Therapy Can Work

Katherine Rabinowitz, LP, M.A., NCPsyA

Licensed Psychotherapist & Psychoanalyst
Union Square area, Greenwich Village, New York, NY

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Therapy Can Work

Katherine Rabinowitz, LP, M.A., NCPsyA

Licensed Psychotherapist & Psychoanalyst
Union Square area, Greenwich Village, New York, NY

Mourning & Loss

Introduction

In everyone’s life, there comes a time when someone or something close, important or valued is lost. We normally associate grief and mourning with the death of a person, but other types of loss can be felt just as deeply.

Grief is what we experience after any kind of major loss. It is a common, natural and normal reaction, a response to a situation that is anything but normal. Grief is also the process by which we heal from the loss.

While the terms grief, mourning and bereavement are often used interchangeably, some distinctions can be drawn. Grief is the intensely personal, internal experience we feel at the loss. Mourning is the more public expression of that grief, and is determined by the society in which we live. Ethnic, cultural and religious differences all play a part. Bereavement generally implies loss by physical death, as opposed to other types of loss. It is the objective state of having lost someone, and also refers to the period of time during which grieving and mourning occurs.

Kinds of Loss

While the most common loss one thinks of is the death of someone beloved, there is actually no limit to what can be experienced as a loss. Divorce and separation, the discovered infidelity of a partner or spouse, a betrayal by a family member or friend and subsequent loss of friendship or connection and the loss of a beloved pet are often as traumatic as the death of a person.

Material or Physical Losses

There are material losses – the loss of one’s home or property to fire or theft as well as the inability to pay for it, loss of employment or any financial reversal of fortune can rob one of a sense of worth. The loss of good health can be devastating. Not just extreme or sudden loss to incurable or chronic disease, but impairments to normal functioning – hearing or vision loss, a stroke resulting in partial paralysis or loss of speech, decline of sexual functioning or body image, incontinence, infertility, chronic pain, impingements on mental health – all can mean a deeply felt loss of what it meant to be “normal”.

Intangible Losses

There are also intangible losses that lie in a more psychological realm: the loss of one’s own identity after the death of a spouse or partner. You were two peas in a pod, inseparable. No one thought of you apart from the other. You shared activities and interests. Now what are you going to do? No wonder it feels so empty. Losing a job or getting passed over for a promotion can change your sense of self-worth. If you were the victim of a crime or abuse, your sense of personal safety may diminish, as well as a sense (illusory though it may be) of control of your environment.

The Experience of Grief & Mourning

Grief

No Right or Wrong Way to Grieve

“Grief can’t be shared.
Everyone carries it alone,
his own burden, his own way.”
~Anne Morrow Lindbergh

Different types of loss set off a host of reactions. There is no one right or wrong way to grieve, and little but the internal ache is universal. The loss of a loved one to death or departure from the relationship is doubtless painful for nearly everyone in our culture, though other cultures have been discovered where loss is experienced differently. If the death is expected, as after a long illness, people may have experienced “anticipatory” grief. The grieving process begins before the death actually occurs because it is expected, and because who the person always was has already gone. However, even when death is certain and anticipated, there is still no way to ever be fully prepared for its finality.

Grief can be overwhelming and affect every part of one’s life, physically, psychologically, socially and spiritually, especially if it was unexpected. Grief is real. It is normal. And it is painful. But grieving is an intrinsic part of the process of recovering from the loss and, while there is no right or wrong way to grieve, to deny oneself the feelings that naturally arise is a mistake.

Normal, Expectable Reactions

Numbness, disbelief, anger, guilt, sadness, depression, longing, despair are all normal responses to loss. Though some people are naturally more resilient than others, convincing oneself that “I’m over it” prematurely is likely to result in emotional problems later on. It is important to remind oneself and accept that these feelings are normal, and more importantly, survivable.

It is not true that the pain of loss is only felt psychologically. It can also be felt physically, and sometimes simulate medical or mental conditions. Crying spells, trouble sleeping, physical numbness, the feeling of no feelings, even shortness of breath and some mental confusion are all common.

It’s always wise to consult your physician to eliminate the possibility that something other than grief has developed if any of these occur.

Grief can be exhausting. It saps energy and makes many people prefer to withdraw and be alone with their feelings to going out socially to “cheer up.” There may be a loss of interest in usual activities. You might feel cheated. Cheated of the chance to say goodbye, to say how you felt, to clear up that unfinished business you always meant to do. Cheated of what might have been. You might wish to join the person. All this is normal, too.

Some sources you consult (including Elisabeth Kubler-Ross’s landmark work On Death and Dying) cite an orderly series of stages everyone goes through – generally denial or disbelief, anger and blaming, bargaining, depression, and finally acceptance – but it does not always play out exactly that way. There is no set path to grief and mourning and it is not orderly. A roller coaster would be a better description.

Long after you would expect it to be “done”, the feelings sometimes re-emerge out of nowhere, in a wave that takes you by surprise. Memories of your loved one and the life you lived together live on and can continue to stir up feelings of sadness and loss. And it might feel somehow disloyal to re-engage in the activities you used to do together, or begin to court someone new, but this is how one begins to engage in a new and different life experience.

Mourning

A Process of Adaptation

Mourning, which includes the many different cultural expressions of grief, is a process of adaptation. It can go on for a long time, and usually the intense pain eventually lessens. But even after the acute symptoms of grief have abated, things are never the same again. That doesn’t mean they can’t ever be good again. They can. They’re just different without that person in the world, and mourning is what helps us adapt to the loss. Certain cultural rituals, starting with the funeral, help take us to the place where it’s okay for the person not to be in our lives anymore. Loving and happy memories help.

Complicated Grief

The internal turmoil and the overt expressions of grief usually diminish over time. If they do not, if the intensity of the initial grief remains after years have passed, and resumption of normal life routines does not happen, what’s called “complicated grief,” an interference of the normal healing process exists. People with complicated grief should seek professional help.

No Timeline

Adapting to life that’s different from before the loss has no definite timeline. What or who was lost and the importance to you, will affect how long it takes, and every person’s experience is unique. What you must accept is that it can’t be like it used to be. Avoiding or denying it only serves to prolong the suffering, delay healing, and interferes with emotional well-being.

Adaptation Doesn’t Mean Forgetting

“When you are sorrowful look again in your heart, and you shall see
that in truth you are weeping for that which has been your delight.”
~Kahlil Gibran

Some people fear that adapting means forgetting. It doesn’t. You can always have your memories and cherish them, without being taken over by them. Adapting also doesn’t mean “getting over it.” It means accepting the loss and being able to function normally again. Your loved one would want you to. It means understanding that you can live without them. It’s important to allow yourself to grieve and recover in whatever way works for you. It doesn’t mean losing yourself in drugs, alcohol or other self-destructive behavior. That’s a false and temporary fix that will work against you in the long run. But maybe it means being alone, or crying, talking to people, or a combination of these. Maybe it means expressing yourself in some other way – writing, composing, drawing, or nurturing yourself in whatever way comforts you. Or maybe it means eventually making certain changes in your situation. It always means that it’s ok to grieve. Avoiding grief not only increases the likelihood of future emotional distress, it can even make you susceptible to physical illness.

Being Happy Again

It is possible to be happy again. Most people are. No one can determine for you when that will be, but if you accept that your loss is real, understand that your feelings, however distressing they might be, are normal, call on your internal reserves to summon whatever coping mechanisms work best for you, most likely a day will arrive when it occurs to you that life is good again.

How to Help a Grieving Person

Most of us want to help those we care about when they suffer a loss. Most of us don’t have a lot of experience with loss – our own or someone else’s, and so, well-intentioned though we may be, we aren’t as helpful as we could be. It’s sometimes hard to know what the grieving person needs or how to offer sympathy appropriately, but a few basics should put us on the right path.

It can be very uncomfortable for us to see someone else in profound pain, and we naturally want to help them out of it. It is critically important to understand that we can’t take away someone else’s pain, and they need to be allowed to grieve. For however long that takes. So being patient in your understanding is a virtue. Don’t expect them to “let it go” on your timetable or because of your discomfort with their pain.

Best Not to Say

Best not to tell someone you “know how they feel.” You don’t, not really. You may think you do, and especially if you have also lost someone dear to you, you may be utterly convinced you do, but you don’t ever truly know what someone else is feeling. And in any case, they will never believe you. It’s important to offer sympathetic understanding, and you can say you imagine how hard it must be, but preempting someone’s grief does not help. Best not to tell them to “hold on.” “deal with it,” “move on,” “get over it,” “be brave.” Best not to talk about your own losses. “I remember when I lost my…” is not what the grieving person wants to listen to.

Be a Good Listener

In fact, more often than not, they don’t want to listen at all, they want to be listened to, so one of the most supportive functions anyone can offer is to be a good listener. Do your best to contain your own squeamishness if they want to talk about their loss and how awful or how angry they feel. It is a mistake to assume they don’t want to. However, try to be attuned to what they do and don’t want to express, and don’t push them into talking about what they’re not ready (if they ever are) to reveal. But give tacit permission by showing that it’s safe for them to say whatever they want to, or just cry.

Offering Help

Be available to help, not just in the immediate days after the loss, for several weeks or even months to come. Be available in a specific way. Understand that the grieving person may be overwhelmed and have difficulty picking up the phone to ask for something. So rather than say “if there’s anything I can do to help, just let me know” offer to pick up groceries, dry cleaning, movie rentals, children. And offer again, and again, so they understand they’re not burdening you by accepting. Offer your company but understand if they don’t want it. Imagine what it’s like for them the first time they go to that special restaurant, that weekend place, that favorite band or museum. Sensitivity, patience and continued support over longer than you might guess are among the most appreciated gifts a grieving person can receive.

Children & Grief

Different From Adults

Grieving children do not have the same reactions as adults. Perhaps because they are not yet mentally equipped to handle such intense feelings, or perhaps because the loss does not strike them in the same way. In any case, they often do not show their emotions as openly as adults and should not be expected or forced to. They may not be able to articulate what they’re feeling. That doesn’t mean they shouldn’t be given the opportunity to so they can better absorb their loss. Since children often act out their feelings in play, don’t be surprised to see death games and fantasies. They may not show their grief as consistently as adults, but it will pop up here and there over a longer period of time.

Inclusive Behavior & Appropriate Language

They should be allowed to go to a funeral if they want (but allowed to stay home if they’re scared), but if they do go, they should be told in advance what to expect. Questions should be answered in age-appropriate language but as directly as possible. Euphemisms for death (grandma’s gone to heaven) and terminal illness (Daddy has a tummy ache) do not help the child understand that grandma is dead and Daddy has cancer. Whenever possible use correct terminology and explain simply but within their capacity to understand exactly what has happened.

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