Mourning: Death, Loss, Trauma, & Psychotherapy – The Universal Agent for Recovery and Change

Robert Berezin, MD
7
219

Mourning is the process by which we heal from grief. I’ve heard people say, “What’s the point of grieving, you can’t bring a loved one back from the dead.” That of course, is true, but it is what allows us, the survivors, to return back to the land of the living and resume our lives. There is an emptiness that always remains, as the pain of loss can never completely heal. At best by grieving our loss we can allow it to live on and be enshrined as a loving memory where it belongs. Once an attachment forms it can never be undone. It enters our world as a monument to the living. All loss leaves scars.

There are no set rules for grief. It takes however long it takes, sometimes years, sometimes more. Grieving operates on its own time. The very idea that the DSM-5 gives a two-week grace period before diagnosing a ‘biological depression’ is obscene on the face of it, never mind the handing out of Prozac. Other psychiatrists would like to push the window all the way to three or even four weeks. How compassionate. There is no place for antidepressants, ever.

I have taken many patients off of antidepressants, all of whom had had their necessary mourning stunted. After dealing with the pain of death, they were unanimously furious at being numbed and blocked from grieving. Grieving is painful. A lot of life is painful. Where is it written that we should be spared the pains that life brings. To deal with it one has to give the pain its due. Then we can move on. You can prolong it by avoiding it, or trying to override it, but you can’t make it go any faster.

But not only this, it turns out that mourning is the universal process of the brain that generates recovery and change. (See “Mourning is the Key”). For our functioning in life, the brain operates through consciousness itself. This is the level of brain organization where life’s adventures, conflicts, and sufferings reside. The very idea that molecular and neurotransmitter operations of the brain are deterministic of human behavior completely misses the boat. They are merely brain mechanisms, not the cause of human behavior. There is zero evidence to support this widely believed fallacy. Nevertheless, these unsubstantiated theories are amazingly accepted as fact. Human conflict and suffering operate at a much higher level of brain functioning. This is on the level of the organization consciousness itself.

Consciousness is organized as a play in the theater of the brain, composed of personas, relationships between them, scenarios, plots, set designs, and landscapes. It is a believed synthetic illusion through which we live our lives. It is also the stuff of dreaming. Mourning is the process by which the brain repairs itself in consciousness – it is how we heal from problems that range from from simple learning, to grief from death, to losses of all kinds; it is how we recover from Post Traumatic Stress; it is at the heart of healing our personalities in psychotherapy; it allows us to recover in general from damage to our plays of consciousness. It is the key to all change in the brain.

We’ll start with a simple model. When Eddie was in junior high school, he learned to play the guitar. As a beginner, he had mastered the easy chords — E and A. He wanted to expand his repertoire to B7, which is a much more challenging hand position. It required total attention to separate his fingers in a precise way in order to hold down the strings within certain frets. When first attempted, he couldn’t do it. He had to slowly place each finger in the right place. The muscles didn’t feel like they could get there, hold the position, or get sound out of the string. And it hurt. It required seconds to finalize the correct hand position. Each finger needed to be placed individually. Eddie thought to himself, Damn, I’ll never get this. As he continued to play B7, leave it, and come back to it again, it got a little easier. He finally quit that practice session. After a night’s sleep, he tried it again, but he still didn’t have it. He kept working on that B7. Full conscious attention was still required to get his fingers correctly onto the frets. The sound was coming out better. But it was still slow getting there. The chord was not, as yet, usable. Eventually he got it. Eddie’s experience of repeated efforts created a cortical map of the B7 hand position. The neuromuscular experience of his hand and fingers created a web of neuronal connections glued together by neuronal memory. Electro-chemical processes take place within synapses between neurons that establish a permanent electrical pathway connection. This took place throughout the millions of connecting neurons that created the B7 map in Eddie’s cortex. Once this neuron memory (the linkage between neurons) got established in the sensory and motor areas of the cortex for his fingers and hand, it became available to be activated as one B7 unit. The cortical map then became accessible for top-down processing—playing the chord.

However, there was a problem. Eddie played B7 with a scrunched up hand position which caused him to have trouble moving quickly to other chords. To fix this problem, he needed a new hand position that was open and not constricted. He decided to change his B7 hand position. In order to do so, he first had to force himself stop to using his previously scrunched up hand position. In addition, he had to give his full conscious attention, once again, to holding his fingers and hand differently. This took him back to muscular pain, clumsiness, slowness, inability, and frustration, just as it did the first time but not quite as bad. This was required for him to establish a new and different neuromuscular B7 map into his cortex. Soon enough, he got it.

This is, in fact the rudimentary model for brain change. Once the neuromuscular pattern gets established, it had had to be deactivated and relinquished. Then new experience using new pathways could get laid down to create a more fluid hand position.

The B7 chord is just simple neuromuscular learning. When we are dealing on the far more complicated level of the play of consciousness, the processes of change involve the limbic system and the amygdala. So now, in the realm of feeling – deactivation and rewriting is called mourning. If a man’s wife dies, despite the fact that the widower knows cognitively that his wife has died, his marriage play continued to live on in the deeply held mappings of his consciousness. Mourning her death is the process by which the older play of his wife will cease to be his activated play. The process of mourning would allow him to inhabit the new play—that she is gone.

Elisabeth Kubler-Ross’s five stages of grief – Denial, bargaining, anger, sadness, and acceptance – accurately describe the processes involved in relinquishing the old play to accept and inhabit the new one. [These five stages is just a shorthand, mourning is a far more complicated process than this.] Denial means that the widower continues to inhabit the old deeply held play, as he keeps the new traumatic play at bay (that she has died). Denial can’t really work, because the truth inevitably begins to creep in. Then he attempts to hold onto the old play and toss the new one away by bargaining. He employs magical thinking as he bargains with a personification of an all-powerful fate, or God, or death. “I’ll do whatever you want if I get to keep her.” When it becomes apparent that this doesn’t work either, he gets angry at the inexorable truth that his wife has been taken from him. Eventually, this gives way to the sadness of losing his attachment. And finally, he accepts the new play of death and loss and absence. The old play finally recedes and is no longer in ascendancy, and the new play takes its place. Then she will take her proper place in memory. The original play of their life together is deeply written in his cortical mappings. It takes years for the new play to be accepted, that she is gone.

In post traumatic stress, the trauma overrides the original play and writes a new one of violence or wrenching loss. This then becomes the new reality which gets played out over and over again. To recover from post trauma, one must digest the new trauma to return to regular functioning. This too is never perfect.

In fact, the formation of our characters comes from the traumas of deprivation and abuse all the way through development. These write traumatic plays in consciousness, as our unique constellations of temperament process the trauma. Psychotherapy is the specific process for recovery from such suffering. In psychotherapy, the primary characterological play has to be mourned, digested, and deactivated. This takes place in the context of a responsive relationship with the therapist. In its place a new play will be written by through responsive experience during the therapy. The characterological play is the most deeply held story of all, even more so than our story of the death of a wife. In psychotherapy, a patient mourns the story of his life, his meaningful attachments, and more profoundly, the mask figures of his life – the attachments to his mother, father, sisters, and brothers, through whom he wrote his play in the first place. Remember, for the stories to be relegated to memory, sadomasochistic attachments need to be mourned just the same as loving attachments.

The mourning of a life play is the specific and literal biological operation for the repair and healing of suffering. Biological psychiatry, neurology, and neuroscience in general, have pre-empted a claim on what is biological. They have defined biology as the domain of physical brain structure; brain organization, brain anatomy, and functional brain centers; neurotransmitters; hormones; information learned from studying brain lesions; and activated patterns of neurons that can be seen in brain scans associated with certain localized functions. There is a great deal of knowledge to be appreciated from these approaches. Unfortunately, their orientation has mistaken the parts for the whole. They have ignored the brain’s most important biological manifestation of all: the play of consciousness.

7 COMMENTS

  1. Thank you so much Dr. Berezin, I think I finally ‘get’ what you mean by the play of consciousness.

    Have you or could you write a blog like this that talks about the stages that someone who is suffering from thought disorder might be going through ?

  2. “I have taken many patients off of antidepressants, all of whom had had their necessary mourning stunted. After dealing with the pain of death, they were unanimously furious at being numbed and blocked from grieving.”
    I would also be furious if someone knocked on my door after a tragedy and suggested I take a pill to help me deal with things.
    But doctors are not knocking on doors. They are sitting in their offices waiting for patients to come to them. The real question is, why are bereaved people going to a doctor in the first place? What do they expect the doctor (or psychiatrist) to do – give them therapy? Did they think that a pill exists that can help them deal with pain without numbing them? What do they want?
    Pushing the issue away from psychiatry and into psychology is only part of the answer. The underlying problem is that there is often no longer any social/religious structure for people who need to go through a grieving process. How did people manage two hundred years ago pre-Freud? Most likely, a lot better than they manage today.
    The deceit that is today part and parcel of psychiatry is indeed something that should be battled and hopefully overcome. But we shouldn’t ignore the fact that many people do seek unhealthy ways to deal with the fact that, as the author writes, “A lot of life is painful.” If they weren’t doing that, then many psychiatrists would find themselves without clients. (Unhealthy ways meaning, that they seek to numb the pain rather than deal with it in a constructive way. Looking for a pill to lift their mood, rather than numb them, for instance, is little different. In short, they don’t want to do the hard work themselves.)
    Furthermore, I believe that many people find themselves referred to or heading of their own accord to psychiatrists after psychotherapy failed them – either they just didn’t see the results they wanted, or they ran out of funds for endless sessions, or whatever other reason. Again, what were people doing 200 years ago? Who would have thought, back then, to go to any sort of doctor to deal with grief – which is, after all, a normal part of life?
    What we are missing today is not so much organized religion, but the deep faith that underpins it, the faith that the Supreme Being is running the world with total precision and, crucially, with the ultimate good of all of creation in mind.
    I think that many people instinctively rebel at any approach to dealing with grief whose underlying message is, “Stuff happens. Move on.” Sure, the brain/consciousness can be rewired to exclude the missed person from the picture and enable the resumption of normal functioning. But we aren’t just boxes of wires and circuitry! Life isn’t just about being able to function – and the life of a person who does not seem to be functioning at all still has value.
    The author writes, “Where is it written that we should be spared the pains that life brings?” I would ask him, “Where is anything at all written to guide a person through the maze that is life?” Each person must find his own answers. Without them, a pill to numb the feelings suddenly seems ever so appealing.

    • That is a good point. I think there are many reasons for what you describe. One is how fragmented and lonely our societies have become. In the old times most people had a big family structure which for better or worse (we all know how families are) was there all the time and provided social framework of support. Now we often don’t have anyone to talk to and if we do we’re expected to fit it in one evening. Psychotherapy is not the same as grieving together with other people who go through the same process (not mentioning that psychotherapy in my experience is not much better than psychiatry – it may not poison you but there are other insidious ways to do harm when someone is incompetent or abusive). The other thing is time – we are supposed to get over it fairly quickly because we have to work and perform and we are not allowed to show our grief. In old times you were supposed to wear black for at least a year after your spouse dies and that was considered normal (which could have been oppressive in some ways too – now we just swung the pendulum to the otehr extreme). It’s a byproduct of capitalistic profit-oriented system when you’re expected to give 100% effort at all times. You’ve also mentioned religion and spirituality which is also a big factor. While I don’t think much of organized religion, I know that this provides a lot of people with hope and acceptance.

      Modern civilization is not healthy for us in general but we don’t seem to be doing much to change it – instead we’re drugging ourselves to oblivion.

  3. Thanks for this very intensive, thought-provoking article, Robert. I think you’ve really elaborated the huge reductionistic mistake inherent in biopsychiatry, i.e., reducing human consciousness and feelings to the “squirts and twitches” of neurons that simply need to be chemically regulated to correct problematic thoughts, feelings and behaviors. Your analysis in a way brings to mind the words of a famous, ancient king, who said “The heart of the wise is in the house of mourning”–even though I know that wasn’t really your point. I especially love your illustration of Eddie’s learning to play the B7 chord–that helps me understand and further appreciate the incredibly complex interplay between human consciousness, neurology, learning, behavior, etc.

  4. “Denial can’t really work, because the truth inevitably begins to creep in.”

    Oh, really?! Well, there seem to be many pro-coercion, anti-spiritual, pro-life-long-drugging, anti-dialogue psychiatrists out there. Their views are contra-factual, illogical and outright cruel, yet most of them appear to be free of openness, doubt and remorse, despite being shown both valid criticisms and workable alternatives. Most of them feel no hesitation to proceed on their faulty way. I wonder what depth of constant and persistent denial it requires. One should literally shield oneself from the world around, remaining encapsulated in the cocoon of self-righteousness and loyalty to the ideological construct which is effectively refuted.

    I can only hope that the few psychiatrists who is capable of critical attitude towards the foundation of their own profession can initiate its rebirth. Unlike so many of their colleagues (or former colleagues, in case of rebels who left the system, like Loren Mosher long ago), they are among the people whom I sincerely respect.