Grieving, The Return of Hope, and A Life Reclaimed
by Martha Stark, MD / Faculty, Harvard Medical School
Harold Searles (1979) has suggested that “realistic hope” arises in the context of surviving – and grieving – disappointment, loss, heartbreak, betrayal.
I think that all of us have experienced one or more “traumatic losses” over the course of our lives – whether a single, devastating trauma or a series of smaller, incremental traumas – whether the trauma involved abuse and violence (“presence of bad”) or deprivation and neglect (“absence of good”).
People we have loved and trusted will violate, betray, and disappoint us. Our hearts will get broken. People will let us down. Our dreams will get crushed. We will suffer defeat. We will let ourselves down. We will periodically lose our way. We will make bad financial decisions. People will die on us. We will get sick, develop chronic illnesses. We will get old, become infirm, experience pain in our bodies. None of us has an entirely charmed existence; none of us gets through life unscathed.
Admittedly, the “fact” of a traumatic loss can never be changed, but how we position ourselves in relation to it can. In other words, the “reality” of an overwhelmingly devastating loss can never be altered, but the narrative we create in an effort to understand it, to make sense of it, and to put it into perspective can make a difference.
Indeed, how we position ourselves in relation to our heartbreak will determine whether we are able to move forward in our lives (perhaps even stronger for having mastered the challenge) or whether we remain defeated, stuck, and broken.
Perhaps it could be said that maturity is achieved once we have transformed our need to have the world (and ourselves) be a certain way into the capacity to accept things as they are – once we have transformed our defensive need to deny painful truths into the adaptive capacity to confront them, grieve them, and ultimately accept them. It could therefore be said that maturity is a hard-earned adaptation to the impact of devastating truths – it requires the acceptance of heartbreaking realities that sober and sadden.
In what follows, my contention will be that if we are ever to evolve beyond the devastation and paralysis of the heartbreak we experience in the aftermath of our losses, then we must ultimately be able to confront – and grieve – the reality of the losses that we have sustained.
Only once we have had the courage to face the pain of our grief will we be able to mend our hearts and recover our hope.
I present now one of the most heartrending consultations I have ever done. It is a story about Alicia, who came to see me many years ago because she was haunted by a tragic event that had occurred half a century earlier.
Alicia presented as a strikingly attractive, elegantly refined, and immaculately dressed 58-year-old woman who held herself with grace and dignity. By dint of her razor-sharp intelligence and extraordinary hard work, she had established herself in a highly successful career but had no life partner and no family and suffered from multiple health problems, most notably malignant hypertension. She also reported having felt low-level depression and a quiet despair for most of her life.
At the age of seven, Alicia had been involved in a horrific accident. She had been vacationing with her family at their summer cottage and was out slalom water skiing on the lake. In the water ahead and to the right, she had seen something breaking the surface. Was it a rock? …the end of a log? …a clump of seaweed? She couldn’t quite make out what it was. Next thing she knew, she had run over it. Tragically, it had been a little boy out swimming – whom she had decapitated with her ski, instantaneously killing him.
Alicia had then spent every single day of the next five decades brutally punishing herself, wracked with guilt, haunted by her shame – her blood pressure inching up year after year. She couldn’t live with the knowing that she had done what she had.
Every one of the many therapists with whom she had consulted over the course of those years had done their best to reassure her – telling her that she had not been at fault; how could she have known; my God, she had been only seven at the time, a mere child; it was an accident; she had not tried to kill the little boy; she had to forgive herself.
But in her heart of hearts, Alicia knew that, although she had been only seven at the time, she was an experienced water skier and, had she chosen to do so, she could have steered clear of, and thereby avoided, that mysterious object in the water.
And so Alicia had spent a lifetime wrestling with her shameful secret, her inner demons, and her intense self-loathing – the knowing that she had been responsible for the death of that little boy, who, as it happened, lived only several doors down from her family’s cottage and had been her friend.
As I listened, my heart was breaking – for this devastated, broken, guilt-ridden, tormented soul who lived every single day of her life with unspeakable grief and unbearable pain. I said very little as her story unfolded; but, with hand on my heart and tears in my eyes, I nodded my understanding. The horror of it. Her decades of guilt, shame, private grief, profound hopelessness, and relentless self-punishment.
When I finally spoke, I said, softly, that I got it, why she felt responsible for his death. I told her I understood why she was having such trouble forgiving herself, such trouble figuring out a way to live with herself, what with her knowing that she could have chosen to do something different – but that she had not. I went on to say that it broke my heart to think that she had had to carry inside of her (all these years) her crippling guilt, her secret shame, and her unrelenting grief.
And then Alicia began to reveal more and more of the horrific – and incriminating – details about what had actually happened that fateful summer day on the lake… that as she had approached the object in the water ahead of her and to the right, she had found herself wanting to know what exactly it was. She, always one for a challenge, had decided to test her skills as a slalom water skier by seeing how close she could get to the object without actually running it over – and so, even when she had gotten close enough to see that the thing in the water ahead of her was moving and possibly alive and even with her knowing that she could and should veer away from it, she, as if driven by some uncontrollable inner compulsion, had made a split-second decision to jump the wake behind the boat so that she could get closer to it – instead of staying inside the wake and carefully steering clear of that unknown object bobbing in the water ahead…
While Alicia – with unflinching honesty and raw vulnerability – was recounting these more specific and revealing details, I sat very still, barely moving, barely breathing, just quietly taking it in and occasionally nodding. I knew that it was for me to be able, simply, to listen, to be present, to be there to help her bear the pain of it, the horror of it, the guilt of it, the shame of it – and not to withdraw, not to recoil in horror. It was for me, simply, to listen with compassion and without judgment.
Alicia alternately wept, raged, wailed, howled, fell silent – decades of pent-up anguish, heartbreak, guilt, shame, fear, anger, torment, despair, loneliness, isolation, regret, and high blood pressure. My heart was breaking for that spirited little girl Alicia had once been and the solemnly dignified but privately broken woman who now sat before me – surrendering, at last, her long-held secret guilt and searing shame.
Alicia explained that she had (robotically) recounted her story to many over the course of the years – but that it had always been an abridged version. She said she had held back for fear that people would not be able to bear the horror of it – that they would offer her pat reassurances that would make her feel even more misunderstood, disconnected, isolated, alone, and alienated.
As she wept, sobbed, and wailed, she and I both knew that she was releasing, at long last, the reservoir of tears, pain, heartbreak, and anguish that had been accumulating inside of her for decades. She had so needed to be able to tell her truth – and she had finally found someone who was willing to listen – and to bear witness.
At the end of Alicia’s harrowing narrative, exhausted from the effort of remembering but visibly relaxing as she revealed the devastatingly painful details, blow-by-blow, she said she suddenly felt a tremendous rush of relief, at having shared, finally, what had really happened those years earlier – a wondrous release followed by an exhilarating inner calm, sense of gentle peace, and serene acceptance. Alicia said she no longer felt quite as alone – because now someone else knew the real story and the incriminating details about what she had never before dared to share with anyone – now someone else knew the truth about what had happened that day on the lake.
And then Alicia was done and, although she came back to see me a number of additional times, at the end of the tenth session, she said she was ready to go. I told her she would always be welcome to return, were she ever to want to. She said that meant a great deal to her. At the end of our last session, as Alicia was leaving, she lingered at the door for a moment to give me a heart-felt hug.
Alicia did not ever come back but, in the interim, has referred me at least 15 of her friends and colleagues. And, periodically, she will drop me a little note, reiterating her gratitude that I was able to bear the horror of what she had done and, in that way, had helped her to make her peace with the crime that she knew she had committed, albeit with no malice or ill-intent, those 50 years earlier. She has discovered, to her surprise and absolute delight, that she no longer struggles with depression and that she now finds herself feeling hopeful.
And in one of her notes she told me, with much pride, about the nonprofit organization that she had set up, shortly after we met, to help people who had survived the tragic loss of a loved one to deal with their heartbreak and grief. There also came a time when she informed me that her malignant hypertension was gone and that her blood pressure had returned to normal!
I think of Alicia often and of how she was finally able, with incredible courage and integrity, to confront – and grieve – the haunting reality of her past, which allowed her not only to evolve to a place of self-forgiveness, humble acceptance, and inner peace but also to channel all of that now freed-up energy into the creation of her nonprofit! I believe that, in Alicia’s case, an important part of what enabled her to find absolution was the opportunity she had to confess to someone who listened with compassion and without judgment – to someone who was able to be present with her as she dared to remember, dared to confront, dared to relive, and, finally, dared to relent and to forgive herself. I believe that it was this that enabled her to restore her hope and reclaim her life.
In truth, the Serenity Prayer – “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference” is very apt here. I had always mistakenly assumed that the Serenity Prayer spoke primarily to the importance of our capacity to accept disappointing realities about the people in our world and to relinquish our relentless hope with respect to them – I had, rather naively, not fully appreciated that perhaps equally relevant is the importance of our capacity to accept disappointing realities about ourselves and to advance from hopeless and helpless to hopeful and empowered.
Searles, H. 1979. Countertransference and Related Subjects: Selected Papers. Madison, CT: International Universities Press, Inc.