A Word Less Spoken - Grief !

C.S. Lewis said "No one ever told me that grief felt so like fear."

I see patients every day who are sad, anxious or angry but hardly anyone ever mentions grief, fear, being scared or being afraid.  I don't seem to get those emotions out easily from them, hence many of them remain unaware of their grief and the fear that comes with it.

Grief is tricky, grief is sneaky and grief is scary.  I say it is tricky and sneaky because we generally don't think of grief when we see people for therapy.  The most common feelings we hear are sad or anxious.  I tend to think there is always grief that lurks in the corners of their minds, sometimes obvious, mostly not.  Rage and anger to me are directly proportional to the grief people carry around.

Children need security of consistency, affection, love and care to thrive and become self sufficient, adequately attached adults.  No matter what your inclination is theory wise, an overwhelming majority of professionals do believe in importance of the early year bonds we as humans need.  When these bonds are dysfunctional or absent a perfect storm simmers.  How unfortunate it would be to come to this world and question the reason for being here not because of pure existential concerns but because no one ever made a big deal about you being here?  I wonder how many of us can relate to this feeling conveyed by any number of patients?  

My guess; probably most.  

I always wonder about the people growing up with feeling unwanted, unloved, uncared for or all of the above.  How it shapes them and their relationships?  What is it like to live in a perpetual state of being irrelevant?  It makes people angry, sad, enraged, anxious, worried, doubtful and so on and so forth.  But come to think of it, would all of these feelings not be linked to the feeling of grief?  

Grief for not having what seems so natural and right for us to have when we are born.  It's the sort of grief that lies so deep and is so intense that it almost demands to be acknowledged yet is so intolerable that it's almost always ignored because how can you grieve something you never had.  

But why can't you grieve not having something at all?  Wouldn't deprivation lead to indulgence but without gratification?  Adults with early attachment challenges mostly keep looking for what they never got.  Sometimes in form of one after another dysfunctional relationship, sometimes in substance use and many times in both ways.  The early age deprivations drive people to indulge in relationships with people and/or drugs in such self destructive ways but seldom result in gratification of what they need.  A bottomless pit of despair that always seem to be wanting more.  

I wonder if the grief of deprivation is so immense and scary that people can't seem to face it?  It must be very scary to never know what is it like to trust that one is worth anything.  It must be terrifying to ever think that your being in this world would ever matter to someone else.  May be it's the fear that realizing one's grief would mean staring the deepest darkest moments of despair in their face while at the same time acknowledging the hard work that it will take to own it and learn to live with it.  Grief isn't like sadness because sadness fades away but grief never leaves.  It etches permanently and it always have fear close by.  

To live with grief is to live with fear but to not respect and acknowledge grief; is to live in a constant storm that always simmer, is consuming and unpredictable because the more it is denied, the stronger and scarier it becomes.  

As C.S. Lewis says it's a process not a state, 


“I thought I could describe a state; make a map of sorrow. Sorrow, however, turns out to be not a state but a process.” 

Let It Go!!

Is Elsa singing about empowerment, liberation and accepting yourself or is this one of the all times, most reproduced, re-sung, reposted expression of the anger we as human beings carry around all the time?  Anger, rage, fury, incensed, irate, pissed off, livid, there are over 75 synonyms out there for this very basic yet one of the most consuming human emotions.

Anger like sadness is not socially appealing, accepted or appreciated.  We don't like to deal with sadness and we don't like to face anger, be it personal or not.  At one point or another all of us have come across these emotions beyond what is normal and necessary for daily ho hum of the life, yet for the most part I personally am responsible for not handling it right when it happens to me.    

Why am I talking about this today?

Our process group had to deal with this question yesterday.  

"How do you deal with people who are angry or make you angry?"  We couldn't answer this.  Not one of us offered to confront the anger nor we suggested setting boundaries to protect ourselves from the rage others would displace onto us.  That in itself said a lot about us as a group.  Why is it so vital to address this and yet we don't or we can't?  

First off as a group of residents who have various roles in the span of our residencies ranging from over time to day to day role transformations like brand new intern to different roles from one rotation to another and more frequent role changes of on call doctor after hours to the resident on unit or clinic during the day, we are required to switch hats frequently.  

In the bigger picture of training this is completely normal and actually required for us as residents to be able to switch between decision makers on call to an active learner in normal duty hours, so we can eventually be able to work independently.  But the fluidity and flexibility also leads to confusion among ancillary staff leading to conflict and many times residents are front and center of attention in such conflicts.  The concept of physician autonomy is at times hard to apply to residents because they are still under training and therefore are easier to be put in the middle of such situations.  At the same time being residents we also feel obligated to make everyone happy and play nice mostly to get over with the day, call, rotation and residency in general.  

We all beat around the bush yesterday, some of us tried to see the other side and tried calming the negative feelings we were having and so on.  We were unable to allow ourselves to be angry and were uncomfortable with expressing that anger even in the safe and contained setting of our group.  Not because we can't get angry but because we worry about the natural consequences of expression.  But it doesn't help the fact that the longer you don't deal with your feelings the worst it gets.  Again so easy to tell your patients yet so hard to apply to self.  

We will deal with angry bosses, angry administrative staff, abusive supervisors and loud and obnoxious staff who will talk over us and yell at us because for the most part such people do get away with their behavior because we fail to protect ourselves from their rage.  People who express anger in socially and at times blatantly disrespectful way are at ease with it because most people want to get over with it and go back to business but it doesn't address the issue nor does it avoid a repeat.  A simple "you are yelling and I am sorry I cannot talk with you like this." was so hard to produce yesterday from all of us that I was taken aback by how we would allow this to happen to ourselves.  I realized yesterday why we were lucky to have the group leader we have because he pointed out the basic flaw in our approach.  We are two extremes of responders, too angry to engage and too avoidant to disengage from our therapist role for the aggressor even when we are the victim.   

Anger doesn't dissolve when it is pushed back and denied it's existence.  It is consuming and drains us of energy while we try to tell ourselves it doesn't bother us that much.  It piles up with each occurrence and makes us anxious because of how uncomfortable we are with the conflict.  Avoidance of setting boundaries doesn't resolve conflict but actually gives way to passive aggressive even more toxic conflicts.  

I hope yesterday's process taught us that it is okay to protect ourselves from abrasiveness and set limits.  We have to let go off the anger in ourselves to continue to maintain fluidity our roles as residents and for us to be able to say "I do not appreciate your tone." without being afraid of it's impact and be able to disengage ourselves.    

The only way to "Let It Go." is to actually stop and deal with it because your anger is almost always a sign that you have been quiet for too long and besides Elsa didn't save Arendale by running away from it.