Complicated Grief, Attachment, and Art Therapy. Группа авторов
between spirituality and religiosity. Virgina Satir (1988) described spirituality as “a pipeline to universal intelligence and wisdom through our intuition, which can be tapped through meditation, prayer, relaxation, awareness, the development of high self-esteem, and a reverence for life” (p.338). Maisel and Raeburn (2008, p.149) describe spirituality as:
a more honest self-relationship, where the desire to be authentic replaces the idle hope to exert complete control…it means that you move on from an egoistic defensiveness…to an acceptance of the demands of personal responsibility…a leap from pride and isolation to mindfulness and connection to the larger whole.
In other words, spirituality is an existential leap towards taking responsibility for authoring your own life’s narrative, and achieving a sense of meaning by sharing that narrative with others. Religiosity is an adherence to external tenets established by a group ethos and unquestioned tradition. To practice religious adherence without spiritual awareness is to absolve oneself of personal responsibility, and use external constructs as an auxiliary ego: “It’s bad because the Bible says so,” not because you know it to be morally wrong, based on personal principle.
When we experience loss we may question both our religious and spiritual convictions, and find ourselves asking “How?” and “Why?” questions. “How could God let this happen?” “Why me? Why now?” This speaks to a fundamental sense of helplessness and lack of control, in the face of loss. Blaming God and punishing Him/Her by withdrawing a belief in His/Her existence (if it was ever previously present) are common reactions. If you take the existentialist perspective, you are responsible for answering those questions for yourself. You could also consider the same notion in a more religious context: as much as God is an omnipotent force, He/She is also present in each and every one of us. In short, “God helps those who help themselves.”
HOW DOES SPIRITUALITY COMPLICATE UNFINISHED BUSINESS?
In the context of loss, faith and religion can play a protective role in the healthy navigation of grief. For example, in a 1983 study of 92 families who had lost a child, 70 percent of the parents said their religious beliefs gave them comfort at the time of their child’s funeral. A year later, 80 percent of the parents had found strength and solace in their religion, and 40 percent felt their religious commitment was actually stronger after the child’s death (Matthews and Clark, 1998, p.25). But it is in a discerning examination of the word “stronger” that the spiritual complications for unfinished business become apparent. Wolfelt (2003, p.43) points out:
Mistakenly, people may think that with faith, there is no need to mourn. If you buy into this misconception, you will set yourself up to grieve internally but not mourn externally. Having faith does not mean you do not need to mourn. It does mean having the courage to allow yourself to mourn.
While the respondents to the study above may have self-reported a stronger religious commitment, we must take into consideration the degree of personal insight into the underlying mechanisms of their faith: is it truly the result of spiritual integration, or of an exaggerated adherence to external structures in order to avoid internal pain?
When it comes to the benefits of spiritual and religious practices in dealing with grief, grievers and practitioners working with grievers must take into account “spiritual bypassing.” Spiritual bypassing is a tendency to use spiritual and religious practices as a way to bypass or avoid dealing with emotional unfinished business. Welwood (2000) states, “While struggling to find themselves, many people are introduced to spiritual teachings and practices that urge them to give themselves up. As a result, they wind up creating a new “spiritual” identity, which is actually an old dysfunctional identity—based on avoidance of unresolved psychological issues—repackaged in a new disguise” (p.12). In this way, spiritual and religious teachings become a way to rationalize and reinforce old defenses, including and exemplified by the “six myths about grief.”
Key terms and definitions
At this point, it may be useful to examine a few key terms that are used in everyday vernacular, but perhaps are not so clearly understood.
Attachment
Attachment is a deep and enduring emotional bond that connects one person to another across time and space (Ainsworth, 1973; Bowlby, 1969). Attachment theory in psychology originates with the work of John Bowlby, who defined attachment as a lasting psychological connectedness between human beings, which is motivated by a need for physical proximity, includes appraisals of the primary caretaker’s availability, and is intended to stimulate “felt security” (Fonagy, 2001). Wallin (2007,p.1) identified three findings which he felt had “profound and fertile implications” for psychotherapy: 1) attachment relationships are the key context for development, 2) preverbal experience makes up the core of the developing self, and 3) the stance of the self towards experience (a person’s innate predisposition or temperament) predicts attachment security better than the facts of personal history. In this text, a developmental view of attachment largely influenced the frame in which grief is discussed. Attachment styles are also discussed.
Loss
Loss is a broad term used to encompass any number of real-life experiences, the result of which leads to feelings of grief. It may include the death of a loved one, divorce, loss of a job, a big move and/or lifestyle adjustment, the ending of a romantic relationship, estrangement of a family member, the dissolution of a friendship, receiving a chronic and debilitating diagnosis, surviving an assault, and so on. Typically, what qualifies a loss event is that it negatively impacts our sense of emotional and mental wellbeing, and may even threaten our sense of self-efficacy and identity. In fact, loss can change our worldview entirely, leaving us feeling insecure in its wake.
Trauma
Trauma is the result of a profound loss. Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life (Herman, 1990). “Trauma theory” is a relatively recent concept that emerged in the healthcare environment during the 1970s, mostly in connection with studies of Vietnam veterans and other survivor groups (Holocaust survivors, abused women and children, disaster survivors, refugees, victims of sexual assault). Post-traumatic stress disorder (PTSD) was added as a new category in the American Psychiatric Association official manual of mental disorders in 1980. Chronic post-traumatic stress disorder (C-PTSD) has also become an area of study for individuals with prolonged exposure to traumatic experiences. Trauma theory represents a fundamental shift in thinking from the idea that those who have experienced psychological trauma are either “sick” or deficient in moral character, to the reframe that they are “injured” and in need of healing. The impact of trauma is discussed throughout this text.
Grief, bereavement, and mourning
While some people tend to use the three words interchangeably, there is a difference. Grieving is a multifaceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions. In the context of this text, grief is understood to encompass one’s reaction to any major loss that causes a disruption to the attachment system. Bereavement is a period of sadness following the loss experience; it refers specifically to the state of loss. Mourning is best understood as the way we express our grief in front of others. Religious practices and cultural customs (such as funerals, memorials, ancestral altars, etc.) are frequently the most obvious examples of this expression.
Complicated grief
Sometimes called “persistent complex bereavement disorder,” complicated grief is differentiated from “normal” grief, in that the symptoms last for a prolonged period of time (from a diagnostic perspective, longer than six months), and severely impact the ability of an individual to resume healthy functioning and maintain a quality of life. Complicated grief is like being in an ongoing, heightened state of mourning that keeps you from healing. There are many similarities between complicated grief and major depression, but there are also distinct differences. In some cases, clinical depression and complicated grief occur together. Signs and symptoms of complicated grief may include: intense sorrow and pain at the thought of your loved one, focus on