Dr. Justin Yopp, a psychologist, and Dr. Don Rosenstein, a psychiatrist, work together at the University of North Carolina’s Lineberger Cancer Center both comforting and studying terminally ill patients and their families. Almost a decade ago, Yopp and Rosenstein agreed on a diagnosis: Mourning fathers didn’t have adequate support systems. Yopp and Rosenstein decided to create a group not only to facilitate conversation, but to research the mourning process of fathers. Having spent the last seven years meeting with dads who lost their wives, they are now sharing the hard lessons they learned at the intersection of fatherhood and grief, including that the everyday demands of children can amplify and compound trauma.
The Group: Seven Widowed Fathers Reimagine Life, Yopp and Rosenstein’s book about their experience, tells personal stories and offers a broader, but confusing narrative about loss. The authors worked with their subjects, watching them rebuild their lives, and ultimately concluded that their journey through the mourning process didn’t precisely follow the stages of grief (denial, anger, bargaining, depression, acceptance) popularized by Elizabeth Kubler Ross and David Kessler.
Yopp and Rosenstein spoke to Fatherly about how men can support each other and why honesty before and after death is critical for those determined to start again.
What was the impetus for the support group that you two began?
Justin Yopp: Don and I thought we knew what we were going to do with this. We had prepared for a quick session group intervention, but by the end of that first night, we had totally changed course. We had plans to do a lot of presentations, talking, and lecturing to the men and quickly realized that the most valuable part that the group had to offer was the chance for these dads to talk with each other.
So how did you guys adjust to better meet their needs?
Don Rosenstein: We learned that it probably takes longer for these guys to metabolize their loss than the literature would suggest. It’s possible that this was just a selection bias, that that’s what these guys experienced. But then we did other research and had detailed surveys over time from about 450 other men. This is not simple grief. This is complicated grief. These are men who are mourning their partners and their wives. They’re having to help their children grieve the loss of their mothers, and at the same time, they are having to go it alone as parents. It’s not like divorced parents who take turns. It’s just them. We came to think of what they were experiencing as “grief plus.” It was complicated, and they were all working with their kids, but it wasn’t easy for them. Their struggles were real and continued for a long time.
JY: We changed the format to an open-ended, ongoing group, that was primarily group discussion based. Over time, we saw these men support each other in ways that really moved both of us. We saw them reimagine their lives in ways that seemed unimaginable that first night that we met them.
You mentioned that you recognized that the dads in the group talking to each other was the most valuable aspect of the support group. What did you see that challenged them? How did you see these dads show up and be there for each other?
JY: One of their challenges was to figure out how to be the sole parents. There was a lot of self doubt. They were not sure if they could do it. This was a place where every month they could come in and talk about their perceived failings or shortcomings as parents, and hear from other fathers who were in the same position, that were having the same issues. There’s nothing like hearing from others that are experiencing the same thing, to help you realize that you’re not as bad or crazy as you might fear you are.
Don and I could have told the guys: ‘Hey, you’re doing better than you think.’ But that’s not a substitute for hearing it from someone who can really, truly relate to what you’re going through, and share a story of his own that would be a very similar feeling.
These guys had a very traumatic shared experience: losing their partners far earlier than they expected or ever even considered. What were some things you saw in response to that loss?
DR: As parents, what they do, quite frankly, is get more competent over time. They figure out how to get it done. How to elicit help from family and friends. How to figure out the best way to organize the house, when and how to ask their kids to step up, and how to strike a balance between the nurturing warmth and the structure and discipline. It’s not easy for them to take it all on themselves but they get better at the parenting thing because they have to. They wouldn’t recommend it to anyone.
As men, they essentially had to figure out a new plan. Sometimes, that involved just being a sole parent for several years, in many cases until their child grew up and left the home. In other cases it meant being open after a year or so to start a new family or a new relationship with someone. They had to contemplate an alternative trajectory from what they had assumed was going to be their trajectory. That involved a lot of reimagining and creativity and being open to differences. I think all the men we worked with would say that they grew as individuals, even though they wish they hadn’t had to.
It sounds like these are common themes and threads that you saw from these seven fathers.
DR: Absolutely. I think the main domains they all struggled with were: How do you grieve when you have to keep all the trains running on schedule? How do you recognize and help your kids grieve? How do you manage solo parenting, and then how do you start moving forward in time with a new life for yourself? How do you move forward? How do you date again? How do you get back in shape? How do you think about a career path, because for a while you didn’t think about all of that?
And these conversations lasted for four years. Did you expect that?
JY: That thought didn’t cross our mind. Primarily, the reason why the men came to the group was for their own healing, and increasingly for each others’ well being. But it also became a partnership between Don and I and the men. There had never been a support group of this kind. We were interested in not just learning about these sets of men but conducting research and really getting the word out about a need for support for widowed fathers.
What do you think men and fathers who are coping with their partner having a terminal illness learn from your work?
DR: I don’t have hard data for this, but as painful as it is to have explicit conversations about prognosis between the patient and her physician and partner, fathers need to have explicit conversations about prognosis. I don’t think we do that as well as we should in medicine in general.
At some point it becomes clear that it’s not a matter of beating the cancer anymore. It’s a question of how long is the reasonable expectation of living with a terminal illness, so that there can be some planning. Justin and I have had the experience with a lot of fathers where even if you don’t know when someone’s going to die, that’s likely how it’s going to happen. The fathers we’ve worked with would say it’s helpful to have conversations when you’re able to do it, rather than wonder how your wife would feel about X, Y, or Z after the fact. For some of the men, there were very concrete, practical, brutally honest conversations about what was coming down the road. For other men, they never did that, because everyone was so engaged in a fight to beat the cancer up until the bitter end. I think that in the former case, it helped the men cope more.
Is there anything that people with perfectly healthy partners can learn from your book?
DR: I’m sure this is true of everyone who’s ever written a book: You want everybody on the planet to read it and like it and find it meaningful and valuable. We’re no different in that regard. This was not intended to be a self-help book directed solely at men who lost their wives to cancer. We were hoping that this would be a book about loss, mourning, adaptation, and how one can deal with adversity.
What I would hope for someone who couldn’t relate immediately to what these men have gone through, is that if they have any experience in their life where what they thought their lives were going to unfold didn’t unfold that way, and they had to try out a different way of thinking and being, that they would find some inspiration as well as practical advice about how you do that.