The experience of grief is perhaps one of the most mysterious manifestations of spiritual life.

How miraculously will a person devastated by loss manage to be reborn and fill his world with meaning? How can he, confident that he has forever lost the joy and desire to live, be able to restore peace of mind, feel the colors and taste of life? How is suffering melted into wisdom?

All these are not rhetorical figures of admiration for the strength of the human spirit, but pressing questions, to know the specific answers to which it is necessary, if only because sooner or later we all have to, whether by professional or human duty, console and support grieving people.

Can psychology help in finding these answers? In domestic psychology - do not believe it! – there is not a single original work on the experience and psychotherapy of grief.

As far as Western studies are concerned, hundreds of papers describe the smallest details of the branching tree of this topic - grief pathological and "good", "delayed" and "anticipatory", the technique of professional psychotherapy and mutual assistance of elderly widowers, grief syndrome from sudden infant death and the impact of videos about death on children in grief, etc., etc.

However, when behind all this variety of details you try to discern an explanation of the general meaning and direction of the processes of grief, then almost everywhere the familiar features of Z. Freud's scheme, given back in "Sadness and Melancholy" (See: Freud Z. Sadness and Melancholia // Psychology of Emotions) Moscow, 1984, pp. 203-211).

It is unsophisticated: "the work of sadness" is to tear psychic energy from a beloved, but now lost object. Until the end of this work, "the object continues to exist mentally," and after its completion, the "I" becomes free from attachment and can direct the released energy to other objects.

"Out of sight - out of mind" - such, following the logic of the scheme, would be an ideal grief according to Freud. Freud's theory explains how people forget the departed, but it does not even raise the question of how they remember them. We can say that this is the theory of oblivion. Its essence remains unchanged in modern concepts.

Among the formulations of the main tasks of the work of grief, one can find such as "accepting the reality of loss", "feeling pain", "re-adjusting to reality", "reclaiming emotional energy and investing it in other relationships", but it is vain to look for the task of remembrance and remembrance.

Namely, this task is the innermost essence of human grief. Grief is not just one of the feelings, it is a constitutive anthropological phenomenon: not a single most intelligent animal buries its fellows. To bury is, therefore, to be a man. But to bury is not to discard, but to hide and preserve.

And on the psychological level, the main acts of the mystery of grief are not the separation of energy from the lost object, but the arrangement of the image of this object for storage in memory. Human grief is not destructive (to forget, tear off, separate), but constructive, it is designed not to scatter, but to collect, not to destroy, but to create - to create memory.

Based on this, the main goal of this essay is to try to change the paradigm of "forgetting" to the paradigm of "remembering" and in this new perspective to consider all the key phenomena of the process of grief experience.

The initial phase of grief is shock and numbness. "Can't be!" - this is the first reaction to the news of death. The characteristic state can last from a few seconds to several weeks, on average, by the 7-9th day, gradually changing to another picture.

Numbness is the most noticeable feature of this condition. The mourner is constrained, tense. His breathing is difficult, irregular, a frequent desire to take a deep breath leads to intermittent, convulsive (like steps) incomplete inspiration. Loss of appetite and sexual desire are common. Often occurring muscle weakness, inactivity are sometimes replaced by minutes of fussy activity.

A feeling of unreality of what is happening, mental numbness, insensitivity, deafness appears in the human mind. The perception of external reality is dulled, and then in the future there are often gaps in the memories of this period.

A. Tsvetaeva, a man of brilliant memory, could not restore the picture of her mother’s funeral: “I don’t remember how they carry, lower the coffin. How they throw clods of earth, fill up the grave, how the priest serves the memorial service. Something erased all this from memory ... Fatigue and drowsiness of the soul. After my mother's funeral in memory - a failure "(Tsvetaeva L. Memoirs. M., 1971. P. 248).

The first strong feeling that breaks through the veil of numbness and deceptive indifference is often anger. It is unexpected, incomprehensible to the person himself, he is afraid that he will not be able to contain it.

How to explain all these phenomena? Usually, the shock reaction complex is interpreted as a defensive denial of the fact or meaning of death, preventing the mourner from facing the loss in its entirety at once.

If this explanation were correct, consciousness, trying to distract itself, turn away from what happened, would be completely absorbed in current external events, involved in the present, at least in those aspects of it that do not directly remind of the loss.

However, we see the exact opposite picture: a person is psychologically absent from the present, he does not hear, does not feel, is not included in the present, it seems to pass him by, while he himself is somewhere in another space and time. We are not dealing with the denial of the fact that "he (the deceased) is not here", but with the denial of the fact that "I (the mourner) am here".

A tragic event that has not happened is not admitted into the present, and it itself does not allow the present into the past. This event, without becoming psychologically real at any moment, breaks the connection of times, divides life into unconnected "before" and "after". The shock leaves the person in this "before", where the deceased was still alive, was still nearby.

The psychological, subjective sense of reality, the sense of "here and now" gets stuck in this "before", the objective past, and the present with all its events passes by without being recognized by consciousness as its reality. If it were given to a person to clearly realize what is happening to him in this period of stupor, he could say to those who sympathize with him that the deceased is not with him: "I am not with you, I am there, more precisely, here, with him."

Such an interpretation makes clear the mechanism and meaning of the emergence of both derealization sensations and mental anesthesia: will terrible events subjectively occur; and post-shock amnesia: I can't remember things I didn't participate in; and loss of appetite and decreased libido, those vital forms of interest in the outside world; and anger.

Anger is a specific emotional reaction to an obstacle, an obstacle in satisfying a need. The whole of reality turns out to be such an obstacle to the unconscious desire of the soul to stay with the beloved: after all, any person, a phone call, household duties require concentration on oneself, make the soul turn away from the beloved, get out of the state of illusory connection with him even for a minute.

What theory supposedly infers from a multitude of facts, pathology sometimes visibly shows in one striking example. P. Janet described a clinical case of a girl who took care of her sick mother for a long time, and after her death she fell into a painful state: she could not remember what had happened, she did not answer the doctors' questions, but only mechanically repeated movements in which one could see the reproduction of actions , which became familiar to her during the care of the dying.

The girl did not experience grief, because she lived completely in the past, where her mother was still alive. Only when this pathological reproduction of the past with the help of automatic movements (memory-habit, according to Jean) was replaced by the opportunity to arbitrarily recall and tell about the death of her mother (memory-story), the girl began to cry and felt the pain of loss.

This case allows us to call the psychological time of shock "the present in the past." Here the hedonistic principle of the avoidance of suffering reigns supreme over soul life. And from here, the process of grief still has a long way to go until a person can strengthen himself in the "present" and remember the past without pain.

The next step on this path - the search phase - is distinguished, according to S. Parkes, who singled it out, for an unrealistic desire to return the lost and a denial not so much of the fact of death as of the permanence of loss. It is difficult to indicate the time limits of this period, since it rather gradually replaces the previous phase of shock and then the phenomena characteristic of it occur for a long time in the subsequent phase of acute grief, but on average the peak of the search phase falls on the 5-12th day after the news of death.

At this time, it can be difficult for a person to keep his attention in the outside world, reality is, as it were, covered with a transparent muslin, a veil, through which the sensations of the presence of the deceased break through quite often: a knock on the door - a thought flashes: it is he; his voice - you turn around - strange faces; suddenly on the street: he is the one entering the telephone booth. Such visions, woven into the context of external impressions, are quite common and natural, but frightening, taking them as signs of impending madness.

Sometimes such an appearance of the deceased in the current present occurs in less abrupt forms. P., a 45-year-old man who lost his beloved brother and daughter during the Armenian earthquake, on the 29th day after the tragedy, telling me about his brother, spoke in the past tense with obvious signs of suffering, but when it came to his daughter, he smiled and with a gleam in his eyes he admired how well she studies (and not "studied"), how she is praised, what an assistant to her mother. In this case of double grief, the experience of one loss was already at the stage of acute grief, and the other was delayed at the stage of "search".

The existence of the deceased in the mind of the mourner differs in this period from that which pathologically acute cases of shock reveal to us: shock is unrealistic, search is unrealistic: there is one being - before death, in which the hedonistic principle reigns supreme over the soul, here - "as it were, a double being "("I live, as it were, on two planes," says the mourner), where behind the fabric of reality, another existence is constantly felt latently, breaking through islands of "meetings" with the deceased.

Hope, which constantly gives rise to faith in a miracle, coexists in a strange way with a realistic attitude, which habitually guides all the external behavior of the mourner. Weakened sensitivity to contradiction allows consciousness to live for some time according to two laws that do not interfere in each other's affairs - in relation to external reality according to the principle of reality, and in relation to loss - according to the principle of "pleasure".

They coexist on the same territory: in a series of realistic perceptions, thoughts, intentions (“I’ll call her now”), images of an objectively lost, but subjectively living being become, become as if they are from this series, and for a second they manage to deceive the realistic installation, accepting them as "their own". These moments and this mechanism constitute the specifics of the "search" phase.

Then comes the third phase - acute grief, lasting up to 6-7 weeks from the moment of the tragic event. Otherwise, it is called a period of despair, suffering and disorganization and - not very accurately - a period of reactive depression.

Preserved, and at first may even intensify, various bodily reactions - difficult shortened breathing: asthenia: muscle weakness, loss of energy, a feeling of heaviness of any action; feeling of emptiness in the stomach, tightness in the chest, lump in the throat: increased sensitivity to odors; decreased or unusual increase in appetite, sexual dysfunction, sleep disturbances.

This is the period of greatest suffering, acute mental pain. There are many heavy, sometimes strange and frightening feelings and thoughts. These are feelings of emptiness and meaninglessness, despair, a feeling of abandonment, loneliness, anger, guilt, fear and anxiety, helplessness.

Typical is an extraordinary preoccupation with the image of the deceased (according to one patient, he remembered the deceased son up to 800 times a day) and his idealization - emphasizing extraordinary virtues, avoiding memories of bad features and deeds. Grief leaves its mark on relationships with others. Here there may be a loss of warmth, irritability, a desire to retire. Daily activities change.

It can be difficult for a person to concentrate on what he is doing, it is difficult to bring the matter to the end, and a complexly organized activity may become completely inaccessible for some time. Sometimes there is an unconscious identification with the deceased, manifested in involuntary imitation of his gait, gestures, facial expressions.

The loss of a loved one is the most difficult event that affects all aspects of life, all levels of the physical, mental and social existence of a person. Grief is unique, it depends on a one-of-a-kind relationship with him, on the specific circumstances of life and death, on the whole unique picture of mutual plans and hopes, insults and joys, deeds and memories.

And yet, behind all this variety of typical and unique feelings and states, one can try to isolate a specific set of processes that constitutes the core of acute grief. Only knowing it, one can hope to find the key to explaining the unusually variegated picture of the various manifestations of both normal and pathological grief.

Let us turn again to Z. Freud's attempt to explain the mechanisms of sadness. "... The beloved object no longer exists, and reality suggests the demand to take away all the libido associated with this object ... But its demand cannot be immediately fulfilled. It is carried out partially, with a great waste of time and energy, and before that the lost object continues to exist mentally.Each of the memories and expectations in which the libido was associated with the object is suspended, takes on an active force, and the release of the libido takes place on it.It is very difficult to point out and justify economically why this compromise work of demanding reality, carried out on all these separate memories and expectations, is accompanied by such exceptional mental pain "(Freud Z. Sadness and melancholy // Psychology of emotions. S. 205.).

So, Freud stopped before explaining the phenomenon of pain, and as for the most hypothetical mechanism of the work of sadness, he pointed not to the method of its implementation, but to the "material" on which the work is carried out - these are "memories and expectations" that "suspend and "acquire an increased active force".

Trusting Freud's intuition that it is here that the holy of holies of grief, it is here that the main sacrament of the work of sorrow is performed, it is worth peering carefully into the microstructure of one attack of acute grief.

This opportunity provides us with the subtlest observation of Anne Philip, the wife of the deceased French actor Gerard Philip: “The morning starts well. I learned to lead a double life. your face, a little blurry, like a photograph taken out of focus. And it's moments like this that I let my guard down: my pain is quiet, like a well-trained horse, and I let go of the bridle. A moment - and I'm trapped. You are here. I I hear your voice, feel your hand on my shoulder or hear your footsteps at the door I lose control of myself I can only shrink inwardly and wait for this to pass not here, you're there, in icy nothingness. What happened? What sound, smell, what mysterious association of thoughts brought you to me? I want to get rid of you. although I understand perfectly well that this is the most terrible, but at this very moment I lack forces allowed let you take possession of me. You or me The silence of the room cries out louder than the most desperate cry. Chaos in the head, the body is limp. I see us in our past, but where and when? My double separates from me and repeats everything that I did then "(Philip A. One moment. M., 1966. S. 26-27).

If we try to give an extremely brief interpretation of the internal logic of this act of acute grief, then we can say that the processes that make it up begin with an attempt to prevent the two currents flowing in the soul from coming into contact - the life of the present and the past: they go through an involuntary obsession with the past: then through the struggle and pain of the voluntary separation from the image of a loved one, but ends with the "coordination of times" with the opportunity, standing on the shore of the present, to peer into the notes of the past, without slipping there, observing oneself there from the side and therefore no longer experiencing pain.

It is remarkable that the omitted fragments describe the processes already familiar to us from the previous phases of grief, which were dominant there, and now are included in the integral act as subordinate functional parts of this act. The fragment is a typical example of the “search” phase: the focus of arbitrary perception is kept on real deeds and things, but the deep, still full of life flow of the past introduces the face of a dead person into the realm of representations.

It is seen vaguely, but soon attention is involuntarily attracted to it, it becomes difficult to resist the temptation to look directly at the beloved face, and already, on the contrary, the external reality begins to double [note 1], and the consciousness is completely in the force field of the image of the departed, in a mentally full being with its own space and objects (“you are here”), sensations and feelings (“I hear”, “feel”).

The fragments represent the processes of the shock phase, but, of course, not in that pure form, when they are the only ones and determine the entire state of a person. To say and feel "I am losing power over myself" means to feel how my strength is weakening, but still - and this is the main thing - do not fall into absolute immersion, obsession with the past: this is a powerless reflection, there is still no "power over myself", there is not enough will to control oneself, but there are already forces to at least "inwardly shrink and wait", that is, to hold on to the edge of consciousness in the present and realize that "this will pass."

To "shrink" is to keep oneself from acting within an imaginary, but apparently so real, reality. If you do not "shrink", a condition may occur, like the girl P. Janet. The state of "numbness" is a desperate holding oneself here, with only muscles and thoughts, because feelings are there, for them there - here.

It is here, at this step of acute grief, that separation begins, separation from the image of the beloved, a shaky support in the "here and now" is being prepared, which will allow you to say at the next step: "you are not here, you are there ...".

It is at this point that an acute mental pain appears, before explaining which Freud stopped. Paradoxically, pain is caused by the grieving person himself: phenomenologically, in a fit of acute grief, it is not the deceased who leaves us, but we ourselves leave him, break away from him or push him away from us.

And this self-made separation, this own departure, this exile of a loved one: "Go away, I want to get rid of you ..." and watching how his image really moves away, transforms and disappears, and causes, in fact, spiritual pain [note 2].

But here is what is most important in the performed act of acute grief: not the very fact of this painful separation, but its product. At this moment, not only does the separation, rupture and destruction of the old connection take place, as all modern theories believe, but a new connection is born. The pain of acute grief is not only the pain of decay, destruction and death, but also the pain of the birth of a new one. What exactly? Two new selves and a new connection between them, two new times, even worlds, and an agreement between them.

"I see us in the past..." - notes A. Philip. This is the new "me". The former could either be distracted from the loss - "think, speak, work", or be completely absorbed by "you". The new "I" is able to see not "you" when this vision is experienced as a vision in psychological time, which we called "present in the past", but to see "us in the past".

"Us" - therefore, his and himself, from the outside, so to speak, in the grammatically third person. "My double separates from me and repeats everything that I did then." The former "I" was divided into an observer and an acting double, into an author and a hero. At this moment, for the first time during the experience of loss, a piece of real memory of the deceased appears, of life with him as of the past.

This first, just born memory is still very similar to perception (“I see us”), but it already has the main thing - the separation and coordination of times (“I see us in the past”), when the “I” fully feels itself in present and pictures of the past are perceived precisely as pictures of what has already happened, marked with one or another date.

The former bifurcated being is united here by memory, the connection of times is restored, and pain disappears. It is not painful to observe a double acting in the past from the present [note 3].

It is no coincidence that we called the figures that appeared in the mind "author" and "hero". Here the birth of the primary aesthetic phenomenon really takes place, the appearance of the author and the hero, the ability of a person to look at the lived, already accomplished life with an aesthetic attitude.

This is an extremely important point in the productive experience of grief. Our perception of another person, especially a close one, with whom we have been connected by many life ties, is thoroughly permeated with pragmatic and ethical relations; his image is saturated with unfinished joint affairs, unfulfilled hopes, unfulfilled desires, unfulfilled plans, unforgiven insults, unfulfilled promises.

Many of them are almost obsolete, others are in full swing, others have been postponed to an indefinite future, but they are all not finished, they are all like questions asked, waiting for some answers, requiring some action. Each of these relationships is charged with a goal, the final unattainability of which is now felt especially sharply and painfully.

The aesthetic attitude, on the other hand, is capable of seeing the world without decomposing it into ends and means, outside and without ends, without the need for my intervention. When I admire a sunset, I don’t want to change anything in it, I don’t compare it with what it should be, I don’t strive to achieve anything.

Therefore, when, in an act of acute grief, a person first manages to completely immerse himself in a part of his former life with the deceased, and then exit it, separating in himself the “hero” who remains in the past, and the “author”, who aesthetically observes the life of the hero from the present, then this particle turns out to be won back from pain, purpose, duty and time for memory.

In the phase of acute grief, the mourner discovers that thousands and thousands of little things are connected in his life with the deceased (“he bought this book”, “he liked this view from the window”, “we watched this movie together”) and each of them captivates his consciousness into "there-and-then", into the depths of the flow of the past, and he has to go through pain to return to the surface. The pain goes away if he manages to take out a grain of sand, a pebble, a shell of memory from the depths and examine them in the light of the present, in the here-and-now. The psychological time of immersion, "the present in the past," he needs to transform into the "past in the present."

In a period of acute grief, his experience becomes the leading activity of a person. Recall that the leading activity in psychology is the activity that occupies a dominant position in a person’s life and through which his personal development is carried out.

For example, a preschooler works, helping his mother, and learns, memorizing letters, but not work and study, but play is his leading activity, in it and through it he can do more, learn better. It is the sphere of his personal growth.

For the mourner, grief during this period becomes the leading activity in both senses: it constitutes the main content of all his activity and becomes the sphere of development of his personality. Therefore, the phase of acute grief can be considered critical in relation to the further experience of grief, and sometimes it acquires special significance for the entire life path.

The fourth phase of grief is called the phase of "residual shocks and reorganization" (J. Teitelbaum). At this phase, life gets back on its track, sleep, appetite, professional activity are restored, the deceased ceases to be the main focus of life. The experience of grief is no longer a leading activity, it proceeds in the form of frequent at first, and then more and more rare separate shocks, such as occur after the main earthquake.

Such residual attacks of grief can be as acute as in the previous phase, and subjectively perceived as even more acute against the background of normal existence. The reason for them is most often some dates, traditional events ("New Year for the first time without him", "spring for the first time without him", "birthday") or events of everyday life ("offended, no one to complain", "in his name the mail has arrived").

The fourth phase, as a rule, lasts for a year: during this time, almost all ordinary life events occur and begin to repeat themselves in the future. The death anniversary is the last date in this series. Perhaps it is no coincidence that most cultures and religions set aside one year for mourning.

During this period, the loss gradually enters into life. A person has to solve many new tasks related to material and social changes, and these practical tasks are intertwined with the experience itself. He very often compares his actions with the moral standards of the deceased, with his expectations, with "what he would say."

The mother believes that she has no right to take care of her appearance, as before, before the death of her daughter, since the deceased daughter cannot do the same. But gradually more and more memories appear, freed from pain, guilt, resentment, abandonment. Some of these memories become especially valuable, dear, they are sometimes woven into whole stories that are exchanged with relatives, friends, often included in the family "mythology".

In a word, the material of the image of the deceased released by acts of grief undergoes a kind of aesthetic processing here. In my attitude towards the deceased, wrote M. M. Bakhtin, “aesthetic moments begin to prevail ... (compared to moral and practical ones): I have before me the whole of his life, freed from the moments of the temporal future, goals and obligations. The burial and the monument are followed by memory.

I have the whole life of another outside of myself, and this is where the aestheticization of his personality begins: fixing and completing it in an aesthetically significant image. From the emotional-volitional setting of commemoration of the departed, the aesthetic categories of shaping the inner person (and the external one) are essentially born, because only this setting in relation to the other has a value approach to the temporary and already completed whole of the external and internal life of a person ...

Memory is the approach of the point of view of value completeness; in a certain sense, memory is hopeless, but only it can appreciate, in addition to purpose and meaning, an already completed, completely present life "(Bakhtin M.M. Aesthetics of verbal creativity. P. 94-95).

The normal experience of grief that we are describing enters its last phase, the “completion,” about a year later. Here, the mourner sometimes has to overcome some cultural barriers that make the act of completion difficult (for example, the notion that the duration of grief is a measure of our love for the deceased).

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 ongoing semantic whole of my life (it can, for example, become a symbol of kindness) and be fixed in the timeless, value dimension of being.

Let me conclude with an episode from psychotherapeutic practice. I once had to work with a young painter who lost his daughter during the Armenian earthquake. When our conversation was coming to an end, I asked him to close his eyes, imagine an easel with a white sheet of paper in front of him and wait until some image appeared on it.

The image of a house and a gravestone with a lit candle arose. Together we begin to complete the mental picture, and mountains, blue skies and bright sun appeared behind the house. I ask you to focus on the sun, to consider how its rays fall. And so, in the picture evoked by the imagination, one of the rays of the sun is combined with the flame of a funeral candle: the symbol of the dead daughter is combined with the symbol of eternity. Now we need to find a way to get rid of these images.

The frame in which the father mentally places the image serves as such a means. The frame is wooden. The living image finally becomes a picture of memory, and I ask my father to squeeze this imaginary picture with his hands, appropriate it, absorb it into himself and place it in his heart. The image of the dead daughter becomes a memory - the only way to reconcile the past with the present.

Cherepanova "Psychology of grief"

Grief is not just one of the feelings, it is one of those feelings that makes a person a person. Not a single most intelligent animal buries its fellows. To bury is to be human. But to bury is not to discard, but to hide and preserve. Human grief is not destructive (to forget, tear off, separate), but constructive, it is designed not to scatter, but to collect, not to destroy, but to create - to create memory.

In principle, such an experience and symptoms may not necessarily occur only in the event of the death of a loved one.

A person goes through similar states (although they may be less pronounced) with any loss of a loved one - separation from him or, for example, when a parent leaves the family during a divorce. And even in the event of the death or loss of a dog or cat (also, after all, almost a family member!) Or in a quarrel with a close friend.

It is especially important to distinguish between "normal" and "pathological" grief, because grief, like any traumatic reaction, is a normal process. Using the example of grief, one can trace the natural dynamics of the course of any traumatic stress, i.e. how psychological traumatization is overcome in the optimal case the duration varies greatly depending on the severity of the injury as well as other factors.

GENERAL SYMPTOMS OF GRIEF

somatic disorders. Specific respiratory disorders. Breathing becomes intermittent, especially when inhaling, symptoms of physical overwork appear, loss of appetite, sleep disturbances (recurring nightmares, insomnia), symptoms of the disease from which the loved one died are possible.

Psychological sphere. Guilt (the main experience in any trauma, and in grief - dominant), immersion in the image of the deceased. Feeling of emptiness, fading, dullness of the world, irritability. Idealization of the deceased. Feeling abandoned, causing anger. This anger comes into conflict with idealization, causing strong conflicting feelings. A person, feeling his anger and its injustice, tries to restrain himself, and a kind of "stiffness" arises, a desire to get away from contact. At first - avoidance of talking about the deceased, then - importunate storytelling.

What is this anger? Where does it come from? It is usually difficult for those who are grieving to admit this feeling, but it is very important. And understanding this allows you to more accurately feel a person who has lost a loved one.

Children especially often tend to perceive the death of a loved one as betrayal, like the fact that they were abandoned, promising to always be there. This is a very painful experience, causing internal conflicts and conflicting feelings.

Other common symptoms of grief include specific disturbances in the sphere of meaning. Suddenly it turns out: no matter what you look at, everything was connected with the deceased. A strange forgetfulness appears in everyday life - for example, a plate is placed on the deceased, and this again causes a deterioration in the condition. Violated performance, attention, memory, which enhances and emphasizes the feeling of their own low value.

PHASES OF GRIEF

The initial phase of grief is shock and numbness."Can't be!" - this is the first reaction to the news of death. The characteristic state can last from a few seconds to several weeks, with an average of nine days. Numbness is the most prominent feature of this condition.

Oddly enough, a person in this phase feels quite well. He does not suffer, sensitivity to pain decreases and even disturbing diseases “pass away”. A person does not feel anything so much that he would even be glad to feel at least something. His insensitivity is regarded by others as a lack of love and selfishness. A stormy expression of emotions is required from the mourner, but if a person cannot cry, he is reproached and blamed. Meanwhile, it is precisely this "insensitivity" that testifies to the severity and depth of experiences. And the longer this "light" period lasts, the longer and more severe the consequences will be.

This phase is characterized loss of appetite, often occurring muscle weakness, inactivity, sometimes followed by minutes of fussy activity.

Appears in the human mind a feeling of unreality of what is happening, mental numbness, insensitivity, stupor. The perception of external reality is dulled, and then, in the future, gaps often arise in the memories of this period.. How to explain all these phenomena? Usually, the shock reaction complex is interpreted as a defensive denial of the fact or meaning of death, preventing the mourner from confronting the loss in its entirety at once.

The shock leaves the person in the time when the deceased was still alive. The present is accompanied by so-called derealization and depersonalization sensations ("this is not happening to me", "as if it were happening in a movie".)

Outwardly, at this phase, a person looks, in general, as always. He behaves as usual, fulfills his duties - studies, works, helps with the housework. Of course, if you look closely, you can see some features. So, his movements are somewhat mechanical (as if a robot), his face is mimic, motionless. The speech is inexpressive, low intonation. A little late with the reaction: he does not answer immediately, but after a little hesitation. Moves and speaks a little slowly. He does not show strong feelings at all, at times he can even smile, etc.

So, despite all the outward deceptive well-being, objectively a person is in a rather serious condition. And one of the dangers is that at any moment it can be replaced by the so-called an acute reactive state, when a person suddenly starts banging his head against the wall, throwing himself out of the window, i.e. becomes "violent". Surroundings, whose vigilance is "lulled", may not always be ready for this.

How can loved ones help a person who is experiencing grief and is in the phase of shock? What should and should not they do?

1. Talking to such a person and comforting him is completely useless. He still "does not hear" you, and to your attempts to console him, he will only say in surprise: "I feel good."

But what you can really do is to follow him everywhere with a "tail", not for a second letting him out of the field of attention, not leaving him alone. It is not necessary to speak to him, you can do it silently. It is only important not to leave a person alone with himself, if an acute reactive state suddenly begins.

2. If this is a child who is in school, it is better to keep out of school, even if he claims to be doing just fine.

3. Try your best more and more often to touch a person who is grieving hard. Tactile contact occurs very early in our life. In fact, this is the very first contact of the baby with the outside world. Therefore, no matter how the interactions of the grieving person with the outside world are disrupted, the tactile connection is most often preserved. Sometimes tactile contacts alone are enough to bring a person out of a severe shock. Especially if these are such symbolic actions as stroking the head. At this moment, most people begin to feel small, defenseless, they want to cry, as they cried in childhood. If you managed to cause tears, then the person moves into the next phase.

4. Need evoke any strong feelings in a person that will bring him out of shock. Strong joy in a person in such a situation is apparently not easy to arouse. But anger will do. Sometimes even the helper is worth "causing fire on himself", angering the mourner.

Existing cultural rituals facilitate and help a person survive grief. Therefore, the duration of the phase, on average, corresponds to the ritual dates.

The phase of suffering and disorganization lasts 6 - 7 weeks. On average 40 days. At this time, a person happens it is difficult to keep one's attention in the outside world, reality is, as it were, covered with a transparent muslin, a veil, through which the sensations of the presence of the deceased break through quite often. The doorbell rings - a thought will flash: this is it; his voice, you turn around - strange faces; suddenly on the street - it's him entering a telephone booth. Such visions, woven into the context of external impressions, naturally frighten, being taken for signs of impending madness.

Various bodily reactions persist and at first may even intensify - shortness of breath, muscle weakness, asthenia, loss of energy, feeling of heaviness in any action, feeling of emptiness in the stomach, tightness in the chest, lump in the throat, increased sensitivity to odors, decreased or extreme increase in appetite, sexual dysfunctions, sleep disturbances.

This is the period of greatest suffering, acute mental pain. There are many difficult, sometimes strange and frightening thoughts and feelings. These are feelings of emptiness and meaninglessness, despair, a feeling of abandonment, loneliness, anger, guilt, fear and anxiety, helplessness. Typical is an unusual preoccupation with the image of the deceased and his idealization, especially towards the end of the phase, emphasizing extraordinary virtues, avoiding memories of his bad features and deeds.. Grief leaves its mark on relationships with others. Here there may be a loss of warmth, irritability, a desire to retire. Daily activities change. It can be difficult for a person to concentrate on what he is doing, it is difficult to bring the matter to the end, and a complexly organized activity can become completely inaccessible for some time. Sometimes there is an unconscious identification with the deceased, manifested in involuntary imitation of his gait, gestures, facial expressions.

Grief work becomes the leading activity. This is the hardest period.

Guilt is the main experience. So-called pathogenic chains arise when a person, remembering an event, sees various hints that were given to him - since I knew, I could have prevented the event.

As I said before, guilt is an extremely unproductive feeling. A person who feels guilty will do nothing to alleviate his condition. On the contrary, the worse he is, the more the feeling of guilt is satisfied. Therefore, such people very rarely turn to a psychologist for help. And relatives and friends should help them in this. When it comes to a child, adults should be especially attentive to his condition, which will make it possible to accurately determine the moment when professional help may be needed. In the emotional sphere, such a child feels depressed, fearful. In particular, the fear of death is actualized. The child begins to feel that everything in life is fragile and can end at any moment, he begins to fear for the lives of loved ones.

Often children who have lost a loved one demand that their mother or father be with them all the time, even accompanying them to the toilet. Sometimes parents interpret this as a fear of being alone. This is true. But most importantly, they are afraid that while they are gone, something might happen to the parent, he might die. They note with fear the signs of the approaching old age of their parents: gray hair, wrinkles, etc.

Highly this phase is characterized by severe impairment of memory for current events. This is expressed so strongly that the child cannot go to school. Therefore, it is very important to provide the child with the necessary psychological assistance in time.

People around notice that even outwardly a person experiencing grief changes a lot. Amimism as it never happened . The face becomes very expressive, a mask of suffering freezes on it. The gait changes, the person stoops ("grief bent to the ground"), even the hair becomes dull. There are a lot of health problems. Something hurts all the time. At this phase, emotional lability appears - feelings are very easily evoked, at any moment a person is ready to cry.

What can be done to ease the suffering of the grieving?

1. If in the first phase you should always be with the grieving, then here you can and should give a person, if he wants it, to be alone.

2. But if he wants to talk to you, must always be at his disposal, listen to him (even if you are listening to it all for the hundredth time and it’s hard for you yourself) and support.

3. As already mentioned, these people are often irritable, however, understanding their condition, should be more gentle with them., forgiving a lot (but not all!).

4. If a person cries, at all it is not necessary to do what we call "comfort." Tears provide an opportunity for the strongest emotional discharge. Our lacrimal glands are designed in such a way that tears contribute to the production of sedatives. Calming a person, we do not allow this process to be completed.

5. At the end of this phase, you need start to slowly involve a person in socially useful activities: send to school or work, start loading homework. This is very useful, as it gives you the opportunity to distract from your main problem. Naturally, the regime should be gentle, since the person is still weakened.

6. It is believed that one must be extremely careful with a grieving person, I would say, reverent. But it's not. Try to imagine yourself surrounded by people, each of whom looks at you with a pitiful, sympathetic look. Yes, you will want to escape from them as soon as possible! Because everything will remind you of your loss.

In fact, at this stage you can already treat a person quite normally and sometimes you can even quarrel with him. A particularly remarkable method is the formation of a feeling of real guilt in a person. There is nothing you can do about survivor guilt, as it is irrational in its mechanisms. But you can transfer the center of gravity to reality. For example, you can say to a person who, in your opinion, is too carried away by the experience of grief, something like this: "Shame on you! You are busy with your feelings and do not care about those people who are around and who need your help. You are an egoist!" I assure you, these words will be like a balm to the wound for the grieving. He will be very pleased to hear them. He will not be offended by you, and even will feel gratitude, as you kind of "allowed" him to complete the work of experiencing grief.

7. And of course, a person must constantly demonstrate that although you understand his problem, but treat him like an ordinary person, without giving him any discounts and indulgences. This will also be highly appreciated and will help in readaptation. Of course, you must understand that this person is in a "state of grief", but do not show him this in any way.

Generally the phase of acute grief can be considered critical in relation to its further experience, and sometimes it acquires special significance for the entire life path. How it will be overcome will determine the strategy for later life. If positive, then it will be a very important emotional experience. If a person does not cope with grief, then he will forever remain in this phase (pathological grief), or he may like the sympathy and pity that he causes, and a professional Victim will form from him.

Residual shock phase and reorganization. This phase begins 40 days after the event and lasts about a year.

At this stage, life gets into its groove, sleep, appetite, daily activities are restored, the deceased ceases to be the main focus of life. The experience of grief is no longer a leading activity, it proceeds in the form of rare individual attacks. Such residual grief attacks can be as acute as in the previous phase, and subjectively perceived as even more acute against the background of normal existence. The reason for them most often are some dates, traditional events ("New Year for the first time without him", "spring for the first time without him", "birthday"), or events of everyday life ("offended, there is no one to complain", "about his name received a letter").

This phase usually lasts for a year. During this time, almost all ordinary life events occur and in the future they begin to repeat themselves. The death anniversary is the last date in this series. Perhaps it is no coincidence that most cultures and religions set aside one year for mourning.

During this period, the loss gradually enters life.. A person has to solve many new problems, and these practical problems are intertwined with the experience itself. He very often compares his actions with the moral standards of the deceased, with "what he would say." So, the girl refuses to eat sweets, because her dead brother cannot do the same. Gradually, more and more memories appear, freed from pain, guilt, resentment. Some of these memories become especially valuable, dear, they are sometimes woven into whole stories that are shared with relatives and friends. At this phase, a person, as it were, gets the opportunity to escape from the past and turns to the future - begins to plan his life without the deceased.

That's why the main psychological help at this stage is to help, to facilitate this appeal to the future, to help make all kinds of plans.

The normal grief experience we are describing enters its final phase about a year later.

Completion phase. Here, a person sometimes has to overcome some cultural barriers that make it difficult to complete the "work of grief". (This is one example where cultural traditions do not contribute to state optimization.) For example, the idea that the duration of grief is a measure of our love for the deceased.

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 our lives. A sign of this phase is that a person, remembering the deceased, no longer experiences grief, but sadness - a completely different feeling. And this sadness will remain forever in the heart of a person who has lost a loved one.

PATHOLOGICAL GRIEF

The normal "work of grief" can become a pathological process if a person "gets stuck" in one of the phases. As a rule - on the second. This leads to dire consequences when a person is doomed for an infinitely long time. experience the acute phase of grief - the most difficult, most painful. All symptoms of the second phase are intensified and emphasized. And a person develops a severe syndrome of post-traumatic stress disorders in full.

Causes of pathological grief:

Conflicts or quarrels with a loved one before his death.

Unfulfilled promises. For example, the son promised his mother to come to her, but put it off until it was too late...

Certain circumstances of the death of a loved one.

When a person for various reasons is not present at the funeral and does not have the opportunity to say goodbye.

Finally, a situation that largely causes pathological grief (I would even say - to the maximum extent) are the so-called "unburied dead" - the missing, those whose bodies were not found, those whose death was not reported to relatives, etc.

The reaction of loss to the death of a loved one can be manifested by emotional shock with numbness and "petrification" or anxiety, crying, sleep disturbance, appetite, narrowing of consciousness on psychotraumatic 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 recurring recurrences of the disease state, when the patient returns to an 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.

The practitioner's knowledge of the boundaries of uncomplicated, adaptive grief can help them 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 internal and external 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 time, strong character and a natural support system will correct the situation and free the grieving person 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.

People with complicated grief are characterized by specific psychological attitudes associated with difficulties 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.

© S.V. Umansky, 2012
© Published with the kind permission of the author

Grief reactions.

Stages of grief.

Tactics of medical personnel with patients in a state of grief.

Death and dying.

Stages of approach to death.

Psychological features of incurable patients, changes in the psyche.

Rules of conduct with the dying patient and his relatives.

The themes of death, dying and afterlife are extremely relevant for each of the living. This is true if only because sooner or later all of us will have to leave this world and go beyond the limits of earthly existence.

Elisabeth Kübler-Ross was one of the first to trace the path of the dying from the moment they learned of their near end to the moment they breathed their last.

Approaching death

Life leaves the earthly shell, in which it has been for many years, gradually, in several stages.

I. Social death.

It is characterized by the need of the dying person to isolate himself from society, to withdraw into himself and move further and further away from living people.

II. Psychic death.

Corresponds to the person's awareness of the obvious end.

III. Brain death means the complete cessation of the activity of the brain and its control over various functions of the body.

IV. Physiological death corresponds to the extinction of the last functions of the organism, which ensured the activity of its vital organs.

Death and subsequent cell death do not mean, however, that all processes in the body stop. At the atomic level, elementary particles continue their endless dizzying run, driven by energy that has existed since the beginning of all time. "Nothing is created anew and nothing disappears forever, everything is only transformed...".

Emotional stages of grief

Often there is an incurable patient in the department. A person who has learned that he is hopelessly ill, that medicine is powerless and he will die, experiences various

psychological reactions, the so-called emotional stages of grief. It is very important to recognize at what stage a person is at the moment in order to provide him with appropriate assistance.

Stage 1 is denial.

Words: "No, not me!" - the most common and normal reaction of a person to the announcement of a fatal diagnosis. For a number of patients, the stage of denial is shock and protective. They have a conflict between the desire to know the truth and avoid anxiety. Depending on how much a person is able to take control of events and how much support others provide him, he overcomes this stage easier or harder.

2nd stage - aggression, anger.

As soon as the patient realizes the reality of what is happening, his denial is replaced by anger. “Why me?” - the patient is irritable, demanding, his anger is often transferred to the family or medical staff.

It is important that the dying person has the opportunity to express his feelings.

3rd stage - bargaining, request for a delay

The patient tries to make a deal with himself or others, enters into negotiations for the extension of his life, promising, for example, to be an obedient patient or an exemplary believer.

These three phases constitute a period of crisis and develop in the order described or with frequent reversals. When the meaning of the disease is fully realized, the stage of depression sets in.

4th stage - depression.

Signs of depression are:

Constantly bad mood;

Loss of interest in the environment;

Feelings of guilt and inadequacy;

Hopelessness and despair;

Suicide attempts or persistent suicidal thoughts.

The patient withdraws into himself and often feels the need to cry at the thought of those whom he is forced to leave. He doesn't ask any more questions.

5th stage - acceptance of death.

The emotional and psychological state of the patient at the stage of acceptance undergoes fundamental changes. Man prepares himself for death and accepts it as a fact. He, as a rule, humbly waits for his end. At this stage, intensive spiritual work takes place: repentance, evaluation of one's life and the measure of good and evil by which one can evaluate one's lived life. The patient begins to experience a state of peace and tranquility.