The sun is simple. A sword is simple. A storm is simple. Behind everything simple is a huge tail of complicated.-Terry Pratchett
Names have been changed and stories used with permission.
Sudden, traumatic, and ambiguous losses are almost always complicated.
Beth had been “euphorically married” to Joel for 12 years. For the first six years of their marriage, they “struggled” with infertility. During year seven of their marriage, just as they’d both “given up hope for a baby”, Beth became pregnant.
They were thrilled. Before Seth was even born, they moved into a family oriented neighbor in the best school district in the state and, with Joel being a professor himself, they started Seth’s college fund. Seth died of cancer when he was only five years old. He was diagnosed only a year earlier, and his parents ensured he received the best medical care available. They were understandably devastated. Seth's death was complicated by the death of Beth’s father only three days later. The chronology was overwhelming for her, yes. But so was the fact that Beth had been estranged from her father for decades because of his alcoholism and physical violence toward her (and her mother) during childhood. She felt her grief for Seth couldn’t be “clean”, that it was “tainted” by her conflicted relationship, or lack thereof, with her father. The dominant emotion she presented was anger, both as it related to losing Seth and her father. She “rarely cried” and felt a “constant tug” to both relive and avoid thoughts of her traumatic childhood. This ambiguity incited significant emotional and physical distress in her. At several points, she said, though she would “never do it,” she wanted to die from the hopelessness of losing Seth. I asked if the pain felt familiar and she affirmed. She remembered feeling the same way as a child when her father would rage at her mother and at the harbinger of the “snapping belt” which he directed toward her.
The concept of ambiguous loss is based on the work of a researcher named Pauline Boss. Family situations featuring high degrees of ambiguity in which there is physical absence and psychological presence tend to evoke considerable distress. This is a feature common to bereaved parents: their child is physically absent but ever so psychologically present, and pining for their physical presence often continue for years. However, in the case of her father’s death, the preceding factors complicating mourning both for him and for Seth. For decades, as with many children of alcoholic parents, she also experienced ambiguous loss in the sense of her father's psychological absence and physical presence. This confounded her grief for Seth.
During the time we worked together, we would pay careful attention to both the painful spaces that were hers as a bereaved mother and the spaces that were hers as a traumatized and abused child. They became separated but interrelated entities. She started to feel more specificity about her emotions, better able to pinpoint feelings that were once more diffuse. Once she was able to do that, she said she felt more comfortable with her feelings and understood how complex her own emotions really were. One day, she came into my office very tearfully. I was quiet and waited for her to speak. “I just realized that, even though I hate him, I’m still a bereaved daughter too.” I nodded, sympathetically, and waited. “He hurt me… he hurt my mother… he affected my whole life. And now he’s dead and I don't even get a chance to fix that… and he never even knew Seth.” There were so many layers of loss for Beth in this moment: the death of her son, the loss of her childhood, the trauma and abuse she suffered, the death of her father, and that her father never knew Seth. She cried for a very long time, moving between the “why” and eventually resolving to just let herself feel the simply complicated nature of her grief.
Rose’s husband ended his life very suddenly. They’d been happily married for 10 years. The evening before his death, they’d taken a walk together, talked about their future plans, and ended the night by watching their favorite movie. They were “good partners, good parents,” living the “good life.” She awoke in the early morning to find him missing from bed. The garage light was on but when she tried to open the door, it was blocked. She knocked and called to him. He didn’t answer. She repeated this several times and then felt a "sinking feeling" in her gut. She called their best friends and, before they could arrive from less than a mile away, she decided call 9-1-1. She was terrified he’d had a heart attack or a stroke and collapsed beside the door. The first responders came outside where she was sitting with her knees curled into her chest, their best friends on either side of her. Her husband was dead: he had completed suicide. She shook her head as if to throw their words far enough that they would become unreality. Shock and confusion trembled through her body. Mostly, she wondered: how would she tell their three young children? It would take another two years for her to confront her anger – even rage – at his suicide. There were so many unanswered questions, so much “mess to clean up” in the aftermath. Did she love him? Yes, of course, still and as she said "until the end of time". Was she angry at him? Yes, she was. And, she felt such conflict over those mutually occurring emotions. Even though it feels ambiguous, we can feel anger and love simultaneously. This was the case with Rose. Together, when she felt safe, we did a powerful meditation together. She invited him into the meditation with her. He walked toward her, crossed a wide ocean, walking on the water, to get to her, and said he was "so very sorry". She wept when she saw him, hugged him, and was so happy to see him and also so angry at him for leaving their family of five with, now, four. She realized that she could feel many things in addition to just love and anger in that moment, even a decade after his death, and that she could invoke his presence anytime she wished. Rose experienced anger toward her husband for “leaving the family”, for "abandoning her and the children" even though she "knew he wasn't thinking clearly" and that he "loved them more than anything" and then questioned whether she should feel both poles of that experience. This point of tension was a cause of added distress for her. Once she realized she could feel and express her emotions, and that she need not judge them, she was able to have an honest dialogue with him about her pain.
None of this, of course, was intended to assuage the potent emotions of ambiguous or traumatic loss for either family. That’s the point: being with what is without having to change it. The thing about grief is that it often is complicated because of what happens before, during, and after those we love die. Relationships - the cornerstone of our lives - are oft anything but simple. What makes us think this would change upon having lost them?
Simple, yet complicated, just like many experiences grief.
Still, and of course, we have a proposed diagnostic criteria for a mental disorder, acontextual, called persistent complicated bereavement disorder (PCBD).
PCBD is an optional diagnosis of mental illness when patients exhibit prolonged emotional distress that includes symptoms of yearning or sorrow or preoccupation with the deceased. Um. Right. Preoccupation. Why would we not be preoccupied by the absence of someone we love? We are concerned with functional impairment and economic productivity while people are grappling with intense suffering; the kind of suffering that calls us to connect with one another at a level of deep compassion and tenderness. We seemingly disregard evidence that the ways in which others treat us is one of the most salient predictors of negative outcomes of bereavement, blaming grievers themselves instead of the often inhospitable environment to which they must learn to adapt. All of this without much consideration to the type of loss and the circumstances (i.e. context) which do, and should, matter. Of course, my reaction to a neighbor's death will be very different from my reaction to my child's death. I will never understand this intentional omission of context (as I lamented in my viral blog from 2012 about the bereavement exclusion).
Brian’s third child, Julia, died during birth three years before we met. He and his wife had a wonderful marriage, their only conflict around whether or not to have a third child in an attempt to (finally) have a girl after two boys. Brian was angry when they got pregnant and “wouldn’t let (himself) love Julia.” He was terrified that the reason she died was that he “didn’t want her”. Still, he felt surprisingly “enormous love” – even if preceded by such ambiguity- the first time he held her in his arms. Brian was understandably devastated and guilt-ridden. Their marriage was on the path to steady decline, and he was, for the first time in their decade together, contemplating separation. The first four to five times we met, Brian’s focus was solely on the obvious story-line: “I didn’t love Julia and that’s why she died.” He attributed his disinterest in his marriage purely to grief. As he began to trust our relationship, and the process of expressing with specificity, he began to unearth the complexities of losing Julia. About six months into our work together, he shyly admitted the anger he felt toward his wife, noting how shameful he felt for having those feelings. When I met his honest emotions with nonjudgmental compassion, his heart “blew open.” He admitted blaming her for the “unbearable rollercoaster” of emotions he felt so deeply. Once he was able to confront those beliefs consciously, he began to invest in his marriage, and family, again. The space for transparency was exceedingly therapeutic for him and that was immediately visible in his face and the way he held his body. He noted feeling “relieved” and, eventually, Brian and his wife began counseling together. They were then able to work through the more abstract facets of their loss and felt more "solid" and intimately connected than ever.
The reality for many is that grief, particularly when traumatic or ambiguous or complicated by our past or present relationships, is not oft simple. As human beings, our relationships are nuanced, containing moments and micromoments of connection and disconnection, joy and frustration, certainty and doubt, anger and love, esteem and failure. And the ways in which others give us permission to feel our feelings, to reenact our trauma, and uphold us nonjudgmentally during the darkest moments of grief matter in helping us stay with the inherently complicated nature of grief. The full inhabitation of grief, and all its complications, is certainly painful. Complications can, sometimes, move us away from the center of our pain. We may even be distracted from the core quality of grief by instead focusing solely on historic or interpersonal aspects of loss. Negative cognitions about our own emotions can cause us to judge, often harshly, our own grief, and these can lead to prolonged grief and added suffering. But diagnosing grief, even when complicated, is not likely to help. Sadly, too many providers fail to understand many aspects of pure and fully inhabited grief expressions, too many mourners do not feel seen. The results of being invisibilized in grief, whether by myths or medicalization, are devastating.
If you are looking for nonjudgmental support through your grief experience, please see if there is a Compassionate Bereavement Care (tm) provider near you.
I talk much more in depth about grief in my book Bearing the Unbearable.