Anxiety- The Missing Stage of Grief

by Claire Bidwell Smith

  I was able to help George see that the panic attacks were a result of not processing both the guilt and the grief. After we worked through some initial coping tools to help him if another panic attack came on, we eventually went on to do the deeper work of first forgiving himself for the argument and then allowing himself to grieve.

  George was resistant to writing an apology letter to his father, so instead we recounted several other arguments George had had with his father throughout their lifetimes and looked at how each one had eventually been resolved and his father had forgiven him. After George allowed himself to realize that his father would have forgiven him this time too, only then was he able to truly let himself feel all the sadness of losing his parents. While George continued to grieve for a normal period of time, he never had another panic attack.

  It is inevitable that we will experience guilt when we lose someone suddenly, but if you have lost someone to suicide, the anxiety that can come from carrying so many layers of guilt and anger can be debilitating. As you do the work to move through the anger and make the amends you need to, you will see a discernible decrease in anxiety. There are many wonderful resources and books to help cope with suicide survivor’s guilt, and I’ve listed some in my resources section.

  PROCESSING LOSS TO ILLNESS

  Losing someone to an illness comes with its own particular variations of guilt and anger. There are countless people to blame for steps along the way that led to the death, and there are countless moments and decisions to second-guess. Having recurrent thoughts about things that could have been done differently is normal and natural. This is your brain’s way of eventually working its way to a place of accepting the reality that your person is no longer here.

  Having counseled so many people through hospice, I have met a great many individuals who feel angry or guilty that they did not do a better job as a caregiver or as a health advocate for their loved one. Over and over, I have listened to clients lament not trying different medications or procedures or getting second opinions for their ill loved one.

  Sometimes we are even angry with our loved one. We feel that they could have tried harder to get better or made different health care decisions. This is a more common feeling than you might imagine, and I’ve had many clients confess feelings of guilt for thinking these thoughts.

  Last, many people express guilt about not having understood that their person was really dying, lamenting that if they had better understood, they would have made different decisions. The first step to moving through this involves coming to terms with not understanding that death was approaching and then realizing that you can still make amends and say good-bye.

  WHY WE DO NOT SEE DEATH COMING EVEN WHEN THE PERSON IS SICK

  We are not properly informed by the medical team.

  We are in denial.

  We are attempting to be optimistic.

  The death truly was unexpected, even by physicians.

  The loved one themselves did not wish us to know.

  For many years, I was consumed with guilt over the fact that I did not make it to my mother’s bedside when my father told me she was dying. At age eighteen, driving by myself from college to her hospital in another state, I stopped to see a friend and decided to stay the night and go on to my mother in the morning. My father called in the middle of the night to tell me that she was gone.

  I was instantly sick with regret for not having gone straight to her side. For years, I beat myself up over this decision and felt that I was a terrible person and an unloving daughter for having made the choice to be with my friend that night.

  It was only years later, through the help of therapy, and also maturity, that I was able to understand that at age eighteen, I was too young not to fall prey to my feelings of denial. I finally understood that an unconscious part of myself could not bear to see my mother die, and that is why I did not go to her. There was yet another part of me that did not even believe that she would actually die.

  While working in hospice ten years later and encountering so many other grieving individuals who had similar experiences, I finally began to forgive myself and to see my choice as one typical of a teenager facing extreme stress.

  Dr. B.J. Miller, whom I introduced in Chapter 2, has helpful insight into the ways in which people sometimes end up feeling that they failed their loved one during the final days or months. “I have a couple of thoughts on this,” says Dr. Miller.

  The first is to just call this out—death is really hard. And closure is beautiful, but it’s an invention. It’s not that you or anyone else fails to reach closure or reconciliation—those things are not to be expected. Closure is a made-up thing. Nature didn’t create that. So if we’re failing, we’re failing at something that nature never designed us to succeed at.

  The second piece is that if I had to exercise one muscle in all this, it would be forgiveness. Let’s say your loved one had a spectacular death—you’re still going to come up with things that you didn’t get to, that you should’ve gotten to, and whatever else. So, I think that really, we just need to get much better at forgiving ourselves and forgiving each other.

  This is our problem as humans. We have incredible imaginations, so we can always imagine something better than what we have, and we have to watch that and we have to get better at forgiving ourselves.

  I myself have since heard countless stories of remorse for the way someone behaved around the time of death. There are people who didn’t answer the phone that last opportunity. And others who had recently shared harsh words that had yet to be resolved before someone died. And still others who simply wished they had been more present to their loved one when they had the chance.

  In a 2017 HBO documentary titled Diana, Our Mother: Her Life and Legacy, Princes Harry and William both speak candidly about the guilt they felt surrounding the last phone call they had with their mother.

  “If I’d known what would happen, I wouldn’t have been so blasé about it. But that phone call sticks in my mind quite heavily,” William said. When asked about his last words with his mother, he said he would never forget them, but he did not elaborate on what those last words were.

  Harry, who has admitted to continuing to grapple with grief over his mother’s death for the past twenty years, said that he will have regrets “for the rest of my life, how short the phone call was. And if I’d known that was the last time I’d speak to my mother, the things I would have said to her. … Looking back on it now it is incredibly hard.”

  When we carry this kind of regret and shame around inside us, it manifests in other symptoms—anger, depression, self-hatred, and, of course, anxiety. Finding ways to release the guilt and forgive ourselves is vital.

  RECOGNIZE TO LET GO

  So how do we go about releasing the guilt? First, we must recognize that it is fueled by our personal beliefs about ourselves and about the situation. The first step to reckoning with it requires an honest examination of the beliefs we are holding on to.

  For some, even just this step may take some work. I have found that sometimes grievers hold on to guilt as a way of holding on to the person they have lost. Some part of them feels that if they were to release themselves from guilt, then they might also be letting go of the person they lost, that if they let themselves feel free and happy again, they are not honoring the person who died. Dr. Miller suggests:

  When situations like this come up, I urge people to ask themselves, if your person were here right now, what would they tell you to do? And almost every time the person says, “Oh, well, he wouldn’t want me to suffer.” Of course. Because if you’re really trying to love and honor that person, what would that person tell you to do right now?

  In my experience as a physician, I do believe that we as a society could do death better. But when I really think about the person who is actually doing the dying, most of the time they’re doing all right. Even if there is pain involved, even if there’s lots of pain. We just don’t know what those shoes feel
like. Most of the time the hard part is for those of us who have to keep on living.

  What we as onlookers are witnessing of the dying process—the death rattle and these other things—that person is not actually feeling at all. That’s our pain. The hazard of projection is a huge one. But alternatively, let’s say your loved one did suffer. He’s not suffering now. You did what you could at the time. Suffering isn’t always bad. It teaches us things. Perhaps someone suffered and then was able to feel the relief that his death presented him. I do think so much of the anguish is in the family members who have to live on and witness these things.

  If you have found yourself in a similar situation, ruminating on a circumstance that perhaps does not call for as much guilt as you are feeling, ask yourself some questions. Ask if you might be holding on to guilt because you are afraid that letting go of it means also letting go of your loved one. If the answer is yes, then examine this idea. I know that in my case, this was partially true. I was afraid that letting go of my guilt and reengaging with my life again meant that I would be moving on from my mother’s death and, in turn, letting go of her.

  Dr. Miller shared a recent experience that also illuminates this point.

  Just recently, I was at a conference, and this guy came up to me and told me his mom had died a year and a half earlier. He was the one chosen to make the call to pull the plug. He explained that his mother had been very clear with him that she did not want to live on a ventilator, and she’d made it perfectly clear what he should do on her behalf. So he did that on her behalf, but he presented as feeling guilty and horrible about what he had done. So we talked about it, and the bottom line was that he did exactly what his mom had asked him to do. He did what she had educated him to do, precisely. He got no flak from doctors or nurses for making that decision, but still, it was like he was honoring his mother by blaming himself for the way she died.

  The truth is that we never truly let go of the people we love. Releasing negative emotions around the death, and finding meaning in our lives again, does not mean that we have forgotten our loved one or that we no longer miss them. Once you are feeling ready to release your guilt and forgive yourself, the next step is to examine the guilty thoughts.

  QUESTIONS TO ASK YOURSELF ABOUT YOUR GUILT

  What did you expect of yourself that you were not able to do?

  Were those expectations realistic?

  What could you have done differently?

  Were you hindered by emotional stress?

  Would your loved one forgive you now, given the opportunity?

  What would you tell a friend who made the same mistake you made?

  What have you learned from this mistake that you can apply to your current life?

  If after answering these questions you feel that your mistake was legitimate and that you truly failed in your expectations of yourself, then can you own your failure and take responsibility for it? This is called healthy guilt. This is the kind we learn from and grow from.

  If after answering these questions you realize that you are being hard on yourself and have been holding on to unrealistic expectations, then it is time to begin to release the guilt. Further into this chapter, we will explore various exercises that will help you in the letting-go process.

  Either way, remember that holding on to guilt—either the healthy kind or the negative kind—does not serve you and will hold you back from overcoming your grief and your anxiety. Doing this work now, even if it seems scary and hard at first, will be the very work that will set you free from these lingering feelings.

  RUTH’S STORY

  I began to see Ruth three years after the death of her husband. Ruth was in her early eighties and suffering from a medical condition that did not allow her to drive. Since she lived not far from my office, I agreed to pay house visits.

  In our first session, Ruth told me about the death of her husband, Bernard, three years earlier. Ruth wrung her hands as she spoke, anxiety crackling through her like electricity. “Everyone thinks I’m such a nice person,” she told me. “But really I’m awful.”

  She paused, her voice trembling. “I wasn’t there,” she explained. “The night he died, I wasn’t there.” Her eyes filled with tears, which spilled over, dripping onto her blouse.

  As she began to tell me more of the story, I sneaked glances around her home. Old photographs of Ruth and Bernard lined the shelves, and trinkets from their travels together dotted the tables. Ruth told me how they had met later in life, each becoming the other’s second marriage. Together for thirty years, they shared a happy, comfortable life together. “Thirty years, just like that,” Ruth said, snapping her fingers.

  A little more than three years ago, in his nineties by then, Bernard grew ill with several various afflictions. He sought opinions from different doctors, and Ruth struggled to sort out the different diagnoses and conflicting medical opinions regarding treatment. Bernard continued to grow sicker until it was apparent that he was truly declining. Finally, he ended up in the hospital, unable to feel comfortable at home. After several days, the doctors finally told Ruth that Bernard was not going to make it.

  “And here’s where I made the mistake of my life,” Ruth told me through her tears. She took a deep breath, shaking her head and wringing her hands some more. “I went home, Claire,” she finally said. “I left him there.” I nodded at her sympathetically, waiting for her to say more. “What kind of person does that?” she begged me to tell her, but I said nothing, wanting her to continue with the story.

  “I left him there, and I went home, and the doctor called in the middle of the night, and he was gone.” Ruth began to cry again, and I gently passed her a tissue, but she refused it, her tone suddenly growing stronger and angrier. “He died all alone in the hospital, and I was here doing nothing! For thirty years he took care of me, and I couldn’t be there for him at the end?! What kind of person does that to someone they love? A horrible person, that’s who.”

  Finally, all the energy drained out of her, she leaned back against the couch cushions, letting out a mournful sob. I waited for her to recover, and then I sympathized with how hard it must have been to lose him and what a wonderful relationship it sounded like they had.

  “It was all perfect,” she said. “Every minute of it. But I took it all for granted. And then I destroyed everything with this one awful act,” Ruth continued.

  I thanked her for being so honest about that night and how she felt about herself, and I asked her if we could take a closer look at what happened. She nodded tearfully, and we commenced a pattern that would become familiar to our future sessions—one in which Ruth recounted the actions that led to her guilt over not being there for Bernard’s death, followed by my attempts to deconstruct her beliefs around her decision that night.

  I began by asking her how she felt the night that she left Bernard in the hospital. She told me she felt scared and confessed that Bernard had always made most of the decisions around important matters. She felt overwhelmed by all the medical information and did not know how to sort through it. She also admitted that she felt very tired that night, that it had been a long few days of Bernard going through ups and downs.

  I reiterated how challenging it is to be a caregiver and how sometimes we don’t always make the most sound decisions when we are stressed and tired. “It doesn’t matter. I should have been there. I was being selfish, and he died alone,” she insisted.

  “Ruth,” I asked carefully, “did you know he was going to die that night?”

  “No,” she replied quietly.

  “Did the doctors say that he would die that night?” I pressed on.

  “No,” she said.

  “If someone had told you that he was going to die that night, would you have left the hospital?” I finally asked.

  “Of course not,” Ruth answered quickly, snapping her head up. “But it doesn’t matter,” she insisted. “I should have been there. But I wasn’t because I am a selfish, horrible person.”r />
  Over the course of the next few weeks, our regular sessions followed a similar pattern. No matter how many times I was able to poke holes in her belief system, Ruth would return to the story that she had failed Bernard because she was a miserable person.

  As we got deeper into the therapeutic process, I learned that Ruth had lost her father at age ten. He was a fisherman, and one day his boat was caught in a storm in the ocean off the coast of Washington and he drowned. What I also came to find out was that the morning he died, he called her, but she was too busy to talk to him. After his death, she was consumed with guilt for not taking his call. Her ten-year-old mind told her that she was a selfish person, and she never did the kind of grief work that would have helped release this negative thought.

  Almost seventy years later, at the end of her life, grappling with Bernard’s death brought this very old, very ingrained belief rushing up to the surface. Upon examining the parallels between these two losses and seeing how her old belief system had come into play, Ruth was finally able to begin to release her guilt around Bernard’s death.

  Yet still, there was some work to be done. Along the way, I had come to realize that, in addition to carrying around this old belief about herself, Ruth was also simply afraid to stop feeling guilty because she felt that in doing so, she would be letting go of Bernard. Thinking about him all day and fretting over her fateful decision had helped Ruth continue to feel connected to him. If she wasn’t puzzling over this piece of guilt, then would she still remember to think about him? Would she still be connected to him?