Life After Loss

The Lessons of Grief

Vamik D. Volkan, Elizabeth Zintl

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429915666
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

How we cope with grief and come to terms with the death of a loved one shapes our world. In this comprehensive guide to the mourning process, Dr Volkan, a world-recognised authority on grief, shows how each mourning is as individualised as our fingerprints, encoded with our past history of losses. Anecdotal and compassionate, this is a profoundly moving and informative study of how grief and loss shape all our lives.

PART ONE
Uncomplicated Mourning

CHAPTER I
Crisis Grief

The Hour of Lead

This is the hour of lead
Remembered if outlived
As freezing persons
recollect
The snow—
First chill, then stupor, then
The letting go.

—EMILY DICKINSON

In the fall of 1970 as I prepared one morning to go to work, my sisters phoned from Cyprus to tell me my father had died. I cannot say I was unprepared. The last two times I traveled from my home in Virginia to Cyprus to see him, he barely recognized me. He had been a champion backgammon player. On my last visit, we tried to play a few games. For a moment or two, he regained his former vitality and pleasure in the board, only to recede into confusion again. I knew the end was near and I had returned home disconsolate.

In the months preceding his death, my sisters' letters and phone calls told of his further deterioration. I sadly agreed with their assessment that we were blessed that he had died peacefully in his sleep. Still, as I hung up the telephone, I felt exhausted; my mouth was bone-dry, my eyes were filled with tears. I canceled my appointments. As the dry mouth and tearfulness persisted, I was struck by grief's power to ambush. Here I was, steeled for my father's death, someone who had spent decades studying human response to loss. "In spite of everything," I thought, "I'm giving a classic physical reaction,"

Our response to loss is reflexive and to some degree, psychobiological, even in the face of a relatively tame loss such as the death of my father, which was expected, merciful, and age-appropriate. His life had been full. By the time of his death, he and I had few unresolved issues and the last time we said goodbye, I had begun to grieve his passing.

The Idiosyncracies of Mourning

Our mournings are as individualized as our fingerprints, marked by our past history of losses and by the particulars of the relationship. Even within the same family, griefs are highly personal. My sisters, who had always lived near my father, taken care of him until the end, and were daughters not sons, doubtless had different "hot" issues than I in mourning his death. Yet despite common environment and gender, each of my two sisters' mournings were no doubt separate and unique.

Poets and writers have called loss a "spiritual wound" and it may be helpful to think of one's ability to mourn in terms of physical healing. How quickly we mend physically depends on the depth and character of the cut; the same is true of grief. The course of mourning depends on the preparation for the loss, the character of the lost relationship, the mourner's psychological strength, and the capacity to grieve. An infected cut takes longer to heal than a clean one; a difficult relationship or one in which we were highly dependent takes longer to mourn than an uncomplicated one. Even a scratch can be life-threatening to a hemophiliac, just as a minor loss, a move, a promotion can profoundly trouble someone who has had difficulty separating in the past.

I am a psychoanalyst, so it will come as no surprise that I believe that the ability to handle life's transitions begins with our first interactions with a mother or caretaker. If those early interactions were by and large constant, trusting, and loving, we have reservoirs to draw on in the face of change. Throughout life, our ability to give up is directly related to our readiness to make the next step, the security in the environment, the support of those around us, and our track record with letting go.

Mourning consists of two stages. The first is crisis grief, which begins the moment loss occurs or is threatened (for instance, in a diagnosis of terminal illness). Our bodies and minds balk. To avoid facing the death, we flip in and out of denying, splitting, bargaining, anxiety, and anger. The crisis period ends as we assimilate the terrible reality. Many assume that mourning ends with the acceptance of the death. In fact, the second stage of mourning is just beginning. Only once we have accepted the fact of the death can we begin the subtle and complex negotiations required to convert the relationship into a memory that no longer preoccupies.¹

What Is "Normal" Grief?

I have often thought that the expression normal grief was a contradiction in terms; there is little normal about grief. To lose a compelling figure in our lives is agonizing. Our reactions, dreams, or daydreams, laced with anger, denial, and splitting, may seem downright weird. Such responses in the first weeks or months after a death or loss are typical symptoms of grief, just as hallucinations accompanying a high fever are common. Difficult to endure, to be sure, but not in themselves a sign of madness.

When should a specific mourning reaction cause alarm? Reading this book should enlarge understanding of the dynamics of grief and also, I hope, share my continuing amazement at the resiliency of the human spirit in the face of loss. However, the best indicators of when to seek help for grief are the persistence of a symptom over a long period of time and the level of distress.²

Anyone who reels isolated in grief or worried about the course of mourning should seek out a compassionate ear. As to the standard length of mourning, I am loath to assign timetables since everyone grieves at a different pace and intensity. However, the course of uncomplicated—which is not to say painless—mourning usually takes from one to two years.

Crisis Grief: From Denial to Acceptance

Loss, even misplacing one's car keys, strikes at our illusion of control and predictability. When we lose drastically, our primitive fears of abandonment and helplessness unconsciously reactivate. From infancy, we experience that to be human is to need others. A baby dies without a caretaker to feed and clothe him or her. At a slightly later age, we perceive that we cannot survive—psychically—without a mother's love. Separation, real or threatened, is dangerous. That is the first truth we learn.

And so in the moments after a loss, we are launched into the panic of crisis grief—the period in which we move from denial to acceptance of a loss. Our reactions are a primitive jumble of the physical and psychological. In 1944, psychiatrist Erich Lindemann published a now-classic paper describing the crisis grief reactions of 101 individuals (some of whom were bereaved in Boston's legendary Cocoanut Grove nightclub fire).³ Although the group was diverse, the reactions proved remarkably uniform. In the hours after a loss, the subjects experienced shortness of breath, tightness in the throat, a need to sigh, muscular limpness, and loss of appetite. They retreated into shock and numbness; other people seemed far away or shadowy. Life took on a surreal quality. Lindemann noted an urgency in their speech, especially when talking about the deceased. Also, he reported that some mourners manifested "traits of the deceased . . . especially symptoms shown during the last illness, or behavior which may have shown at the time of the tragedy." In those cases, a mourner had been observed doing a sort of unconscious mimicking, for instance walking with his dead father's stride or assuming one of the dead man's gestures. This is known as an identification, which is an unconscious expression of an emotional tie with someone. The concept will be explored in later chapters.

After the shock abates, the physical reactions lose their intensity as we begin to absorb reality. If there is a persistent wish during crisis grief, it is to have the loss reversed. That is the hope expressed when we say, "I keep thinking I'm going to wake up and find this has all been a bad dream."

A news account following the 1988 explosion of Pan Am Flight 103 over Lockerbie, Scotland, gave a vivid depiction of crisis grief at its most naked.⁴ The family and friends of Flight 103's passengers had gathered at Kennedy Airport expecting a day of reunion, which ended instead in devastation. A clergyman who was present noted that the mourners "shook their heads, pounded tables, pushed their fists in their eyes. After the first awful wave of disbelief, some wept, others grew softly reflective. One woman seemed to be arguing with fate over her lost child: 'I would give my kidneys, my heart, my life. It just makes sense that I should have gone instead.' "

This account provides heartbreaking contrast to my own muted reaction to my father's death which I had been slowly grieving for months through the process of anticipatory mourning.⁵ Yet the scene at Kennedy captures the kaleidoscopic nature of crisis grief and the ways that denying, splitting, bargaining, and anger rise and fall. The unconscious mind has no sense of time and is illogical. Its defenses collapse and then revive. One minute, we think we have faced the death; the next we are dialing the dead man's phone number to ask him round for dinner.

I've outlined the phases of crisis grief individually in order to explain the psychological underpinnings. However, do not assume that they are experienced as neatly— or as starkly—as this categorization implies. When we are prepared for a loss, these phases may be so muted as to seem nonexistent; in other cases, they can appear as a jumble. "In grief nothing 'stays put,' " C. S. Lewis noted. "One keeps on emerging from a phase, but it always recurs. Round and round."⁶

Denying

Six months after the Pan Am flight crashed in Scotland, the widow of one of the passengers told a reporter from The Wall Street Journal her reaction to the news of the explosion. "At first, you deny it, your mind plays tricks, you think the reports must be wrong," she said. She spent the night phoning Pan Am to check that her businessman husband had been on the downed airliner. At 3:30 A.M., the airline confirmed her husband had been a passenger. She tried one last gambit: "I asked if anyone had ever jumped from a plane at thirty-one thousand feet and survived."⁷

Denial is a shock absorber that helps us slowly assimilate an awful truth. Total denial generally bows quickly to reality. We visit the funeral home or attend the graveside burial and those doses of realism make us face the fact of the death. However, without such reality-testing, denial can persist. In Casualties, a collection of interviews with families of U.S. soldiers killed in Vietnam, a young woman who had never seen her brother's corpse explained how her denial expressed itself.

For a long time, I thought, "Well, it's just a mistake. It's just not Paul." ... I would look for him, really. Then, every once in a while, you'd hear stories about somebody losing their dog tags or something like that, and they'd end up on another body. I felt that's what probably happened, that we had buried somebody else.⁸

Splitting

A variation of denial, splitting allows one part of the mind to acknowledge the loss, while the other denies it. A son driving home from arranging his father's memorial service makes a note to get his father's approval of the selected psalms. Splitting is also at work when a grief-stricken widow "hears" her spouse's car crunch the gravel in the driveway; or "sees" him walking the dog as he once did; or "feels" a beloved's presence in the room. The day after a young friend of mine lost her father she came down to breakfast enormously comforted. She had the sense of him in her room the previous night, reassuring her that he was okay and not unhappy with his fate.

Splitting is such a common phenomenon that in some societies, these "visitations" are built into the culture and accepted as part of the normal mourning process.⁹ Survivors expect and take comfort from the "visit" of the dead as a last chance to say goodbye.

Bargaining

In bargaining, there is a greater level of acknowledgment that the loss has occurred, but resistance lingers to the extent that we make psychic deals trying to reverse fate. We replay the last days, weeks, hours before the separation, trying to redo them.

Janice drove down the highway on the way home from her brother's funeral. In the distance, she saw a green mileage sign which she seized on as an invitation to bargain: "If I can correctly guess the distance to home," she told herself, "the death was all a bad dream. And, if it's a dream, I'll let him know how much he means to me."

Along with bargains, we recite a litany of I-should-haves; "I should have paid more attention to his cold, gotten the book she wanted from the library, stayed up with him that last night, told him I loved him."

In the weeks after my father's death, I round myself reviewing his medical care. I recalled that he had an abscessed tooth several years earlier. I developed the theory that the infection had never been properly treated and had spread to his brain, causing his mental deterioration. I was plagued by guilt. Why hadn't I insisted on antibiotics, or had him flown to a U.S. medical center where I could have overseen his care? I obsessively plotted how I could have handled the situation differently. This tapped into a more general guilt I often feel in relation to my family; that I have lived in comfort in the U.S. during a time of political turbulence on the island of Cyprus. After a few such go-rounds, I was able to let go of these thoughts and reassure myself that I had made proper decisions at the time. I separated my irrational guilt about my father's tooth leading to his death from my legitimate regret about the effect Cyprus's political instability had on his life.

These temporary moments of guilt and recriminations commonly mark crisis-stage grief. Certain cultures have even incorporated expressions of guilt and ritualized punishment into their grief practices. In some primitive societies, such as that of the Maoris in New Zealand, families of the dead person cut their breasts to express their loss. If the death occurred by accident, relatives of the dead person were ritually beaten by delegations from other tribes. The visitors also expected to collect...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Introduction
• Part One: Uncomplicated Mourning
• Part Two: Complicated Mourning
• Part Three: Resolutions
• Notes
• Bibliography
• Index