Translation: Pepy Scordeli, psychologist-psychotherapist, Msc
Abstract
Death and the pain that follows is an inherent life experience that everyone eventually has to face. The process of grief entails experiencing and managing the pain that follows the loss of a loved one and the effort to weave again the meaning of our life, after being shaken from bereavement, by reassessing our goals and priorities in life. Accepting and adjusting to loss is a long-term and active process that happens through complex and interrelated interactions with the important people in our families and communities. As we process the meaning of loss in our life and the pain that follows, we learn eventually to adjust to a world that has definitively changed due to bereavement, maintaining as far as possible the love for the one that passed away and for our own life.
Key words: loss, mourning, grief, bereavement, narrative, meaning, therapist’s role
And in the end this is the end. Nobody can do different. That ensures everything, but above all it ensures solidarity. The body exists, the body doesn’t exist, the body has been, the body will not be. How reassuring is that thought. How it lowers the voices, how it quiets the noises. This thought. The only true one. The only unfalsifiable. (Dimitris Dimitriadis, Oblivion, 2011).
_Story 1: _ My daughter is just under three years old and one day she asks me how her grandfather died: “Did he got bitten by a snake?” I answer rather realistically “No, his heart just stopped beating”. Surprised, she asks me: “Mom, are you going to die, too?” I reassure her, telling her that this will happen when I am very old and she will not need me anymore. She goes away for some time, pushing her doll in the stroller. After a while she returns and in a very serious face she asks: “Am I going to die?” Feeling upset by her question, I assure her that this will happen after many years, when she is really old. I feel that her questions enclose the entire mystery of human existence. In the end she tenderly asks me if I loved my father, and when I tell her a story about him she says with conviction: “You know mom, grandpas shouldn’t die either. Why should everyone we love have to die?”
_Story 2: _ I am at the airport, observing two emotional parents saying goodbye to their son who, as I’m guessing, is going away to study. I stand bewildered and watch them. I feel this moment of separation from their child, so sacred and unique. The mother is in tears and the father tries but cannot eventually hide his tears. The son stands feeling awkward and surprised, torn between the things he leaves behind and the things that lie ahead. I am thinking of how many families consciously or unconsciously resist experiencing such painful yet necessary moments of separation, and come in therapy with symptoms and disabilities in a desperate attempt to avoid the pain of loss and saying goodbye. At the same time I am wondering about the “little deaths” we face daily on a physical and emotional level; losses, frustrations, separations, the wear of time that goes with no return, the crises and sudden changes that are ultimately inherent parts of the process of growing up.
_Story 3: _ In summer, an elderly woman suffering from bipolar disorder shows serious symptoms of depression, regression, insomnia, while shortly before and after the Christmas holidays she presents manic symptoms including euphoria, hyperactivity, spending money and gambling. After many years of psychiatric treatment with prescribed medication, the following meaning was given to the story of the patient. In the summer when the patient was 7 years old, her father was diagnosed with cancer. The mother and other members of the family were caught up in father’s care, somewhat neglecting the patient and her siblings. An uncle who was an Army officer had assigned the care of the children to his orderly. The soldier, not knowing how to entertain the children, taught them how to play poker. The patient’s father died eventually in early December of the same year. After 80 years the connection was finally made. In summer, when the patient comes in touch with the fear of loss, she gets depressed. During Christmas, when the loss has already taken place, the patient, in denial of the bereavement, resorts to manic defenses. The main symptom is resorting to a gambling frenzy throughout Christmas and the New Year: invited to friends’ and relatives’ houses, she plays poker till dawn, sometimes losing and sometimes winning great amounts of money.
Introduction
In western modern and postmodern communities death has been gradually ostracized from public life, ceasing to be part of communal life as it was in traditional communities and helped members come to terms with death and the dead. As a result, death is confined to the private sphere and hospital rooms, shrouded in silence and partly blocked out from everyday life. We could say, more than ever before, that death is a taboo subject that upsets and scares us and thus we avoid talking about it. In our effort to control the death anxiety we tend to repress it from our thoughts, unconsciously convinced that the less we refer to it the less it concerns us. Very often people who grieve the loss of a loved one convey a feeling of being socially isolated, since other people find it hard to provide emotional support and avoid listening to their pain, resorting to plain logic and stereotypes that stop the discussion instead of providing space for further thinking, processing and talking about it.
The pain and grief of mourning persons upsets their social environment which usually feels unable to contain and manage such a sensitive and threatening issue, thus silently implying that reference to painful feelings is pointless and socially unacceptable; those in grief are discouraged from openly discussing their awkward feelings and thoughts about loss. Often they are forced to hasten back into a daily routine, locking away their feelings along with the potential to process and heal their grief. Yet bereavement requires an open interlocutor so as to be communicated, put into words, narratives and meanings, so that the pain of loss can be shared and become more tolerable; eventually this experience will lead to realizations and renegotiations of life after bereavement. We could then say that the bereavement process takes place where the intrapsychic and the social spheres meet. Mourning is never a personal issue but a social one, since it happens through active interaction in a community of important others that witness and share our grief and can facilitate or obstruct our adjustment to loss.
Loss as a part of the living process.
Losses are the shadows of all our possessions—tangible or intangible
Carlos Sluzki
There´s no growth without pain and conflict and no loss that cannot lead to gain
Lily Pincus
The story of human development, from birth to death, is nothing but a sequence of critical developmental changes that are essential for growing up. In a way evolution precludes loss, since it demands leaving behind familiar things in order to search for and conquer what new and unknown lies ahead. Every new developmental phase in our lives presupposes leaving behind and losing previous things in order to open up to the new. The experience of birth is essentially the first separation of the infant from the mother’s body. Later on, a toddler has to leave the safety of his home in order to gain a sense of autonomy in the world of his peers by entering school, while as a teenager he will have to question the parental models in order to be liberated from dependency and his position as a child and eventually form his own identity. Even positive transitions in the life cycle include loss that entail change and reorganization. Upon the arrival of their firstborn, parents have to forgo many privileges and freedoms in order to live up to their new role and duties, and when the child eventually leaves the family nest to claim autonomy, the parents will have to manage the loneliness of their “empty nest”. So loss is an inherent part of life itself, and in small doses loss or absence is in a way a motive force of creativity, thought, imagination and desire. Freud refers to the symbolic play with a string in his essay “Beyond the Pleasure Principle” (1920). The mother is away and the 18-month infant has devised a game with a spool tied to a string to alleviate the anxiety of her absence. He rolls the string to the spool and shouts “away” (fort) and then unreels the string shouting “here” (da). The spool represents the mother. Through play, invented by the infant, he verbally represents mother’s absence, making it tolerable. By pulling and throwing the spool the infant is not subjected passively to the mother’s absence. It is he who makes the spool-mother come and go andthus soothes his separation anxiety.
We would then conclude that delaying satisfaction and partial absence is a necessary condition for the child to develop thought and through that to reform a reality that is often traumatic and frustrating. Growth demands experiences of separation and loss, as well as leaving place for new conquests and potential.
When death comes
We die twice: when we die, and then when those who knew us and loved us die.
Goethe
“One day there is life. A man, for example, healthy, not aged, without a history of illness. Everything was like always, as they will always be. He lives one day after the other, minding his business, dreaming only about life that lies ahead. And then suddenly it happens- death” These are the opening words of Paul Auster’s autobiography, _The invention of solitude _ (2001), in which he unravels his thoughts upon his father’s death. Man is the only living being with conscious knowledge of death and mortality. In fact, we perceive death through the death of others. Dolto (2000) considers death to be other’s people affair, not ours. Without a doubt, the death of someone important to us is one of the most difficult yet inescapable realities one has to face. Experiencing death traumatizes the bond of love with the important other. Through death we experience the sudden shuttering of the attachment we have formed with a significant other. Grief and pain seems to be the price we pay for love (Fleming, 1998). When we experience the death of a loved one, our life seems to fall apart. Our certainties, the predictability and the expected collapse, we lose our hope for the future and our trust in the forces of life. Our sense of the order of things and ourselves is affected. We experience a fragmented self, alone and helpless. We are flooded by intolerable, painful, frightening emotions. Our world will never be the same again. We are upset, shaken, destabilized, we try to make sense of a seemingly meaningless and pointless world. As Didion (2011) says, “Grief turns out to be a place none of us know until we reach it”. According to Freud (1915) the mourning person knows whom he lost, but doesn’t know what has been lost by losing the loved one. Death in a family brings multiple losses; loss of the person, loss of the role he had, the relationship we had, loss of the entirety of the family, loss of hope and dreams of things that were still to come in the future. Although unique, every death links to previous losses. It entails rearrangements, reevaluating purposes and priorities, redefining and changes in the roles of those left behind, who are called upon to manage intense feelings while also bringing back meaning to their lives that have been deranged by loss, and gradually proceed to new positions and responsibilities and the new reality of life after the death of their loved one.
A crucial aspect of bereavement is the experience of derangement in the sense of how our self was organized, through the loss of the relationship we had to the deceased; a relationship that defined the way we perceived and defined ourselves (Neimeyer, 2006). Through the loss of a loved one we feel like losing a part of ourselves, which was molded through interaction with the deceased. Bereft of the presence of the deceased, we are called upon to deal with facts or special occasions, celebrations, anniversaries, holiday, milestones like going to university, marriage, birth but also with unpleasant situations, and we wonder how we can handle the new reality alone.
Chloe, an 18-year-old girl who recently lost her mother, and the loss coincided with the pleasant fact of going to university, shares her thoughts and anguish in our meetings. It hurts that her mother died in the intensive care unit of a hospital, so that she couldn’t be with her as much as she wanted. She wonders how lonely her mother must have felt, what thoughts passed through her mind. She says that when her mother was in hospital her “entire world was in that intensive care unit”. It was a very difficult time that signified the end of their communication, which had been very close and warm until recently. She had felt terribly lonely and wouldn’t allow herself to believe that her mother wouldn’t make it. Deep inside she believed that since her mother was a strong person, full of love and wish to live, she would overcome her illness. But it didn’t happen, and finally her mother lost the battle. She is upset that her mother will not be on her side in her new life as a student. In dismay she confesses that mother was a person who offered her emotional support and taught her how to fight for her goals and dreams: “I am afraid that now that she’s away, I will lose this quality and settle for less”.
Thomas Attig (1996) describes the mourning process by using the metaphor of “relearning the world”, and Neimeyer (1998, 2006) talks about the process of “learning our self anew”. The death of a loved one leads our autobiography to a dead-end, since “we struggle to redefine and redirect the story of our lives that goes on” (Attig, 1996). Gradually we approach objects left behind by the deceased, their clothes, personal belongings, pictures, diaries and much more that remind us of their presence. Sometimes we may even discover parts of them we ignored. Locations, places, habits, facts that mattered for our loved ones—,after their death, we are called upon to reprocess their meaning for our life (Attig, 2001). Similarly, while grieving we are required to discover new aspects of ourselves, so we need to reorganize our sense of self. We often wonder how we will experience ourselves without the presence of the important other and how the next chapters of life will unfold after bereavement. As we realize that our life will never be the same, we seek a new direction and purpose in life and we struggle to build a new identity that includes the reality brought about by death, while at the same time maintaining a sense of continuity between the past and the future.
Death often dissects time, becoming a milestone in the life of an individual or a family. There was one life before and one after the loss. After a loved one’s death the family’s story is deranged, its cohesion and continuity is lost, resulting in experiencing life as meaningless and incoherent. As Papadatou (2005) reports, the family seems to temporarily lose the map and the compass that guided it till then, and they are called upon to adjust to a new way of life, reconstructing a new narrative that will gradually regain coherence and meaning, while containing the loss they experienced.
Death has been likened to an earthquake that shakes, destabilizes or sometimes destroys the personal world of meanings of the bereaved. When we suddenly and unexpectedly lose a loved one, we reconsider our previously held sense of security and control as we realize how life can be end prematurely and without warning, how unpredictable it is. It is not uncommon for the loss of a loved one to be followed by a process of stocktaking and reassessing the relationship we had, the importance of the deceased in our lives and the opportunities we enjoyed or missed while they were alive. The death of a loved one essentially brings us upon the end of the potential of a relationship. As a person dies, a host of future possibilities are lost as well.
Ismini, a 35-year-old woman who experienced the death of her younger brother, George, in an accident, seeks therapy; she confesses that before her brother’s premature loss she felt they had all the time in the world. Now that he was gone she wished they had spent more time together. Because of their different stages in life—she was married with children, he was single and very active— they didn’t spend much time together, despite their warm and tender relationship. In the beginning, the pain for her brother’s loss was so intense that she found it hard to talk about him, to remember moments she had spent with him. She didn’t want to see pictures of him, she fell apart. Over time, having processed his loss and given her pain some space, she gradually started to put into words what had happened without being emotionally overwhelmed. She says: “Now I can say ‘my brother died suddenly"; before, I felt it like a tsunami/tidal wave that overwhelmed me. It is still hard to know that I will never see him again. I still have intense flash-backs of him entering the house in the village, with his backpack; it seems like yesterday. On the other hand, I can’t bear the thought that these memories gradually fade through time. At this point, I feel responsible for keeping him alive inside me. Even today, when I refer to George I get emotional, sometimes tearful; the pain remains strong and for that I may avoid referring to him. In the future I would like to be able to talk about my brother without crying, to give space to the beautiful moments of his life and our relationship, to relate the joyful aspects of our life without them being outshined by the pain of his tragic loss.”
According to Fleming (1998), mourning can be described as a transition from a situation where you lose what you had to one where regain what you have lost. A very important task of mourning is the need to repair the disarray that death brought to the relationship with the deceased, through maintaining the continuity of the bond. Barnes (2014), in his latest book The three levels of life , submerges into the world of bereavement and talks in a confessional tone about the pain of loss. He claims that those who have not yet crossed the tropic of bereavement are not able to realize that the fact that someone is dead does not mean that he ceases to exist. People who have lost an important person maintain connection, they often picture their response to important moments in life and reproduce imaginary dialogues with the deceased in order to keep the relationship alive. All the important elements that characterized our relation to the deceased —favorite habits, routines or something special we shared— will be a source of memories, feedback and consolation for a relationship that is now carried within.
The power of storytelling and narration
In recounting our woes, we often soothe them
P. Corneille
Give sorrow words
W. Shakespeare
Humans are storytellers (MacIntyre 1981, McLeod, 1997). As Chimonas (1984) wrote, “human means speech, as bird mean flying and scorpion means venom.” We are born in the middle of a narrative that has begun before us and will continue to unravel after we cease to exist. Through stories we get to learn ourselves and the world that surrounds us. We transform our experiences to words, to stories with which we build our relation to reality, in our effort to understand and give meaning to things. When we narrate our story we can distance ourselves from facts, relive the experience in a non-threatening way, name it and give it shape and form. Through the stories we tell and retell we seek for alternatives, we refer to connections with the past and we shape a prospect for the future; in other words, we try to give cohesion, order and meaning to our experiences. At the same time, as we share our story we connect to other people with whom we co-construct and reconstruct our stories. The way we are heard and the things that will be exchanged in our interaction make it possible to enrich and develop our experienced reality.
Winnie in Beckett’s Happy Days depends on memory and speech to exorcise solitude and death. Existence for Βeckett is synonymous to naming, narrating existence, talking about it. Man’s decline and ultimate death is the decline of words, the death of speech, the absence of names. Narration is like a game, in a sense that through repetition the narrator tries to take control of a situation (Wolfenstein, Janoff-Bulman, 1992). In this sense narration is an active process through which we become subjects of our story. Narrating is often the natural reaction for people in the face of a life-threatening illness. Stories can act as antibodies to illness and pain. According to Frank (1995), the ill person who conveys his illness through a story essentially transforms what appears to be fate to an experience. In a similar way, we could claim that through mourning we are called to organize the chaos caused by loss into a narrative. According to Neimeyer (2006), when we experience a significant loss, the expected storyboard of our life is deranged, disrupting our narration. Like a novel that loses a key character in the middle of the book, the story of a life disrupted by loss has to be restructures, rewritten to discover a new thread to connect past and future in e legible way.
In our clinical practice we come upon an ambivalence in people who experience grief after an important loss, which is often exacerbated by a social environment that discourages an open discussion. The bereaved experience a kind of internal conflict between the need to talk about death and to remain silent so as to avoid painful thoughts and emotions. When you discuss loss you relive it, re-experiencing all the painful feelings around the loss of your loved one. Remembering things that are emotionally overwhelming, often disorganizing, can make one sink in a feeling of futility and inertia, as if there is no future. On the other hand, if one doesn’t speak, if one doesn’t put into words and narratives all that is incomprehensible and absurd about death, it is like it never happened, it is like denying its existence and along with that the importance of the person that no longer exists. Moreover, this obstructs the resolution of grief.
The same ambivalence can be found in the final moments, just before a person’s death. Nike refers to her mother’s final moments and how she lost the opportunity to tell her what she felt and thought. She can remember talking about superficial things—the weather, or what was on the news. She admits she was afraid to get more personal and tell her how much she loved her, how her presence would be missed, as if she wanted to postpone the separation and the subsequent pain. She clung to pointless details in order to prolong the end, which she felt was close, while another part of her refused to accept it. Inconsolable, she says: ”If I had finally spoken to her, if I trusted what I felt inside and shared it with her, maybe we would both feel less lonely; we might have met in another way”. According to Henezel (2007) the last moments of a loved one may be the greatest possible chance to approach them. However, instead of facing up to the reality of imminent death we often act as it will never happen. We lie to ourselves and to others and instead of expressing the essential, exchanging words of love and apology, leaning on each other to get through this unique moment, we end up shrouding it in silence and solitude.
The stories that surround a loved one’s death and are narrated over and over by the family members and their social environment reflect their attempt to give meaning to loss and regain a sense of control over the incontrollable experience of death. Open and clear communication among family members and respect towards different reactions to loss helps adjust to bereavement and empowers the family as a network for its members’ support (Walsh,1998). With the stories they exchange they try to explain the reason why it happened and the meaning life may have now without the loved one. These meanings that emerge through collective interactions are important for processing loss and change over the life cycle of a family or an individual, as they are affected by the new facts that are added over time. The very act of telling and narrating reinforces the connection with those who witness the pain of grieving, and their response can be an experience of solidarity, togetherness and sharing which helps relieve the pain of bereavement and create a healing condition.
According to research findings, the possibility to share our feelings and stories of loss with others is therapeutic and highly protective of our physical health, provided that the narrating of unpleasant or traumatic experiences gradually builds a more coherent story which essentially reflects an improved organization and a more satisfactory interpretation of these experiences (Pennebaker, 1997). An important aspect in the process of mourning is for the bereaved to seek and ultimately ascribe some meaning to the loss, incorporate it in his life story and regain a sense of purpose in his life after the disorientation caused by the loss.
Daphne’s story
Daphne, an unemployed woman of 52, comes to the Family Therapy Unit because she needs to talk about the terrifying events of her life in recent years. She reports having two adult children, Helen (30) and Lambis (26), both of whom developed serious health issue when they turned 26. Four years ago, Helen was diagnosed with Hodgkin's lymphoma and has been fighting it ever since, with constant relapses. Lambis was recently found to be suffering from ADEM Syndrome (acute disseminated encephalomyelitis), a self-immune disease that affects his mobility to the point of being partially paralyzed, and had to spend two months in a rehabilitation center.
Daphne got married rather young, at 19, and by the age of 27 she was already divorced with two children of 8 and 14 years. Her relationship with her husband was intensely conflictual and the rage and hate between them still exists, although they have gone their separate ways. Even when they had to meet in the hospitals, because of their children’s illness, they continued to argue and attack each other.
In the first appointment Daphne looks expressionless, soulless, dried of emotions although she narrates tragic events. I wonder if I can help her, since she seems almost unlikeable. She speaks as if telling the news, giving disjointed information as if those events did not concern her own life. On the other hand I am thinking that she’s probably acting in a detached, emotionless way as a defense against the enormous burden and the insufferable pain of having two sick children. The material she is bringing is so heavy to bear that I guiltily confess to myself that I would rather she didn’t come back. The next appointment is scheduled for later in time, as she has to go away to the city where the son’s rehabilitation center is. On the second appointment Daphne talks mainly about her children’s health issues, and towards the end of the session she refers to her mother’s loss, after whom she named her daughter. When Daphne was 17 years old she lost her mother from cancer; she had been ill since Daphne was 11. She says she was a lovely, sweet and sensitive woman whose death tore the family apart. Her elder sister was married and had a baby, while Daphne and her younger brother went to live in another house by themselves, since the father would stay with the girlfriend he had had even before his wife died. Daphne is still angry at her father, whom she holds responsible for her mother’s illness, because, she says, he always had other women and he hurt his wife with his behavior.
Daphne with her narration inflicts on me a huge burden of pain and tension, and sometimes I feel overcome by fear, anxiety and the cruelty of death. I think about the loneliness and the helplessness she must be experiencing and how, unconsciously she makes me abandon her, like her mother who fell ill and died, as she has abandoned herself, without containing and giving meaning to these life events. There is a fragile, helpless part of herself she wants me to nurse, while at the same time she looks defensive, showing the side that had to toughen up and deal with everything in order to survive, even at the price of getting alienated from her emotional world. In our next appointment we agree that she brings along her children so that we discuss the difficulties they have to face with their health issues and how Daphne as a mother can be supportive.
In the family meeting a part of the conversation is dedicated to the past, before the illness. Helen remembers herself full of anger, lashing out to everyone, as if something was wrong. That was the family atmosphere she had experienced as a child, in a house like a war zone due to the parents’ fighting. But even after divorce the parents accused and denigrated each other.
Lambis says that his sister was like a second mother to him, since the parents, caught up in their own things, weren’t available. He experienced their arguments in the hospital as particularly traumatic, in a way feeling guilty that his illness forced them interact once again, unsuccessfully (implying on another level that deep down he wished to see them united, supporting him in a difficult moment of his life).
Helen refers to the illness using the metaphor of an axe falling and cutting through her life. She says she changed her attitude towards life, thinking more of herself and trying to relax and take it easy. She feels supported by her partner. She tries to keep her distances from her father, who seems unable to support her, while her mother feels more helpful now than in the past, when she used to pass on her own personal issues and burden Helen with responsibilities that didn’t belong to her.
The mother remains silent for most of the family session. Towards the end she says that it is the first time she had listened to her children without having to give excuses; something that has probably hasn’t happened in the past.
In our individual sessions Daphne shares her guilty feelings toward her daughter, because by naming her after her mother she feels like she transferred her fate. For the first time she refers to her fear of losing her. She mentions that in a difficult moment of her daughter’s health she went to her mother’s grave to ask for help. Actually, it appears she went to demand her mother for the help she owed her. She was very angry at her and said: “Why don’t you help me now that I need it most? You left me alone to deal with everything”. For the first time she realizes the anger she felt for her mother for her premature loss, abandoning her to deal with the difficulties. Gradually she unravels the thread of her mother’s loss and all the untold and conflicting emotions that were never processed or thought out. She confesses how she always felt that her mother was somehow close to her after she’d died, protecting her. With her daughter’s illness and constant relapses, this conviction collapsed and she was left alone to face the harsh reality.
Following Daphne’s story, we could say that her children’s physical illnesses somehow stopped the flow of a life full of arguments and tension, and a persistent search for action. On an unconscious level, through physical illness both children regress and ask for care they had missed. They symbolically return home, asking their parents to assume the caring and protecting role they never had. On the other hand, the illnesses brought to the fore the unmourned ghost of Daphne’s mother.
In the therapeutic process Daphne is called upon to speak about the trauma from her children’s illness as well as about the earlier trauma of her own mother’s loss; a death so painful that she had it repressed, sealed tight in order to avoid suffering, although this stopped her from processing and resolving grief and thus making her to unconsciously associate her mother’s story with that of her daughter’s. (on complicated mourning cf. Thanopoulou 2012).
Seeking meaning through mourning
If you can’t find spring, you must create it
Odysseas Elytis
Death _ is not the greatest loss in life._
The greatest loss is what dies inside us while we live.
Norman Cousins
Creating meaning is a primary human need. We weave and construct meanings through a process of transforming reality. Through meanings we make relations and connections and we try to process and join the scattered pieces of our experience in a way that provides coherence (Thanopoulou, 2013). “The fact that we are finite paradoxically bonds us to others” writes Marie de Hennezel (2007) in “Intimate Death”, and adds: “This is the reason why their death concerns us. It allows us to penetrate the core of the only essential question: What is the meaning of my life?”.
In this context, the process of reconstructing meaning around an important loss is the most dynamic part of mourning (Neimeyer, 2006). Despite common reactions to loss, the way bereavement is experienced depends on the personality of the grieving person and generally on his personal history, the relation he had to the deceased, experiences from previous losses and bereavements, and the circumstances surrounding death. In order to understand the course of mourning, we need to take into account the subjective reality of loss as it is experienced differently by every individual, every family, in any given socio-cultural context.
According to Fleming (1998), grieving persons often seek the (metaphorical) legacy of the deceased, and this legacy should not be sought only in death but more in the life of the deceased. Seeking the legacy through a reevaluation of the relation to the deceased is an emotional process, associated with the importance and the pain caused by this particular loss. Acknowledging and experiencing pain will lead the mourner to find meaning and potential for growth through the grieving process. Other theorists and researchers define meaning as a person’s ability to develop new goals in his life or to reconstruct a perception of himself that embodies the importance of this negative experience (Thompson & Jianigian, 1988). Through the grieving process a person affirms or reconstructs a world of meaning that was shaken by loss and tries to restore cohesion in his disrupted life narrative. Factors that can inhibit this process include family secrets, fragile family ties, cutoffs (family members avoiding all contact with other family members), divergent beliefs, and family rules that prohibit sharing (Nadeau, 2001).
According to the dual process model of coping with bereavement, encompassing loss demands constant oscillation between two modes of functioning: 1. Turning to loss (the mourner is absorbed with mourning, experiencing and exploring a multitude of emotions regarding loss, in an effort to capture its importance for his own life and Keep the memory of the loved one alive. 2 Turning to restoration. The individual concentrates on the external adjustments demanded by loss, maintaining or creating new relationships and activities and trying to ignore the waves of intense grief that keep coming (Stroebe et al, 1998).
I will now briefly describe my experience as therapist to a bereavement management group in the Family Therapy Unit. The group started in December 2010. It was a short-term, 12-session group. All members had previously been in individual sessions for over a year. It was the time of the first major demonstrations about the socioeconomic crisis. A long strike in public transport was on, and I thought it might disrupt the group, leaving me to think that we might have to postpone it. The group members proved me wrong, being incredibly diligent and not missing any meeting, despite the adverse external circumstances. Their constant presence, the emotional sharing in the group, the relationship among them and among us seems to have provided a supportive environment and allowed their narratives of loss and the meaning of life to emerge.
I have selected some characteristic stories:
I realized that a composed and well-structured self could cope with any overwhelming event. In the group I saw not only my weakness, but also my achievements and parts of myself that I love and feel proud of.
I thought that since I had coped with my husband’s death, this crisis wouldn’t frighten me. I feel more optimistic. I told myself that we will not be lost, we’ll find solutions. It’s like I have grown up emotionally and put priorities in life, which you never know when will be over. I used to be overwhelmed with any little thing; now I don’t care if the house is not tidy, or if I don’t cook for a day, it’s not that important.
Initially, listening to the other members of the group I realized that I used to treat loss as bad luck or as a punishment. I had the feeling I was defeated in life. Over time it is like I tried to look deeper into myself. To come to terms with loss. This doesn’t mean that my life didn’t still suffer a dramatic change. I lost a part of me that was happy, optimistic, light. I got burdened, shaken as to where the meaning lies. What’s the point of being with others with whom I can’t share a thing.
Many changes took place inside me. I began to be more lenient and less strict towards myself and that affected my relationship with others, as I try to be more understanding and communicate better. The value of life, even with the fears and the weaknesses I have, became important and remains beautiful. I redefined my needs, my relationship to others, since loss revealed the true scale of things. My priorities changed. On the other hand, there are moments when I lose hope and wonder why bother fighting, since people are eventually gone, and then I seek support in poetry, in my friends…..
I began due to my sister’s loss. I was not only supported in managing emotionally bereavement, but I think the group supported me generally, making me feel more able to face issues unrelated to bereavement; personal, professional… I never expected that through externalization I would have felt stronger to live up to situations that appeared difficult.
_Being in the group helped me understand that it’s not death that concerns us so much, nor the people gone. It’s the things that death brought to the surface; all the things we hide so well and avoid. That’s why instead of talking about our dead we switched to talking about us. We are the ones on stage—our lives, our frustrations, our weaknesses and fears. And I realized that time is not the best doctor if you don’t make good use of it, if you don’t give yourself the opportunity to evolve along with the pain for your loved one. _
The role of the therapist in supporting bereaved individuals and families
In our clinical practice we often come across unmourned loss, bereavement, transgenerational traumas and repetitions, stories of untold pain. As mental health specialists, on one hand we carry a theoretical toolbox obtained through training; on the other, we carry within us personal experiences and previous experiences about loss and pain. It is important to acknowledge and process our personal losses in order to contain the intensity of our patients’ emotions and at the same time to empathize with their grief, while recognizing that it is not our own pain.
Death reminds us of our fragile human nature. This fragility, according to Papadatou (2009), gives us the opportunity to discover new aspects of ourselves and alternative ways of connecting to others. Realising that human life is finite can be a source of pain and sorrow, but also gives us the potential to contemplate about life, to put priorities in life and to seek meaning.
When working with bereaved patients, one can often feel the inconsolable aspect of death. There are times when words seem unfit to bridge the psychic experience of the mourner. It then seems that the least one can do is just be emotionally present, containing the pain. And most of the times this is very therapeutic. As Bachtin (1975) says: “For the word and consequently for a human being, there is nothing more terrible than a lack of response”. It is very important for a therapist to listen in silence and endure the uncertainty of mourning, until a crack emerges and leads to new paths and realizations.
The therapist is a discreet partner on the patient’s journey, sometimes quiet and sometimes speaking, in this unpredictable course of mourning, trying to help the patient adjust to a reality where an important person is missing. At the same time, he is an interpreter and a mediator that accommodates and receives the patient’s un-metabolized pain, helping him to reshape personal history, to symbolize unprocessed experiences, while seeking new connections and meanings. Often the individual, or the family has no other means of support in grief and difficulties except the therapist, who becomes an important figure. He needs to combine the ability to understand this pain with a consistency that will keep him from diffusing, or being overwhelmed by despair, dead-ends, or guilt through a defensive process that actually aim at protecting one’s own self from difficult feelings, so that it doesn’t lead in a premature discarding of the patients painful experiences. (Charalambaki & Thanopoulou, 2008)
It is really important for the therapist to provide a facilitating context that enables the open expression of thoughts and emotions that mourners often find difficult to share with their own people because, as mentioned earlier, the subject of death often causes a disruption that discourages thinking and talking about loss.
The therapist, like an adequate parent, is available, consistent, sensitive to the needs of a patient suffering loss, conveying the feeling that he can understand, empathize, contain the pain and bring hope (Thanopoulou, 2013). The understanding provided by a therapist who allows himself to be touched by the pain of the grieving patient, without being overwhelmed to the point of losing boundaries, may alleviate the sense of fear and isolation and sooth the feeling of loneliness and helplessness of people facing the death of a beloved person.
When working with bereaved people, what is more important than the theories and knowledge to which, alas, we sometimes resort as a defense against pain is to remain human, genuine and open to the experience of people that mourn the loss of a loved one; to recognize that it is not only we that affect them by being their therapists and supporting them through this difficult process, but they also touch and affect our emotions. Eventually, perhaps we can learn with them to renegotiate again and again the question of where the meaning of life lies .
Epilogue
Mourning entails experiencing and managing the pain caused by the loss of a loved one and trying to weave again the meaning of life. We gradually move from ‘being in pain to carrying pain in our hearts”. These two functions of grieving affect each other. As we learn to live in a world where we have incorporated our bereavement, we can give meaning to pain. As the pain is alleviated, we are then able to handle more effectively the new challenges of the world we live in (Attig, 2001). Indeed, mourning can often become a chance for personal growth and maturity, where one may reach unprecedented internal strengths and resources.
Grieving allows us to heal, to remember with love rather than pain. It is a sorting process. One by one you let go of things that are gone and you mourn for them. One by one you take hold of the things that have became a part of who you are and build again.
Rachael Naomi Remen (2000)
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