FreePsychArticles #7 A Mourning Story
Not long ago a 45 year old woman arrived for an Initial Psychiatric Interview. From her early childhood she had suffered serious abuse within a chaotic family system. Personal boundaries were often blurred or nonexistent. She struggled to survive among extremes of unpredictability, and violence.
In her attempts to adapt to a maladaptive family she found herself gravitating to a life of “drugs, sex and crime.” She had several related arrests and incarceration. About sixteen years ago she gave birth to her only son but was completely incapable of raising him so her mother assumed the role.
A few months ago, in her mid-forties, she was blessed with the insight she could not continue on her self-destructive path. She went through a program and became clean and sober. Her goal was to re-establish a relationship with her son and set an example of “what one could do if truly desired.”
Once she was free of substances, all her emotional turmoil began to flood back and she gradually realized she needed help from Mental Health professionals. A month before her scheduled appointment for a psychiatric intake she entered the local clinic taking the first step toward her own mental health by going through the screening and enrollment process. The second phase of this process would be meeting a psychiatrist.
One week before her meeting with me she received crushing news. While her son waited on a bus stop to go to school a car load of local “gang bangers” mercilessly gunned him down with multiple rounds of ammunition. The story was so shocking it came out in the newspaper. When she arrived to my office she was preparing for the boy’s funeral the following week.
As I attempted to conduct the interview I was overwhelmed and humbled by the extent of her grief. I had a job to do and managed to get enough information to arrive at a presumptive diagnosis and treatment plan. Yet that was clearly not enough. She nobly attempted to restrain herself but the tears flowed almost silently throughout the entire interview. (Yes, and at times so did mine). I knew I had to try to help her in that moment. It was her first exposure to a ‘professional psychiatrist’ and on some level might well judge the entire clinical community on what happened at that minute.
But what could I say? She had “been around.” With her street smarts she had an acute sense of what was real and genuine and what was not. It was not a time for platitudes or cliches. The purpose for her life appeared to have ended in that rash of violent madness a week earlier. She was at a great risk of relapse or worse, much worse.
In times when I am at a complete loss and don’t know where to go I return to Torah. The only thing I could think of was how we Jews have been taught to navigate through the grieving process with the laws of “aveilus (or mourning).” So, I attempted to further bridge the gap between her suffering and the future, between the doctor and the patient, and between death and life…
She sat quietly waiting for something she hadn’t heard before that might relieve her pain and bewilderment. Realizing she really wanted me to speak I began. “There is a people that has a unique set of laws of mourning prescribed by G-d. (She had told me she believed in G-d previously) When a parent dies, the surviving child is obligated to follow them as prescribed for a one year period. They entail reciting an additional prayer (Kaddish) to the three daily prayer services. Public displays of joy are prohibited so festive and musical gatherings are avoided. All this to fully mourn the passing of a parent…
“…But when there is a death of a sibling, spouse or child these laws are observed for only thirty days. This may seem very unusal or even inappropriate. After all, most of the time a parent dies in old age having lived a full life. Their death is the natural outcome of normal living, and generally comes as no great surprise or shock. There is sadness and grief but life goes on…
“…In the case of the other relatives thirty days mourning seems to almost trivialize these deaths. Often times they are experienced with a greater sense of shock, disbelief, bewilderment and pain. The shear awareness of the life cut short can be almost too much to bare. This is especially true in the death of youth (and all the more so in the extreme case of this unfortunate woman’s story)…
…”what can we learn by this difficult practice? Once the funeral is over and things begin settling back into the routine of life the mourning must stop. In G-d’s Omniscience He is telling us, “move on.” He doesn’t want us to hold on to our suffering through a whole year like with the parents, but rather to move on and live on for that lost loved one. The year of mourning takes us through each of the recurring events in the cycle of life and allows us to release the soul of that parent as experienced through every step of the way. But for the others, we are compelled to move on and continue where we were in a forward looking direction…
“…There are others in your life who need you and although you were unable to serve his needs in life, you must try to serve them in his death. In some inexplicable way this was the meaning of his life, to bring you to save your own. His mission requires you to help complete it. Would he want you to fail and end your life?”
By now she was quiet and calm, not without tears, but clearly effected. She answered, “no, he wouldn’t want that.” I gave her a prescription, the next appointment and we said good bye.
Two weeks later she returned for a follow up. The funeral was moving beyond belief and not a dry eye remained. She admitted at one point she leaned toward the casket as it was lowered into the ground and family members held her back. She’s planning to move on with her life. The medications were helping and she’s gaining support from the clinic and some family members.
The religious clinician is in a position to utilize the best in modern clinical medicine and diagnostics. Medications serve to reduce the major symptoms and obstacles of those afflicted with major mental illnesses to establish a “level playing field.” But once this occurs the long term work of rehabilitation and integration into life goes on. In those with an awareness of the spiritual journey, the need for faith and belief guidance with the basic principles of Torah are a welcome part of the treatment. For those who deny the role of G-d and faith I do my best, with G-d’s Help.
Gershon Freedman, MD