How We Integrate Loss: The Palpable Phenomena of Bereavement

Bereavement, the grief we feel in response to the death of a loved one, is part of our being in the world. It includes different categories of loss. There is the literal loss of the unique and irreplaceable other person. There is also the apparent loss of the functions that person carried in the relationship (he was the one who always filed our taxes; she was the one who held the family together). Here we can find as well the loss of the one who witnessed us (he was the last person who knew me when I was a teenager).

Less conscious is the—again, apparent—loss of self, of who one was in relationship to the loved one who passed.

Who among us wants to go through bereavement? Yet grief is a healthy response, and a necessary one in order to adjust and go on in a world where people die. At such times, our religious, spiritual, and philosophical beliefs can support us. It can also happen that such structures of belief or hope, which were previously unconscious, come forward spontaneously in response to loss. This can happen in the form of highly subjective, deeply personal experiences.

In the discussion that follows, names have been changed and personally identifying material has been screened out in order to preserve confidentiality.

After the death of his partner, Jim finds himself waiting for him to come home, to hear the jingle of his keys in the door or to share a piece of news with him. Leah hears her husband call her name from the next room as she’s falling asleep at night. It’s not scary for her, but it brings her grief back when she starts to get up to attend him and remembers that he’s gone. Janet feels her husband sit down on the couch next to her when she’s watching television before going to bed. Annie, out on lunch break, has her eye caught by what appears to be a dear and departed colleague, waiting across the street at a bus stop. Mark sees a close friend twice after the friend’s death: once walking down the street “looking like hell,” the second time some months later, standing outside an Alcoholics Anonymous meeting. John rages at God each afternoon for the loss of his wife, and God—silent, invisible, but palpably present—hears him out.

These phenomena form a broad spectrum, from a subjective feeling to transitory perceptions when in a relaxed or distracted state. It’s important to note that none of these folks met the criteria for psychotic, mood, or substance dependence disorders at the time of their experiences. Bereavement, while not a formal diagnosis, can be a time of disruption, during which material that was previously unconscious comes into awareness. Often, the material serves an adaptive function. One way to support that adaptation is to treat it as symbolic rather than literal. As in dreamwork, we’ll look for what the experiences mean to the one having them rather than debating whether or not they “really” happened. When supported with empathy and respect, the events yield meaning and can be integrated into the person’s worldview, enriching it and making it more resilient.

Leah acted as caregiver for her husband in his final illness. As a result of hearing him speak her name, she reconsiders her situation. The role she filled for the last several years no longer has a purpose. The house where they raised a family and lived together is “too big” for her now. She begins thinking about moving into someplace smaller and closer to her adult daughter, so she can help out with her grandchildren. Annie notes that when she looked again “I saw it wasn’t Greg, not even someone who looked like him, really. But for that moment, I got to see him again. It’s like he paid me a visit.” When asked where Greg “was” when he visited, Annie gives a bittersweet smile and says, “In my thoughts.” Both Leah and Annie assimilate their experiences easily.

As in dreamwork, we’ll look for what the experiences mean to the one having them rather than debating whether or not they “really” happened. When supported with empathy and respect, the events yield meaning and can be integrated into the person’s worldview, enriching it and making it more resilient.

Like Annie, Mark sees a dead friend. Richard died of an accidental overdose, and Mark grieves as much for what seems to him the waste of his friend’s life as for his actual death. His two glimpses seem to be sequential and almost tell a story. In the first, Richard looks to be doing badly. Mark’s associations are that he has continued on the downward spiral he was in at the time of his death. The second glimpse, some months later, is of Richard among a group of others apparently taking a break outside an AA meeting place and looking “better than I remember seeing him for a long time.”

Mark doesn’t subscribe to the idea of life after death. But he was raised as a Roman Catholic in a small New England town. He notices that these experiences seem to refer to the idea of purgatory, a place or state where corrective balance takes place. Or as Mark puts it, with some humor, “It’s like Richard had to go to summer school so he could graduate.” Then he adds, “It makes me feel hopeful. I don’t want to make a religion of this, but it’s like the message is it’s never too late to get your act together.” The psyche provides Mark with images that help express and heal his grief.

Like Mark, John is surprised at his experience. He describes himself as “a scientific humanist, like Carl Sagan.” His wife’s death from cancer was drawn out and marked by suffering, both from the disease progress and from the treatment. John suffered with her. In this second month following her death, he tells me that he “indicts God” on his afternoon walks, giving vent to anger and bitterness that “someone who never hurt anyone suffered so much for no reason.” Angie wasn’t just his wife, she was his primary companion, and her loss makes the world an empty place for John.

The image of God, never previously active, becomes so in this crisis. It functions like a container for what might otherwise be overwhelming feelings, which John is then more safely able to identify and express in the form of his “indictments.” And more than an image: somewhat like Janet feeling her husband sit down next to her, John describes feeling God’s presence as an almost bodily sensation. Whether or not he goes on to live a religious life, in this period this experience provides a supportive and adaptive function.

As we see, some of these experiences are perceptual—auditory, visual, sensate. As a therapist, when someone describes such things, I look for some awareness on his or her part that these experiences are unusual. Also, that what’s experienced is characterized by feelings of grief or loss, or conversely by feelings of relief or hope. If the material is held concretely or literally, I would expect to find some cultural support for that. For instance, Kenny, a practitioner of Santeria, tells me that his recently deceased brother has given him some important information during a shell reading, or divination ceremony. Mary, first-generation Italian American, covers the mirrors with cloth so she won’t see her husband and “get taken by him.” Where I might become concerned is when there’s no such cultural cuing, or when the material is characterized primarily by feelings of guilt or worthlessness.

Alice tells me that she’s very distressed over the loss of her mother two years ago. She can hear the voices of the dead, blaming her not only for her mother’s death but for theirs as well. In order to get some relief from the voices, she accesses alcohol on a daily basis. She becomes distraught as she tells me this, weeping hopelessly. I don’t argue the matter with her, nor do I help her open it up for meaning. I tell her that I believe that she’s hearing the dead and it must be very rough. I ask if she’ll sign a release so we can call her doctor together and see if there’s something that might work better than alcohol.

Not everyone experiences these types of phenomena. For many of us, bereavement can be tracked through dreams. David, unable to be present when his father died, describes a dream a few months later in which his father enters the room David is in. After making eye contact with David (“so I could feel that he was at peace”), the father smiles, closes his eyes, and slowly leans back until David is left looking at the soles of his feet. Barbara dreams of her husband several times in the year following his death due to cancer. The dreams seem to form a sequence, in which she observes that her husband recovers from the symptoms of Alzheimer’s that were increasingly present the last three years of his life. “He looks like his old self now,” she says.

This phenomenon, the healing of the deceased in dreams, can generate different meanings. For Ron, his father wanted to come back and show him that he was all right. Bridget experienced this as a promise that our sufferings and their impact on us are reversible, and that there’s mercy operating in the universe. One additional meaning we might consider is that the healing of the image of the loved one corresponds to the healing and adjustment of the dreamer to the fact of loss.

We derive our personal meanings from the common experiences of loss. I expect you to come home because there are corners of the psyche where news of your death hasn’t reached yet. I hear your voice because I’m shocked by the sudden silence. I see you because I’m looking for you, and my eye assembles your lovely face out of whatever the environment provides—a stranger waiting for a bus, or someone smoking outside of a meeting place.

Although we know one another, much of our knowing is activity in our brains. The familiar face is conveyed by light that enters the eye and causes impulses to travel along the optic nerves and stimulate processing in the visual cortex, whose patterns of response are rendered semi-stable in the temporal lobe. Likewise, the voice. And likewise, too, our feeling responses and memories of shared events. The image we form corresponds to the other person, is alive, but is “made” of our own processes. When someone dies, it seems to be essential to successful adaptation to acknowledge and adjust to that fact. And after that adjustment, many of us find that in some very real ways, the image of the other person continues to live in us.

In psychotherapy, the first time a person tells me she dreamed of me, or that when facing conflict he imagined what I would tell him, I smile and say, “Now you have my image, and it belongs to you.” Later on, when working through closure and termination, we return to this idea. Bereavement is about ending. It’s also about ending’s opposite, which is continuation.

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