Dear Dr. Neimeyer,
My only sister died three years ago after a long battle with cancer during which I was a primary caregiver. She was like a second mother to me since she was sixteen years older than me, and I cannot say what a profound affect her loss has had on my life. Since she died, our mother has been diagnosed with Alzheimer’s, and she is deteriorating. I have tried to take care of her but have become extremely withdrawn, as being around family and friends tends to make me very uncomfortable now. Feeling bad for my mother, I planned a birthday dinner at her house tomorrow. Now I just do not feel that I can make myself go. It hurts me to see my sister’s family without her and to see her grandchildren with another woman. It hurts to see that my mother has forgotten her. Would it be ok if I were to set everything up for the dinner and just not attend at the last minute? I have a great desire to withdraw from my family permanently as being with them now, experiencing the hole that is left where my sister used to be and dealing with my mother’s illness just hurts far too much.
Although much of the social world may not understand the true meaning and impact of these twin losses for you–of your sister to cancer, and your mother by degrees to dementia–it sounds like you have experienced the collapse of two of the major pillars that have anchored you for a lifetime. Just as you imply, it as if you have lost your mother twice. Add to this the heavy demands of caregiving for both, and it is easy to understand that you feel depleted and reclusive, and feel the urge to recoil from gatherings that only make the past and present “holes” in the family that much more visible. It is a natural human impulse to draw back from that which causes pain, and to hunker down in a place of refuge.
And yet, it is important to consider the long run costs of this form of self protection, in effect providing a thin buffer from your grief at the cost of shrinking your world further, and leaving another hole in your family where third crucial “mothering” figure–you–used to be. To recognize the cost of this sort of retreat from pain, imagine that someone you know and love, perhaps a daughter of yours, were to break an ankle, and rather than following a painful but necessary course of physical therapy to return to full functioning over a period of months, chose to withdraw to her bedroom, avoid the prescribed weight bearing exercises, and allow her leg to atrophy to the point of becoming a permanent handicap. As her caring mother, would you support her retreat into a crippled and isolated life, or apply a gentle and compassionate press to help her return to functionality and a broader world of family friends, and meaningful relationships? What advice would your mother and sister give you if you were this child? Though life would be easier if it were otherwise, reaching through grief to re-engagement with life often requires persistence despite the pain, rather than avoidance of it. As you gradually take steps to reengage them rather than to abandon them, your sister’s children and grandchildren may one day thank you for it.