by Joseph Precker
“Dear Dr. Precker:
“I’m very upset as I write this letter, since I don’t believe you, or anyone else, can help me now! I’ve just learned that my therapist has suddenly died, just when we were beginning to make progress, and I felt, for the first time, that I could trust another human being.
“I’ve had relatives die, and even a few friends and acquaintances, but they were not an important part of my personal life. It’s impossible to cry and no one will understand if I scream. Toward whom, or what, can I be angry, without people thinking I’m crazy?
“At bottom, I feel alone, abandoned and this, heavy sadness, a great sense of loss, helplessness and without energy. In your opinion, what can I do, if anything?
First, allow me to offer my condolences in this unfortunate situation. It is always a shock when the Grim Reaper comes along, particularly if the person is young, vital and apparently in good health. If, in addition, the person plays an important role in one’s life, the loss may have profound effects, but that does not have to mean the end of the world.
The feelings you express (“deep, heavy sadness, a great sense of loss, helplessness and without energy,” plus inability to cry, some wish to scream, unfocused anger, a feeling of abandonment) are characteristic of depression.
Whether your reasons for visiting a counselor/ psychotherapist were related to depression or not, what you describe now seems to be a classic portrayal of clinical depression, exacerbated by the very real loss of a person playing a significant role in your life.
There are many factors contributing to depression, but there is a characteristic pattern which may follow the loss of an important person. A brief review of the psychodynamics involved includes the following: a sense of abandonment which may involve old feelings of being unworthy and rejected, accompanied by strong feelings of anger. Yet, under most circumstances, it is not “socially acceptable” to be angry with the dead, particularly if they died “an innocent death.”
Therefore, the anger cannot be expressed, nor does the individual sufferer allow himself, consciously, to acknowledge the anger. As a result, the anger is repressed, kept out of conscious awareness and turned against the self. The resulting feelings become those characteristic of deep depression.
Most of us, deep down, have at least some feelings of being “abandoned,” and resulting anger. There is no mother, or loving substitute, so perfect that all our needs, from infancy onward, are immediately known, heard, attended to. Even the best mother or friend or spouse or lover must attend to their own affairs and cannot be immediately available to serve our needs, small or great.
Psychotherapists and child psychologists no longer expect to find the perfect mother or mother-substitute but hope that each of us might be lucky enough to have the “good enough mother.”
Also, in serving those who come to them professionally, well trained clinicians work hard to be “good enough” substitutes, on a short-term provisional basis, for all those important people in our lives who did not serve us well enough, such as fathers, mothers, sisters, brothers, teachers, bosses, friends, spouses, lovers, etc., but never (if they are wise and professional) taking the place of any of these significant persons, and always, at appropriate moments, pointing out that the client is confusing the real person they are with (the therapist) with other people, or with an ideal, or with a symbolic representation of a “significant other.”
The feelings experienced may be positive, negative or ambivalent and are usually highly charged, thereby providing a valuable vehicle for the experienced professional to make progress in clarifying the life situation and the psychological needs and confusions of the person seeking help.
Much of what I’ve said above may seem to be of little relevance to you in your present plight but, based on what you wrote, perhaps there is more pertinence than you might think.
For example, you said that your therapist was a human being you could trust “for the first time.” According to Erik Erikson, the first major crisis we humans have to deal with is the crisis of trust, and this happens to be the first year or two of our lives in relation to the single most important relationship we are likely to experience, our relation with mother or mother substitute.
Is this person there when we need them? Consistent? Responsive to our needs? Do they answer our calls of distress? Do they provide us with warmth, comfort, food, caresses appropriately and reliably? Or are we left alone, unrewarded, in effect “abandoned?”
An early sense of abandonment is very likely to permeate our entire psychological functioning, leading to doubt, distrust, even to self-loathing (“If I’m abandoned, that must mean I have no human value!”) And what is the most fundamental and totally irreversible abandonment of all? Simply, DEATH.
Turning to your question, “What can I do, if anything?” First, allow yourself the realization of how fortunate you were in finding someone you could trust. If there appeared one trustworthy person in your adult life, almost certainly there must be another, or others. (Nature very seldom, if ever, creates just one copy of any biological form.)
Realizing that someone paid attention to you and to your needs, it may be a very good idea to go in active search of someone else who may be equipped to do so. Don’t limit your search, but spend time with several of the professionals in Tokyo who may be capable of carrying on your therapist’s work, in order to find someone with whom you feel comfortable.
At the same time, allow yourself to mourn. Mourning and expressions of grief are very important human functions. If you have religious beliefs, go through the rituals prescribed within the framework of your religion. Or, alternatively, follow the forms acceptable in your therapist’s religious background.
Speak about the loss, particularly with others who knew this valuable person. Attend memorial services or testimonials. Remember, and keep reminding yourself, that the departure of this person is not aimed at you. Jesus cried out because he felt “despised and rejected,” but nothing you have written indicates this was the case for you.
The dead person, and his loved ones, have lost the most. You have gained an important experience which may help you deal with subsequent loss in the future. All of us, sad to say, must eventually lose some of those of great significance to us.
The pain is deep and mourning may well continue for a long time. But remember, your therapist’s work with you had as a major aim the intention of making you feel, act, enjoy the process of being vital and alive. Perhaps the best tribute to the deceased, and to yourself, would be active re-engagement with the excitement of being truly alive, within the framework of your own personal needs, desires and resources.
Best wishes in the exciting enterprise that lies ahead! And may you find a “good enough” replacement.