Thoughts From The Couch – The individual journey of grief

This thing that we call grief that connects us all is one of the most talked about topics in my therapy room. Grief can refer to any form of loss as a person may grieve the loss of a loved one, a limb, a home, a sense of self and much else. ‘We are all in grief. All have experienced loss. Even if your loved ones are still alive, there is a place within of disappointment and loss because we live in a world where everything changes’ (Levine: 97).

For this piece, I am going to use the word grief to indicate the experience of losing a loved one to death. Something that all of us as human beings will face at some stage in our lives and, as a result, something that unites us all. It is useful to bear in mind that there are many types of death: accidental death, suicide and violent death, to name a few. There are also many different stages of life at which people die, as well as experience the grief of death. Different kinds of relationships, backgrounds, original attachment patterns and divergent circumstances inevitably shape and influence the meaning of each loss, and all these ramifications present endless implications to me as a therapist. 

People have been grieving for thousands of years – long before the advent of health professionals. It is a natural process, and yet the empirical reality is that many people seek help with their grieving process in the form of therapy and bereavement support. This may be in part because of the increasing secularisation of our age and consequently, the general loss of shared ritual and periods of collective mourning. For example, the Shiva house of the Jews, the Irish wake and the Hindu Sredu, are important but are declining publicly sanctioned opportunities for the grieving and their wider community to come together. So whereas previously, people would have been consoled by a collective belief in God and an afterlife, looking first to priests and religious institutions for comfort in their grief, now, perhaps because so many no longer adhere to such formal religious beliefs, they are more included to turn to their family doctor or therapy.

In addition, the excessive mobility and increasing speed of our modern society further lends itself to this change of focus. In the past, extended families and communities were in closer proximity than today and neighbourhoods provided cohesive support systems in which people were more available to help each other cope with loss. It seems that in contemporary Britain, there is an almost complete absence of any established ritual and guidance around death and bereavement. In a mass society that appears to prioritise consumerism, youth and technology, engagement with death is often avoided perhaps because it implies a failure to heal, cure or solve.

In modern Western society a more restrained attitude and the subduing of the natural expressive sounds of grief such as wailing and keening contrasts strongly with African and Arabic nations which embrace public displays of grief and allow their emotions to be visible and heard, helping the mourner to express themselves within a shared, public space. In addition, many spiritual traditions recognise a particular time period, such as a certain number of weeks as a timeline for bereavement, thus acknowledging, allowing and respecting the need to mourn. All this seems to be lacking in our culture where, mostly, mourners do not manifest their pain outwardly or even follow a specific dress code. Instead, the bereaved are expected to work through it themselves, as if mourning were solely a private process.

Regardless of our personal views on grief, what is clear is that mourning often involves a culturally appropriate process to help people cope with their grief. While many cultures mourn differently, the process usually serves a common purpose: acknowledging and accepting death, saying goodbye, grieving for a specific time period and some means of continuing to honour the deceased. Ultimately the mourners are encouraged to move through their loss and form new attachments. ‘Grief is really a social process and is best dealt with in a social setting in which people can support and reinforce each other in their reactions to their loss’ (Worden: 87). Bearing this in mind I question whether we in the Western World are partly responsible for creating the need for bereavement counselling as what appears to be a natural community support in other cultures seems very different here.

Grief reactions can have physical, emotional, cognitive, behavioural, sexual and spiritual components, varying in length and disruptiveness. ‘Grief, writes Parkes, ‘is a process and not a state’ (1998: 7). For some people, their attitude to death, funerals and the immediate aftermath seems to be a social embarrassment, almost as if death is a taboo subject. For others, it seems as if they believe that there is a time limit for grief, after which it should simply be ‘got over.’ This makes it difficult for the clients of mine who struggle to ‘fill the void’ that people talk about after someone’s death. For them, they feel rushed and well as ashamed to be ‘still grieving’ and concerned that they will ‘never stop grieving’ and the judgements they will face from others. The language of ‘closure’ is often used, implying that there is an end point to which we need to get to. It also assumes that people want closure, that there is a ‘right’ way of getting there and that people even understand what it means.

You cannot rush grief. It is not a linear process and it takes huge courage to open the door to it once it knocks. The challenge that I face each time I meet a bereaved client is to find a way forward together, bearing in mind that an individual’s grief is as unique as their fingerprint. This involves listening intently to their story, acknowledging their feelings and guiding them towards a new, different and meaningful life without the deceased. It does not necessarily mean filling any ‘void’ or ‘closing’ anything. What we are working towards is how they want to adjust to a new reality and integrate the missing person into that reality.

Bonhoeffer, who was a Lutheran theologian who lost many friends and family members in World War 11 wrote :

Nothing can make up for the absence of someone whom we love, and it would be wrong to try and find a substitute; we must simply hold out and see it through. That sounds very hard at first, but at the same time, it is a great consolation, for the gap, as long as it remains unfilled, preserves the bonds between us. It is nonsense to say that God fills the gap; God doesn’t fill it, but on the contrary, keeps it empty and so helps us to keep alive our former communion with each other, even at the cost of pain.

Although there is nothing fundamentally different in working with the bereaved than with any other client group, it is worth considering that grief presents an extra dimension for both clients and me facing existential concerns and unresolved losses of our own. Therefore I believe it to be imperative that I have addressed and, when necessary, continue to address my fears and beliefs around both my own inevitable death and those closest to me. There are few things of which we can be absolutely certain, but death, our own and that of others we care about, is one of them. ‘Each person must make his way through life encompassing two important facts. If he loves, there will be great reward of human intimacy, in its broadest sense; and yet when he does so, he becomes vulnerable to the exquisite agony of loss. And one day – he knows not when or how – he will die’ (O’Connor: 107).

I have come to know that everyone grieves differently, at different times, in different ways, and with different intensities and as a result, I remind myself always to remain open to working with what each individual presents in the here and now. Grieving is one of the hardest and most painful experiences a human can endure. I firmly believe that by finding the courage to work through it, in our own way and in our own time – we can appreciate life with a renewed passion and can engage in choices and changes with a more profound sense of personal meaning and a greater understanding of ourselves and others – which can only be a good thing.

Levine S (1998) Who Dies. Wheaton; Exeter, GB

O’Connor R (1997) Undoing Depression. Little, Brown and Company; New York

Worden W (1983) Grief Counselling and Grief Therapy. Tavistock; London

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