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  • Writer's pictureDr. David Bonanno

Grief & Loss

Updated: Jun 7, 2022

When someone close to you dies, it feels like part of you dies too.

The “clean pain” associated with loss is the sadness and how you miss the person and what could have been going forward into the future. We will talk about the best way to handle that, but what’s really important is how much quote dirty pain” you may have. Because that makes losing someone that much worse. Dirty pain is pretty much everything else: anger, guilt, resentment, and even confusion. Those things really just seem to keep us stuck. Why is that? My theory is that they get in in the way of our acceptance of reality.

As Buddhism teaches, the best possible resolution to any problem is acceptance.

Most of us have heard of the work of Elizabeth Kubler Ross. She outlined five stages of grief: denial, anger, bargaining, depression and acceptance. Her work was very important, but her research was purely anecdotal, and it was with people who they themselves were dying, not losing others. I learned this because one day on a whim, I looked up other psychologists with my last name. I found only one. His name is George Bonanno and he wrote a book called the other side of sadness. It’s a great book and I recommend it to everyone.

There are very few books on grief because it’s not a sexy subject. But Dr. Bonanno asserts that people move in and out of the stages indiscriminately, and that most of the time people are very resilient. After all, death is a natural part of life and humans have adapted to manage it.

Anger and resentment keep us from accepting what has happened because they involve your living in an alternate reality. It should not have been this way, it should have been like this. If you think about it, the plus side is that you get to feel energized and powerful. As opposed to acceptance, which requires that you acknowledge that you are completely powerless. When people feel guilty, they are indulging in a fantasy that they were more powerful than in actuality, and they could have done something to prevent this loss. Guilt tortures us, but it allows us to stay in the fantasy.

I did a successful course of therapy with a Marine who lost his best friend right next to him on the battlefield. He spent almost every waking minute for years believing that he could have or should have saved his body. His friends and family try to talk him out of it. Logically, of course he would have done something if he could have! But PTSD is not logical, and they didn’t realize the payoff for his belief. Even confusion, which is very common in younger people, allows us to delay inevitable acceptance. In order to let go of dirty pain and start the process clean pain, we need to see that there is nothing we can or could have done. And that drives a lot of us crazy.

I didn’t have the best relationship with my father. He was a good guy but his father died when he was a teenager so he wasn’t able to connect with me very well. Before we had a chance to learn to figure each other out, he died when I was a teenager. I remember thinking, “Well maybe it will be easier to let him go since I didn’t have such a perfect relationship with him.” But it wasn’t. I started going to therapy after he passed and therapists try to support their patients and help them understand themselves. We ended up blaming both my parents for a lot of my problems and it didn’t seem to resolve anything. I always assumed that his smoking caused his lung cancer, so that in effect he chose to slowly kill himself and leave us behind.

I wished so badly that I could talk to him one more time to have a real conversation. So then I did!

My therapist was doing eye movement therapy and she invited me to imagine speaking to my dad. This is a form of therapy known as Gestalt, and it can be very effective. When you combine it with eye movements, it’s fantastic. Because it bypasses your logical brain and interfaces directly with your broken heart. I use this technique with all of my patients who have lost someone close to them.

The Marine finally worked up the courage to imagine talking to his best friend. And you know what he said? He said, quote why the hell have you been picturing me for all these years bleeding out, at the worst moment of my entire life? Instead, why don’t you picture us when we were at that bar in France where we had such a great time?

That was incredible. His body language completely changed from the beginning of the session to the end. This was not something that cognitive behavioral therapy would have accomplished so deeply. My patient knows that he didn’t talk to his friend, but he felt like he just did. It may have saved his life. He had so much survivor guilt. I think survivor guilt is fueled by our wanting to do something. Once again, most of us unconsciously choose to feel guilty and live in a reality of shoulds as opposed to concede that we were not in control.

Part Two: Living With Clean Pain

“David I can’t wake up Noah!!”

It was like I flew out of my bed into his room and put my hand on his cold wrist. “Holy shit! Holy shit! We gotta call 9-1-1.”

I couldn’t do it. Until I realized I was entering 911 instead of my iPhone passcode! I called! My wife was screaming. I hate it when she hurts and losing a child is the worst thing that can happen to a person. When my Dad died it ruined my mother. I was already wondering if this would break my wife. I told the dispatcher there’s no use doing CPR. His lips were purple. Told him my stepson was dead.

I huddled with the other two kids in the spare room off the kitchen while cops and ems came and went. I didn’t want my four-year-old to see his body. I told them their big brother is dead. I looked them in the eye so they knew. We sat there in horror. I remember thinking, “This is what horror is.” I felt like my eyes were going to burst out of my head. At times I was leaving my body.

The images and sounds and sounds played in my mind for days until I did something about it- The one thing that I know of that really works. I used my app on myself.

There are a lot of sayings that we have heard, but it doesn’t mean that they are true. It at least not always, for every circumstance. “What doesn’t kill you makes you stronger.” I myself have comforted myself with that, but as a clinician I don’t think it’s always true by any means. I believe that traumas add up throughout our lives and make us less resilient. “Time heals all wounds.” I don’t know about that. Maybe it just helps you to live with them. I don’t think you should say that to someone in gut wrenching pain. It annoys the shit out of my wife. To her it feels dismissive, like they are throwing her a bone without being willing to see what she’s dealing with.

So now we have to deal with the clean pain. There is no way around it. You have to go through it, and that doesn’t even happen until you resolve your dirty pain. But how do you begin to process and amount of pain that is so big? You don’t. You do it a little at a time, and it’s not like you are opening Pandora’s box. Dissociation will save you.

I researched dissociation and didn’t find very much. It is the type of abstract, unconscious, vague phenomenon that left brained scientists don’t enjoy trying to quantify or examine. But dissociation basically is when your brain shuts off so that you don’t have to consciously feel pain. I think it’s still there, but you are just not aware of it. It’s obviously protectionary.

I used to give my patients advice about how to grieve. I would tell them that they should give themselves a certain amount of time and then get back to living their life. Do it in digestible chunks. Some people can’t go there because they think that they are opening the floodgates and they will drown. But that just doesn’t happen. When I was a kid, dealing with my mom’s stroke and my dad’s death and the loss of my family and childhood as I knew it, I couldn’t cry for three years. I knew that was weird so I would drive around at night listening to sad music trying to make it happen.

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