164 Grief and Loss Across the Lifespan
legacies of loss. She is highly responsive to pressure exerted by her surviving
relatives. This responsiveness is intensified by loyalty to Susan and Jane born
out of early parental loss and their role as surrogate parents. Yet, she refuses to
share her doubts and fears with either Susan or Jane. She is relieved her physi-
cian recommended she postpone risk-reducing surgery despite her family’s
insistence otherwise.
Emily’s awareness of life-threatening illness risk was out of sync with the
experiences of her peers who are more likely to be pursuing developmentally
normative tasks such as exploratory partnering, developing educational or
job prospects, and building an identity through experimentation. As a result,
Emily reports feeling different from peers and other mutation-positive fam-
ily members, a feeling intensified by (a) her peers’ lack of understanding or
capacity for mature and measured responsiveness, (b) her knowledge that she
was the youngest participant in the breast imaging study, and (c) the mys-
tique around her family’s experiences with cancer and her mother’s death.
Her sense of isolation leads her to worry about whether she will be accepted
by a future partner after surgery. As a result, she hopes to stave off surgery
until she is “married and settled.”Practice Recommendations
Experiences such as Emily’s highlight the need for emotional support beyond
genetic counseling (Werner-Lin, 2008) to manage surveillance fatigue (Hoskins,
2012) or assist with decision making about surgical risk reduction. Access to
competent and compassionate genetic and mental health providers is essen-
tial. Emily’s case also speaks to the need for improved family communication
between 18- and 25-year-old mutation-positive women and their families of ori-
gin. Emily understands that her family’s commitment to surgical risk reduction
is connected to grief over the untimely death of her mother. This grief compli-
cated communication among all parties (Sobel & Cowan, 2003). A basic assess-
ment of family dynamics around cancer and loss would illuminate the coercive
pressures on Emily to pursue genetic testing and surgical risk reduction. Emily
might benefit from an examination of how her family’s medical history, as well
as her family’s relationships and prolonged grief (Daly, Farmer, & Harrop-Stein,
1999) impact her ability to autonomously consider genetic testing and navigate
risk management. Such resources, or a forum to approach her family, might
empower her to make an autonomous, informed decision about genetic testing,
whether or not her decisions are consonant with her family’s interests.Inheriting an Unfortunate Legacy: Growing Up Fatherless by Suicide
Chris Michael
Chris Michael founded Collaborations for Change after over a decade of developing
and leading human rights advocacy campaign and multimedia strategy trainings
for human rights groups from over 115 countries. In 2014, he took a brief sabbatical
to launch Fatherless by Suicide, a collaborative storytelling project by and for men
who lost their fathers to suicide. The portfolio of interviews, portraits, and the audio