Episode #050 · Rachel Cash
How Do You Grieve Someone Who’s Still Here?
Many of the conversations on this show have circled career change. This one is about change that ripples through every corner of your life. Change that you didn't expect and would never choose.
Therapist (and my former student), Rachel Cash, joins 10,000 Tabs for a conversation about mental illness, caregiving, identity, and a type of grief many people experience but few have language for: ambiguous loss.
Rachel shares the story of her mother's sudden psychotic break and the years that followed. Together, they explore what it means to lose the version of someone you once knew while they are still physically present, how family roles shift in the wake of illness, and why some forms of grief never receive the acknowledgment they deserve.
When Someone You Love Is Still Here, but No Longer the Same
Rachel was extremely close to her mother growing up. In their family of four, Rachel and her mom were the ones who understood each other. Her mother was the person who understood her sensitivity and anxiety, the person she relied on through the ups and downs of her life, and her connection to her Jewish identity and family history.
That relationship began to change when her mother started experiencing episodes of delusion. What initially appeared episodic eventually became something much more permanent. Conversations became circular. Her mother's personality changed. The warm, empathetic person Rachel remembered could now be cruel, fixated on things that weren't happening, or say things that felt completely unlike her.
“The person that she was no longer exists in a lot of ways,” Rachel says.
And yet, her mother is still here.
Rachel introduces the term ambiguous loss to describe the particular kind of grief that creates: grieving someone who is physically present while losing the person—and relationship—you once knew.
How Mental Illness Changes an Entire Family
At first, Rachel responded the way many capable people do when someone they love is in trouble: she tried to fix it.
By then, she was training as a social worker herself. She knew the healthcare system. She could find doctors, investigate treatment options, arrange care, and advocate for her mother. She pushed to find the intervention that might bring the person she knew back.
None of it produced the outcome she wanted.
Meanwhile, the roles inside Rachel's family were changing. Growing up, she had very little relationship with her father. He worked a lot, was the disciplinarian in the family, and felt fundamentally different from Rachel. She remembers being afraid of him and stepping into arguments between her parents to defend her mother.
Decades later, she found herself in an almost unimaginable reversal.
“Going from being fundamentally afraid of your father to becoming now your father's defender in this current environment has been really quite insane.”
Her relationship with him rebuilt gradually before reaching a point Rachel describes simply: “You're all I have.”
Her mother's illness hadn't changed one relationship. It had reorganized the entire family.
Caretaking Without a Resolution
Rachel jokes that while a full therapy caseload might be 25 clients, her mother is her 26th patient—the one who takes up all her time. The reality underneath the joke is much more complicated.
Her father lives with and cares for her mother. Rachel remains deeply involved. Her mother's illness affects her sister, her aunt, her mother's friends, and the way everyone relates to one another.
“We're all ill because of it,” Rachel says. “It's a family disease.”
Rachel also hasn't allowed herself to declare that her mother will never get better. Years of experience suggest the illness may remain, but leaving some room for hope affects how she's able to interact with her mom now.
That's especially difficult when her mother blames Rachel for parts of her illness or behaves in ways the mother Rachel remembers never would have.
Rachel has to hold both versions at once: the person in front of her and the person she knew for most of her life.
“I have to remind myself that this is not her.”
Her work now is figuring out how to enter those conversations remembering who her mother was without denying the reality of who she is today.
Finding an Outlet for the Things That Are Hard to Explain
There is another thread running through Rachel's life: the need to express what is happening inside of her.
She started writing poetry as a child and found early validation through school poetry contests and publication. Years later, after a painful breakup, she returned to it because she needed somewhere for the grief and anger to go.
“I've always felt this urge to take what's inside me and try to make other people be able to understand what's going on inside of me.”
Eventually, writing privately turned into performing publicly. Rachel began reading her poetry at open mics, including a terrifying first appearance at Chicago's Green Mill. Acting had always given her someone else's words to perform. Poetry required her to stand in front of an audience with her own.
Today, Rachel isn't trying to force all the pieces of her life into one clean identity. She's a psychotherapist and social worker. She's an activist. She's a poet and performer. She's a daughter whose relationship with both of her parents looks radically different than it once did.
When I ask what question she's living inside of now, Rachel returns to the most fundamental one:
“Who do I want to be? What do I want to do? Basically, who am I?”
Mentions and links
Rachel Cash
Rachel is a Licensed Social Worker. She has earned a Master's in Social Work from The University of Chicago, as well as a Bachelor's of Science from The University of Michigan. She specializes in fostering positive change through a strengths-based, goal-oriented approach that draws inspiration from behavioral and psychoanalytic modalities. At the core of Rachel's practice is a deep belief in the transformative power of the therapeutic relationship. She recognizes that individuals who have experienced interpersonal trauma often find the greatest healing in reparative relationships, and she strives to provide a non-judgmental and supportive space for her clients. Rachel's goal is to cultivate relational security and trust with her clients, using these as a springboard for healthier and more fulfilling connections beyond the therapy office. In treatment, Rachel treats each client's suffering with compassion and curiosity.
