Grief and IBS: some thoughts on how to survive it and recover.

‘Tonight I can write the saddest lines.
I loved her, and sometimes she loved me too.

…… I no longer love her, that’s certain, but maybe I love her.
Love is so short, forgetting is so long.’

From Pablo Neruda.

As soon as she entered the room, I could sense how tense Gayle was. The atmosphere was electric. She sat down on the edge of the chair and without pausing, told me how bad her symptoms were, how much they controlled her life, how many doctors she’d seen, what treatments she’d tried, how nothing had worked and nobody seemed to care and how desperate she felt. I looked at her and listened, breathing slowly and deeply. Eventually she paused.

I let the silence settle between us and then asked, ‘So how long have you had IBS?’.

‘Oh, I don’t know, I think it started last November. Not long after mum died.’

‘I’m sorry. That must have been a very sad time. So do you think it was the loss of your mother that brought all this on?’

‘Oh no. She had been ill for a long time. It was not unexpected.’

‘But it still upsets you.

‘I …’ Her voice faltered, She looked down, And when she looked up again, the tears were running down her cheeks.

‘I wasn’t there for her. I was too busy. And I feel so guilty’

The loss of somebody you love, whether through abandonment, dementia or death, can be a devastating experience that is so often followed by illness. Nevertheless, while society recognises grief, it often seeks to cover it up. There is an implicit expectation that you go through a brief process of bereavement, get everything sorted out and then just carry on. There is no statutory right for workers in the UK to have paid leave for bereavement, but it is considered reasonable for most employers to grant to few days of unpaid leave to arrange a funeral and start probate proceedings. No wonder so many people seem to deny or conceal their grief and bury themselves in work. But suppression of grief so often leads to illness; unable to be voiced and shared, the energy and the anguish of it are expressed in the body. It is the unbearable pain, sleeplessness or diarrhoea rather than the devastating loss that can leave people feeling desperate. In our so-called ‘civilised societies’, it is much more acceptable to be desperate through illness than devastated by grief.

Freud, in his 1917 paper Mourning and Melancholia, asserted that healthy mourning is a conscious process that lasts about a year during which psychic energy is withdrawn from the deceased as the bereaved gradually forgets and gets on with the rest of life. It is when that process is complicated by ambivalence or trauma, that if fails to reach a natural conclusion and can lead to melancholia or depression. Psychoanalyst, Otto Kernberg has challenged this, suggesting that the deceased remains incorporated in our unconscious mind often for years, transforming the way we think and live our lives. So instead forgetting and moving on, current ideas focus more on a continued internal relationship with the deceased. In the beginning, grieving fills up all the space, but as the business of living intrudes and takes precedence, thoughts of the deceased may fade into the background but they still continue to influence our thoughts and actions.

There are, however, circumstances in which this natural transformation is impaired. These include:

• sudden and unexpected death
• uncertain death – ‘closure’ is impossible when somebody is missing, presumed dead.
• unresolved or frightening memories of the circumstances of a person’s death.
• when bereavement is complicated by guilt. ‘I wish I had gone to see her more.’ ‘If only we hadn’t argued.’ ‘We should have talked and made up and now it’s too late.’ If the damage to the self inflicted by guilt is not worked through and repaired, then the loss can persist as illness and pain.
• during the living bereavement that can occur when the one you love leaves you and finds someone else. The sense of betrayal and rejection intensifies the loss and becomes a source of anguish that is rekindled by anything that brings it back to mind.

Traumatic Grief

Trauma complicates grief by inflicting a wound on the psyche. The things that might have been said; the apologies, explanations or mitigations, cannot be voiced. So, without forgiveness or redemption, the pain can take a long time to heal, if at all. Such complicated grief is not only more likely to be associated with extended anguish or depression but also physical symptoms of IBS, chronic fatigue, fibromyalgia and other illnesses. We cannot grieve the loss until we have processed the trauma. If we suppress the conditions of loss, then dreams, memories, flashbacks and associations rekindle the shame and horror of it, preventing resolution and arresting the progress of life.

It is often the people struggling to cope with the emotional and physical illnesses of complicated grief, who seek help from psychotherapy. The goal of therapy is to help them resolve their ambivalence by seeking a sense of understanding and forgiveness, not only forgiveness of ‘the other’ but also forgiveness of oneself. Therapy for grief is often regarded as a dual process, that oscillates between the work of grieving and the work of restoration that accommodates the loss and facilitates life.  If therapists can help their clients construct a credible and coherent narrative that they can live with, the internal relationship with the deceased is recreated as one that is less ambivalent. Some people find they have a much closer relationship with the deceased after they have died.  They find that they remember the good things and can grieve the parent they wanted to have.  ‘It is never too late to have a good dad.’

I’ve heard of people, whose death was the last act of vengeance. ‘When I die, you will be sorry’. The bereaved should try not to feel angry or guilty, but to understand it as a dying person’s last, desperate attempt to convince themselves that their life is still meaningful.

The Metaphysics of Grief

The ancient Norse imagined a person’s life as a bird that flies in at one end of the hall, where the banquet is going on, and flies out at the other. Their brief existence doesn’t really matter. Life carries on. Death is merely an absence. The only meaning in death is what we chose to imbue it with. Soldiers in wartime or concentration camp survivors had no time to grieve. Death was around them all the time; the focus was on survival. In contrast, the author, critic and broadcaster, Clive James, who has been dying for nearly seven years, has written written his most moving and meaningful poetry during this protracted terminal illness. Grief ends not when you forget, but when remembering is no longer painful.

What many people fear most about loss and bereavement is the loneliness. This is not just social loneliness that can be assuaged by company, it is an altogether deeper emotional loneliness, an absence of the meaning that the presence of the other represented. The nothingness of loss is so appalling to a civilisation that thrives on meaning.  Being alive is such an exquisite, tormented experience that love and grief are the illusions that we use to comfort us that we are not alone. But all love is in essence self love and equally all grief is grief for the loss of that part of oneself. We shouldn’t assume we have lost the person, we never had them; only our illusion of them.

You can’t heal emotional loneliness with company.  Most people are so scared of death, they don’t want to talk about it.  They would rather take you out of your place of mourning and divert you with something amusing or interesting, but that is only relieving their own discomfort.

Optimising the process of grief.

You need time to grieve – and space. Other people are important as long as they do not try to help too much. Life needs to assume its own rhythms. Exercise and rituals can help, nature, wild life, music, writing, painting – all the aspects of mindfulness. And sleep. If we can allow ourself to sleep, it brings us closer to the painful reality of the loss where thoughts can be transformed.

Pain is the agent of change and should not be dulled out of existence with drugs or alcohol or diverted with work, activity or entertainments. It is not there all the time, but comes in waves when beckoned by association.  It occurs less frequently as time passes and eventually disappears. Working through the pain of bereavement with a good friend, counsellor or therapist allows the loss to be accommodated safely in the mind so that you can grow around and beyond it. Friends, lovers, parents or siblings may be gone, but they are never really lost to us, they just cease to be so relevant and so painful. (Klass, Silverman and Nickman, 1996).

Before she died, my mother used to say, with a twinkle in her eye. ‘If you don’t look after me, I shall come back and haunt you.’ It was true! She has! But we can still laugh about it.

This post was inspired by The Landscapes of Grief, a recent conference organised by CONFER and featuring Julia Samuel, author of Grief Works: Stories of Life, Death and Surviving and founder of Child Bereavement UK.