The Family Dynamics of Gratitude by Dr Ira Byock

The Family Dynamics of Gratitude by Dr Ira Byock

All the passages below are taken from Ira Byock’s book, “The Four Things That Matter Most”, published in 2004

I have long thought that the phrase dysfunctional family is redundant. Family life tends to be messy. Boundaries of privacy that are expected in other relationships simply don’t exist within families. Parents and children commonly intrude in one another’s personal affairs. This is appropriate when children are young. Parents set the agenda, and young children interrupt their parents with problems at any time. But difficulties in the relationships will inevitably arise if kids remain dependent into adulthood or parents continue to be intrusive or controlling.

Family dynamics are just that, dynamic. As individuals grow and develop over time, so, too, relationships naturally change. They must if they are to remain healthy—or become healthy. Therein lies hope for us all.

The wisdom within the Four Things can help a child and parent remove any and all barriers to the love they share. Gratitude can be both a vehicle and an earned reward for accepting and nurturing one another.

Arlene, a colleague of mine, learned this lesson when she helped care for her stepfather at the end of his life, a man to whom she had never felt particularly close.

We were working together on a study of how a son or daughter experiences caring for a terminally ill parent. “This project is hitting close to home,” Arlene said and sighed. “But in my case, it wasn’t my father who was dying, but my stepfather. And when I heard that he was finally dying, my first response was `Good! It’s long overdue!’ I never thought his death would end up transforming me or completely recasting my relationship to him, my mother, and, for that matter, his children as well.”

Failure of the Heart

Arlene’s parents divorced when she was eight. An alcoholic, her father moved away after the divorce and Arlene hardly saw him. Her mother, Hazel, was single for eight years and so reclusive and shy that Arlene assumed she would never remarry.

Hazel’s temperament perfectly suited her vocation as porcelain sculptor, but severely constricted her social circle. She met Conrad, a surgeon who painted watercolors as a hobby, at a juried art show at which they both had work on display. She was in her midforties, he a few years older. His eye was captured first by Hazel’s work and then her delicate features.

Because Conrad was married when he met Hazel, they didn’t get involved. Conrad’s wife was usually isolated from him and their children because of severe depression. She was often suicidal and occasionally had to be hospitalized. For months at a time she lived in supervised housing for her own safety. Conrad eventually divorced, later saw Hazel at a local art opening, and asked her out.

Arlene recalled that, even after her mother and Conrad were married, she never fully trusted him or his motives. “It always irritated me as a child when we’d have company and he’d say that he had been `smitten’ with my mother at that first meeting because he was married at the time. He meant to be endearing, but it grated at me. It felt wrong. My mother kept quiet, which always made it seem as though the feeling was mutual, but I assumed she was quiet because she was so introverted. I couldn’t imagine that she would have the slightest interest in a married man. I guess I felt Conrad had somehow manipulated my mother and I turned it into a grudge.”

The year of their courtship was during Arlene’s first year of junior high school. She remembered sitting in the kitchen doing homework. Her mother came flitting into the room. Arlene said she had never seen her mother flit! Hazel was humming and pulled out her sewing kit. It seemed she had offered to mend a couple of things for Conrad. Arlene couldn’t believe it. This was a side of her mother she had not seen and could never have imagined.

“Soon it was clear that my mother had fallen head over heels in love with him,” she said. “Not me. I never fully trusted him. Maybe it was because my mother seemed beside herself—on cloud nine. She had always been so contained. So considered. Now she seemed giddy, and, to my adolescent eyes, more than a little bit silly. He tried to connect with me, I suppose, but they were so caught up in each other. I felt excluded, as though I were an encumbrance. It was difficult for me, after having my mother to myself all those years.”

“How did he try to connect with you?” I asked.

“He would sometimes take me with him to the hospital.

He encouraged my interest in science. It’s really because of him that I pursued biology and research.”

“So he did have positive influence on you.”

“Yes. But I couldn’t accept it or allow myself to really see it at the time.”

At 63, Conrad suddenly became sick, just as Arlene was entering graduate school. “He almost died those first few days,” Arlene recalled. “But during the next ten years he was like Lazarus, dying and arising again and again.”

Conrad had been stricken with viral myocarditis, an infection of the heart muscle caused by a variant of a common cold germ. Overnight his heart lost its power to pump, his blood pressure dropped dangerously low, and fluid backed up in his lungs. He spent two weeks in the ICU of the hospital in which he practiced. The doctors and nurses hovered, making sure that no stone was unturned in the quest for a cure. Over time he gradually improved, except for occasional cardiac arrhythmias, episodes of fluttering in his heart, during which his blood pressure bottomed out. Without a quick push of the right IV drugs or an electrical jolt to his chest, any one of these episodes could kill him. Before leaving the hospital, he needed a pacemaker, a combination of pills, and, after nearly dying on two occasions, an internal defibrillator.

Conrad was grateful for every day. His father had died at 57 and no man in his family had lived beyond the age of 60. On every one of his next 10 birthdays he would make a toast and say, “This life is a gift to me. Thank you for being part of it.”

“In retrospect I realize his gratitude was sincere,” said Arlene. “But, at the time, my mistrust of him made it seem contrived and somehow phony.”

Soon after Conrad’s seventy-third birthday, he began to have headaches. An MRI showed multiple small brain tumors, characteristic of cancer that has started elsewhere. A search for the source tumor (which is often found in the colon or lung) didn’t turn up anything. There was nothing to do but control symptoms and make good use of the time left. Conrad had radiation treatments to his brain and for a few months did fairly well, though the edges of his intellect dulled and he gradually became dependent on Arlene for basic things, such as dressing and using the toilet.

“My mother was a mess,” said Arlene. “I was living nearby so I was often around. My stepfather gradually lost interest in eating. His cardiologist, who was also a good friend of theirs, suggested getting hospice involved. Mom wouldn’t hear of it. To her it would have meant giving up.”

This is an all-too-common situation. Medicare and many insurance plans typically will only pay for hospice care after a seriously ill person agrees to forgo life prolonging treatment. As a result, in the United States hospice has become associated with “giving up.” It’s too bad because hospice provides a long list of services that sick people and their families need, including in-home nursing and bathing, and 24/7 emergency support for family caregivers.

“One day Mom found Conrad on the floor, delirious,” Arlene continued. “She called me from the hospital that night. `I can’t do this anymore,’ I remember her saying.”

It turned out that the emergency department physician on duty that evening had told Hazel soon after Conrad was admitted that her husband was probably dying. He remained incoherent and looked as if he might die at any moment. Conrad’s cardiologist and friend admitted him to the hospital and sat with Hazel for several hours. He suggested to her that it might be time to consider turning off Conrad’s internal defibrillator. Conrad was unconscious at the time.

Hazel contacted Arlene and then Conrad’s children late that night and conveyed the details of his condition and the doctor’s suggestions as carefully as she could.

His children didn’t ask many questions, but by the next afternoon they were at the hospital in force and in foul moods.

“I hardly knew Conrad’s children from his first marriage,” Arlene explained. “I’d met Florence, the youngest, but his sons, Edward and Stafford, were in their late twenties during the time of the divorce and his courtship with Mom. There was no tradition of holidays or anything else that brought us together, so I hardly ever saw them. I always assumed that it was their choice. They always seemed miffed so I wasn’t about to reach out. I suspected that they blamed Mom for causing the divorce, which was ridiculous, of course.

“Stafford and Florence were at the hospital when the oncologist made rounds and cheerfully remarked that he thought Dad would do well with a new treatment. His children had been suspicious that Mom wasn’t feeding him enough; now they were horror-struck to think she’d considered turning off the defibrillator.”

After two days of intravenous fluids and a new medication, Conrad was indeed more alert and mostly coherent, and his children’s suspicions deepened. Meanwhile, the hospital abruptly sent him home.

“Mom felt she was being unfairly attacked by Conrad’s children and withdrew even further into herself. At the hospital, his children would avoid us and talk only with him. But then Conrad’s brother, Roger, came over to the house.

“He sat me down in the kitchen. `You know,’ he said, ‘Conrad’s children would really like to come visit. But they don’t feel welcome in your mother’s home. They want to be part of this, but they’re afraid of your mother.’ I almost laughed. My mother is all of five foot one. Although she looks strong willed, she is totally timid. Roger said, `Do you know that they have never once been invited to dinner at your mother’s home? Not once in over twenty-five years of marriage?’

“And it hit me—that was true! I had never thought about it. But Mom’s social phobias, her insecurities about cooking, and her assumptions about what his children thought of her made her shrink from any such prospect. And Conrad deferred to her, his porcelain wife.”

Arlene didn’t defend her mother, but did explain that what Conrad’s children understandably felt to be disdain was nothing of the sort. Her mother was intimidated by the thought of them. In a sense, Conrad was at fault. He could have asserted himself and simply insisted on having his children visit. Arlene was sure that her mother would have been fine once her shyness gave way to familiarity. By being overly protective, Conrad had made matters worse.

Arlene immediately became resolute. She asked Roger to tell Conrad’s children that they were welcome at any time in her mother’s house and invited them to come over that evening. When they arrived, she told them they were welcome at any time. Hazel didn’t resist at all. She seemed relieved that Arlene had taken matters into her own hands. Arlene’s emotional transformation was just beginning.

“At first I felt ashamed for my part in keeping them away. As I opened our home to them, someplace within me opened as well,” said Arlene. “The distrust and low-grade animosity I’d always felt for my stepfather eased. For the first time I was able to stand outside `my own story’ and look at the history of our family from his perspective. And for the first time I understood how much he really and truly loved my mom. To protect her from his own kids! Then I realized how much I had lost in holding myself aloof and apart from him and my stepsiblings.

“At one point, I looked over at Florence, who was sitting with her eyes swollen and both hands wrapped tightly around a hot cup of tea. I said, `I’m so sorry I didn’t know you and your brothers before now. I feel like it’s my fault.’ I watched as tears poured down her cheeks. I started bawling, too, got up, and hugged her.”

Rewriting History

The scene Arlene described was a true watershed moment. From that point on, the adult children were on the same side and decided to take charge of Conrad’s care and support Hazel together.

Learning to relate to adult stepsiblings whom we didn’t know as children is a challenge that has become fairly common in contemporary families. Yet it’s one of those things for which my generation, the boomers, haven’t had many role models. I’m not faulting our parents; we simply live in different times. It’s one example of many situations in which we boomers are faced with figuring out things for ourselves in order to live fully, honestly, and responsibly. The way Arlene and her stepsiblings handled this predicament offers essential wisdom for all of us.

I asked Arlene if her stepsiblings had been able to say any of the Four Things to Conrad before he died.

“To an extent they did. But they really had a hard time asking for what they needed. They didn’t know how. Conrad was old school in a lot of ways. He wasn’t able to be direct in saying `I love you’ or those sorts of things to his children. I don’t think he ever realized that they were waiting for some words of approval or forgiveness from him. But they were able to forgive my mom and even express real warmth and affection for her. In a way, I think that helped them feel complete with their father.”

Arlene explained that Conrad’s kids realized during those days just how much in love Conrad and Hazel had always been. They recalled how their father and Hazel held hands as they walked and cuddled whenever they sat together. Conrad’s children no longer saw Hazel as a malevolent force but instead a meek soon-to-be widow. Conrad’s oldest son told Arlene that if responsibility needed to be assigned for the decades-long chasm that cut through their family’s history, his father was mostly to blame.

Anger and blame gave way to the fact that their father was dying.

“Day by day more of him leaked away,” said Arlene. “In his weakness, his edges softened and each day his disposition seemed more innocent and childlike. He was a pleasure to take care of, even though taking care of him was a lot of work.”

Once they were home from the hospital for the last time, Hazel was able to accept hospice’s help. The hospice team arranged for an electric hospital bed and a bedside commode and gave them instructions on how to use medication to alleviate discomfort and confusion.

Arlene explained that in the last few days of his life, Conrad was sometimes in a world of his own. He would seem very busy, muttering to himself and making hand gestures as though he were conducting an “air orchestra.” Although he was usually calm, he occasionally became agitated, trying to get out of bed and saying, “I need to go home now. Help me get ready!”

“At one point,” said Arlene, “Conrad was trying to get out of bed and Mom was leaning over and talking to him quietly. He grabbed her shoulders with both hands. She was frightened. ‘Conrad, it’s me—Hazel. Sweetheart, you’re here with me. You’re fine, darling. It’s all right.’ He looked up in recognition, relaxed his hold, and smiled at her. He reached up, put his arms around her neck, pulled her down, and gave her a long kiss.

“`I love you, Hazel,’ he said. `I love you, too, darling,’ my mom replied.

“`I’ve been so happy,’ he said. `How can I thank you for these years together? It has been wonderful to be married to you.’ He paused for a second and exclaimed, `I want to do it again!’

“She looked at him and I could tell she was too moved to speak. `Will you be my lawfully wedded wife?’ he asked. She nodded. `Always,’ she managed to say. He smiled broadly and then floated again off into another world.”

“Did your mother say anything to you at the time?” I asked.

“Not at first. We just looked at one another. Mom’s eyes welled with tears. Then I said, `He is the great love of your life, isn’t he?’ And she said, `Yes, he is my great love.’

“Suddenly, when she said that, it was as if whatever lingering resentment or distrust I felt for him fell away. I felt this overwhelming feeling of gratitude. He had made my mother incredibly happy. He meant so much to her. I recognized in a flash that she had her own life apart from me. At that moment I grew up the rest of the way in my relationship with my mom—and with my stepfather.

“The next time Conrad was lucid, I went and sat with him. My mom was reading in his room and I asked her if I could have some time alone with him. She was surprised but seemed pleased and left us. I then apologized to him for being so difficult for so long, and I thanked him for loving my mother. `You have made her so happy,’ I said to him. `Thank you.’

“He just smiled at me and reached out his hand, which required a significant effort for him at the time. He nodded and said, `I know. I know.’ And I realized that he had always been aware of my animosity and mistrust toward him, but accepted it as something he couldn’t change. He had honored my right to have my own feelings, even if they were unfair toward him. What a generous thing that was! I thanked him again and, for the first time in our lives together, I kissed his cheek.

“That evening he died. He had been restless and breathing irregularly and he suddenly started to sit up. He stared ahead as if trying to discern something in the distance and took one last breath. Just then my mother came into the room. I turned off the oxygen machine and the room was suddenly quiet and still. Mom kissed his forehead and then climbed into bed and held him. She lay there with her hand on his cheek, her body molded to his.”

Losing a Stepfather, Gaining a Family

The church at Conrad’s funeral was overflowing with family, friends, colleagues, and patients. The day after the funeral, Conrad’s children returned to Hazel’s house for a few hours. There were things to organize and notes to write acknowledging and thanking people who had helped during the long months.

“When it came time to leave, it was very hard. We were all hugging one another—mom, too! Conrad’s children had all made the transition from being strangers to being relatives. We realized that we are connected. The feeling of gratitude I had toward Conrad when he kissed my mother had spilled over and I felt open, utterly forgiving, thankful, and even loving toward them. It was amazing.”

Gratitude was the vehicle for Arlene’s journey from being the victim of a fractured family to feeling part of a family that was healthy and whole. In allowing herself to feel gratitude to Conrad for his unwavering love and devotion to her mother, the walls of anger that separated Arlene from Conrad and her stepsiblings dissolved. With her defenses down, Arlene suddenly felt thankful for all the things he had done for her mother, and she was surprised at the love she felt for him. In the course of Conrad’s dying, Arlene gained the stepfather she never realized she had, and in the process she also discovered two brothers and a sister she will have for the rest of her life.

Arlene observed, “I wish I hadn’t waited so long, but it took Conrad’s dying for me to discover that I really have a family.”

Anger constrains our options. If pain and regrets make you see only the wounds and ways of defending yourself from being hurt again, practicing gratitude—starting with gratitude for life itself—can expand your perspective on the world and your options for living. In no longer acting from woundedness, you will regain emotional balance and control of your interactions. Without minimizing the pain of the past, your own healing will become possible.

Arlene said, “My stepfather’s death was one of the most important events in my life, up there with my marriage and the birth of my children. It was truly healing. Ironically, in his dying, things happened within our family that he most wished for in his life.”

Marie de Hennezel, a psychologist who works with cancer and AIDS patients in Paris, has observed, “Life has taught me three things: The first is that I cannot escape my own death or the deaths of the people I love. The second is that no human being can be reduced to what we see, or think we see. Any person is infinitely larger, and deeper, than our narrow judgments can discern. And third: He or she can never be considered to have uttered the final word on anything, is always developing, always has the power of self-fulfillment, and a capacity for self-transformation through all the crises and trials of life.”

Our human potential can be nurtured at any time in life. I asked Arlene how her experience influenced her current life. She said, “The life lessons for me were about responsibility and creativity. We didn’t have family traditions or religious customs for dealing with my stepfather’s dying or his funeral. I took responsibility because someone had to, but at first I felt lost without a rudder. Then I realized it was alright to make it up as we went along, to be creative about taking responsibility. We wrote this chapter in his life and our family’s life the way we wanted the story to unfold.”

Arlene’s attitude of creative responsibility for her relationships and life continues to be an important theme for her and her family. “In addition to consciously creating family relationships with Conrad’s children, my family has begun designing our own rituals. We draw on timeless traditions, but work together to create something new, that has meaning for us. For instance, we held a rite of passage for my son, Chad, when he turned thirteen. We discussed and designed the event together. We gathered with relatives and friends at a park that has been part of Chad’s life since he was an infant. People read passages or poems they had chosen for the occasion and offered Chad some piece of wisdom. It was a wonderfully warm and heartfelt occasion, as well as a funny and joyous celebration of Chad at this time of transformation in his life. In his gracious acceptance, laughter, and poise, I saw my son mature that day.”

We should never underestimate the possibility for change and growth in any human being. Emotional health and happiness are ours to create. When we reach, as Arlene did, to nurture and complete our most important relationships, we are practicing self-care, as well as extending an inestimable gift to others. [119-133]

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