We usually think of grieving as healing from losses that we have already sustained, yet we can also cope with losses before they occur. Healing beforehand is termed anticipatory grieving. Since anticipatory grieving prepares us for our new world of the future, it is also termed preparatory grieving.
Anticipatory grieving is similar to grieving for past losses in two ways: The symptoms of acute grieving appear as soon as we are forewarned of the loss, and we must perform the same tasks to recover from past and future losses. The main difference is, because the real world has not yet changed, we must start re-drawing our world-image from imagination, not observation.
The opportunity to cope with a future crisis is precious, for it gives us time to brace ourselves for the loss, and to prevent at least some of its associated losses. For example, if a man knows that he will lose his job in three months, he can use those 90 days to look for a new job--provided he faces his anticipated loss squarely and manages his anger-energy effectively. By preparing in this way, he may prevent the loss of his home.
Unfortunately, many people lose the advantages of preparing for their loss. Some ignore the impending loss because they want to avoid the pain of losing. Others magically think the loss won't occur if they disregard it. Regardless of the reasons, if we don't prepare when we have the opportunity, we risk paying an even higher price. This is especially poignant when we expect death--a loved one's, or our own.
Anticipating our own death means expecting many associated losses: everyone we love, everything we cherish, and every plan we nurture for the future. We won't be able to grieve for these losses after we die, so we must prepare ahead of time--if we have enough time. On the other hand, our surviving loved ones aren't limited in time. They can postpone their healing until after we die. These different time frames make couples especially vulnerable to estrangement during anticipatory grieving.
Recall, for example, the crisis of Frank and Melody, the couple you met briefly in Chapter 5, "Mastering Guilt." Melody was receiving treatment for cancer, and though her treatment slowed the course of the illness, it didn't cure her.
The couple knew that Melody's impending death would mean major losses for each of them. However, each faced different losses at different times. These diverse viewpoints separated them, and each of them was confronting a serious crisis alone. Their story shows how this happened and what they did about it.
Frank and Melody hadn't been apart for more than a few days at time during their 30 year relationship. After they learned that Melody's treatment might not cure her, however, they realized that they could be separated permanently. Unfortunately, they coped with this knowledge in different ways.
Melody stopped using denial fairly early, and had come to the point of facing her death directly. She knew that she would lose, not only Frank, but everyone and everything that was precious to her: Her body, friends, and home; her neighborhood, pets, and flowers; her books, records, and piano; her sky, river, and mountains; her hopes, dreams, and plans for the future. Everything.
Melody knew she could never recover her losses. She needed to prepare for these losses, but she didn't know how to do this. More than ever, she needed the support of her closest friend--her husband, Frank.
Frank, however, didn't support Melody. Instead, he unintentionally undermined her. He was overwhelmed by his own problem: the looming loss of his greatest treasure. His anticipated loss was too painful for him to think about, so he continued to deny it.
Frank withdrew from Melody because he was drawn into a perpetual obsessive cycle to maintain his denial. He worked heroically to keep her alive, but she continued to become sicker. This made him work harder. And the harder he worked to keep Melody alive, the more he retreated emotionally from her.
Melody was losing Frank as though he, not she, were dying. As though they had switched places, she had turned her attention to grieving for losing him in the present, rather than preparing for her own future death.
Ironically, loneliness was the price they were paying for their love. Because Frank wasn't giving up his denial, he was losing Melody long before she died. Because he did not deny this, he was experiencing profound guilt. This was his reason for agreeing to discuss their problem with me after Melody suggested it.
After introducing ourselves, I asked the couple to describe their problems. Melody began.
"I'm dying of cancer, and . . . "
"Don't say that," Frank snapped. "You're doing much better."
I said nothing, waiting to watch the developing pattern. This didn't take long.
"You're always interrupting me," Melody wailed at Frank. "You don't think I have anything worth . . . "
"I don't interrupt you," Frank interrupted forcefully. "You just don't pay attention."
"I don't pay attention. What about that can of tomatoes I needed for the sauce?" Melody leaned forward in her chair and stared at Frank. He met her challenge squarely.
"I got tomatoes!"
"Fresh tomatoes! What were you thinking?"
This was enough. Frank and Melody were engaged in an ongoing conflict at a superficial level, but they weren't addressing the real problem. Further, they were acting as adversaries when they needed to be partners. Maintaining their conflict was draining their energy and wasting their limited time. To help them find common ground, I wanted to change their perspectives as soon as possible.
"Melody, you started to talk about `dying of cancer.'"
Then I looked at Frank. "And you didn't want to hear about it. I suspect this is a major reason for your conflict."
Both of them looked at me with surprised expressions. They had been so absorbed in their battle, they had lost track of me, the outsider. They remained silent to listen.
"Frank, why don't you finish what Melody started to tell me."
Frank appeared staggered by my asking him to promote Melody's argument while he was preparing to attack it. He swallowed hard several times and flitted glances around the office as though seeking refuge. Then, he haltingly started to reply.
"She has cancer . . . . She's being treated."
"Thanks. Go on," I said. Clearly, by forcing himself to take Melody's perspective, Frank could not maintain his denial. He continued.
"The treatment's working pretty well. But the side effects are bad. She's weak. She vomits without much warning. We can't go anywhere."
By retreating to his denial, Frank found it easier to talk about Melody's symptoms and treatment than about her looming death. Nevertheless, Melody patiently settled back in her chair, and caressed Frank with warm, understanding eyes. I continued.
"You aren't vomiting, Frank. Do you go out?" I asked.
"I do the shopping. That's about all."
"Do you stay home because Melody can't go out?"
"Of course. We used to go places together. Now we stay home together."
Melody smiled at this and lifted her hand to interject a statement. "May I say something? I've been arguing with Frank a lot lately, but I want you to know that he's precious to me."
It was Frank's turn to smile. He gazed quietly into Melody's eyes. Rather than losing his battle by voicing her point of view, he had won her esteem.
"It's obvious to me that the two of you love each other very much. It's also obvious that you know each other so well that you can speak for one another. Melody, it's your turn. Would you tell me about Frank's biggest problem?"
She started to speak when she caught Frank's protective gaze. She dropped her head and started to cry into her ever present handkerchief.
"Are you crying for yourself? Or for Frank?" I asked.
Melody answered me by looking at Frank. It was clear that she had taken his point of view. Seeing this, Frank couldn't contain his own tears. He arose from his chair, crossed the room, and hugged Melody. They held each other and wept together for a few minutes.
After Frank settled back in his chair, Melody looked at me and asked, "What did you ask me?"
"I asked you to tell me about Frank's biggest problem."
Melody's answer came quickly, as though she had rehearsed it often. "I am his problem. If he didn't love me . . ." Melody's voice dissolved in tears.
Frank fidgeted, as though preparing to help her. With a hand gesture I asked him to hold his thought. Then I waited for Melody to regain her composure before I spoke to her again.
"You are his problem? That's pretty brutal. Would Frank agree with you?"
Frank flicked a sharp glance at me as though to shield Melody from difficult questions. But she answered, anyway.
"No, he wouldn't. Frank would say that his biggest problem was seeing me suffer."
"Is she right, Frank?"
Frank inhaled deeply, and then exhaled completely before he answered. "Of course. As she said, if I didn't love her, I wouldn't be upset." Then, he cautiously amplified his answer.
"But I worry about the future, too. I don't think I could live if she didn't."
Melody realized the significance of this immediately. She had been waiting a long time to share her grieving with him.
"I don't want to lose you, either, Frank. But I will, and I know it. I just don't want to lose you before I die."
As she started to weep, Frank bolted from his chair and pointed his finger at her accusingly. "You keep talking about dying! You sound like you want to die!" His denial wasn't leaving gracefully.
Melody squeaked faintly, shrinking from Frank's attack. She looked frightened, frustrated, and disappointed. Then she said she was sick at her stomach.
"I'm sorry," Frank said, retreating from his attack and replacing his frown with a concerned expression. He handed her a plastic basin he had brought, but she didn't need it. Then they both sat silently, perplexed by their new situation.
In her excitement, Melody had started too fast for Frank. He needed time to adjust to her point of view. He also needed to be assured that his problems were important, too. I decided to address the nausea episode to help him with this.
"Frank, I noticed how considerate you were by helping Melody when she felt sick. When she was in trouble, you were right there for her.
"Melody, is Frank always this tender with you?"
"Always. I couldn't imagine a more attentive nurse," she said through a smile.
"I thought so," I observed. "Frank, how do you feel when Melody gets sick?"
"I feel sick, too. I want to help her."
"You are very empathic with her, it appears. Does Melody show you as much empathy?"
"She always has. Until lately."
Hearing this, Melody looked thoughtfully at Frank. She appeared, not upset, but curious.
"What do you mean?" she asked.
"I don't know how to explain it," Frank responded, looking first at Melody, then at me. "I just don't think she understands me anymore."
Melody stiffened. Her previous remarks had revealed that she understood him well. Yet, she said nothing and listened as Frank and I continued.
"What is the most important thing you want Melody to understand about you?" I asked.
"I don't want to lose her. I want . . ."
Frank's answer was interrupted for a few seconds by his sobbing. Then he continued.
"I want to make her well again."
"I'm sure you do. Do you understand that, Melody?"
"Of course, I do. Don't you think I want to get well, too?" She addressed this question to Frank.
"It's not the same. You're always talking about dying. You don't talk about getting well."
Melody started to say something, but I stopped her. I didn't want dying to be the subject yet. Melody's death was still too raw a topic for Frank.
Melody answered. "It seems we never talk. We just argue."
Frank nodded in agreement.
"I want to encourage you to talk with each other. After all, talking isn't difficult. The problem is, certain subjects are easier to discuss than others."
The couple watched me, and waited to see where I was leading.
"Arguing the way I you have been isn't talking with each other. It's just blowing off steam.
"It's a good idea to learn to stop an argument when one breaks out. You can do this by retreating.
"From what I've seen so far, it's fairly easy for both of you to talk about Melody's treatment and its side-effects. This is a good place to start. This subject may be a safe place for retreating if you start arguing.
"Another way to retreat is to pull back literally. One of you can say, `Excuse me. I'm going in the other room for awhile.' And, to avoid hurting the other person's feelings, it's a good idea to add, `I'll be back soon.' This should alert your partner that you think a retreat is in order."
"Who should do this?" asked Melody.
"Either of you. Whoever is first to identify a useless argument. Okay?" I asked, looking at Frank. He nodded, and I continued.
"At first, it won't be easy to retreat because it requires breaking a habit. But if both of you practice retreating this week--even when you aren't arguing--you'll master it."
Next, since I had identified the couple's primary communication problem as Frank's inability to deal with Melody's approaching death, I made a special request of Melody.
"Melody, for this week only, I want you to stay away from any subject that you know makes Frank uncomfortable. Will you?"
"I can do that." She smiled.
As they were leaving the office, I reminded the couple to practice two things: talking with one another about easy subjects, and retreating when they couldn't. I also assured them that their working together as partners showed that their relationship was intact.
Next, I reminded them of a key point about communicating.
"Remember that talking with one another requires two things: talking and listening.
"Frank, you have a problem with listening. Every time you hear Melody identify a problem, you feel that it's up to you to fix it. For example, if she says she feels nauseous, you get her a basin. There's nothing wrong with that, but her problems aren't always as simple as that.
"Sometimes, Melody feels lonely and isolated. You can't fix this problem by bringing her a basin or by talking about her treatment.
"To help Melody with her loneliness, you must listen. Listen to her, and let her know you are listening. Don't do anything else.
"Melody, your part in this is to start your conversation with Frank by explaining exactly what you want--you want him to listen. After practicing, this won't be necessary, but listening to you talk about difficult subjects is a new idea for Frank now. He needs your help."
The couple attended to my remarks together, as partners. They held hands and looked at each other frequently, and they nodded their agreement when I asked them to practice listening.
Frank and Melody were fortunate because they were highly motivated, eager to learn, and flexible. They changed their behavior patterns quickly, so they didn't need psychotherapy. Instead, my work required only a few sessions for teaching and counseling.
"While we were talking about the treatment yesterday, Frank asked me, `What if it doesn't work?' He has never admitted before that the treatment might not cure me.
"I told him that the treatment had been doing something. If it hadn't, I would have been dead already.
"This seemed to hit Frank between the eyes. He knew I was right. He started crying, and I cried, too.
"After awhile, we stopped crying and looked at each other. Then, we started laughing.
"Frank told me, `Let's enjoy your being alive now.'" Melody's eyes filled with tears, which seemed to magnify her cheerful laugh. "That was all I wanted to hear!"
Frank, too, smiled in appreciation. But he didn't say anything.
"How do you feel right now, Frank?" I asked.
"I think I can talk about anything now. Before Melody showed me that I could have already lost her, I felt cursed. Now, I feel blessed. She's here!"
"Thanks to you. Now, we can now solve some other problems.
"Frank, do you remember when I asked you to tell me what Melody started to say?"
"Of course," he replied. Then he proceeded without my prompting him.
"She knows that she is living on borrowed time. I know that, too. She has wanted to talk with me about dying. But I haven't been helpful to her. I want to help her from now on."
Melody gazed at Frank lovingly--and proudly, it seemed. She seemed confident that, from now on, they would be on the same side, partners and lovers again.
Indeed, Frank and Melody were of great help to one another over the next few weeks. Frank helped Melody by listening to her express her anger about dying. Melody also helped Frank by listening to him express his anger about losing her.
It was during this time that Frank felt guilt about his problem-solving dream. Because he and Melody were intimate in expressing their feelings, she was able to help to him with this, as well.
I phoned Frank last week, two years after Melody's death, to ask how he was doing. Today Frank cherishes his memories of the times he and Melody spent together during the last few months of her life.
He told me that grieving with Melody for her anticipated death had been one of the most deeply rewarding experiences of his life. And, he told me, of Melody's.