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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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