This blog article was inspired by a sentence I read on Twitter recently: “It’s okay to be sad”. That got me thinking about a concept I have been exploring for some time now: the stages of grief I notice in my bereaved clients. I don’t mean the ‘denial, pain, resolution, moving on’ stages first noticed by John Bowlby and Colin Murray Parkes. I describe the stages I am talking about as
Sad, yearning grief,
Happy, fond grief.
Not only are each of these stages clearly observable in my research, they also have a basis in affective neuroscience. Anyone who has witnessed, or worse, experienced the painful phase of grief, will know what I am talking about. Clients bereaved of a loved-one often tell me that they had tried to anticipate just what grief would be like, but in the event, their imagination did not come anywhere near the reality. Many people report that grief is like a physical pain: it actually hurts. The advance in neuroscience known as a functional magnetic resonance imaging (fMRI) scanning, explains this. The brains of those experiencing that raw, intense, often frightening grief (C. S. Lewis, writing about the loss of his wife Joy, noted that grief was like fear) show heightened activity in a region deep in our brains called the periaqueductal grey. This region also ‘lights up’ in response to physical pain. One way that individuals avoid this acute pain seems to be to deny the reality of the loss, for example, keeping busy and avoiding reminders, such as photographs and visits to places which remind one of the deceased. Client Jenny (a pseudonym) found it difficult to visit her grandmother at home because she could not bear to see that Grandpa was not sitting in his favourite chair. I suspect, though I cannot prove it, that short-term denial of the realities of bereavement, serves a useful function in allowing us to gently get used to the idea. It allows for continued day-to-day activities, and in more primitive eras, could well have ensured our survival. I tend to be reluctant to initiate grief counselling with clients at this stage, and if I do, it is about supporting them when they are, rather than doing anything which would intensify and reinforce the pain of grief even further.
How may the denial phase have been useful in human evolution? The intense pain of grief can be debilitating to the point that we are unable find food or keep safe from predators. Individuals who could get themselves into a stable position and safe place before they grieved would have been more likely to survive and pass on their genes, particularly if kinship individuals chose to care for them. Even today, in wars and natural disasters, individual grieving is sometimes delayed until it is safe to do so. Maslow’s hierarchy of needs might suggest that basic survival takes precedence over space to vent our grief. I have noticed that women with newborn babies who are bereaved of a family member, will often delay their grieving until the baby is a few months old.
In time (wildly differing periods of time, dependent on the nature of the loss, relationship to the deceased, personality factors etc.), this intense and painful grief is replaced by a sad, yearning kind of grief that descends in overwhelming waves or pangs, though interspersed with periods of relief. Neuroimaging has demonstrated that the region of the brain called the nucleus accumbens is one of the points of activity in the sad, yearning phase. For a time this may encourage searching activity; a primitive attempt to find the lost loved-one. The nucleus accumbens is associated with ‘wanting’ (as opposed to needing) behaviour and will encourage ‘seeking out’. In evolutionary terms it would have encouraged primitive humans to maintain links with breeding partners, as well as keeping dependent individuals such as children, the old and the sick, close to caregivers.
As the pain and yearning diminish, this can be followed by what John Bowlby saw as a despair phase; akin to depressive symptoms. Sadness without the yearning; perhaps born of an acceptance that the lost one cannot and will not return. Some writers have suggested that the evolutionary function of sad, depressive symptoms is that it encourages the grieving person to ‘stop actively seeking’. In evolutionary terms, individuals who searched beyond reasonable hope, and who continued to function below par for too long would put themselves at risk from predation, hunger and malnutrition: increasing susceptibility to disease. It is know that grieving individuals in modern society are at an increased risk for morbidity and mortality. There is clearly an evolutionary trade-off between maintaining a bond for an optimum time, thereby maintaining a family unit fit for survival, and ‘moving forward’ into a new relationship, thus increasing the chance of passing genes onto the next generation. Grieving spouses in modern society often face the dilemma of new relationships, and what this means in terms of love and a continuing bond with the deceased partner. Grieving spouses often express their sense of guilt, disloyalty and betrayal for even fleeting thoughts of ever having a new partner. Some individuals may express the decision never to have another partner, though this sometimes changes with time.
Some losses however, present no such dilemma. Grief for a dear friend, a sibling, a parent, grandparent, child or grandchild, are such losses. Freud was clear that what he saw as pathological grief was an introject of the deceased, which could only be overcome by relinquishing the affective bond. This became viewed as ‘letting go’ and ‘moving on’, a concept central to grief work hypotheses for most of the twentieth century.
Those of us who pay closer attention to our clients than to the theoretical pronouncements of the experts, discovered for ourselves that clients in general, neither let go nor move on. In truth, in spite of his theoretical position, Freud never relinquished his bonds with either his deceased daughter or his grandson. Gradually the experts caught up with what practitioners have known for years; that most of us seek to maintain a continuing bond with those we have lost. Step up to the rostrum, my concept of ‘Happy Grief’ which can follow ‘Sad grief’. I believe that we as counsellors, can, perhaps should, help our clients develop a new relationship to those we have lost, a construct which I call ‘Happy Grief’. My parents have been dead for many years. I still grieve for them, and I guess I always will. I am sad that they never met my wife, or their great grandchildren, never saw me at the contented life stage I am at now. Yet when I picture my dad, retired and at his hobby woodwork bench, or my mum’s self-contained contentment in the simplest of activities, I smile. I even experience Happy Grief for my son Paul, victim of Sudden Infant Death Syndrome, at 14 months old in 1982. I smile at the memory of him splashing in a paddling pool on a warm August day, at his one and only visit to a shoe shop and his delight in his first proper lace-up shoes, bought not long before he died. C.S Lewis discovered for himself, that once he was able to move away from the raw pain and despair of grief, he grew closer to his deceased wife Joy, and could find pleasure in the memories. For those keen to know about the neuroscientific aspects, emotional memories; happy and sad, appear to dwell in the small brain region called the amygdala. Also involved in processing affective and cognitive responses to powerful events such as loss, are the subcortical regions called the cingulate gyrus. Our human ability to explore and modify our attitudes to loss appears to be due to a well-developed cortex, particularly the prefrontal cortex which apparently is active when we discuss grief.
When I write of Happy Grief, I emphatically do not mean enforced, denial-based, rictus grin happiness. Speaking personally, I do not think that Continuing Bonds Theory as documented by Klass, Silverman and Nickman, has yet been properly explored. I sometimes meet clients who cling desperately to the past and display a kind of sham happiness. If this clinging behaviour is perceived as a healthy continuing bond, we probably fool ourselves. It seems to me arguable that each of us needs to move properly and undeniably through the painful, sad reality of each loss before we can develop a meaningful symbolic relationship with the deceased that we can carry healthily into a future. This idea figures strongly in my research, so watch this space over the next three or four years. In the meantime, I recommend my friend and colleague Dodie Graves’ book, Talking With Bereaved People, as a pragmatic, hands-on guide to what works.
Few people need a counselling or psychotherapeutic approach to move through what is essentially a normal, healthy, biologically based process. The small but significant number that do, can be helped to choose to relearn and reinterpret an everlasting relationship with those they have lost, and learn to find a new happiness in their lifelong grief.
I have tried to write this without being too academic. If any reader would like to explore my sources, the references are as follows:
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