The problem of grief

There are many problems that can cause unhappiness, and that might compel one to seek the help of a therapist. Such problems include loneliness, relationship issues, low self-esteem, anxiety, and so on. I’ve discussed some of these in previous posts, but today I want to talk about one of the most pervasive problems that I encounter, and that we will all have to deal with at various points in our lives: the problem of grief.

What is grief? There are lots of definitions, but one I like to use is short and simple – grief is the natural reaction to loss. The predominant emotion of grief is sadness. Other feelings, like anger and guilt, are often present as well. Often, when we think of grief, we think of how we feel when someone we care about dies, and this is certainly one of the most painful types of grief we will experience. But there are lots of different types of losses other than death, and whenever we experience a loss, we will feel grief, whether we like it or not. Sometimes, we feel grief without being consciously aware of it. (In fact, this is quite common.)

So what are some of the other losses we experience? One really big one is the breakup of a significant relationship. This hits us much like a death, because in a way, it is a death – the death of the relationship. Some years ago, a group of researchers compiled a list of the 100 most stressful events that virtually all of us will experience throughout our lives. At the top of the list was the death of a loved one. Right below that was the end of a relationship. For some people, a breakup is even worse than a death (but that’s a topic for another day). But they are both significant losses. Other losses include the loss of a job, moving to a new location, and children leaving home. Then there are the types of losses that are less tangible, but no less painful, such as the loss of youth or innocence, or of some physical or mental attribute that is diminished. We can lose our confidence, our self-esteem or our sense of identity. We may lose an important role that we play. We might lose our dream of the future, or some important goal that we set for ourselves.

Not only can we lose what we had, but we also feel the grief of what we needed, but never really got. For instance, if one or both of our parents withholds love, affection, attention, or some other form of nurturing, we feel that loss as well. However, it’s important to note that the losses of the things that we had, and that went away, are easier to identify than the losses of those things we never got. Grief of the things we never got is usually a good example of the type of grief we feel, but we aren’t consciously aware of it, or don’t know why we feel it, or both.

All grief is painful. There is nothing we can do about that fact. And it is inevitable. It is not a sign of weakness. It is not unnatural or bad, no matter what you might have been taught about it. A great many of my clients were taught from a young age that sadness, grief, and tears were something to be ashamed of. THIS IS NOT TRUE. If you were taught that, I’m sorry, because you were misled, and now you have to try to unlearn it. This is no easy task.

There is only one cure for grief: to grieve. “Grieve” is a verb, meaning it is something we do. We can choose to avoid our grief, to run from it, but here is another fact: your grief will not go away if you ignore it. It will wait you out. It will lurk inside you, occasionally leaking or bursting out, and it will make it very difficult for you to feel joyous and free. If you want to be free of your grief, no matter how old it is, then you must face it. You have to slog your way through it, like a nasty bog that you cannot go around or fly over. We all have to do it. The good news is, like all feelings, grief is neither dangerous nor permanent, if you allow yourself to feel it.

A few years ago, I was working at a psychiatric hospital here in Dallas, Texas, when a middle-aged woman whom I’ll call Gloria was admitted to the adult unit. Six months previously, her husband had died, so naturally, Gloria was grief-stricken. But, like all humans, Gloria did not want to feel the pain of her loss, so she ran from it. She also received a lot of well-meaning but ultimately harmful advice, like, “You’ve just got to stay busy all the time.” This she tried to do, by throwing herself into her work. For six months, she worked almost sixty hours a week, and when she wasn’t working, she was doing something else. Anything but sitting with her grief. After six months of this, she ended up in the hospital when she reached the point where she was seriously considering killing herself.

After she had been on the unit a few days, her attending psychiatrist told her he would have to send her home soon, but she was going to end up right back in the hospital, or dead, if she did not grieve her husband’s death. He instructed her to set aside an hour every day to feel her feelings.

“But I don’t want to grieve,” she said.

“You must,” said her psychiatrist.

“But I don’t know how,” she insisted.

“Do you still have your husband’s clothes?” he asked.

“Yes, his closet is full of them. I don’t go in there.”

“Here’s what I want you to do,” said the doctor. “I want you to go into your husband’s closet, and I want you to smell his clothes. And then you cry your eyes out.”

Gloria wasn’t happy about this, but she agreed to her doctor’s advice. I don’t know if she actually followed it, but we never saw her again. It is my hope that she worked her way through the pain of her grief and came out the other side.

Many clients have asked me how to grieve, and my response is always this: crying is probably the most effective way to allow pain to leave our body. There’s an old adage in sports that says, “Pain is weakness leaving the body.” I don’t know about that, but I do believe that tears are the best way to let pain out. This is why it is so important to challenge any old rules we might have that prohibit us from crying. When I worked at the same hospital mentioned above, I had a woman in a group tell me, “When we were kids, we weren’t allowed to cry.” She went on to explain that her parents forbade their kids from crying because “it’s in the Bible.” I challenged her to show me where in the Bible it says, “Don’t let your kids cry.” I also encouraged her to consider the shortest verse in the New Testament, which is only two words: Jesus wept. When she thought about that for a little while, she decided that she was angry at her mom and dad, and who could blame her? I would be pissed, too, if my folks taught me that the most effective way of releasing pain was forbidden and shameful.

Now, we all know that crying isn’t necessarily something we can just turn off and on, like a faucet. It would be great if we could, because every time we felt we had accumulated some grief, we could just turn on the old emotional faucet, and let it drain right out. I truly wish it were that easy, but maybe it’s a good thing it’s not, because I might be out of a job. So the two biggest reasons why it is difficult for many of us to cry are, one: it’s painful, and two: we are embarrassed. But if we must suffer a little embarrassment in order to be free of our pain, then I call that a bargain.

I am of the opinion that the core task of the person in therapy (and a great many people who aren’t) is grief work. I believe grieving is the core task regardless of the presenting problem or diagnosis. I have seen people with diagnoses including major depression, bipolar disorder, generalized anxiety disorder, agoraphobia, obsessive-compulsive disorder, borderline personality disorder, as well as countless substance-abuse disorders, and many others, as well, and almost all of them had unresolved grief at the core of their problems. Unresolved grief can affect us in myriad different ways, and no two people are exactly alike.

By the way, not everyone agrees with my assertion that grief is the core problem, but there it is. And of course, there are exceptions. But not a whole lot.

Here’s a typical example of what I’m talking about: Let’s say a male client, Mark, comes in for counseling because he is depressed. Mark is thirty-three, single, and working at a job that he hates. He’s smart, but never finished college, and he knows he’s not living up to his full potential. He’s had a series of unsuccessful relationships, usually with partners who end up becoming verbally abusive to him, or worse. Mark has low self-esteem, and he has enough insight to see how it affects him, and even where it came from. Growing up, Mark’s mother was loving and nurturing, but this wasn’t enough to offset the effects of his father, who made it perfectly clear he was disappointed in Mark in just about every way. According to Dad, Mark wasn’t smart enough, strong enough, clever enough, manly enough, or just plain good enough to win his approval. As a result, Mark grew up learning to feel a deep sense of inadequacy. He desperately wanted his father’s approval, and tried very hard to win it, but nothing worked. This lead Mark to come to the conclusion that there was something inherently wrong with him, some core defect that prevented his father from being able to love him.

Like many people who grow up learning to believe they are inherently inadequate, Mark became an under-achiever. The fact that he was an under-achiever was then interpreted by Mark as further evidence that he was screwed up, which became a vicious cycle. By the time he sought counseling, Mark was profoundly unhappy. He was also basically a nice person, to everyone but himself.

Now, let’s say Mark’s therapist, Dan, comes from a cognitive-behavioral school of thought, which looks at the role of irrational beliefs on one’s mood. Dan assesses, correctly, that Mark’s beliefs that he is an inherently defective person is a false belief that must be changed in order for Mark to be happy. So he helps Mark to see that his father’s unrealistic expectations and non-acceptance of him were examples of bad parenting, and not the result of Mark’s inadequacy as a human being. Over weeks and months of therapy, Dan and Mark continue to challenge Mark’s harmful beliefs, and strive to replace them with healthy, more accurate beliefs: Mark was an okay kid and is an okay adult whose growth was stunted by his father’s parenting, a problem that could be remedied as Mark gained confidence in himself and learned to believe that he was not a walking defect.

Finally, after months of hard work, Dan tells Mark that his irrational beliefs have been successfully replaced, and there is nothing more he can do for Mark. Therapy is over, and the two part ways. But something is still amiss, and although he feels better, Mark is still troubled by a subtle but deep sense of unhappiness.

The problem, as I see it, is that Mark and Dan stopped working too soon. Their work together was productive, but it did not address Mark’s core problem, which is grief. And what is it that Mark is grieving? He is grieving the loss of the father he never had. Once he realized that his father’s treatment of him wasn’t his fault, then the question became, who was responsible? Obviously, the answer is that Mark’s father bore the brunt of responsibility, but this is not a happy truth for Mark. In fact, it is quite painful for any of us to fully realize that one or both of our parents let us down in a way that proved to be truly harmful. Mark might even be tempted to let his father off the hook by continuing to believe that he, Mark, was a bad kid that got what he deserved. That would allow him to maintain the illusion that dad wasn’t that bad of a parent, and who wouldn’t want to believe that?

Clearing up Mark’s distorted beliefs merely paved the way for him to get down to the real problem of grieving the father he never had. Doing so means that Mark will have to allow himself to come face to face with his ambivalent feelings towards dad – on one hand, he feels love, and on the other, he feels anger and disappointment. Like many of us, he has learned to believe that his feelings of anger and disappointment are bad, and he shouldn’t feel them. So he tries to make them go away by telling himself they are bad feelings. This never works. He feels that way whether he likes it or not, and the only way to work through those feelings is to be honest with them and give them a voice. His anger and disappointment are perfectly valid feelings, and taken together, we can recognize them for what they are: grief.

A psychiatrist I once worked with made the statement that if one were to make a list of the core problems that brought people to seek the help of a therapist, the most prevalent problem could be stated as this: “My parents were not there when I needed them.” My experience as a therapist bears this out. Sometimes, this problem is overt and obvious; other times, it is more subtle, and involves physical presence but emotional unavailability. The effects that this absence has on a child can be profound. It hurts us in two ways: it damages our sense of self, and it creates a deep sense of grief. Often, one must address the first problem before the second. Neither task is easy, and they are not entirely separate from each other as well. It is the task of the therapist to assist with the resolution of both problems.



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