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Sreemoyee Sen Ram, MHF Kolkata Co-Founder, speaks on how to come to terms with ‘Loss’ and emphasizes ‘One should not grieve alone’

Reconciling to Loss

It is extremely difficult to come to terms with any loss. Grief is a normal, healthy response to loss. Grief or bereavement intervention is challenging and complex. The death of someone we love is one of the greatest sorrows that can occur. Feelings of bereavement can also accompany other losses, such as the decline of our health or the health of someone we care about, or the end of an important relationship. Everyone feels grief in his or her own way, but there are certain stages to the process of mourning. It starts with recognizing a loss and continues until that loss is eventually accepted. People's responses to grief will vary depending upon the circumstances. If the person died of a chronic illness, for example, the death may have been expected. The end of the person's suffering might even come as a relief. If the death was accidental or violent, coming to a stage of acceptance could take longer.

We may experience confusing emotions in grief. We may be in shock initially followed by a stage of denial, we may be angry and blaming somebody for a situation, sad or depressed, could be in a bargaining stage and then accepting it. (Kubler- Ross). Everybody may not experience all these emotions and there is no particular order. The process of grieving becomes complicated if it is accompanied by symptoms of Post Traumatic Stress Disorder.

Couple of years back, I met an elderly lady who was grieving her husband’s death. I had known the family for some years and knew that she had occasionally survived episodes of domestic violence in the early years of their marriage. Supports and interventions sometimes worked, sometimes didn’t. When her husband was diagnosed of cancer, she had to become the primary caregiver. Their son lived overseas and treatment costs were borne by him. Surviving the treatment and care giving was a laborious affair, both for the gentleman and the care giver, his wife. As we all know, the journey of the person undergoing cancer treatment is complicated & painful. The key to continue in this difficult journey is to live in hope. But it has its impact on the family in more than one way. During the years of cancer treatment, this gentleman often was irritable and abusive towards his wife. This naturally, impacted on her and made her feel more depressed. There was hardly any respite She had sleep disturbances and bad memories of her plight vis a vis domestic violence. This added to her trauma and made her feel burdened. Finally, after his death, she stayed in a different neighbourhood and refused to visit their home- where the couple stayed.

Her grieving was complex. She did not miss him and that thought made her anxious. She felt guilty about it. It often made her feel paralysed. I also learnt that she did not perform the ‘shradh’ ritual, in the way their relatives wanted. She was tormented by this conflicting thought, even after one year.

Grief processes depend on the relationship with the person who died, the situation surrounding the death, and the person's attachment to the person who died. Sometimes grief can be delayed long enough that when we do start to experience it, we can’t think back far enough to figure out where it’s coming from. This makes it difficult to work through the bereavement process. Brief therapy may have worked in such a scenario. The focus would be to free her from the guilt feeling and enable her to come to terms with the death and move on.

This type of short-term intensive therapy is particularly useful when the presenting problem is very specific. Unlike longer term psychodynamic psychotherapy, which would examine the emotional underpinnings of the meaning of the loss to the patient, as well as its historical antecedents (the experience of losses starting in childhood) in-depth. Brief therapy uses history and explores issues psychodynamically, only when they are specifically relevant to the issue being treated. In addition, with a specific number of sessions, the end is planned from the beginning and is talked about throughout the treatment. Ironically, termination becomes another opportunity to talk about loss and how to cope with it.

Humans tend to make strong bonds of affection or attachment with others. When these bonds are broken, as in death, a strong emotional reaction occurs. After a loss, a person must accomplish certain tasks to complete the process of grief. These basic tasks of mourning include accepting that the loss happened, living with and feeling the physical and emotional pain of grief, adjusting to life without the loved one, and emotionally separating from the loved one and going on without him or her. It is important that these tasks are completed before mourning can end. Mourning is the process by which people adapt to a loss; mourning is also influenced by cultural customs, rituals, and society's rules for coping. Bereavement is the period after a loss during which grief is experienced and mourning occurs. The time spent in a period of bereavement depends on how attached one was to the person who died and how much time was spent anticipating the loss. Grief therapy enables a person to reconcile to loss and regain the ‘self’. Children grieve differently and may not express the same way as adults. Grieving children may not withdraw and dwell on the person who died, but instead may throw themselves into activities (for example, they may be sad one minute and playful the next). Children's minds protect them from what is too powerful for them to handle. Also, children have trouble putting their feelings about grief into words. Instead, their behaviour speaks for them. Strong feelings of anger and fears of abandonment or death may show up in the behaviour of grieving children. Children often play death games as a way of working out their feelings and anxieties. These games are familiar to the children and provide safe opportunities to express their feelings. Adults must be careful and vigilant.

One must not grieve alone. Family, friends and neighbours provide supportive networks. Exploring new hobbies & activities, new places, making new friends, enable to build a refreshing and meaningful life.

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