Francine Cournos was born in 1945. She was the middle of three children in a lower-middle-class family in the South Bronx. Her father died suddenly from an undiagnosed brain tumor when she was three. Her mother died of breast cancer when she was 11. The following passages are taken from her extraordinary new memoir of loss and healing, City of One, just published by W.W. Norton & Company.

My mother never said good-bye to me. I stared out the window at her receding figure, arm in arm with her brother, and I thought: I may never see her again. I suspect she knew she was never coming back. I had no name for her condition, but this time was worse than the others. This time she was barely able to breathe.

I am haunted by this parting: she said nothing to me as she walked away. No “I love you,” no “I’m sorry,” no reassurances that she was happy to care for us despite her debilitating illness, no instructions for what I was to do without her. Maybe I wanted something impossible to give to an eleven-year-old, something that would sustain me for a lifetime, making up for all I would miss. Maybe she was too sick to say good-bye. Maybe she was too upset to confront the end. I will never know nor will I ever stop wondering.

Mine is an account of loss and reconnection that begins with my earliest memories and ends in the present. I have recorded the facts just as I remember them, using written documentation whenever it was available. It is also, to be sure, a subjective account, told from an internal perspective, first that of a child, later that of a young woman and a physician practicing internal medicine, and finally that of a psychiatrist.

School

Sixth grade had just started, and I was huddled with my five classmates on a street corner, catching up from our summer break. I was ashamed to tell them, but I finally got up the courage. My mother died. One week ago. That’s all I said. My friends looked ill at ease, shifting from one foot to another, saying nothing. I felt bad for them. Well, at least I had gotten it over with. Still, I was left thinking: Would they now think less of me? Children without parents are bad: they lost them—killed them—drove them away. I hated myself—hated my body—hated how I looked. My yellow polo shirt clung to my body, revealing my tiny breasts. Shame on me for letting them show. I folded my arms across my chest to hide them.

The Unveiling

We arrived. I put my pretty yellow daffodils on the grave. Everyone else picked ugly gray pebbles and put them on the top of the headstone, the Jewish way. Ugly rocks. I was determined not to cry, to show them I was grown up. When the tears started to come, I took my [younger] sister by the hand and we walked away from the grave site. We cried together where we could not be seen. “We can’t cry in front of anyone else,” I instructed my sister. Alexis had faith in the rules I’d made up for us. Afterward, I overheard the adults explaining to one another that Francine and Alexis hadn’t cried because they just didn’t understand. The adults around us, intellectually or emotionally incapable of imagining the intensity of our pain, chose to imagine that we suffered none. Still, I was pleased. I was where a dutiful daughter belonged, at the unveiling of my mother’s headstone marking the first anniversary of her death, and I felt that I had, at least in some way or to some degree, made up for missing her funeral.

Some Solace

One day, when I felt particularly lonely, I climbed into the double bed where Mom used to sleep and imagined her returning. I’d throw my arms around her and cry in bittersweet happiness. I absentmindedly reached down and touched myself. It felt nice, so I continued, and then an amazing sensation I’d never had before shook my entire body. In an instant my mind turned from thinking about Mom to thinking about having sex with a man someday. I was amazed by my discovery. Now I had my own way of making myself feel better whenever I wanted to, which turned out to be quite often. If at night I felt sad, or if I was upset about something, or if I couldn’t fall asleep, or even if there was no real reason at all, I indulged in this private pleasure and didn’t feel as bad about having to live without my mom. Maybe someday I’d have a man and children of my own, and then I could be part of a normal family again. To this day, I believe that my ever-present sexual drive was a powerful life force that helped save me, and I’m grateful for it. … [It] allowed me to recognize how much I still longed to be close to other people.

Foster Care

The woman spoke. Alexis and I would be moving to a foster home, she informed us, to live with a family that had not yet been selected. As the words sank in, rage took over. “I’ll jump off the Empire State Building,” I shouted, striving for the most dramatic possible statement, one that would really have an effect. If I threatened something outrageous enough, they surely wouldn’t go through with this. But they just humored me. The unfamiliar woman described the virtues of a new home, but I had stopped listening. I could barely distinguish between the fury I felt toward my relatives and the rage I turned on myself for being so helpless. “You can’t do this to me, you can’t give me away if I don’t want to leave.” I wished I really could jump off the Empire State Building, but if I was to be loyal to my mother, I would stay in control no matter what anyone did to me or how tempted I was by my own anger. I took my mother’s stoicism and self-control [during her illness] as the model, and did my best never to deviate….

Just as the psychoanalytic theories posit, my mourning, unlike that of an adult, consisted of holding on to my dead mother even more tightly than in life, rather than moving further away from her. When I realized there would be no acceptable substitute, I redoubled my efforts to stay conscious of Mom, to re-create her, to use her in place of any living relationship. It was much less frightening than facing just how alone I really was.

A New “Mother” at Adolescence

I was faced with a task not in the ordinary developmental sequence of events—to connect at just the moment it feels more important to disconnect. We [Cournos and her foster mother] had no common history to fall back on—we hadn’t known each other when I was little, and needy in a very different way. Orphaned adolescents have a terrible dilemma: they have a developmental need to break away, but their parents have beaten them to the punch. Continued adult involvement in my life was essential, and yet it was the wrong time to begin again.

Adulthood, On the Couch

I was terrified by my inner life, which of course was to be the focus of our conversation. The subject of my mother was the most fearful of all. My resistance could be summarized as follows:

“You’re angry with your mother.”

“No I’m not.” 

“You idealize her.”

“No I don’t.”

“You’re angry at me, too.”

“No I’m not. And you’re perfect. Just like her.”

After all, as long as you’re going to have an imaginary mother, why not make her a perfect mother and have your perfect feelings for her? If I no longer had to concern myself with having a real live mother, if I had to invent one, why would I invent a flawed one?

Another advantage to my delusion: when I became a mother myself, I would know just what to do, because I would be just like my own mother. It never crossed my mind that emulating my mother would mean feeling convinced that I was ill and dying, about to desert the child I so desperately wanted to raise.

Francine Cournos, M.D. is a professor of clinical psychology at Columbia University.