The experience of grief following bereavement is ubiquitous and falls within the normal range of human experience. We therefore need to be careful not to pathologise it, although the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has recently – and for some controversially – added a diagnosis of prolonged grief disorder. Nevertheless, just because the grief associated with death and dying is generally normal, this does not diminish how acutely distressing it can be, and sometimes the experience of grief can exacerbate other, more long-standing psychological issues.
Grief is painful partly because it involves an unavoidable reckoning with reality and the limits to our control. Elisabeth Kübler-Ross, an eminent researcher of reactions to loss, proposed a five-stage model of grief. While the idea of stages has been challenged by the idiosyncratic, cultural and non-linear nature of the experience of loss, her work highlights the common employment of defences such as denial and bargaining.
In denial, we refuse to believe that the loss has happened, whereas in bargaining we try to undo the loss by offering up something in return. In The Year of Magical Thinking, Joan Didion evocatively illustrates a type of magical thinking that can accompany grief. In this state of mind, we both know that the loss is real and yet at the same time don’t truly believe it. Didion, in the face of her husband’s death, avoided throwing out his shoes as she magically believed he might still need them.
These defences are an important anaesthetic in the early stages of grief – without them, the reality of the loss would be too overwhelming. We absorb this reality in titrated doses to avoid being completely unravelled. Over time, we generally accept that the loss has happened and confront the complex feelings this evokes.
One of these feelings is commonly that of identity rupture. Our sense of ourselves is intricately associated with our sense of ourselves in relation to others. When we lose significant others, our self-identity is rocked. Who am I now, when I am no longer the daughter who strives to impress her father or the husband who cares for his wife? How do I perceive myself as a single person in the world? Or as an adult orphan? As Didion writes: “When we mourn our losses we also mourn, for better or for worse, ourselves. As we were. As we are no longer.”
This struggle with identity was what brought Ivan* to see me. His father died of a heart attack when Ivan was three, and he had been raised as an only child by his mother. Sadly, when Ivan was 28, his mother developed breast cancer, and she had died six months prior to him seeking my help. Ivan had lived with her for much of his life, barring a stint in a university share house, and he had been her primary carer through her illness. While Ivan had known his mother was dying, he nevertheless experienced her death as a profound shock, and struggled to believe she was never coming back.
He told me that while he missed his mother, the issue that was troubling him the most was that he felt like a stranger to himself in an alien world. His world had tilted on its axis and no matter how hard he tried, he couldn’t find a way to right it again. Although he was a capable person with good friends and an interesting job, Ivan felt destabilised, lost and alone. He lamented that “I just can’t get a grip on who I am any more” despite trying very hard to “move on”. Usually a social person, he had found himself withdrawing from others as he didn’t want to burden them with his feelings.
Ivan hoped I could help him “get over” his mother’s death and find a way to feel more comfortable in his own skin again. I gently broke the news to him that the only way is through when it comes to grief – there is no way over or around. However, I was hopeful that we could work towards him integrating his mother’s death into his life trajectory and re-forming a more robust sense of self. I was aware that Ivan had lost many identity roles – son, care receiver, caregiver and being a member of a family. To complicate matters, Ivan had fiercely loved his mother yet also resented her reliance on him. Suddenly he was free of the latter, but this freedom felt guilt-ridden and empty.
I felt a lot of empathy for Ivan, being no stranger to the anguish of grief myself. Few of us ultimately escape the price we pay for loving deeply. But to help Ivan I had to move beyond empathy and identification. Together, we needed to find a way for him to maintain a meaningful relationship with the memory of his mother while also reorganising his self-identity to incorporate her absence and continuing to find meaningful connections to people and experiences in the present.
This was, as always, easier said than done. However, Ivan left our first session feeling relieved to hear that his identity rupture was a common response to loss. Over the time that we worked together, he discovered that his relationship with her was able to transcend her death. His memories and experience of her continued to shape and influence him. With some encouragement from me, he began to speak more openly to his friends, and as his relationships with them deepened he felt more able to find himself again.
Grief is a highly individualised process. The death of a loved one is not something we get over, but we do gradually reorganise ourselves around it. We may be forever altered, but we are able to reintegrate. For many, this happens naturally over time. Others, like Ivan, may benefit from a little extra help in what is an extraordinarily difficult process.
• Prof Gill Straker and Dr Jacqui Winship are co-authors of The Talking Cure. Gill also appears on the podcast Three Associating, in which relational psychotherapists explore their blind spots
* Ivan is a fictitious amalgam to exemplify many similar cases they see. The therapist is a fictional amalgam of both authors
