LOSS, GRIEF, AND MOURNING

By definition an experience of loss is anything that is related to the destruction or reduction of an aspect of our lives, material or immaterial, large or small, external or internal, and perceived or real that it may be. A threatening event like a biopsy for a breast lump that is found to be benign, for instance, despite being a perceived threat, can cause loss because it undermines our sense of security, predictability and sense of control in life. 

The concept of loss may also extend beyond what one has lost now, to include what one never had and now never will have (e.g. for example, the loss of a parent with whom one has had an unsatisfactory relationship, or the loss of childhood through abuse). Finally perceived loss can accompany significant changes in life that may be thought as 'positive' by others at large. Marrying and having children may for instance carry a significant sense of loss of individual freedom, a fact that becomes difficult to discuss with closed ones and instigates grief.

Now in the counseling for grief realm, important distinctions between types of losses are made along variables such as primary and secondary, and external and internal losses, with external losses being related to concrete material losses, such as a house, a job, a business, a person, and internal losses being related to internal events, such as friendship, self-esteem, identity, hopes, dreams, and future plans. 

For instance a divorce leading to one partner moving out of the premises and losing custody of a child might entail a primary external loss in the form of house security and other material needs, as well as primary internal losses in the form of a loss of bonding and contact with the child. It might, however, also imply secondary losses in the form of a foundational loss of confidence in the ability of being a parent. For the partner staying, and the child, the divorce might also signify a significant primary internal loss in terms of their family dreams and the desire of the child to grow with full parental support, but a secondary loss might come in the form of lower school grades for the child.

Further, the loss is assessed for how attuned it is to the developmental stage of the person incurring the loss and whether it is sudden, or anticipated. For example we say a loss is on time and anticipated if a person in their 60s loses their father or mother to a slow process of old age, but off-time and sudden if they lose their own child to an accident. If the loss incurred is due to natural disaster, we call these losses time-irrelevant. These losses are for the most part sudden, and sudden losses often lead to the feeling of having been 'robbed' of something precious.

The final category of losses we consider are those called ambiguous, a category I have dedicated a bit more writing on this page. 

All of these kinds of losses lead to the process of mourning, the integration of grief, a process that can manifest verbally, behaviourally, emotionally, in changes about our thought patterns and views about the past and the future, spiritually, or in the form of physical pain, and/or persistent and prolonged yearning and/or preoccupation. The manner in which grief is expressed depends on our personality and our conditioned thoughts and beliefs about loss, but also on the family system and the culture in which the loss occurs (e.g. the traditions and customs surrounding the management of loss in a family or culture). Deeply religious families embedded in a close-knit ethnic group, would process the loss very differently than a secular nuclear family. Grief is experienced collectively rather than individually, so one way of looking at it is that an individual grieves while a community mourns. So, when we are looking at mourning, we tend to be concerned with such matters as rituals and other established patterns of groups of people, whether communities in the sense of a neighbourhood or the broader sense of a community of interest (for example, a set of colleagues in a workplace). What we are dealing with is the way a community collectively responds to an experience of loss and grief. This is important because it emphasizes the social dimensions of loss and grief that are so often neglected, with the tendency to focus primarily (or even at times exclusively) on psychological aspects.

Whenever the grief is not socially validated, we speak of disenfranchised grief, and this type of grief, like grief for ambiguous losses, carries supplemental complications. Disenfranchised grief is often linked to losses whose circumstances are regarded as taboo, or secretive. For instance, suicide, losses from abortions or drug addictions or crime, often lead to disenfranchised grief for those whose loss is important to their external or internal sense of being. The people left to feel these losses often suffer further secondary losses in the form of abandonment, rejection, betrayal, judgments, and exclusion.

Having considered and discussed all of these variables, the central process in grieving for a client is seen as an attempt to re-affirm, or re-construct, a world of meaning that has been challenged by the loss. The therapist is there to help deepen and direct the client's engagement with their grief experience, a process which may or may not lead to the final acceptance of the loss, but a process which should lead to an increased sense of meaning, validation, perceived value in the loss, and a sense of connection and purpose in life.

Wishing you Well,

Your Shrink in Bansko