Death, Dying and Grieving
I had an unusual death experience with my father, who was physically still alive. The unusual thing about my relationship to my father was that I had lost my father, he was dead in many respects. He no longer functioned as a father, he did not communicate, I had no response that indicated he even knew who I was. This went on for 11 years. On the other hand, his body was alive, yet I felt that my father had died. This is what is termed social death or psychosocial death. We can refer to psychosocial death in those cases in which the psychological essence, individual personality, or self is perceived as dead, though the person physically remains alive. (Doka 189) This significant change in my fathers personality and functioning was caused by brain damage incurred from alcoholism.
Because the essence of my father no longer existed, I did experience loss and grief. Rando states that:
Grief is a reaction to all kinds of losses, not just death. Grief is based upon your unique, individualistic perception of the loss. It is not necessary for you to have the loss recognized or validated by others for you to experience grief. (Rando 12)
After I read this, it did validate my view of my father as dead. I previously had thought of grief and loss as applying only to physical death. I experienced a prolonged, complicated grieving and remained stuck in this mode for 11 years.
The kind of loss and grieving that I experienced is what Rando calls symbolic loss, which is in contrast to physical loss. Rando classifies death as physical loss. Symbolic losses are psychosocial in naturerelated to the psychological aspects of a persons social interactions. (Rando 12) Examples would includes divorce or social death.
Social death has particularly difficult aspects for the family. Loss has occurred, but its not necessarily recognized by society as something to be bereaved. Yet the persons body remains, while the individual has significantly transformed to the point of not being the same person. I grappled with my relationship with my father, and guilt about not visiting him often. I procrastinated about visiting because it was difficult (almost pointless) to see him in his debilitated state. This type of loss and guilt is discussed by Doka and Aber.
Disenfranchised grief can be defined as the grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported. (Doka 4)
With irreversible conditions, the loss is certain, and though that knowledge may be resisted by defense mechanisms such as denial, there will often be a sense of hopelessness. The irreversibility of that loss may create high levels of ambivalence and subsequent guilt as one copes with the daily tasks of life. There may be a a sense that therapies are useless and time spent on the person is wasted and unappreciated. There may be deep, guilt-provoking desires for the victims institutionalization or even death. (Doka 191)
Along with the loss of my father from our lives, my family also experienced secondary losses. Secondary losses are experienced through all types of loss and death. These are the physical and/or symbolic losses that develop as a consequence of the death of the person you loved. (Rando 15) My mother mentions some examples of this in the film where she experienced loss of some friends, loss of her retirement plans, loss of her partner, loss of financial income.
On top of the primary and secondary losses, there was another complication by the psychosocial death. Rando explains:
When a loss is not socially validatedthat is, not acknowledged by society as an important loss to be mourned you are put in a difficult situation. Since the loss is not viewed as valid by society, you lack the social support necessary to face the pain and accommodate to it. Additionally, if the relationship that has been severed is not openly acknowledged, often there are no bereavement rituals to help you cope with the loss. You miss the confirmation, expression, and support they can offer. (Rando 57)
Rando goes on to state that:
there are distinct social problems for grievers when their loss involves the death of a person who has been socially devalued for one reason or another. The person whose loved one was a criminal, an alcoholic, mentally ill, retarded, or an AIDS victim often is robbed of social support at the time of death. (Rando 60)
This is known as disenfranchised grief. Disenfranchised grief can be defined as the grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported. (Doka 4)
Then there are cases in which the reality of the loss itself is not socially validated. Thanatologists have long recognized that significant losses can occur even when the object of the loss remains physically alive. Sudnow (1967) for example, discusses social death, in which the person is alive but is treated as if dead. Examples may include those who are institutionalized or comatose. Similarly, psychological death has been defined as conditions in which the person lacks a consciousness of existence (Kalish 1966), such as someone who is brain dead. One can also speak of psychosocial death in which the persona of someone has changed so significant;y, through mental illness, organic brain syndromes, or even significant personal transformation (such as through addiction, conversion, and so forth), that significant others perceive the person as he or she previously existed as dead (Doka 1985). In all of these cases, spouses and others may experience a profound sense of loss, but that loss cannot be publicly acknowledged for the person is still biologically alive. (Doka 6)
The problem of disenfranchised grief can be expressed in a paradox. The very nature of disenfranchised grief creates additional problems for grief, while removing or minimizing sources of support. (Doka 7) For my family, the nature of our disenfranchised grieving became the stigma of the alcoholism, becoming a homeless person, and being institutionalized. The institutionalization itself was complicated by the fact that it was difficult to find an institution who would accept him. The psychiatric hospitals felt he belonged in a nursing home, and the nursing homes felt he belonged in a psychiatric ward. Luckily because of his veterans status, he was admitted to a long term care floor on a veterans hospital. But even after being there for 10 years, they also were trying to discharge him.
In summary, then, psychosocial death complicates grief. The grieving person experiences deep personal loss, but the very nature of the syndrome complicates emotional responses, creating ambivalence, anger, and guilt. The condition can isolate the primary caregiver from critical sources of support. Yet when grief is convoluted, it is essentially unresolvable. Because the afflicted person is physically alive, and may even be part of the immediate environment, the emancipation from ties, which is the essence of grief work, is precluded. In fact, early resolution of grief can be detrimental. It can lead to a total withdrawal from the victim which can further complicate grief at the time of death. At best, significant others may achieve a partial resolutiona temporary resolution of feelings that allows those others to maintain emotional equilibrium, recognizing the losses experienced while continuing to give care. Grieving is, in effect, held in a state of partial suspension. (Doka 193)
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