Soon after I began practicing, I noticed a common thread for patients coming to see me. Most of them had suffered or were anticipating suffering a loss. They had been fired from a job, a divorce was imminent, or a relative had died.
Last month I discussed some of the research on attachment styles. Attachment is the primal bonding process that unites a child with its mother. It is a fundamental building-block of our personality and a key determinant of our adult relationships.
Loss is the counterpart to attachment. It is the traumatic twin of bonding; it is the disintegrative threat to that sense of unity that characterizes a healthy attachment to another. Loss is the trauma that occurs when attachments are broken.
The literature on loss is profound. Sigmund Freud wrote a famous book, “Mourning and Melancholia”. In that book, he observed that people who were clinically depressed looked like the mourners at a funeral. He drew a line between depression and the initiation of loss.
Modern clinical research developed the Holmes-Rahe Scale. Thomas Holmes was a physician who studied life expectancy. He was curious about events in a person’s life and their effect on a person’s longevity and health. He found that losses were associated with the early onset of death. His research led him to rank ordering life events and their impact on health and the lifespan. He saw losses as a form of stress. The most stressful events were (1) Loss of a spouse. (2) Divorce. (3) Marital separation. (4) Jail term. (5) Death of close family member. (6) Personal injury or illness.
Losses have both physical and psychological consequences. Modern researchers have classified loss as a depressogenic stress. Contemporary research acknowledges that people have a biological susceptibility to depressions, but there are also environmental stressors that will trigger depressive episodes. The severity of the depressive events depends on their severity, the amount of disruption, and irregularity of the event.
Severity: Severity depends on the centrality of the loss. According to the Holmes-Rahe Scale, the greatest attachment leads to the most profound sense of loss. As one can imagine, a long-term marriage which leads to a loss through death is one of the most psychologically damaging and unsurprisingly often leads to depression.
Disruption: Disruption depends on the amount of life change a loss leads to. Deaths are irrevocable, and some deaths alter our lives profoundly. Many of us have experienced the loss of pets. Often the feelings are profound and depressing, but, for most of us, the mourning period is relatively short. We replace pets and, despite our emotional attachment to them, their loss rarely affects our lives profoundly; most of our life goes on. On the other hand, the loss of a spouse leads to profound loneliness, a change in overall relationships, and often substantial economic changes.
Irregularity: This refers to the fact that some events are not consistent with the expected tragedies in life. While the death of a spouse at 75 years of age is stressful, the death of that same spouse at 25 years old is profound. I have consistently observed that the most extreme and life-changing stressor is the loss of a child. When I have met people who have lost children, they “confess” it almost immediately and never escape the feeling of loss. Often their lives center on that fervent event, and it becomes their identity.
From a Buddhist perspective, a loss is a break with attachment. The first reaction is an attempt to hold on. We often idolize the lost person, memorialize them in kept photos and objects, and will not clean out their belongings. But a loss is seen as one example of the constant that is changing, and we must move on. Our life practice is to exist in the present, and this entails devoting our energy to the life we have in the present. While the loss of others still exists in our lives and memory, we need to incorporate and integrate the life lessons we have learned from a loved one, but we must move on.
Therapy of loss involves two stages. The first is going through the mourning process. We need to let go. The second stage is to find meaning in one’s present circumstances. That is, one must live in the moment, and learn gratitude for what the present holds. We need to let go. But let go with love.
