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Good Mourning

It is difficult to make the case that there is anything good about loss, for loss creates a wound. There is, however, very much a thing we might call, 'good healing.'

Let's first bring our attention to the concept of loss. One can fairly say that loss is built into the fabric of life. We lose our childhood, and eventually our parents. If we life long enough we will lose our spouses and many friends. Such loses 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 coming from murder or calamitous accidents.

We in the business of mental health not infrequently 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. Rather, I explain to my patients 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 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 hinders physical wound healing so we keep our wounds clean, and if necessary, we"sometimes apply antibiotics to hasten the healing process. Let's use such a parallel to consider psychic wounds.

The mourning involves the 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 reinvests itself to the bereaved in a way that can promote growth. A part of the energy of the former relationship also reemerges directed toward others.

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, the comfort of which, 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 imbedded on the comforting side of the coin. Successful mourning promotes our development.

I encourage my patients to not be afraid of their pain because the pain is a reflection of their love. To not run from 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 a kind of 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 is who is blustery, exploitative, and self centered in a way that is harmful to others. Such narcissism certainly exists, but we lose track of the fact that there is a normal level and quality of narcissism that is a part of every healthy psyche. One can look at healthy narcissism as being akin 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 boomerangs back to the self at such a core level that it becomes frozen in the psyche. The loss becomes undigestible. 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 because these patients will 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 complicated psychological issues that are at play, can also have a constructive role.

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