Dear Dr Neimeyer,
I am in a state of parental distress, anticipatory grief, and I’m not sure what to do.
I’m 68 and my eldest son (whom I’ll call “Tom”—not his real name) is now 38. The bottom line is this: Tom has a drug habit that is killing him, and I am experiencing anticipatory grief. If Tom does die, this would be the second child our family has lost. The first child we lost was Norman (not his real name). He had a broken heart (broken love relationship) and died by suicide 12 years ago, aged 20.
Tom’s spousal relationship is completely broken and toxic. He is also prevented by the court from seeing his children and this has caused him unbearable heartbreak (which I think is a major reason for him to live in the blur of drugs). But it also connects Tom to his lost brother.
I can’t even formulate a sensible question out of all of this. Whatever happens, I expect it will involve pain for those of us who love Tom. If you have any comments or observations, I would be grateful.
Many thanks,
Bill (not my real name, because I am still clawing my way from SHAME—a journey that is virtually complete, but which pulls at me now and again)
Dear Bill,
As I read your heartfelt letter so filled with anguish, a part of me is counting your losses, as well Tom’s. Not only are you contending still—and apparently with some success—with the wrenching grief and shame following Norman’s death by suicide, but you are also filled with foreboding and anticipatory grief over the seemingly inevitable loss of your older son to addiction. And each could bring in its train a host of secondary, but very consequential losses: of control over Tom’s erratic and tragic course, of the sense of family you likely had as a young father, of what was likely a secure and protective bond with both of your boys in more innocent days, perhaps loss of hope that Tom can climb out of the deep well into which he seems to have fallen, and the future that you imagined for your family following your retirement. Significantly, all of these heavy losses are likely to be borne silently much of the time, as there are no cultural rituals, no funeral services, no casseroles brought by caring neighbors when what has been lost is a cherished past, a wished-for present, or your future dreams.
Of course, even in your brief account, it is clear that Tom’s losses are equally heavy, even if they are compounded by the way he is coping with them. He no less than you suffered Norman’s death, a fate that he could not prevent as a big brother might well expect himself to. How he carried that loss into his relationship with his wife is impossible to guess, but one could imagine that those earlier wounds might have been reopened by a difficult relationship that could have conjured the specter of further abandonment, and as it evolved, the loss of his own children. And he, also like you, is likely fighting a battle with shame—and apparently losing.
So, what might be done in connection with all of this suffering and loss, across at least two generations, and likely a third, as Tom’s children now grieve separation from their father? Here are a few humbly offered ideas, with no implication that a few easy steps will turn this around.
1. Start with understanding. This is easier said than done, as there is so much in all of this trauma and tragedy that is senseless, to the point that, as you note, it is even hard to formulate a sensible question about it. Perhaps a place to start is with yourself, and your own world of tumultuous emotions, as you seemingly watch your elder son following a course that looks like suicide in slow motion. I don’t use that phrasing lightly, as drug abuse commonly follows a chaotic course in which hope is dashed again and again, and the helplessness of the family extends over a period of years. And if as too often happens, the user dies of overdose—intentional, accidental or ambiguous—our research tells us that the prolonged grief and posttraumatic responses of family members closely mirror those that follow suicide. So, exercise self-compassion and self-care where you can, so that you can extend that same care to others.
2. View Tom through X-ray glasses. By this I mean look beyond his surface behaviors, perhaps of anger, and certainly of avoidance in the form of drug-related coping, to the pain that he carries historically, in his present sense of being trapped, and in his feared future. If his drug use arose as a way of managing his grief for his brother or the current loss of his family, the best-intentioned efforts to wean him of substances are likely to fail until he has some other way to deal with the pain and problems to which the drugs are an intended solution. Finding help at that level would be a high priority.
3. Reach out for assistance beyond the family frame. If love alone could have saved your sons, both would be alive and thriving now. But as essential as it is, it so often is not enough. Nor are many addiction treatment programs, unfortunately, as they too will often orient to a presumed set of universal steps to sobriety devised a century ago, before the psychology of grief and trauma, and effective family therapies were even invented. If I were in your shoes, I would seek a therapist who has deep experience with grief, and ideally grief after suicide, as well as working with addiction in a family-focused frame. If you can’t find those competencies in a single therapist or treatment program, I would look for two providers—one to attend to the private emotional pain that contributes to Tom’s drug use, and another to address the substance use itself. Perhaps seeking a family level consultation that involves you, your wife and Tom would be a place to start. Tom’s best chance of getting his kids back will come after he gets his life back, and the drugs are taking that from him, one dose at a time.
–Dr. Neimeyer
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