Coping with Loss: Denial

This is my earliest memory of my own denial in the face of loss. What I was losing when I was eight years old was the family structure that I had known for my entire life. There was mom, dad, older sister and I. It was not a perfect family by any means, but I was familiar with it. I was used to it. I found the prospect of having another child added to our family so scary as to be unacceptable. If a new child arrived, the relationships that I had become comfortable with would change forever. I would lose the attention of my mother and father. I would lose my role in the family as the youngest child. Faced with these losses, I simply refused to believe what my parents were telling me.

Gradually, as my mother grew larger, I had to accept that whether I liked it or not, the old family system that I was part of was on its way out. I remember some feeling of awkwardness and embarrassment that I was wrong, that I had made myself look foolish by insisting to my parents that they were wrong and I was right. Luckily, no one rubbed my nose in it, no one made a point of pointing out how wrong I had been back when the arrival of the new baby was announced.

It is not just children who have this reaction when they hear news they had not been expecting. In his book Lost in Place, Mark Salzman tells the story of how he called his father the day he was accepted into Yale University. Salzman never had an occasion to call his father at work before. He reached a secretary where his father worked and she paged him. After a few minutes Salzman's dad got on the line with an anxious hello, giving the impression that he thought it was the highway patrol calling to say that an accident had wiped out his wife and children.

Mark Salzman said: "I'm fine Dad. You won't believe this, but I got into Yale."

"What?" his dad asked.

Salzman told him again. There was a long pause. Finally his father said "Okay, let's not get excited yet. Call the admissions office and check. They might have stapled your application to somebody else's or something . . . " Salzman called the admissions office, and they assured him that his application had not been stapled or glued to anyone else's. When he called his dad back and told him, his father was speechless.

I do not mean to suggest that Mark Salzman's father believed that being accepted to Yale was a reason for grief. What I am suggesting is that we have a hard time accepting news that dramatically changes the structure of our family and how we view the world.

When I was about 14 years old, I encountered denial in a much more difficult form. My mother became ill, and after several months of treatment, she died. No one in my presence gave a name to her illness. Eighteen years later at a family reunion I was talking to a nurse who had been involved in my mother's treatment, and she finally named what illness my mother had: leukemia. In the 1960s when my mother died, this denial of illness was much more common then it is today.

Back in 1965 four students at Chicago's Theological Seminary approached Dr. Elisabeth Kubler-Ross, a medical doctor and psychiatrist who worked at a hospital in Chicago. These students preparing for the ministry admitted the helplessness and confusion they felt when it came to talking with people who were dying. None of them had ever talked with a dying person or seen a dead body. They ask if they could observe Dr. Kubler-Ross when she visited with a dying patient.

Dr. Kubler-Ross agreed, and she began a search of the wards at the hospital where she worked for a suitable patient. When she asked physicians at the hospital if they had any dying patients, they reacted much the way I did when my parents told me that my mother was pregnant or the way Mark Salzman's father reacted when his son told him that he had been accepted into Yale. Most of the doctors at the hospital told her that none of their patients were dying. They refused permission for her to speak to their patients and told her that talking to patients about dying was disgusting. The diplomatic doctors gave excuses why their patients were not good candidates for her to interview. The less diplomatic doctors told her she was a sick woman and refused to let her talk with their critically ill patients. Dr. Kubler-Ross noticed how everybody at the hospital avoided the subject of death. In this way doctors and others coped with their own feelings of failure and their own sense of loss when one of their patients died.

Thanks to a few doctors who permitted her to have access to their patients, Dr. Kubler-Ross began to find a few patients who were very willing to talk about the experience of dying. By the spring of 1967 she was leading a seminar on Fridays. Not one member of the hospital's faculty attended, but the seminar was very popular among the theology students and the medical students, and priests, rabbis, nurses, and social workers. She later wrote:

Once the patients started to speak . . . it was hard to get them to stop the flow of feelings they'd been forced to repress. They did not waste time with small talk. Most said they had learned about their illnesses not from their doctors but from a change in the behavior of their family and friends. Suddenly there was a distance and a dishonesty when what they desperately needed was the truth.

Word of her work eventually reached an editor at Macmillan publishing house. He offered Dr. Kubler-Ross a contract to write a book on dying patients. She finished the manuscript in two months and it was published in 1969. Five years later, in my first year of graduate school, preparing for the ministry, a teacher assigned the book On Death and Dying in a class I was taking. I read about a five-stage process on adapting to death. Dr. Kubler-Ross emphasized that the stages are coping mechanisms that she had observed in most patients. She said that the stages were more fluid than absolute. Some people pass through all the stages. Others will skip a particular stage. Still others will get stuck in one stage and never experience the other stages. And still others will pass through a stage and then revert to it later. Nevertheless, I found her model to be a helpful tool.

The first stage is denial. A nine-year-old child insists that his mother cannot be pregnant. A father of a teenager insists that Yale must have made a clerical error when they sent his son an acceptance letter. The doctors at a hospital insist that none of their patients are dying. A woman who hears that she has a serious illness says "It cannot be true. Someone has made a mistake." Denial is a defense, a normal, healthy way of coping with unexpected, sudden news.

The second stage is anger. It includes rage, envy, resentment, even hatred. Faced with loss our anger can scatter like buckshot hitting everyone, including family and friends.

If a person who is experiencing loss can express anger, they often move onto a stage of bargaining. Okay, Mom can have a baby, but I want a promise that I will not have to share my room with it. Okay, you can go to Yale, but you have to promise that you will come home for Thanksgiving. Okay, I accept that I have a serious illness, but I am going to live to see my children get married.

At some point when we experience loss, we find ourselves depressed. When we are depressed, it sometimes helps a great deal to talk openly to others who can listen. Other times when we are depressed because of a loss there are no magic words others can say. Saying a prayer, or simply sitting and holding a person's hand may be all that we need.

If we can work through denial, anger, bargaining and depression, we can often reach a stage of acceptance. Acceptance is not happiness, but it is also not anger or depression. It is period of quiet resignation or peaceful expectancy.

When we are under too much stress, denial protects us from the pain of facing more reality than we can bear. Denial protects us when we are under the full, sudden assault of difficult news. While denial is often described as an immature reaction that mature people have moved beyond, it is not. Looking at a great loss is like trying to look at the sun. Because it is so painful, we can only look at it for short periods of time. Denial is a natural process that protects us and helps us manage.

Sometimes, little by little our denial begins to break down as we let in the news. However, when it comes to death, many of us hold on to our denial, for months or even years. In Denial of Death, a Pulitzer Prize winning book, Ernest Becker wrote:

The idea of death, the fear of it, haunts the human animal like nothing else; it is a mainspring of human activity, an activity designed largely to avoid the fatality of death, to overcome it by denying in some way that it is the final destiny for everyone.

No one is immune. Underneath all the appearances of people the fear of death is universally present.

I remember a man who was suffering from a skin cancer. The illness was so frightening to him that he refused to seek medical help or to tell anyone. In isolation he hid his illness from others. He was constantly buying new shirts to replace shirts that he had stained with blood. When he finally went to see a doctor, his illness had progressed to the point that he only had a few days to live.

I remember a daughter whose eighty-eight-year-old mother was in a car accident. The mother was placed on a respirator to help her breathe and she lived for days and then months and then for over a year on that respirator. When I visited, I looked into the eyes of a woman who could not speak. I imagined that she was trying to tell me with her eyes that she wanted to be taken off the respirator. When I said this to her daughter, she ran from the room, refusing to talk with me, isolating herself from others. When the hospital staff also recommended that they remove the respirator, the daughter, at great expense, had her mother moved to a private nursing home, increasing the isolation of both the daughter and the mother. After thirteen months on the respirator my old friend finally passed on in the middle of the night, in spite of her daughter's wish that everything possible be done to keep her mother alive.

Denial is healthy when it helps us retain our sanity and our ability to function. Denial is a problem when, because of it, we do not receive help that can improve our lives. It is a problem when we prolong the lives of others because we are in denial. And denial is a problem when medical staff and clergy cannot help others because of their own denial of death.

Dr. Kubler-Ross's book became a best seller and had a positive impact on how we live and die. Patients and their families spoke publicly about how much they appreciated her work; however, in this success the other doctors at the hospital where she worked found another reason to resent her. In 1969 Life magazine came and photographed one of her seminars and this woman doctor from Switzerland became famous. Still the hospital staff where she worked was not pleased. The day the Life magazine article appeared, the first doctor Kubler-Ross saw at the hospital said to her in a nasty tone: "Looking for another patient for publicity?" A hospital administrator criticized her for making the hospital famous for dying. Others say that the Life article was proof that Kubler-Ross was exploiting her patients. The hospital administration ordered doctors not to cooperate with Kubler-Ross. The Friday after the Life article she faced a virtually empty lecture hall, for her seminar. In frustration she eventually left the hospital, and devoted her life to writing, lecturing, and leading workshops. About this experience Kubler-Ross wrote in 1982:

If you have a clear conscience and are doing your work with love, others will spit on you and try to make your life miserable. Then ten years later, you are honored with eighteen doctorates for the same work.

In other words, the first reaction to her work with dying patients was denial. Still, over the years the denial of the medical establishment started to break down. Today thirty-one years after Kubler-Ross published her first book, when I visit hospitals or talk to clergy, everyone I talk to is aware of denial as a common reaction to loss. Still, it is one thing to be intellectually aware of an idea in a book, it is another to be able to integrate awareness into our hearts and souls so that we can use denial to help us cope with the great stresses of life, while not letting our denial harm our health or render us ineffective in trying to help others. That is the struggle.

In April of my ninth year a baby brother was born into my family, and in spite of all my initial denials I found him to be interesting to have around. Two years later a baby sister came along, and I also found her interesting. Today my baby brother lives and works near Annapolis, Maryland. By profession he is a chef, but by vocation he is an artist. His real love is to start up his chain saw and carve large blocks of ice into swans or doves or whatever strikes his fancy. When I eat one of his excellent meals or see his sculptures, I am glad I was wrong and my parents were right forty years ago. Change is hard, but it is inevitable, and it can lead us in beautiful and exciting new directions.

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