Bereavement is a time of “letting go” of someone or something which now ceases to exist for us. Kubler Ross tells us that life is full of little bereavements, as we shed one by one the different phases of life. Each is a step forward in growth and maturity – a life long task for us all. So it is here that bereavement has its rightful place and the time of productive mourning can be seen for what it is worth.
What People Experience Following a Loss
Anything we are comfortable with, we grow attached to – so the pain of ”letting go” is more or less acute depending on our degree of attachment and our value system. Before we can understand the impact of loss and the human behaviour associated with it, we must have some understanding of attachment. John Bowlby tells us that attachment comes from a need developed early in life and directed towards specific people, eg our parents. Hence attachment is considered normal for a child or an adult. Separation is painful, particularly when it is as final as death.
Four Main Tasks
The four main tasks in bereavement are:
1. To accept the reality of what has happened. Even when someone dies whose death was expected, there is usually some degree of denial. One often hears the remark, “It should never have happened” as if one expects the right to life to con tinue indefinitely.
2. To experience the pain of loss. This pain can actually lead people to believe that there is nothing left in life. They can even die within hours or days of a broken heart. In the old Testament, Isaiah spoke of “binding up the broken hearted”, no doubt speaking about a similar situation. To lose someone very dear has its own degree of pain for each of us. At the actual time, this pain seems endless but nevertheless it is the staying with it that produces growth and strength to help the individual become more alive to their own capabilities and more understanding to the needs of others, which in turn leads to a wholeness within themselves.
3. To adjust to living without the loved one. This will mean different things for different people, depending on their roles, e.g a wife losing her husband. Bowlby says that avoidance of this task produces a state of suspended growth in which the mourner is held prisoner by a dilemma which they cannot solve.
4. To re-direct in time their emotional energy to another. At times this can be difficult as it seems like eliminating all memory of the loss of the loved one. On the other hand, the risk to re-invest again can seem too great, lest another loss follow and leave yet again another void.
How To Help People Through These Four Steps of Mourning
Taking time to listen on every level is the key. It may well be that the endless repetition is all part of the “letting go” process, when coming to terms with grief. I can recall one young woman who was just devastated having lost her husband almost two years earlier. Her own words were, “I am worse now than when it happened.” She had truly got stuck in the mourning process. Our first five minutes together were spent assuring her that she had permission to cry. The deluge of tears which followed took me somewhat by surprise at this early stage, bringing with them a torrent of grief, guilt, and resentment. I just sat there with her, the very air seemed so full of sadness, before long I too was able to shed a tear. This was the most reassuring part of our meeting and it did help her to understand that she would not be told once again to “pull herself together”. It took three months of allowing her to work through her grief, so that she could reach the stage of letting her husband go. It was then that she started to live again, planning to re-build on the happy memories which she could cherish. She also realised that sadness would at times be part of the building material that she would use, and so she learned to cope again. Certainly all bereavements do not follow the same pattern but given time they can come to a conclusion which is right for them.
How to Know When Grief is Complete
Since each person is special and unique there can be no time limit on their bereavement. William Worden says: “Mourning is finished when the tasks of mourning are accomplished.” One step along that road would be to arrive at thinking and speaking freely of the loved one without experiencing the intense pain of the past. Some degree of sadness may still linger, and that is acceptable for there is a sense in which mourning can be finished and yet there is also a sense in which it is never finished. Freud tells us that, no matter what may fill the gap, even if it be filled completely, the sense of loss nevertheless remains. In the usual run of things one needs to have lived through the full cycle of one year before mourning is finished. The first anniversary has something about it that marks time, which in turn helps in the “letting go”.
How Complicated Mourning Can Be Recognised
In some cases, the client themselves will recognise that they are not getting over the loss, as mentioned previously. In other cases, the client may present with some other disorder, possibly of psychological origin, and hence the grieving can get tangled up in other problems. Some of the ways this can present itself are:
1. The person cannot speak of the loved one without experiencing intense grief.
2. Some minor event triggers off intense grief.
3. Loss will figure largely in their conversation.
4. They cling on tenaciously to the things of their loved one.
5. Sometimes they may even develop symptoms like those of their loved one’s illness.
6. They may exclude from their lives activities which the other may have followed.
7. They may show false euphoria, or a lowering of their self-esteem.
8. They may feel a compulsion to do exactly as their loved one did.
9. An unaccountable sadness may occur at set times each year.
10. If the death was from cancer, the person may develop a cancer phobia.
Some Basic Considerations on Bereavement
Grief counselling on certain levels can be offered by anyone who can truly listen and offer the necessary support. But grief therapy on the other hand has its goal to identify and resolve the conflicts of separation which are causing either prolonged, somatic or exaggerated grief, having first ruled out physical illnesses. Then a contract is set up between the professional and the bereaved. An alliance or relationship is created within which negative thoughts and feelings are explored in an atmosphere of trust; this in time will reinforce the positive. It is a matter of finding the right person at the right time and then being able to accept that help. In the case of terminal illness, and if the diagnosis is known in advance, much of the “letting go” can be worked through and as such this can be very profitable time. The time span can be weeks, or months or in some cases even longer. Used to the best advantage, it can facilitate the mourning process for the family.
How to Maximise One’s Own Effectiveness
The loss of a loved one is one of the most intensely painful experiences any human being can go through. Not alone is it painful to experience but also painful to witness, especially if one feels impotent to help. Bowlby tells us that normally the counsellor has been through an experience of loss of one kind or another, which facilitates the desire to help another. But it may also present a challenge to the counsellor, for at times it surfaces much of their own pain which still remains from a past event. Consequently, it is important to be able to assess for oneself how much one can take on. Personal stress and burn-out needs to be continually reviewed. One needs to know where personal help can be obtained and likewise it is vital to be able to accept this help. William Worden says that the counsellor may be the uncomfortable witness of the pain of another, and this discomfort can lead them to cut short a relationship, which could leave the client with unfinished business which may never be resolved. When we take on the bereaved, we are taking on a responsibility that is ours to complete to the best of our ability.“For on the dew of little things the heart finds its meaning and is refreshed…”
(The Prophet, Kahlil Gibran)
Maisie Murphy worked at the Royal Marsden Hospital and at the Westminster Pastoral Foundation in England
Judy Tatelbaum, Courage to Grieve
John Bowlby, Separation 1973
Sigmund Freud, Letters, 1961 New York Basic Books
Elizabeth Kubler Ross, On Death and Dying 1970
William Worden, Grief Counselling and Grief Therapy