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Dealing with grief

It is not possible to put into words the unique experience of grief and loss in all its myriad forms, yet there are ways to come to terms with it

Dealing with grief

Browsing through Facebook, I came across an entry by a friend. A year ago, his oldest daughter, aged thirteen, had died suddenly. They never did find out what happened. She went to the bathroom and never came out. When he went looking for her, she was dead in the shower.

At the time, I had called him to commiserate although what one is supposed to say on such occasions I don’t know. He seemed okay and said he and his wife were trying to put on a brave front for the sake of their two younger children. But his Facebook post that day betrayed his pain, one year later.

Grief and loss have been extensively studied and some common themes have been found. Those who survive usually go through well-known ‘stages’ of grief first enumerated by Swiss psychiatrist Elizabeth Kubler-Ross in her 1969 book On Death and Dying inspired by her work with terminally ill patients: denial, anger, bargaining, anger, depression and acceptance. In more recent times, the noted American psychiatrist Irvin Yalom has written extensively about death and dying as part of his ground-breaking work in existential psychotherapy. In addition, countless scientific studies have been published about various aspects of grief.

One of the most poignant descriptions of grief and loss that I have ever read though, came, not from a scientific study, but from a book written by a psychoanalyst. It deserves to be quoted in some detail: “Your mother is dead. She will never return. So reason tells you. But in your heart, you know she still exists. When you speak of her, you say ‘she is lost’, ‘I have lost her’.

You see her strolling down the street, her shoulders slightly hunched over, shading her eyes from the bright sun. Your heart leaps. You wave and start to run toward her. Then you remember. Your mother died a long time ago and will never walk on any street, not ever again. You scold her for fooling you” — No Voice is Ever Wholly Lost, Louise J. Kaplan (1995)

And further on “You find yourself doing things your father would have liked you to do when he was alive. He would complain about your messy habits, not making your bed, not picking up your wet towels and dirty socks. But you never listened. Now, six months after his death, there you are, folding and refolding the laundry, straightening the picture, picking up specks of dust. You and he are reunited in these little gestures of life”.

Despite being a psychiatrist who is supposed to help people get through grief (among other things), I must admit that my personal experience with grief has been, thankfully, rather sparse. My parents are alive and in reasonably good health, my last surviving grandparent passed away over fifteen years ago, I have not endured any family tragedy and the closest I came to experiencing grief was the sudden death of a childhood friend many years ago in a motor vehicle accident. He died in Pakistan, I was living in the US at the time and so that incident, too, was somewhat ‘removed’ from my immediate experience.

Not being too religiously inclined, I also do not care to offer religious platitudes to the grieving.

So now, a year later, what would I say to my friend who lost his daughter if we met?

Probably that I can never imagine the unfathomable depth and intensity of his grief. That as a parent myself, I can’t imagine how he and his wife still find the strength to go on. That a tragedy such as this, in the West, would probably have destroyed the parents. One or both parents may have turned to alcohol or drugs to numb their pain and that would have been the end of what remained of their family. While we may complain about the straitjacket of family life that binds all of us together in Pakistan (similar to most ‘third world’ countries), it does allow us a chance to heal together after a tragedy like this.

I would say that while I cannot feel his pain in the way that he himself can feel it, I can empathise and offer an attentive ear and a shoulder to cry on, metaphorically speaking. That I agree with his desire to be strong and keep going for the sake of his wife and his children. That the pain, while it will never go away, will eventually recede and, maybe not in a year or two but in five or ten years, they will be able to remember the good times they had with their daughter: her laughter, her kindness, her smile and to forget the lifeless corpse they put into the ground.

The ‘rituals’ of grief differ from culture to culture. Some cultures (Egypt for instance) encourage open expression of grief; crying, wailing, shrieking, beating of breasts. Others (like Indonesia) enjoin composure and silence. Our culture encourages religious expressions: recitation of the Quran, duas and the like. All of these cultural injunctions serve a definite purpose: a severing of the physical and emotional ties that bind the dead person to the living. Every culture encourages these rituals not for the sake of those who are gone but for those who remain. Even those who do not adhere strictly to religious edicts observe these ‘last rites’.

But after the departed person’s mortal remains are interred and the last mourners have left, how does one find the strength to carry on? Perhaps it just consists of, as the old joke goes: “breathe in, breathe out, repeat”. Most people who have suffered loss will say that’s what it was like in the early days. Going through the motions of living without really understanding or caring what one was doing.

As the reality of what has happened begins to sink in, one may develop a variety of feelings: sadness, anxiety, panic, anger, agitation, frightening dreams along with a variety of physical symptoms — aches and pains, headaches, upset stomach, nausea, dizziness and many others. Usually, these feelings reach a peak within a few weeks or months after the death and then gradually, sometimes imperceptibly, begin to subside.

By about one year after the incident, most of these symptoms have abated although they can flare up again on the first anniversary of the death and on subsequent anniversaries or other ‘milestones’ (birthdays etc). If the intensity of symptoms is such that sleep and/or appetite is seriously affected, if work/school etc. is being impaired or a person is finding it difficult to function in social or occupational settings, it may help to seek out professional help from a psychiatrist (who can prescribe medications, if needed) and/or a psychologist (who can offer psychological therapy/counselling).

In the usual cases of ‘uncomplicated grief’ a short course of medication or a few sessions of psychotherapy are all that is required. Ignoring serious symptoms usually makes the problem worse.

All of this may sound rather ‘prescriptive’ and it is, of course, not possible to put into words the unique experience of grief and loss in all its myriad forms. Writers and poets through the ages have grappled with this ultimate truth of life and many have described it in exquisite detail. One of them, our own Mirza Asadullah Khan Ghalib, buried seven of his own children (none survived past infancy) as well as his brother who suffered from severe mental illness and numerous close friends and acquaintances murdered by the British after the failed rebellion of 1857. About this holocaust, he wrote ‘so many loved ones (yaar) died that now, when I die, there will be no one to bury me’. But it was the death of his adopted son Zain-ul-Abidin Khan Arif in the prime of youth that hit Ghalib the hardest. In his heartrending elegy to Arif, Ghalib wrote perhaps the most appropriate ode to grief:

Jaatay huay kahte ho qiyaamat ko mileNge
kyaa khoob qiyaamat kaa hai goyaa koi
din aur
(Going away you say, we will meet on the
Day of Judgement
As if there is another Day of Judgement)
(besides this one)

Ali Madeeh Hashmi

ali hashmi
The writer is a psychiatrist and a Trustee of the Faiz Foundation Trust. He can be reached at ahashmi39@gmail.com

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