5 6292 July 26, 2020 at 11:44 pm Author of the publication: Tatyana Sosnovskaya, teacher
Unfortunately (or fortunately), we live in a world where nothing is permanent, everything is temporary, including ourselves. And sooner or later, every person is faced with the death of loved ones: parents, relatives, friends, spouse, sometimes even their own child. For every person, the loss of a loved one is a great grief. Just recently he was somewhere nearby, saying something, doing something, smiling. And now he's gone. And you have to live with this somehow.
Today in official psychology there are no theories of grief (loss, bereavement) that fully and adequately explain how people cope with losses, why they experience grief differently, how and after what time they adapt to life without deceased people who are significant to them.
Why can one person’s reaction to the death of a loved one manifest itself as numbness, “petrification”, another – crying, anxiety, a third – a pathological feeling of guilt, and some can steadfastly endure the blows of fate without experiencing pathological manifestations?
In the classification of grief reactions, different researchers identify from 3 to 12 stages that a person experiencing loss must sequentially go through. The main difficulty with these classifications is that:
- they are different;
- there are no clear boundaries between the stages;
- a person’s condition changes, and he can return to a seemingly passed stage;
- The severity of symptoms and experiences varies greatly from person to person.
In this regard, the concept of J. Worden has recently become widespread, who proposed a variant of describing the reaction of loss not by stages or phases, but through four tasks that must be completed by the grieving person during the normal course of the process.
Let us briefly list them. The first task is to acknowledge the fact of the loss. The second task is to survive the pain of loss. This means that you need to experience all the difficult feelings that accompany loss. The third task is to organize the environment where the absence of the deceased is felt. The last, fourth, task is to build a new attitude towards the deceased and continue to live. Each of these stages may have its own deviations. Worden’s concept does not reveal why exactly these deviations and in this particular person.
The work of grief
Psychologist Larisa Pyzhyanova herself experienced the loss of loved ones and, while working at the Ministry of Emergency Situations, hundreds of times helped people whose relatives died tragically and suddenly. We are publishing an excerpt from her book “Sharing the Pain. The experience of a psychologist from the Ministry of Emergency Situations, which will be useful to everyone,” which talks about what the work of grief is, what processes and why a person experiences after the death of a loved one, how long this can last, what is considered normal, and what should be of concern.
The book can be purchased on the Nikeya publishing house website.
Grief crisis
It is impossible to draw clear boundaries and determine exactly whether a person’s experience of loss is complicated or not complicated. But it is still possible to indicate when the process of natural grief goes through certain stages, each of which is characterized by its own set of physical and psychological symptoms.
The symptoms of “normal” grief were identified in the middle of the last century by the German-American psychiatrist, specialist in social psychiatry, Erich Lindemann. The grieving process is divided into two main stages: the grief crisis and the work of grief.
A grief crisis begins with the death of a loved one or the discovery of imminent loss, for example, when a loved one is diagnosed with a fatal disease and his days are numbered. A person’s consciousness rejects the fact of loss, rushing between denial, splitting, persuasion, anxiety and guilt.
According to Lindemann, the first hours after a loss are usually characterized by the presence of periodic attacks of physical suffering, spasms in the throat, attacks of suffocation with rapid breathing, a constant need to breathe - this breathing disorder is especially noticeable when a person talks about his grief. At the spiritual level, grief manifests itself as tension or acute suffering. Usually the grieving person feels the unreality of what is happening, stunned, the feeling that everything is happening as if not to him. He develops so-called “tunnel vision”, a veil grows before his eyes. Time speeds up or, conversely, stops. The perception of the surrounding reality becomes dulled, and sometimes in the future gaps will appear in the memories of this period.
Lindemann noted that during deep emotional experiences, changes and disorders of consciousness can be observed. He describes a typical case when the patient seemed to see his dead daughter calling him from a telephone booth. He was so captivated by this scene that he stopped noticing his surroundings.
It happens that a grieving person completely lacks manifestations of strong feelings. Despite the deceptive external well-being, in fact the person is in a serious condition, and one of the dangers is that at any moment this imaginary calm can be replaced by an acute reactive state.
We can identify the mechanisms that are necessary for living through a grief crisis: denial, splitting, persuasion, anxiety and guilt. When the first shock passes and the person begins to realize the reality of what is happening, physical reactions weaken, and often there is a strong desire to return everything as it was before, before the loss. At this time, people think that this is just a bad dream, they just need to wake up and the nightmare will pass.
The famous Russian psychotherapist, Doctor of Psychological Sciences, Professor Fyodor Efimovich Vasilyuk in his work “Surviving Grief” says that denial at this stage of grief is not a denial of the fact that the deceased is no longer there, but a denial of the fact that I, the “griever,” are here.
But denial of loss allows a person to maintain the illusion that the world remains unchanged. This softens the shock and helps to gradually accept reality, which is facilitated by the rituals of farewell to the deceased accepted in different religions. Such important actions as a funeral service in church, a memorial meal, help to accept the death of a loved one as a fait accompli. Farewell to the deceased Farewell in the morgue, civil memorial service, funeral service - what you need to know about them Vera Foundation
Without such contact with reality, a person can get stuck in denial of loss.
This is well demonstrated by cases of missing people. Their death is very difficult for their loved ones to accept. Splitting allows one part of the mind to know about the loss when the other denies it - this is when a person mentally understands that a loved one has died, but feels his invisible presence. This is such a common phenomenon that many experts perceive it as part of the normal grief process - people find comfort in it, a last chance to say goodbye to a loved one.
Vasilyuk writes: “There is... “a kind of double existence” (“I live, as it were, on two planes,” says the mourner), where behind the fabric of reality one can always feel an underlying other existence, breaking through with islands of “meetings” with the deceased. Hope, which constantly gives rise to faith in miracles, strangely coexists with a realistic attitude that guides all the external behavior of the grieving person.”
Persuasion is manifested in the resistance of consciousness to what happened in such a way that, trying to deceive fate, a person enters into an internal deal, again and again remembering the last days, hours before separation, as if wanting to change the course of events: “Oh, if only... I would give everything to ..." Those who are grieving constantly replay in their heads the events associated with the loss: they remember what they did not have time to do for the departed; they regret that they gave him little care, did not fulfill some requests, were not affectionate enough, did not have time to say “I love you,” offended him unfairly and did not have time to ask for forgiveness.
When the reality of loss hits people, they feel anxious and helpless. For a person who feels very insecure without his loved one, life is full of fears. Sometimes it is, for example, a fear of sleeping in the same bed or room, or living in the same house.
The most difficult feeling when experiencing grief is guilt. Sometimes it can be real, more often it can be far-fetched, but it is always necessary to treat it with great seriousness. Death intensifies the problems that have ever occurred in relationships, and previously unnoticeable “stumbling blocks” turn after the death of a loved one into an insurmountable obstacle. Lindemann describes it this way: “A bereaved person tries to find in the events leading up to the death evidence that he did not do what he could for the deceased. He blames himself for inattention and exaggerates the significance of his slightest mistakes.” A person repeats the word “should” like a spell: “I should have done this” or “I should not have done that.” Many heavy thoughts appear, a feeling of emptiness and meaninglessness. Over time, a rational explanation for what happened will soften the feeling of guilt, but it usually returns until full acceptance of the loss occurs.
Feelings of guilt before a deceased loved one: how to sort it out? When a loved one dies, a feeling of guilt often arises: you didn’t give enough, you didn’t say anything, you didn’t do anything, and now you can’t fix anything. Is this guilt always fair, or is there something else hidden behind it? Alexandra Imasheva
Israeli director Shmuel Maoz told an episode from his life. It was about his teenage daughter, who constantly woke up late, missed the school bus, and had to call her a taxi, which cost the family dearly. One day he told his daughter to ride the bus like all children, and if she overslept and was late, let it be a lesson for her. The next morning, the girl got up on time, left the house, and half an hour later her father heard a message that an explosion had occurred on this bus - a terrorist attack, dozens of people were killed. He rushed to call his daughter, but could not get through. In the next hour he experienced more than he had ever experienced in his entire life. And then the daughter returned home safe and sound - she was still late for that bus. Shmuel Maoz said that later he tormented himself for a long time with the thought that he seemed to have acted correctly, logically, but how would he live if his daughter died?
Probably, this “but” always faces a person when trouble happens to his loved ones. It seems like I did everything, but... But I could have done more, better, I could have foreseen everything, warned, and averted trouble.
The stages of grief come in waves; one wave of denial, splitting, persuasion, anxiety, and guilt is rarely enough to accept the loss.
Over time, they change qualitatively and the impulse “I need to call my mother” is gradually replaced by a more urgent need - “I need to be able to call my mother.” The full weight of the loss begins to be felt. During a crisis of grief, many processes occur at the level of the unconscious; dreams indicate that serious internal work is underway to overcome the feeling of loss. They solve the main problem of the grief crisis - the recognition of the need to accept the death of a loved one.
The work of grief
The grieving process is called grief work. This is a huge mental work of processing tragic events, the main task of which is not to forget, to preserve the memory of a dear person, while building new relationships with a world in which this person is no longer there.
The work of grief begins when a person accepts the fact of death. Then complex processes of overcoming occur, as a result of which the lost relationships gradually become memories, which ideally do not completely absorb the person, but transform grief into a state of light sadness.
It should be noted that with all the diversity of Western research, the experience of grief and loss comes down to one scheme of Sigmund Freud, given by him in “Sadness and Melancholy”: “Out of sight, out of mind.” “Freud's theory explains how people forget those who have passed on, but it does not even raise the question of how they remember them. We can say that this is a theory of oblivion,” writes psychotherapist Fyodor Vasilyuk.
In the book of Metropolitan Anthony of Sourozh “Life and Eternity. 15 Conversations on Death and Suffering” is an important evidence of the English attitude towards death: “Here in England, the attitude towards death is very surprising to a Russian person like me. It has improved somewhat, dare I say, not much, but it has become, let's say, less terrible. And when I first met him, I was amazed. I got the impression that for a good Briton to die was something completely unseemly, that people should not do that to their friends and relatives, and that if they stooped so low as to leave this world, they would be hidden in their room until the funeral home will not take them to their resting place and will not free the family from their presence, because in relation to their loved ones a person should not do such an indecent thing as die.”
“Grief is not just one of the feelings, it is a constitutive anthropological phenomenon: not even the most intelligent animal buries its fellows. To bury is to be human. But to bury is not to discard, but to hide and preserve. And on the psychological level, the main acts of the mystery of grief are not the separation of energy from the lost object, but the creation of an image of this object for preservation in memory. Human grief is not destructive (forgetting, tearing away, separating), but constructive, it is designed not to scatter, but to collect, not to destroy, but to create - to create memory,” it is written in Vasilyuk’s work “Surviving Grief.”
We can note two main components of successful grief work: re-awareness of the relationship with the deceased in order to appreciate what it means to us, and then “translate” it into the category of “memories without a future.”
To survive means to realize what happened, accept changes in life, adapt to a changed situation and gradually replace the feeling of suffering and pain with a calm memory.
Freud, in his work "Sadness and Melancholia", emphasized that we never voluntarily give up our emotional attachments, and the fact that we were abandoned, rejected or abandoned does not mean that we end our relationships with those who did it. After the death of a loved one, we, one way or another, continue to react to his emotional presence, while realizing that the person is not with us. To understand what we lost together with the departed and what this relationship was for us, we return to them, review them over and over again and play them again in memory, dreams, and daydreams. Warm memories evoke feelings of happiness, unfinished controversial situations and conflicts make us experience disappointment, anger, and sadness again and again. The task of grief is to return us again and again to these situations and states until we calmly look at them and accept them for what they were.
One of the biggest obstacles in adjusting to a new life, according to Lindemann, is that many people try to avoid the intense suffering associated with grief and avoid expressing the emotions necessary for this experience.
That is why painful manifestations are observed in the form of delayed reactions or various kinds of distortions. The ability to perform the work of grief depends on many things, including age and the degree of personal maturity. Without a history of healthy breakups, the work of grief happens much more slowly. Before coming to terms with a new loss, a person is forced to experience previous unfinished losses.
The work of grief is exhausting. Unconsciously, a person returns to the past again and again and is under its weight. He constantly faces loneliness and acute melancholy. It takes a lot of energy. Time passes, and little by little the demands of the present begin to assert themselves. The person begins to feel the desire to move on. However, part of him is still overcome with grief. The desire to end grief and only occasionally remember the deceased can be unconsciously perceived as a betrayal, cause feelings of guilt and inhibit the processes of grief.
When does grief end?
When it seems that grief has been experienced and everything is behind us, it can sometimes return in the form of acute experiences. In memorable places or on memorable dates. And that's okay.
I'll give you an example from my life. Two and a half years passed after my mother’s death, and I finally decided to come to her empty apartment to sort out her things and prepare the apartment for sale. It seemed to me that I had already experienced everything and accepted everything. My son and I sorted things out, sometimes hovering over something for a long time, sometimes deciding very quickly who to give what to, where to give what. Behind each item there were many of my memories. I talked about something, we laughed, joked, sometimes we were sad, but overall I had the feeling that everything was going well and in vain I was so afraid. And I also thought: “It’s so good that my son went with me.” And on the third day I suddenly had a very familiar and very severe headache, and I said: “How strange, it’s as if I’ve been working for an emergency for three days.” My son answered me: “And you work for emergencies.”
Loss Oncopsychologist - about personal experience of loss, feelings of guilt and warm memories that illuminate the darkness Pavel Sapozhnikov
Loss can always “revive” and cause acute pain again, and can return on anniversaries or at important life milestones. But gradually more and more memories appear, freed from pain, guilt, and resentment. A person gets the opportunity to escape from the past and turns to the future - he begins to plan his life without the deceased. At this stage, life returns to its groove, sleep, appetite, and daily activities are restored, and the deceased ceases to occupy all thoughts.
The meaning and task of grief work is for a person to forgive himself, let go of resentment, and accept responsibility for his life. The image of the deceased must take its permanent worthy place in his life, then the person will return to himself.
Remembering the deceased, he will no longer experience grief, but sadness - a completely different feeling. And this sadness will forever remain in the heart. If there are tears, they must be cried. But then the time comes when you can tell yourself: if right now you can restrain yourself and not cry, don’t cry. We need to get off the path of tears. If you continue to walk along it, the path can turn into a ditch, and then into a trench, so deep that it will be impossible to get out of it unless a hand is extended from above. And if you don’t want to extend your hand in response, then after a while no hand will simply be able to reach you - you will be so deep.
Severe grief is not synonymous with love, and stopping grieving does not mean betraying the departed. Because he will not leave the heart anywhere, because Love does not go anywhere.
Stages of Grief
- Shock and numbness (from a few seconds to several days). May result in an acute reactive state.
- Suffering and disorganization—acute grief (6–7 weeks). The work of experiencing grief becomes the leading activity.
- Stage of residual shocks and reorganization (up to a year). Loss gradually enters life.
- Completion (1–1.5 years after loss). Grief is replaced by sadness.
The acute stage of grief may include:
- Denial is a natural defense mechanism that allows us to maintain the illusion that the world remains unchanged. It is not the fact of loss that is denied, but its irreversibility.
- Aggression. Expressed in the form of indignation and hostility towards oneself and others. At this stage, reactions of the clinical spectrum are present.
- Depression. The period of greatest suffering and acute mental pain, the search for the meaning of what happened. It is typical to idealize the image of the deceased and attribute extraordinary virtues to him. Cooling of relationships with others, irritability, desire for privacy.
- Anxiety. The experienced feeling of helplessness leads to a feeling of loss of control over one's life.
The main task of grief work is not to consign it to oblivion, but to preserve the memory of a dear person, while building new relationships with the world in which this person is no longer there.
How to support someone during depression
When the first, acute pain of loss subsides and the person truly understands the situation, the stage of depression begins, which can last several years. According to the expert, during this period the grieving person may experience feelings of guilt, suffer from insomnia, anxiety, and strive for isolation. A person may lose the desire to take care of himself or others, and there may be a fear of death, loneliness, and philosophical questions.
“At this stage, your task is to talk with the grieving person about what was lost. If we are talking about the death of a loved one, then let him tell you about this person, about the relationship with him, about the stories that happened to him. Such conversations help, on the one hand, to “revive” the deceased in memory, and on the other, to finally accept his passing,” notes Alisa Galats.
Gradually, having experienced all these stages, the grieving person will enter the acceptance phase. At this stage, he will be able to come to terms with the loss and begin to truly live again. And if you have been there and supported all this time, you will be able to notice how your relationship will improve, becoming deeper and more mature.
The work of a psychologist in an emergency situation
An emergency situation is a situation in a certain territory that has arisen as a result of an accident, a dangerous natural phenomenon, a catastrophe, or another disaster. During an emergency, people's living conditions are significantly disrupted, it poses a threat to people's lives and health, etc.
The occurrence of emergency situations is usually associated with scientific, technical, technological progress, and, of course, there have always been and are natural disasters and catastrophes. Due to the fact that people now live in megacities, emergency situations can potentially lead to a huge number of casualties, because it’s one thing to have a sparsely populated place, and another thing where there are subways and skyscrapers.
In classical psychology, it is believed that a person goes to a specialist if he has some problem, he thinks about it, tries to somehow cope with it, but understands that he cannot cope on his own. When working in emergency situations, not only psychologists from our system work, but also from other ministries, and we can observe exactly this classic approach: psychologists occupy some place, sometimes they even equip it, put up a table, a sign and wait for people to come to them request help and, as a rule, they are left without work.
When a person is shocked, he will never in his life go looking for a table where there is a “psychologist” sign. Therefore, in emergency situations, we take the opposite approach - we go to people. And we go without introducing ourselves: “Hello, I’m a psychologist, how can I help you?” We see people who need our help, we approach them and begin to help.
How can you tell who needs help first and who doesn’t? In medicine there is the concept of “medical triage”: lightly wounded, seriously wounded and moderately wounded. We do not have such psychological sorting, but we have an understanding: which person needs help first and why. For example, in a situation where the dead are being identified, a woman is sitting, sobbing violently, and next to her is a woman in a strange position with her hands clasped, her legs clasped and her gaze fixed on one point, and she sits absolutely calm. If I work alone, and I need to choose which one I should approach first, who to give help and support, and all my colleagues are busy, I will naturally go to the one who sits completely calmly, without disturbing anyone.
Sometimes we even have questions from our colleagues: “Isn’t a psychologist supposed to help and calm you down? What do we see? A calm, completely collected, concentrated woman was sitting, a psychologist talked to her, sat next to her, held her hand, and the woman began to sob. What good have you ever done? Why didn’t you come and calm that sobbing woman over there?”
It is always difficult to answer the question: how do you help people and how do you work? First you get a higher education, then you attend master classes, specialist trainings, you study, you study, you learn to understand people. It happens that young girl students come and say: “You show us techniques, how to work with a person to help him, why are you telling us what thinking is, what memory is, what attention is, what stress is? The client won’t ask us about this, so you teach it, give it to the technician.” Then the question arises: if you do not understand what is happening to a person, how will you help him? How will you know he needs help now if you don't know the stages of grief?
I didn’t do anything, why should I do this?
Why do people feel so scared and difficult in emergency situations? Because at one moment their usual well-established life, which was under some kind of control, collapses, because we live with the basic illusion that, in principle, the world is arranged fairly, and that if I don’t do anything bad to anyone, then to me, and even more so No one will do anything bad to my child. The first question that arises is: “why?” That is, the illusion of justice in the world collapses: I didn’t do anything, why should I do this?
The next illusion is your own immortality. We understand with our minds that our body is perishable, and sooner or later we will actually have to die, but still we live as if we will live on earth forever. Otherwise, if we understood that at any moment, for example, while walking a child to school, I may not see him again, because either he will not return, or I can fall and die, anything can happen, we simply would not could live, but could not give birth, raise children, or generally make plans for the future. What helps us is a basic trust in the world, that everything will basically be fine with me, I can control some things in my life, I can manage some things.
And suddenly, at one moment, everything collapses, and a person has the feeling that he cannot control anything in his life at all. That he is a feather in the wind, that anything can happen to him and his loved ones. And then the question is: how to live further and why? The usual life collapses, and the person finds himself in the abyss. He was walking along the road, an abyss opened up, he fell there and realized that he was now there. Something happened that brought down the usual life.
