Saturday, 1 December 2012


Loss occurs in may forms, death of a loved one, parent, child or friend, break-up of a relationship, separation from those we love, loss of a beloved pet and leaving a home full of memories when you move house. When we experience the loss of someone we love we can feel confused and part of the suffering comes from striving for clarity whilst trying to make sense of everything that is happening.

Why did this happen?
What went wrong?
Why did they die? As if death could have been controlled. 
How can I go on?  

Because life is about searching for meaning and making sense of the world around us a close personal death and traumatic loss brings a need to for order and reason. In my own experience after the death of my husband I could not see the future. I was desperate to find a clear path and find meaning and order and felt frightened by the lack of structure. A grieving person can experience a clouded mind and heart interspersed with clear moments of lucidity. However at the same time ones mind is crowded with self doubts and uncertainty. Perhaps life is truly meant to be directionless? Maybe each one of us is fumbles our way down corridors without end, one merging into the next.  Each scrabbling down gravel paths, grasping for foot holds, reaching out blindly for something solid to hold on to but finding only shifting ground.  

My first husband Alan died over eleven years ago and up to his diagnosis and subsequent death I thought I knew where I was going and life felt reasonably secure. I realise however that uncertainty is a part of grief and insecurity becomes a part of the daily survival. This was something I could never have anticipated. As a  psychotherapist I have become over the years self aware and during my phases of grief I travelled very slowly through the process taking two steps forward and one step back. 

Coming to terms with the reality of his death was the early part of the path I travelled and even though each step involves expressing painful emotions and struggling with the emptiness inside every so often I would touch something that brought meaning back into my life. However that dissolves slowly like a carved figure in ice. At the time of moulding it bore shape and substance, but as the days past its once sharp edges became blurred as it melted against the heat of any new found hope.  

During the first year after the death of any loved one it seems as if one is thrashing around for a place to rest, yet there seems nothing to rest on. Nothing seems solid enough to sustain you, maybe wishing you had died as well whilst also afraid to die. 

When someone we love dies we are thrown into a surreal world where everything looks different and yet remains the same. In many ways those first weeks of bereavement can be likened to having a psychotic breakdown where the world has changed around you, the people you knew are not the same and the only person who understands your reality is you.  

When someone you love is dying before your eyes, in a terminal illness for example; it is difficult not to be sucked down the dark tunnel to the unknown, clinging on to the hands of someone who hangs over a cliff edge, knowing they cannot return, being the one to let go because you have no choice, feeling fingers stretching to hold onto the loved one as they make the rest of the journey alone. Wanting to go and yet wanting to stay in the world, fighting the invisible force that is death as it waits to take the life they hold.

As a young woman I was a nurse and came very close to those who were dying, to those whose loved ones were dying and to those who were left behind. Years later as a psychotherapist, I  worked with individuals who wanted to die, who find the world difficult to be in and life hard to manage. I have worked with the grief stricken and the recently bereaved. However the closest I have stood next to death was seeing my husband die of terminal cancer and face his own death. I recall being on watch for the moment of death, and waiting for the right time to say goodbye. Even though I wanted to stay with my husband and did not want him to leave me we had to let go of each other as his time drew nearer. His not wanting to leave was the greatest pain I have ever experienced; his not wanting to die caused me the greatest suffering. His fear of the unknown and having to go there without me was the most dreadful fact I have ever held. He used to say that death did not frighten him but the passing through the process of dying did! That is familiar to most of us I think.
We humans suffer an internal conflict that rests somewhere inside between the concept of living and dying. It is a daily event to experience the possibility of death or be next to areas alluding to death. It waits with its unknown quality around every corner and when individuals are faced with it and feel its alien presence, some respond overtly with calm assurance, ‘yes’ it comes to all of us. Whilst others struggle with the dilemma, it’s not about me, and it’s not my turn and I intend to live a long time.  

It is familiar to catch and absorb glimpses of the wonders of life as we see, feel and touch the beauties of nature. Sunset on an autumn evening and the early morning song of a thrush form your roof top, only to merely ponder upon the mysteries of death, we do not want to look it in the eye lest it notice us. It is not easy to come to grips with living and existing alongside the permanence of death and the anxiety it brings.  

Death Anxiety runs through our tissues, a bodily occupation popping in and out of conscious awareness. Like the feel of a missed heart beat or a mishap that shocks us into conscious reality. We are confronted by it day by day, both in fantasy and reality, within our relationships and by the media. It is offered with its starkness as a regular diet. Something we are forced to eat even though it may make us sick. We have to chew on the toughness of the meat even when vegetarian.  

We live in a society that is conditioned to deny death, hidden and talked about behind closed doors.
‘Guilty for dying and unsure how to live’ (Lang   )

In our society we do not fully succeed in defending against death but we humans encompass a basic psychological defence; denial.  Denial means non-communication, disguising death in encoded messages and doing very little to decode it. So often we collude with others to avoid discussion. Some pass over the subject of death as if a swear word, too disgusting for family members to hear. When a loved one is ill, injured or there is a terminal condition in the family there are those amongst us who use expressions like, ‘hope’ and ‘lets not cross that bridge’ in order not to feel and to pretend that death will not occur. Covering the ears of our children should they have to know of its certainty too soon?  Sadly for those who are grieving, the space where they are tolerated may be limited by fears of infection. 
Loss is painful, and if undelt with, reinforces denial which helps stifle the pain and reality. Patterns of learned behaviour in relation to dealing with painful feelings are handed down through families, misguided methods on route to protection. Denial itself is a protective mechanism, a method of self support when little or no holding was offered in times of need and loss as children. Denial may be encouraged in order to protect those who are afraid of the emotions surrounding loss. Shushes and silence fill the gaps of awkwardness when unspoken instructions are given not to speak of ‘conditions’ or ‘illness’.   

When an individual is faced with the loss of a loved one they have to contend with their own historical patterns of behaviour about dealing with it. How loss and death were dealt with in the family will be the legacy and coping mechanism from those who have gone before. Familial methods will be the base line coping strategy. Conscious awareness of illness, injury or death in others often arouses feelings of loss and depression; it opens up a path of vulnerability and helplessness; bringing a sense of impermanence and instability to the world around.  

It can be seen in many forms in someone who has experienced bereavement.
Living for the children
Being constantly on the go
Hyperactivity, which helps keep the pain at bay
Suppression of tears and breath holding
These are also indications of the early stages of grief but if they continue indefinitely then it moves more into the category of avoidance.

When someone is not willing to fully express feelings of grief there are generally symptoms of some kind. These can be either psychological or physiological.

Physical symptoms may manifest in the form of aches and pains at the least, and at worst peptic ulcers, heart conditions, blood pressure etc.

Psychological symptoms might be seen as vehement self reproaches, emptiness, phobic behaviours and suicidal attempts.

When we avoid grief it lies deep within, only to manifest at some stage later in life. Suppressing the pain of loss takes up a great deal of emotional and psychic energy which eventually leads to exhaustion.

When grief becomes chronic the individual is obsessed with thoughts of the dead person, unable to think about anything else. For example, the bereaved person keeps the bedroom as a shrine, clothes in the wardrobe and photographs everywhere. Those with chronic grief can also isolate themselves and will not take support from friends and family. 

For some bereaved there is a natural urge to isolate, but again, when it progresses beyond healthy it becomes chronic. This can be identified when the grieving person is unwilling and unable to acquire new skills and move on, this means they are unable to reinvest energy into other people and form new ways of being and new relationships. There is a fine balance between healthy and chronic. 

Death anxiety comes in day to day ways of being but also we are forced to look at our own mortality when we are faced with the concept of our own loss or someone else’s.

Death anxiety is a form of anticipatory loss, a fear of death itself which is forced into conscious awareness bringing the true sense of life and its impermanence, its fragility in our daily lives.  

We cope with this in two major ways Primarily bringing it fully into our conscious awareness by working with those who are dying, or with religion. Believing in life after death helps us face the fear of the unknown. Imagining our loved ones waiting for us helps us cope with the sense of emptiness that comes with the anticipation of our own death. Foreseeing another life after this one eases the fear and insecurity that surrounds death.

Secondly, not facing the concept of death at all, keeping it in the recesses of the mind to avoid there being nothing else, this way the individual can avoid facing the unknown quality of death, thus making communication about it conscious, and unconscious, direct or disguised.It seems that for many of us, we manage the death anxiety as short term, mobilising the obliterating defence of denial that prevents the disruptive element of our mortality from arising. However there are others of us who face death each day and manage it but still only in short bursts.

Death is inherent in all living creatures a struggle goes on between creation and destruction, operating in harmony or in opposition. John Bowlby has written much about attachment and the significance of mourning in childhood, and tenuous or disorganized systems that influence the child’s urge to adapt and stay attached to the original carers it is later that is work was brought in line with motivation to live thus striving to live. Much of psychotherapy is working with early anxious attachment and anticipatory loss influencing adult here and now relationships.  When an individual comes to terms with the early death anxiety and acceptance that everything must end and die attachments and ambivalence in attachments would seem to diminish. It is the fear of endings based upon death anxiety that instills fear of loss because it may incur death itself; within a child it is more likely to be fear for survival itself. 

Finally when we allow the concept of death to invade our conscious awareness there is nothing to fear in forming new attachment because loss is inevitable in all things. In the theory of bereavement an individual who comes to terms with the early death anxiety accepts everything must end. Allowing the concept of death to invade the conscious awareness makes fear of attachment meaningless.

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