Julia Samuel | Every Family Has a Story: How We Inherit Love and Loss

I went to Cancer Research UK for the statistical context for Archie’s medical condition, and also include some North American statistics here for further context. Statistics can be useful to gain perspective on a particular diagnosis, but they often ignite fear or fury when we’re at the wrong end. The understanding I took from the numbers was that Archie was much too young to have a rare and terminal cancer. As he and all the members of his family reiterated, while they knew life was not fair, this unfairness was particularly cruel.

• There were more than 690,000 cancer deaths in North America in 2018.
• In males in Canada, kidney cancer was projected to be the seventh most common cause of cancer death, leading to around 1,250 deaths in 2021.
• Each year nearly half (43 percent) of all cancer deaths in the US are in people aged 75 and over (2015–19).
• Half (50 percent) of people diagnosed with cancer in England and Wales survive their disease for ten years or more (2010–11).

Reviewing my client caseload over the decades, at any moment in time, there is always one client whose situation calls on my deepest levels of compassion and at times concern. At this moment Archie Craig is that client.

I was looking at Archie on the screen; he was luminously pale, bald on his head and his eyebrows. He wore heavy-framed glasses that looked a little too large for him. It took me a few minutes to notice that Archie didn’t move. He sat upright in his bed, dressed in a smart collared shirt; his words were not accompanied by any hand movements, or visual gesticulation. It was as if he had to conserve every molecule of energy to speak. Archie’s opening words to me were “Cancer turns things on its head, turns white to black. Cancer is a thief. It steals bits of your body.”

 It does.

Archie was fifty-four, and had been diagnosed with kidney cancer in his early forties. He’d had successful surgery to remove the kidney and for four years he had lived cancer-free. The milestone five-year green light of it being less likely to come back seemed in sight. But then, cruelly, he learnt he had secondary cancer, and most recently after having headaches, a scan gave him the devastating news that he had a tumour in the brain. The consultant informed him there was no cure. They might be able to prolong

his life with treatments, but his life expectancy was twelve months. Of course, Archie was the person most affected, but it would inevitably negatively impact everyone in his family.

I knew from a 2013 National Center for Biotechnology Information study (Golics et al, 2013) that, in a family with a chronic illness, 92 percent of the family members interviewed were affected emotionally by the patient’s illness, mentioning worry (35 percent), frustration (27 percent), anger (25 percent), and guilt (14 percent). That is a big cocktail of emotions swirling beneath their outward appearance. They are the emotions of grief, and a natural response to illness. I knew I couldn’t reduce or release any of them from the intensity of this, but I sincerely hoped that I could support them in it. This wasn’t a relationship where huge shifts of understanding were likely, more about stabilizing the family members to manage the ongoing onslaught of difficulties they were facing. If necessary, I could make suggestions of the things to do and say to protect them against potential regret.

I was a presence from outside their family, with whom they could be completely open, whom they didn’t need to protect or worry about, and I trusted that would be of benefit. Even if this was only small, it was worth it. I never underestimate the value of being fully heard: good-quality listening was a valuable resource I wanted to offer.

Additionally, Archie valued the opportunity of participating in my book, telling me, “My experience has got to be worth something for somebody.” Perhaps knowing his story would be out in the world was a small solace.

Archie was to be the main focus of our therapy, often joined by his fiancée Katharina. Greg was a biologist, who lived with Archie. Isla, an essential medical worker, lived a few hours away. I would see Greg and Isla separately. We decided it might be overwhelming for Archie to witness their collective distress. He would have access to what they thought and felt in the case study, which he could read at his own pace.

As I heard the words, “The cancer returned in my lungs and chest,” I felt the anxiety spike in my body. Due to my own family’s history of cancer this is not a neutral zone for me. I live in a place where I choose to be in denial. I don’t believe a useful purpose would be served by dropping my defences in this, but the alarm bell of cancer coming back is never far away. Two years had passed since the person in my family had cancer and I felt resilient enough to work with cancer patients again.

It is an area of my work that I find rewarding and meaningful, but intense. I hoped I would have increased insight into this family’s experience. I was aware of the other side of that: I would require extra supervision to ensure I upheld the focus on meeting their needs: this relationship was for them, and my job was to remain psychologically robust to support them. This was not about me.

I include this because I think it is important to mention that all of us therapists have our own history of losses, injuries, errors, faults and likely triggers. I am often told, “For a therapist you are very upset …” as if being a therapist means I should have magical powers to manage life with equanimity, love and peace. If only. No. I have my own ongoing work to do to stay loving, connected, curious and open, and that will include failing, falling and not coping.

In the crisis of Archie’s terminal diagnosis, having his family as a resource of support, love and connection was for him, and anyone in his situation, the key component in his being able to bear the pain of his illness. The complexity is that each person in a family will have their own unique responses and ways of dealing with the difficulty, which will, in turn, impact the others.

Grief starts at the point of diagnosis. Every new diagnosis brings an additional wave of all the emotions of grief: shock, sadness, anxiety, anger, fear or even hopelessness. When every member of a family is experiencing those feelings, it can be overwhelming. Bad news activates our threat system to high alert. We inevitably and viscerally affect each other because our emotions are contagious. Being able to have honest and open communication between

everyone, naming and expressing their feelings, discussing their fears and even hopes is the route to maintaining as much stability as possible in such a turbulent time.

It also means that every individual within the family system has to take responsibility for their behaviours: being sensitive to the needs of others, pulling together, recognizing and adapting their own responses when they are having a negative impact on those around them. Archie’s parents were unable to do this.

In our first session I learnt from Archie that “My parents are alive but I am not speaking to them … It is painful but my mother says extraordinarily strange things, not just to me but to my fiancée and my children. The thing that did it was when she heard the devastating news that my cancer had gone to my brain and said to Katharina, ‘Archie has always been a difficult child. He gave me a hard time growing up …’ She went on for about twenty minutes, and finished by saying, ‘Cancer patients love going into hospices.’”

Clenching his fists as he spoke, I imagined if he’d had more energy he would have expressed his fury with more than that clench. I felt a stab of shock in my stomach at the insensitivity of his mother’s words.

Archie continued, “When I first heard that, I was outraged. I have a significant brain injury. I mustn’t get upset or angry. I have a high risk of stroke or seizure. I couldn’t expose myself to that danger. I had to stop seeing them.”

Katharina later told me it had taken Archie two months to recover from the wounding of his mother’s statement. I could still see the hurt in his eyes, as he nodded sadly. “Yes, it took me a long time to sort it. I got stuck in the pain. It took me a while to realize I had a choice. I could be the hurt teenager at the mercy of Mum’s whims, or I could be me as a fifty-four-year-old who doesn’t need my mother any more. Her words still cut into him but they aren’t so raw now. I have to accept the way it is.”

I told him that there was a profound difference between him and his mother. He had the insight, empathy and self-compassion

to shift his perspective. But it was not without cost: memories of his mother regularly emerged along the lines of “She could have said something more compassionate … The need for compassion or the need for vindictiveness, and she went with vindictiveness.” Despite his parents’ inadequacies and even cruelty, it weighed heavily on Archie that he couldn’t see them. They were still his parents and he loved and missed them, but he knew he had to hold the boundary. That was a burden I wished he hadn’t had to carry. As I grew to know Archie over several weeks, the significance of the dysfunction of his birth family became increasingly apparent. There was not a single session when he didn’t talk about his mother in particular, and often his father. He had learnt ways to cope with it, but it didn’t mean he could forget it. Like all of us, our wounds from our parents go deep: we may learn to manage them, but sadly we cannot erase them. When he spoke about his mother he often put on her voice, which was hectoring at best and threatening at worst.

He understood the roots of it. His mother had been molested as a child by her father and had never dealt with the trauma. Her unprocessed heightened emotions of trauma played out in her life every day. She constantly demanded attention, usually through exaggerating illness—her bad back, her diabetes or her mini strokes. Archie said, “All the sympathy has to be fed into her. She’s a proper drama queen.” She would indiscriminately hijack the suffering of others by elevating her own—even her son’s terminal diagnosis. As for his father, although Archie’s parents had “furious fights,” basically his mother controlled him. When Archie spoke, I could see in his eyes, and hear in his tone of voice, the clarity of his understanding and the injury he carried.

He summed up the environment he grew up in: “There was no nurturing, no parental care. I think there was love but not tenderness.”