself in the usual routine of your life, but the anniversary remains present nonetheless. You might find yourself unaccountably anxious or forgetful or irritable, all messages from the unconscious that feelings are brewing and need to be attended to one way or the other.
I faced the first anniversary of my husband’s death with dread. I knew I didn’t want to be alone nor go on with my life as usual nor be someplace I could envision George and I enjoying old haunts or exploring new adventures. I couldn’t figure out what to do or with whom to do it. In the end I flew from Florida to Oregon to spend time with two of George’s children and then, for the actual anniversary, I went with George’s daughter and two close friends to a spa in California, something I knew the man who took me scuba diving in Yap would never have been interested in doing.

I know of two widows who found the unveiling, the Jewish ceremony that literally unveils the gravestone and marks the one year anniversary of a death, extremely helpful. For them it signified the end of the year of mourning and gave them permission to begin moving forward in their lives. This didn’t mean they stopped grieving or that they felt less connected to their deceased spouses, but rather that they could begin thinking more of themselves and their own lives. Another widow spent the first anniversary of her husband’s death reading over all the cards he had given her over the years. I asked whether she found that comforting or whether she was torturing herself. She said that it was comforting. I believed her, but could hardly imagine it. For years I couldn’t even walk by a card display without crying, without thinking about all the cards - birthday, anniversary, Valentine - I would never again give or receive.

On the second anniversary of George’s death my grief was not as acute, not as all-encompassing. But rather than experiencing this as a relief, I felt as though George was slipping away from me. I felt emptier, lonelier. Sometime later a widow said to me, “Grief is my friend.” I knew exactly what she meant. Grief itself provides a connection to the deceased. Without the intensity of that grief we feel more alone, more isolated. By the third anniversary I thought that I could venture further afield and return to my warm writing community in Washington, DC. I was incorrect. The flight to Washington on the eve of George’s death felt way too painful. Usually a calm flyer, I became increasingly distressed and had to fight to keep myself from passing out. Year four was less traumatic, spent with my husband’s grandson, reminiscing about George, the man we both loved.

And so I’m back to anticipating year five. I suspect I’ll feel more of a sense of missing, of longing for that which was and is no more. But like all other days, October 22 will last only 24 hours. It will end and I will continue on with my life – seeing patients, writing, spending time with friends. And carrying George in my heart, as always.