Nazan Artun PhD, RPh
While getting prepared to write an article focusing on another subject, life threw an unexpected extremely painful challenge on me during pandemic. I lost my grandmother, my guardian angel who had literally saved my life multiple times since I was born. I was stuck at home, in Boston and was not (still not) able to travel to Ankara (Turkey) my other home. I was muddled with the rush of all sort of emotions which many were new to me, like meaninglessness accompanied by numbness.
Healthcare professionals have an ailment unique to them, i.e., trying self-diagnosis and cure instead of asking for help. After the loss of my grandmother, I wanted to understand what was happening to me so I could find relief from this painful emotionally imbalanced situation. My goal was to use the “emotional tagging” technique so I can have some sort of control over my realm of emotions. Before this “tagging stage”, I had to understand all these different emotions that I was drowning in. That’s how I started to write this article. According to some studies, people going through grief mostly feel like there are no transitions in between difficult emotions and you have to live them all at once as if you are in an emotional roller coaster. One moment you may think that you are in peace, and not too far from that moment you may experience a burdensome emotional confusion.
Grief is a type of experience in life that cannot be described without living through it.
Some researchers have tried to define grief with distinct phases including conversion from numbness to depression in the early stages, acceptance and recovery afterwards. The transition in between stages and the severity of emotional experience differs from person to person. As Kubler-Ross – the founder of “stages of grief” theory stated, “Our grief is as individual as our lives (1)”. Studies have found cognitive, social and existential adaptations occurring in humans going through the process of losing a loved one, and permanent changes in world views, relationships, values and personalities (2). Though there might be various emotional aspects of bereavement; guilt, remorse, sadness, numbness and meaninglessness are among the most commonly experienced. Rather than being viewed as a primarily emotional and individual process, grief is increasingly being seen as a process in which important cognitive, social and existential adjustment occurs. Mourners struggle not only with the absence of their loved one and a corresponding flood of emotions, but often with a bewildering sense of meaninglessness (3).
GUILT AND REMORSE AFTER LOSS
Self-blame, guilt and remorse are among powerful determinants of grief-specific difficulties following the loss of a loved one. Guilt in the bereavement context has been defined as ‘‘a remorseful emotional reaction in bereavement, with recognition of having failed to live up to one’s own inner standards and expectations in relationship to the deceased and/or the death’’ (4). This is considered to be among the most difficult emotional experience following a loss (5). People always struggle with the idea that they could have done things differently after losing their loved ones. There are studies showing that emotional intensities, thought to be stages of grief, such as guilt, self-blame and regret cannot be drawn completely and may relate to depression. The grieving person can enter an internal showdown, questioning whether she/he could have prevented the death or spend more time with the lost one. This personal inquiry may lead the person to a different direction in life choices and eventually may shape his/her life differently. I have found communicating with other people who have had similar experiences and listening to their stories very helpful in remembering that death and loss are natural processes of human life. Exchanging our experiences may be helpful to move away from guilt and like self-harming emotional situations.
The PARADOX of PLEASURABLE SADNESS
Psychology continues to explore the paradoxical correlation between feeling sad and satisfaction. “Why do we enjoy listening to moody music that remind us our painful experiences?” A positive correlation was found between sadness and sense of pleasure in some studies focusing on this unusual area. This relationship is thought to be rooted from sadness activating our senses and creating an intensity in our emotional state (6). Jay Michaelson believes that joy and sadness are not opposites, they coexists like two consonant notes of a complex yet harmonious chord.
In time, the pain or sadness attached to our grief can turn into a bond with our lost ones, and giving up on this pain might feel like you are giving up on that person. In other words, our suffering can turn into a comforting state knowing that we are still connected. Though suppressing or straining emotions is not a solution, it still may be beneficial to approach these painful attacks with self-awareness and lead us to love and spiritually centered state. Staying in touch with our memories of that person, remembering his/her values, teachings, likes, etc and keeping their belongings close to us may also fulfill the need of staying connected.
When I was extremely struggling with these emotions, I took a friend’s offer to chat. His question of “What I loved most about my grandmother?” and his encouragement of speaking some of my good memories of her was a shifting moment where my pain was replaced with gratitude and love. After that moment, whenever I feel the pain of the loss sitting in my heart, I practice gratitude for the times that I spent with her. I pull a good memory from our library of memories; like lying on her knees, her playing with my hair and encouraging me against to challenges at the time. Talking about loss is not easy for both the speaker and the listener, but sharing our memories with our people of support and ones who used to know our loved one may ease our pain and make us still feel connected. Confrontation with the fact of death prompts a renewed awareness of the value of life and the need to engage fully in daily sources of life significance.
RECONSTRUCTION OF A WORLD OF MEANING
Confusing sense of meaninglessness is another major struggle of grieving in addition to the absence of the loved one and of emotional intensities (3). Even under normal conditions, “What is the meaning of life?” is a weighty and complicated question for humans. During bereavement, the weight of this question can be directed from general to personal as “What is the meaning of my life?”. The phenomenon of meaning can be called all of the ideas and beliefs of the world and ourselves. This fact gives individuals the perception that their lives matter (3). Losing the meaning of life has been stated to cause psychopathological and clinical health problems. According to many psychology theoreticians, reconstruction of sense of meaning has been thought to be at the core of recovery from bereavement. There are various approaches and models in practice.
A psychology model explicitly labels three ways in which mourners reconstruct “meaning”: sense making, identity change, and benefit finding. The processes of sense-making by explaining why it happened, and benefit-finding play a crucial role in bereavement adaptation for many of the bereaved, and accordingly, these interventions facilitate processes of meaning reconstruction (7) . Mourners may need to direct coping efforts toward understanding the loss itself, or toward making sense of their lives, and of their surrounding world, now that the loss has occurred (3). The ability to identify benefits or “silver linings” whether or not such benefits are actually experienced is thought to promote grief recovery. Individuals who perceive benefits, meaning in bereavement have been found in some studies to experience shorter or less intense grief (3, 7)
In the context of reconstructing “meaning”, positive psychology helps individuals gain “the good life” rather than focusing on mental illness and psychopathology. The good life is living a happy, engaged, and meaningful life, all of which are associated with well-being, happiness, and life satisfaction (8)
Another approach emphasizes importance of relational well-being and relationships are considered to be at the core of meaningfulness in life. In many occasions this is experienced by connecting and valuing a matter that is larger than self, such as God or the divine Universe. Additionally, taking action to fulfil purposes and goals for inner harmony, self-worth, relatedness and belongingness are other ways of expressing meaning to life (8 ).
Victor Frankl, one of the most influential theoreticians of this field, realized that extremely difficult external conditions and experiences give people the opportunity to grow and mature spiritually beyond their limits. The distress of grief may in itself be viewed by mourners as a source for life’s significance, as described by Frankl in his discussion of the value of suffering. According to Frankl, three sources of meaning in life are Work, Suffering and Love. Work or being productive can provide long-term goals that can result in deep satisfaction. Suffering can be an important source of meaning given the pain that leads to enlightment. Love is the strongest link between human beings and can lead to great inspirations and sacrifices (8).
Considering all these different theories focusing on the reconstruction of “meaning”, the main source of the meaning of life is mostly linked to the relationships we establish in time. Moreover, every concrete step we take to achieve our goals and objectives which contribute to our inner harmony, our self-worth and our sense of belonging can be considered as expression of the meaning of our lives. Fostering reconstruction of a world of meaning would be a priority for many bereaved individuals and alleviate complicated symptoms of grief but also renew a sense of hope and self-efficacy in their changed lives (9). For the ones going through bereavement, an approach focused on love, relationships and productivity may be helpful to restore the sense of damaged meaning.