Froma Walsh Interview, Psychology Today

Loss loss loss

An interview with University of Chicago's Froma Walsh on the subject of loss, exploring salvation in loss, legacies of loss that are destructive for generations to come, helping people speak about it, and human need to make sense out of it.
By Owen Lipstein, Hara Estroff Marano, published on July 01, 1992 - last reviewed on October 01, 2009

An interview with University of Chicago's Froma Walsh

The 1990s are clearly an age of loss. The AIDS crisis is wiping out whole communities. America's largest population group--the baby boomers--is experiencing the loss of its much-touted youth. More profoundly, they are coming to grips with death as they face the loss of their parents. For all Americans, the undiminished expectations of the '60s and '70s are now mired in economic uncertainty, at best. The same economic climate is daily taking its toll in business loss--from the smallest entrepreneurs to seemingly invulnerable multinational corporations.

At the University of Chicago, where Froma Walsh, Ph.D., co-directs the Chicago Center for Family Health, loss is a subject of cutting-edge research. How to deal with loss? How to explain it? There are important lessons to be learned in how we face loss--even a chance to grow. Walsh, who is also president of the American Family Therapy Association, spent a day at the offices of PSYCHOLOGY TODAY talking to Owen Lipstein and Hara Marano. This is the first of several articles on the subject to run over the next few months. It is deliberately wide-ranging in content and emotional reach.


PT: It's spring, a time of renewal. I suppose it is appropriate for us to talk about salvation in loss.

FW: It is in how you do the death. When people feel a lack of control about the outcome, one way of helping them is to see that they have control over the dying process. You can control, for example, whether you bring a dying father home or leave him in the hospital. Whether you spend time with him and how that time is spent. Now, with the AID'S crisis, that's what many are reporting: Once they've realized that time is limited, they think about how they want to experience the time they have. "Okay I may not be able to control the outcome and this is likely to be fatal, what I have control over is the relationships, what T do with my part in those relationships--being with the dying person." When people come to accept that they cart's control other things, they usually report they get into a much fuller, deeper experience of connectedness with the person who is dying.

PT: They experience their relationships through the process of loss.

FW: I'm teaching a course on this now, and a woman who was a minister reported a wonderful experience she had with a dying grandmother who made everybody come and visit her. The old woman had wonderful conversations with them about the things she wanted to pass along to them, things she wanted to share with them. The times they had together during that last month were the most precious of their entire life. They all said that was the way to die.

PT: What about the people who die poorly, a person who draws his dying breaths by making everybody experience the moment-by-moment pain, fear, blackness, or whatever?

FW: That's where you see legacies of loss that are destructive for generations to come.

PT: So something gets passed on if loss is traumatic or isn't handled right.

FW: That is why it's important to look at loss from a systems perspective. Loss is usually looked at from an individual perspective; there's the individual who dies, the individual who has the loss, their dyadic relationship, and the consequences of that loss for that individual throughout his or her life. But that doesn't even begin to suggest all the indirect influences through the family, to everyone in the family, then to the generations after, so that individuals who never knew the deceased are affected by the way the family handled the process.

PT: What is the damaging agent in the legacies of loss?

FW: First, let me say there can be positive legacies when loss is handled well. The negative legacies tend to be where there's tremendous cover-up, secrecy, distortion around the circumstances of the loss, or denial of a very traumatic death. The worst example I experienced was a young adult hospitalized for very serious mental illness. This kid had a dissociation episode at 15; he went out in the street and stabbed an elderly man, out of the blue. The family did nothing. The kid had another episode, almost repetitive, a year later, and a third one at age 17. He had no remorse, no feelings about it at all. The mother was a very disturbed woman who had bizarre religious fantasies. One was that she and her son had been present at the crossing of the Red Sea. Everyone was focused on her contribution to the boy's pathology, just as in our culture we look at what mothers do more than at what fathers do.

I am very careful in my interviews always to ask each parent about the other parent's experience. I learned from the woman that the boy's father, at the age of 15, had witnessed the stabbing death of his father. Such events are so traumatic, there's a dissociating process, where the family can't process the loss. It goes underground. When there's not permission in the family to communicate about it, it tends to come out in some kind of action, like a repetition compulsion, in the next generation. The next generation acts it out at precisely the same point in the life cycle. When I see somebody in a suicide attempt or having difficulty with a separation, I always ask whether there were traumatic losses at the same moments in the life cycle a generation earlier

PT: How common is this?

FW: It's very common, but there hasn't been good systematic investigation. In one new study on adolescent suicide, investigators looked at the family and found many traumatic losses. There's a whole decade of research on substance abusers and their self-destructive course. The families are just littered with highly traumatic losses that are unmourned. Two factors are at work. One is that some losses are more traumatic than others, like witnessing the murder of your parent. If on top of that, the family can't help you process that loss, it's doubly likely that it's going to reverberate and have consequences in later relationships.

PT: How do these things show up in relationships and how do you know it's a loss issue?

FW: That's where you have to be attuned, and why I always do a genogram in clinical work.


PT: Could you explain what a genogram is?

FW: It's an intergenerational family diagram that shows who's who in the family, the significant events, births, losses, and their timing. A child born around a significant loss may have a special role to replace a person who was lost. I pay particular attention to past losses and their connection to the person who's coming in for help.

For example, a man came in for help around the breakup of a relationship. Previously married and divorced, now turning 40, he was desperate for a meaningful commitment and children. What was blocking him, he told me, was that he had a mother with a very controlling personality. He had done a lot of work in prior therapy to find a woman who would not be like his mother. I explored his family origin to shift from viewing his mother as a controlling personality--that was just something inherent in her personality--to understanding the context of the behavior he experienced as controlling.

It was only through talking with his older sister that he learned that his father had had a serious heart attack when he was around five. The physician had told the father, "You have to drastically alter your life if you want to live." But he loved adventure, risk-taking, dangerous sports and travel, and was a workaholic. He was also a man who didn't want to admit vulnerability again. So he turned over the control of his risky behavior to his wife.

All the son knew growing up was that his mother was very controlling of his father, and he feared he might marry a woman who would control him the same way. It was important for him to understand that the mother's controlling behavior kept his father alive and the family intact. This knowledge shifted his perception of his mother, of women, and of himself, and gave him a contextual view of the dilemma in the family. It's a classic example of the indirect effects of loss or threatened loss that can block a person from intimacy.

PT: The family tremendously shapes loss and one's reaction to it and that in turn shapes what happens to the family.

FW: Trying to protect one another, the family blocks communication about what they're frightened of, often about an impending loss. What I see too often is that somebody becomes symptomatic. A child develops a behavior problem. Families set up such rules to protect one another, but ultimately they're doing themselves a disservice. After the fact they come to me with regrets: "There were things I wanted to say. things I wanted to do." Or, "I wanted to respect my mother's need not to talk? so none of us talked about it."

PT: How do you help them speak?

FW: I urge a conjoint life review, where family members sit down together towards the time of death, review their life, and hear each other's perspectives. It's a wonderful time for things like, "Well I never knew you felt that way," or "Is that why you got angry?" or "I didn't understand." It's a chance to go back over old business. I like to track the family development, have the parents in to talk about the courtship, the birth of the children, the different transitions in the family, its high points, and the painful moments. Too often, after death, individuals are struggling in their heads with, "I wish I had asked him this," or "I never knew my mother, I only knew her as a parent to me," or "We had a terrible fight and didn't speak for years and then my sister died and there was never a chance to make up."

When there hasn't been a reconciliation, a person tends to carry the loss with him and often has conversations in the head--"I wish I had said"--that keep him caught in the past, unable to move on.

PT: Loss is a process. What are the kinds of challenges,that occur in this process and what are the tasks that need to be done? What things can families do that are helpful?

FW: The first is acknowledgement of the reality that loss is impending or has occurred. It isn't just that daddy went away and we don't know when he's coming back, but that daddy died.

PT: Perhaps we should go back a step, if the loss is impending. How does one say to a father, "Daddy, you're dying"?

FW: That's the problem--we don't do it. We have social expectations that inhibit us from saying the "D" word, and we keep thinking, "I shouldn't say 'are you dying' or 'you may die soon.'" Perhaps it's partly the fear that if I say it out loud he may think I want it to happen, or if I say it out loud maybe it'll happen sooner. It's kind of a superstitious belief.

To say to someone, "You're dying aren't you?" or "Are you dying?" or "Do you think you're dying?" may help that person feel more comfortable. Often there's tremendous relief when the person who's dying can now say it out loud. What he may say is, "Yes, but I didn't know if you realized it," or "I didn't want you to feel worse by talking about it." Everybody avoids talking about it because they're afraid they're all going to break down in tremendous grief or it will be too painful for others. If there were a single message, it's for people to take that risk to talk about the unspeakable together.

PT: You're saying it's not bottomless.

FW: That's right. It's the fear that there's no bottom to it. Taking the risk to talk more directly should begin with the hypothetical: "Have you ever thought about What if?" It's also important to get clear medical information. Is the patient dying or could he live for years? Is it a one in a hundred chance the patient is dying; is it three months or three years? Doctors are often unclear in their diagnosis, but there are probabilities and it's important to know them .


Families have a lot of trouble with ambiguity. Where there is a lot of ambiguity around loss, there's more depression and inability for the family members to master the situation. PT: What must families communicate in loss situations?

FW: There has to be permission to tolerate different expressions of grief. One person may yell and scream, another may cry for weeks and weeks. Another may walk around numb and the grief surface three months later.

A father may be angry at his son for using drugs and overdosing; that anger is part of his grief. Or, even though her parent didn't choose to leave, a daughter's experience is one of abandonment. It's important to check with one another. Everyone's got feelings of regret, and it's helpful to hear, "Oh I didn't know you have regrets too." Often I'll track families through the last week or last day together. I'll ask, "Is there anything you wish you had done differently," to help them come to terms with the fact that you can't do everything perfectly.

In the case of a shameful death like a suicide, there's a tendency to distort what happened. The more distortion there is--covering it up, pretending it was an accident, distorting the facts--the more over time the cover up and the secrecy set up walls that keep people from being able to really be close again. often they can't reconnect until they're able to let down the' barriers and say, "Here's the truth," "What really happened," or "Let's talk about how we really feel about this." It's important to know what happened and how it happened, as well as the meaning given those events. The more we understand what happened, the more we can make sense of the loss.

PT: Is there always the need to make sense out of the loss?

FW: There's a human need. Some people make sense out of it through their religious affiliation: it may be God's will, or that God understands even though we can't. One family that experienced the death of a child shared the belief that the child was so special God wanted him.

It is necessary to explain death to children, to help them understand very simply from early on. Kids are highly sensitive to the intensity of feelings in the family and they try to construct meaning out of what's going on. They'll either construct their own fantasies or come out of the experience with a belief that death is so horrible it can't be spoken about. That will create a catastrophic fear of loss.

PT: So it actually magnifies their fear, perhaps a generation later.

FW: Yes, and the same is true of divorce or abandonment, which are also forms of loss. One of my clients was a woman whose child was stealing money from her. When I asked about her family, she said, "Well my father just left one day when I was about four, and so I grew up with my mother. It was never talked about. My father came to my graduation because somebody else was graduating; he didn't even recognize me." Tears came to her eyes, and I asked, "What was the legacy of that for you now?" She said, "I've lived with a constant fear that our family will fall apart and my husband will just leave me and I won't understand why." She carries a legacy in part because her father left but in part because no one helped her to understand the circumstances of his leaving. The legacy is a global apprehension that at any time a husband may leave. Just in case, she squirrels away money.

PT: How did you get interested in loss?

FW: In my family of origin my mother had traumatic loss experiences that she kept to herself over the years. She had lost her father as a teenager just after she left home and never had a chance to say goodbye to him. Many years later her mother died and once again she wasn't told until after the funeral. I realized that she carried around with her this unfinished business. I was aware from early on what can happen if your relationships with family members end without you having a sense of resolution. PT: What did she carry around with her? How did you observe it?

FW: There was a quiet sadness. Then, when my mother died, I was in my 20s and in social-work school. Though I had read the developmental theory of Erik Erikson and others about the tasks of young adulthood and later life, it was clear to me that they didn't fit together.

I was on the brink of marriage, and as happens in our culture I was praised for not missing a beat. I was in a very heavy internship at Yale. I took off a few days for the funeral, then went right back. Everybody said, "You're terrific, so resilient." our society likes winners; there's no legitimization of a time to mourn or grieve, or a time out from moving forward.

PT: We don't have an attitude that permits us to deal with loss in a way that is going to help us move forward?

FW: The myth is that once you grow up and leave home, you're not very deeply connected to your parents, and you're not supposed to be. Then people are often surprised at how strong their emotions are about the connections with their aging parents. If you're an adult and a parent dies, people just expect you to go on with your life; it's not a big deal. In fact it is a very big deal. Launching is our landmark of reaching adulthood. You're supposed to leave home, be emotionally independent. If a parent is terminally ill at that time, it's much harder to come together.

Also, in general our culture has always discouraged the showing of grief publicly. We think back to the funeral of J. F. Kennedy, and Jacqueline Kennedy being praised for being so stoic. The model of the ideal mourner is one who doesn't show grief, keeps a stiff upper lip. We tend to not legitimize the need to be sad.

PT: Is there growing recognition that we have to give loss its due?

FW: Some things, particularly the AIDS crisis, have forced us to do so. Whole communities are dying; particularly in gay communities, people are dealing not with one loss but with many losses. Also, the baby-boom generation is reaching midlife, with aging family members, and dealing with questions of how long do we prolong treatment attempts of terminal illness, when does life end? For the first time, we're coming to terms with our own mortality.

In addition, our ways of dealing with loss have been gendered. Women carry all of the emotions around; real men don't show any emotions, they don't let their guard down. Many men are starting to challenge that, coming into touch with feelings that they've been cut off from, relationships with their fathers. They're recognizing that the stuffing of emotions in life has kept them remote from intimate relationships.

PT: So no matter how much men pursue intimacy, keeping a stiff upper lip about loss is actually going to keep them from achieving intimacy in relationships.

FW: A good example is a couple that came to our outpatient clinic a few years ago. A working-class couple had lost their only child, a son, at 21 or 22. The husband brought the wife in for help with her depression; he would sit out in the car and wait. The therapist suggested that perhaps he could benefit from treatment as well, to which he replied, "I'm functioning fine, I go to work every day, she's the one, please help her." And in fact, it is usually the women who seek treatment for depression or other complications of loss.

But the danger is that if women get the treatment, men are then left without any chance to let down their guard and begin to experience their own loss. After all, it was his only child and his only son, too. If we had just agreed to individual therapy for her, the couple's relationship would have grown increasingly distant.

PT: Why?

FW: When they first came in he was avoiding her; he was avoiding her pain in order to protect himself. I felt it was very important for him to be in the room even adjunctively, without defining him as a patient, so that he could share in the grief process, even though it was directed more at her. And in that process they could begin to comfort each other.

Some studies show a high rate of divorce following the death of a child. Couples are at risk when they wall off from one another because they can't tolerate the pain of the shared grief. They feel it will overwhelm them. If a couple can come together in their grief and comfort and support each other, and if the one who's uncomfortable with the grief can let down and begin to be in touch with that, not only will each individual benefit but the relationship will be strengthened.

PT: But it's usually the man who can't be emotional because of the cultural rules.

FW: In the case of a child brought in with garden-variety behavior problems, we took a recent history of the family and found that the father had been diagnosed with a brain tumor about seven months ago. He had surgery, was told it was malignant, is on chemotherapy, and went back to work the next week. The family is living with a life-threatening situation that carries a very poor prognosis, and all communication in the family is blocked because the father wants to tough it out: "I had my surgery. I don't want to talk about it. I'm just going on with my life." In deference to the father, the mother keeps a veil of silence. But every night the son secretly prays for his father. He has no way to express his feelings with the family.

PT: Let's look at losses other than death. Right now, people in America are feeling a lot of anger over the loss of the American Dream. We're not only in a recession, people are realizing it's not going to be better tomorrow. They've lost hope. To what extent is the prudent reaction to reality a loss of hope?

FW: Studies show that the more realistic individuals' appraisals of situations, the more depressed they are. There's probably a point at which you have to switch modes. We have to think of loss as a process, not just an event. If there is an impending or threatened loss, that's when you marshal all of your resources and try to master the situation, to fend it off.

Combating any serious adversity in life, there comes a point where either we master that adversity or we give in to it. With an illness, you may try many doctors or treatments. In a business, you may go to many banks.

I'm working with several individuals right now who are facing bankruptcy. As they go through these phases, the question becomes, "when do I throw in the towel? When do I admit defeat?" A man who is bound to look upon bankruptcy as a sense of failure can rationally say the economy is terrible, lots of companies are folding. Internally, when he thinks of his family, he can say, "but I've surmounted all odds, my family surmounts all odds. I should be able to beat this."


PT: You can also say to yourself that the company went down the tubes but what I did was heroic. I built it; I took risks. That strengthens your sense of self and helps you get through the other parts of the loss, the money loss, the job loss.

FW: Loss is experienced against a larger system. We're in a culture where we value personal responsibility. In another culture it's Allah's will that happens. If the company folds it's not your fault. In our culture, we believe we get what we deserve. And if a business fails it's a personal failure. There has to be an allowance for misfortune along with personal responsibility.

Complications around loss often occur when there's a lot of blaming or guilt. A parent may feel blamed or negligent because a child died of, say, Sudden Infant Death syndrome. There is nothing the parent can do, but blame, shame, and guilt complicate the loss process.

PT: What about cases where they are slightly negligent or could have done more? A father who shouldn't have let his son, who had a habit of drinking, ride off on a motorcycle.

FW: That's why accidental deaths of adolescents are especially difficult. There are all the complications of the risk-taking behavior, the sense of vulnerability that teenagers have; but then the parents wonder, what was my responsibility? What should I have done? I usually help them track through the process: What could you have done? What regrets do you have? It is natural to respond by attributing cause or feeling self-doubt. But sometimes it ends up in scapegoating someone. That's why families of homicide victims have tremendous difficulty over coming to terms with the loss when they feel justice has not been served.

PT: Doesn't there come a point when this doesn't work?

FW: In healthy families and well functioning families there is a sense that death is part of the life cycle and that it's inevitable. Healthier individuals and families tend to be more accepting of death as part of the life cycle. Given the life cycle, the most painful and unjust deaths are early deaths, untimely deaths. The death of a young adult or a kid is inherently unjust, doubly difficult because it reverses the life cycle.

PT: Are you seeing more people dealing with loss than ever?

FW: Many more people are coming in for help with business losses. One man was having night sweats, hadn't slept well in months, and got to the point where he was paralyzed because he was trying to pursue two opposite alternatives at the same time. One was trying to get new business to save the business, and the other was trying to figure out how he could unload the business to another buyer. He'd make a move in one direction, then feel absolutely torn because he was also trying to cover his face on the other side. Meanwhile he was having to fire people left and right, so there were constant and debilitating losses of the people that had built the business with him.

The business bore his name, so his whole identity was wrapped up in it. The question becomes, at what point does the captain either go down with the ship or abandon it. He was in such despair about how to get through each day that he had no vision of how he wanted to live his life in the next five or 10 years. He had to finally come to a point where he could at least put the worry out of the way for 48 hours and not act out of desperation, to feel like he could make a choice and not just be forced to do something. He may not be able to stop the forces destroying the business, but he's got some choices to make about what comes next. If he can't save the business, he needs to start to plan for the aftermath.

PT: How does he do that?

FW: He has a cabin in the woods, but he felt he couldn't even take a day off because he now had to cover the workload of all the people he had fired. I told him I wanted him to take his family with him down to that cabin for a few days just to get in touch again with why he built it and why it means something to him. At this point he can say, "I may have lost the business, but thank God I have the family. I could have lost my family." He's already shifting; there's a great deal more to life than the business he's losing.

PT: How do these people come to terms with their personal responsibility? FW: Sometimes they're not aware that they're blaming themselves until I ask them, "What would your family think about it if this business failed?" and "What do you think your friends are saying about you?" At first they feel more like a total failure if society, their families, and they define themselves by their business. This is especially true of somebody who names his business for himself. John Jones Company failed, John Jones is a failure. It is a total failure for a man. It isn't for a woman, because she usually defines herself differently.

PT: What do you say if that's true?

FW: That is a heavily stereotyped way to have to think about yourself--that you're no more than the business. I help people get out of the trap of gender stereotypes. A man is more than his business. He isn't merely as good as his last performance or his paycheck. There's more to him than that, and I help him find other aspects of himself.


PT: What if there really wasn't very much besides that?

FW: Such men are at very high risk for major depression and suicide. Suicide in midlife men is extremely high and it's associated with business failure. But it can be an opportunity that forces a man to reorient his life so that it isn't so totally defined by the job he holds and the amount of money he earns. Most men want to get out of that. By midlife it feels like a straitjacket. Most men in midlife are turning back to their families. The good news about a business failure is you're still alive and you are able to reorient your life. It's like a near-death experience. You see yourself with a real clarity--what really matters in life and what doesn't matter.

PT: What about other non-death losses?

FW: The same principles that apply to loss by death apply to major family changes like divorce. There's the loss of a significant family member. Divorce is in fact more complicated. The marriage is dead but the person is still alive. It is more painful to continue to relate through children knowing that the marriage is dead. In therapy, some people admit they are very much ashamed that they wished their spouse had died; it would have been easier. In that case, you idealize the spouse; in divorce, the legal process heightens the conflict while you continue coparenting and watch your former spouse remarry. It's a partial loss you have to deal with on a recurring basis. That is why so many fathers cut off--it's too painful to keep coming back to their former home where their wife isn't their wife any more. That's also why so many men murder their estranged wives.

PT: What rituals and tasks can a family use to help with loss? You talked about life review. What else is there?

FW: Loss is not simply letting go, it's not losing. It's really a transformation. If you lost your spouse, while you no longer have the day-to-day physical involvement, you never lose the past. You carry that with you. You transform your day-to-day experience to memories and to things that have become part of you. The important thing is to sort out what can be carried on and what kinds of continuity can be maintained in the face of loss. Rituals are a form of continuity. Holidays and rituals are tremendously important. Families having trouble with loss sometimes avoid family holidays. That's a big mistake.

PT: How do you find meaning for a life that was disappointing?

FW: Say your parent dies and this is a parent who abused you as a child. It's the coming to terms with life as it has been lived. We struggle to find some conclusion, especially where the relationship was complicated or disappointing.

Or a parent dies who you've never been able to forgive, even many years after the death. I usually help people distinguish between the behavior, the abuse, and the person. And I help them get to learn more about that parent as a person, and understand how he got to be the person who eventually ended up abusing his children, or being an alcoholic, or whatever. Adding dimension to the abusive parent is critical. The aim is to put compassion in place of only anger or bitterness. You have a choice about how to live in the present and the future.

PT: So you send someone on a research project. What other things can people do to help them through loss?

FW: First of all, turn to others. Most people report that what really matters are their near and dear. They spend more time with their children, with their loved ones. That's one of the most important things.

PT: Is this how loss clarifies the importance of relationships?

FW: Yes, but there's also something comforting about not being alone in your loss. We're so solution focused in our culture. Sometimes what people need is just someone who can sit there with them in their pain and let them have their pain.