Freud’s warning about listening gives this history of the talking cure its starting point: if the listener selects only what fits an expectation, the encounter may return only what is already known. His account of evenly suspended attention asks for a different kind of openness. (Freud, 1912)
To follow that question into the history of grief care, I want to begin with Cicely Saunders and then return to Freud. Cicely Mary Strode Saunders was born in Barnet, Hertfordshire, in 1918. She trained as a nurse, a medical social worker, and later a doctor. While working as a medical social worker in 1948, she met David Tasma, a Polish-Jewish refugee dying of cancer. (St Christopher’s Hospice)
David felt that his life had been wasted. He had no relatives in England and only a handful of friends. In a brief and intense relationship, they discussed the idea that she might find a home for dying people to find peace in their final days. He left her £500, then a substantial sum, and the wish of "can I be a window in your home?" A window is now dedicated to him at St. Christopher’s; it is plain and has a view of the car park.
Dame Cicely Saunders, the founder of the modern hospice movement, used the phrase “total pain” to make room for physical, psychological, social, and spiritual suffering. This required listening to a whole life, rather than treating pain as an isolated symptom. The evolution of hospice care has been extraordinary since these early days; it remains committed to helping people cope with dying and the pain of loss. (St Christopher’s Hospice)
So what Cicely was saying is that when we see someone in pain, we may not see the total story. We may not understand where the pain is coming from. When I think of a person's grief story, I naturally think of the endings that person might have experienced but locating the pain there might not be the total story. What if we don’t just grieve endings but also beginnings - meaning, we can grieve how life may not seem to start over after loss, rather, the same pain keeps mysteriously repeating over and over again.
Come along with me to solve a mystery - the mystery of a talking cure for grief. Meet a family with authority, trusted theory thieves. They have left behind curious clues to find and we need not travel far. Just look inside right where you are, the clue is the letter ‘r’.
This story about grief is told through the lens of a family. In a way, it is the modern grief family and we will begin our story with their most famous daughter.
Against her father’s wishes, Elisabeth Kübler-Ross became a doctor. Her seminars with dying patients at the University of Chicago brought the sufferer’s voice into medical education. She made the point that patients had as much to teach as the clinicians had to learn, changing the conversation about death and care. End-of-life services owe much to that insistence on hearing a person whose treatment had too often been discussed without them. (Kübler-Ross, 1969)
As a result of this pioneering research, she wrote her seminal work On Death and Dying where she presented 5 stages of grief: denial, anger, bargaining, depression, and acceptance. These stages have become a global model for grieving. Now in the therapist's office, her model was being tested for its real results. When some read the stages of grief, they felt that if they passed through the stages into acceptance they would feel better and move on, but for many grievers - that is not what happened. Mourners got stuck in their grief. Like a dying person stuck in their bed, grief can feel restraining instead of releasing and it can illuminate patterns that have formed in our life.
In Kübler-Ross’ account, the sadness of facing death was not automatically a clinical illness. It needed to be heard rather than hurried away. I want to distinguish that observation from Klein’s depressive position, which concerns ambivalence and will enter this story later. Both raise questions about what becomes possible when painful feelings are not immediately treated as a failure. (Kübler-Ross, 1969; Klein, 1940)
There is a point when the dying person realizes he or she will not be rescued but rather must take on the courage to be, and conquer the fear which is to accept it by faith. This is an ancient paradox of accepting fear as a friend, rather than a foe. Authorities have used our fears for manipulation and coercion, most particularly religious authorities, but who knew there was a forgotten wisdom to allow fear to be a sacred spiritual guide? Fear can help the human heart identify their needs in grief which is to encounter a new form of love we have yet to encounter. Dr. Ross doesn’t talk too much about love. Most doctors don’t. But one of Dr. Ross’ patients mentions a loving encounter with a visitor,
“He was here the other day. Yes, he sent me a beautiful bouquet. But from him, I got my faith. It’s my faith now. And it’s faith, it isn’t a theory of someone else, meaning I don’t understand God’s way and many things that happen, but I believe that God is greater than I am, and when I look at the young people dying, and their parents, and everyone says what a waste and that, I can see. I say, ‘God is love,’ and I mean it now. It isn’t words, I mean it. And if he is in love, then he knows that this moment of this person’s life is their best moment.” (pg. 70) (Kübler-Ross, 1969, p. 70)
The stages were often received as a linear path toward getting over a loss, even though that is not a requirement of Kübler-Ross’ work. I mean, what if grief remains with us even if we aren’t consciously invested in its pain? Dr. Ross joined David Kessler to correct some myths about her stages in a book called On Grief and Grieving where they clarified the variability of grief and the continuing impact of loss but she included in the afterword of the book:
“the reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.”(pg. 230) (Kübler-Ross & Kessler, 2005, p. 230)
What does it mean to rebuild oneself ‘around’ a loss? Does our sense of self over our loss to hide it in some way? Does the loss become front and center and take over our identity? What does it mean to change in grief? If you love a good mystery to solve this is where the fun begins. We will rebuild the narrative by looking back to ancient history for the first letter ‘r’ in grief work.
When we find the first ‘r’ we find where this mystery puzzle began to unfold. But let us pause for a moment and consider what may have happened at this point in the story or any story. You see once Doctor Ross constructed the stages she told a story about grief. Stories are dangerous things. It is very difficult to construct a story without splitting the narrative between a hero and villain, what is good or bad, even right or wrong.
Grief plays by the same rules. If we are stuck in feeling the one we grieve is ‘all bad’ or ‘all good’ with no blend of human imperfections then we lose something within our experience of love.
Returning to Freud, repression becomes the first “r” in this family of ideas. His writing on religion also raises the question of how an image of authority can carry the force of an earlier relationship. In Totem and Taboo, he connects the representation of God to a child’s relationship with the father. This is Freud’s theoretical interpretation, rather than an explanation of every person’s faith. (Freud, 1913)
“psychoanalysis teaches us with quite special insistence that the god of each of them is formed in the likeness of his father, that his relation to God depends on his relation to his father in the flesh and oscillates and changes along with that relation, and that at bottom God is nothing other than an exalted father.” (1) (Freud, 1913)
The father complex and the superego are related concepts in Freud’s work, but they are not simply the same thing. The superego can function as a demanding internal authority, carrying prohibitions and ideals. I am interested in how these demands become entangled with images of love. Not all images of God resemble a father; a god may also be imagined as maternal, withholding, protective, or promising completion. (Freud, 1923)
But if the family gives space for the Father to be disciplinarian, he is the one who denies the children free association and his moral voice is appropriately internalized. But this demanding, unrelenting voice of the superego was not characterized as a moral voice, it was just a stronger voice that demanded authority. The Father’s ideal role for teaching in the home not only religious values but all matters of morality can become an attempt to control all manners of conflicts within the family instead of working them through. (Freud, 1923)
Dr. Freud insisted that his patients not filter their thoughts and feelings, rather, allowed them to let their thoughts and feelings speak through free association. But even if we fill up a session with all our words and stories something can still seem hidden. Like the epitaph on a tombstone that says, “Gone but Not Forgotten”, Father Freud noticed there was a phenomenon of “Forgotten but Not Gone” in the psyche which he called repression. Repression is an unconscious defensive process through which a representation is kept from awareness because the patient is strangely inhibited or prohibited from freely associating with themselves. To put it plainly, the mind refuses to know what it knows about the trauma of life until a later experience ruptures our reality and pulls us backward to an earlier life memory.
When it comes to modern mental health, there is an emphasis on what is normal or maladaptive behavior or healthy or unhealthy emotional coping. For Dr. Freud, or as he will be referred to here, Father Freud, his concern was with what is real or unreal in the mind of the subject. This may sound unimportant, or even insensitive, but this split is the beginning of a new model of the mind. Notice he was not exploring what was real or not real in the subject but was exploring the ‘unreal’ or the fantasy structure in the mind that gets woven into our ideals where we miss something in real of life.
In his theory, the trauma was often in accepting life as it is, when the mind can create a too-much-ness that must be integrated. An experience can be very good or very bad and how we experience this too-much-ness on either side is within our fantasy as a way to mark it in memory. Trauma is a Greek word for wound and in a subjective or emotional sense, the wound is quite invisible and thus it becomes unspeakable for the patient.
In other words, the wound is repressed but can be seen by the third eye in the therapy office.
The third eye Freud identified in the therapy office was the symptom. The symptom most identified with grief is often depression but Freud was interested in anxiety. Not to analyze grief, as it were, but an attempt to analyze what was lost (or hiding) in the subject, which to him was an unintegrated memory. Anxiety also spoke of a too-much-ness in desire, which he called libido, and desire remains part of the story of grief.
A symptom can carry something of a conflict when our words and even actions can hide the truth in some way. The symptom is speaking the unspeakable of the unconscious and comes most alive in our dreams. If you think about it, why are our dreams hiding truth from us? That’s right. We are in our bed at night watching these movies we have made in our head and we won’t even disclose the truth of what they mean to ourselves.
What?!
The symptom would be speaking the unspeakable in the patient’s grief and also would slip out in how something was heard/misheard or said/mis-spoke. He termed this parapraxis. The unconscious was also speaking through the characters in the stories told by the patient as they borrowed from the conflicts of others rather than facing their inner conflicts. The patient talking about these other things was talking about themselves but they were not aware of those associations. (Freud, 1900)
Another clue lies in the setting of the session itself. Freud’s use of the couch reduced the demand to read the analyst’s face, making a different kind of association possible. It can be imagined as both people facing the same unfolding account, rather than one person having to perform for another’s gaze. That is a way of thinking about the arrangement, rather than its single historical explanation. (Freud, 1913, “On Beginning the Treatment”)
Father Freud's choice of not looking face to face was more intimate in that the words meant so much more than the stories themselves. Not what words were used, but how they were used - even misused. Their words became a map of the meaning or signification of the symptom. Once Father Freud enters the world of the patient's words it becomes clear how the patient is attempting to speak the unspeakable by what words are said and omitted, and in particular words that are misspoken.
This gentle listening to the wounds in their words is how the analysis can reconstruct the trauma and therefore can reconstruct reality through the reconstruction of one's relationship to a listening cure. We can get caught up on meaning or answers, which strokes the ego validating intelligence, alone. To me, the wound in our words of grief is less about our relationship to answers and more about our relationship to mystery and the non-answers in life.
The meaning is most pungent in the ways the absence of meaning takes meaningful form. To cope with this absence we can be looking for a type of mother when our grief is looking for a mirror. This search for comfort strangely seems more like an unconscious search for conflict as loving support just can’t do enough to make us happy and feel nourished. The mourner can be protesting how they feel unseen and invisible, yet, when the caring person sees their life falling apart they refuse the mirror and demand a mother.
In everyday life, it actually might be rare to see people face to face even when we are talking to their eyes. We look at someone and see what we want to see in them and make judgments instead of creating the space of their subjectivity to speak about their experience of their world and even their experience of us. When we talk to another person we are projecting on them our needs and wishes through association. If they are a person of authority we try to read what they think or feel about us which interestingly gets linked or associated with other authority figures in our past. We can not control this because it is how our minds are structured when making meaning with words. (Freud, 1912)
This is also another key to the mystery cure for grief which is how Father Freud centralized the unconscious in psychotherapy ensuring psychotherapy remains compassionate. We are asking people to reconstruct their painful associations with the world which were likely taught to them by their parents (or lack thereof) and this is very precarious. A patient's defense to discovering these unconscious associations is sustained by a loyalty to love. Reality testing loss has a triangular effect. No matter what is lost by Freud’s patient - use of a hand, side of the face, death of a parent or child - the patient has a third person in mind, often the parent. This means the patient, the thing lost, and a third is always present in the therapy room and slowly the therapist begins to symbolize this third person.
This notion that we can be unconsciously grieving for an audience creates meaningful associations to uncover how we suffer. Freud’s use of the Oedipus complex, which will be taken up later in the book, speaks of how our individual needs may be caught up in the flaws we perceive in our parents. As we come to terms with the humanity of our parents, the conflicts of grief are more associated and located within rather than in them. So we get it, the symptom is the third eye in the therapy office to show us the unconscious - blah, blah, blah. What about the mystery cure for grief and when does Father Freud tackle this idea of mourning?
Freud’s 1917 paper Mourning and Melancholia addressed the distinction between mourning a loss and the severe self-reproach of melancholia. His use of melancholia should not simply be equated with a modern diagnosis of bipolar disorder. He asks what has happened when conflict with a lost object becomes an attack upon the ego. A bereaved person may idealize the one who died while keeping all the badness of the relationship for themselves. I find this a useful question for mourning: what becomes difficult to acknowledge when the image of the loved person has to remain entirely good? Continuing a bond does not itself produce this difficulty; the particular relationship and its conflicts matter. (Freud, 1917)
Father Freud's psychoanalysis was less about helping his patients ‘let go’ of what was haunting them as if the pain was primarily linked to a regressive state from childhood and more about ‘letting it out’ because something was speaking in the here and now of their life. Freud resisted naming the ‘it’ (known as the id - in German is literally ‘it’ - in classical ego psychology) as a deeper essence within us. Freud argued that the ‘it’ - perhaps the wound within - is often hiding in everything we do.
He invited his patients to speak their free associations so that he could catch the subtleties of their language understanding the ‘it’ would slip through almost unnoticeably in what was wished for. Stories of loss are so linked with stories of love that we can not separate the two - even if what we have lost can feel so benign. Like losing our hair, keys, or losing a presidential election. In Freud’s paper about mourning, he discusses both bereavement and losses that may be less consciously understood.
In his paper, he used the example of a symbolic death of ‘a woman who had been jilted on the altar.’ For Father Freud, grief was an invitation to explore this symbolic world often in our dreams where there should not be limits but yet our mind creates them. When within our mind there becomes an impasse between limit and loss, a lack can form and feed self-reproach. He writes,
Freud distinguishes the impoverishment of the world in mourning from an impoverishment of the ego in melancholia. The person may describe themselves as worthless or morally despicable, expect punishment, and experience disturbed sleep or appetite. His inquiry follows the way self-reproaches can carry a conflict within a lost relationship. (Freud, 1917, p. 246)
Father Freud explored the trauma in the loss of love throughout his career, finding helpful insights into human sexuality and the way we deal with limits within our loving relationships. Father Freud taught us that feeling stuck in mourning may not only be an encounter with painful endings but also a resistance to healthy beginnings. Maybe we have felt stuck for a very long time repeating the same conflict just with a different face. Maybe there are repeated patterns, and loops of behavior, that prevent us from creating a new story with our life.
This is the key to going to the unknown of grief because the temptation is to find the ‘it’ or core meaning, deep within the story; however, Father Freud discovered that the ‘it’ is always hiding in plain sight and slips through within human relation not in what we say to each other but in how the patient tries to tell a story to make the the suffering story complete and coherent when it is split. (Freud, 1937)
Melanie Klein gave psychoanalysis a new way of listening to children and their play. Her development of play technique opened questions about unconscious fantasy, love, aggression, and the child’s inner world. For this story, I think of her as “Mother Melanie”: an image within a family of ideas, rather than a literal family or uncontested history of psychoanalysis. (Klein, 1921; 1940)
Working with children, Klein explored how images of caregivers become part of an internal world. She also developed the concept of projective identification: aspects of the self can be split off and experienced as belonging to another person. It is not simply a child consciously taking on a parent’s mood, and it cannot establish what a parent secretly intended. In an everyday illustration, a child may hear “you are not listening” and experience an accusation of being bad, even when the conflict is more complicated. (Klein, 1946)
Now this blame game causes a lot of war within families, but for Klein, she wanted to look closer to interpret the unconscious anxiety in the child. Children are taught, “I’m rubber and you’re glue, what you say bounces off of me and onto you.” What if a trusted caregiver does project onto the child something they don’t like about themselves and the child identifies with the projection? It would be great if the child thought of a parent's criticism, “oh, yes, dad’s just feeling insecure today.” Or, “Mom just doesn’t think she is beautiful today.” But the child often thinks, “I am not good enough.” A child can feel trapped in this identification which was a projection from their primary caregiver who needs something and yet they have told their child they need it.
These questions become especially difficult when the child engages in infantile rage, acting out in screams and fights with the parent. Instead of engaging with the child's needs, the parent can neglect them. But if the parent engages the rage, understanding how the child needs to experience all of their emotions in a facilitated environment, otherwise, these things will discharge in an environment that may irreparably harm others and themselves. As we grow, and conflicts become more complex and less spoken in adult relationships, we can fantasize about what others are feeling instead of integrating our inner conflicts.
In this fantasy, we can project our self-hate on the other and they begin to hate us. A conflict can become enacted between people before either understands what they are responding to. This is not a claim that a person causes another’s abuse. Parenting takes on this impulse by children to engage in projective identification and recognize the emotional exchange. The ‘good- enough’ parent notices the conflict and creates a space for limits and loss without agreeing with the child on their sense of lack.
Another insight from Mother Melanie is how children are taught the psychological technique of ‘splitting’ by the nature of survival. In Klein’s account, splitting concerns keeping loved and hated aspects of an object apart; it is not simply learning a moral rule. Our parents teach us that this is hot and this is cold. This is safe and this is unsafe. This is good and this is bad. But more fundamentally - this breast will feed me this breast won’t.
This breast is good and this breast is bad. Coping with the limits of love are threshold of growth. But often when a child is testing the limits, it is not based on their fantasy sense of reality, rather, there is some unconscious wish for repair of security and care from the parent. Object relations theory teaches us how rebelling against limits (as children or adults) often hides through symbolization, some kind of loss about the primary caregiver.
Entering the world of a child's words is often entering the world of words of the parents and detecting their ‘voice’. (Klein, 1946)
Klein describes an inner world of internalized objects: representations of parents and others, shaped by external relationships and unconscious fantasy. These figures can be experienced as loving, destructive, protective, or persecuting. Analysis may make it possible to revise a relationship to them, whether the people concerned are dead or alive. This revision does not require dismissing actual grievances. (Klein, 1940)
For Mother Melanie, the mourner, no matter how old, can enter these repeated patterns of childhood persecution. This means the mourner is not only searching for the comfort of a primary caregiver but may be searching for a conflict to deal with feeling neglected and their needs unwitnessed. The mourner, through grief work, learns that these re-enactments in the here-and-now are projections from their past that have been internalized, and there's work to be done to see the world more ambivalently. (Klein, 1940)
In her book Love, Guilt, and Reparations Mother Melanie shares a case study about a young boy named Fritz and proceeds to illustrate this process of entertaining the machine gun-like questions from the anxious child testing limits. Mother Melanie entertains his questions about existence and sex, his ‘interest’ in poop and urine, and the discovery of real things in the world like the sun, garden, electric cars, and even a train. After the onslaught of questions, the child notices his parents (and therapist) do not have the answer and begins to explore this with ambivalence, which is to say, the parent has what he wants and sometimes doesn’t. She writes,
“When the reality principle gets the upper hand in this struggle and maintains the necessity to limit the boundlessness of one's omnipotence-feeling, a parallel need arises to discover mitigation of this painful compulsion in the detraction from parental compulsion. If however, the pleasure principle conquerors, it finds in parental perfection a support that it tries to defend.” (2) (Klein, 1921)
It’s funny how sometimes the parent is really smart and kind of dupes their kid into thinking they do have all the answers which is not true. When Fritz went to school, this re-enactment continued, but now with his friends. It was Fritz's playmates who started teaching him about truth and lies and he was conflicted inside. At first, he didn’t want to admit their unkindness hurt him, rather, he defended them until his brother said they couldn’t be trusted. And Melanie shared,
“Aggressive tendencies now appeared quite openly; he spoke about shooting them dead with his toy revolver, about shooting them in the eye; and showed his death wishes in his remarks and in his play.” (3) (Klein, 1921)
Oh yes, ‘normal’ children have destructive tendencies, including in play. But like Fritz, this splitting is repressed and so he returns to his playmates as friends and ambivalently accepts that they are just kids. The therapy allowed for this expressed aggression to exist and thus the child became unstuck in the need to act out this sense of loss. Mother Melanie expanded reality testing to what she called reparation which was to explore how our primary caregiver or friends may not be what we have hoped but also might not have been what we had feared.
Reparation paradoxically begins to accept that our primary caregiver is like us - full of wishes and lack - and often we are trying to fill in the story of love without all the right details. Sometimes a child's belief/projection that their parents think they are bad, can become a self-fulfilling prophecy which creates guilt and a paranoid schizoid position. It’s when the psychotic core of good or bad is further split in two rather than integrated as good and bad within the subject.
Mother Melanie's last paper published posthumously in 1963 is titled The Sense of Loneliness in which she mirrors the end of life with the beginning of life. Since we begin life usually in a clinic in need of a caregiver, any subsequent illness is a return to the clinic where we find we continue our dependence upon a primary caregiver, and the longing for a mother persists.
In “On the Sense of Loneliness,” Klein considers the wish to be understood without words, linked to the earliest relationship with the mother. Integration can feel painful when a person experiences a part of themselves as bad and alone. A harsh superego can intensify this difficulty by demanding that destructive impulses remain excluded. (Klein, 1963)
For Mother Melanie, the mourner has a lifelong journey to experience the losses in life as limits and not punishments or a sense of withholding, rather use this empathy to give voice to the exiled experience. Similar to Kubler-Ross’ acceptance, Mother Melanie invites mourners to embrace what she called the depressive position which is to experience the lack within as less punitive or persecutory and more universal. Loss and loneliness are a trauma that all of us will encounter no matter our socio-economic position.
When faced with the possible meaninglessness of our sufferings, it is easier for the sufferer to find meaning in a belief they are being punished rather than absorb the possibility that their suffering is part of ordinary vulnerability without a ready explanation. The anger towards this predicament can point outward or inward and surface old traumas of desertion and forgottenness to remind us how mourning is not only about endings but beginnings whereby we are repeating behavior patterns we are not aware we are repeating. (Klein, 1940; 1963)
The Modern grief care story goes beyond the daughter, father, and mother to who I think of as the son of the modern grief family and he was attached to ‘mother’ Melanie’s hip. John Bowlby also studied mourning through the lens of beginnings, not endings. Before the 5 stages of grief, Dr. Bowlby created the four stages of grieving to describe the separation from a caregiver. 1) shock/numbness, 2) yearning/searching, 3) disorganization-despair, and 4) reorganization. Dr. Bowlby explored the idea of ‘separation anxiety’ when he wrote,
“my view is that the principal trauma, which is potentially present in the life of a young child, is loss of a mother, or loss of her love.” (4) (Bowlby, 1960)
Consider this analogy. As a child transition to school, a teacher can become another important caregiver and their pencils and crayons become their new objects to tell stories of what feels missing in their young world. As they grow older, perhaps coaches become other important figures and even give them balls to play with. A ball or instrument may acquire meanings that invite comparison with Winnicott’s transitional phenomena, though an ordinary play object is not automatically a transitional object which beyond mother breasts, are our first ‘not me’ objects we connect to who are not enmeshed with mother. For example, the ball becomes a symbolic object with profound internalized relations. But some kids struggle to pick up sports, so they choose an instrument or other object of meaning and these objects mediate conflicts that were unspoken at home with primary caregivers.
Bowlby’s emphasis on attachment met significant disagreement within psychoanalysis. He nevertheless remained a psychoanalyst; it would be inaccurate to say that he was simply expelled from the profession. The disagreement matters because it exposes different accounts of internal fantasy, external care, and what a child needs from a relationship. (Bowlby, 1960; 1980)
But the work of object relatedness was to reveal how this distance just wasn’t always therapeutic. Children need a bond, a nearness, a parental figure to attach to. Since psychoanalysis often is a guided quest into our childhood aggression and regressions, patients transfer a need for the security and support of a parental figure. Bowlby's theory about attachment ultimately invited the therapist to be vulnerable so that the patient can transfer this need of a caregiver upon them and over time can experience their inner world of needs. But it takes discipline for the therapist to see themselves as a symbol of an unsettled attachment. (Bowlby, 1988)
Modern therapists understand that assuming this position of attached caregiver, knowing they can’t fulfill a primary caregiver role, is very fragile and can cause psychological harm if not facilitated skillfully. Sometimes patients can form a co-dependent relationship with their therapist as a surrogate parental figure and the patient never learns to face the world with their own courage. For me, this is a reason to keep the therapy relationship available to inquiry, rather than settle into the position of mentor or guru. But if therapists are symbolic, they are taught to re-enact the symbolic inner conflict the patient is seeking to have with a caregiver, which means exploring their destructive impulses and ambivalent feelings, so they can become a healthy individual through an encounter with the conflicts and limits of love.
Brother Bowlby’s attachment theory helped psychoanalysts lean in further and build better alliances with their patients so they understood the unconscious power of a transference relationship and need for a secure bond. Dr. Bowlby argued that a secure base supports exploration and a growing capacity for independence, but the healthiest place to start was to allow this projection of primary caregiver to animate the story of what the inner child feels is lacking within themselves.
Bowlby's attachment theory is now adopted broadly by psychotherapists who are taught to model a caregiver role to not only patients but also parents to help the family attach for the sake of healthy differentiation over the discovery of their child's deeper capacities for resilience through vulnerability. In this account, the loss of a caregiver or of the caregiver’s availability can remain important; it is not an explanation of every difficulty a person brings to therapy. (Bowlby, 1988)
Attachment should not be reduced to a requirement that a biological mother provide every aspect of care. Families and cultures organize caregiving in different ways, and children may have several important attachment figures. The clinical question is about the availability and quality of care, not a prescribed family form. Within Bowlby’s account, grief and separation make visible the significance of those bonds. (Bowlby, 1980; 1988)
Bowlby reads Freud’s later writing as moving toward a clearer appreciation of grief and mourning in infancy and early childhood. His discussion links separation anxiety, attachment, pain, and mourning, while giving the child’s actual relationships greater emphasis. (Bowlby, 1960)
Bowlby searched for Freud's overall view of grief and mourning, knowing that in bereavement in particular, a child is searching for a primary caregiver. But so are adults. Mourners can unconsciously reach back in the past to anchor their sense of love, to feel like they belong to a larger story. But in mourning, we are often uprooted from a caring world. We don’t recognize this new path forward, so we go where it is familiar - we go backward and can get lost searching for ghosts. Bowlby believed the stage in which the mourner was most likely to be stuck was in the yearning or searching stage. (Bowlby, 1980)
But who has that much time to explore with a patient all this content of lost stories in family, work, religion, history, etc? Don’t we have patients who just need cognitive and behavioral guidance? To think and do more positive things for their family and themselves. Well . . . the ‘r’ list keeps growing as other grief experts keep using the alliteration. Dr. Robert Neimeyer teaches the idea of reconstructing the meaning of the loss through narrative therapy and keeping journals of one's grief experiences.
Alan Wolfelt emphasizes making room for grief through mourning. Other approaches attend to the conflicting parts of a person’s experience and the ways a loss is told. As it turns out, the best grief therapy still honors holding a deep story of suffering for patients needing more therapy rather than less to understand what it is that still feels lost to make the story more nuanced and the patient enjoys the sense of incompletion so they may remain curious to their own choices in the meaning of their life. (Neimeyer, 2019)
It was the French Psychoanalyst, Jacques Lacan, (aka French Freud) who took the old Freudian garden of the unconscious seriously and went to work pulling the weeds. He began to re-language the unconscious through the frames of the imaginary, symbolic, and the real to make restitution with the past. What is fascinating to me is this framing had been the history of psychoanalytic work up to this point. The lost story of the repressed unconscious was still stuck in finding what feels hidden rather than missing, perhaps stolen in the subject.
It creates a tremendous amount of therapeutic activity to keep going through this content in hopes we recover something that had been lost in the past. Lacan believed the tradition of healthy therapy should take the storytelling of narcissistic musings seriously but be willing to wound it if necessary with a discipline of seeing ‘the real’ coming out in the here and now of therapy. (Lacan, 1964/1978)
Lacan’s “real” is not simply an underlying factual truth waiting to be seen; it concerns a limit in what can be contained by images and language. (Lacan, 1964/1978) It was speaking through the symptoms of what the patient was (un)doing to cope with the truth. Therapy can get lost in addressing unmet needs when in truth its power is in confronting desire in engagement with what Donald Winnicott called the ‘False Self’. One can know when grief needs therapy and not support alone when there is an obsession with grieving the right way or good way or after a trauma there is a voice of righteous rage that becomes persecutory. Health mourning becomes less about making us be good and more about making us more true - which is to have a more ambivalent relation to what we want out of love.
Dr. Winnicott writes in his paper Maturational Process, “On the basis of this, one could say the False Self deceives the analyst if the latter fails to notice that, regarded as a whole functioning person, the False Self, however set up, lacks something, and that something is the central element of creative originality.” (pg. 152) In other words, while grieving the lost object of love which feels be missing in one’s life I am drawn to a question Winnicott’s account opens: might a mourner also be missing from their own story, living through an image of who they must be? This is my application to mourning, rather than a claim that every loss conceals the same problem. (Winnicott, 1965, “Ego Distortion in Terms of True and False Self”)
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