Dear Dr. Neimeyer,
How do I stop blaming myself for my mother’s death? She was 85 and 18 hours away from heart valve replacement, doing well, ready for it. She was told to walk some before surgery, and her last walk was fatal. I think I could have stopped her from overdoing it, but I wasn’t there. Other family was at the hospital with her, and I was to stay the last afternoon and evening with her. I took some time to paint my toenails, and take care of a few other things before leaving for the hospital. If I hadn’t done those minor things I could have been there and feel like the course of the day would have been different. This is hard for me to get out of my head.
Psychologists have a name for the kind of repetitive and self-accusatory thinking that you find “hard to get out of your head”—rumination. This sort of obsessive, circular thinking, while punishing and even anguishing, makes a kind of sense if we understand it as an attempt to make sense of a seemingly random and unnecessary loss—even if we do so at our own expense. And so what might we do to shake this pattern, and the sense of corrosive guilt to which it gives rise? Here are a few alternative responses that other bereaved people have found helpful.
1. The path of logic. Though seemingly plausible, the persuasiveness of your ruminative self-accusation relies on a delicate series of unsubstantiated assumptions. Did your mother indeed “overdo it,” or was she within the minimal levels of cardiac stress prescribed by the physicians? Could you have detected it if she were not? Were other family members grossly negligent, or were they attentive, just as you would have been, but sadly paid the price for their attention with their presence to her dying? If you had not taken a bit of time for self care and instead have been held up in traffic or at the nursing station, would you have held yourself accountable in the same way? Looked at closely, much of the tissue of which self-blame is made is insubstantial stuff indeed, and falls greatly short of what would be required to establish guilt in a fair court of law.
2. The path of compassion. If your sister or teenage child had been accompanying your mother on that final walk, or stayed home for a time taking care of themselves and daily tasks, would you be constantly attacking or accusing them of malfeasance as you are yourself? Would you berate them or lament their negligence in their presence as you do with yourself? That is highly unlikely. If anything, you are likely to feel compassion and empathy for the hard position they were in. Why then torture yourself with hurtful barbs that you would spare another person you love?
3. The path of humility. Though we sometimes would like to believe that we can control life’s negative outcomes, and spare those we love misfortune and even tragedy, life teaches us relentlessly that such control is elusive at best, and utterly illusory at worst. However attentive and careful we are—even to the point of obsessiveness—many or most of the outcomes are beyond our limited control, and in the end death will come to all. This truth asserts itself more and more forcibly as we (and our loved ones) reach venerable ages, as did your mother. Viewed in this perspective, the lessons of loss teach us the folly of grandiosity, and acceptance of our simple human condition. Coming to terms with this, and even embracing this truth, can allow us to ask, “What now is mine to do? Where can I contribute, if I relinquish the grandiose illusion that I can protect my loved ones from all suffering?” The answers, while more humble, can move us to make differences in the ways we can, and ultimately to accept that there are other outcomes that elude our inherently limited ability to predict and control the precious lives that our ours… for a time.