| INTRODUCTION
Mrs. Alexander
first contacted our office in July of 1991. In
this initial contact, and during subsequent visits,
Mrs. Alexander indicated that there had been a
series of sudden and/or agonizing, prolonged deaths
in her family of origin. She further indicated
that her family had been, and continued to be,
beset with serious illnesses, illnesses which
she believed would result inevitably in a further
early facing of death. The illnesses and resultant
deaths which Mrs. Alexander discussed covered
the interval 1980-1991. A further death has occurred
during the period of our consultations with her.
It became readily apparent to this therapist that
Mrs. Alexander was suffering from extreme stress
as a result of the serious illnesses and unusual
number and types of deaths in her family of origin.
DETAILS OF ILLNESSES AND DEATHS IN MRS. ALEXANDER'S
FAMILY OF ORIGIN
Although we believed
that it would be emotionally difficult for her
to do so, we asked Mrs. Alexander to provide us
with a detailed outline of the deaths of family
members in her family of origin, the dates of
these deaths, the circumstances surrounding the
deaths, an outline of her family structure, and
her position in that family, including the role
she was asked to assume during each of these family
crises. We further asked her to provide us with
details of the health status of surviving family
members and some indication of the status of her
own physical health and that of members of her
own immediate nuclear family.
Role Played by Mrs. Alexander
This sister had
been somewhat of a surrogate mother figure to
Mrs. Alexander. There was a very close bond between
the two sisters. The other family members turned
to Mrs. Alexander for advice and support.
Role Played by Mrs. Alexander
Mrs. Alexander
had to view the body of her brother in Toronto
before shipment to his home town for burial. She
was asked to make the decision for the family
as to the relative trauma involved for other family
members in the choice of an open or closed casket.
This decision had to be made due to the extreme
deterioration of the lower jaw and the attempted
cosmetic rebuilding. This office was contacted
at the time of this brother's illness and we provided
a liaison between the various hospitals, the funeral
parlour, and Mrs. Alexander, who was then in England.
Mrs. Alexander made two (2) trips to Toronto -
one at the doctor's request as the demise of her
brother became imminent, and the other to view
the body, with this therapist present, before
accompanying her brother's remains to their home
town for burial. A clergy of the Church stationed
in the Metropolitan area was contacted by this
office at that time. This individual was extremely
helpful in aiding our office with funeral parlour
arrangements, and with later caring contact with
the elderly parents.
Role Played by Mrs. Alexander
From January to
March 1990 she confided the heartrending details
of her sorrow to Mrs. Alexander by long distance
telephone contact. She had no one else to turn
to, no one else who she felt would understand
the depth of her grief and the enormity of her
need. The daughter died and Mrs. Alexander's sister,
left totally alone with her heartbreak again talked
out her heartbreak to her sister in British Columbia.
Mrs. Alexander was the sole source of strength
for her sorrowing sister.
Role Played by Mrs. Alexander
Mrs. Alexander
received news of her father's death, and flew
home alone for the funeral, staying with her widowed
sister, the still grieving mother of the dead
son. Together, they visited the funeral parlour
on the day of Mrs. Alexander's arrival. The funeral
was postponed an additional day due to weather
conditions. Mrs. Alexander, very tired from her
trip, talked with her sister. She listened as
the sister spoke of her loss/losses. Evening came
and the sisters retired, prepared to attend the
father's funeral the next day. The following morning,
Mrs. Alexander walked into her sister's bedroom
to call her and found her dead. Doctors and the
police were called. Some attempt to assist Mrs.
Alexander was made then and again a few days later.
These local, medical and police officials, aware
of the post-trauma involved in such a situation,
provided Mrs. Alexander with an opportunity to
discuss her shock, her sense of horror, and they
attempted to help her relieve the horror of the
accumulative traumas by talking about them. The
father's funeral was postponed yet another day.
Mrs. Alexander again was looked to for advice
and solace and had to call upon her now depleted
reserves of strength. This sister died on February
14, 1991 -on her child’s birthday, and a little
less than a year before the anniversary of her
death. There had been a much earlier death in
Mrs. Alexander's family--the death of a four-year-old
nephew, tragically killed in a car accident. The
funeral of this child occurred as well on February
14th. Mrs. Alexander, who was then ten (10) years
of age, remembers this event with great clarity.
She remembers seeing the child's blood on the
road, the sound of her father's sobs, etc.
*Therapist’s Note:
Specific dates, particularly dates that are prominent
on the calendar--dates such as February 14, Valentine's
Day, create an especially poignant problem for
survivors of traumatic events. Because their whole
immediate world is celebrating Valentine's Day,
the day cannot be ignored by the survivor. He/she,
suffering from an Anniversary Reaction1 really
does not want to remember. However, life goes
on and the survivor wishes to celebrate the event
with his/her spouse and children. So the day has
forever a bittersweet quality, one always tinged
with trauma and one associated with devastating
loss. February 14th can no longer be thought of
by Mrs. Alexander in a benign light. Nightmares,
flashbacks, memories of the event/events are more
likely to recur on such a date.
Early 1992 - Disposal of Sister's House
and Personal Effects
Mrs. Alexander,
as the executrix of her sister's estate, was forced
by circumstances to revisit her hometown--a town
which by now had come to symbolize illness and
death--to examine and distribute her sister's
effects, to consult with her sister's attorney,
to dispose of the estate, and to again be a source
of strength and support for her remaining siblings.
Again, she relived the horror of the event as
she returned to the house where death had come
so suddenly and so horrifically. All three members
of a family that had been particularly kind to
Mrs. Alexander, to her husband, to her children,
were gone.
Role Played by Mrs. Alexander
Mrs. Alexander
again returned to her hometown for the funeral.
Again, her advice was solicited. Again she was
a source of solace and strength.
FAMILY OF ORIGIN - SURVIVING MEMBERS - HEALTH
PROBLEMS
Mrs. Alexander
has four remaining siblings. Both sisters suffer
from high blood pressure from time to time. Both
brothers have heart problems with blockages in
the arterial walls. The activities of the brothers
are severely limited.
Role Played by Mrs. Alexander
Mrs. Alexander
contacts or is contacted regularly by her siblings
with respect to their health status. Again, she
is a source of strength and comfort and a symbol
of integrity for the remaining members of her
family of origin.
MRS. ALEXANDER - PSYCHOLOGICAL PROFILE
Mrs. Alexander
presented as an intelligent, well-integrated,
intensely private individual. At the time of her
contact with this office, she stated that she
then had recently been transferred to the Metropolitan
Toronto area, in part due to medical concerns
over the state of her physical health.
Death is a part
of life. However, as Mrs. Alexander presented
this office with the detailed outline of the number
and types of deaths in her family--deaths which
covered an eleven year period--it was clear that
death in her family had presented itself with
unusual facets of horror, horror that included
the number of deaths, types of deaths, overlapping
hospitalizations, overlapping deaths, suddenness
of deaths, etc. It was clear, too,
that because of her position in her family, due
to the intense value she places on the innate
right of all individuals to privacy, each family
member, although older than she was, had depended
on her and trusted her with their joys, sorrows,
and heartrending confidences. This outpouring
of confidences had been ongoing throughout the
years but had accelerated after 1980 and had steadily
increased throughout the ensuring decade, reaching
new heights in January of 1990 and continuing
throughout 1992 and into 1993.
DIAGNOSIS
Mrs. Alexander
suffers from Posttraumatic Stress Disorder.
MRS. ALEXANDER'S PRESENT NUCLEAR FAMILY
Mrs. Alexander's
daughter has been suffering severe pain over the
last two years, pain which makes the child frequently
come home after school and retire to her bed:
pain which makes tears roll down her face as she
visits her physician. An appointment has been
made with a specialist for further investigation
of the child's presenting problems. Needless to
say, given the family history, both parents and
their daughter are extremely worried about the
possible results of this further investigation.
MRS. ALEXANDER’S PHYSICAL HEALTH
After her return
to British Columbia in 1991, Mrs. Alexander's
cholesterol count was found to be extremely high.
Heart problems were suspected, given her physical
condition and her family history. An angiogram
was performed. At that time there were no blockages
in her arterial walls. However, given her family
and personal medical history, she was informed
she suffered a much higher level of risk for eventual
heart disease than the general population. She
was instructed to watch her dietary intake; to
embark on an exercise program; to subject herself
to little or no stress. She was informed that
she must take care of herself.
Authorities in
the church in British Columbia were aware of the
overlapping deaths of Mrs. Alexander's father
and sister. They were further informed of Mrs.
Alexander's health status. Mrs. Alexander is very
grateful to the church for their prompt attention
to her situation and for their decision to transfer
her and her family to the metropolitan area, where
church personnel felt she could obtain more comprehensive
medical attention.
Mrs. Alexander
gradually began to build up her support systems
in the city with the help of this office.
THE ROLE OF MR. ALEXANDER--ALEXANDER NUCLEAR
FAMILY COHESIVENESS
We have met briefly
with Mr. Alexander and with their two children,
Paul and Patricia.
The Alexanders
present as a very close, loving family. Mr. Alexander
presents as an individual with a high level of
personal integrity; he presents as a highly intelligent,
deeply sensitive and caring, yet quiet individual.
He is clearly an individual possessing a deep
sense of commitment to his chosen profession.
Because of Mr. and Mrs. Alexander's positions
as clergy, they were often posted far afield when
the above enumerated tragedies occurred. Due to
financial restraints and due to Mr. Alexander's
responsibilities, Mrs. Alexander made the majority
of these trips to the scenes of death, sudden,
horrifying, and otherwise--alone. No one was there
at the scene to support her as she gave her support
to others.
PRESENCE OF DENIAL MECHANISMS
It is the considered
opinion of this office that, as the deaths and
diagnosed heart conditions mounted, as Mrs. Alexander
continued her journeys to the scenes of family
deaths; as Mrs. Alexander's cholesterol level
soared; as she went for intrusive diagnostic heart
investigations; as she suffered periodic chest
pains; as father and mother were informed that
their children should visit a physician for cholesterol
testing, Mr. Alexander, on some level, went into
a form of denial. With the enormity of all of
these illnesses possibly affecting his immediate
family, a family which he loves more than he loves
life itself, Mr. Alexander's mind unconsciously
focused on the improvements his wife was making.
His mind, overburdened by secondary trauma, no
longer wanted to consider the severity of her
earlier health problems and her occasional relapses.
Neither did Mrs. Alexander want to burden further
her already overburdened husband. She herself
now became afraid of further medical testing.
She, too, went into a form of denial.
The children,
too, we believe, loving their mother dearly and
loving their lives together, no longer wanted
to believe that Mom was under stress, that Mom
had any health problems or potential health problems.
Neither did they want to pursue any medical testing
for themselves until this issue was forced by
the daughter's now near-constant pain.
Denial is not
an unusual defence mechanism. Denial acts as a
protection mechanism in cases where the traumas
bombarding a family have been as frequent, as
sudden, as prolonged, as horrific and as complex
as the traumas affecting this family. Denial on
the part of all family members set in. No family
member wished to conceptualize that any further
personal disaster could, or would, occur. Denial
is one of the components that has kept this family
functioning as effectively, as lovingly, and as
supportively as they have.
MRS. ALEXANDER'S TREATMENT PLAN
This therapist
has talked weekly with Mrs. Alexander. When she
initially presented at this office, she was suffering
from sleep deprivation, nightmares, flashbacks
and fears of the impending death of loved ones.
Her movements were slow and lethargic. Her voice
was benumbed, shocked, deadened. She tired very
easily. She had frequent chest pains and suffered
from a painful and sometimes debilitating sinus
condition.
As is usual in
survivors of trauma, she had become hyper-vigilant.
She awakened and checked her husband and children
frequently at night to see if they were still
living. She would often awaken her husband to
see if he was still living. She was having flashbacks
to the scene of her sister's death and had intense
memories of the death and intense memories, too,
of her sister's confidences to her and her desperate
need of her.
Gradually, Mrs.
Alexander began to improve. A more intense program
was instituted. Mrs. Alexander was encouraged
to enroll at University. A marked change in her
trauma-induced numbness occurred at this time.
Her voice contained more vitality as she wrestled
intellectually with new ideas; as she explored
subjects that were new and challenging--subjects
that held no content specifically related to her
traumas.
Since mid-1992,
she has been involved in a rigorous exercise program
(three evenings a week). She has developed contacts
in the city that have been, and continue to be,
helpful to her in this area. This program has
helped her immensely in the enhancement of her
physical well-being.
Gradually she
has, with help, developed a strong support system
outside her family and work circles.
NEW STRESSOR--RETURN OF TRAUMA STATE
Mrs. Alexander
and her husband received word from their church
that they were to move to a new pastorate outside
the metropolitan area. The move was to occur within
four to six weeks.
The community
to which they were told to proceed is a small,
isolated community located by the ocean. Mrs.
Alexander's "home of origin" and "home
of trauma" was a town with very similar characteristics.
The location, the isolation: these ever present
"triggers" of place made Mrs. Alexander
feel very anxious.
PRESENT HEALTH STATUS
Mrs. Alexander's
health deteriorated over the next two weeks. Her
voice showed signs of numbness. On some levels,
she felt immobilized; her walk again slowed to
a near crawl. She suffered from sleep deprivation
and intensified fear for her fami1y's physica1
we11-being and physica1 survival.. Again, she
began experiencing chest pains. Since stress is
a prime component in heart disease, given this
lady's family history, premature strain on her
physical and emotional systems could be deadly.
Although Mrs.
Alexander had made marked progress on her journey
out of trauma, it was apparent to this office
that news of a possible move outside the sphere
of her support systems catapulted her back into
the trauma state. Her emotional health was too
fragile to withstand another change of residential
location, of vocational position at this time.
Thus the previous symptoms returned with the stressor.
RECOMMENDATIONS
This office contacted
the national head of the church. It was the considered
opinion of this office that Mrs. Alexander urgently
needed to remain in the metropolitan area so that
all of her support systems could remain intact.
We did not believe that it would serve anyone's
purpose for this lady's health to further deteriorate.
It was the hope
and belief of this office that the church, with
its humane approach to the needs of its personnel,
would make any necessary arrangements to allow
this woman and her family to maintain the necessary
support systems which would make it possible for
Mrs. Alexander and her family to continue their
journey of healing through the pain which the
past decade of prolonged trauma had created.
CONCLUSION
The church cooperated.
The couple remained in the metropolitan area for
a further year. Therapy, education and support
systems continued. One year later, the church
offered them a promotion, a position of higher
authority. The couple were ready to move to a
new location. Mrs. Alexander's PTSD Symptoms were
under control. The other family members had also
reached resolution and healing.
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