⇒Life is about bonding, but it is also filled with loss. “Life is loss,” an early mentor once reminded me.
In the early 1980s, whole communities—and eventually nations—were decimated by an unforeseen plague. It began in southern California, where young healthy gay men contracted Pneumocystis carinii pneumonia and other opportunistic infections (OIs) found in the immunosuppressed. In 1981, in New York City, physicians found a rare tumor in the same group; the tumor was Kaposi sarcoma (KS) and was usually found in elderly men of Eastern European descent.
Pneumocystis and the “gay cancer” were spreading among the gay men of Greenwich Village, where I had recently opened my psychiatry practice. Greenwich Village is an area of lower Manhattan with a history of artistry and iconoclasm. In the early 1980s, it was also the home of a vibrant gay community. It was the rare place in America where gay people could walk hand-in-hand and display affection. It was also a font of creativity, filled with the shops of artisans, designers, and antique dealers.
At the time, I received many referrals from primary care colleagues and I began to take gay men as patients. Many had KS/OI and were facing death. I was there to help them with their rage against the dying of the light,1 and I was as helpless as they were. They were so young! They had people they loved, and their lovers were dying as fast and tragically as they were. They were so unprepared. They had books in publication, they had patients in their offices, they had antiques to buy and sell. And their physicians had no treatments. (AZT was not approved until 1987.)
One day, O. P. walked into my office, referred by a friend. I had prepared myself for another story of sickness and imminent death, but O. P. did not have the virus. He was a young, gay entrepreneur who was physically healthy but emotionally devastated. “I cannot control my emotions,” he told me. “I’ve lost more than 50 friends to GRID. To AIDS. One was my lover.”
I knew that GRID (gay-related immune deficiency) was the term used by researchers before they learned that the virus, and immune deficiency, went well beyond gay men to hemophiliacs, straight partners, infants, and others. In gay communities, GRID was known before AIDS.
“Why are you coming in now?”
“Someone from my grief group killed himself. When that happened, it triggered a flood of losses. Now everything triggers terrible memories.” The sound of a patient using a pentamidine nebulizer in his doctor’s office triggered memories of his lover on the respirator in the intensive care unit at the local hospital. Even his grief group was unhelpful to him because “each new member reminds me of what I’ve lost.”
He was having an anniversary response to the loss of another friend, who had died 2 years earlier after great suffering. He was guilty that he was not there when the friend died. He felt equally guilty that he had not known his grief-group friend was suicidal.
He could not grieve for his lover because he could not talk about their love. He was a grieving widow, but his friends could not validate his widowhood. O. P. had only recently renewed his relationship with his former lover, before the lover died. He spoon-fed his lover, bathed his feet, and cared for him for months—but because they did not live together and because his lover had other lovers before, he felt he could not claim to be his widow. His sense of rage and isolation overwhelmed him. When caring for his lover, he was constantly frustrated at attempts to get him the best of care; the insurance companies were often deaf to requests for coverage. The national government was failing him and his friends. He wondered if he could ever freely express his homosexuality again.
Dr. Woesner is Director of Medical Student Training at the Bronx Psychiatric Center in New York City. She is also Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, at the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
1. “Do Not Go Gentle Into That Good Night,” by Dylan Thomas, who visited and died in the Village.
2. MacNeil CH. School bars door to youth with AIDS. Kokomo Tribune. August 31, 1985. http://www.hemophiliafed.org/news-stories/2014/03/1985-ryan-white-banned-from-school-because-of-aids/. Accessed July 18, 2016.