Sunday, January 15, 2006

grief

Elizabeth Kubler-Ross coined the term grief-work to describe the overwhelming emotional and psychological process of dealing with a severe personal loss. Grief is a normal inner experience that follows bereavement and in most cases is overcome with time. When the loss of a very close intimate, such as a spouse, is unexpected, the experience of grief appears to be totally unavoidable and overwhelming-so much so that it is difficult to describe it to anyone who has not had the experience. (See, for example, A Song for Sarah, written by Paula D' Arcy, which records the devastating pain experienced by a pregnant young mother when her one-year-old daughter and husband were killed at her side in a car accident caused by a head-on collision with a drunken driver who had crossed a median divider).
A most revealing account of grief was published by C. S. Lewis, the distinguished British scholar and author, professor at Oxford and later at Cambridge University, who late in life married the American poet Joy Davis. A committed Christian of strong religious faith, Lewis is sometimes called "the apostle to the skeptics" for his books that addressed a variety of difficult religious problems for the benefit of persons who have doubts about religion (e.g., The Screwtape Letters-letters from a senior devil to a junior devil with instructions on how to capture a young man's soul).
His late-life marriage to Joy Davis, not only American but a former member of the Communist Party and Jewish in religious origin, seemed most improbable, but turned out to be a perfect match-Lewis loved her with all his heart. Within a few years after their marriage Joy contracted cancer, and after a period of remission that gave them both hope, she died. Lewis was devastated, but, always the writer, he kept a diary to record, and perhaps relieve, his inward pain. He eventually published a book based on the diary under the title, A Grief Observed, to serve as an aid to others who might be engulfed by a similar devastating loss. Lewis found that his grief overwhelmed his religious convictions; they were not able to assuage his pain even though he prayed for relief. At one point in A Grief Observed. Lewis compared his unremitting agony to the inner state that arose when he had felt fear as an officer in trench warfare in France during World War I. His description is not unlike the account of grief given by psychiatrist Erich Lindeman in an article written for the American Journal of Psychiatry in 1944, which reads:
. . . sensation of somatic (bodily) distress occurring in waves lasting 20 minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an empty feeling in the abdomen, lack of muscular power (weakness), and an intense subjective (inner) distress described as tension or mental pain. [parentheses added]
And, of course, for many people, grief includes uncontrollable sobbing and weeping. A number of specialists have described the phases of normal grief that reveal certain broad characteristics:
1. A period of intense grief, lasting from a few weeks to several months, when the bereaved are unable to control their feelings, sometimes crying without ceasing for hours at a time, when a strong effort just to carry on with life is essential
2. An intermediate period of sadness, with occasional reversion to periods of overwhelming emotion, relieved by the gradual reconstruction of life
3. establishment of a new life, wherein the lost intimate companion is not forgotten but is remembered lovingly, where the bereaved person has reached a new state and sense of competence
The experience of grief is unavoidable. The task of filling the emotional gaps are indescribably painful. The difficulties of developing the competence to perform the tasks (often financial ones for widows) formerly carried out by the loved one are difficult. Yet, Helen Znaniecki Lopata's monumental studies of widowhood show that over 60 percent recover from their bereavement experience within a year. She also observed that the recovery period may take more than two years for 16 percent of widows, but that nearly everyone does recover.
Death rates for men increase following bereavement, and for both sexes it is quite common for distress to reach a level of clinically observable depression. For the rare instances of pathological grieving there are, fortunately, a variety of therapies. These include the use of psychotropic medicines (to assist with sleep, to overcome depression, and to improve appetite), and psychological approaches, such as grief counseling, cognitive therapy, and behavioral counseling.
Studies of grieving people show that those who experience an "on-time" loss (such as the death of a spouse in late life) may experience a somewhat less intense and also briefer period of grieving than those who go through losses earlier in life. Lopata's studies also showed that help, especially from close family and kin, is usually available to the bereft. Daughters generally provide emotional support to widows, and sons supply instrumental help by performing yard work or making repairs around the house.
Other research shows that those who anticipate a loss, as in the death of a spouse that follows several months of serious illness, may go through considerably milder forms of grieving because they have had more time to anticipate the loss. The results of anticipating death are not universally beneficial, however--extended periods of waiting, especially when accompanied by a heavy burden of caregiving, can wear the waiting individual down. The death under such circumstances becomes a positive relief.
Perhaps the most significant finding of studies of grieving is that other people, especially non-family members, may be unaware of, or insensitive to, the inner pain of the bereaved person. Since we have abandoned the ritual symbols of mourning-widows' weeds for women and black armbands for men-in the 20th century, there is no way for strangers and acquaintances to recognize that a person is bereaved and may be carrying a massive internal psychological wound.
Today, however, a variety of self-help books may offer some support to the bereft, as do organizations like Widow-to-Widow, Compassionate Friends, and others. Both friends and family in contact with bereaved persons need to realize that the aftermath of death brings on a period of grieving that can be overwhelmingly intense. Affection, kind words, and consideration are essential during this time.
La Rue, A.; Dessonville, C.; and Jarvik, L. F. "Aging and Mental Disorders," in Birren,
J. E., and Schaie, K. W., eds. Handbook of the Psychology of Aging. 2nd ed. New York: Van Nostrand Reinhold Company, 1985.
Lopata, H. Z. Widowhood in an American City. Cambridge, Mass.: Schenkman. 1973.
Ward, R. The Aging Experience. 2nd ed. New York: Harper and Row, 1984.

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