“It is our aim to help, as far as we can, those who are bereaved, so that they, too, may once again be able to celebrate life, and live the rest of their lives as fully as they are still able.”

Patrick Casement: “Mourning and Failure to Morn”, fort da, 6(2) 20-32, (2000).

Introduction.

John Bowlby’s theories of attachment and loss are split into three categories.

• Volume 1: Attachment. 1969/82.
  
• Volume 2: Separation: Anxiety And Anger. 1973.
  
• Volume 3: Loss: Sadness And Depression. 1980.
  

Bowlby claimed that a strong attachment to a mother figure was essential for a child’s psychological health, both in infancy & in later life. That separation from mother had profound adverse affects on the infant, and he disputed Anna Freud’s contention that infants cannot mourn loss because of an insufficient ego development, and Klein’s claim that loss of the breast through weaning was the infant’s greatest loss.

Instead, Bowlby advanced the view that grief and mourning appear whenever any attachment behaviours are activated but the mother continues to be unavailable

‘The young child’s hunger for his mother’s love and presence is as great as his hunger for food. This love and presence are as essential for healthy psychological development as vitamins & minerals are for physical development’ (Bowlby, 1973)

Grief work.

Grief is a highly individual, although universal, process. Grief work describes bereaved individuals’ efforts to accept reality of loss (with or without assistance through counselling).

As attachment, separation and loss are normal experiences of life, grief work in counselling comes into play when a person has experienced a loss but has not been able to work through it through a mourning process.

I define “loss” to include:

• Death of someone – natural causes, murder, suicide.
• Loss of someone (although person is still alive somewhere).
• Loss such as a job or retirement, theft.
• Loss of the body: a woman’s loss of her breast though cancer, a man’s loss of erection through impotence.
• Loss that has not yet occurred, but is about to.
• Loss of ability to manage life (and hence a need to come to counselling).

Grieving for loss is a normal process whereby the person undoes the bonds that bound him or her to the thing that was lost (Raphael, 1984). It’s a healing process that allows a person to move from experiencing the loss as pain and denial and life being worthless, towards a state whereby the loss is accepted and life is seen as worthy of participation again.

Not all mourning is recognisable by others – for example experiencing a hysterectomy, miscarriage or even moving house for some can lead to mourning reactions.

Some may be assumed to have completed mourning when in fact the mourning process still goes on unresolved and done quietly within. To continue living – or giving a pretence of doing so – when a part of us (physically or psychologically) has died.

So, problems begin when there is a failure to mourn, failure to grieve and the person may become stuck either not entering the grieving process, or persistently stuck within the process.

Indications of Failure to Mourn.

Quotation from Anonymous on Bowlby newsgroup:

“My mother died when I was eight, and I had one of the classic states of confusion which is chronic mourning. But I didn’t know it as a state of confusion, I just oscillated between two mental states (“I know she’s dead” vs. “she’s around here somewhere if I just keep searching.”)

It is therapeutic, in a small way, just to know that one’s state of “chronic mourning” or “disorganisation” itself is part of nature… is related to the behaviour of primates in the wild… it relieves somewhat the bubble of isolation which the chronic griever is stuck in.”

(Dr Juan Carlos Garelli – http://attachment.edu.ar/loss.html)

One’s own identity can be affected by a death. The experience can be so painful and so individual that we as counsellors may need to understand that the client’s pain is beyond any description … and that there is the real fear that the pain may never end. It is no wonder that some find ways to avoid the grieving process.

Attempts at replacement.

Casement (2000) – paraphrased: Death of a child is perhaps the most common experience I have encountered. In a particular case the parents had never quite recovered from the experience in the family there had remained a sense of a dead child somewhere. Often attempted is replacing the dead child with another one, in seeking comfort to fill the unbearable gap left by the other child. Too often, however, it is the replacement child that absorbs the family’s distress and never really succeeds in being the replacement.

Mourning is about eventually letting go – and replacement is a form of resistance to letting go. Setting up shrines to the dead also resists letting go as with one family who not only sought a burial plot for their dead child but sought a family grave so that all the family could be buried together one day.

Splitting and Idealising, magic thinking.

Casement (2000) – paraphrased: A woman and her husband came for couple counselling and saw individual counsellors, wife to one counsellor and husband to another. The wife spent a long time complaining of her husband’s faults. During the counselling the husband died of a heart attack. The wife arranged for an elaborate funeral and in counselling spoke of her husband with praise. She became profoundly depressed and developed a skin irritation that drove her to distraction. The doctors could not find any cause for the irritation.

Casement considered that the skin irritation may have been somatising the husband’s irritation; effectively “getting under her skin.” The splitting off of the original irritation (her complaining about it) was now replaced by her words of praise. By “magic thinking”, unconsciously the wife had come to consider that her despising words had killed her husband and her unconscious guilt lead her to idealise him in his absence.

Working with Mourning…

… or with failure to work through mourning.

Casement suggests that the counsellor needs to learn from each new person afresh what helps and what doesn’t help. That waiting to go through the unbearable pain and then to stay with it during the client’s mourning is important:-

With a patient who had lost several babies through miscarriage I spent a long time listening to her in silence as she poured out her pain. I knew she needed me to be able to bear being in touch with her pain and distress. After a long time I said:

“I know there is nothing I can say to make any of this feel less devastating for you. The only thing I feel I can do is to be here for you in your distress and to go through it with you for as long as may be necessary”.

She said: “I know you can’t take this away from me, in fact I would not want you to take it away. But it helps that you are there. And it helps that I can see in your face that you are prepared to feel my pain along with me”. A bit later she added: “Your eyes have said to me all that matters.

I had not tried to hide from her the fact that there were tears in my eyes while she had been crying so desperately. Casement (2000).

Models.

Being aware of different models of grief and mourning may be useful for the counsellor in understanding stages their client is going through during grief work.

John Bowlby developed a four stage model of grief:

• Phase of numbing that usually lasts from a few hours to a week and may be interrupted by outbursts of extremely intense distress and/or anger.
• Phase of yearning and searching for the lost figure lasting some months or sometimes for years.
• Phase of disorganisation and despair.
• Phase of greater or less degree of organisation.

Elizabeth Kübler-Ross took this model further and developed a five stage model that she holds a dying person goes through when they are told that they have a terminal illness. The five stages go in progression:

• Denial,
• Anger,
• Bargaining,
• Depression,
• Acceptance.

This model has, claims the author is useful many other situations where someone suffers a loss or change in social identity.

Closing.

Mourning has to do with experiencing the pain of loss and learning to let go of that which can no longer be retrieved or replaced. It is assisting the client in understanding their grief in real terms and highlighting where phantasies are working to keep the person stuck within the mourning process.

In part it is the re-finding an internal relationship of the person or object that has gone and gaining a sense of support from within where originally the support had come from the external relationship or object.

Bibliography.