Reliving Grief - Five Stages Of Mourning

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

EXPERIENCE THE MOUNTAIN

The experience of grief is perhaps one of the most mysterious manifestations of mental life. How miraculously can a person devastated by loss be able to be reborn and fill his world with meaning? How can he, confident that he has lost his joy and desire to live forever, can he restore peace of mind, feel the colors and taste of life? How is suffering melted into wisdom? All these are not rhetorical figures of admiration for the strength of the human spirit, but pressing questions, to which you need to know specific answers, if only because sooner or later we all have to, whether due to professional or human duty, console and support grieving people.

Can psychology help you find these answers? In Russian psychology - you will not believe it! - there is not a single original work on the experience and psychotherapy of grief. As for Western studies, hundreds of works describe the smallest details of the branching tree of this topic - pathological and "good" grief, "delayed" and "anticipating", professional psychotherapy techniques and mutual assistance of elderly widowers, grief syndrome from sudden infant death and the impact of video recordings on death on children in grief, etc., etc. However, when behind all this variety of details you try to discern an explanation of the general meaning and direction of grief processes, then almost everywhere you can see familiar features of Freud's scheme, given back in “Sadness and melancholy "(See: Freud Z. Sadness and melancholy // Psychology of emotions. M, 1984. S. 203-211).

It is ingenuous: the “work of sorrow” is to tear away psychic energy from the beloved, but now lost object. Until the end of this work, "the object continues to exist mentally," and upon completion, the "I" becomes free from attachment and can direct the released energy to other objects. "Out of sight - out of mind" - this, following the logic of the scheme, would be the ideal grief according to Freud. Freud's theory explains how people forget the departed, but it does not even raise the question of how they remember them. We can say that this is the theory of oblivion. Its essence remains unchanged in modern concepts. Among the formulations of the main tasks of grief work, one can find such as “accept the reality of loss”, “feel pain”, “re-adapt to reality”, “return emotional energy and invest it in other relationships,” but look in vain for the task of remembering and remembering.

And it is precisely this task that constitutes the innermost essence of human grief. Grief is not just one of the senses, it is a constitutive anthropological phenomenon: not a single most intelligent animal buries its fellows. To bury - therefore, to be human. But to bury is not to discard, but to hide and preserve. And at the psychological level, the main acts of the mystery of grief are not the separation of energy from the lost object, but the arrangement of the image of this object for preservation in memory. Human grief is not destructive (to forget, tear off, separate), but constructive, it is intended not to scatter, but to collect, not to destroy, but to create - to create memory.

Based on this, the main purpose of this essay is to try to change the paradigm of "forgetting" to the paradigm of "remembering" and in this new perspective to consider all the key phenomena of the process of grief.

The initial phase of grief is shock and numbness. "Can not be!" - this is the first reaction to the news of death. The characteristic condition can last from several seconds to several weeks, on average by the 7-9th day, gradually changing to another picture. Numbness is the most prominent feature of this condition. The grieving person is constrained, tense. His breathing is difficult, irregular, a frequent desire to take a deep breath leads to an intermittent, convulsive (like on the steps) incomplete inhalation. Loss of appetite and sexual desire are common. Often arising muscle weakness, inactivity are sometimes replaced by minutes of fussy activity.

In the mind of a person there is a feeling of unreality of what is happening, mental numbness, insensitivity, deafening. The perception of external reality is dulled, and then in the future, gaps often arise in the memories of this period. A. Tsvetaeva, a man of brilliant memory, could not reconstruct the picture of her mother's funeral: “I don’t remember how the coffin was being carried and lowered. How clods of earth are thrown, the grave is filled up, how a priest serves a requiem. Something has erased it all from the memory … Tiredness and drowsiness of the soul. After my mother's funeral, memory is a failure”(Tsvetaeva L. Memories. M., 1971, p. 248). The first strong feeling that breaks through the veil of numbness and deceptive indifference is often anger. She is unexpected, incomprehensible to the person himself, he is afraid that he will not be able to restrain her.

How to explain all these phenomena? Usually, a complex of shock reactions is interpreted as a defensive denial of the fact or meaning of death, which protects the grieving person from colliding with the loss at once in its entirety.

If this explanation were correct, the consciousness, trying to distract itself, turn away from what happened, would be completely absorbed by current external events, involved in the present, at least in those aspects of it that do not directly remind of the loss. However, we see the opposite picture: a person is psychologically absent in the present, he does not hear, does not feel, does not join the present, it seems to pass by him, while he himself is somewhere in another space and time. We are not dealing with a denial of the fact that "he (the deceased) is not here," but with a denial of the fact that "I (the grieving one) is here." The tragic event that did not happen is not admitted into the present, and it itself does not admit the present into the past. This event, without becoming psychologically present at any moment, breaks the connection of times, divides life into unconnected "before" and "after". The shock leaves the person in this "before", where the deceased was still alive, was still near. The psychological, subjective sense of reality, the feeling of "here-and-now" gets stuck in this "before", the objective past, and the present with all its events passes by, not receiving recognition from the consciousness of its reality. If a person were given a clear realization of what was happening to him in this period of numbness, he could say to his condolences that the deceased is not with him: “I’m not with you, I’m there, more precisely, here, him.”

Such an interpretation makes clear the mechanism and meaning of the emergence of both derealization sensations and mental anesthesia: whether terrible events will subjectively occur; and post-shock amnesia: I cannot remember what I did not participate in; and loss of appetite and decreased libido are vital forms of interest in the outside world; and anger. Anger is a specific emotional reaction to an obstacle, an obstacle in satisfying a need. The whole reality turns out to be such a hindrance to the unconscious desire of the soul to stay with a loved one: after all, any person, a phone call, household duties require concentration on oneself, force the soul to turn away from the beloved, to get out of the state of illusory connection with him at least for a minute.

What the theory supposedly deduces from a multitude of facts, then pathology sometimes visibly shows with one striking example. P. Janet described a clinical case of a girl who took care of a sick mother for a long time, and after her death fell into a painful state: she could not remember what had happened, she did not answer the doctors' questions, but only mechanically repeated movements in which it was possible to see the reproduction of actions that became familiar to her while caring for a dying woman. The girl did not feel grief, because she completely lived in the past, where her mother was still alive. Only when this pathological reproduction of the past with the help of automatic movements (memory-habit, according to Janet) was replaced by the opportunity to voluntarily remember and tell about the death of her mother (memory-story), the girl began to cry and felt the pain of loss. This case allows us to call the psychological time of shock "present in the past." Here the hedonistic principle of the avoidance of suffering reigns supreme over the mental life. And from here the process of grief still has a long way to go until a person can gain a foothold in the “present” and recall the past without pain.

The next step on this path - the search phase - differs, in the opinion of S. Parkes, who singled it out, by an unrealistic desire to return what was lost and by denying not so much the fact of death as the permanence of loss. It is difficult to point out the time limits of this period, since it rather gradually replaces the previous phase of shock and then the phenomena characteristic of it are found for a long time in the subsequent phase of acute grief, but on average, the peak of the search phase falls on the 5-12th day after the news of death.

At this time, it is difficult for a person to keep his attention in the external world, reality is, as it were, covered with a transparent muslin, a veil, through which all the time the sensations of the presence of the deceased break through: the doorbell rings - the thought flashes: it is he; his voice - you turn around - other people's faces; Suddenly on the street: it’s he who enters the telephone booth. Such visions, woven into the context of external impressions, are quite common and natural, but they are frightening, being taken as signs of impending madness.

Sometimes this appearance of the deceased in the current present occurs in less dramatic forms. P., a 45-year-old man, who lost his beloved brother and daughter during the Armenian earthquake, on the 29th day after the tragedy, telling me about his brother, spoke in the past tense with clear signs of suffering, but when it came to his daughter, he smiled and I was delighted with a sparkle in her eyes, how well she studies (and not “studied”), how she is praised, what an assistant to her mother. In this case of double grief, the experience of one loss was already at the stage of acute grief, while the other was delayed at the stage of “seeking”.

The existence of the departed in the mind of the bereaved differs in this period from that which pathologically acute cases of shock open to us: the shock is unrealistic, the search is unrealistic: there is one being - until death, in which the hedonistic principle reigns supreme in the soul, here - “as it were, double existence”(“I live, as it were, in two planes,”says the grieving person), where, behind the fabric of reality, another existence is felt all the time, bursting with islands of“encounters”with the deceased. Hope, constantly giving birth to faith in miracles, strangely coexists with a realistic attitude that habitually guides all external behavior of the grieving person. Weakened sensitivity to contradiction allows consciousness to live for some time according to two laws that do not interfere with each other's affairs - in relation to external reality according to the principle of reality, and in relation to loss - according to the principle of "pleasure." They coexist on the same territory: in a series of realistic perceptions, thoughts, intentions (“I’ll call her on the phone now”), images of objectively lost but subjectively living existence become installation that takes them for "theirs". These moments and this mechanism constitute the specifics of the "search" phase.

Then comes the third phase - acute grief, lasting up to 6-7 weeks from the moment of the tragic event. Otherwise, it is called a period of despair, suffering and disorganization and - not very accurately - a period of reactive depression.

Various bodily reactions persist, and at first may even intensify, - difficult short breathing: asthenia: muscle weakness, loss of energy, a feeling of heaviness of any action; feeling of emptiness in the stomach, tightness in the chest, lump in the throat: hypersensitivity to odors; decreased or unusual increased appetite, sexual dysfunction, sleep disturbances.

This is the period of the greatest suffering, acute mental pain. Many heavy, sometimes strange and frightening feelings and thoughts appear. These are feelings of emptiness and meaninglessness, despair, feelings of abandonment, loneliness, anger, guilt, fear and anxiety, helplessness. Typical are extraordinary absorption in the image of the deceased (according to the testimony of one patient, he remembered the deceased son up to 800 times a day) and his idealization - emphasizing extraordinary merits, avoiding memories of bad traits and actions. Grief also affects relationships with others. There may be a loss of warmth, irritability, a desire to retire. Daily activities change. It is difficult for a person to concentrate on what he is doing, it is difficult to bring the matter to an end, and a complexly organized activity can become completely inaccessible for some time. Sometimes there is an unconscious identification with the deceased, manifested in the involuntary imitation of his gait, gestures, facial expressions.

The loss of a loved one is a complex event that affects all aspects of life, all levels of the bodily, mental and social existence of a person. Grief is unique, it depends on a one-of-a-kind relationship with it, on the specific circumstances of life and death, on the whole unique picture of mutual plans and hopes, grievances and joys, deeds and memories.

And yet, behind all this variety of typical and unique feelings and states, one can try to isolate a specific complex of processes that is at the core of acute grief. Only by knowing it, one can hope to find the key to explaining the unusually variegated picture of various manifestations of both normal and pathological grief.

Let us turn again to Z. Freud's attempt to explain the mechanisms of work of sadness. “… The beloved object no longer exists, and reality prompts the demand to take away all libido associated with this object… But its demand cannot be immediately fulfilled. It is carried out in part, with a great waste of time and energy, and before that the lost object continues to exist mentally. Each of the memories and expectations in which the libido was associated with the object is suspended, becomes active, and libido is released on it. It is very difficult to point out and economically justify why this compromise work of the reality demand, carried out on all these separate memories and expectations, is accompanied by such exceptional mental pain”(Freud Z. Sadness and melancholy // Psychology of emotions. P. 205). So, Freud stopped before explaining the phenomenon of pain, and as for the hypothetical mechanism of the work of sadness, he pointed not to the way of its implementation, but to the "material" on which the work is carried out - these are "memories and expectations" that "are suspended "And" acquire increased active strength."

Trusting Freud's intuition that it is here that the holy of holies of grief, it is here that the main sacrament of the work of grief is performed, it is worth looking closely at the microstructure of one attack of acute grief.

This opportunity is provided by the subtle observation of Anne Philip, wife of the deceased French actor Gerard Philip: “[1] Morning starts well. I've learned to lead a double life. I think, speak, work, and at the same time I am all absorbed in you. [2] From time to time, your face appears in front of me, a little blurry, like in a photo taken out of focus. [3] And at such moments I lose my guard: my pain is meek, like a well-trained horse, and I let go of the bridle. A moment - and I'm trapped. [4] You are here. I hear your voice, feel your hand on my shoulder, or hear your steps at the door. [5] I am losing control of myself. I can only shrink internally and wait for it to pass. [6] I stand in a daze, [7] the thought rushes like a downed plane. It is not true, you are not here, you are there, in the icy nothingness. What happened? What sound, smell, what mysterious association of thoughts brought you to me? I want to get rid of you.although I understand perfectly well that this is the most terrible thing, but it is at such a moment that I lack the strength to allow you to take possession of me. You or me. The silence of the room cries out more than the most desperate cry. The head is chaos, the body is limp. [8] I see us in our past, but where and when? My double separates from me and repeats everything that I did then”(Philip A. One moment. M., 1966, pp. 26-27).

If we try to give an extremely brief interpretation of the inner logic of this act of acute grief, then we can say that its constituent processes begin with [1] an attempt to prevent the contact of two currents flowing in the soul - present and past life: they pass through [4] an involuntary obsession with the past: then, through [7] the struggle and pain of voluntary separation from the image of the beloved, n end [8] with the “coordination of times” with the opportunity, standing on the bank of the present, to peer into the notes of the past, not slipping there, observing oneself there from the side and therefore no longer experiencing pain …

It is remarkable that the omitted fragments [2-3] and [5-6] describe the processes already familiar to us from the previous phases of grief, which were dominant there, and now entering into a holistic act as subordinate functional parts of this act. Fragment [2] is a typical example of the “search” phase: the focus of voluntary perception is kept on real deeds and things, but a deep, still full of life stream of the past introduces the face of a deceased person into the field of representations. It is seen vaguely, but soon [3] attention is involuntarily attracted to it, it becomes difficult to resist the temptation to look directly at the beloved face, and, on the contrary, the external reality begins to double [note 1], and consciousness is completely in [4] the force field the image of the departed, in a mentally full-fledged being with its own space and objects ("you are here"), sensations and feelings ("hear", "feel").

Fragments [5-6] represent the processes of the shock phase, but, of course, not in that pure form, when they are the only ones and determine the entire state of a person. To say and feel “I’m losing power over myself” means to feel how strength is weakening, but still - and this is the main thing - not to fall into absolute immersion, obsession with the past: this is powerless reflection, there is still no “power over myself”, there is not enough the will to control oneself, but there are already forces to at least "shrink internally and wait", that is, to hold on to the edge of consciousness in the present and realize that "this will pass." To "shrink" is to keep oneself from acting inside an imaginary, but seemingly such real reality. If you do not "shrink", you may experience a state like the girl P. Janet. The state [6] of "numbness" is a desperate holding of oneself here, with only muscles and thoughts, because feelings are there, for them there is here.

It is here, at this step of acute grief, that separation begins, a separation from the image of a loved one, let the shaky support in the "here-and-now" be prepared, which will allow at the next step [7] to say: "you are not here, you are there …" …

It is at this point that acute mental pain appears, before the explanation of which Freud stopped. Paradoxically, pain is caused by the grieving person himself: phenomenologically, in an attack of acute grief, the deceased does not leave us, but we ourselves leave him, break away from him or push him away from ourselves. And this self-made detachment, this own departure, this expulsion of a loved one: "Go away, I want to get rid of you …" and watching how his image really moves away, transforms and disappears, and actually cause mental pain [note 2].

But here is what is most important in the performed act of acute grief: not the very fact of this painful separation, but its product. At this moment, not only the separation, rupture and destruction of the old connection occurs, as all modern theories believe, but a new connection is born. The pain of acute grief is not only the pain of decay, destruction and withering away, but also the pain of the birth of a new one. What exactly? Two new “I” and a new connection between them, two new times, even worlds, and the agreement between them.

"I see us in the past …" notes A. Philip. This is already a new "I". The former could either be distracted from the loss - “think, speak, work”, or be completely absorbed in “you”. The new “I” is able to see not “you” when this vision is experienced as a vision in psychological time, which we called “the present in the past”, but to see “us in the past”. "Us" - therefore, him and himself, from the outside, so to speak, in the grammatical third person. "My double separates from me and repeats everything that I did then." The former "I" was divided into an observer and an acting double, into an author and a hero. At this moment, for the first time during the experience of loss, a piece of real memory appears about the deceased, about living with him as about the past. This first, just born memory is still very similar to perception ("I see us"), but it already contains the main thing - the separation and reconciliation of times ("I see us in the past"), when the "I" fully feels itself in the present and pictures of the past are perceived precisely as pictures of what has already happened, marked with one or another date.

The former bifurcated being is united here by memory, the connection of times is restored, and pain disappears. It is not painful to observe from the present a double acting in the past [note 3].

It is no coincidence that we called the figures that appeared in the minds "author" and "hero". Here, the birth of a primary aesthetic phenomenon, the emergence of the author and the hero, the person's ability to look at a past, already accomplished life with an aesthetic attitude really takes place.

This is an extremely important point in a productive grief experience. Our perception of another person, especially a loved one, with whom we were connected by many life ties, is thoroughly permeated with pragmatic and ethical relations; his image is saturated with unfinished joint affairs, unfulfilled hopes, unfulfilled desires, unfulfilled plans, unforgiven grievances, unfulfilled promises. Many of them are almost outdated, others are in full swing, others have been postponed for an indefinite future, but they are all not finished, all of them are like questions asked, waiting for some answers, requiring some action. Each of these relationships is charged with a goal, the final unattainability of which is now felt especially acutely and painfully.

The aesthetic attitude is capable of seeing the world without decomposing it into ends and means, outside and without goals, without the need for my intervention. When I admire the sunset, I don’t want to change anything in it, I don’t compare it with the due, I don’t strive to achieve anything.

Therefore, when, in an act of acute grief, a person manages to first fully immerse himself in a part of his former life with the departed, and then get out of it, separating in himself the “hero” who remains in the past and the “author” who aesthetically observes the life of the hero from the present, then this piece is won back from pain, purpose, duty and time for memory.

In the phase of acute grief, the grieving person discovers that thousands and thousands of little things are connected in his life with the deceased (“he bought this book,” “he liked this view from the window,” “we watched this film together”) and each of them captivates his consciousness in "there-and-then", in the depths of the past stream, and he has to go through pain in order to return to the surface. The pain goes away if he manages to take out a grain of sand, a pebble, a shell of memory from the depths and examine them in the light of the present, in the here-and-now. The psychological time of immersion, "the present in the past", he needs to transform into "the past in the present."

During a period of acute grief, his experience becomes the leading human activity. Recall that the leading activity in psychology is that activity that occupies a dominant position in a person's life and through which his personal development is carried out. For example, a preschooler works, helping his mother, and learns, memorizing letters, but not work and study, but play is his leading activity, in it and through it he can do more, learn better. She is the area of his personal growth. For the grieving person, grief during this period becomes the leading activity in both senses: it constitutes the main content of all his activity and becomes the sphere of his personality development. Therefore, the phase of acute grief can be considered critical in relation to the further experience of grief, and sometimes it takes on special significance for the entire path of life.

The fourth phase of grief is called the phase of "residual tremors and reorganization" (J. Teitelbaum). At this phase, life goes into its own rut, sleep, appetite, professional activity are restored, the deceased ceases to be the main focus of life. The experience of grief is no longer a leading activity, it proceeds in the form of first frequent, and then more and more rare individual shocks, which occur after the main earthquake. Such residual attacks of grief can be just as acute as in the previous phase, and against the background of normal existence, subjectively perceived as even more acute. The reason for them is most often some dates, traditional events ("New Year's for the first time without him", "spring for the first time without him", "birthday") or events of everyday life ("offended, there is no one to complain", "in his name the mail has arrived"). The fourth phase, as a rule, lasts for a year: during this time, almost all ordinary life events occur and then begin to repeat themselves. The death anniversary is the last date in this series. Perhaps it is no coincidence that most cultures and religions set aside one year for mourning.

During this period, loss gradually enters life. A person has to solve many new problems associated with material and social changes, and these practical problems are intertwined with the experience itself. He very often checks his actions with the moral standards of the deceased, with his expectations, with what he would say. The mother believes that she does not have the right to monitor her appearance, as before, until the death of her daughter, since the deceased daughter cannot do the same. But gradually more and more memories appear, freed from pain, feelings of guilt, resentment, abandonment. Some of these memories become especially valuable, dear, they are sometimes woven into whole stories, which are exchanged with relatives, friends, often enter into family "mythology". In a word, the material of the image of the deceased, released by the acts of grief, undergoes a kind of aesthetic reworking here. In my attitude to the deceased, wrote MM Bakhtin, “aesthetic moments begin to prevail … (in comparison with moral and practical): I have before me his whole life, freed from the moments of the temporary future, goals and obligations. The burial and the monument are followed by memory. I have the whole life of another outside myself, and here begins the aestheticization of his personality: its consolidation and completion in an aesthetically significant image. From the emotional-volitional attitude of remembrance of the departed, aesthetic categories of the design of the internal person (and also the external one) are essentially born, because only this attitude in relation to the other has a value approach to the temporary and already completed whole of the external and internal life of a person … Memory is an approach from the point of view of value completeness; in a certain sense, memory is hopeless, but on the other hand, only it knows how to value, apart from the goal and meaning, an already finished, entirely present life "(Bakhtin MM Aesthetics of verbal creativity. pp. 94-95).

After about a year, the normal experience of grief we are describing enters its last phase - “completion”. Here, the grieving person sometimes has to overcome some cultural barriers that make it difficult for the act of completion (for example, the idea that the duration of grief is a measure of our love for the deceased).

The meaning and task of the work of grief in this phase is for the image of the deceased to take its permanent place in the ongoing semantic whole of my life (it can, for example, become a symbol of kindness) and be anchored in the timeless, value dimension of being

Let me conclude with an episode from my psychotherapy practice. I once had to work with a young painter who lost his daughter during the Armenian earthquake. When our conversation was drawing to a close, I asked him to close his eyes, imagine an easel with a white sheet of paper in front of him, and wait for some image to appear on it.

The image of a house and a burial stone with a lit candle appeared. Together we begin to paint a mental picture, and behind the house there are mountains, a blue sky and a bright sun. I ask you to focus on the sun, to consider how its rays fall. And now, in a picture conjured up by the imagination, one of the rays of the sun combines with the flame of a funeral candle: the symbol of the deceased daughter is combined with the symbol of eternity. Now we need to find a means to distance ourselves from these images. Such a means is a frame in which the father mentally places the image. The frame is wooden. The living image finally becomes a picture of memory, and I ask my father to squeeze this imaginary picture with his hands, appropriate, absorb and place it in his heart. The image of the deceased daughter becomes a memory - the only way to reconcile the past with the present.

Footnotes

1. Here the analysis reaches the level of concreteness that allows the intention to reproduce the analyzed processes. If the reader allows himself a small experiment, he can direct his gaze to some object and at this time mentally concentrate on the currently absent attractive image. This image will be vague at first, but if you manage to keep your attention on it, then soon the external object will begin to double and you will feel a somewhat strange, reminiscent of a subsonic state. Decide for yourself whether you should dive deeply into this state. Please note that if your choice of an image for concentration fell on a person who was close to you, from whom fate parted you, then when you get out of such immersion, when his face will recede or melt, you can hardly get a large, but quite real pain a dose of grief.
2. The reader who dared to go to the end of the experience described in the previous footnote could be convinced that this is how the pain of loss arises.
3. The reader participating in our experiment can check this formula, again plunging into the sensation of contact with a loved one, seeing his face in front of him, hearing a voice, breathing in the whole atmosphere of warmth and intimacy, and then, when leaving this state in the present, mentally leaving the place of its double. How did you look from the outside, what were you wearing? Do you see yourself in profile? Or a little on top? How far is it? When you’re sure you’ve been able to take a good look at yourself from the outside, note if anything helps you feel more relaxed and balanced?