Good grief, bad grief

Pieces of debris found in the Indian Ocean indicate that a missing Malaysian jet may have plunged into the waters. Counsellors tell T.V. Jayan that family and friends of the passengers may find it difficult to cope with the grief

Grief has its own symbols. Little bouquets of roses, teddy bears and candles often dot a scene of horrific death. In the vast waters of the Indian Ocean, though, death lies hidden. Earlier this week, Malaysia said a jet that had been missing for over three weeks had probably plunged into the ocean.
For the families of the 239 passengers — including five Indians — aboard MH370, the news would bring little solace. Though debris seen in the waters may be identified as those from the Malaysian Airlines plane, the fact that the bodies will be difficult — if not impossible — to retrieve from the sea would always haunt the kin.
“To mourn properly for a death, having a sense of closure is very important,” says Dr Alok Sarin, a clinical psychiatrist with the Sitaram Bhartia Institute of Science and Research in New Delhi. And for this to happen, it’s important to find the bodies, he says.
Dr K.S. Shaji, professor of psychiatry at the Thrissur Medical College, Kerala, agrees. “The finite part of the death is seeing the dead body. You can grieve only when you are definite about the loss. If you are uncertain about the loss — as is the case here — there is also a possibility that you’ll keep hoping against hope,” he says.
The fate of the jet and its passengers has opened the lid on an emotion called grief. Most people tend to take grief in their stride. Death, injury, separation, loss, illness, break-ups and many such developments lead to grief. People mourn and come out of it. But increasingly, mourning is becoming difficult.
In cases such as the jet’s disappearance, the ensuing grief is more difficult to handle. “Confusion (over the fate of the flight), bereavement and the fact that there are multiple narratives — each with contradictory sub-texts and agenda — make it more difficult for people to deal with their personal grief,” Dr Sarin says.
In hospitals in the Indian metros, handling grief is turning into a crucial part of care. Counsellors discuss death and mourning with relatives of those who are terminally ill, or others facing serious health issues, giving them emotional support. “When we know a patient is critical, we prepare the relatives for the inevitable,” says Baljeet Kaur Arun, head of the counselling department at the Holy Family Hospital, New Delhi.
Relatives are encouraged to speak with the patient — even if the patient is unconscious or unable to speak. “When they say how much they love the person or that they have pardoned him or her for mistakes or settle other emotional issues, it mainly helps the relatives to accept the reality of death,” she says.
Grief and its aftermath are also subjects that concern Dr Salman Akhtar, a psychoanalyst with the Jefferson Medical College in Philadelphia in the US, who was in Delhi recently for a lecture series. “Any death is painful, but some are more difficult to mourn,” he says, referring in particular to unexpected deaths, murders, suicides and death of children.
Guilt often goes hand in hand with grief. Dr Sarin recalls a person he met, who could not forgive himself for the death of his mother, which had happened many years earlier. “He had a feeling all through that if he had reached home 15 minutes earlier, he could have saved his mother. But traffic delayed him,” he says.
Arun remembers Gokul (name changed), an eight-year-old boy who was brought to the hospital in an unconscious state. The family said he had collapsed after the cremation of his older brother. Then, after days of treatment, he started talking to the counsellor. It transpired that he had quarrelled with his brother over a ball — and wished him dead — just days before the brother died. “It was important to remove his feelings of guilt. Otherwise, guilt would haunt him for years,” she says.

Hoping against hope: Relatives of passengers on the missing Malaysia Airlines plane

The doctors believe that traditional rituals help people cope with grief, because they make them go through a mandatory period of mourning. When parents lose a child through an abortion or miscarriage, no rituals are conducted, points out Dr Om Prakash, associate professor of psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi. And this, he says, can cause untold grief.
Many people who have not gone through mourning adequately tend to go in “mummification”, or not fully accepting death, says Dr Vivek Benegal, professor of psychiatry, National Institute of Mental Health and Neurosciences (Nimhans) in Bangalore. “They cannot stop making a bed for the person even after death and tend to talk to them when they are alone. They also have ‘flashbacks’ — an imaginary feeling of ‘seeing’ or ‘hearing’ the dead person,” the Nimhans professor adds.
Dr Benegal, who has extensively studied the psychiatric conditions of those who survived the 2004 tsunami in the Andaman and Nicobar Islands and elsewhere, says this happens more in the case of natural disasters or accidents where bodies cannot be retrieved.
But there are no set rules about grief. Dr Akhtar points out that some people may get over with grief within two days but some others will spend two years in mourning. “Both are not right,” he says.
According to him, it is possible to tell whether a person has gone through the process of mourning by simply looking at what he or she has done with physical objects that belonged to the deceased person. Certain objects are thrown away; some given away and some kept either as an heirloom or in memory of the deceased person, he says. “But a toaster that belonged to the mother or the watch that was once worn by the father should be put to use the way they were used. If a person cannot hold this object without fighting tears even two years after the death, then there is a problem,” he says.
Grief, of course, is not just associated with death. Arun stresses that a person whose leg needs to be amputated or a woman whose uterus has to be removed is also stricken by grief.
The cause of acute sorrow is sometimes difficult to fathom. A teenage girl was admitted to the hospital with acute stomach pain. Her appendix — longer than normal — was removed, but the pain continued. Upon counselling, it emerged that the girl’s grief was related to the fact that she had just attained puberty — and felt that she’d lost her childhood.
Efforts are now on to bring sorrow to the forefront, instead of letting it fester in the background. Blogs have come up in recent years to assist digital-savvy generations to go through the process of mourning. Some aim at young people facing acute grief. “Modern Loss” seeks to give young adults emotional and psychological support after a tragic event, be it a miscarriage or a parental death. “Lisa Frank Mixtape” seeks to soothe younger people facing a personal loss by sending them music tapes or CDs, in return for essays on human loss.
Indeed, some of the safety nets that helped people cope with death in India more easily are also slowly disappearing. A joint family meant a house full of people, who shared the grief. Nuclear and small families make grieving that much more difficult to handle. Dr Sarin, on the other hand, argues that people cannot hold on to old-fashioned customs. “More often than not, friends replace family when grief strikes,” he says.
Everybody, however, agrees that unresolved grief can lead to serious health problems. Depression is one of the outcomes of acute grief, the experts point out. They fear that those whose loved ones were on the Malayasian flight will find it difficult to mourn their loss — and that can lead to psychiatric complications among many close relatives.
Allow time to do its healing too, Dr Akhtar says. That’s how, he points out, an angry wound turns into a scar that just throbs once in a while.

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