A ‘psychological death’: Absent parents and the sense of loss
Imagine trying to get through to your parent whom you care about and from whom you want or need some kind of meaningful engagement. Yet despite all of your sincere efforts over the bulk of your lifetime all has come to nought. Perhaps they were or are somehow psychologically and emotionally unavailable to connect with you. That is, physically present but otherwise absent. In this article, I specifically address this type of loss — a ‘psychological death’ — in the context of parental mental illness.
“Psychological death” coined by Kaplan (1995) is where a person is simultaneously physically present and psychologically absent. The concept “psychological death” has an interesting history. Freud’s (1917/1957) writings recognised grief beyond that of a physical death, i.e., as a usual reaction to various losses including “loss of liberty, an ideal, and so on” (p. 243). Children of parents with a serious mental illness most certainly do have a loss of liberty and a loss of an ideal parental figure (Misrachi, 2012). Bowlby (1951) got closer to the crux of this type of psychological death. He addressed loss of a parental figure due to being psychologically and emotionally unavailable. Significantly, he referred to a need to differentiate between various “death” types (Bowlby, 1980). Around this time, Birtchnell (1970) wrote “[i]t is important to differentiate between parent death and parent loss from other causes and quite unhelpful to deliberately confound them” (p. 572). Later, Cicchetti and Toth (1995) referred to a mentally ill parent as an individual’s “psychological unavailability” (p. 280). But it was Miller (1996) who nailed it by adding that the “principal component of this sense of loss is unutterable feelings of grief for the parent who is there but not there” (p. 633).
Many clients and patients appearing in my clinical practice have first hand experience of this type of loss. For example, they describe their mentally unwell parent as intermittently appearing to be psychologically available, yet almost never genuinely psychologically connected to them in any reliable way. This led them to feel somewhat confused. At this point, it may be worth noting that such parents may not have been officially diagnosed via any of the diagnostic manuals or tools used by psychiatry or other branches of medical science dealing with disease classifications, e.g., DSM-5, ICD-11, and RdoC (Stein & Reed, 2019). Some individuals may identify their parent as disturbed due to their parent’s parenting style or behaviours, and then go through a process of deciding in their own mind that their parent probably has a mental illness (e.g.,Landerman, George, & Blazer, 1991; Neff, 1994; Williams & Corrigan, 1992; Camden-Pratt, 2002; Nathiel, 2007; Secunda, 1997). In my practice, it is not unusual for the offspring of unwell parents to unofficially diagnose their parent. Since my primary focus is on addressing their needs as they are the ones attending therapy and if no evidence exists to contradict their often keen, detailed and consistent observations of their parent, I respect their first hand experiences and therefore their judgement. Frustrated at not knowing what they were upset about, such individuals often feel some relief when the notion of a psychological death is introduced and explained to them via psycho-education.
As Bowlby (1980) notes, loss can be due to “death or desertion” (p. 180). One adult child of a parent with a severe mental illness describes this experience of desertion as follows:
“I feel like I didn’t have a mom. I didn’t have a mom to go to when I was a kid, and I don’t do it now. She was there, but she wasn’t there. There’s just that emptiness” (Nathiel, 2007, p.172).
Another adult child of a parent with a severe mental illness likened the psychological death of his ill father “to a living death” (Marsh, et al., 1993, p.27). Following the physical death of a loved one, most adults know why they are grieving (Bonanno et al., 2002). It is not necessarily so with a psychological death.
After a loved one’s physical death, most grievers return to pre-event (i.e., pre-loss) levels of functioning (Bonanno, 2009). But this seldom occurs in cases of a psychological death in the context of those raised by one or both parental figures with a serious mental illness (Misrachi, 2012). In such scenarios, it is critical to understand the difference between a physical and a psychological death. Kaplan (1995) describes this important difference as:
“When someone dies, you eventually say, “They’re gone and they’re never coming back”. But when someone is suffering from severe mental illness, they’re in an altered state of consciousness. A person is unrecognizable and frightening because they’re beyond the border between being dead and being alive. [Yet] They look human” (cited in Secunda, 1997, p.45).
An adult child of a parent with a serious mental illness interviewed by Young and colleagues’ (2004) was able to compare grief associated with a physical death to lack of clarity associated with a psychological death:
“[T]here’s no change. You’re stuck in this powerless pain. It’s part of the same pain, that loss, that painful loss, it’s just that it’s happened over 20 years; you just go along with it. There’s no beginning or end or middle part” (p.189).
What the above individual is grieving for while their parent is alive is less clear than if their mentally ill parent had physically died.
Now that we know a bit about what a psychological death is, in terms of caring for the next generation of children of parents with a mental illness, how will clinicians working within the current mental health system deal with their patients/clients’ losses? Particularly since policy-makers may be participating in, rather than preventing, transmission of trauma by focusing resources on unwell parents but not enough on their offspring, and by maintaining two separate silos: adult mental health vs. child protection services (Misrachi, 2017). For clinicians and others, what might we do with that sense of loss for all those with “absent parents” who suffered due to their parents’ psychological death? In this context, appreciation of this type of loss begins with trauma knowledge (Misrachi, 2012) for at least five reasons:
(1) We need to help people define their losses because for the offspring of parents with a serious mental illness, losses are often not seen as losses at all but “a way of life” (Bloom, 2002, p.5);
(2) Trauma knowledge has the power to identify such losses (Bloom, 2000a);
(3) The intergenerational transmission of such childhood losses and the trauma and grief that follows often occur with low awareness (Dixon, Browne, & Hamilton-Giachritsis, 2005; Dixon, Hamilton-Giachritsis, & Browne, 2005);
(4) Losses that follow a psychological death often lead to legitimate needs (Bloom, 2002); and
(5) Comprehending losses and establishing the needs of such individuals gives clinicians a better chance of addressing a person’s “moral safety” (Bloom, 2000b, p.8).
Clinicians and others need to appreciate the implications of a ‘psychological death’, the sense of loss as a result of absent attachment figures and what type of (individual) needs exist. Doing so helps lift the darkness when psychological death strikes.
This article was originally published in Mind Cafe, September, 2019, Issue 54.
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