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In the mid-1970s I was chatting with a psychiatrist prior to a meeting. He was about 20 years older than I was. I had attended several conferences at which he presented and I was impressed with his empathy and clinical intuitiveness. He displayed a sense of warmth that allowed others to feel comfortable and at ease. He had also referred several patients to me, providing us with an opportunity to discuss clinical work and for me to learn from him.
He asked about my sons, Rich and Doug, who were seven and four years old at the time. I replied that I was having a lot of fun with them and they were a joy. I asked about his son Sean, who had recently started college. He replied that Sean appeared to be enjoying his first couple of months at college but then paused and a sad expression appeared on his face. His subsequent comments were not what I had expected, especially given my perception of him. After a few moments he advised, “Spend as much time as you can with your kids, Bob. When my wife and I said goodbye to Sean at college, I couldn’t help but wonder how much he really knew me or I knew him. I even wondered if I was somewhat of a stranger to him.”
He probably sensed I wasn’t certain how to respond so he continued, “I have regrets about how I’ve been as a father. Years ago I was so busy building my practice that I missed a number of Sean’s games and school events and I wasn’t as available as I should have been. When he was a teenager I had a little more time for him, but by then he was busy with his own friends and activities. If I knew then what I know now I would have done things differently as a father.”
The Haunting Lyrics of a Song
As he spoke I immediately thought about a recently released song by Harry Chapin titled “Cat’s in the Cradle.” The haunting lyrics of this well-known song are about a man who is too busy to spend time with his young son, but he continues to promise that he will do so at a future date. In turn, the son predicts, “I’m gonna be like you, dad, you know I’m gonna be like you.”
The dynamics of the relationship are reversed as the son gets older. When the latter comes home from college and his father wants to spend time with him, the son shakes his head and asks his father if he might borrow the car keys, assuring the father, “See you later, can I have them please.”
Years later after the son has moved away and is married with children of his own, the father calls and asks if he might visit. His son replies, “I’d love to, Dad, if I can find the time.” Unfortunately, it appears as if the son is too busy to welcome his father for a visit, but he tells him, “It’s been sure nice talking to you.”
As the father hangs up the phone, he realizes that his son’s prediction, “I’m gonna be like you, dad, you know I’m gonna be like you,” has come true, that “my boy was just like me.”
I have no idea if this psychiatrist was being overly critical of his parenting, if in fact his relationship with Sean was not as distant as he described it to be. I’m not certain if in the subsequent years they established a closer relationship. However, what I do know is that his words had a profound impact on me. With two young sons I was already very aware of the challenges of balancing one’s personal and professional life, but I didn’t want to look back with regrets when they were ready to leave home and question how available or loving I had been as a father.
I recall that when our sons were very young my wife Marilyn and I were told by several people with adult children how quickly the years go by. At the time Rich and Doug’s emergence into adulthood seemed so far away. But how true an observation from these parents of older children–the reality is that in a seemingly fleeting time our children are adults, many with their own children.
Regrets of Those Near Death
Vivid memories of this conversation with the psychiatrist were triggered when Allan Hayes, who kindly refers to himself as “a loyal reader of my columns for years,” responded to last month’s piece about gratitude by sending me a link to a thought-provoking article written by Susie Steiner that appeared in The Guardian this past February. The article is based on the recordings of Bronnie Ware, an Australian nurse who devoted several years working in palliative care with patients in the last 12 weeks of their lives. She wrote a blog “Inspiration and Chai” based on the reflections of these patients, which she then compiled in a book The Top Five Regrets of the Dying.
Steiner reports, “Ware writes of the phenomenal clarity of vision that people gain at the end of their lives, and how we might learn from their wisdom.” Ware identified the five main regrets of those facing imminent death, “common themes that surfaced again and again.” The five themes resonated with many of the ideas that my colleague and close friend Dr. Sam Goldstein and I have addressed in our writings, especially in our book The Power of Resilience: Achieving Balance, Confidence, and Personal Strength in Your Life.
As I read the five regrets I thought immediately of many of my adult patients as well as people who have attended my workshops who have expressed similar regrets. Those who recognize they are burdened by regrets but are not facing death in the near future are fortunate in the sense that they still have a choice. They can continue to live with these regrets or they can assume a proactive stance and initiate changes to lead a more meaningful, resilient lifestyle. While the specific regrets we have vary from one person to the next, it can be beneficial to examine the common themes highlighted by Ware and consider if they represent features of our own lives. The following are the five regrets she describes:
I wish I’d had the courage to live a life true to myself, not the life others expected of me. As we shall see, this regret is implicated in the other regrets as well. Sam and I write about living life in concert with one’s values. In my clinical practice I frequently ask patients to list five things that are most important to them. Once they have created their list I ask them to tell me to what extent and in what ways they achieve these priorities. I have had many individuals list their marriage, or their children, or particular hobbies and interests as most important to them, but yet they spend minimal time in activities that support these priorities.
One of the main goals in therapy is to fulfill these highly valued priorities. Steiner quotes Ware, “Most people had not honoured even a half of their dreams and had to die knowing that it was due to choices they had made or not made. Health brings a freedom very few realize, until they no longer have it.”
I wish I hadn’t worked so hard. Ware asserts that she heard this regret from every male patient with whom she met. “They missed their children’s youth and their partner’s companionship.” She notes that several women also voiced this regret, but most of her patients were from a generation in which women did not work outside the home. Given a newer generation of women who are increasingly employed full or part-time, I have heard this same regret from them.
I am cognizant that the demands of work often increase the pressures we experience and curtail the time we have available to be with our family, but on the positive side I have conducted therapy with many individuals who discover that they can undertake even small changes to lead a more balanced life. It is vital that we do not sacrifice our relationships with friends and family as we attempt to meet the demands of the workplace. An imbalance will produce even more stress and regrets.
I wish I’d had the courage to express my feelings. Ware discovered that many of her dying patients “suppressed their feelings in order to keep peace with others… Many developed illnesses relating to the bitterness and resentment they carried as a result.”
My intervention with a number of patients have focused on their ability to be honest with themselves and to express this honesty in an empathic manner so as to lessen the likelihood of defensiveness or anger on the part of others. Associated with this intervention I emphasize that while we have control over the ways in which we convey our feelings we basically do not have control over how others respond to our words or actions. Consequently, as carefully as we word our beliefs and display our emotions, we must be prepared for and not blame ourselves if others become angry or prefer to distance themselves from us. If the fear of others not liking us is followed by an urgency to hide our emotions, the outcome may lead to the sad refrain, “Why didn’t I say something to that person?” or “Why did I agree to do something I didn’t want to do?” or “Why didn’t I tell that person how I was truly feeling?” As Ware found, such sentiments are accompanied with bitterness and resentment.
I wish I had stayed in touch with my friends. In the Power of Resilience Sam and I write about the importance of connections with others as a key ingredient of a resilient lifestyle. We note that at different points in our lives our friendships might change so that someone who played an important role in our 20s might not do so in our 40s or 50s. I believe that Ware’s observations refer to instances in which meaningful relationships were allowed to lapse, prompting those near death to wonder what happened to someone with whom they were so close. I don’t believe this particular regret requires keeping in touch with countless people but rather making a concerted effort to maintain contact with the significant people in our lives. As I examine the friendships Marilyn and I have, there are several dear friends we have known for more than 40 years. Almost all live in the Boston area and we make certain that we see them regularly. These are people with whom we have shared numerous joys and sorrows and we know they will always be at our side.
I wish that I had let myself be happier. Ware notes, “This is a surprisingly common one. Many did not realize until the end that happiness is a choice. They had stayed in old patterns and habits. The so-called ‘comfort’ of familiarity overflowed into their emotions as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again.”
Some might question if happiness is truly a choice, especially those who suffer from clinical depression or other psychological or medical disorders. I am more comfortable interpreting this regret in terms of what Sam and I refer to as “negative scripts,” that is, those behaviors in which we repeatedly engage although they do not lead to productive outcomes and actually result in feelings of unhappiness. In my workshops I frequently assert that many of us are hesitant to leave our “comfort zones” even when these comfort zones are not very comforting. The known seems less risky than the unknown even when the known provides little, if any, satisfaction. Perhaps one day I will author a paper titled “Living in a Comfort Zone that Provides Little Comfort.”
Rather than positing “happiness is a choice,” the following may be a more accurate statement: we frequently do not have control over the emergence of certain emotions but as mentioned earlier, we do have more control than we appreciate in the ways in which we deal with and express these emotions. This sense of “personal control” is what promotes greater happiness and resilience in our everyday lives. The energy of individuals who are resilient is directed towards constructive ways of coping in the face of particular challenges and feelings.
A Final Question
In ending I offer a question for consideration. Imagine that you were one of Bronnie Ware’s patients with just a short time to live. She asks what, if any, regrets you have about the life you have led. How would you respond? Since almost all who are reading this article have more than a few weeks to live, your answer can serve as a catalyst and guidepost for the behaviors you adopt in the future. Most of us still have time to take actions to address our current regrets in a realistic fashion. Regrets are part of the human experience, but if we are burdened by too many of them, there is a lessening of joy and satisfaction. It is for this reason that it is beneficial to embrace and apply the wisdom shared by dying patients to our own lives.