It is difficult to make the case that there is anything good about loss, for loss creates a wound. There is, however, something we might call, 'good healing.'
Let's first bring our attention to the concept of loss. It can be said that loss is built into the fabric of life. We lose our childhood, and eventually our parents. If we live long enough we will lose our spouses and many friends. Such losses are an inevitable part of the cycle of life.
Of course there are also brutal, unfair losses, such as the death of a child or a young soldier in battle, or outrageous events resulting from murder or calamitous accidents.
We in the business of mental health often accompany patients as they are dealing with loss. Fortunately, there is much we clinicians know that can help our patients.
First, let me say that we never 'get over a loss.' This is something that should be explained to our patients as a means of showing respect for the gravity of what they are going through. Instead, I explain that it is more realistic to think of digesting a loss. An analogy to reckless eating in not inappropriate: on a Thanksgiving day when one has eaten too much, the bolus of food within feels foreign, almost painful. Slowly, as the hours pass, the food becomes integrated into the self and and one begins to feel normal, hopefully even well nourished.
Loss creates a wound; mourning is the wound healing. Because loss is universal, our psyche has the means to naturally heal from psychological wounds, just as our bodily self does so with physical wounds. The process takes time and can be painful, but absent factors that might interfere, the process proceeds in a spontaneous way. We know that bacteria hinder physical wound healing so we keep our wounds clean, and if necessary, sometimes apply antibiotics to hasten the healing process. Let's use this parallel to consider psychic wounds.
The mourning involves relinquishing of an attachment to someone we love. Despite the pain, there is something beautiful in this process because the energy of the attachment doesn't simply go away. In cases of healthy mourning the attachment redirects itself to the bereaved in a way that can promote growth.
I like to remind patients that loss is like a coin. One one side is the brute pain of immediate loss. On the other side is love whose comfort, early on, is smothered by the acute pain of the coin's dominant painful side. Yet, as mourning unfolds, one begins to experience more and more a positive resonance with the love embedded on the comforting side of the coin. Successful mourning promotes our development.
I encourage my patients not be afraid of their pain because the pain is a reflection of their love. To encounter the pain is a way of honoring the lost love one.
Having given a sketch of healthy mourning let us now look at elements that can create interference.
Paradoxically, one destructive element is a history of conflict with the lost love one. Bitterness or disappointment in a relationship can act like sand in a psychic wound. The reasons for this are that people often find negative feelings toward people they love unacceptable, so they suppress awareness of these feelings. Suppression of feelings almost always creates emotional stagnation. The psychology of all of this can be quite complicated and is related to a second irritant in the wound of loss, that is, a narcissistic attachment to the lost one.
We need to digress for a moment and deal with the term 'narcissism.' The conventional meaning refers to a person who is blustery, exploitative, and self centered in a way that is harmful to others. Such narcissism certainly exists, but we overlook the fact that there is a healthy level and quality of narcissism that is a part of the healthy psyche. Healthy narcissism can be compared to the nucleus of an atom. Though spatially small the nucleus defines the atom's identity. Narcissistic elements to the personality are self-centered to be sure. However, the self involves essential aspects of our being: identity, core values, and self protection. Because these facets are so important to who we are we can fairly say that narcissistic elements of the self are non-negotiable.
So if the person we have lost is somehow linked with a narcissistic core that is unhealthy it greatly complicates the mourning process because the energy that was attached to the lost one recoils back to the self at such a core level that it becomes frozen in the psyche. The loss becomes indigestible. Children experiencing loss can often be troubled by such complications as can dependent adults.
Clinically one can guess that there is a such a disturbance when patients appear stuck in their loss, unable to process their pain in a constructive way. We clinicians then must dig down, scratch our heads, and identify what is interfering with the natural unfolding of mourning.
Sometimes it is as straightforward as identifying and helping patients with practical concerns that threaten the patient's sense of basic security, such as financial issues. In other cases, especially when there is a troubled relationship to the lost one, or problematic narcissistic ties, the psychological work can be complicated.
The silver lining to the dark cloud of inevitable loss in life is that healthy spontaneous mourning not only leads to the healing of a psychic wound, but it can often contribute to personal enrichment.
Psychotherapy is ideally suited to facilitate such outcomes, and medications, if applied in a way that respects the complex psychological issues that are at play, can also have a constructive role.
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