Finding Comfort in Memory
The quality of the relationship is less important than expected in a grief reaction because we don’t grieve the facts. We don’t grieve the actual details of the relationship. We grieve only what we remember of the relationship. And the accuracy of our memories does not determine how we grieve; that is determined by what we do with our memories, how we experience them, and what we take from them during bereavement.
Karen Everly thought often about Claire and felt that in many ways Claire was still with her. Karen was able to summon calming and soothing recollections: reminiscences from Claire’s childhood, images of her accomplishments, or simply memories of daily life together, at the dinner table, walking in a park, or caring for their dogs. She seemed to have an endless variety of memories that she could call up to help her feel that Claire was still with her.
Julia Martinez used photos to help remind her of her father. There was something remarkably purposeful, almost precocious, in the way she did this. She would decide on a good time to remember her father, a time when she was unlikely to be interrupted. She would close the door to her room, carefully get out the photos, and let her eyes and her mind roam over them: “It was like visiting him, in a way. You know, it made me sad sometimes, when I remembered him. But usually it made me feel better. It helped me remember how lucky I’d been when he was alive. It was a little bit like he was still there.”
Heather Lindquist made a deliberate effort to keep alive the positive memories of her husband, John. She felt she owed it to her sons. She thought they should have a strong image of their father. She kept photos of John in prominent places around the house. She talked about him often and made sure that John’s friends remained a part of her family’s life. She found that positive memories came to her in private moments, and without much effort: “We had so many good years together. I couldn’t forget that. There is no way those memories were going to fade.”
We are not accustomed to thinking of grief as a process of finding comfort. The idea seems a bit odd, but this is precisely what resilient people tend to do. Regardless of what the relationship was actually like, resilient people are generally better able to gain a feeling of comfort from remembering the relationship during bereavement. They are also more likely to find comfort in talking about or thinking about the deceased, which, they report, makes them feel happy or at peace.
it is not surprising that the bereaved people who are able to deal with a loved one’s death, and who are able to accept the finality of the loss, are also able to find comfort in memories of that person. They know their loved one is gone, but when they think and talk about the deceased, they find that they haven’t lost everything. The relationship is not completely gone. They can still call to mind and find joy in the positive shared experiences. It is as if some part of the relationship is still alive.
When Death Opens New Doors
The death of a loved one may come as a relief even when caregiving is not involved. There are times when we can do nothing but lessen a loved one’s suffering; their death comes as a relief mainly because it brings an end to their misery. A loved one’s death may also bring changes to our lives that we couldn’t have imagined. Sometimes a loved one’s death opens new doors.
In his autobiography, the famous scientist Edward O. Wilson described a period in his life just after having graduated from college. Although he was passionate about science and on the verge of a promising career, he feared he might have to forestall his research endeavors just as they were getting off the ground. Wilson’s father suffered from a number of chronic health ailments. He also had a serious drinking problem and was growing increasingly depressed and helpless. Then, early one morning, Wilson’s father “wrote a calm note of apology to his family, drove his car to an empty section of Bloodgood Street near the Mobile River, seated himself by the side of the road, put his favorite target pistol to his right temple, and ended his pain.”
How could such a tragic event not be devastating? To Wilson’s surprise, he found that “after a few days the shock of grief was infiltrated by feelings of relief, for my father who was now released, for [my mother] Pearl whose desperate siege had been broken, and for myself—the filial obligation I had feared might tie me to a crumbling family was now forgiven. The impending tragedy took final form, and happened, and was over. I could now concentrate entirely on my new life.”
It would be neither fair nor accurate to say that Wilson had no difficult feelings related to his father’s death. He tells us that he did experience sorrow for his father, as well as guilt over having felt relief about his death. But he did not grieve extensively, and whatever the lingering feelings he harbored, they did not impede his ability to live out his dreams. After his father’s death, Wilson went on to a brilliant career and ultimately myriad achievements and awards, including the National Medal of Science. Over the years, too, he came to admire his father and to view his life not as failure but as a courageous struggle.
Prolonged Grief
It is only recently that the professional community has begun to understand extreme and prolonged grief. Ironically, this shift came about in part because of the greater attention paid to healthy adjustment. When we began to cast our net broadly, to capture the full range of grief patterns, including successful coping and mild grief reactions, we also began to move toward a greater appreciation of what it means to suffer. The focus on resilience made prolonged grief stand out in greater contrast.
Approximately 10 to 15 percent of bereaved people are likely to struggle with enduring grief reactions. In other words, one or two out of every ten people tends to have grief reactions that continue to interfere with their ability to function for several years or longer after the loved one’s death. In absolute terms, 10 to 15 percent is a relatively small proportion. However, when we recognize that almost everyone must confront the pain of loss at some time, 10 to 15 percent represents a lot of people, and makes it clear that prolonged grief is indeed a serious matter.
Resilient people cope well, in part, because they are able to evoke comforting memories of the lost loved one. These memories provide relief and help make the loss more bearable. But longer periods of grief can make it difficult to hold onto those memories. When grief persists for even longer periods of time, when it drags on for months and then years, the image of the deceased becomes elusive, fragmentary, and increasingly disturbing. Relentless suffering and yearning color everything. What was once a feeling of safety or happiness becomes mixed up with worry and fear and dread. Memories fester and sour. They become, literally, haunting.
Watching someone go through this kind of loneliness is heartbreaking, especially for other people in the bereaved person’s life, like the well-intentioned family or friends who try to help draw the bereaved survivor back into a full life. Try as they may, these efforts are often futile. Others in the bereaved’s life are repeatedly rebuffed, denied access, locked out.
This kind of frustration eventually takes a toll, and others begin to give up, adding further to the ongoing sense of loss. The downward spiral may begin in a remarkably short time. One study revealed that it takes only about fifteen minutes of conversation with a depressed person for people to begin to feel an increase in their own levels of anxiety and depression and a hostility toward the depressed person. The people in this study also reported that they would be less willing to interact with the same depressed person in the future and that they would be willing to tell that person about their negative reactions. The depressed people, in turn, anticipated that they would be rejected, and they, too, were willing to express rejection of their counterparts. Close friends and relatives, of course, are generally more patient and tolerant, and for longer periods of time. But even their patience is not bottomless.
Treatment for Prolonged Grief
When someone has been exposed to a potentially devastating event—for example, a serious automobile accident, a physical or sexual assault, or a terrorist attack—it is reasonable to assume that that person may have suffered a psychological trauma. But most people recover from these kinds of events without lasting harm and without professional intervention. On the other hand, people with severe trauma reactions are more likely to benefit from intervention. We will need a reliable criterion, some sort of agreed-upon marker to help us to distinguish people with severe trauma reactions from people who will recover or already have recovered on their own. We already have such a criterion in the form of posttraumatic stress disorder, or PTSD. There are also empirically validated treatments for PTSD.
If we apply this same simple logic to bereavement, we should also be able to help people who are suffering from prolonged grief. To be fair, one of the reasons that grief counseling has had such a poor track record is that until recently there was little appreciation of the difference between normal and severe grief reactions. Again, the emerging research on resilience has helped clear things up. As we began to see just how resilient most people are in the aftermath of loss or potentially traumatic events, we were also able to see more easily when someone might need help. And there is now a relatively well-established diagnostic category for extreme grief reactions, called prolonged grief disorder, or PGD.
One of the key factors in determining whether someone has PDG is the severity of the person’s reaction. The symptoms must be severe enough that the person is unable to function as he or she did before the loss. Another crucial component is time. Although there is still no clear consensus, six months is generally considered the minimal time passage for identifying a prolonged grief reaction. That is, as much as we might want to encourage a person to seek treatment after a loss, we can’t reliably determine whether there is a true psychological problem until at least six months have passed.
Once the critical time period has passed and a reliable diagnosis has been made, the question of treatment becomes much more straightforward. Although no single treatment approach yet stands out clearly as the gold standard for prolonged grief, several treatments have shown promising results, and these treatments share a number of elements. One of those elements is a technique generally known as exposure, which is also a core element of the common treatment for PTSD. Exposure involves having patients confront those aspects of the event that they most dread. For trauma, the patient gradually relives the traumatic experience in the safety of the therapist’s office and with the therapist’s guidance. With time, the patient becomes able to tolerate the memories of the trauma and learns to control his or her fearful reactions to those memories.
Exposure treatments for extreme grief reactions are a little bit different. To begin with, the focus is usually less clearly on the specific event of the loss. Generally speaking, exposure for grief therapy focuses broadly on those aspects of the loss or the lost relationship that most haunt the bereaved survivor.
The therapist may help patients organize the different aspects of their loss in a hierarchy of difficulty so they can gradually come to terms with the things that bother them, beginning with the least distressing and eventually working their way up to the most difficult aspects of the loss. The therapist can also help prolonged grief patients to understand what might be behind the most difficult or disturbing aspects of the loss. This process often involves helping patients to see how irrational some of their beliefs are. The pain of severe grief is real—there is no mistake about that—but often it is fueled by an illogical chain of reasoning.