Distress and Avoidance After Child Loss

      It was three years after the passing of her 4 year old daughter, Allison*, that Emma* was finally ready to enter Allison’s bedroom.  Since Allison's death, Emma couldn’t bring herself to open the door let alone pass beyond the threshold. Allison was diagnosed with a rare form of cancer and, despite grand efforts of chemotherapy and treatment, passed away in a hospital bed at the threshold of life.  “I died the day she did,” the mother told me.

 

     Emma’s life was filled with triggers, reminding her of her daughter’s painful battle with cancer. Colorful scribbly pictures that Allison drew while in the hospital were posted on the refrigerator.  Children’s picture books remained on the coffee table untouched. Little toys were left behind on the ledges of the tub, unable to be relocated.  Emma came into therapy while stuck in a stasis of intense prolonged grief.

      When a loved one dies, especially a child, it can be extremely difficult to get out from under the heaviness of grief.   It is not typical for a parent to outlive a child, violating the typical order of the life cycle.  Parents anticipate years of watching their children grow and experience wonderful life moments together.  The death of a child shatters this much longed for reality and evaporates all those possibilities for family joy.

     The parent-child bond is one of the strongest human attachments, serving as a fundamental source of security and identity throughout a person's life. When a child passes away, the surviving parent must navigate an overwhelming combination of traumatic distress and the sudden void of this primary attachment loss. This dual burden often causes the grieving parent to struggle with basic functioning, as they lose the unique emotional affiliation and purpose that only their child provided. 

     As a caregiver, parents hold a sacred duty to protect their children and when a child dies, it effects them on a very deep, primal level.  A profound sense of failure, guilt and shame typically accompany the loss.  Emma blamed herself for Allison’s genetics, for how she behaved during pregnancy despite taking very good care of herself, for the type of baby food Allison ate (a standard widely used brand).  “It was my fault that she got cancer.”   

       Many parents’ identities are splintered when they experience the loss of a child. “Mother” or “Father” is a large portion of how they oriented in life, the role from which they dutifully devoted their immense love, time, and resources.  Adrift, surviving parents must adjust to being a different person in a world where they are no longer a parent to a living child.

     Emma had an additional layer of loss as her other roles dropped, roles of being a constant caregiver, nurse, social worker.  Her entire waking life revolved around the needs of her daughter.  The intensity of caregiving was a severe juxtaposition to the silence and emptiness of a life without Allison on so many levels. The house was too quiet.  The days, too unfilled.  It gave her a great amount of time to be alone in her grief.

Why Humans Avoid

     The defense mechanism of avoidance is very powerful and related to survival.   When a person’s fight or flight system is triggered, the mind’s algorithms determine what the best course of action is to keep a person safe: fight; flight; freeze; fawn; play dead.  Because the pain of the loss is so intense, the survivor’s brain treats memories like a physical predator. Avoidance is a form of flight, a self-preservation tactic to escape emotional overwhelm.

     Together, Emma and I constructed a list of things that she couldn’t bring herself to do, such as going into Allison’s room and hearing advertisements on the radio for the hospital where Allison received treatment.  The reminders rendered Emma devastated, anxious, and distraught, paralyzed by grief and overwhelm.  Emma’s mind associated these and other triggers are a threat and adaptively wanted to avoid them at all costs. 

Healing

     The path to healing requires: processing the immediate trauma of the event; addressing the distress-avoidance patterns; and, the embarking on the long-term challenge of redefining one's world without the essential connection of a loved one.  In an effort to cope with these multiple layers of loss, the mind must take grief in doses. 

     Avoidance is a normal defense mechanism which affords the brain time to accommodate to the loss of the loved one.  Over time, situations, people, and circumstances that have been avoided may become more tolerable to face.  Therapists who work with people with Prolonged Grief Disorder assist with increasing a person’s distress tolerance, building a capacity to sit with all the complex emotions that come with grief.  Gradually, over time, survivors learn how to tolerate triggers. 

     For Emma, the thought of opening Allison’s door was overwhelming.  She even avoided that part of the house.  Therapy began in my office, then transitioned to Emma's home. Our sessions started in the kitchen, far away from Allison's room.  Over the course of weeks, we gradually worked our way closer to Allison’s bedroom as Emma could tolerate the proximity.  She was able to experience time in the room, process all the thoughts and feelings associated with the clothes, the toys, everything.  Months later, she decided to donate some of the items so that other children could benefit from them.  Some of the items were connection objects and she found a way to incorporate the precious keepsakes into her household, some things displayed and others preserved.  This demonstrated her integration of the loss and moving forward instead of being stuck in a stasis of grief.  

     If you or a loved one are struggling with avoidance and distress, there is help for you. Please contact me or another therapist specifically trained in the treatment of Prolonged Grief Disorder. Healing takes time and we are here to be with you, every step of the way.

*Names and specific details of the situation have been altered to protect the anonymity of the family.

Gera McGuire, MA, NCC, LMHC, is a specialized mental health counselor serving the Maple Valley and Enumclaw Plateau communities, as well as clients throughout Washington and Montana via telehealth. With advanced clinical training from the Center for Prolonged Grief at Columbia University, she provides evidence-based support for those navigating anxiety, depression, relationship challenges, and the complexities of 'stuck' grief after a loss.

Disclaimer: This article is for informational purposes only and not a substitute for therapy.  It is not a guide to diagnose any of the conditions above.  Only a qualified mental health professional can diagnose and treat these conditions.  

If you or someone you know is experiencing symptoms of depression, anxiety, PGD, PTSD or any other concerning mental health symptoms, please contact Gera to set up an appointment..