Month: June 2016

Mourning my Mom

Christmas day 2013 is when it all began. My very small family’s holidays were centred on Mom and her brilliance in the kitchen. On this day, she was scurrying around to get things prepared for us and fell down in the bedroom, her feet became tangled in the bedspread. She laughed when she told us the story.

From that day on she complained “a pulled muscle in her back.” She started physical therapy soon after but never seemed to kick the pain in her back. March came and her new affliction began: constant nausea. None of us knew it was related. Her pulled muscle and nausea were more than likely caused by her enlarged liver which was full of cancer and had spread from her lung.

Death came for my mom 6 days after she was officially diagnosed with lung cancer. From the beginning of the 6 days, she was very weak from being unable to eat much for the previous 6 weeks. She went from fully aware (still bossing my dad and me around) to unaware of things beyond her bed within that time frame.

We, as human beings, are guaranteed a grieving process unique from all others. Coping with loss is ultimately a deeply personal and singular experience. Nobody can help you go through it more easily or understand all the emotions that you’re going through. The best thing you can do is to allow yourself to feel or lean in to the grief as it comes over you. Resisting it only will prolong the natural process of healing.

Easier said than done. If you are anything like me, you don’t indulge in the pain, you run from pain. I typically dull my discomfort with my obsession to work, alcohol, and food …anything to pull the focus from what really hurts. However, I am a therapist and hopefully somewhat self-aware, so this is what brings me to writing this blurb. I am leaning into my pain by sharing my experiences with you, hoping that you who are grieving can KNOW that this is temporary, and you will heal from this pain, but it won’t be easy.

DENIAL AND ISOLATION.

There wasn’t much time to for me to deny it, but my mom had a couple of days to do so. On the Wednesday before the Oncologist appointment, my mom, dad, and I went to the emergency room of a local hospital because my mom’s doctor noted her yellow color and wanted some tests. After eight hours of caring for my dad who has many more health issues (wheelchair bound) than my mom at this time and my mom who is so weak she has to be in a wheelchair of her own, we were told, “You have cancer, but we can’t tell you how bad it is or in what organ it lies.” Two days later, we were at the Oncologist, and before we went in, my mom said, “We don’t know if I really have cancer.” I just nodded. But I knew it. I just didn’t know how bad it was. In talking with my dad, he says she never mentioned cancer or her dying on the hour and a half back home drive from the hospital. They spent the next day living the way they had for 50 years, except for the physical weakness in my mother and the ever presence of their only daughter moving in to take care of things. The next day is when it all changed forever; hospice came.

ANGER.

My mom’s anger was never voiced because she instantly became too weak to talk. When I looked in her eyes, I didn’t see anger, I saw “This is not what I expected; I don’t want to leave my family. I am disappointed. This will kill your brother.” Although I had little time to be angry for all the things that needed to be done for someone in hospice care and the other very unhealthy parent witnessing the ordeal, I found time to be angry with the initial physician she saw. It took him 6 weeks to send her for tests. My mom was uncomfortable, weak, and couldn’t eat much for 6 weeks because the doctor (or so I thought) was an idiot and “just a country doctor who didn’t care about my mom.” She was terminal, and I knew that 6 weeks would not have saved her, but I was still angry at him, and shortly after her death I convinced my dad to change doctors all together.

In the 6 days, before she died, I cleaned the house (it was in disarray because she had been sick for a month prior to this), my brother and I took care of my mom and dad’s personal care, laundry and linens, bought the groceries and prepared the meals, dealt with hospice, dealt with the visiting community members, paid the bills, located bank accounts and wills, and you name it. Who had time to be angry? There wasn’t much time to be angry and what would I be angry about? I guess I could be mad at her for smoking since she was 15.

In retrospect, I haven’t really been angry. I continue to grieve my mom’s death and my dad’s current dying process, but calling it anger never really nails it. I mean, isn’t this the natural order of things? Parents get older, they die, and you live life without them. This statement does NOT make it any easier for the person grieving. And the next person who tells me that…GRRRRR.

BARGAINING.

Bargaining is the normal reaction to feelings of helplessness and vulnerability and is often a need to regain control. For some control-freaks like me, this will be a more difficult stage because there is NOTHING you can do about saving your mom from death. Nothing. Secretly, my mom may have made a deal with God to postpone the inevitable. But probably not, my mom probably did not bargain with God in her last days. She had said to me many times before on days when her COPD had gotten the best of her, “I’ve done this to myself.” So I don’t think that bargaining with God for more time with her family was on her mind. Regret maybe.

My mom and I had a complicated relationship. So this phase has done a number on me in many different ways. This phase showed up as:

If only I had tried to be a better person toward her…given her a break on whatever we disagreed upon.
If only she had had another “better” doctor who would have treated her more effectively.
If only I had not been so wrapped up in my career, I would have paid more attention to her and got her the help she needed much sooner.
My heart is broken because I never could agree to disagree on what we didn’t see alike. I just want one more day with my mom to apologize or to make it up to her. I will never know if she forgave me or knew how much she meant to me or knew how much the holidays will NEVER be the same without her.

DEPRESSION.

Again, it wasn’t obvious that my mom was experiencing depression because it happened so quickly. I am not convinced my mom ever truly believed she would die so soon. Depression has been mine to bare. There were so many things to do and get done that my depression lingered backstage for several weeks, and came center stage a good two or three months after her death, and remains there. My depression has more to do with the change my little family has undergone and what it continues to go through due to my mother’s death and father’s illnesses. The concept of the finality of your family members leaving is pretty tough. You will never say another word to your mom, you will never get the joy out of buying her a gift, you will never be comforted by her chicken soup when you are ill, and you will never be able to apologize about not being the perfect daughter, and soon enough your father will be gone forever as well. Some get through this with prescriptions; some weather it out…but it ALWAYS comes in one way or another.

ACCEPTANCE.

The only words uttered by my mother in her last day was, “I want peace.” I believe that this was her voiced stage of Acceptance. This stage is marked by withdrawal and calm and a tightening of the visual aperture. Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. She in her last day, appeared to be unaware of things occurring beyond her bed.

This stage is not afforded to everyone. I have not reached it as of yet, and she died 8 months ago. Of course, I have accepted I have spoken my last word to my mother and of course, I have accepted that my father is not on this earth for very much longer; however, I haven’t accepted it without a lot of emotion, and I am all but calm. I continue to lean into the pain every single day, and yes, I numb my pain with food and work, and calm still has not come.

When you experience grief, it is best to experience it with others (if it is a healthy support group). I share mine with my ever supportive husband, grief stricken brother, a couple of dear friends, and a group of intelligent and compassionate therapists (yes, therapists have therapists.) I believe I am doing it in the healthiest way I can…less numbing of the pain, and more leaning into it. But here I am in the final edits of this article, and I am weeping like she died yesterday. I miss her.

There will never be another holiday with her, and we will miss her huge spectacular turkey and dressing and delicious pies, her charm and sarcastic whit and beautiful voice and spirit. We are the lucky ones though; we got to meet her, even be born from her. She mothered us with all of her might. The holidays will still come, but they will never be the same. Eventually we will get through them and remember how lucky we are to have had her in our lives for almost 50 years. If you turn to God in this time, this is the scripture that gets me through the darkest of days. Psalm 3:3 “But you, O LORD, are a shield about me, my glory, and the lifter of my head.”

Wendy J. Poole

Dysthymic Disorder and Codependency

Stressed businesswomanDysthymia or chronic depression is a common symptom of codependency; however, many codependents aren’t aware that they’re depressed. Because the symptoms are mild, most people with chronic depression wait ten years before seeking treatment.Dysthymia doesn’t usually impair daily functioning, but it can make life feel empty and joyless. In the Shadow Sufferers have a diminished capacity to experience pleasure and may withdraw from stressful or challenging activities. Their emotions are dulled, though they may feel sad or melancholy or be irritable and anger easily. Unlike with major depression, they’re not incapacitated, yet they may have difficulty trying new things, socializing, and advancing in their career. Some may believe that their lack of drive and negative mood is part of their personality, rather than that they have an illness. Like codependency, dysthymia causes changes in thinking, feelings, behavior, and physical well-being.

Dysthymia was renamed “persistent depressive disorder” in the 2013 edition of the Diagnostic Statistical Manual V. (I use the terms “dysthymia,” “persistent depressive disorder,” and “chronic depression” interchangeably.) Symptoms must have persisted for at least two years (one year for children and teens) and includes at least two of the following:
• Low energy or fatigue
• Sleep disturbances
• Increased or decreased appetite
• Irritable or angered easily (for children and teens)
• Low self-esteem
• Difficulty concentrating or making decisions
• Feeling hopeless or pessimistic

The symptoms must create significant distress or impairment in social, occupational, educational or other important areas of functioning. Although mood remains persistently “down,” it may improve for several weeks of feeling better. Untreated, depression soon returns for longer periods. People are usually motivated to seek help in order to cope with a relationship or work problem or a major loss that triggers more intense symptoms. When they rise to the level of major depression, which can often occur in people with dysthymia (persistent depressive disorder), the diagnosis is “double depression” – major depression on top of dysthymia. Unlike chronic depression, an episode of major depression may only last a few weeks, but it makes a subsequent episode more likely.

Persistent depressive disorder affects approximately 5.4 percent of the U.S. population age 18 and older. The numbers may be much higher, since it often goes undiagnosed and untreated. Over half of dysthymic patients have a chronic illness or another psychological diagnosis, such as anxiety or drug or alcohol addiction. Dysthymia is more common in women (as is major depression) and after divorce. There may not be an identifiable trigger; however, in cases of onset in childhood or adolescence, research suggests that there is a genetic component.

Although stress can be a factor in depression, some people don’t experience a life event that triggered their depression. There are individuals with chronic depression who blame their mood on their relationship or work, not realizing that their outer circumstances are only exacerbating an internal problem. For example, they may believe that they will feel fine when they achieve a goal or when a loved one changes or returns their love. They’re unaware that the real cause is that they’re striving to prove themselves to compensate for feeling inadequate, or that they have no life of their own, have sacrificed self-care for someone else, or that they feel unlovable and worthy of love. They don’t realize that their depression and emptiness stem from their childhood and codependency.

Codependents, by nature of their addiction to people, substances, or compulsive processes, lose touch with their innate self. This drains their vitality and over time is a source of depression. Denial, the hallmark of addiction, can also lead to depression. Codependents deny their feelings and needs. They also deny problems and abuse and try to control things that they can’t, which add to feelings of hopelessness about their life circumstances. Other codependent symptoms, such as shame, intimacy issues, and lack of assertiveness contribute to chronic depression. Internalized shame from abuse or emotional abandonment in childhood causes low self-esteem and can lead to depression. Untreated, codependency worsens over time, and feelings of hopelessness and despair deepen.

Codependency and depression can be caused by growing up in a dysfunctional family that’s marked by abuse, control, conflict, emotional abandonment, divorce, or illness. The Ace Study demonstrated that adverse childhood experiences lead to chronic depression in adulthood. All subjects with a score of five or more were taking anti-depressants fifty years later. Other causes of dysthymia are isolation, stress, and lack of social support. (Research shows that people in abusive relationships aren’t likely to disclose it.)

Psychotherapy is the treatment of choice. It is more effective when combined with antidepressant medication. Cognitive therapy has been shown to be effective be eliminating negative thinking to prevent recurrence of depressive symptoms. It may mean healing trauma and PTSD from prior abuse.

In addition, patients need to develop better coping skills, heal the root cause, and change false shame-based beliefs that lead to feelings of inadequacy and unlovability. Goals should be to increase self-esteem and confidence, self-efficacy, assertiveness, and restructuring of dysfunctional thinking and relationship patterns. Group therapy or support groups, such as Codependents Anonymous or other Twelve-Step Program are effective adjuncts to psychotherapy. Lifestyle changes, such as exercise, maintaining healthy sleep habits, and participating in classes or group activities to overcome isolation are also ameliorative.
©Darlene Lancer 2015