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Getting Back to Life When Grief Won't Heal
By PHYLLIS KOSMINSKY
The McGraw-Hill Companies, Inc.Copyright © 2007 Phyllis Kosminsky
All rights reserved.
When Grief Becomes a Way of Life
No one told me grief felt so much like fear.
—C. S. Lewis, A Grief Observed
If love has the power to open a heart, the loss of love can break it. The enveloping grief that accompanies the death of a loved one is a subject many have tried to capture in words but, like love itself, is something that cannot be fully understood other than through direct experience. Love stretches our heart to the limits of what it can hold, and grief, to the limits of what it can bear.
There is no way around the pain that accompanies the death of someone we love. Sorrow saps our energy, making it difficult to accomplish the simplest tasks. The return to a fully active and engaged life seems a distant possibility. We may wonder whether we can ever be the same, even as we struggle to remember who we were before our loss. As C. S. Lewis observed, the experience of grief can produce emotions that feel very much like fear: physically and emotionally we may feel as though we are in peril, as if our very survival is in question. Our instinct is to try to regain control, to find what we have lost. But what we have lost is truly gone; there is no replacement, and at least for now there is no consolation.
Yet, despite the immensity of the experience, the pain of losing a loved one is a blow from which most people do recover. Over time, the fear and emptiness start to subside. Harsh and painful emotions gradually are softened by memories of what was and thoughts of what may lie ahead. With the support of family and friends, and perhaps a good therapist, acceptance of death is followed ultimately by reengagement in life, and people move on.
But not always. Sometimes, and more often than generally is recognized, people do not make a healthy recovery from loss. For many months or years, they find themselves pulled down by the powerful gravity of grief, drawn inexorably back to the same dark place of fear and sadness. I see people like this in my office every day, people who are experiencing a grief so intense and unrelenting that they can barely express it, much less heal from it. For a variety of reasons, they simply cannot stop thinking about the person they've lost. They mentally rerun their lives together. They replay the death again and again. Thinking about the past evokes unbearably painful emotions, but so does thinking about the future.
People in this situation have described it to me as a feeling of being stuck. Instead of getting better, they seem to be getting nowhere. Something is preventing them from moving past their loss. Let's look at what it means to be stuck and how it is that some people come to find themselves in the grip of unrelenting grief.
Mourning is the process through which we recover from the emotional wound inflicted by the death of someone we love. As with a physical trauma or illness, some emotional healing occurs spontaneously. We are remarkable beings in this regard, each of us the product of millions of years of successful evolution and adaptation. Our minds and bodies are built to recover from illness and injury. But as we all know from experience, some illnesses and injuries, if left untreated, overwhelm our bodies' healing capacities and continue to get worse. Similarly, some grief is so intense or so complicated that it overwhelms our mind's ability to heal. Instead of proceeding steadily toward recovery, the mourning process falters or breaks down entirely, and the emotional and physical symptoms of grief become chronic and can even intensify. What does it feel like to be stuck in grief? Here's how it was described to me by Suzanne, a sixty-two-year old grandmother, a year after her mother's death:
I feel like I'm on a wheel, going around and around. I'm just not getting any better. I'm so frustrated. It's been a year, but it still feels like it happened yesterday. I still cry out for my mother. I wait for her to call. I think of going to see her. I just can't stop thinking about her.
Suzanne is not alone in her feelings. Perhaps one out of three people experiencing a close personal loss find themselves similarly stuck at one point or another, unable to move on through mourning and adapt to their changed life. In Suzanne's case, despite the fact that she has children of her own, and her children now have children, she just can't get her own mother out of her head. It's not just that she thinks often of her mother or that she misses her mother: Suzanne is consumed by thoughts of her mother.
I meet many people whose experience with grief is similar to Suzanne's, and I hear from many others who know people like Suzanne and want to help but don't know how. It may be a parent who has died, a spouse, a sibling, or even a very close friend. Whatever the nature of the relationship that was lost, the feelings people describe are much the same. People who believe they should be feeling better are feeling worse; they feel frustrated and increasingly are absorbed in thoughts of what was and what might have been. In their own minds, they simply are not the person they were before, and they have begun to fear they never will be again.
People stuck in their grief sometimes ask me, "Am I going crazy?" or "Is my situation hopeless?" Having witnessed the recovery of hundreds of grieving people, I would say that almost always the answer to both questions is no. Most people, even those who believe they never will recover, do. No matter how wounded and lost they feel, most people eventually find a way to come to terms with their loss and find new meaning in their lives. I see it happen all the time. Still, by the very nature of grief, there are times it may seem an impossible task. Grief, after all, is a response to loss, the ultimate loss, and, more than any human experience, something over which we ultimately are powerless. But we are not powerless in how we respond to it. Like anything that frightens us, we can move toward grief rather than trying to avoid it: we can let ourselves fall into the truth of what we have lost rather than trying to resist it.
Willingness to face the truth of what we have lost and to experience the full range of our feelings about the person who has died is the beginning of healing. It is also, more often than not, the beginning of a fuller appreciation of who we are and what we're capable of becoming. What I often observe is that people who are able, on their own or with help, to confront and understand their feelings about the loss of a loved one discover in the process that they are stronger and more resilient than they had imagined themselves to be. The more they learn about themselves, the more they seem able to believe that they can get through their pain and move on with their lives.
Our New Understanding of Mourning
As a culture, we have come a long way in our common understanding of grief and loss. When I was growing up in the sixties, people dealing with the death of someone close to them were pretty much expected to get through it on their own. Certainly it was assumed that friends and family would help out, bring food, lend a sympathetic ear. But nobody read (or wrote) books about getting over the loss of a loved one, and few people sought help outside of a small circle of friends and family.
That's the way I remember it, anyway. I was nine when my mother died, and no other event in my life has affected me as profoundly, or likely ever will. As with most people I speak to who lost a parent when they were young, my mother's death defined me. It influenced my feelings about myself, my expectations of life, and my ability and willingness to form relationships. After my mother died, people were kind, but no one knew how to talk to me about what I was feeling. There was never any mention of seeking outside help or otherwise dealing in a serious way with all the thoughts and fears of a nine-year-old girl who had just lost her mother. My father tried once or twice to talk to me, but I knew that he was sad too, and I didn't want to make him sadder. Like most children in this situation, I understood that it was important for the adults around me to believe that I was OK, and that's how I tried to appear. From what I've heard from other people my age who lost a parent early in life, my experience is far from unique.
In my work with grieving individuals and families, I have come to appreciate just how much things have changed for the better since I was a child. Generally, people are more conscious of their own and other people's need for support after a significant loss and of the need to express their feelings and to encourage children to do the same. There are books, TV shows, and Internet sites about death and grieving, and people seek out this information and make use of it.
Thanks to these resources, many people who experience a loss understand something of what they are in for. They understand that they are facing a process and that it will not be quick or without pain. Because they have read about it, or someone has talked to them, many mourners expect that they may go through a period of denial ("I can't believe he's gone") and then confrontation of the full range of feelings ("Sometimes he was hard to live with"), and that they eventually will come to accept and accommodate their loss ("I'll never forget him, but I don't want to stop living").
While simplified, this is a pretty accurate description of normal grief. As people move through mourning, they begin to engage in healing tasks—acknowledging, experiencing, and accepting the loss of the relationship and all that it meant to them. As a person's attention and energy are less involved with mourning, a greater share of personal resources becomes available to invest in life. A distinct shift in focus takes place. Day-to-day life is less about what happened in the past and more about what's happening in the moment. Thinking about the person who has died is as likely to bring a smile as a tear. The mourner gradually becomes less absorbed with thoughts about what death has taken and more conscious of what has been gained from having had that person in his or her life. People experiencing normal grief eventually come to a point at which they again are able to enjoy the things that used to give them pleasure and explore new ways of finding meaning and satisfaction in their lives. Like an everwidening passageway, mourning begins in the dark, narrow isolation of intense emotional pain and gradually broadens into the light of new experience and relationships. For people who have lost a loved one, the realization that they can go on—often accompanied by the sense that this is what their loved one would have wanted for them—helps give them the energy and the courage to make a new start.
Even when it is going "well," of course, mourning is rarely straightforward. People don't just march right through the process of mourning. They have good days and bad days. They make progress and have setbacks. Almost anyone who grieves has moments of doubt. At some point, almost everyone experiences frustration with their inability to get hold of their emotions. With time, patience, and support, they move forward again and reach a new level of understanding and adjustment. They may face other setbacks, but experience tells them that these too will be temporary. Deep down, they know that they are healing and that they are moving away from their isolation and pain toward reengagement with the world.
Then there are people like Suzanne, whose grief is not unfolding in the way they, and others, expected it to. They may have turned to the literature on grief, and it doesn't seem to be written for them. In fact, the more they read, the more frustrated they become, because they just do not seem to be healing the way people typically heal. They wonder why they are not "on schedule" in their recovery process. Some begin to feel that if their grief isn't following a normal pattern, there must be something not quite normal about them.
They are right to question, but wrong to blame themselves or think that they are in some way lacking or even a little crazy. While the majority of people experience what we have come to understand as a typical mourning process, many do not. And by many I mean that each year for hundreds of thousands of people in this country who experience a close personal loss, mourning does not proceed normally. Why not?
It's clear to me, and I hope it will be to you as you read this book, that there are many reasons people experience prolonged, intense grief, but the explanation is not that they are by nature weaker or less courageous than other people confronting loss. Suzanne is a resilient, positive woman who finds pleasure in her family and her work. She has no shortage of courage, strength, or insight. It is simply that something is interfering with her healing, preventing her from moving through the stages of mourning to recovery. Her mourning, and the mourning of so many others I see, is what experts in the field of bereavement call "complicated mourning." For Suzanne and so many others, time will not be enough to heal the wounds inflicted by the loss of a loved one. They are stuck, and to get unstuck they will first have to find out which memories, feelings, and emotions are standing in the way of their recovery.
What Do We Know About Complicated Mourning?
Twenty years ago, in the first major study of its kind, Harvard researchers interviewed hundreds of widows and widowers to see how they were adjusting to their loss. One thing the researchers were after was to understand how the quality of a marriage affected recovery from grief. What they expected to find was that the men and women whose suffering was most acute would be those who had had the most compatible, loving, and happy relationships. After all, they theorized, these were the people who had experienced the loss of not just a mate, but in many cases the love of their lives, their best friend and soul mate. The study's findings, however, indicated something very different. The people who were having the roughest time were those whose relationships had been less than ideal.
This is not to say that the survivor of a warm, loving relationship experiences any less grief than the survivor of a tempestuous relationship. Far from it. It's just that that person's recovery from grief is likely to be easier, and it isn't hard to see why. One inference of the Harvard study, and something I see confirmed every day, is that love can be a great source of strength as a person moves through mourning. If a mourner was in a loving relationship, relatively uncomplicated by excessive anger, guilt, or resentment, he or she is able to draw on that love freely to foster healing. But when love is closely tied to other powerful emotions, or to memories that are confusing and painful, it can become impossible to draw on that love without dredging up parts of the past that the mourner wants to forget. This is one of the ways that mourning gets complicated and people get stuck.
In the Harvard study, one year after the death of a spouse, individuals whose marriages had been more troubled reported higher levels of tension and anxiety, and their emotional problems were accompanied by physical problems ranging from headaches and back pain to insomnia, hair loss, and heart palpitations. By contrast, those who looked back on uncomplicated, harmonious relationships were far more likely to have come to terms with their situation. Even after another two or three years, the results were much the same. Survivors of conflicted relationships more often reported a yearning for their lost spouse, while those from more loving relationships had been more successful in moving on with their lives and were more likely to report something along the lines of "I carry him within me" or "I know she'll always be there."
Another finding of the Harvard study, somewhat less surprising, was that husbands and wives who felt extremely dependent on their lost spouse had a lot more trouble adjusting to their loss. For some, the fear of going on without their lost partner was so overwhelming that they were unable to fully accept the fact that their loved one was gone. This inability to accept reality interfered with their recovery from grief and it deprived them of the energy and desire to go on with life.
The Harvard researchers concluded that the nature of the relationship between husband and wife during life is a pretty good predictor of the nature of the surviving partner's mourning. When a relationship marked by unresolved issues is ended by death, the surviving partner may replay those issues for years, perhaps for a lifetime. People yearn for their loved ones not only because they love and miss them, but also because they still have things they want to say to them, or things they still need from them, or emotions they want to express to them—and never can.
In the years since the Harvard study, we have learned a lot more about complicated grief and its causes, but the heart of the message remains unchanged: recovery from the loss of a loved one is harder if the relationship had elements of unresolved dependence, ambivalence, or conflict. Experience confirms this time and again, and it is true not only for husbands and wives, but for siblings, lovers, parents, children, friends, or just about any other close human bond. It is said that death ends a life, but it does not end a relationship. The more complicated the relationship was, the more leftover conflicts, questions, and needs the mourner carries with him or her, the more likely the mourner is to remain emotionally entwined with the person who has died. This continuing attachment, as uneasy and uncomfortable in death as it was in life, interferes with the person's ability to accept and adjust to the loss. Someone stuck in this kind of emotional mire may well need help in getting out of it.
A problematic relationship is not the only reason people get stuck in the mourning process. Over the years, we have learned that mourning also can be complicated by the circumstances of a death, which can burden the mourner with traumatic memories that stand in the way of healing. The family of someone dying from cancer or Alzheimer's disease can spend months or years in a stressful world of hospitals, difficult life-and-death decisions, and sleepless nights, all the while watching someone they love tortured by illness. Death ends that trauma, only to be followed immediately by grief and the prospect of reentry into a world that may not have felt normal for a long time.
Excerpted from Getting Back to Life When Grief Won't Heal by PHYLLIS KOSMINSKY. Copyright © 2007 by Phyllis Kosminsky. Excerpted by permission of The McGraw-Hill Companies, Inc..
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