"On Healing" June 2004

Posted on Mon, Jun. 21, 2004
Remember with every loss, there's a gain, too
By Dan Gottlieb

Dear Sam,

Happy birthday! I have written you a letter each year since your birth; this is the fourth. The first was to welcome you into our family. The second was to tell you that when you were 20 months old we discovered that you had some autistic characteristics (pervasive developmental disorder). And last year I wrote about what your parents were going through trying to get you special education services through the school system.

This year, I just want to wish you a happy birthday and congratulations on what has been an important year for your growth and development. Some of your repetitive behaviors have improved, as has your speech impediment. You have begun to develop an internal moral compass, observing what is right and what is wrong with people's behavior. But the news that brought tears to my eyes was when your mother told me that in your preschool play, you were finally able to sing this year with the other children.

But not all of your growth has been easy. For several months before your birthday, your parents told you that 4-year-olds don't use binkies. In the weeks leading to your birthday, I could see you were both excited and scared about giving it up. On the big day, your mother took you toy shopping, and traded your binky in for a toy.

When you got home, though, you cried almost all night, saying "I don't want to be 4 anymore; I want to be 3."

Sam, many years ago a British psychoanalyst named D. W. Winnicot created the term: "Transitional Object" to describe how you move from dependence on your parents to independence. Things such as baby blankets and pacifiers represent a parent's touch and help you manage anxiety and insecurity during this transition.

Now that you no longer have your binky, you have nothing to protect you from your anxiety and insecurity. That's why transitions are hard. Those transitional objects give us the illusion of security and when they get lost, we are left with the insecurity that was always there.

If you can understand, Sam, that with all change is loss, then you can see that the loss must be mourned. Remember how you cried most of the first night? You're not alone. When adults experience change, they also ache inside and long for what they once had.

So what can we do? First, understand the truth about the problem. The problem is not the loss of the binky, the problem is the feelings you experience in the wake of those losses. You see, Sam, eventually almost everything we become attached to is lost, including most of our possessions, loved ones, and even our youth, health, and life itself.

Many of our possessions help us manage our anxiety and give us the illusion of security. Like you used your binky to help you feel secure, other people who feel insecure use food or drugs or alcohol to manage painful feelings. Some try to make a lot of money and buy things such as bigger houses and pricey cars to help them feel secure.

Even people can be transitional objects. Many people divorce because their spouses don't make them feel secure. But all of these things are transitional objects and none of them really works.

So what does work? There is a Sufi saying: "When the heart weeps for what it's lost, the soul rejoices for what it's gained." So as much as anyone who loves you would like to rescue you from your pain and give the binky right back to you, that wouldn't be a good idea. Each stage of growth involves loss and each stage involves gain. When you feel the pain of loss, please don't grab at something to take away the pain. Just feel the pain and have faith that pain, like everything else, is transitional. On the other side of the pain, you will learn something about who you are.

And when you are in pain and longing for what you had, remember that you are not alone.

Before I became a quadriplegic, I loved playing golf. So after my accident, when it was time to give my clubs away, I cried for many days. During those days, Sam, I wished I were younger also.

By the way, last week when I visited, you didn't bring up missing your binky one single time.

Love,

Pop

Posted on Mon, Jun. 07, 2004
Cancer became a personal issue
A health insurance v.p. becomes a patient.
By Dan Gottlieb

Over the years, this column has frequently been critical of health insurance companies. I have described insurance companies as insensitive and profit-seeking. But the industry does have some leaders who care. Lorina Marshall-Blake, vice president of government relations for Independence Blue Cross, is one of them.

In addition to her work at Blue Cross, Marshall-Blake is the associate minister of the Vine Memorial Baptist Church in Philadelphia and a volunteer at the Linda Creed Breast Cancer Foundation. She devoted her energy to this cause because almost everyone she knew had been touched by breast cancer. Because of her knowledge of preventive measures, she did everything she could to minimize her own risk.

She was fastidious about annual mammograms, visits to the gynecologist, diet, and exercise. That's why she was so shocked a year ago when the phone rang and the voice on the other end said: "Lorina, you have cancer." She was 52 years old.

As she tells the story of her journey through breast cancer, she talks with the speed and intensity of anyone who has recently been traumatized: "Do you believe that they gave me the news over the telephone? Nobody should ever receive news like that on the telephone. And then they had the audacity to say, 'Are you OK?' So I said to them 'No, I am not OK, but I will be.' "

When she hung up the phone, she sat in her office alone and confused. "I did everything I was supposed to do," she thought. "How did this happen to me?"

She felt so overwhelmed that she could not imagine coping with this horrible news. Nevertheless, in the back of her mind, she knew she simply had to. So she sat in her office, wondering who could help. Fortunately, she had access to current medical information through the chief medical officer at her job. He helped her sort through volumes of options and statistics, and she decided to have a lumpectomy followed by radiation.

Like many with breast cancer, she talks about how she "went through it" but, unlike many, she also talks about how she came out of it. In her words: "You either have to deal with it or dwell on it."

She attributes much of her resilience to her faith. Following her religious teachings, she determined that in order to survive, she had to turn her energy to helping others. So she redoubled her efforts to get the word out about this disease, which strikes one in eight women. Although this path gave her meaning and contributed to her resilience, there were many days when she wanted to stay home and cry. She kept going because she knew there were other women who needed her. In the process, she met some women she considers close friends. And now she says she has a great deal to be thankful for.

Fortunately, Marshall-Blake had insurance, Personal Choice, that covered all of her medical care. And, like many who are traumatized, she saw a psychologist. "There are some things we just can't deal with on our own," she said. "This was one of them."

Although Personal Choice reimbursed all of Marshall-Blake's medical care, it paid for only about half of her psychological care. She was able to pay the remaining $70 or so per session herself.

I asked what she would say to other women who were suffering similar pain and confusion but could not afford $70 per week: "I would tell them that if the help they want is not covered by their insurance, the help is out there somewhere. There are wonderful programs such as the Wellness Community, which offers support, fellowship and hope. I would tell them that the key to survival is information. And information is out there."

If she had the authority to change the reimbursement structure for mental health care, would she make it more equitable? After a brief pause, she said: "You know I can't answer that one." Despite her politically appropriate answer, I wished she did have the authority. I wished that even more after her next statement.

"This past year has changed me in fundamental ways. Life has become more urgent. Knowing the reality that I could die, everything and everyone I love in my life became even more valuable. I have a fresh view of what is important and what is not. For example, my job is still very important, but it no longer drives my life. My love for my family does."

Hearing that, it was nice to know that, inside an industry that sometimes behaves in a very uncaring way, we can find some very caring people.

Marshall-Blake will be speaking at the annual conference of the Wellness Community of Philadelphia on Friday. For more information, call 215-879-7733 or visit its Web site at www.twcp.org.

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