Death and grief: dealing with, processing and helping with losses

At the funeral, relatives, friends and acquaintances say goodbye together. (Image: Kzenon / fotolia.com)

Living with death - grief as work

Death is part of life. But it is just as difficult for us humans to come to terms with our own death as it is to come to terms with the death of relatives, partners and friends. One reason for this is that we, as social beings, are fundamentally dependent on ties in relationships, and with the death of an important member of this network of relationships, our system of order gets out of hand. We can neither suppress nor abbreviate grief, we have to live through it consciously. However, there are a few ways to come to terms with the loss of a loved one that will help us shape the life after.

'

Death - a taboo?

In the Middle Ages and early modern times, dying and death were publicly present and ritually integrated into everyday life. High child mortality and low life expectancy meant that people had to accept the loss of relatives and friends at a young age. After the Second World War, the great death, death shifted to anonymity. Advances in medicine increased the age in all industrialized countries; Previously fatal diseases treat themselves better and better.

Medical advances mean that what were once fatal diseases can now be treated better and people can live longer and longer. (Image: bilderstoeckchen / fotolia.com)

The view of the doctors shifted: dying was increasingly seen as the doctors' fault. Not only dying, but also the weakness of aging people moved more and more into a taboo zone. Seniors should not only live longer and longer, but also remain active until death. Medical devices prolonged the dying process - people who would have been dead a few generations ago can be kept alive with today's technology, sometimes for years.

Old age, weakness and death moved from the center of the community. In the past, people died in the village and in the extended family. Not only burial but also death was part of social life.

In the 20th century dying moved away from the community. Old people came to old people's homes and died there or in hospitals. In any case, the generations were drawn far more apart than in traditional societies; Adults often had no contact with their parents for years.

But not only the dying, but also the bereaved remained increasingly alone. Because death was pushed out of the mind, outsiders often did not know how to deal with the sadness. Often people in the social environment avoided the conversation or even withdrew from those affected.

Meanwhile, a rethink is taking place. A broad discussion about euthanasia focused on the practice of extending life with apparatus, although real life is long gone. Increasingly, people are concerned about how they want to die and are preparing not to end their lives anonymously in a clinic.

Because sickness and dying disappeared from everyday life, the bereaved lost the development of saying goodbye. Saying goodbye hurts, but it is a profound experience and already part of the grief work. Whoever has accompanied someone as they die, this experience usually remains anchored in their memory as a maturation process. If the dying are still mentally in their senses, they often leave important messages for their companions.

Children and death

Many parents today no longer know how to talk to their children about death. Some vets even get rabbits the same color as the deceased, to hide the fact that their pet is no longer alive.

Not talking to children about dying is a mistake. Children are curious about everything that happens around them and sooner or later they will encounter death. Be it that you see a dead animal, be it that you hear that someone has died. If the parents press around now, avoid the questions or give "half answers", this triggers fear in the child. Because children have a keen sense of whether their parents are hiding something from them and feel that the secret must be something terrible.

At the latest when the first person who is close to the child dies, the child wants to know what is happening. It is much better to talk to the child about death beforehand. Many adults prefer to protect the child. Statements like “it's still too small to understand” or “he's coming back” really only protect parents who don't know how to explain the subject.

Small children usually cannot yet understand that the deceased will not come back. (Image: pingpao / fotolia.com)

However, that does not mean that young children simply understand what it means to be dead. Many children believe that a dead person is only temporarily absent. That someone no longer exists is difficult for toddlers to understand because everything they imagine is real in their world.

What is happening in the brain

When someone close to us dies, it disrupts brain processes, especially in the brain stem such as the cerebellum and in the limbic system. On the one hand our feeling and memory centers are affected, on the other hand eating, sleeping, breathing and circulation.

Anyone who finds himself in this state after the death of a loved one suffers from sleep problems, he forgets a lot, can hardly find his way around, he feels sick and cannot eat.

The brain runs in a state of emergency and signals: threat. Those affected react with flight, aggression and / or freezing.

Flight, aggression and freezing

“Fear doesn't prevent death. It prevents life. " Naguib Mahfouz

We often only notice escape when it turns into a panic attack. But we know all escapes in everyday life and hardly notice them because they don't feel dramatic: We then drive through the area by car without a destination, take a short trip to Paris because the ceiling falls on our head, or we get drunk us.

When we are on the move, it relieves the feeling of not getting any further. We move, and that means: We do something. When we are sad, we step out of the constant brooding for a while - we distract ourselves.

The grief remains, but when we're driving, we have to concentrate on the way: braking, turning, deciding where to go.

Physiologically, it is a biological reaction caused by fear: when we feel threatened, the brain signals “danger” and we try to escape the dangerous situation.

If we are grieving because someone has died, the partner has split up, or if we are simply imagining a better life, escapes are as sensible as they are risky. They don't solve the problem, but they give us a buffer zone between our terrible feelings and their immediate processing.

A temporary “escape” creates distance and helps to escape the carousel of thoughts for a moment. (Image: sognisondesideri / fotolia.com)

However, these escapes can quickly become independent. Every alcoholic knows that who lost his footing because someone who was previously supportive died, he took refuge in drunkenness and now has no control over his alcohol consumption.

Another response to fear is aggressiveness. This is also biologically anchored: If an animal or a person is in a situation that directly threatens their life (or seems to threaten their life, the brain does not differentiate), then they intuitively decide between attack and flight. This decision takes place in the fast part of our brain, the biologically old one.

If we were to “strain our heads” first, that is, to switch on the analytical thinking developed in humans, it would be too late in an emergency: If I wonder for a long time whether the shadow under the trees could be a tiger, the tiger would have killed me long ago, if it had it would be one.

In animals living in social groups, the death of a pack member triggers the chain of fear reactions. This is no coincidence either, because if the animal does not die of an illness or old age, death is a threat to all other pack members: Even in an avalanche or fire, escape is the best action, in the case of a predator the decision is: I am, are we strong enough to drive it away or we flee.

The fear reflexes of flight, aggression and rigidity are not rational, that is, they do not pass through the part of our brain that reflects and analyzes. They take place on the "unconscious" level, the associative action - they correspond to what we call instincts in animals.

Therefore, from a rational point of view, mourners sometimes behave unfairly: They react aggressively when loved ones want to help them. They blame others for death. This may occasionally be justified, but it arises from an unconscious fear reflex. Aggression towards a predator, for example, which caused the death of a pack member, is useful and even necessary in evolution.

In addition, the diffuse feeling of fear is controlled by a concrete action. If there is a culprit, I have the opportunity to act. In relation to a blind incident, I do not have this option.

For mourners, everyday things like getting up and getting dressed are hardly feasible - the feeling of inner emptiness overwhelms everything else. (Image: Paolese / fotolia.com)

Those affected are well advised to forgive themselves for the "irrational" reactions and feelings. When they know that they control the upheaval of their social structure in this way, biologically, they understand that they are not "sick".

Rigidity goes hand in hand with flight and attack. Mourners have problems coping with everyday life. They barely manage to get up, get dressed, wash or eat. Even if they function on the outside, they freeze on the inside: no matter what you do, you just feel an inner emptiness inside.

This, too, is a biologically sensible response to a threat. The emptiness provides a blueprint so that those affected do not overwhelm their feelings, they isolate themselves from the emotions. However, the emptiness alternates with extreme emotional outbursts.

helplessness

Literally speaking, mourners are no longer masters of their senses. They have little control over their reactions. This is also due to the brain.

Death and other personal disasters disrupt the neocortex where our thoughts and actions sit. If this center works, then we can control our impulses to a certain extent. We “freak out”, at least now and then, but then “get a grip” again.

Those affected lose this influence. You want to organize your everyday life, but you can't manage it, you don't want to be aggressive, but you attack bystanders. Those who mourn get lost in circles of thought. You are constantly thinking about what to do next, but you are unable to develop a line.

The reason for the shock is not only the loss of the loved one, but above all the total change. Joint celebrations, shared work, vacation, the house, all symbolically occupied coordinates of one's own life disappear.

Before that, those affected made decisions within a coordinate system in which they had their fixed place and therefore knew what they were for or against. Now all references are missing.

Those affected also revolve around the past without being able to come to a conclusion. The drama consists precisely in the fact that the person you could talk to about it is no longer there. In fact, it does not matter whether the mourners would have said, thought or done something else in a certain situation.

Feelings of guilt such as “if I had stopped him from smoking, then he would not have died of cancer” or “if I had prevented him from driving the car that day, then he would not have had an accident” alternate with curses at that Fate: "Why is this happening to me?"

Here, too, we are dealing with psychologically meaningful constructions of the unconscious, but which lack references. The human brain works less logically like a computer, but rather it gives us meaning: It constantly creates storylines that we can use to orient ourselves in life. Whether these are objectively correct is irrelevant, this is proven by the worldwide existence of religions that have been scientifically refuted.

In the first phase of grief, it is impossible to confront those affected with a rational analysis of the situation.

In all religions there are rituals for dealing with death. (Image: Dan Breckwoldt / fotolia.com)

Death as metamorphosis

Death rituals are central to all religions: the Egyptians built pyramids as tombs for their dead rulers, in Normandy the princes and their slain slaves, horses and property were buried in barrows, and the Vikings sent their chiefs out into the open sea in a burning dragon ship - all of them believing that death was just the passage to another world.

On the other hand, some cultures like the Navajo see everything that has to do with death in a negative way and avoid places where people are buried. To even mention the deceased has bad consequences in their imagination. In contrast, there is probably nowhere a neutral approach to death.

Not only is death central to all religions, it is possibly the main reason why people developed religions. Although our ancestors also tried to explain the phenomena of nature to themselves, they created a close connection between the “we” group with the common ritual, they arranged nature, culture and the environment in a system and were thus able to orient themselves in the world.

But even more important was the answer to the question: “What comes after?” This is where humans differ from all (other) animals. Highly developed mammals such as elephants or wolves presumably mourn their dead, that is, they perceive the death of a member of their group as a loss. They are irritated or act aggressively, so they are shocked in a similar way to how people are shocked when faced with the death of a relative.

But there is one thing only humans can presumably be able to do: perceive death as a change from one state to another. When the carcass has decayed, no longer smells, no longer looks like the living individual, animals no longer associate it with the deceased conspecific.

On the other hand, people observed how the previously living person who breathed, laughed and spoke, at first no longer breathes, no longer speaks, no longer lives; then they see how the body changes color, the flesh decays and, in the end, man becomes earth.

People also ask themselves what makes sense. You can imagine things, even things and worlds that do not exist - that is precisely what culture is. But while our ancestors could see the process of dying and death and saw the body decay, they could only imagine what would happen then and if then.

Organized religion gave answers, and the priests claimed to know what happened next. This is how a caste that did not work secured its status by absorbing the insecurity of the people. The first religions were ancestral cults.

The idea that the ancestors have a say in this world may seem superstitious at first, but it is deeply human. People don't just live in nature, they live in culture. The contact with the ancestors is the connection to tradition and thus passes on the cultural experience: We can only shape the present with knowledge of the past.

In addition, we always think about the deceased, at least on a subconscious level. The experiences with our grandparents reappear in our dreams, and the ideas of the spirits of the dead reflect only too precisely the errors, confusions, fears and feelings of guilt with which even atheist mourners confront.

Spirits of the dead go around to seek revenge or because they have failed to pay a debt. They appear to the bereaved to tell them that they are fine. You appear like the white woman to warn the living of calamity. They return as revenants and drag the living to the grave.

In summary, the spirits of the dead who believe in the supernatural correspond exactly to the fears, fantasies and memories that haunt the part of our brain that makes associations.

At the funeral, relatives, friends and acquaintances say goodbye together. (Image: Kzenon / fotolia.com)

What helps?

“Death rearranges the world.Apparently nothing has changed, and yet everything has changed. ”Antoine de Saint-Exupéry

The religious ritual, the rest of the dead, the last anointing and any form of burial, the cremation of the corpse as well as the burial or the seaman's grave create a collective framework in which to order the mourning. The ceremony, in which relatives, friends, but also acquaintances and followers of celebrities take part, integrates the sufferers into the community.

At first glance, religion and neuroscience seem to have little to do with each other. In the polytheistic religions in particular, however, it becomes clear that they do not draw their strength from unconditional belief in one God, as in Christianity and Islam in particular, but from common ritual.

The ceremony also supports the mourners from a neuroscientific perspective. Because the people concerned understand themselves in connection with understanding others, and consciously chosen symbols and rituals help our brain to cope with the situation.

When we understand ourselves and also get understanding from other people, the brain releases dopamine and serotonin. We feel better and free ourselves from rigidity.

If other people assume that we are withdrawing, reacting in an overstimulated manner or trying to flee, this also increases the production of these "happy substances".

So it is wrong for us to grieve ourselves, to want to “grit our teeth” and to judge ourselves when we are not in control.

This works best when we have already learned to accept ourselves, with our weaknesses as well as with our strengths, our crazy thoughts and also with behavior that we do not always like. Accepting does not mean that we think everything about us is great, but that we accept ourselves for who we are.

If we haven't learned this, as hard as it sounds, the grief after a loss is a great opportunity. To hug ourselves, we can watch ourselves closely, so ask, what exactly am I thinking now, what am I feeling, what do I want to do?

We can also observe the scissors in our head and note which thoughts are scary to us. It helps a lot to keep a journal and write everything that is inside of us.

The feelings, thoughts and ideas that we develop in this phase are probably some of the most intense in our lives. Writing down not only helps to give form to racing thoughts and thus to get out of the idle of circling around ourselves; they are also a great treasure for the future.

Our most intimate fears, memories, but also conflicts, values ​​and norms never come to light as clearly as in times of crisis. Even if we don't understand it in the first phases: The cuts set the course for our lives and not the times when everything goes smoothly - provided we deal with the crisis constructively.

Many people make the mistake of believing that it is a "sacrilege" to do something good for the dead. The deceased would probably want just that. The dead don't benefit from it if we feel bad.
We can think of beautiful moments with the dead, think of what he taught us, but also do something we like. We can go to a place we've always wanted to see, listen to the music we like, or take a walk in the woods.

Instead, thinking that honoring the dead when we are particularly dirty adds to the problem. It is important to let the feelings out, that is, to cry or even scream, but not to mop up "because it is proper".

Dealing constructively with the crisis sets an important course for future life. (Image: Gerald / fotolia.com)

How do we support those who grieve?

Most people find it difficult to deal with those who grieve. When people react aggressively, withdraw, or, on the contrary, rush into action, we worry. Or we don't know how to behave.

Instead of forging theories about behavior, avoiding those affected or treating them like a raw egg, we can ask the questions: What do you think now? What you wanna do?

The most difficult lesson to guide a person through this crisis is not to do too much. Grief takes time, and those affected are least helped by outsiders giving them advice - no matter how well-intentioned it is.

Giving people their own ideas in acute crises on how they could improve their "crisis management" harms them and disrupts their healing. Let them talk without judging or making suggestions. Much better than "solution programs", which sufferers may not even be able to do, is to accompany them - literally.

Perhaps those affected are in the mood for a walk in the woods, want to go to a cafe where they often sat with the deceased, visit a place from their childhood together or watch a film that they associate with the dead.
For those not affected, this does not look like active support, because no ad-hoc results can be seen, but it is precisely this active passivity in which the mourners can say everything but do not have to do anything, which makes coping much easier for them.

The bereaved need friends who are just there. You don't need anyone who says “I understand” but can't understand it. Instead, friends can honestly express their own feelings. Friends can be prepared for the pain and sadness of those affected to come back even after a long time. You should also talk to the mourners about the dead long afterwards. It hurts sometimes, but it's good.

Do not try to talk away the loss with a replacement, following the motto “You are still young, you will find a new partner.” No one is interchangeable. Take care of family members. For example, when a child dies, those who suffer are not just the parents, but the siblings as well. Make sure that no mourner is neglected.

What is the effect of rituals?

All religions know about the effects of rituals and symbols. Atheists shouldn't dismiss this as superstition. Humans differ from animals in that they actively use symbols to communicate and organize the world. We even have to: If a person is alone in the wilderness, he will soon begin to charge his environment with symbols.

The conscious use of your own symbols does not mean showing up with a crucified Jesus in the hand of those affected. It's about the associations, memories and symbols that the survivor internalizes himself.

Visiting the grave can be important, as can a memorial service with real friends. But it can also be objects that remind of the deceased: paint a picture on his easel, go into nature and observe the landscape with his binoculars.

Visiting the grave can help process the death of a loved one. (Image: patrick / fotolia.com)

What remains of the dead is the memory. In order to enter life, it helps immensely to bring these memories to life. Instead of brooding over the past and keeping things of the deceased like in a museum, he remains present in a certain way when we use things. For example, you can write a letter to the deceased and throw that letter into his grave.

The individual symbols and rituals may determine why people develop religious ideas, but they cannot be explained metaphysically, but biologically. The orbitofrontal cortex stores our early learning experiences, not as words in the analytical sense, but as feelings and subjective truths expressed as symbols.

In addition to understanding yourself and through others, symbols and rituals are enormously helpful in dealing with the death of a close person. Neuroscience can explain why this is so.

Without believing in the supernatural, the dead are very close to us on this level, because the memories associated with them are part of us. Even more: because we empathize with what the deceased have given us, they stay among us.

But we can also create special rituals that only concern the deceased and us. For example, we can ask him questions and think about what he would have answered. We feel so close to the dead and at the same time that they are gone. We understand our own contradicting feelings better through such dialogue.

Don't let anyone tell you how to grieve. It is an individual process: each person organizes the emotional experience, the understanding of what has happened, the ordering of the chaos and the external functioning differently.

Some mourn a deceased person for a few weeks, for others this phase lasts for years and still others never get over a loss.

Grief instead of depression

Depressive illnesses are increasing in Germany; Most people rarely show grief. It does not fit the image of the "dynamic successful"; we prefer to put on an active mask and hide what it looks like inside us.

When someone dies, open grief is very important. It helps us to understand the loss, to express it and ultimately to process it. If we suppress it, our unbearable feelings continue to proliferate in the unconscious: They appear in our dreams, they anchor themselves as a negative mood and as silent suffering that we can no longer even name.

Lethargy, stupidity and depression take the place of tears. The process of healing is suppressed. The individual phases are a mental process that is comparable to the healing of physical wounds.

The shock caused by the loss means that the nerve connections first have to be re-established. Telling someone who has been affected, "Now pull yourself together, life goes on" is like kicking the buttocks of someone with a broken leg to get them going.

Grief is neither a mental illness nor an infection. It doesn't need resources to get rid of them, but time to do its job. Grief makes sense: through it we realize the loss; only then can we adjust ourselves mentally and practically to the new situation.

It is wrong to maintain the illusion that the deceased is still there: Parents whose children are dying, for example, often leave their rooms untouched. So they never get over the loss. It is better to keep the personal things associated with memories, but rearrange the house so that there is no more room for the deceased.

Grief work is important in accepting the loss of a loved one. (Image: marjan4782 / fotolia.com)

displacement

The problem is not grief, but either avoiding it or not processing it. Some people never learned to stand on their own two feet; they remained attached to their parents in an infantile state and never actively broke away from them. If a parent dies now, these people have little opportunity to come to terms with the loss because parental care is part of their life structure.

These people often attach themselves to an ideal image of the dead after death. In a morbid narcissism they are reflected in the part of themselves that is still in the parent because they never became independent. It is particularly difficult for them to say goodbye and organize their own lives.

The stages of grief

There are several phases in grief. First of all, the person concerned is in a state of shock. He feels paralyzed, he looks like he's standing next to him - like in another world. This can take up to a week.

During this time, relatives can take over the everyday work of those affected: however, do not touch the dead person's things. Those affected should do it themselves and understand that the person is gone.

In this phase, those affected often do not allow death to get close to them; they claim the deceased is still alive; they talk about loss nicely; they pretend nothing has changed.

The second phase is that of control. The sufferers are now trying to organize the funeral. He "still stands next to him". Help should now be more cautious, because those who suffer must not forget how to regulate everyday life for themselves.

The third phase is regression. Only now does processing begin. The funeral is over, as is the shock - now comes reality. The loss is now perceived in full severity. Many try to suppress death. They talk to the deceased, think they are still there, think they hear, see or smell them.

Everything now appears empty, every action loses its meaning, they feel as if they do not belong to the world, they often take refuge in arrogance over the “facades of the people out there”. At the same time, outsiders expect “normal life” to go on. The survivors are under pressure to reintegrate.

Usually during this phase there are conflicts between the person concerned and his environment. Now he is torn in his feelings; he decides on something and immediately rejects it. He appears moody, reacts from shortness of breath and insomnia, has no strength and no hunger.

Anyone who helped before is now faced with a challenge. He is offended because those affected seem to behave ungratefully. The outsiders also have a right to their feelings and no longer want to let everything go.

But the emotional outbursts that the helpers hit often apply to the deceased himself, who is missing as a contact person. Those who know this can support those affected by showing them that their psychological chaos is a matter of course in this situation and that they have a right to be angry at the deceased.

If you just suppress the pain, you will be confronted with it again and again. (Image: Michael Schindler / fotolia.com)

Controlling emotions by outsiders does not help, but: To flee as a victim in this situation is just as understandable as it can worsen the pain. Instead of facing the grief, those affected may move house, break friendships that connect them with the dead, or plunge into senseless activity.

But they only suppress the pain, and it will come back in concentrated form, often when they least expect it.

The fourth phase is the re-entry into life. Now the survivor understands that life must go on without the dead. The past is slowly becoming a thing of the past; those affected can now reflect and see their relationship with the dead in a distant light.

At best, he is now building new relationships and reorganizing his life.

The phase model is not static: with some people the individual phases take a very long time, with others the individual stages do not take place in this way, and still others jump from new beginnings to despair and avoidance to open expression of their feelings.

Not all grief is created equal

Every person grieves differently, and every death is different. If a person dies at the age of 93 after a long period of dementia, the relatives are better prepared for it than if an 18-year-old commits suicide.

Children grieve differently than adults, and mentally unstable people differently than people who work through strokes of fate.
Parents whose child has killed themselves are usually plagued by feelings of guilt, which alternate with anger at the child. Often, accusations from others increase despair. Those affected also see themselves denigrated as perpetrators.
The parents torment themselves with the question of what they did wrong. But there is no answer to why, because the child who could answer it is dead.

In this situation, survivors should seek therapeutic help. Self-help groups of people with the same fate also help.

Young children cannot control their emotions; they grieve by leaps and bounds. One moment they are in a good mood, playing at Grandpa's funeral in the cemetery, the next they break into crying fits. In children, grief manifests itself in its entire spectrum: They sleep poorly, they withdraw and become aggressive. They want to know what happened. They ask where the dead man is now and how he died.

Children feel the shock of death more than adults, they long for an "ideal world" and they idealize the dead. They are sensitive to how adults deal with grief. The more open a family shows, the easier it is for the child to express their sadness.

A child is never too young to talk about what happened. Parents have a duty to speak to the child about it in a way that they can understand.

Dealing openly with feelings within the family makes it easier for children to let out their sadness. (Image: Eléonore H / fotolia.com)

What should you avoid?

1) Do not infer from yourself to the mourner. It's not about what they can withstand, but about who is affected.
2) Don't tell people how long they can mourn. That is only their business.
3) Avoid using phrases to cheer up those affected, such as “it'll be fine”.
4) Do not downplay death for false care; it is better not to say anything and show those who suffer that they are not alone.
5) Support the bereaved with small gestures. Write a postcard from vacation, bring him something nice, invite him over.

I-strength

In general, the more a person has developed his self and integrated his life conflicts, the better he can endure negative feelings and express his own emotions. The better someone can enter into bonds and relationships, the better they can separate: detachment and attachment belong together.

Getting through and overcoming despair is also heavily dependent on the relationship with the deceased. It is by no means easier for us to say goodbye to someone we hated.

If we have developed our own autonomy together with the dead, then it is easier for us to stand on our own two feet after their death. With a love-hate relationship, a smoldering conflict that bound the deceased and me, that is much more difficult.

Psychologist Goldbrunner says that there is no simple pattern for grief. This is characterized by various impulses that are in the balance: enduring and avoiding pain, between feeling and understanding, activity and passivity, detachment and retention.

The process takes time, but as a process it must also come to an end. In this sense, grief is the opposite of depression, or depression is unprocessed grief. It's about not just plunging into despair at some point, but rather recognizing that there are events that can neither be calculated nor controlled. (Dr. Utz Anhalt)

Tags:  Subjects Diseases Holistic-Medicine