Loss and Bereavement (Emotional therapy views)

This is another from the reports I write for my course, it’s also a topic that was very hard for me to write about at the time so it’s a little bit awkward in points. Regardless, I hope whoever reads it finds it interesting!

large (1)Loss is something that will unavoidably affect us throughout our lives, for it comes in many different ways. Death is of course the first thing we think of when it comes to loss and bereavement but loss does not have to refer solely to the loss of a loved one; whether it be the loss of a job, a limb, health, innocence, home, or happiness (or many of the other things that can be lost throughout our lives), each loss—no matter how small—can be difficult and require a period of adjustment, or ‘mourning’ if you will.

Loss is not exclusive to death, whereas bereavement only deals with loss through a death, and both words are not interchangeable but do share a core meaning which is that the person suffering from loss or who is bereaved has lost something that was, in any capacity, important to them. Both do elicit a wide variety of feelings that might depend on the person lost, the person suffering from the loss, or the situation surrounding the occurrence of the loss. Where a sudden, unexpected loss has as higher chance of leaving someone feeling angry or numb, a loss that takes place over a long period of time, that someone can see coming is just as likely to give way to exhaustion and hopelessness. But even those examples are vast generalisation and it is impossible to predict what losses and bereavement will leave people feeling. Far more often than not, it is the tangle of numerous emotions that form the process of mourning, if one can only traverse it to the other side.

Grieving people will often be afraid of ‘being left behind’, not just by the deceased but by those around them, because grief may make them less social then they were. With this loneliness and fear of isolation they might start to fear how they will be able to cope with the intensity of their feelings, as well as the day to day life that still requires their attention. Having to look after others if they too were affected by the death might be extremely difficult and make some people put their own emotions on the back burner whilst they try to help others. This may cause them to turn to drinking/drugs to help coping with the situation. Some may lose themselves to religion or work as an attempt to keep themselves busy (more of this when I talk about denial). The over-empathic reaction of friends and families, as well as overwhelming subjective advice and the social pressures surrounding the bereaved are all things that can add up to make grief an even more complicated process than it already is.

The framework for some of the effects of loss reflects the general categories of emotions that come into play and I shall be using it as a guide to go through some of the stages of loss and large (3)bereavement in more detail. Grief itself is often preceded by shock. Any loss, even those we might have expected, comes with a measure of shock. Grief and the sadness/tears that represent it more commonly tend to show themselves only once the shock has receded and allowed for the reality of the situation to register. Below grief and in the centre of the framework sits denial: the refusal to believe that the loss is real, maybe accompanied with the belief that ‘things will sort themselves out’ (if we’re not talking about someone’s death). Denial can manifest in many ways, from people acting as though the other person is still around (talking about them in present tense, not mentioning their death at all), to small actions that reveal that our mind has not yet registered the loss fully (turning around to address someone we used to live with, picking up a phone to call someone who is deceased). Similarly, some people can go in denial over the loss of a relationship, stubbornly believing that they can get back with the other person even if that isn’t going to happen.

From there the framework goes in three different directions. Now not all people will go through all of those paths, and the order might be different for everyone, but they do offer a clear image of grouped reactions. On the right sits the concepts of ‘minimising’ and ‘idealising’. The first word refers to the process of trying to make the loss seem lesser than it is. This might be mostly seen in losses of jobs, home, health, or similar situations where it would be easier for the person to pretend that the loss and changes did not affect them a lot, even if they do. Idealising for its part, is when a person might put on a pedestal the one that has died, or looks back upon what has been lost through rose-tinted glasses. It is a fact that people ‘do not speak ill of the dead’, which is one of the primary causes of idealisation as only the ‘good’ sides of that person are ever talked about and whatever else they were is lost to memory. Similarly people might look back on a job or relationship, remembering how wonderful it all was before whilst completely disregarding all the issues/stress that it came with.

On the opposite side of the framework we see another three concepts: avoidance, depression, and withdrawal. Avoidance is self-explanatory and occurs when the person suffering the loss tries to avoid anything that is related to it, including but not limited to thinking about it and facing up to the consequences of it. Depression is to an extent a separate problem all together, although it can be triggered by the occurrence of the loss of bereavement.  Finally, withdrawal is used here to mean the departure of the person who has suffered the loss from their usual circles of society, with a possible nuance that they are pushing people away. This can be done for different reasons, whether it is that the person is private in their mourning process, or that they are distancing themselves from others as a way to avoid further pain, protect others from their own pain, or something entirely different.

Finally, the last segment of the framework goes down from guilt to anger. Anger is a totally normal feeling when facing loss. Anger at the situation, its possible unfairness, anger at our helplessness or the injustice of the world: it is rare that loss does not at some point elicit some form of anger. Anger in turn can give way to guilt. Be it guilt over being angry in the first place, or over events that happened prior to the loss that the anger may have been masking before it dissipated. That anger and guilt cannot be felt at the same time does not prevent one from masking the other, and it is often the case that we may be angry at something as a way to disguise how we may feel guilty about it (whether there is an actual reason for guilt and not just a perceived one). After this comes bargaining, although as discussed during the study day, this is almost a stage that could happen before the actual loss. This can be seen in people who pray and may bargain with their god(s), promising to do certain things if the loss is avoided, if the person is saved. Also outside of that, people do it in their daily lives ‘if this doesn’t/does happen, I will/won’t do this’ is a very common thing.

large (2)After that, one starts to move in the stages where one can learn to deal with the loss and grief more effectively. First comes the adjustment period, often particularly relevant for people who have had a particularly strong phase of denial or have carried through habits that are no longer relevant/healthy now that the loss has occurred. Adjustment can take many shapes, depending what the loss was. In the case of career, it could be finding a new path to walk down, when it comes to health or an ability to be self-dependent, it would be taking the correct steps to ensure that all needs are met. In the case of bereavement, it could mean moving house, putting away the belongings of a partner that are no longer needed, or anything else that would allow the person to start moving on with their lives. At last, the final step of acceptance can happen. This does not necessarily means being ‘over’ the loss, but being capable of acknowledging it and the effects it has had on our lives, as well as being capable to handle the emotions still attached to it.

Talking about grief and loss is one of the most difficult things for people to do: we live in a culture where the ‘get over it’ mentality is unfortunately dominant and forces people to bury how they truly feel about what is happening in their lives. Alongside this there is the awkwardness that comes with talking about loss: it is an uncomfortable, often difficult topic, and those that are going through it might be afraid of hurting others by bringing up their own issues. Similarly, they might be afraid of other people’s reactions: will the people around them try to appropriate the grief onto themselves (even if they were not as close to the deceased), might they only respond by bringing up their own experiences in loss? People will also be afraid of their own reactions when talking about this: they might not be wanting to show their more vulnerable side for fear of being judged (especially true for men who are told from a very young age that ‘boys don’t cry’ and other such fabricated societal ideas).

This is where the job of the counsellor is particularly important as we offer a safe place for people to work through the stages of loss and bereavement. As with every other client it is important that we respect the boundaries of what they can and cannot handle, which means we must never rush, patronise, pity or make promises. What we can offer however is an attentive ear, someone who is capable of empathising with them. It is important to allow the person to cry if tears come during the session, although it is perfectly okay to give physical and verbal expressions of concern and understanding. We are here to guide the person through what is a process that everyone who suffers loss goes through (and even those that bury it all away will eventually need to go through it or it will come back to them after the fact), we are here as someone who offers a safe, supportive environment that they may not have access to anywhere else, especially as we are totally separate from the situation. With the counsellor that person can safely start to actualise the loss and allow themselves to feel the pain of grief, and the time we give the client who is grieving is entirely theirs: there are no children, friends or family who require their attention during that time. It is also important to remember to have non-emotional (and obviously non-judgemental) reactions to whatever it is that our client is telling us. Where empathy and validation are important, if the client see that the counsellor themselves are upset by the topic they might close off and not speak as openly.

As counsellor we must, however, also be aware of our limitations. It might be that a particular client is in a situation that hits too close to home for ourselves, or that we have just largeundergone a loss of our own and cannot take on the task to help someone else through grief. When such situations arise it is good to know how, and when, to refer someone to a colleague, or doctor, or anyone who will be able to offer better care to them.


Grief sucks

This is a very personal, kind of rambly post that I wrote yesterday when I was upset and hurting. I was all ready to chuck it in the recycle bin after I wrote it because I felt ashamed and embarassed by my emotions. I still am today but I realise that maybe, one day, someone might stumble upon this on the big wide internet and find themselves feeling a little less alone. Or maybe someone will read this and look at those around them who are grieving differently. Speaking up about personal experiences is important. Hard, but important. Thank you in advance for reading.

large1Grief sucks. There’s not really many other ways to say it. It sucks balls (if you’ll pardon the phrase) from here to the next galaxy. And back. And then probably there again. That’s just how much it sucks. It’s a messy ball of tangled emotions that’s more tangled up than a wool of yarn that’s been a cat’s victim for a week. And worst of all, no matter how much you know the theory behind it, when you’re feeling all the crap that comes with it, it’s hard as hell to remember.

Be gone with your inspirational ‘But grief means you have loved and been loved’ poetry stuff. Only an idiot wouldn’t realise we only grieve because we loved someone. It might look super cool and inspirational when stuck on a pretty background, but grief doesn’t want inspiration, it doesn’t want pretty poetry and sunsets. Sometimes it doesn’t know what it wants. Tears? Distraction? A hug? Understanding? Acknowledgement? It changes. It varies, sometimes from day to day, sometimes from hour to hour. Sometimes you’ll only know what it wanted/didn’t want, when someone tries to give you it.

This happens because, like I’ve said above, grief isn’t just one emotion. It’s a collective term that forms the sum of all types of emotions. Those emotions may be different, and come in different quantity and intensity, for different people. Similarly, it is unlikely you will ever grieve the same twice.

Which in itself is a massive pain because it means we can never learn how’s the best way to do it.

Grief is one of those things that doesn’t come with a manual. When you lose someone (because this is the type of grief I’m talking about here), you don’t get handed a manual with steps to follow. You’re on your own. And that’s tough (and sucky, let’s not forget sucky) and it’s probably going to take a hell of a lot more out of you than you thought.

At least I know it did me.

Last year (it almost makes me sick to think that it happened last year) I lost someone. I called her my sister, regardless of the fact we didn’t share blood, or parents, or hadn’t even grown up together. But we were family who had chosen each other, whose bond was as undeniable as the one that blood siblings have. We bickered like siblings, we laughed at the same stupid jokes, we cried together. She was as big a part of my heart as if we had been raised together. She called me her brother. Blood didn’t matter, never should matter when it comes to the people you pick as your family.

But to the world it does matter. You lose a sibling and your world is allowed to stop. Friends are supposed to help look after you where possible. Your emotions are validated by everything society tells you what losing a sibling feels like.

Lose a friend, and no one expects you to fall apart. They expect you to hurt but losing friends, losing people, happens, and we live in a world that very much so wants us to sweep our grief under the carpet before it makes everybody feel uncomfortable. It didn’t matter that she was more than a friend, that she was a sister, because all everybody around us could see was a friendship. A close one, sure, but just a friendship.

So last year, when I got the news that she was gone (which I got second hand because her parents had decided that I was the be-all and end-all of all evil), my world tried to stop. I was ready for this news. I had watch her slowly fading away for a year and the last time I had seen her face to face I had left with the gut wrenching certainty that I would never see her again, never hear her laugh (she had the most contagious laugh I have ever known a person to have and I have laughed at so many things I normally wouldn’t because her laugh would get me going).

She was gone. It was still abstract. Every wall I had put up for the news dropped was up and ready to take the battering. And they took it, and I didn’t cry. Instead I stayed calm (maybe too calm in retrospect) and informed some mutual friends that lived near us. We agreed to all go for ice cream that day. As they’d never been that close to her, not as close as me and my brother anyway, I’d expected them to be there for me. But no one knew what to do. We talked awkwardly about everything but after the necessary. There was awkward hugging.

I think I remember the ice cream didn’t taste much, but instead all I could think was of all the times we had come to this exact place with her, had laughed, had talked, had been together.

That was the day I realised that our society has made grief into something…unwanted. Other people do not want you to be grieving (especially not if you are usually ‘the strong one’ that everybody relies upon) because it makes them awkward. This is the same reason why it’s perfectly ok to laugh whilst in the street but crying would be….unseemly.

Because it makes people uncomfortable.

So grief is expected to be private, so private as to be invisible to those around you. You pull it in, and in, and in, until everything looks normal on the outside. Until even you are convinced that you have this under control and that it’s fine, that you’re fine, and that life can carry on by itself.

And then one day, for a reason you might never figure out, it blindsides you. large

I don’t remember when or why it happened to me, but I remember sitting on the side of bed, howling with tears. I was angry, I was sad, I was a thousand things beside for which I don’t know the words. That day, for reason I still don’t know, my walls, my carefully constructed walls, came tumbling down.

Grief rushed in.

I know now (and I knew at the time but it was hard to see) that that was healthy. Not allowing myself to feel was only going to lead to damage in the long run and as I have a history of making myself sick with withholding my emotions, I think it was a blessing that my walls cracked long before I thought they would.

And now that grief is in, it keeps catching me off guard. A dream there, a thought here and I feel this pain in my chest. It’s been very true of the last few days where I’ve hardly felt like I can dislodge the ball of pain that is living somewhere in the middle of my chest. It’s distracting, from pretty much everything I want to do, and today it’s come with an added veil of profound sadness that has just made everything just that little bit harder, that little bit more difficult to get done.

It’s also why I’m writing this, because on top of the knot-in-chest today I also had the knot-in-throat. There is so much I never say, so much I never talk about. Mostly I can’t get the words out, or people’s reaction to my words make me clam up all over again. Sometimes I don’t feel like I’m allowed to talk. This has as much to do with the fact that when I do talk, some people just reply with silence, or the fact that I don’t want to burden the people who do reply because they are definitely dealing with more shit than they need to be already as it is.

But then today I saw some people I know making great dramas over twitter of how bad they felt, how tired they felt, how down they felt. Tweets about crying and about feeling shitty. And it made me feel bitter. Bitter that they were throwing their pain everywhere for everyone else to deal with and I always felt that I needed to hide mine because it was going to make everyone feel awkward, and in turn make me feel awkward about it. Today I feel like I’m being torn up inside by this sadness and for once, I actually needed to say something. If it was okay for everyone to cry and tell the world how hurt they were when two celebrities died, then it had better be okay for me to tell the world how much losing my sister makes it hurt.

And if it isn’t, then this messed up society needs to take a good look at itself. Today I needed this pain to exist somewhere else than inside my chest, and for once, for goddamned once, I am not going to apologise for how my grief is making me feel and act.

largeI woke up feeling like I was falling apart, and I still do feel like that. I’ve managed precious little because I think my brain’s energy has been focussed inwards on trying to work out how to cope with all the feelings going on. The one thing I did was get dressed (I had to go out after all) but I think that had as much to do with putting armour on as it did anything else. I got dressed ‘my style’ today, not because I felt like it, but because it felt that if I was me on the outside, maybe it would prevent me inside from crumbling.

I’ll let you know if I ever work out whether it worked or not.

Now it’s later in the day than I wanted it to be, and the knot-in-throat is partially gone (what I really need is to get the tears out but that hasn’t happened for a while), and the pain in my chest is still there. But at least I feel a little bit less alone, even if the only thing that ever reads this is my computer.

Sometimes, I guess, we just need to lay our thoughts bare before we can start to feel better.