Mourning Theory

I am posting this for people who have more of an interest in understanding the grieving (mourning) process.

I am giving a lecture on Moving Beyond Grief and Loss in New York on Tuesday May 6th. (it won’t be this academic :) ) The lecture will break down the grief process and the healing process and advise how to move through the grief process and move past your loss once and for all.

To register Click —-> HERE

This paper is very academic and a bit dry because it was part of my undergraduate thesis and, of course, contained footnotes in the original. The footnotes are not contained here but this is about a year’s worth of research and reading and writing. If you need a reference to something, please let me know. Although academic and dry, it gives a good overview of healthy grieving and why it’s important and what happens when you don’t grieve. It also contains a good amount of attachment theory by John Bowlby who is one of the major influences on my work.

Although written with death as the loss, the grief process is the same no matter what the loss and there is a lot here to explain the emotional process after a breakup. If you have questions, please let me know and if you cite to this please give me credit but please please please don’t take this information from here as it is NOT properly footnoted. The reason for that is that this represents about a year’s worth of research and I don’t want to risk someone just taking my work and slapping their name on it. The original contains all the footnotes so please don’t copy this because I don’t want to be sued or accused of plagiarism or of not documenting my sources properly. :) Thanks! This is for informational purposes only.

From Freud Forward: Mourning Theory by Susan J. Elliott

Copyright 1999 Susan J. Elliott No part of this may be copied without the author’s permission.

In 1917 Sigmund Freud wrote “Mourning and Melancholia” to explain the “morbid disposition” of unresolved mourning. Contrasting the process of “normal” mourning to the pathological state, Freud intended this treatise to be recognized for its important focus on the complicated aspects of melancholia and its relationship to his earlier studies on depression and hysteria. Instead, the paper became the foundation for all psychological studies on mourning.

“Mourning and Melancholia” was one of the papers that resulted from Freud’s communications with Karl Abraham, who was studying depressive psychosis as a condition of unresolved mourning. Both Abraham and Freud were exploring the normal and pathological variants of mourning, responding to and amplifying each other’s writings. They agreed that mourning is a natural and necessary psychological reaction to loss and even though it “involves grave departures from the normal attitude to life,” it should not be treated as a malady. Freud’s writings focused on the significant loss of a loved one to death but said mourning would also result after “the loss of some abstraction which has taken the place of one, such as fatherland, liberty, and ideal or so on.”

The work of mourning is the reordering of object relations or letting go of the ego’s attachment to the object (loved one). This process involves a difficult struggle—definitive of the work of mourning—between wanting to hold on and needing to let go. It is carried through slowly, under great expense of time and cathartic energy. Because of the enormity of the work, the mourner often attempts to modify, delay, inhibit or stop the process before it is complete. When the psychologically necessary phases of mourning are interrupted, the conditions exist for the pathological variant, melancholia, to develop.

A painful self-absorption and self-abrogation characterizes melancholia. The world appears flat and lifeless due to what Coleridge called “a stifled, drowsy, unimpassioned grief.” Melancholia is sad, anxious depression that culminates in continual self-reproach that exacerbates the melancholic state. The loss in melancholy is often that of the mourner’s positive self-image and a “constant dissatisfaction” with the self that can’t seem to regain interest and vigor. This self-flagellation compounds and deepens the depressive state.

“Mourning and Melancholia” suggests that for mourning to be successful, the loved one must be totally relinquished. Years later Freud revised this, after his own daughter died, stating that the loved one was never totally relinquished but instead internalized. Successful internalization allows the relationship to be reframed in a context that permits the bereaved to go on with pleasant memories instead of being constantly besieged by painful flashbacks of the shared past. When the grief work is complete, a new, redefined interpsychic relationship is possible that is of great benefit to the bereaved. This redefinition has occurred when “deference for reality gains the day.”

Another difficulty of mourning is the inability to recognize and resolve the ambivalence felt for the lost object. While Freud believed that the aftermath of loss provides an excellent opportunity for the “ambivalence in love relationships to make itself felt and come to the fore,” few people know how to process ambivalence about someone who has died. Much of Freud’s important work stems from his acknowledgement of the dual nature of human relationships, but this idea is not understood by many experiencing the process of mourning and was not even initially understood by Freud. Originally he thought ambivalence toward a deceased loved one was indicative of melancholia, but Abraham believed it was present in all human relationships. Freud would, in papers published after “Mourning and Melancholia,” agree with him. However, most bereaved lack any understanding of this ambivalence, feel guilty for its presence and repress it, making it impossible to resolve.

As he did with ambivalence and relinquishment Freud would later reverse his position that identification with the deceased in the beginning stages of the mourning process is pathological. In “The Ego and The Id” he revised this theory stating that it, too, was a necessary part of all human relationships. He said, “If one has lost an object or has been obliged to give it up, one often compensates by identifying oneself with it and by setting it up once more in one’s ego.” In other words, identification substitutes for attachment with the object until internalization is possible.

Freud’s writings on mourning reveal a theory that was constantly evolving. Although “Mourning and Melancholia” is heavily quoted and often isolated as Freud’s main work on mourning, it is actually part of a larger progressive work of essays written both before and after 1917. It is not only part of a larger body of Freud’s work but has been considered as the basis for every mourning theory since.

In 1937 Helene Deutsch wrote “The Absence of Grief,” a paper detailing the manifestation of unexpressed mourning. Although it bears similarities to the Freud’s theories of repression, it was the first paper to connect self-defeating behaviors with unresolved mourning. Seven years later Erich Lindemann published his classic work, “Symptomatology and Management of Acute Grief”in the Journal of American Psychiatry. In attempting to examine difficulties in mourning, Lindemann studied 100 clinical cases, which was the most comprehensive sampling done up until that time. Lindemann was the first to use the phrase “grief work” and insist that successful resolution of mourning depends mainly on the commitment to actively work through grief in spite of the intense emotion brought on by that work. In his study, Lindemann noticed and documented two reactions, delayed reaction and distorted reaction, for the first time. In delayed reaction, grieving is set aside sometimes for days, sometimes for weeks, and even sometimes for years. In distorted reaction, pathological states, such as hypochondria, develop after a loss but are often classified by psychiatrists as neurosis and not recognized as a variant of unresolved mourning.

Lindemann, like Deutsch, also proposed that the absence of any reaction is pathological. When people are said to be “doing well” after a loss, they generally have no affect or do not engage in display of emotion. Lindemann suggests that such a reaction is evidence that the person is not doing well at all. Because sorrow in others causes most people to be uncomfortable, this non-reaction is rarely challenged and usually commended. Because of this implicit approval, people who do struggle to release emotion during grief are subtly encouraged to repress it. The inability to allow grief to “just happen” is what leads to its subsequent appearance as pathological behavior.

Following Lindemann’s study, Charles Anderson published “Aspects of Pathological Grief and Mourning” after treating soldiers returning home from World War II. Although many of them had been typed with “battle fatigue,” Anderson felt it was the inability to mourn their losses that led to anxiety, depression, self-reproach, and nightmares. He wrote, “The post-war scene is studded with innumerable Hamlets unable to live in peace without those they have lost, nor yet able to live in peace with the memories and images they carry within.” He felt that the neurosis he saw in over 60 percent of his patients were attempts to deal with crushing depression. His patients were wracked with survivor guilt, suicidal ideation and hysterical symptoms, such as the somatic “killing off” of parts of the body. These reactions serve to keep debilitating depression at bay. These manifestations of mourning are usually present at the outset, when the psychic shock is so severe that neurotic and hysterical developments actually serve to keep the patient alive.

In the 1950s the pain of mourning became the focus of human development researcher John Bowlby. He studied development and personality in terms of object relations theory, agreeing with Freud that the sorrow inherent in the work of mourning is a result of the inability of the ego to give up its objects and without that surrender, the reordering of reality can not take place. However, Bowlby was determined to find out why it was so difficult to achieve. Bowlby theorized that if detaching was so important but so difficult, learning about how humans attach must be vital to mourning theory.

He began his studies on attachment by studying the affects of young children taken from their mothers and placed with strangers in unfamiliar surroundings. Bowlby described their reactions as “one of protest and of urgent effort to recover the lost mother.” Alarm reactions in children upon being separated from their parents involve disbelief followed by a heightened fear reaction, protesting, crying, intense emotional distress and searching. This response represents the natural grief process that occurs in all humans when it is not inhibited by intellect and social conditioning.

After the initial intense reaction, the child becomes hypervigilant—constantly scanning the environment—for signs of the mother’s return. The heightened sensitivity to movement and sound starts to be offset by introverted moments of despair and hopelessness. For a time, the child is observed to be on an emotional roller coaster where great anticipation is offset by great sorrow. As time passes, the affective state is reduced and emotional withdrawal develops. This correlates to the middle period of mourning when the psyche is struggling between holding on and letting go. Inability to resolve this middle phase leads to melancholia.

Like Freud, Lindemann, and Anderson, Bowlby was interested in the pathological forms of mourning and his main interest was how disordered variants of attachment lead to the disordered variants of grief. His observations of children led to Bowlby’s theory that attachment behavior facilitates bonding in humans and is as significant as feeding and sexual behavior. However, Bowlby makes it clear that the need for attachment is more than just biological. These bonds give humans a feeling of safety and security in the world as well as assure the survival of the species.

According to Mary Ainsworth, as soon as infants begin to crawl, they travel short distances from the mother. However, the infant keeps a sense of the mother’s position and when the distance grows uncomfortable, the infant scurries back. As the child grows and becomes more secure that the mother is still present after exploration, confidence to move further away develops. This “secure base formation” gives the child a reference point from which to explore. With a healthy flow of moving away and coming together, a child is able to understand the balance of attachment needed for subsequent relationships. John Bowlby believed that the Ainsworth “secure base formation” studies were remarkably important in explaining malfunctions of attachment in humans.

According to Bowlby, early formation of affectional bonds influences all later relationships and failure to form healthy bonds can be passed through a family. Attachment relationships, as studied by Bowlby and Ainsworth, also play a key role in the transgenerational transmission of deprivation. Pathological attachments are usually the result of early over attachment or under attachment to primary caretakers. Bowlby likens the emotional system to the biological and physiological processes that keep the body temperature within a certain range to prevent hypo- and hyperthermia. When environmental stressors cause extreme body temperature and threaten the ability of the body to achieve homeostasis, acute physical distress is the result. Similarly, when attachment bonds are threatened, the emotional system experiences personal distress. The anguish experienced when separated from the attachment figure is designed, first and foremost, to get the attachment figure back and restore a sense of security and safety. However, if the affectional bonds are not consistent, the child grows anxious or ambivalent and that is the pattern that is followed throughout life.

Drawing on Bowlby’s work with children, Colin Murray Parkes studied bereaved adults. He wrote of the fluidity of grief, calling it a process and not a state. As in Bowlby’s children studies, Parkes found in adults that after the initial stage of realizing a loss has occurred, an urge to search develops. During this phase there are feelings of anger and guilt and the feeling that a piece is “missing.” Occasionally there are identification phenomena that results in the adoption of traits, mannerisms or symptoms of the deceased. Attempting to reconcile loss may result in feelings of anxiety, hopelessness, helplessness and general uneasiness.

This process is the manifestation of “simple” grief but Parkes noted that grief is not a “simple” stressor. Likening grief to physical trauma, he said that the loss can be “spoken of as a ‘blow’,” the wound gradually heals but if healing is interrupted or not completed, further “blows” will reopen it and make it worse.

Parkes used the word “stages” to describe the progression through the grief process but Beverly Raphael disliked that word. She said that the word “stage” did not accurately describe the grief process because it sounded as if the stages were passed through in an orderly and linear fashion. Instead,the bereavement reaction may be described as comprising a series of phases, representing some of the processes of adaptation to loss. It must be acknowledged, however, that any such phases are not clear-cut or fixed, and that the bereaved may pass backward and forward among them or may indeed become locked in one or another partially or completely.

In the journal he kept after his wife’s death, C.S. Lewis wrote, “…in grief nothing ‘stays put.’ One keeps on emerging from a phase, but it always recurs. Round and round. Everything repeats. Am I going in circles, or dare I hope that I am on a spiral? But, if a spiral, am I going up or down it?” The inability to recognize the back and forth progression of grief is another obstacle to its completion. Often people are bolstered by the belief they have passed a stage and are unprepared for the return to it. Sometimes they struggle out of it to avoid going there again. Other times they castigate themselves for not “being done” yet and repress the pain they feel.

All the theorists speak of unresolved mourning, melancholia and neurotic manifestations of mourning. These morbid reactions to loss are so prevalent that it is sometimes difficult to understand exactly what healthy mourning is or how it happens. Elisabeth Kubler-Ross said that people need to be aware of the fact that grief will happen, “either as an open, healing wound or a closed festering wound, either honestly or dishonestly, either appropriately or inappropriately. But emotions will be expressed…” The inability to resolve a lifetime of loss can result in many manifestations of neurosis. Bowlby wrote that people who consider the steps to resolving mourning as a weakness or unacceptable are often tense and difficult and will suffer from depression, insomnia, nightmares, empty personal relationships and a sense of unreality that cloaks each day. Unresolved mourning can lead to alcoholism, drug abuse, severe forms of mental illness and suicide.

With that in mind, it is useful to understand what healthy mourning is and how it happens. The first phase of mourning involves avoidance or shock. Some have erroneously labeled it denial, but in the case of death, it is difficult to actually deny that a death has occurred. Instead there is acknowledgement on some level that a separation has happened, but the inability to fully comprehend it leads to a feeling of shock, avoidance and inability to understand the nature of the loss. This is a normal part of the bereavement process when a death has occurred. However, when the loss is not death, it is relatively easy to dismiss the profound effect of the loss and to avoid dealing with it for many years.

The first step is to acknowledge that a loss has occurred, the second to acknowledge the magnitude and extent of the loss, and the third step is to understand that the loss must be actively grieved. Therese Rando states that when recognition first begins to appear, there is often a need to go back to denial. Therefore the acknowledgement phase may actually be a time of floating in and out of dealing with reality. Many bereaved people put the emotions aside for a time and come back to them.

After acknowledging the enormity of the loss, the psychological process of mourning begins. The “bit by bit” letting go that Freud talked about involves reviewing “the complex multidimensional image” of the loved one in an attempt to relinquish the relationship. This review and relinquishment results in the “buffeting of emotion” that must be felt if a person is to achieve a favorable outcome of mourning.

The emotions of grief include sorrow, anger, guilt and confusion. These emotions can be overwhelming at times and temporarily disable a person. Rando calls grief a “roller coaster ride of emotion with foreign feelings and a confused sense of self.” The first waves of emotion are usually sudden, strong and unpredictable. Parkes labeled them “grief pangs” that indicate “…an episode of severe anxiety and psychological pain. At such time lost people are strongly missed and the survivors cry aloud for them.” Acknowledging the extent of the loss can cause a person to be swept up in a feeling of deep, intense and inconsolable sorrow. Sometimes the emotion is so great that people fear losing control or going crazy. The psychologically necessary expression of emotion is what people fear most and attempt to avoid. However, there is no resolution to mourning without it.

Others avoid the feelings of anger and hostility that they feel toward the deceased. Rando says that anger “is a natural consequence of being deprived of something valued.” Many bereaved people report feeling abandoned followed by unexpected rage and fury at their circumstances, the departed and the world. With unresolved losses, the anger may be masked as moodiness, depression, irritability or low tolerance for change. However, sometimes even in the normal course of grief for those who feel that anger toward life or toward a deceased loved one is “unacceptable” or “bad” or “wrong,” it will have other manifestations. Parkes noted that “anger” was not an emotion identified among the proper British widows in his studies, but they all reported a feeling of “general irritability and bitterness” that is a variant of anger.

Guilt is a normal part of the grief process. After a death there is often the guilt about what was done or not done, what was said or not said. There is a persistent feeling of being incomplete or unsatisfied with the close of the relationship. Guilt comes from a sense of wanting to have done things differently, thinking the outcome could have been controlled if only “enough” was done. Guilt stems from the inability to accept what happened and a misguided sense of having power over the situation. Parkes noted that “bereaved people found themselves repeatedly reviewing…the events leading up to the death, as if by so doing they could undo or alter the events that had occurred.” In addition to survivor guilt and guilt for being helpless, some bereaved feel guilty for still being sad after a short time has passed and not being able to “get on with it.”

The mourning process causes profound confusion and disorganization. A person is highly distractible, disoriented, dazed, and less effective in every day life. Raphael says, “At the earliest stage of the psychological mourning process, the bereaved’s whole external world appears to be one of disorganization.” The power of reasoning appears to be distorted and there may be increased stress from mundane tasks such as shopping or going to the bank. When people feel bewildered doing “normal” tasks, they start to feel drained and question if they are losing their grip on reality. Often this feeling causes a person to move out of their grief work in an attempt to put themselves back together even if they are not finished.

The next phase of grief involves pining and searching. Raphael says, “There is intense yearning, pining and longing for the one who has died.” Parkes defined pining as “a persistent and obtrusive wish for the person who is gone…” and said that it is “the subjective and emotional component of the urge to search for the lost object.” This pining can result in a phenomenon known as searching.

In his studies on bereavement in humans after a death, Parkes notes that there is desire to search for and recover the lost object. To explain this phenomenon, Parkes drew on Lorenz’s studies of geese. Lorenz found that these birds, who mate for life, run about frantically after their partner is killed. Although the mate’s body was in full view, the goose would try to “find” the actual mate and go about searching for it in a frenzied state. In human bereavement there is often this same kind of searching behavior. Many times after a death a person will attempt to call the deceased on the phone or scan crowds looking for the loved one. Bowlby said that this behavior is part of the refusal to consciously accept the permanence of the loss. For some it is the desire to exert rational behavior into irrational circumstances. Bowlby said the searching may happen “unceasingly or episodically” but that the world continues to be in disarray and the searching aspect of grief is triggered by the desire to arrange it properly.

Therefore, for mourning to be successful, emotion must be expressed, disorganization tolerated, and searching behavior accepted as a normal response. All previously uncommunicated “appreciation, resentment and regret” must be communicated and be rigorously honest in its depth and scope. It must have the authority to “cut through—to talk to you—as I didn’t when you had a mouth.” Without acknowledging what was left unsaid, and saying it, mourning cannot be resolved.

The final phase of grief is accepting, reorganizing, and integrating the loss. Acceptance is “not a happy state, but rather the end of a long search for peace.” Accepting the loss does not mean forgetting or never feeling sad again, but it is a turning point that signals the final phase of grief has begun. According to Claudia Panuthos and Catherine Romeo, recovery “depends not on a denial of tragedy but on the painful acceptance of what cannot be changed.” After the difficult feelings have been felt, there is often the first glimpse of acceptance. Although emotions may re-emerge and the bereaved will experience the middle phase of grief again, the acceptance phase will return eventually. In time, the periods of peacefully accepting the loss last longer than the periods of sorrow.

During the final phase, a new understanding life and death results in profound reorganization of a person’s life. People who have worked through a significant loss have new priorities, new values, and a different perspective. This is the time when people will change jobs, return to school, move to another state or become serious about goals in life.

Integrating the loss means finding a new outlook on life, enjoying life again, and living without guilt or sorrow. In integration, there is a resumption of taking care of one’s own needs and feelings and often a sense of courage and strength that was absent before the loss occurred. Kander states, “To achieve integration there must be permission given to yourself to stop grieving and to reaffirm the meaning of life.”