“Grief is a place none of us knows until we reach it” Joan Didion
Hereʼs some thoughts following my interview with BBC Radio Berkshire earlier this week. Letʼs start by defining some terms:
Bereavement is to be ʻrobbedʼ of something valuable
Grieving refers to psychological aspects of loss – especially emotional suffering
Mourning is the cultural expression of that loss
George Bonanno – Clinical Psychologist at Columbia University studied grief for over 20 years. Surprisingly, 50 – 60 % of people show no outward signs of grief one month after their loss.
Relevant psychological theories:
Bowlbyʼs attachment theory (1969 – 1980)
– desire to be near the attachment figure
– return to the attachment figure for comfort and safety
– the attachment figure is the base for security (enables confident exploration)
From the age of about 9 or 10 we can understand death as a permanent biological process. When attachments are broken or lost this understandably leads to distress and anxiety.
Kubler-Ross Stages of Grief (1970s) -continues to be influential:
but we now know this is not rigid, nor do all people pass through all stages. Itʼs more like a complex shifting between states that feels like waves of emotions experienced.
Silverman & Klass (1996):
Grieving is never fully resolved.
In learning to let go, the bereaved person negotiates and re-negotiates the meaning of their loss over time. The person is remembered and not forgotten.
Stroebe & Schutt (1999):
Oscillation occurs between loss orientation and restoration. The grieving person will focus on restoration plans or activities when focusing on the loss becomes too much to bear. Coping or recovery means negotiating / seeking a meaningful life without the deceased. (Difficult to do if the person is missing or not proven deceased).
The radio interview focused on ambiguous loss, where the grieving process would be incomplete. Here are some thoughts on this:
Ambiguous loss is a term that has been around since 1970s – first used by Pauline boss to describe the impact of grief on families of soldiers who went missing in action.
It can be an experience that is confusing and hard to comprehend.
There can be no ʻclosureʼ or understanding typically expected with the death of a loved one. This leaves the person searching even more for answers and this complicates or delays the process of grieving. It becomes harder to move towards acceptance of the loss.
Missing person or unrecovered body from a war or an extreme incident = physical loss and loss which is somewhat ʻfrozenʼ or incomplete.
Psychological loss can also occur when the person is still there e.g. with dementia, vegetative state or via brain injury.
Resilience and hope are important to encourage in ambiguous loss, as in other forms of grieving.
There are no social rituals to deal with such losses. This can leave the person feeling ʻstuckʼ or ʻin limboʼ. People can under-appreciate the unending absence, the void or opposite of meaning – the experience of meaninglessness itself. This is hard to share and communicate and also hard for others to tolerate and support.
The goal of psychological therapy does not equal attempting to find a state of closure, but rather to become more tolerant of the ʻstill-open doorʼ. Learning to hold a paradox in mind can help, i.e the person is both absent but also has a presence in the bereavedʼs life. Life goes on without that person, but has also massively changed.
Pauline Boss suggested guidelines for resilience in the face of such complicated and unresolved loss:
1. Finding meaning in the situation as it is
2. Tempering mastery, i.e. not feeling the need to have absolute certainty
3. Reconstructing identity – to a changed situation
4. Normalising ambivalence – e.g. the conflicting emotions that will be experienced of
sadness and missing, but perhaps relief or optimism
5. Revising attachment – recognising what has been lost but also what is still present about
that person in our lives.
6. Discovering hope – often essential for psychological resilience
Personal rituals – often performed alone and in private – are often helpful.
Public mourning rituals have a clear purpose – to help mourners strengthen their social bonds and re-enter the social world after the loss.
Private rituals help provide emotional meaning, to feel less out of control (less helpless and less powerless), more connected to the lost person. Examples of these private rituals can be always having breakfast in bed on a Sunday, washing the car, going for a favourite walk, listening to a meaningful piece of music, keeping a favourite possession of the deceased and looking at it or using it. These things help to keep that personʼs memory alive and the attachment to that person.
Grieving (of all kinds) can be an emotionally difficult and lonely process, but in looking after oneʼs resilience, mobilising personal support, expecting the waves of emotions, and keeping the memory of the deceased person alive, one can regain a footing in a world that has become a lot emptier than it was before.