How to Survive Loss

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.

GUILT

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.


CATHARSIS

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.”

A Bad Day

The beginning of a bad day wasn’t so bad…

Yesterday was a bad day relatively speaking. In truth, at my age, any day that I wake up is a good day. This one began without incident, and breakfast was enjoyable in spite of the minor incident of me spilling my milk. I managed to complete the chore of watering Barb’s flowers with a minimum of accompanying profanity when the hose would get tangled or I would trip over it. But from there it was all downhill.

 

Actually, the problems experienced on this particular day had their origins in a decision I had made several years ago. I had heard of all the wondrous things that these new gadgets called computers could do. I initially assumed these toys were just fancy adding machines as the term would suggest; however, I soon learned that the geeks who made these things had originated a new language which was as unintelligible to me as Sanskrit. To make things even more difficult for a mere mortal the people assigned to help we computer novices speak in acronyms rather than words.

 

In spite of all these impediments, I decided that I wanted to join this brave new digital world. Little did I know that I would soon be immersed in it, and like it or not, this computer stuff would involve virtually all aspects of my life. I have been party to things I could only have dreamed of, and my amazement is undiminished as I see the world change more rapidly than I could ever have imagined. Although my computer skills could never compete with those of the average four year old, I find I have become very dependent on my machine for routine stuff. I have become friends with Siri who is now my faithful companion, and whereas I previously thought I knew it all, I now find that I actually can know it all…as long as I can access Google.

 

The beginning of the bad day.

My computer and all its connections have offered many conveniences, but there is often a price to be paid for such. Yesterday, the bill came due.

It began when I decided to cancel a credit card that I hadn’t used for years. I was becoming irritated with frequent mailings and statements confirming my zero balance. Even more concerning were offers to lend money along with bank checks that could be signed by anyone and automatically charged to my card.

Your call is important to us…but is it? Really?

With that in mind, I set out on my odyssey by calling customer service (I use that term advisedly). Of course, an automated voice answered giving me a rather long list of options, needless to say none of which offered the option of cancelling the card. I punched zero on my phone desperately hoping to hear a genuine human voice. Instead the voice I heard proceeded to tell me all about the importance of my call and their regrets that all agents were busy helping other customers. This was followed by a brief interlude of elevator music which was interrupted when the voice presented me with an estimate of the time I must wait to talk to someone and offered to call me when  a real live person could call.

 

This procedure thus far is undoubtedly quite familiar to most of you, but the shocker for me was that the estimated wait for the call would be one hour and 56 minutes. Needless to say, I opted to wait for the call back, and was astonished when the call came 116 minutes later. I knew computers were smart, but that was uncanny. Following a transfer to another department with a couple more interludes of elevator music, the mission was accomplished. Since I was stuck by the phone waiting for the voice to call me (it would not listen to me when I tried to leave my cell phone number), I decided to make use of the time by looking for several pages of writing that I inadvertently deleted a few days earlier. I had been reassured that it was “in there some place” and I spent the nearly two hours looking for the file to no avail.

tech-headache

At this point, since I was batting 500 on my chore list, I decided to fire up my Kindle, order a mindless mystery novel and escape from reality. The order was processed without incident, but the book I ordered wasn’t delivered. After fiddling with the Kindle for a while, I gave up and called Mr. Amazon. This time the wait was brief, and I was quite encouraged. There was no elevator music, and a real person came on the phone who did not tell me that my call was important to him. As a matter of fact, before we were done I became convinced that my call had become very unimportant and he probably would have preferred waterboarding to helping me with my technological problem.

 

Keeping the faith. Help is just around the corner.

He tried but from the gitgo there was significant communication problem. This became more troubling to him as time went on and his voice gradually climbed in volume to just a few decibels below the  level of an all-out scream. His accent coupled with my inability to translate computer jargon into language I could understand was further aggravated by dead batteries in my hearing aids. He said the problem was that my Kindle needed to be updated. I told him that I had recently updated it, and he did not seem to take too kindly to that statement. He attempted to guide me through the update process, but I had difficulty following instructions.  I would screw it up and we would start all over again. After nearly an hour of this he apparently had reached the breaking point and transferred me to another guru who introduced himself and wanted to start at the beginning. I went to the home page of my Kindle and was astonished. It appeared that the computer angels had come to my rescue, and the book I had ordered was there. Go figure.

 

Bad day compounded. Lost check. The digital update prompt: kiss of death.

My sense of relief that it was all behind me was short-lived; however, when the phone rang. The call was concerning a sizable check I had written that hadn’t arrived at its destination. This was a time sensitive matter and the intended recipient was concerned as was I. My first impulse was to check my computer to be sure I had sent it, but I was halted by a prompt that asked me if I wished to complete the latest update. I should have known better, but being a compliant person by nature I clicked yes, and it suddenly everything locked up. Although I did that “ctrl, alt, delete” trick (the only one I know) I was stuck. I continued to fiddle with the thing for an hour or so and miraculously it started doing things it was supposed to do. I have no idea why.

Piling on…it just keeps getting better.

As an aspiring 21st century high-tech dude, I of course became an online banking devotee years ago. After confirming that I had written the check online, I called the bank to see if it had been cashed. I was told that it had not been cashed, and that it was likely still in the mail. Having become depleted of tolerance by the previous events of the day, I launched into a diatribe about how the bank had been dishonest by claiming to deliver money electronically within three days. When I  paused for a breath, the lady calmly informed me that a three-day transfer of funds could only be done for those who were signed up for electronic delivery, while for others, it required 5 to 10 days. Had I written and mailed a paper check, it likely would have required no longer than three days to reach its destination. Although the whole affair was something of a downer, I comforted myself with the thought that I had saved myself the cost of a check, envelope, and postage. Besides, I had kept my bonafides as a genuinely modern digital dude intact. In spite of my love-hate relationship with this thing on which I am now typing, I remain optimistic much as did the little boy who when asked why he was repeatedly diving into a pile of manure responded: “with all this shit there must be a pony somewhere.”

Epilogue: For those who might take the title of this little essay seriously, I assure you that I am quite aware that my definition of what constitutes a bad day differs greatly from that of the vast majority of this planet, and that most would gladly trade their best day for my worst. Or, as my editor and daughter says in quoting her late husband, “A bad day in America is better than the best day in most of the world.”

Epilogue 2 by eshrink’s daughter and editor Maggie.

My dad’s bad day must have been contagious as I had a similar disruptive experience while on vacation in Mackinac Island with my friend of 40 years Annette, her daughter, and my daughter.

After a day of biking on the island, I went to pay for the bike rental. DECLINED read the message on the screen. The rental agent tried again with the same result. At this point, my credit union was closed so I vowed to call first thing in the morning. After a phone tree with options “listen carefully as the options have changed” and a brief hold, I was able to speak with a live person. She said the balance wasn’t the problem. As she searched the database, she found that my card was part of a potential database hack and the card had been deactivated for my security and a new card had been issued. She wanted to know if I received the letter about the hack and if I had received the new card. “No,” was my response on both counts.

She explained that the new card was in transit and I would need to come to the credit union and use cash/checks until I received the new card. I explained that I was on an island on vacation with no access to checks. She tried to find a bank I could access that would be able to give me money from my account. The closest one was on the mainland. She was very understanding and leaped into action calling the company that handles the security access of the credit cards the credit union issues. I’ve devoted about 30 minutes at this point. She is assures me the TPS company has released the block on the card and I am good to go.

WRONG: At dinner, I try the card and again, DECLINED.

Day 2 of the security breach saga: I call again. Rachel gets to the bottom of the problem. The lady at TPS had done everything correctly, except the final step. That final keystroke had caused me the pain of yet another denial to use my money. She assured me the card was unblocked and I was good to go.

Later, me and vacation buddies went to The Grand Hotel (which really is grand) for the lunch buffet. Absolutely fabulous. Since we paid the exorbitant price for the buffet, we had access to tour the hotel and the grounds. And you know what’s next: card DECLINED.

After I pay with my other credit card that is quickly reaching its limit and enjoy the extraordinary buffet, I jump on the phone again for call number three to my credit union. Julie is my rep and I tell her, “I’m thinking third time is the charm Julie. I’m confident you can fix this problem.” Julie is on it. She says everything on her screen looks good and she doesn’t see that I even tried to use the card (no card declined messages in her database). She offers to stay on the phone while I try to charge something. I head to the bar for a $10 beverage. DECLINED!

 

Julie puts me on hold to investigate further. After another 30 minutes of my life down the tubes, Julie says the TPS people are at a loss because they unblocked the card. The only thing they can figure is that it is that damn “chip”…you know the ultr-secure chips they have put on our cards. The damn thing is so smart that it won’t allow the humans to override the block. Julie suggests I find a retailer or old bank machine that doesn’t use the chip, but allows you to swipe the card instead.

 

I couldn’t find a retailer that allowed a swipe instead of a chip, but we did manage to find an antiquated ATM by the dock. I swiped. I entered my PIN. BINGO….cash dispensed.

I felt like Julie and I had taken on the beast of ultra security and won! However, I can’t help but be a little grumpy that approximately 2 hours of my life was spent trying to get access to my money. Oh…the benefits of technology that is getting so smart that even the humans can’t control it. The CHIP rules the world.