Grief: Make Room for Death
One of the hardest moments in our lives is when we lose a person close to us. We often develop feelings of injustice about the world or are unable to find any sense in their passing, which fills us with anger. When the death was caused by an accident, it’s possible that guilt appears, because of the remorse about things that could have been done differently to avoid such fate.
How does one deal with something like this? In this article I will share with you the experiences of a grieving woman who, with few interventions and a lot of patience and respect, was able to continue her life after the loss of her husband.
Patricia asked for an appointment over the phone, explaining to me that she was having trouble sleeping and that a friend had suggested to her that psychotherapy could help. When she arrived for the first session, she told me smiling that she had never slept well and had been taking sleeping pills prescribed by a neurologist for years. The pills had always worked well for her, but for three months she has slept poorly, even with the double dosage that her doctor had recommended.
When I asked her if she had any idea about what could have provoked this change, she told me “nothing special happened three months ago”, so she was surprised that the pills were no longer working.
To allow her subjective position appear, I began by starting to explore her history, asking about her family. She started to cry right away, telling me that her husband died six months ago of a heart attack and that she was still not recovered from that. While she was telling me all of that, she apologized profusely for her crying and told me she knew that “by now this shouldn’t be affecting me this much. After six months… this is not normal, right?”
Even if it seems obvious, it’s worth remembering that it is not the place of the psychotherapist to say what is normal and what is not, nor to explain to the patient the grieving process from the perspective of a specific theory. Our work is to understand the patient in their singularity, within their own story, allowing their subjective position to appear. Because of this goal, I simply showed myself to be perplexed about how she reached that idea, and invited her in this way to keep unfolding her story. Patricia told me then that her sisters, psychologist themselves, had explained to her that it wasn’t normal for mourning to last that long.
It was clear to me that it was a good idea to leave unsolved the issue of whether it was normal or not to be affected by a loss six months later. After all, without even trying, I had already differentiated myself from the sisters who were adamant about her process being abnormal.
When Patricia started telling me about her sisters and their lives, I gently interrupted her and I asked her to tell me first about what happened to her husband. In this way, without explicitly stating it, I was showing her that it was something that we should talk about, whether it was normal or not.
John was her husband for almost thirty years. Patricia told me that his great pleasure was the food she made. “Everyone always tells me ‘you are a great cook’ ”, she explained, and started enumerating all the desserts she made almost daily.
On a Saturday like any other, after the two of them had dinner, John felt a sharp pain in his chest, and despite Patricia immediately calling an ambulance, the doctors at the hospital were not able to save his life.
There was so much paperwork to do, between banks, hospital bills and the funeral services, that for the first month she couldn’t sit down to cry. Her three daughters, all independent adults, asked her to handle everything because they were “too sad to function.”
In the following two months Patricia was able to cry. Every night at least one of her daughters joined her for dinner and they talked about John. After that time, however, her daughters grew tired of her suffering, telling her to stop crying, and that if the only topic of conversation would be their late father they would stop going for dinner. “Again?” her daughters told her when she forgot and talked about her husband.
Nevertheless, Patricia was still very upset, mainly because she felt responsible. “The heart attack was because of his cholesterol… maybe if I wouldn’t have indulged him in everything, doing those desserts every day… maybe he would still be alive.” She told me that in a checkup with his cardiologist, the doctor had recommended a change in his diet, but that she “couldn’t say no to his pouting.”
Without a doubt, the most shocking statement she said in her first session, and that she would repeat in following encounters, was: “In a way, I killed him.”
Here we can see a statement that clearly reflected her subjective position towards what happened, that will allow us to understand a patient and be able to work with them.
If we take this specific position into account, it’s not strange at all that Patricia was still suffering and having trouble sleeping. However, her sisters and daughters repeated to her again and again that “a grieving process shouldn’t take more than six months,” and because of this, they were bothered if they saw Patricia was sad. For this reason, lately she had attempted to avoid crying around them, even hiding it when her daughters were at home. “When I do the laundry I take the chance to cry… the noise of the machine hides it.”
When Patricia asked me if it was normal to keep crying, I told her that it seemed there was still a lot to cry about. She told me she felt sad, “thinking where is he now… if I could have done something different… if I will see him again.”
We then further explored these thoughts, discussing how she imagined the place where her husband could be, if she could have in fact done something different to save his life, and other things that you have to speak about when someone dies like that, no matter how much time has passed since the death.
If there was something crucial to talk about it was her position, reflected as we saw in the statement, “In a way, I killed him.” Many people, and more than a few psychotherapists, consider it negative to make room to speak about guilt in a case like this. They believe that will only make the guilt grow. However, the exact opposite is true.
To talk about her guilt, to have the space to examine her ideas about it, without anyone trying to calm her with clichés, is the only way to make that feeling go away. The key to this case, like in most grieving and traumatic processes, is to be patient and give the other person the time to talk, as many times as they need, about their pain. There can’t be any rush, there can’t be any deadline.
Death affects all of us so deeply we often try to make the pain go away swiftly, to keep its damage limited to a superficial level, thereby limiting the degree to which we are touched by that death, and avoiding having to face the reality that it will happen to us someday too. When listening to someone else’s grief we often try to calm the other person, denying them the possibility to feel what they are feeling in that moment, to avoid having to recognize the presence of death in our everyday life.
“What do you feel guilty about? Don’t be foolish,” her daughters told her, trying to calm their mother. But Patricia told me that the lack of understanding from them was yet another reason for her suffering.
We spent a couple of sessions talking about John, of her memories of their life together, of the night of the heart attack, of the guilt she felt about her desserts. We spoke of all of this without any rush, giving her room to examine every idea no matter how illogical it may have sounded. She apologized often because she was still in pain, and each time I had to show her that she had every right to still be suffering.
Bit by bit, Patricia started to ask herself about her future. At first she was worried and sad about continuing life without her husband but nevertheless, she was willing to look ahead. This was a change from the discourse focused on her husband’s death, to one speaking about what was to come and the things she dreamt of doing. Without proposing it directly, just by giving her time and space to vent without restriction, Patricia started speaking less frequently about John, was able to sleep more, and saw the relationship with her daughters improved.
The guilt was also disappearing, something that was clear when she told me she had begun to prepare desserts again, this time for her grandchildren. “But I will make healthier versions of them,” she said at the end of one session.
When we were finishing her treatment Patricia was planning a trip with her daughters, who were “happy that mom is thinking positively.” She was no longer feeling guilty, because she was able to recognize for herself other factors that contributed to John’s death: he didn’t just eat her desserts every day but also had fast food every day at work, had never played any sports, and refused her invitations to join her at the gym. One of the last things she told me with a smile on her face was: “How foolish I was to think that I killed him.”
It’s not a surprise to learn that Patricia’s sleeping problems disappeared as she worked through her grief, and that she was even able to lower the dosage of the pills she had taken for years, even lower than before John’s death.
Although the goal of psychotherapy can be summed up as the questioning of the subjective position, we have to remember that one has to be respectful of the rhythm and acceptable pacing of the needs of patient. If we push them too fast or too hard, we run the risk of awakening resistance in the individual which can result in the vigorous defense of their current position. I highlight this because in certain traumatic cases, unlike with Patricia, the patient may not seem affected at all, because of the shock they can be numb and thus apparently unaffected by the death of a loved one.
In those cases it’s not indicated to intervene by trying to convince the patient that they should be affected. Even if it’s possible that venting and speaking about the traumatic event would help them, it is crucial to wait for the right time for that. Common mistakes are saying things like: “You must be suffering, but it’s hard for you to recognize it”, “You have an armor that doesn’t let you feel,” or even “Are you sure you are not affected by what happened?”
What do we do then? When the patient is numb or not allowing themselves to feel, we don’t have to push them to feel more, but can instead explore the fact that they don’t feel; our questions can be about the fact that they are not feeling, about the reasons of that apparent dissociation. Sometimes, a simple: “Why do you think you don’t feel affected?” provokes as an answer an opening in their position, a connection with the emotion caused by the trauma. More than once, confronted by a question as simple as that, a patient has answered me with “because it would be too painful.”
It is a subtle difference, but notice that I did not ask, “Why do you think you were not affected?”, which allows the possibility of them not being affected. I asked “Why do you think you don’t feel affected?”, that already tells them they are, but they don’t feel it.
Time and again these kinds of interventions show us that, without needing sophisticated techniques, the patient lowers their defenses and achieves the connection with what they are feeling and thinking, and thus we can begin working on that. Speaking about why it would be too painful to feel affected can thus allow us to build bridges to the trauma itself.
In summary, in psychotherapy a key element is being patient with the rhythm of the other person, something that is even more important in cases that revolve around trauma. By following their lead we avoid re-traumatizing our patient by abstaining from forcing them to talk about what they prefer to forget, or forcing them to explore a painful experience at a rate or depth that produces more pain for them. Respecting their pace, we allow the subjective position to appear and we are able to intervene to produce a shift in it, thus producing a change in the patient’s symptoms and beyond.
We, therefore, have to make room for the patient’s pain, for the trauma, and even for death.
* I have modified the names, jobs, and other identifying information to maintain the confidentiality of the psychotherapeutic process.