Transcription of Mary Plouffe, Ph.D for the show From the Heart #300
Dr. Lisa Belisle: Today, it is my pleasure to have with me Dr. Mary Plouffe, who is a licensed psychologist and writer. Her memoir, I Know It in My Heart: Walking Through Grief with a Child, is coming out in May 2017. She is currently working on a book of essays on listening. Thank you for coming in.
Dr. Mary Plouffe: Thank you for inviting me.
Dr. Lisa Belisle: I don’t often think about the art of listening. How long have you been in practice now?
Dr. Mary Plouffe: About 35 years.
Dr. Lisa Belisle: You probably have some experience with that.
Dr. Mary Plouffe: I do. I do. The book is a chance to peel back a little bit the things that were most powerful for me to hear as a child and an adolescent. Then, it pulls back the screen a little bit in therapy, and talks about who we listen, and to what, and what healing is about in terms of both silence and listening because I think they both weave together in good clinical practice.
Dr. Lisa Belisle: Give us just a taste because that’s not the book we’re going to talk about today.
Dr. Mary Plouffe: No.
Dr. Lisa Belisle: I’m very excited to read it in the future.
Dr. Mary Plouffe: I didn’t bring any piece of that book with me, but I did an essay. This is actually the reason that this book is now on listening is that when I got an agent for this book, she said, “I need to sell writers, not just books. What else do you write?” At that time, I have had one essay published and it was “This I Believe” essay on the power of silence. It talks about all the different silences that I know in a therapy office, the silence of having said just the right word, the silence that follows somebody telling something they’ve never said before. It’s that kind of listening that I’m exploring in the book.
Dr. Lisa Belisle: You had to do a fair amount of listening yourself in this situation that you’ve just written about your sister dying of breast cancer at a relatively young age, and you’re being really pulled into the helping raise her small child. It’s a very different kind of listening for you.
Dr. Mary Plouffe: Yes, it was a very different kind of listening to me. Just to shift that just a little, Martha didn’t die of breast cancer. She was completely free of cancer at the time she went into this research project, which was supposed to be a last treatment that might extend her life. It was unknown and uncertain. She died of complications, unexpected complications of that treatment. There’s a slightly different feel to that. We had no expectation that she was going to die, or no expectation that anything, except a long and full life was ahead of her.
Dr. Lisa Belisle: You’re right. That’s s a big distinction because I believe it was a bone marrow transplant.
Dr. Mary Plouffe: It was a bone marrow transplant research program at Johns Hopkins, which also had a second stage to it. It was a phase two study to see whether people with her particular tumor would have a longer lifespan outcome if after they were freed entirely of tumor by chemo and radiation, they also did this further step.
Dr. Lisa Belisle: At that time, there seemed to be research behind doing this. Then, subsequent to that, it was learned that the researcher who was doing this wasn’t being forthcoming with his information.
Dr. Mary Plouffe: Yes.
Dr. Lisa Belisle: That’s especially tragic, really.
Dr. Mary Plouffe: It was especially tragic. It was exactly a year after her death that the results of the National Association found that no one here in this country or in Europe could duplicate the results of the South African studies that had sounded so promising, and on which all of these programs in our country were based. Following that, they went to South Africa, and looked at those studies, and found them to be falsified.
Dr. Lisa Belisle: How does one work through? I’m just thinking, if this were me and my sister, the anger over that, and, simultaneously the grief over the loss of a sister, and simultaneously trained to help with the grief of a child. That’s so many different things that you’re trying to balance.
Dr. Mary Plouffe: It’s a great question because I don’t think we balance everything all at once. I think, we prioritize. I certainly did. Liamarie was my first priority. She was supposed to be with me for three weeks when she came. That was my first priority.
The way, when you read the book, the story about the research, I put in an epilogue. There were a lot of people said to me, “No, no, no. You have to weave that into the story.” I said, “It’s dishonest,” because the truth is I didn’t weave it into my story. I knew it, but I really walled it off. I could not allow my feelings about that to be primary or even to take up a lot of energy. I had three children. I had a mother who had lost her daughter. I had a three-year-old whose husband was asking me, “Please help me raise this child, and help her understand that her mother is gone.” I think for a long, long time, I said, “Okay. That’s the bad news. That’s the horrible news, but that’s something I can do nothing about.” I walled that off.
One of the things that was hardest for me in writing this story, as a psychologist, is that I came to believe, after a lot of push, that it had to be my story. It was originally just Liamarie’s story. I was not going to be in it at all, except as a narrator. Once I was convinced that that was the way to write it, then I needed to write it honestly. Really, the only way to talk about that was to talk about how I had left that out, known it and said, “Don’t go there. I have other things that need every bit of attention that I can give.”
Dr. Lisa Belisle: This story is specifically about helping a child through grief. It’s written as your story, and as Liamarie’s story, and somewhat is your families story as well. It’s not a how-to. Yet, you still provide insights that may be useful for people who are looking for a way to deal with this. Why did you decide to go in the direction you did?
Dr. Mary Plouffe: That’s a great question because, first and foremost, when I thought about writing it at all, it was when Herb, my brother-in-law remarried, and I had written things just to survive, and to document, and to help myself think through what he and I were trying to do with Liamarie. I had never intended to use them except for us. I shared them with his new wife and family. I could see how they really resonated to living her experience, not just being told about it. That’s the first time that I felt like, “Okay, maybe this would have a life outside of our family.”
The other piece of this, Lisa, is that when I was in my deepest pain, all my textbooks, all my self-help books, all my how-to books were useless to me. I wanted only to resonate with somebody who was grieving as I was. Those were the books I found were helpful. When I thought about that, I thought, “That’s not a lot different from therapy.” You don’t sit there, and give people statistics, and numbers, and instructions. You take them to a place of feeling something about themselves. You use story and metaphor to resonate with that feeling because I believe we learn best with story.
It was always in my mind that it would not be a self-help book if I wrote it at all. It would have to be a memoir, and people would take from it what was relevant to their experience and their situation.
Dr. Lisa Belisle: Would you read to us a passage from your book?
Dr. Mary Plouffe: Sure, I’d be glad too. “This is a piece that occurred the first night I went to Johns Hopkins, went to the hospital, and saw my sister who was, at that point, unconscious on a vent in the intensive care unit of the bone marrow transplant. It was a pretty horrific scene. Here, we took Liamarie up to the hospital. She chose not to go into the room that night.
I didn’t sleep much that night. I wasn’t upset with Liamarie’s choice not to see her mother. Herb and I were both relieved she was so clear. It gave us more time to think. We both knew this could not be Liamarie’s decision. If Martha died, it would be a choice we would have to live with for a lifetime. And no three-year-old could understand the implications of that.
What kept me up was the concept of death. Object constancy, object permanence, Piagetian and experiments with toddlers invaded my dreams that night. Cognitive development in toddlers and young children, I thought when I awoke. You need to read up on this. But Liamarie did not give me the chance. The next morning, when Herb left for the hospital, she pulled me into the living room, ‘Play Ken and Barbie with me,’ she asked, and I cringed. Not my strong suit. I was not a fun of these precocious dolls for young children, but now was not the time to worry about the politics of child rearing.
She led me over to a big dollhouse set up in the corner of the living room. It was an older Playschool house, designed for small figures, but that didn’t seem to matter. I sat on the floor, and she picked up the two dolls from a pile of toys in the corner. ‘Okay, Barbie and Ken are going dancing,’ she announced. She grabbed the figures rather roughly, and stuffed them in a blue plastic convertible. She didn’t bother to change Barbie’s clothes, though she was in a pants and a casual top. Woosh. Liamarie shot the car across the room. She got up, retrieved the car, and came back to the house.
‘Now, they come home and go to bed.’ She grabbed the car, and removed the dolls, leaving Ken unceremoniously on the floor, and laying Barbie across the tiny bed, too small for the oversize figure. I had not yet said a word. ‘And in the night, she dies,’ Liamarie offered tentatively, articulating slowly, ‘But then she wakes up in the morning, right?’ Suddenly, I realized where this was going. ‘Yes, love, toys are pretend, so they can do that.’ ‘And people too,’ she insisted. ‘No, Liamarie, not people.’ ‘Why not people?’ ‘People are not pretend.’ ‘So, if Mama dies, she can come back to life again too?’ ‘No, love. No, she can’t.’ ‘I don’t want to play this anymore,’ she said firmly, and walked away.”
Dr. Lisa Belisle: That must have been quite something to be simultaneously, in your psychologist’s brain, an understanding that Liamarie was at a very specific stage of development that you needed to be aware of, but also being the sister of a woman who was dying.
Dr. Mary Plouffe: Yeah. It was a very powerful moment. There are many of those in the book, times when people say, “How can you remember?”, and I’d say, “How would you forget?” This was the first. We had not sat her down. We were not at a place of thinking that she was going to die. Only that her condition was really very, very serious. At that point, we were still hopeful. We hadn’t used that word. For Liamarie to go there, she was very verbal, almost four-year-old, and it did take me by surprise that she went there instantly.
I was grateful that I had some play therapy training because I could slide into that awareness and that head space, which kept it a little less emotional for me because I could tell when she was saying, “I need to process something with you. I need to figure out something with you,” versus when I just need to play with you and be with you. There was a different tone to it.
Dr. Lisa Belisle: You have, obviously, the good fortune to have had this training.
Dr. Mary Plouffe: Yes.
Dr. Lisa Belisle: You say play therapy, but also developmental stages. Most people don’t. Most people who are in this situation are flying by the seat of their pants really. How were you able to use what you knew to help Liamarie at this very specific three, almost four-year-old developmental stage?
Dr. Mary Plouffe: No. I think it was automatic pilot. She was so attached to me at that time. What we had thought was three weeks, because of delays and things, turned into four months. She’d actually been with my family. I’ve been playing substitute mother for a while. She really looked to me for answers to everything. I think, at that moment, it was the most constructive functional thing I could do, and that was good for me. I had no desire to run away from it. I just wanted to do the best I could to give her the support that she needed.
That was my healing, I think. I think when you can do something … You’ve been in medicine. You know when you can do something to help, you put your emotions aside for the moment, and you do that because that’s the best thing for both you and the patient. That’s really how it felt at that time, “Okay, now I can do something for her.”
Dr. Lisa Belisle: Do children and adults grieve differently?
Dr. Mary Plouffe: I think they do. I think they do. I think that’s one of the things I hope that this book will help people understand. Knowing is a process for children, especially for young children, but even older children. The time of a loss determines how much they can take in, and what level of abstract conceptualization about things like permanence and forever. No matter how many times you explain to a three or a four-year-old that death is permanent, they will still ask you, as Liamarie asked her dad, “Can we go to the train station? Mommy used to get off the train, and maybe she still will.” That sense of the inability to have the constructs that they need.
Every developmental stage, they rework what death means. They rework both in terms of their understanding of what they lost and what they will lose. They also rework it in terms of what it means to them because they, at four, you really can’t imagine what you will be like at 14 or at 44. Losing someone and knowing what that really means is a process that evolves through childhood.
I think for adults, we know. We know the moment it happens that it’s horrific. Our process is in titrating our awareness to that, and regulating our feelings about it, and taking it step-by-step. It’s not that we don’t understand it. It’s that we have to accommodate to it, and figure out how we’re going to make a life around it. When you’re three, your fragments of who this person is in your mind are still being developed. At four and five, Liamarie had few memories of the real mother, but she knew she was missing mothering, and that was her grief then.
Dr. Lisa Belisle: How did your own children work with this process? I know that your youngest, Margaret, was also relatively young herself.
Dr. Mary Plouffe: She was, yeah. My children were 10,15, and 20, actually, when Liamarie came to live with us. Those are very different stages too. The 20-year-old was off in college. The 15-year-old was in high school, and very much involved in athletics and music, and handled this grief, I think, like many adolescences do by diving head first into his own life, which was frankly a joy for all of us too. Margaret, I think, at 10 was in a more difficult position because she had one foot in childhood and one foot in young adolescence.
She was very aware of how big a separation this was for her little cousin. She felt for her. She would say, “I don’t know how she can be away from her mom. I couldn’t be away from you.” She felt with. She felt empathy for this, even more than in a sense was fair because Liamarie did not really have a sense of time. She thought she was just here for a three-week adventure, and she did not have a sense of the seriousness of her mother’s treatment even after the ARDS hit; whereas, Margaret did. She bonded with her really in an emotional way because of the stage she was at developmentally.
Dr. Lisa Belisle: Through this time, you continued to do your work as a psychologist.
Dr. Mary Plouffe: I did.
Dr. Lisa Belisle: You were still seeing patients while you were helping everybody else, and, hopefully, helping yourself to work through this process.
Dr. Mary Plouffe: Yeah. I had to take a great deal of time. When in the month that she was at Johns Hopkins, I was back and forth a lot. After her death, I really couldn’t afford to take another two or three months for grieving. I know myself fairly well. I knew that just not doing my work, my work was my survival. I could walk up to my office. I didn’t work 40-hours a week. I took what I called grieving days then when I have absolutely nothing on my schedule, except whatever my heart and soul needed to do.
I also tried to weave in what I’m here to do, which is to do my job because that also gave me a sense that life would go on. That was very helpful for grieving because we all know how awful it feels. What we need to know is that we can get through it. Sometimes, being able to do small pieces of your life, in spite of how awful you feel, is the affirmation you need that you will get through this and life will get better.
Dr. Lisa Belisle: I was struck by one thing that you said about your husband, who also is a professional working outside the home as an attorney. There’s something like he had made it his responsibility to make sure that you have the space literally and figuratively to help provide care for people who needed it. I thought that was so wise because I know that when you are in the field of working one-on-one with human beings, it’s a very intense situation. For him to want to create that space for you, I think, speaks volumes of his understanding of what you do and also of your relationship.
Dr. Mary Plouffe: Yeah. None of this would be real without him. As I said, it is not a joke, but it was always a joke between us that he would say to me, “My job is to keep you sane, so you can go up to your office and do the same for others.” Boy, if those words had truth in them, they were proven both in going through this and also in the writing of this because the writing was relieving all of this, especially so many years later when I had to dig through so much material just to create a story and arc that made sense.
Dr. Lisa Belisle: That is also interesting because how old is Liamarie now?
Dr. Mary Plouffe: She just graduated from college in June.
Dr. Lisa Belisle: That’s a long, long time.
Dr. Mary Plouffe: Yes.
Dr. Lisa Belisle: That’s a long period of space in which you’ve needed to grieve, and process, and write, and rework. It’s just evidence that this type of thing doesn’t happen overnight.
Dr. Mary Plouffe: It doesn’t happen overnight. On the other hand, I don’t think it’s as continuous a process of that. As I said, I didn’t think about writing the book until she was 10, when her father remarried. I asked her when she was 15. I felt like even then, it was a little risky thing to do. My first and foremost concern was that it wouldn’t disrupt her life. I took another five years with all the drafts, and with the fact that I wasn’t a writer to start with, and had to go out there, and learn how to do things. She was 20 by the time she actually read it start to finish.
That felt right to me because I think she really was able, then, as a young adult, to reprocess what some of which was some material that was very new to her, and very emotional. There, certainly, were years in there in which I would say we were all in a good place. Then, the question came, do I want to write this book? Is this what I’m going to do with this life experience, or am I going to share it, or am I going to keep it to myself?
Dr. Lisa Belisle: What was the turning point?
Dr. Mary Plouffe: To write the book, I honestly think the turning point was seeing how useful it was to Herb and his new wife who became Liamarie’s adoptive mother. A couple of years after that, I went to a conference. I said, “I’m going to write this story, and it’s going to be called Liamarie’s Story.” They said, “Was this your sister?” I said, “Yeah.” They said, “It can’t be Liamarie’s story. It’s got to be your story of grief, and how you tried to care for her through that.” That was a shocking idea. I’m the psychologist who sits behind the desk.
I put it in my bottom drawer for three years, but I had fallen in love with writing. A good friend said to me about 2009, three years later, “You’re not going to write anything unless you get that book out of your head.” She said, “Why don’t you do what they’re saying. Put pieces together, and submit it to a totally objective author, and say, ‘This is how many legs outside the family. This is something you should just keep or could it be a book?’” I was lucky enough to have that person be Suzanne Strempek Shea, who believed in it from the minute she saw it, and kept saying, “You have to write this book, and you have to write it this way.” I think that was wonderful to have writers who felt that it would be a contribution.
Center for Grieving Children, when they saw the first draft, said it was very supportive as well. I’m very fortunate that people said, “This may do some good in the world.” That felt like what my sister would have wanted because she was a rebel, she was a fighter. She was, in the ‘70s, the red-haired Irish Catholic girl who went to Black Panther meetings at night. She was a rebel. I know she would have said, “Do something with this besides just keeping it to yourself. It feels good to be there.”
Dr. Lisa Belisle: I am glad that you wrote it. I enjoyed reading it. I learned something about children and grieving. I learned something about you, and I’ve known you for many years. It was really wonderful to be able to have, I guess, that window open into another, again, human being. I appreciate your being here.
Dr. Mary Plouffe: Thank you for inviting me. I’m excited to see it finally come out in the light of day, and to hear people’s reactions to it, and to share it.
Dr. Lisa Belisle: I’ve been speaking with Dr. Mary Plouffe, who’s a licensed psychologist and writer. Her memoir, I Know It in My Heart: Walking through Grief with a Child, came out in May 2017.