Mental Health

Grief Work

Typically, it isn’t until we experience the death of a loved one that we come to think about our attitudes and expectations around the end of life. Following tradition is then eased by ritual or spiritual practices and funeral/memorial plans. Society dictates rules for how to act, dress, speak, and operate in the world, society also dictates rules around grief, and these rules can be subtle or explicit with defined mechanisms of ritualized social forms according to varied cultures and religions. They work wonders.

We experience disenfranchised grief, when our grief is not publicly mourned or socially sanctioned by the larger community. Delays and limitations to funerals and burials in a pandemic greatly increase the likelihood of unresolved complicated grief (CG) for the bereaved, when our own need for strict isolation makes it often impossible to say goodbye properly. Furthermore, the possible feeling of guilt for having exposed those close to us to disease greatly adds to the already deep pain of a lack of preparation for death.

Disenfranchised grief takes “grief rules” to another level.  The unpredictable trajectory of the illness has practical and emotional consequences and needs work. What to do?  First, identify your grief as an illness to which you are a victim, not its cause. Your ruminative thoughts, excessive bitterness, alienation from previous social relationships, difficulty accepting death, and purposelessness of life are typical and require work on yourself from the start. We, humans, are wired, after all, to reassure and to comfort. In my practice, I’ve seen that it is not only distressing to be deprived of receiving comfort, but similarly to be deprived of the ability to provide comfort. That is the lot of all too many front-line health workers these days.

The father of modern grief counseling, Erich Lindemann, interviewed some 110 grief sufferers in the midst of World War II. He identified specifically the activities that are the external sign of a deeper inward psychological disorder distinct from normal grief. You may experience recurring physical sensations lasting up to twenty minutes involving shortness of breath, physical depletion, choking, or non-stop sighing and crying all made worse by even the comforting words uttered about the deceased. In fact, even under ordinary circumstances, what is unavailable in a pandemic is not a sure-proof cure-all for grief. There is even ordinarily a tendency to blame ourselves for the death, and also regret our former failings toward the diseased now that it is too late to make amends.

”The duration of the grief reaction seems to depend upon the success with which a person does the grief work, namely, emancipation from bondage to the deceased, readjustment to the environment in which the deceased is missing, and the formation of new relationships,” according to Lindemann.  J.W.Worden  in his book Grief Counseling and Grief Therapy, presents that “grief work” in four stages that he thinks are necessary for successful grief resolution. First, the reality of the loss must be accepted. Second, the pain of grief must be experienced. Third, the grieving person must adjust to the environment from which the lost person or object is missing. And, fourth, emotional energy must be withdrawn from the lost person or object and reinvested in someone or something else.

That requires self-help practices beginning with finding alternative online means to carry out meaningful transitional rituals related to a transition from life to death that human beings so badly need, whether you are a Jew, Christian, Moslem, Hindu, Buddhist, secular or a person in need of a shaman among the ancient tribes of Siberia, or a Lama versed in death transitions in the mountain vastness of Tibet.  How that may be achieved electronically is the subject of my next posting.  For now, let me leave you with a mindfulness exercise a little different from the conventional one designed to still your monkey mind. This is a grieving mind, which is a very different thing entirely. This exercise calls on you to judge, and make a decision on the sole criteria, whether the physical/mental experience is wholesome and beneficial or not.

King Milinda of the first century is being thought of creating this thought to identify symptoms and their consequences.

“When mindfulness arises, sire, it reminds one of the states together with their counterparts that are wholesome and unwholesome, blameable and blameless . . . Thus, sire, mindfulness has to remind as its characteristic. . . . When mindfulness arises, sire, it examines the courses of the beneficial and unbeneficial states thus: ‘These states are beneficial; these states are unbeneficial; these states are helpful; these states are unhelpful.’ Then the one who practices yoga removes the unbeneficial states and takes hold of the beneficial states . . . Thus, sire, mindfulness has taken hold as its characteristic.”

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