| 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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