We live in a culture that values youth, spending millions of dollars promoting anti-aging products. Most of us live with a fantasy that we should and will live a long, happy, healthy life. When illness or aging comes to our door, it can feel like an unwanted enemy barreling down upon us. Aging and disease can enter our awareness and lives often sooner than expected.
Staring into the heart of emotional and physical pain unflinchingly is a problematic part of our work that can arouse fear and worry in the mind and hearts of us therapists. We want and often consciously or unconsciously need to see progress in our patients’ eyes (I use patient because it is derived from the word sufferer).
Michelle Lalouche-Kadden, Ph.D. is a psychologist and psychoanalyst in private practice in Solana Beach. She works with adults of all ages.
I am a relational self-psychological psychologist and psychoanalyst. In relational work, one must examine one’s and the patient’s subjectivity. Subjectivity includes transference/countertransference, gender, age, and everything involved within the context of the therapeutic dyad and their relationship to each other as it develops. I want to share my experience working remotely during the pandemic with a patient who faced illness and death in her spouse and immediately after his death, severe illness, and eventual death herself. My journey with her was one of dysregulation, anxiety, devastation, moments of calm, humor, holding, and finally letting go for both of us in our intersubjective experience.
When I think about aging, my own or my patient’s, I think about Robert Grossmark’s concept of unobtrusive companioning. The concept of being interested in and embracing the deep inner world of our patients (Grossmark, R. Psychoanalytic Dialogues: 698-712, 2016).
I also hold Robert Stolorow’s (Walking the Tightrope of Emotional Dwelling: Psychoanalytic Dialogues, 26:103–108, 2016) concept of emotional dwelling. In emotional dwelling, one leans in and stays with the patient’s experience, not only empathically but more deeply, staying and enduring the space of emotional and physical pain, in this case, impending death. In emotional dwelling, one does not provide soothing or reassurance, which can leave patients feeling not deeply understood and alone.
Being with emotional and physical pain, dwelling with and accompanying unobtrusively can be decidedly more challenging than working towards better emotional and physical health, which in some cases may not be possible. In accompaniment, as with emotional dwelling, we not only empathize and understand our patients but also stay with them in the face of impending loss, pain, and death, an experience we will all face one day.
My patient was aging “well” (health and wealth within her grasp), with life ahead seeming to be one of relief. She initially came to me fragmented, overwhelmed, and drowning as she became a caregiver to her very ill partner. Previously, she had lived carefree, shallow, and not emotionally connected to this person she had married years ago. She contacted me when he began his slow decline in their home. She could no longer take another lover or a trip on her own, feeling bound to him.
Our journey started in non-linear disarray. Through our empathic connection, she felt and took her deep longing to be heard, seen, and understood. Wants that had not been met in her childhood home of severe deprivation. Over time, she translated our connection intuitively into caring for her partner. Her emotional world never nurtured before, began to sprout with the nutrients we co-created. In time, deep longings and emotions emerged. Her hidden ability to self-reflect blossomed in our mutual gaze.
A moment of meeting occurred when she discovered that she needed to listen to others to have deep, meaningful relationships, the way I listened to her. This realization opened avenues and friendships never previously experienced. Hidden talents emerged, an artist, a designer of clothes, potentials that had never materialized.
As her husband flopped around, losing his “piss and shit,” fighting his deteriorating body, she suddenly found herself in charge of bills, finances, and computer passwords. Her hope for emotional repair was disappearing. Her despair was palatable.
Theirs was a complicated marriage. Spending more time apart, he at work and she in the arms of other men. Men who loved and admired her body. They loved and admired the shell of the body she knew as her-self. Her greatest asset and the barer of denied intimacy and love she so much craved. Admiration was the only love she knew. Longing to be loved, she sought temporary admiration in the penetration of admiring phallus.
Over time, caring for her husband became a repair for her. She could love him now and care for him deeply. Safe-keeping his body helped her to heal her deep sense of guilt and anguish over the superficial life she had lived with him. She recognized that she could feel close to him only now when he could not return her care, maintaining a protective distance. This came to our awareness with, at times, unbearable feelings of shame. The intensity of baring shame with her deeply touched parts of myself. Interestingly, as he became more impaired, she grew emotionally.
Overshadowing her hopes and dreams for a different future, she began to feel ill as he died. A diagnosis from 20 years ago of “histrionic” was on her medical record. She was met with treatment modalities seen through the lens of a diagnosis lurking in her medical records. This diagnosis created myopia to the possibilities of other causes of her pain.
She was of an age that believed “the doctor knows best .”She went through the various treatments they recommended for her for stress management. The institution the physician worked within did not return my efforts to collaborate with them while she bore the pain that kept growing in her body. Eventually, our work led her toward self-advocacy. The diagnosis was removed from her record.
Pain is a signal; it can signal many things. In this case, it signaled stage 4 cancer. When a diagnostic test was provided, death was barreling down upon her. I struggled to contain my feelings about the precarious nature of health and the sudden prospect of her death, for which we both were unprepared. Her wishes and dreams of one day going abroad, and seeing her friends in related and connected new ways, did not come to fruition.
Her impending death came on the heels of his death. We grieved together, first for their relationship ending and then immediately after, shifting our focus to her growing pain and illness. I felt with her disbelief and anger when finally, only four months later, our resignation that death would soon be her next and final step.
Our work continued. We delved into her dreams filled with confusion, hurt, unrecognizable objects, and a sense of impending doom. We faced her impending death with humor at times and horror at others.
Her last request for me to come to her home and have tea was never granted while I considered this possibility. We never met in person, but we met in the deep spaces between us. I will never forget her and our journey that finally took her life.
Emotional dwelling and unobtrusive companioning are concepts that held me. In addition, trusted colleagues helped me to bear the losses. I imagine, like me, dealing with the death of a patient or a friend or facing our mortality is given little prior thought. We may not want to see or feel these unknown dark places that face us all. My journey with my patient, while painful, left me with an experience I will never forget.