"The Loss Of A Loved One Is More Than Grief." Anticipating Grief And Borderline

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

“In Russian psychology - you will not believe it! - No noneoriginal work on experiencing and psychotherapy of grief. As for Western studies, hundreds of works describe the smallest details of the branching tree of this topic - grief "pathological" and "good", "delayed" and "anticipating", the technique of professional psychotherapy and mutual assistance of elderly widowers, the syndrome of grief from sudden infant death and the impact videos of death to children in grief, etc., etc. " F. E. Vasilyuk - "To survive the grief"

If the topic of grief has somehow touched your scientific interest (I am not writing about those who are grieving, because more often for them all these articles are just "empty words"), then you have probably read many books and articles on the topic of stages, stages, characteristics of grief, etc..d. And more likely, the more you looked for information, the more you came across the fact that some theories contradict each other. Today I myself pick up my training manual, which I presented at a psychological conference in 2007 and read: “Psychologists define grief as a reaction to the loss of a significant object, part of an identity or an expected future. It is well known that the reaction to the loss of a significant object is a specific mental process that develops according to its own laws. The essence of this process is universal, unchanging and does not depend on what the subject has lost. Grief always develops in the same way. The only difference is the duration and intensity of his experience, depending on the significance of the lost object and the personality traits of the grieving person. " And I admit with regret that the practice of recent years has shown that this is not entirely true.

Then we said that divorce, relocation, dismissal, loss of a loved one, illness, etc., all obey the same rules and laws of mourning. But one day, a woman approached me about death former husband. Yes, of course, delayed grief does happen and you can and should work with it. Then another one, and one more, until it became obvious that the problem was not at all a delay, but something more fundamental.

“I could not hold him, because he stopped loving me, but I could just be there and love him from a distance. “I worked on myself, I achieved a lot, and I saw how one day he will see all this and understand who he has lost.” “I realized a lot, he also changed, I thought we could find a common language, explain ourselves and say goodbye,” and so on. Now all this has become impossible.

When we were fired, when we were forced to move, when we got sick, we always have the hope that this process is reversible.… Starting from the fact that we can return to the original position (we apologized, offered to return to work; underwent surgery; the husband / wife realized that they could not live without each other, etc.) and ending with the fact that we can restore the main significant elements (build a new house, but on the same street and with the same layout, garden, etc., postpone the start and create a business from scratch, taking into account the mistakes of the past, etc.). Such experiences are more common. borderline, between crisis and grief. Moreover, often in such situations, the picture of grief may not unfold at all, in contrast to the reaction to the loss of a loved one.

Death is never irreversible, and any attempt to return what was lost is equated with pathology.… therefore the loss of a loved one is more than grief … Therefore, when we talk about complicated, pathological grief, we always give examples related precisely to the death of loved ones. Therefore, when we convey to the client information about the universality of grief, we lose his trust, because a person who has lost a business and a person who has lost a child cannot go the same way, not because the significance of the lost is different, but because even pathognomic the signs and goals of therapy differ (making realistic plans to rebuild a business is okay, while planning to revive the dead is not). And therefore, when we develop tactics of therapy, it makes sense to distinguish the proposed models of "mourning" so as not to mislead the client with the information that "depression" during mourning is normal, etc.

Actually, one of the most striking examples of the corresponding misconceptions is the model of Elisabeth Kubler-Ross, who worked for so long and suddenly began to be subjected to insane criticism from everywhere. And the problem, in my opinion, is not that the model is wrong, but that grief is not universal, as we used to think. When we distinguish grief from the actual loss of a significant loved one, then a lot falls into place. Compare:

Fig.: 5 stages of reaction to the loss of a loved one (Shock, numbness / Denial and withdrawal / Latent stage / Awareness, recognition and pain / Acceptance and rebirth) and 5 stages of accepting death (Denial / Anger / Bargaining / Depression / Acceptance).

1. The beginning of these models is undoubtedly similar, since the reaction to any psychotraumatic situation is the inclusion of protective mechanisms of the psyche. However, this is where the similarity most often ends, since after the information is admitted to awareness, completely different mechanisms and behaviors, including social ones, are triggered. The duration in both cases is also different.

2. The stage of "Bargaining", which is often observed at different stages of diagnosis and treatment of a terminally ill person, cannot normally manifest itself in a person who has lost a loved one. A sick person may say "I will give all my condition to the needy, just let the tests not be confirmed" or "I will devote my life to helping the sick and the needy, only let this treatment help me." A person who has lost a loved one cannot return him in any way.

3. The stage of "Depression" is not the norm in case of loss of a loved one. In a situation of a fatal illness, a depressive state is not just a consequence of "depressed mood", but a completely natural hormonal imbalance caused by the disease itself.

Speaking about the symptoms of depression in the loss of a loved one, we primarily mean the pathological course of grief, abnormal. In the case of a belated recognition, here depression can lead to both explicit and latent suicide, popularly referred to as "deadly melancholy".

4. The latent stage ("waves", "swing"), which we observe when experiencing the loss of a significant loved one, in the event of our own expected death may not occur at all. In the first case, it is this stage that is the main indicator that the grief is proceeding normally. This stage is characterized by what is popularly called "swing", when the state of mind is particularly unstable. The grieving person can communicate, joke in the work process, after a minute experience an acute feeling of melancholy, and after a while return to a normal, working state. Fear, anger (anger), annoyance, longing and emptiness, along with and in a periodic, arbitrary change with activity, determination, calmness and positiveness, all this is characteristic of the latent stage and indicates that the process is going normally, the grieving while depression, on the contrary, is a sign of being stuck.

5. And the most important thing is, of course, the finale. Accept the inevitability of your own death and accept the fact of your own life without a significant loved one, these are simply incomparable units that do not require description.

Thus, border grief in the form of divorce, dismissal, illness, forced relocation, where there is a place for hope (bargaining), depression, etc. may well be viewed through the prism of the E. Kübler-Ross model. The final can generally be a motivated refusal of the lost object, which in case of loss of a loved one should not occur normally, since denying the significance of the loss is also a sign of complicated grief.

The so-called Kübler-Ross model is partially related to the model. " anticipating grief". This is a condition where a person experiences a loss before it took place … For example, when someone close to him falls ill with an incurable disease, we know that he can no longer be saved, but in fact he is still alive, so the stages of bargaining and depression are appropriate here. There may be such a reaction when a loved one is sent to a potentially dangerous zone (hostilities or actions to tame natural disasters, environmental disasters, etc.). Mentally, a person experiences the loss of a loved one, while maintaining hope for reversibility (bargaining, depression).

Such a state may also be of a purely exogenous nature (provoked by thoughts without appropriate threatening conditions), when, due to neurotic disorders, a person can become obsessed with the mental experience of the death of someone close (for example, a husband or a child - what will happen when he dies, how I will behave myself, what I will do afterwards, how my life will change, etc.). “One client told the story of how when she was a teenager, her mother casually dropped the phrase that“she will die soon”. For mom it was a metaphor, while for several weeks the child experienced all the signs of mourning, she constantly cried, dropped out of school and mentally tried on life without mom. In the next post I will write in more detail about the nuances of pathological grief, but here it is important to keep in mind that when such an experience shows real signs of grief, you should immediately seek the advice of a psychotherapist.

Thus, when planning the tactics of managing this or that client experiencing loss, the phrase “ Loss of a loved one is more than grief »Initially sets the direction for a more careful choice of methods, goals of therapy, including the expectations of the client and the therapist from each other and from the very process of mourning, the presentation of information, etc.