by Lisa M. Shulman
Johns Hopkins University Press, 2018
Review by Maura Pilotti, Ph.D. on Feb 26th 2019
One of the most challenging traumatic experiences that we may endure involves witnessing a loved one’s battle with an incapacitating illness until death brings his/her life to an end. Under these circumstances, the surviving person is forced to cope with two consecutive traumas, one induced by the illness and the demands that it poses on all parties involved, and the other brought about by the awareness of the loved one’s death and its consequences. During the loved one’s illness, the recognition of his/her symptoms, the necessities of the therapeutic interventions he/she undergoes, and the hope that all can be returned to normal brutally reshape quotidian activities, thoughts, and emotions. When the unavoidable death knocks at the door of an already fragile existence, the everyday life of the surviving person needs to be reshaped again to adjust to a reality that is missing one of its essential pieces, perhaps the one that keeps the social fabric of that existence together. How can survivors deal with the demands that everyday life places upon them, which may include, at the very least, rearranging their lives and accepting the defeat brought about by the death of the loved ones? Mental health professionals often talk about resilience, the ability to cope with and to recover from adversities that introduce a substantial amount of stress in a person’s life (Lightsey, 2006). The book entitled Before and after loss: A neurologist's perspective on loss, grief, and our brain, by Lisa M. Shulman, is an insightful window into the ordeal of acknowledging the illness of one’s husband, hoping that treatment will reverse a nefarious outcome, and then facing his death. Resilience takes a very personal tone in this book.
Suedfeld (1997) has noted that post-traumatic growth can come from experiencing dire events. According to him, what does not kill a person may make him/her stronger by enhancing the person’s awareness of his/her strengths. Although some good can come from dire circumstances (e.g., increased personal strength, reordered priorities, a greater appreciation for life, and more meaningful relations), not all people deal with the experience of trauma similarly. Consider, for example, witnessing the effects of a terminal illness on a spouse or child until death takes him/her away. Some react to an event of this nature by choosing an active, problem-solving strategy. For instance, they focus all their efforts on seeking remedies whose goal is to counteract the likely end results of the prognosis that the sick person is given. Others react in exactly the opposite manner by diverting their attention from the illness, thereby ignoring as much as possible the situation the sick person is facing and its likely end result. Often a mixture of the two coping strategies is found in the day-to-day life of the witness to the tragedy. The problem-solving strategy may prevail when hope is fostered by the availability of potentially effective treatments, and/or by the fleeting reversal of an undeniably ominous prognosis, whereas reliance on neglect as a coping strategy may emerge when hope faces defeating evidence (i.e., evidence that undermines the justification for believing that the selected treatment will return things to normal). The story of the witness to a loved one’s battle with an incapacitating illness is very much like the story of a rescuer who after having saved a drowning person from a rushing river discovers that other people are also struggling in the river. Similarly, the caregiver of a person with a terminal illness may continue to hope for a miraculously good outcome by actively seeking alternative remedies until the very end. However, in contrast to the rescuer in this story, he/she cannot stop and run upstream to find out what is the source of all drownings. In this story, is resilience the rescuer’s determination to continue jumping into the river to save one more person? Most importantly, what is its source?
The flame that ignites resilience in the author of Before and after loss: A neurologist's perspective on loss, grief, and our brain seems to be her painstakingly narration of the hopes and defeats of a cancer patient (her husband) and his primary caregiver (herself). She chronicles the quotidian struggle of a man who is running out of options and of a caregiver who is an active participant in her husband’s therapeutic decision-making. She courageously shares his pain while he approaches the untimely end of his life. In her narrative, the author meticulously describes to the reader the chronology of events that punctuated her husband’s illness, from the shocking news of his illness to his death. Personal details of the quotidian enhance the reader’s understanding of her state of mind and offer an insight into her coping mechanisms.
Her narrative is a diary of a painful period of her life. It is a guidebook on how a person with means and clinical knowledge might deal with personal loss. People with fewer means who are confronted with the news that a family member has a severe form of cancer may have to face much harsher circumstances. Consider all those who do not have health insurance, or have a limited health insurance policy, and a job that barely allows them to survive. They may start the painful journey of dealing with cancer with little or no hope, and may not even be granted the opportunity to try some treatments. Thus, they may be much more vulnerable to the devastating effects of the illness affecting the loved one. Alternatively, they may display a different form of resilience, one that reflects the survival skills of individuals who have learned how to stay alive in an environment where resources are scarce, and little or no time at all is available for reflection and self-healing. Writing a memoir is a way of copying which may be effective for the few who can afford it. Its effectiveness as a strategy to recover from personal traumas may also be questioned as it promotes self-absorption.
The details of the quotidian that the author shares often relegate to the background analyses of the social, and psychological, and cultural factors of coping and grief. The writer’s desire to narrate her life is a therapeutic strategy that, at times, obscures the need of the reader to be informed not only of the broader scientific context of facts and theories, but also of the varieties of the grief and coping strategies that other people may adopt.
All in all, Before and after loss: A neurologist's perspective on loss, grief, and our brain is an engaging and well-written diary of the writer’s pain and hope for recovery. It is a memoir to be read to gain a deeper understanding of how a person with means may deal with grief. Of course, it may be used as an ancillary text in a college course on death and dying, but only if supplemented by a textbook that provides an exhaustive review of the phenomena of grief and coping strategies in the field of neuroscience.
Lightsey, O. R. (2006). Resilience, meaning, and well-being. The Counseling Psychologist, 34(1), 96-107. doi:
Suedfeld, P. (1997). Homo invictus: The indomitable species. Canadian Psychology/Psychologie
Canadienne, 38(3), 164-173. doi:10.1037/0708-55188.8.131.52
© 2019 Maura Pilotti
Maura Pilotti, Ph.D.