The reaction of loss to the death of a loved one can be manifested by an emotional shock with numbness and "petrification" or anxiety, crying, sleep disturbance, appetite, narrowing of consciousness on psycho-traumatic experiences, constant memories of the deceased, emotional longing, etc. With such symptoms, patients often, in connection with the death of loved ones, turn to psychiatrists and psychotherapists.

The reaction to the loss of a significant object is a specific mental process that develops according to its own laws. This period of life, accompanied by mourning, special attributes and rituals, has a very important task - the adaptation of the subject who has suffered a loss to a “new” life, life without a deceased person.

To date, there are no theories of grief (loss, losses) that adequately explain how people cope with losses, why they experience changing degrees and types of distress in different ways, how and after what time they adapt to life without significant dead people.

There are several classifications of grief reactions. Researchers distinguish from 3 to 12 stages or stages. These classifications assumed that the bereaved person moves from stage to stage. However, some experts criticize this approach. They believe that the main difficulty in using these classifications lies in the lack of clear boundaries between the stages, but recurrent recurrences of the disease state, when the patient returns to the already past, seemingly successfully lived stage.

Another feature of the manifestation of grief, which makes it difficult to use stage classifications and diagnose the current state, is its individual and variable nature. In addition, in certain cases, some stages are absent or are poorly expressed, and then they cannot be tracked and / or taken into consideration. Therefore, some authors prefer to focus not on stages and stages, but on the tasks that must be completed by a person experiencing loss during the normal course of grief.

Thus, the majority of modern specialists identify diverse variants of the course and changeability of grief experiences, which differ significantly in intensity and duration among cultural groups and among different people.

It is important for a psychiatrist (psychotherapist) in his practice to distinguish the adaptive variant of coping with a tragic situation (uncomplicated grief) from the maladaptive variant (complicated grief).

Subjective experiences of loss are individually different for each person, and therefore the clinical manifestations can be extremely variable. However, the psychiatrist (psychotherapist) needs to form an opinion on whether a person's grief develops adaptively or not in order to decide on an intervention. A clinician who does not represent the range of grief symptoms runs the risk of interfering with the normal process and possibly upsetting it.

Knowing the boundaries of uncomplicated, adaptive grief can help the practitioner recognize complicated grief and/or depression following the death of a loved one.

Although uncomplicated grief is determined to some extent by temporal criteria and the depth of experiences, they are not decisive. The criteria for diagnosing uncomplicated grief are:

1. The presence of state dynamics. Grief is not a state, but a process. A “frozen”, unchanging state should inspire fear.

2. Periodic distraction from the painful reality of death.

3. The emergence of positive feelings during the first 6 months after the death of a loved one.

4. Transition from acute to integrated grief. Shear M.K. and Mulhare E. distinguish two forms of grief. The first is acute grief that occurs immediately after death. It is manifested by severe sadness, crying, unusual dysphoric emotions, preoccupation with thoughts and memories of a departed person, impaired neurovegetative functions, difficulty concentrating, and a relative lack of interest in other people and activity in everyday life.

During the transition from acute to integrated grief, the intensity of psychopathological disorders decreases and the person who has experienced the loss finds a way to return to a full life. The loss is integrated into autobiographical memory, thoughts and memories of the deceased no longer absorb all attention and do not disable. Unlike acute grief, integrated grief does not constantly occupy one's thoughts or interfere with other activities. However, there may be periods when acute grief re-actualizes. This often happens during significant events such as holidays, birthdays, anniversaries, but especially on "round" dates associated with the death of a loved one.

5. The ability of the bereaved subject not only to recognize the death of a loved one and part with him, but also to search for new and constructive ways to continue the relationship with the deceased. Faced with the dilemma of balancing inner and outer realities, mourners gradually learn to see their loved one again in their lives as dead.

The researchers found that the presence of the above criteria is a sign of resilience for bereaved people and is associated with good long-term outcomes for them.

Complicated grief, sometimes referred to in relation to intractable or traumatic grief, is a common term for a syndrome of prolonged (extended) and intense grief, which is associated with a significant deterioration in work, health, social functioning.

Complicated grief is a syndrome that occurs in about 40% of bereaved people, which is associated with an inability to move from acute to integrated grief.

In complicated grief, the symptoms overlap with those of normal, uncomplicated grief and are often overlooked. They are perceived as "normal" with the erroneous assumption that the time strong character and the natural support system will correct the situation and free the grieving from mental suffering. Although uncomplicated grief can be extremely painful and devastating, it is usually tolerable and does not require specific treatment. At the same time, complicated grief and various mental disorders associated with it can be maladaptive and severely disabling, affecting the functioning and quality of life of the patient, leading to severe somatic diseases or suicide. Such conditions require specific psychotherapeutic and psychiatric intervention.

Individuals with complicated grief have specific psychological attitudes associated with difficulty in accepting the death of a loved one. They perceive joy for themselves as something unacceptable and shameful, they believe that their life is also over and that the severe pain that they endure will never disappear. These people do not want the grief to end, because they feel that this is all that is left for them from the relationship with their loved ones. Some of them idealize the deceased or try to self-identify with him, adopting some of his character traits and even symptoms of the disease.

Subjects with complicated grief are sometimes noted to be over-involved in activities related to the deceased on the one hand, and excessive avoidance of other activities. Often these people feel alienated from others, including those previously close to them.

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There are many researchers of the "soul" - this most mysterious and incomprehensible phenomenon. Both religion and science often argue about the origin of life, but they agree on the existence of a soul in humans. It is difficult to deny it, but it is also not possible to fully explore it either. The soul definitely exists. But, as it turned out, not everyone. Believers say about people without a soul: “I sold my soul to the devil”, “I ruined my soul”, “drank my soul away”. Esotericists and psychologists are also inclined to argue that a person can lose his soul. But only partially. They name several signs by which one can determine that the soul is “lost”, exhausted, or a person has lost contact with it.

Psychology of "loss" of the soul

In psychology, relatively speaking, the soul refers to the unconscious, intuition, feelings. This is a part of the psyche (translated from the Greek psyche - soul, spirit, consciousness). Is a person possible without it? Obviously not. Therefore, from the point of view of psychologists, the soul cannot leave a person, or “not be born” in him at all. But dissociation can occur - the mechanism psychological protection provoked by strong emotions, internal contradictions. With its help, nature protects the body from psychological trauma and blocks the perception of traumatic situations. As a result, a person begins to treat the current reality as not connected with him, and with his life. It seems to be divided into parts, hiding behind masks or merging with them.

Carl Jung suggested that these psychological personalities of a person are composed of "complexes". They are “an emotionally colored set of ideas, motives and attitudes that have a significant impact on the development and functioning of the psyche, personality and human behavior”, and are either formed in the unconscious or forced out there and still remain unconscious. When a person loses control over one of these "complexes", conscious energy weakens. Thus, a psychological imbalance is created and the natural integrity of a person is destroyed. Psychologists refer to this as "multiple personality disorder" and in tribal cultures it would be called soul loss.

There are complex and mild forms of "split personality". With complex cases, everything is clear - a person is called mentally ill and sent to treat (return his soul) to psychiatric hospitals. In the case of a partial "loss" of the soul (and this includes post-traumatic stress, depression, alcoholism, drug addiction and other addictions), people themselves try to heal spiritual wounds and gain integrity. They turn to God, to healers, to psychologists. Church, charity, meditation, creativity, love, self-sacrifice are means of healing the soul. Not always, but often this helps a person who feels that he has “lost” his soul, has broken the harmony between the world and himself.

Signs of a person "without a soul"

Unfortunately, not everyone realizes that they have lost touch with their own soul. But not always soulless is only the person in whom the “devil” has moved in (murderer, rapist, thief, liar, hypocrite, etc.). “Empty” can be anyone, regardless of the level of education, upbringing or conscience. You can recognize a person "without a soul" by the following signs:

Five defining signs will help you figure out who to stay away from. If there is someone in your environment who has at least two of these traits, try to communicate with such a character as neutrally as possible so as not to become his victim.

After the loss has occurred, the psyche must cope with it. The process of these changes is called a reaction to loss or grief. The loss response is complete when a person is able to function adaptively, feel safe, and feel like a self, a person without what they have lost.

Grief is a strong emotion experienced as a result of the loss of a loved one. Loss can be temporary (separation) or permanent (death), real or imagined, physical or psychological. It is also the process by which one works through the pain of loss, regaining a sense of balance and fullness of life. Grief is a process of functional necessity, not weakness. This is the way in which a person recovers from a tangible loss.

Grief is an emotional response to the loss of a person. Often, to describe this state, a person uses the words of regret, heartache. With the loss of a loved one or even a pet, this reaction develops to some extent.

Grief is a strong emotional reaction to loss that manifests itself as emptiness and sadness, and severe depression can develop.

Grief is characterized by the following manifestations.

1. Physical suffering comes to the fore in the form of periodic attacks, a constant need to breathe; loss of appetite, muscle strength. Against the background of these bodily signs, a person experiences mental suffering in the form of emotional stress or heartache. Changes in the clarity of consciousness are noted: there is a slight feeling of unreality and a feeling of an increase in the emotional distance separating a person from other people.

2. Preoccupation with the image of the lost. Against the background of some unreality, visual, auditory or combined illusions may arise. Such states are distinguished by a special emotional grip, under the influence of which the line between experience and reality can be lost.

3. Guilt. The grieving person tries to find in the events and actions preceding the loss what he did not do for the deceased. The slightest oversights, inattention, omissions, mistakes are exaggerated and contribute to the development of ideas of self-accusation.

4. Hostile reactions. In relations with people, sympathy decreases or disappears, the usual warmth and naturalness of treatment is lost, often a person speaks about what is happening with irritation or anger, expresses a desire not to be disturbed. Hostility sometimes arises spontaneously and is inexplicable to those who mourn.

5. Loss of former, natural patterns of behavior. Haste, fussiness are noted in actions, a person becomes restless or performs chaotic actions in search of some kind of occupation, but turns out to be completely incapable of the simplest organized activity.

6. Identification with loss. In the statements and actions of a person, behavioral traits of the deceased or signs of his last illness appear. As a rule, identification with the loss is the result of preoccupation with the image of the lost.

This is the cross section of the state of grief. In time, he is characterized by dynamics, the passage of a number of stages, when a person, as E. Lindemann wrote, performs the “work of grief”. It requires physical and mental energy: experience includes not only the expression of emotions, but also active actions. The goal of grief work is to get over it, to become independent of the loss, to adapt to the changed life and to find new relationships with people and the world.

Grief reactions are normal reaction person for any significant loss. Conventionally, “normal” mourning and “pathological” mourning are distinguished.

Stages of "normal" mourning. “Normal” mourning is characterized by the development of experiences in several stages with a complex of symptoms and reactions characteristic of each. Let's dwell on them in more detail.

The picture of acute grief is similar in different people. The normal course of mourning is characterized by periodic attacks of physical suffering, and intense subjective suffering, described as tension or mental pain, absorption in the image of the deceased. The stage of acute grief lasts for about 4 months, conditionally including 4 of the stages described below.

1. Stage of shock. Tragic news causes horror, emotional stupor, detachment from everything that happens, or, conversely, an internal explosion. The world may seem unreal: time in the perception of the grieving may accelerate or stop, space may narrow.

2. The stage of denial (search) is characterized by disbelief in the reality of loss. The person convinces himself and others that "everything will change for the better," that "the doctors were wrong," that "he will be back soon," and so on. What is characteristic here is not the denial of the very fact of the loss, but the denial of the fact of the permanence of the loss.

3. The stage of aggression, which is expressed in the form of indignation, aggressiveness and hostility towards others, blaming the death of a loved one on oneself, relatives or friends, the treating doctor, etc. When anger finds its way out and the intensity of emotions decreases, the next stage begins.

4. The stage of depression (suffering, disorganization) - longing, loneliness, withdrawal into oneself and deep immersion in the truth of loss. It is at this stage that much of the work of grief takes place. This is the period of greatest suffering, acute mental pain. Unusual preoccupation with the image of the deceased and his idealization are typical.

The previous stages were associated with resistance to death, and the emotions that accompanied them were mostly destructive.

Acceptance stage. In literary sources, this stage is divided into two,:

1. Stage of residual shocks and reorganization. In this phase, life gets back on its track, sleep, appetite are restored, professional activity, the deceased ceases to be the main focus of life.

This stage, as a rule, lasts for a year: during this time, almost all ordinary life events occur and then begin to repeat themselves. The death anniversary is the last date in this series. Maybe that's why most cultures and religions set aside one year for mourning.

2. Stage of "completion". The normal grief experience we are describing enters its final phase about a year later. Here, the mourner sometimes has to overcome some cultural barriers that hinder the act of completion.

The meaning and task of the work of grief in this phase is to ensure that the image of the deceased takes its permanent place in the family and personal history, family and personal memory of the grieving person, as a bright image that causes only light sadness.

One of the biggest obstacles to the normal functioning of grief is the often unconscious desire of mourners to avoid the intense suffering associated with grief and to avoid expressing the emotions associated with it. In these cases, there is a “stuck” at any of the stages and the appearance of painful reactions of grief is possible.

Painful grief reactions. Painful grief reactions are distortions of the "normal" mourning process.

Delayed response. If a bereavement finds a person during the decision of some very important issues or if it is necessary for the moral support of others, he may show little or no sign of his grief for a week or even much longer. In extreme cases, this delay can last for years, as evidenced by cases where people who have recently suffered a bereavement are gripped by grief over people who died many years ago.

Distorted reactions. May appear as superficial manifestations of unresolved grief. The following types of such reactions are distinguished:

1. Increased activity without a sense of loss may manifest itself in a tendency to engage in activities close to what the deceased did at one time.

2. The appearance of the grieving symptoms of the last disease of the deceased.

3. Psychosomatic conditions, which primarily include ulcerative colitis, rheumatoid arthritis and asthma.

4. Social isolation, pathological avoidance of communication with friends and relatives.

5. Violent hostility against certain persons, with a sharp expression of their feelings.

6. Hidden hostility. Feelings become, as it were, "hardened", and behavior becomes formal.

7. Loss of forms of social activity. A person cannot decide on any activity. Only ordinary everyday things are done, and they are performed in a pattern.

8. Social activity to the detriment of their own economic and social status.

9. Agitated depression with tension, agitation, insomnia, feelings of worthlessness, harsh self-accusations and a clear need for punishment.

Flowing into each other on the rise, these distorted reactions significantly delay and aggravate the mourning and the subsequent “recovery” of the mourner.

The tasks of the work of grief. Passing through certain stages of experience, mourning performs a number of tasks (according to G. Whited):

1. Accept the reality of loss with your mind and feelings.

2. Experience the pain of loss.

3. Create a new identity, that is, find your place in a world that already has losses.

4. Transfer energy from loss to other aspects of life.

The emotional experience of a person changes and enriches in the course of personality development as a result of experiencing crisis life periods, empathy with the mental states of other people. Particularly in this series are the experiences of the death of a loved one.

Conclusions for chapter 1:

1. Difficult life situations arise either in case of imbalance in the system of relations between the individual and his environment; or discrepancies between goals, aspirations and opportunities for their implementation and personality traits. Difficult life situations are classified: 1) by intensity, 2) by the magnitude of the loss or threat, 3) by duration (chronic, short-term), 4) by the degree of manageability of events (controlled, uncontrolled), 5) by the level of influence.

A critical life situation is a crisis. This is a state generated by a problem that has arisen before a person, from which he cannot escape and which he cannot resolve in a quick time and in the usual way. The collision of a person with an insurmountable barrier - the loss of a loved one, the loss of a job, the loss of health, creates a crisis. The process of overcoming this crisis is experiencing. The most serious shock in the life of every person is the experience of the loss of a loved one.

2. Psychological research, dedicated to the loss of a loved one, for the most part made abroad. The main feature of Western American) researchers is a practical focus on adapting a person to a situation and therefore a behavioral approach. The developments of domestic psychology are mostly devoted to urgent short-term psychological assistance in extreme situations. Loss is an experience associated with the impact of super-strong psychic trauma. The loss can be temporary (separation) or permanent (death); real or imagined; physical, psychological or social (loss of work or school).

3. The experience of loss is considered at two levels: event-reflexive and spiritual-reflexive. The following conditions influence the experience of loss: 1) the nature of the loss situation; 2) perception of the loss situation; 3) features of the lost loved one; 4) sociocultural space; 5) individual psychological characteristics of the bereaved.

4. It is necessary to consider the experience of the loss of a loved one as a systemic multilevel experience that has general psychological patterns that are invariant with respect to the situation of loss, the gender and age of the bereaved, as well as the type of the lost. On this basis, it is possible to predict the subsequent stages of the process of experiencing loss and clearly formulate specific steps in providing practical psychological assistance.

5. Grief is a strong emotional reaction to loss, which manifests itself in the form of emptiness and sadness, and severe depression can develop. Conventionally, “normal” mourning and “pathological” mourning are distinguished. The following phases of grief are distinguished: the stage of shock, the stage of denial, the stage of aggression, the stage of depression, the stage of acceptance of what happened. Painful reactions of grief include: delay of reaction, distortion of reactions.

PSYCHOLOGY OF LOSS AND DEATH

Grief reactions

Reactions of grief, grief and loss can cause the following reasons:

1. loss of a loved one;
2. the loss of an object or position that had emotional significance, for example, the loss of valuable property, deprivation of a job, position in society;
3. disease-related loss.

The psychological experiences that accompany the loss of a child are stronger than those of the death of another loved one, and the feelings of guilt and helplessness can sometimes be overwhelming. Manifestations of grief in some cases last a lifetime. Up to 50% of spouses who survive the death of a child divorce. Grief reactions are often found in the elderly and senile age. The main thing in assessing a person’s condition is not so much the cause of the grief reaction, but the degree of significance of any loss for a given subject (for one, the death of a dog is a tragedy that can even cause a suicide attempt, and for another, grief, but fixable: ʼʼyou can get another ʼʼ ). With a grief reaction, it is possible to form behavior that threatens health and life, for example, alcohol abuse. Variants of allocation of various stages of grief are presented in table. 8. Help for people with grief includes psychotherapy, psychopharmacotherapy, organization of psychological support groups. The tactics of behavior of medical staff with their patients in a state of grief should be based on the following recommendations and comments:

Stages of grief

1. one should encourage the patient to discuss his experiences, allow him to simply talk about the lost object, recall positive emotional episodes and events of the past;
2. do not stop the patient when he starts crying;
3. in the event that the patient has lost someone close, one should try to ensure the presence of a small group of people who knew the deceased (s), and ask them to talk about him (her) in the presence of the patient;
4. frequent and short visits with the patient are preferable to long and infrequent visits;

Consideration should be given to the possibility that the patient may have a delayed grief reaction that manifests itself after a short time.

Life has its immutable laws, and we are given both joy and sorrow. However, many diligently try not to notice the "black bars", thinking that such tactics will allow them to live more calmly and happily.

In Soviet times, even doctors believed that cancer patients should not know their terrible diagnosis, because they could not bear it. However, experience shows that people need to be prepared for the blows of fate so that they can endure them with minimal losses and continue to live with dignity and fight for their lives.

Stages of grief

The generally recognized specialist in the field of terminal states, the American psychologist Elizabeth Kübler-Ross spent more than a dozen years at the bedside of dying patients. She identified five stages that a person goes through after receiving a terminal diagnosis or receiving a message about a bereavement.

1. "Negation"(or shock). The person cannot believe that THIS happened to him. “The doctors probably mixed up my tests ...” or “It can’t be, look - my husband was just breathing!”.
2. "Anger". Outrage at the work of doctors: “I went through all the examinations, and how could you miss my illness!”. Anger at other people, including God: “How could He allow this?”.
3. "Trade". A person is trying to "negotiate" with the inevitable fate. The doctor informs him that with the fourth stage of the disease, about six months remain to live. The patient can go to church and light candles in the hope that he will be credited and he will live another 6 months.
4. "Depression". Despair, the patient drops his hands, he withdraws into himself. He lies on the couch all day, staring at the wall.
5. "Adoption". The patient is fully aware of his condition and begins to take reasonable steps to prolong his life and use the chances of recovery.

Why do you need to know these stages?

The fact is that the patient does not always go through all the stages in the order described by Kübler-Ross. I have seen many patients who remain stuck in the Denial or Anger stage. At the same time, they generally refused treatment, announced that the doctors were wrong, and tried to prove that everything was in order with them. In this situation, relatives and friends can tactfully explain to the patient that treatment should not be avoided, because if you do not hide from reality, but make efforts to solve the problem, then the disease may well be cured or, at least, the patient's life will be significantly extended.

Attempts to treat oncological diseases with the so-called "folk remedies" are most often used by patients who are at the stage of Trade. They are ready to do anything, just not to go to specialists. How do you like the treatment of cancer with CANCER (ie, the use of an infusion of the arthropods of the same name)? There are hundreds of idiotic and just not very smart ways that are guaranteed to ruin the patient. They are all typical of the Trading stage: "If I do THIS, I will somehow be healed."

The danger of the Depression stage is obvious and needs no comment. A serious illness is not a reason to give up completely. In any state, a person can do a lot of useful things for himself and others. The novel "How the Steel Was Tempered" was dictated by the completely immobilized blind writer N. Ostrovsky.

If a loved one has passed away

If death occurred as a result of a long painful illness, often loved ones may even experience a sense of relief. And people who have strong religious beliefs generally endure the loss more easily. I have heard: “My husband went to heaven to receive a reward for his suffering on sinful earth!”.

It also happens vice versa - when a person has a feeling of "chronic grief", which lasts more than 12-18 months. And this is an occasion to turn to professionals, here, serious treatment may be required.

Sergei Bogolepov

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