Much of our pain in our lives can be summed up with the word loss. Loss isn’t just about death. It includes divorce from a spouse, estrangement from a child, retirement from a career, relocation from a place or disability with declining health. Catholic priest Henri Nouwen says we’ve lost so much, that life can seem like one long series of losses: “When we were born we lost the safety of the womb, when we went to school we lost the security of our family life, when we got our first job we lost the freedom of youth, when we got married or ordained we lost the joy of many options and when we grew old we lost our good looks, our old friends or our fame. When we become weak or ill, we lost our physical independence and when we die we will lose it all.”
The emotional response to loss is called grief. It’s the mourning after. We can’t avoid mourning. We can’t live above it, underneath it or around it. We can only go through it prompting questions from my clients who come for grief counseling. What does grief look like? Am I going crazy? Are there predictable stages? Is there anything I can do to make this better? I’ll address these.
Simply stated, grief is the emotional process by which we cope with loss when we lose someone we love or something we feel we need to flourish. Rabbi Earl Grollman defines it this way: “grief is love not wanting to let go.” It’s gut-wrenching to lose people we love, share life with, make love to and depend on. It equally heart-breaking to lose jobs, health and homes that we derive our identity from. It fact its crazy-making. Feeling like you’re going crazy is a common reaction to grief and loss. Further symptoms include physical sensations like tightness in the throat, heaviness in the chest and queasiness in the stomach. Many lose all appetite and have trouble sleeping (Lindemann, 1944). Add to this the emotional effects of crying, sighing, confusion, social withdrawal and searching as well as calling out for the loved one to come back (Bowlby, 1977). Compounding these complex layers are also spiritual shifts when people get angry with God and question the foundational core-values. Grief is more than a wave to be surfed. It’s a tsunami to make sense of and recover from. Far from an event, it’s a journey.
Because of the seismic psychic shifts, grief can be misunderstood as clinical depression. This, coupled with the significance of loss and the length of the symptoms make a case for conversation with a qualified professional. That said, its important to recognize that grief isn’t pathological but “normal, natural and necessary” (Haugk, 2004). Holding these truths in tension makes the process more manageable promising light at the end of the tunnel. On a similar note, Elisabeth Kubler-Ross’ landmark book Death and Dying, normalized 5 stages of grief: denial, anger, bargaining, depression and acceptance. As helpful as the stages are, further research makes it clear that the experience of grief is less like a linear line and more like a spiral staircase. No one that I know moves through stages in a neat order like the common cold. Instead, it’s a back-and-forth, recursive movement. We tell our story over and again to self and another, feel guilty about what we should have done, get angry about being left on the lurch and are left wondering if we could have loved better, seen sooner and acted quicker. Rather than looking like stages or the same as another, “bereavement is as unique as a fingerprint or a snow flake. No two people grieve in exactly the same way. Five, ten, fifteen years after a profound loss we will not make sense out of it in the same ways we did when it occurred” (Grollman, ibid).
Since there’s some truth to the old adage time heals, it prompts the question of agency: “Is there anything I can do to make it better?” If its about Kubler-Ross’ stages or other researcher’s “phases” (Sanders, 1999), is the mourner’s role a passive one to sit back until the storm passes? Or to Freud’s point of “grief work” can a mourner take action. Harvard researcher and my first psychology professor, William Worden says yes. He recommends these 4 tasks to which I’ll add specific steps from my own clinical practice:
Task 1: Accept the reality of the loss.
When we lose someone/something that we love there’s a sense it hasn’t happened. Sometimes in shock we experience denial and expect them to return. I remember picking up the phone to call my mother months after her death. Earlier researchers spoke of this as searching behaviors (Bowlby, 1980; Parks, 1972). Often those who have suffered loss literally call out for the lost person. They might think they saw them on a city street, hear them saying their name, or attempt to reinvent them in another relationship. The bottom line is that its gut-wrenching to let go. But if we stay stuck in denial too long, complicated bereavement can set in. This is when a normal grief reaction (uncomplicated grief) can cascade into clinical depression. Acceptance is key and begins by using the right language. Rather than saying my brother “passed,” intentionally say “Bob died.” Another step toward making the loss real is making a memory book with the deceased. Story your relationship with pictures. Create rituals to remember this person on holidays. And tell your story over and again since doing so softens the sting.
Task 2: Work through pain and grief.
Worden wisely uses the German word schmerz for grief. It includes the physical, emotional and spiritual dimensions of pain. It’s impossible and “unthinkable” (Hutson, 2015) to lose someone/something you love without feeling pain. Pain is not the enemy American culture paints it to be. Neither are negative emotions. Positive thinking isn’t the pathway to happiness as so many think. “In fact, more evidence based research suggests that there’s an upside to negative feelings. Negative emotions are not only crucial to our existence but also—ironically—to feeling good. To live optimally in the world and endure its challenges, it's necessary to engage the full range of psychological states we've inherited as humans” (Matthew Hutson, 2015). To ignore negative emotions puts us at risk to know when something is wrong. It creates a false facade that promotes superficiality and side-steps true intimacy leaving people feeling empty and alone. It’s better to acknowledge, language and sit with pain. Cry. Give feelings a name. Journal it. Share it with a friend or therapist who specializes in grief work. Then life becomes more manageable.
Task 3: Adjust to an environment without the missing person/place.
Worden targets 3 areas: external adjustments-how it effects our functioning in everyday life, internal adjustments-how the loss effects our sense of self and spiritual adjustments-how the loss effects our beliefs, values and assumptions. My little article can’t adequately address these areas, but for simplicity’s sake here are succinct insights into each area to think about: external adjustments refers to the roles a person played in our lives before the relationship was lost. Perhaps they paid the bills, filed income taxes, shopped for groceries, etc. These are called secondary losses that force us to learn new skills to replace lost roles. Internal adjustments challenges us to reframe or reinvent our identity in light of the loss. If we’re codependent-we find our identity in someone else-we feel like we’ve lost ourselves too. We may believe we’ll never love again, be married again or even matter again. The internal task for the mourner is reframe your meaning and reinvent your purpose. “Who am I now? How am I different from loving him/her?” (Attig, 1996). The final task targets spiritual adjustments that can shake the foundations of what we believe about God, the world we live in and people in it. For some it can trigger a crises of faith. We wonder if God is good, if the world is a benevolent place, if people can truly be trusted. There’s no easy answers. Instead we reflect, search and struggle. We weave back and forth between what we once held true and making meaning out of new realities. It’s important to reach out for friends and to lean on support group...and when needed contact a trusted therapist to navigate the terrain.
Task IV: Emotionally relocate the loss and move on with life.
When Worden wrote his first textbook on grieving for therapists, he listed Task IV as “withdrawing emotional energy from the loss and reinvesting it in another relationship” (1976). Years later (2002), he changed this task based on further research that supported that mourners never sever bonds with those they lose. “A mourner never altogether forgets the dead person who was so highly valued in life and never totally withdraws his investment...We can never purge those who have been close to us from our own history except by psychic acts damaging our own identity” (Volkan, 1985, p 326). Christian apologist C.S. Lewis, echoes this same sentiment in A Grief Observed (1961). While funerals and rituals can relocate a person/situation in time and space, spiritual practices like detachment and mindfulness are more efficacious in helping mourners free themselves from obsessive thinking and put the matter more to rest. The task too, requires resolving unfinished business in relationships no matter how loving. Naming, blaming, owning our part, and parceling out memories move us toward forgiveness and peace-making with the past. This process reveals redemptive strands in even the deepest loss; leaving us with a sense that the journey though tragic was transformative.
Summarizing, grief is the emotional process by which we deal with life’s losses. It’s unpredictable, painful and uniquely personal. Though there are definable stages, the movement through grief is less linear than spiral. Rather than moving forward in a straight line, we circle back and forth and make new meaning with each cycle. Because grief is a journey more than an event, it’s made more manageable by partnering with the process rather than remaining a passive recipient. Therefore, tasks instead of stages are recommended to make grief matter. For a one page takeaway of Worden’s tasks: https://www.hov.org/sites/default/files/file_attach/four_tasks_mourning.pdf. “Only people who are capable of loving strongly can also suffer great sorrow, but this same necessity of loving serves to counteract their grief and heal them” (Tolstoy). Perhaps that’s why Jesus said “Blessed are the mourners, for they will be comforted.”
References
Attig, T. (1996). How we grieve: Relearning the world. Oxford: Oxford University Press.
Bowlby, J. (1977). The making and breaking of affectional bonds. I and II. British Journal of Psychiatry, 130, 201-210; 421-431.
Bowlby, J. (1980). Attachment and loss: Loss, sadness and depression (Vol III). New York: Basic Books.
Freud, S. (1957). Totem and taboo. (Standard Edition, Vol. XIV, 1913). London: Hogarth.
Grollman, E. (Apr 19, 1993). Sun-journal. Grollman on grief, 9.
Haugk, K. (2004). A time to grieve, I, 3.
Hutson, M. (Feb 2015). Psychology Today. Beyond happiness: The up side of feeling down, 44-82.
Kubler-Ross, E. (1969). On death and dying. New York: Macmillan.
Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141-148.
Nouwen, H. (1994). With burning hearts. New York: Orbis.
Parks, C. M. (1972). Bereavement: Studies of grief in adult life. New York: International Universities Press.
Sanders, C. (1999). Grief, the mourning after.Dealing with adult bereavement (2nd ed.).
New York: Wiley.
Volkan, V.D. (1985). Complicated mourning. Annual of Psychoanalysis, 12, 323-348.
Worden, J.W. (2002). Grief Counseling and Grief Therapy (3rd ed). New York: Springer.