by Hope Edelman
This wasn’t exactly what I’d expected to be thinking about at seventeen. When I tell this story to twenty-eight-year-old Sheila, who was fourteen when her mother died, she says her adolescence and young adulthood were filled with similar fears. For her first five years, her mother was an alcoholic with little time or energy for her children. After she stopped drinking, she and Sheila became so close that when Sheila found her mother dead of heart failure, she became convinced that the same could happen to her at any moment—and probably would.
When my mother died, my safety net was removed. From then on, I felt that if something bad was going to happen, it was going to happen to me. I work with adolescents now, and I see their feelings of invulnerability all the time. I never felt that. I always took precautions, because I never felt safe. I was religious about birth control, because I was sure if someone was going to get pregnant, it was going to be me. At the same time, I definitely did some stupid things. I got into cars I shouldn’t have, with people who shouldn’t have been driving. I drank a lot in high school, and I took a lot of drugs in college. But I was always aware that I was taking a risk, and that there was a very good chance I wasn’t going to get through. It felt like the beginning of the end for a long time.
Sheila spent those years courting death like an ambivalent lover, daring it to find her at the same time she took deliberate steps to keep it away. In my twenties and early thirties, before I had children and the stakes became too high, I also tested the limits many times. I would take the subway alone at midnight, go rock climbing in a remote gorge with someone of questionable skill, and accept rides from people I’d never met before. Internally, I knew, I was vulnerable to cancer, but I would delude myself into thinking nothing external could take me down. “Nothing bad will happen to me” was my insistence that I was immune to harm, that bad luck no longer had an interest in me, that I was one who could take risks and win. It was my urgent self-reminder that I am not my mother, when, of course, underneath it lay the very visceral fear that I was.
Confronting feelings of vulnerability with the actions of the invulnerable is a behavior so common that clinicians have a name for it: “counterphobic mechanisms.” Like the acrophobe who takes flying lessons to overcome her fear of heights, motherless daughters will try to master their fears of dying by taking risks that give them the illusion of having control over their destinies. To gain the exhilaration and validation that come from tempting fate and winning, they’ll often engage in precisely the behaviors—for example, smoking after a mother dies of lung cancer—that put them at highest risk for getting a mother’s disease.
“Some women really walk the line, and not only with health behaviors,” Dr. Milburn says. “Women are less likely than men to drive recklessly or jump out of airplanes. Their risk taking usually is interpersonal, like doing things to screw up their relationships. I see a lot of women who respond to their fears of illness or death by making crummy choices with regard to sexual partners, or having a lot of affairs.”
As Denes-Raj and Ehrlichman discovered, the college students in their study who feared dying early and from the same cause as their parents were also the ones most likely to engage in harmful health habits such as smoking or eating poorly. This may be because children model their parents’ health behaviors, the authors suggest, or because poor health is a consequence of bereavement. But Dr. Denes-Raj believes it more likely that parent loss leads children to develop a sense of fatalism, which in turn leads to the belief, “If my destiny is to die young, or if the disease is already in my genes, why should I bother taking care of myself now?”
As researchers have found, many high-risk women don’t. When Kathryn Kash, Ph.D., was the head psychologist at the Strang Cancer Prevention Center in New York City studying women at high risk for breast cancer, she initially expected to find that women who perceived themselves to be most vulnerable to the disease would be the ones most likely to engage in regular screening. Instead, she found the opposite to be true. Women with the most anxiety about developing breast cancer rarely did breast self-exams and often canceled or missed their appointments for clinical checkups. “These women say if they feel okay, then they’re not going to come in or do self-exams,” Dr. Kash says. “It’s easy to think that if you don’t do any screening, you won’t find anything, because if you don’t do any screening, you can’t.”
Brenda, thirty-two, who was sixteen when her mother died of breast cancer, says because her maternal grandmother also had the disease, she perceives herself as especially high-risk. The memory of her mother’s two-year illness, however, prevents Brenda from taking the suggested precautionary measures for herself.
You think I’d be careful about my own health, but I’m not. I physically can’t bring myself to do breast exams. I have the instructions hanging in my bathroom, but I just can’t do it. My older sister has had a mammogram already. I’m still a little young for it, but I know early detection is the thing. It’s something I’ve got to come to terms with and start taking to heart, because with three girls in the family the odds are, one of us is going to have to deal with this. Every New Year’s, I say this is the year I’m going to start, but then the fear kicks in. I’m not ready to find something. I can’t cope, so I don’t.
Avoidance becomes a high-risk behavior when it prevents a woman from obtaining adequate care. When the mother evaded or eluded medical care, a daughter’s avoidance also can be an attempt to identify with her mother. I won’t say motherless women consciously want to die; I don’t know one who truly hopes for a life-threatening disease. But I have met daughters who long for a connection, any connection, with the mothers they lost during childhood or their teens. For example, a woman whose obese mother died of heart failure may, years later, gain enough weight to put a dangerous strain on her own heart. Or a woman whose mother committed suicide may refuse to get therapeutic help for her bouts of depression.
Twenty-two-year-old Stacey, who lost her mother to AIDS three years ago, says she’s terrified of dying from the disease yet took few steps to protect herself from it after her mother died. She’s been tested for the virus several times and has always received negative results. “But the scary part about it is that losing a mother to AIDS didn’t make me a self-proclaimed, rejuvenated virgin, or even make me more discriminate about men,” she says. “In fact, after she died, I even went through a very promiscuous period. I still had that part of me that needed to feel loved, and I needed to escape, so I did it through men. I didn’t even feel present during those sexual encounters, but for some reason it felt necessary for me to do it as a way to hurt myself. It was weird, because I would almost wish the disease upon myself so that I could feel the pain my mother felt. At the time I felt, and sometimes I still do, that I deserve to feel the same pain, because it’s not fair that she had to go through it alone.”
Stacey’s mother contracted the AIDS virus through heterosexual sex, and her daughter felt compelled to take the same chance, over and over. In a similar interplay of identification and risk, Sheila says her drug and alcohol use during high school and college kept her feeling close to her mother, who drank heavily when she was the same age. “I had my first drink at fifteen, which is how old my mother was when she had hers,” she recalls. “I was using her same coping skills for escape. My aunt even pointed out to me that I was drinking gin, just as my mother had.” Only when she began differentiating from her mother in her midtwenties and mourned her loss for the first time could Sheila leave her self-destructive behaviors—and her expectation of premature death—behind.
After I’d finished college, worked for a while, and started to get some recognition for it, my ego started to get strengthened. I really started dealing with grief for my mother and anger toward my dad. When I started to face up to the emotions I’d spent so much energy on keeping at bay, when I stopped having to hold them back, I was eventually able to start looking at who I was as an individual, and not just as my mother’s daughter.
I
don’t take excessive precautions anymore, or take the same kind of chances I used to. I’ve kind of pulled it in at both ends. I don’t necessarily always bring an umbrella, but I’m more tuned in to what would be painful, what might be difficult for me, and so I look out for that. Because I’m not afraid of everything, I can see where there might be actual danger points. I’m learning to trust my feelings about what’s safe for me, emotionally and physically. I just moved into a new building where I don’t have to kick crack vials away from my door anymore. I can listen to being scared but also live in a city and not be afraid that everything bad I see on the news is going to happen to me.
By separating from her mother while still honoring her importance, Sheila actively engaged in what Naomi Lowinsky calls “attending to the ghost.” “When we don’t have enough of a relationship with the ghosts, they come get us,” Dr. Lowinsky explains. “Once you can develop and maintain some kind of relationship with the lost mother, your fears can become more realistic. You can sort out what was your mother’s fate and what’s your own, and realize that we all have fates that are out of our control. In this culture, we often act as though if we jog every day, go to the doctor, and eat right, we’re not going to have a fate. Well, terrible things happen all the time in everybody’s life, and it’s not because you didn’t eat right.
“I think a lot of motherless daughters tend to place all the responsibility for their fates on their mothers,” she continues. “It almost clears them of the burden. All a daughter has to do is worry about not getting cancer when she turns the age her mother was, or not commit suicide at the age her mother did. It’s important to understand that your mother had her fate and you have yours, that yours is going to have all kinds of things in it, and a lot of them aren’t going to be things you signed up for.” Until a woman separates what’s fear from what’s fact, she remains captive to the belief that her mother’s destiny will double as hers.
The first time I met Rochelle, I was immediately attracted to her energy. Her leather pumps clicked quickly across the wooden floor as she approached me with her arms raised, rushing to kiss me hello the first time I walked through her front door. Petite and slender, she darted from room to room, tossing deep laughs toward the ceilings, her long, curly hair framing her face in a chic halo of disarray. At fifty-three, she was just about the age my mother would have been. But she was younger, much younger, than I imagined my mother would be. If she hadn’t told me, I never—and I mean never—would have guessed that Rochelle survived two separate cancers, one in her colon and the other in her breast.
You see, I never imagine cancer as a disease you can survive. (Never mind that my maternal aunt is alive and thriving eighteen years after her diagnosis. Never mind that one of my friends underwent a double mastectomy and reconstruction in her early forties, and three years later is doing fine. My mother’s death skewed my illness paradigm so dramatically that I automatically equate the threat of cancer with the inevitability of death. I realize this when I speak with female friends whose mothers had mastectomies ten or twenty years ago and today still join their husbands for weekend rounds of golf. Their daughters have some concern about breast cancer, but fear doesn’t dictate their days. They view illness through the eyes of survivors. “Sure, I take precautions,” my friend Cindy says. “But if I get it, I get it. And if it happens, what would I do? Probably the same thing as my mother—have the surgery, do a few months of preventative chemotherapy, and get on with my life.”
Mothers teach us how to cope with illness, both through modeling and suggestion. “One of the things we learn from mothers when they’re sick is how to be sick,” Dr. Milburn explains. “They teach us how to think about our bodies and about physical symptoms. A lot of women come from families that focus on physical symptoms as a sort of style. And lots of daughters whose mothers died young become highly attuned to any physical changes in their bodies. Whereas somebody who didn’t already have a set of beliefs about her potential for illness or early death might ignore a particular physical symptom, a motherless daughter may not be able to ignore it. I try to give women insight into their health behaviors, which gives them a chance to make choices about changing them. We begin with, ‘What did you learn about illness from your mother? How did she think about it?’ and try to interpret a daughter’s beliefs from there.”
“If it happens,” Cindy said, “what’ll I do? Probably the same thing as my mother.” For me to affirm the same would mean to say I would, among other things, die at forty-two. Which I most emphatically don’t want to do. So I’ve been looking for other models now, women who, unlike my mother, caught their cancer in time. Rochelle, whose pragmatic outlook seems the perfect antithesis to my hypochondriachal fears, says that before her diagnosis she viewed cancer very much as I do. She was twenty-three when her mother died of lung cancer that had spread to her brain and bones, and after seeing her mother undergo four years of grueling chemotherapy in the 1960s, Rochelle left the funeral convinced she was already heading down her mother’s path. “I always knew I’d get cancer, but it was ‘later on,’” she says. “That’s why I had a catastrophic health-care policy. My mother was sixty, and I thought it would be like that. Later. All of my mother’s relatives also had cancer, so I assumed it was going to come along for me. But I didn’t assume it would come when I was forty-nine.” Twenty-six years after her mother’s death, that first cancer diagnosis inspired Rochelle to separate from her mother by making choices of her own.
I can’t tell you to this day how I got home from the doctor’s office when I found out I had colon cancer. I don’t know if I walked, took a bus, or a cab, or a bus and a cab. To me, my life was over. I was certain I would end up like my mother, which I always said I would never do. So the first thing I did was sign a living will. I made about twelve copies, and not only did I tape it to my bed, but I also taped it to the door of my hospital room. I handed it to everyone who walked in there. Every resident and intern got a copy. I told my doctor, “If you open me up and see the cancer is all over, I want you to just close me up.” If it was all over, no one was going to make me a guinea pig like they made my mother. My fourteen-year-old daughter was not going to see me suffer and turn into a vegetable like my mother did. No how, no way.
After the surgery, the doctor was so confident he made me very confident. The final biopsies were all negative, so I left very upbeat, counting my blessings, never thinking cancer could be somewhere else in my body. Then, the next year a tumor showed up inside a cyst that was removed from my breast.
There is no question in my mind right now that there’s cancer somewhere else in my body. The point is, they can’t find it yet. My oncologist said I’ll probably be one of his classic, chronic cancer patients. My husband talks about his retirement and I look at him and think, “Mmm-hmm. I’m glad you think so, dear.” I don’t make plans like that. My daughter is what keeps me from crawling under the covers. I’ll be good goddamned if my husband’s third wife is going to raise my child. That’s one thing. The second thing is that life is so interesting. Why would I want to give it up?
I tell Rochelle I can’t imagine how I’d cope with cancer twice, submit myself to the monthly tests she does, and still tell the story in a tone as upbeat as hers. I’ve never had a model for this type of approach, and I’m not convinced such optimism is part of my natural constitution. “Where does your courage come from?” I ask her. “How do you find your strength?”
She leans forward at her desk and rests her chin on her right hand. She is serious now. Her eyes search out mine. “I don’t know if it’s denial or not, but I can sit here and talk about my cancer and it doesn’t feel like it’s me,” she says. “Or at least it’s not all I am today. I guess if I gave you a complete story of those fourteen months, you’d wonder how I was still walking. But I honestly do not dwell on it. The only time I think about it is when I find a breast lump, which I periodically do, and they’re basically cysts. But that’s it. Depression is just not in my make
up. Right now, as long as I’m feeling well and I’m healthy, I’m going to go on with the rest of my life.”
I went alone into the hospital room ten minutes after my mother died. I thought I should say a proper goodbye. I was afraid to press my lips against her forehead, so I kissed my fingers and brushed them against her cheek. It was still warm. My mother believed in heaven, but not hell; she told me once that no sin on earth could be so unforgivable to separate a person from God. If there is such a thing as a soul, I have to believe hers had already taken off for that other place. Her body no longer contained any trace of life. It just looked like a shell to me.
Death loses its romanticism when you’re introduced to it so young. It’s no longer the portentous visitor who rides in on the dark to carry loved ones away. It becomes hard and factual, an event instead of an abstraction. Margie, now twenty-five, learned this at the age of seven when her mother committed suicide. “When someone you love dies, death loses its unreality,” she says. “To me, it’s real. It’s just as real as taking a shit. I never attempted suicide, but death never felt like an extreme I wouldn’t contemplate. It didn’t seem that bizarre to me. It was just another option, an alternative to life. I figured that if my mother could do it, I could, too.”