Life can be defined as a finite period of time characterized by continual change. Consequently, since nothing is permanent, we all experience losses. Some are trivial, others are devastating. We are now living in a time of great turmoil with millions of people subject to losses beyond their control. Thousands of homes and businesses have been destroyed by the effects of climate change with fires, floods and storms throughout the world. Many more have been displaced by wars and political upheavals with thousands having lost their homes, possessions and way of life, but the most immediate and tangible threats are due to the COVID-19 pandemic where in addition to the loss of over a quarter million lives, several million remain unemployed, and self-imposed isolation has taken a toll on mental health.
According to the CDC, 8 out of 10 deaths from the virus have been in those over age 65, but they noted even those in their 40s and 50s are at higher risk than younger folks. Many studies have documented that widowhood carries with it a mortality rate of well over 30% during the 1st 90 days of bereavement and 15% thereafter, powerful evidence that loss of loved ones has serious consequences for survivors. The pandemic has limited traditional mechanisms of dealing with grief since last goodbyes are often denied due to isolation policies, and funerals, wakes, and life celebrations are limited. Time will tell if their lack will result in an increased prevalence of unresolved grief.
Grief | Loss due to death vs Loss due to breakup
Meanwhile, we are still subjected to the ordinary losses associated with the process of living. Much of my time as a psychiatrist was devoted to helping those afflicted with the pain of losses, as I am sure is true for most clergy, counselors, social workers, psychologists and bartenders, etc., but it is only recently that the Board of directors of the American Psychiatric Association has recommended that unresolved grief be considered a diagnostic category. Although death of a loved one may seem the ultimate loss, in some ways it is easier get over than the termination of a relationship via other means, such as divorce or breakup of an important personal relationship. The finality of death encourages one to move on, but when the object of one’s affections is alive a relationship real or imagined will persist. Thus, Don Jackson, a renowned family therapist said there is no such thing as divorce. Or as I have often said: divorce is like a death in the family, but you can’t bury the corpse.
Our nature requires relationships. Relationships help to define our identity, i.e., who and what we are. For example, I am often introduced as Barb’s husband which provides considerable information about me. Our identities are also shaped by those with whom we associate even the organizations to which we belong or those we choose to lead us. Long term relationships invade one’s personal space to the extent that we often absorb some of the involved person’s personal characteristics to the extent that they become part of who and what we are. Consequently, their loss may result in what I call a psychological amputation. Thus, in the face of such losses, one is left with the feeling that a part of one’s self has been taken away.
As with the loss of a physical body part, a psychological amputation can result in myriad feelings and reactions in addition to sadness. There may be anger, at times even rage, directed to whomever one blames even him/herself. Instances in which rejected suitors have stalked, assaulted, or even murdered, are unfortunately not rare, which naturally leads one to question the nature of such alleged love. There may be feelings of betrayal at the deceased for being abandoned or for behaviors thought to have hastened his/her death. God is often a target for anger, especially in deaths, and in such instances the Biblical quote: “the Lord giveth and the Lord taketh away” rarely provides solace. Although I have found that referral to the patient’s pastor or Rabbi is frequently helpful.
Anger may also be self-directed resulting in guilt. In such cases, the patient may spend endless hours ruminating over what he might have done to prevent the loss or even worse how he could have caused it. A close friend of mine, who shall remain nameless, continues to have pangs of guilt over her Grandmother’s death nearly 80 years ago because as a child she had “sassed Grandma” shortly before her sudden death.
There are instances in which survivors may feel guilty for not grieving enough. One case from many years ago, which has stayed in my mind, involved an elderly lady who was referred to me by her family doctor with the complaint that she had lost the strength in her right leg. An extensive workup had not yielded a diagnosis and the referral appeared to be a hail Mary. She walked into the office unassisted. Although using a cane, she appeared to walk quite well. Her story was that her husband of many years had recently died following years of a debilitating illness for which she had been his primary caregiver. She reported that she rarely left the house during all that time, having obviously taken seriously the vow about “in sickness and in health.” Shortly after her husband’s death, she was excited to visit a friend in a neighboring village whom she hadn’t seen since her husband became ill. After starting her car, she was unable to move her leg to the accelerator in order to drive away -a classic case of conversion reaction, resulting from the guilt she felt over enjoying her new found freedom.
The Affect of Death on Children’s Development and Attachment Theory
It has long been noted that children who become orphaned are at risk for significant relationship or mental health problems later in life. (This is a relevant post from Psychology Today). Konrad Lorenz’s studies of imprinting demonstrated the importance of relationships in young animals, and Bowlby, with his Attachment Theory, came to similar conclusions regarding humans. When the process of attachment is interrupted prematurely it may leave the child lacking in skills necessary to develop healthy relationships, and leave them impaired for life.
Much has been written about the stages of grief. However, I have not found that concept particularly helpful, for in my experience people do not always follow a particular pattern of behavior when they have lost something or someone, though I have found that denial is frequently present especially when the loss involves another human life. Although at a conscious level there is realization that a person is gone, a survivor may behave as if expecting them to return. In such cases there are frequent slips in which the deceased person will be described in the present rather than the past tense. There is resistance to disposing of clothing and other personal effects, or to removing the voicemail greeting from the family phone. Frequent trips to the cemetery are common and may involve imaginary conversations with the deceased. The survivor may be said to have “held up” surprisingly well during the burial proceedings.
Perhaps, the most painful loss of all is the death of a child, and in my experience the most likely to result in denial. Although at a conscious level the parent knows their child is dead, they may continue to insist that their room will remain untouched as if they are waiting for him/her to return. Deaths by suicide usually introduce a series of unanswered questions which further complicate the healing process, often leaving survivors blaming themselves.
It goes without saying that it is very difficult to resolve a problem without acknowledgement that it exists, and in my experience, denial following the death of a loved one is quite common. It is usually the first hurdle that must be overcome in order to find resolution of grief. There are numerous exercises which may be ordered to help one achieve acceptance. My favorite is to arrange a visit to the graveyard with a close friend or pastor, simply say goodbye, and have a good cry. For those in denial, there is usually a great deal of resistance to using that word, and the mere suggestion to carry out those instructions is often met with tears.
Loss of Relationship by means other than death can be even more complicated.
The break-up of young lovers, especially first loves, is complicated not only by the level of passion involved, but their lack of experience in dealing with loss. They should be taken seriously as such losses can result in serious suicided attempts especially in teenagers. But for anyone the loss of a love object can be devastating for with it go dreams of an idyllic life with the hope of loving and being loved. It may result in sadness, depression, anger, or even violence.
How to Survive Loss
Hope is invaluable with the loss of things which are replaceable for it inspires one to action. The streets of our big cities are littered with homeless people most of whom have lost hope, while those who have lost their homes in fires or other calamities, although saddened and depressed by the loss of all their possessions, need hope if they are to replace that which has been lost. However, with abandonment by a loved one hope can hinder resolution. It goes without saying that one cannot live in the moment if they are stuck in the past, which happens when we continue to dwell on recovering something which is beyond reach.
Recovery from loss is simple but not easy.
We must “let go” if we are to “move on.”
We let go by grieving. Grieving is the process by which we allow ourselves to grapple with and purge intense disabling emotions following a loss. Grief can be initiated by the loss of anyone or anything to which a person has a personal attachment.
Cultures have developed various traditions which seem designed to promote resolution of grief following deaths. In a previous blog I have written about those I experienced in a rural midwestern village 75 or 80 years ago, but my favorite funeral celebration is the traditional New Orleans jazz funerals in which the funeral procession is led by a brass band to the graveyard while playing a funeral dirge, then following interment the band marches back toward the decedent’s home playing a lively Dixieland tune. The message could not be more evident. There is acknowledgement of the sadness of death followed by the celebration of life, a perfect example of letting go and moving on.
Other Types of Loss
In addition to the loss of loved ones, since the word pandemic entered our lexicon, we have been subjected to losses of some of our most precious possessions. It has been said that you don’t fully appreciate the importance of something until it is gone. Granted, it has been catastrophic for those who have lost jobs, housing, or businesses, but the isolation and cumulative effect of the loss of activities which we previously would have considered mundane have also taken a toll.
On a positive note, if there is one, perhaps we have learned to know the value of some of those things we previously took for granted. There is also hope that constriction of our social activities may result in more family cohesion. Who knows? Maybe kids and parents will even start talking to each other. Losses of all kinds are bound to get our attention, and there is often a lot we can learn from them, especially those we create by our own mistakes for failure is the great educator.
Although in rare instances, loss may result in a sense of relief, in nearly all cases, there will be strong feelings elicited as previously mentioned. Such emotions are disabling and must find expression, a process which we call catharsis. It is not a good time to do the strong silent thing when consumed by grief.
As I have mentioned many times, we are herd creatures, which is hardly a new concept having been the subject of John Donne’s poem, “NO MAN IS AN ISLAND” written in 1624. As such, we are dependent upon others whether we like it or not. In the face of intense emotions we can become overwhelmed and confused. In such times more than ever, we need validation, i.e., someone who we trust to listen, be supportive, and reassure us that our feelings are rational. Indeed, the process of attempting to communicate those feelings verbally helps to organize one’s thoughts, and a recent study in the American Journal of Psychiatry, has confirmed what we already knew, which is that confiding in others helps prevent depression. After all, that is how I made a living.
Surviving Loss is a PROCESS
Usually catharsis is not a one-time thing and there will be triggers that will resurrect some of those feelings in milder form from time to time, but most will learn to let go of past traumas by focusing on the road ahead. Hopefully, they will come to understand that to look back over their shoulder will likely cause a stumble, and that they must let go of the past in order to move ahead.
With millions all over the world facing serious losses, we are not only “all in this together,” but we are also very much in need of each other and there has never been a better time for us to be our “brother’s keeper.”