Tales From the Therapist's Couch: 'Given the space and time to grieve, people find their own ways to heal, or contain, their sadness'

Say the word "bereavement" and most of us think of a physical death. Yet the loss of anything or anyone precious to us can trigger off the same reactions of denial, anger and depression. A refugee who had lost her homeland, a wife whose husband had left her, a man who had lost his job, a woman who had miscarried after more than a decade of trying to conceive... all of these came to therapy undoubtedly suffering from the classic symptoms of bereavement.

Say the word "bereavement" and most of us think of a physical death. Yet the loss of anything or anyone precious to us can trigger off the same reactions of denial, anger and depression. A refugee who had lost her homeland, a wife whose husband had left her, a man who had lost his job, a woman who had miscarried after more than a decade of trying to conceive... all of these came to therapy undoubtedly suffering from the classic symptoms of bereavement.

The difference between these cases and someone whose loved one has actually died often lies less in the mental distress experienced, and more in the way these losses are treated. With a physical death there is a public funeral, a ritual to help us through the unbearable pain of loss. There is also a cultural acceptance that mourning is part of an understandable process, and that, at the end of the day, time alone is the great healer. Yet for those mourning other losses in our society, there are rarely either healing rites or a time allowance. All of those mentioned above were referred to psychotherapy long after they had been diagnosed with depression, and started on the prescriptive treadmill of anti-depressants and dependency.

For many people, the therapeutic space can offer an alternative or complement to the quick-fix route of medication. Over and over again I have been amazed, moved and inspired by how, when given the space and time to grieve, people find their own ways to heal or at least contain and manage their unbearable sadness. Sometimes it is a gradual and lengthy process, step by step, inch by inch. On other occasions there is a more dramatic discovery, or recovery, of some instinct for self healing.

The woman whose marriage had abruptly ended found her own way of helping herself out of darkness and depression. One week she arrived for a session looking tired but somehow stronger and more alive. She described how she had spent three days and most of three nights clearing and cleaning her marital home from top to bottom. At the end of this time she had lit a cathartic bonfire in the garden, then felt the need to put flowers in every room, as if bridging the death of the old with the blossoming of hope for a new beginning.

The use of rituals for healing is, of course, age-old. In many parts of the world, in many tribal cultures, there are rituals for all moments of important change, both times of joy and sorrow. Even in our culture they are still very much a part of our everyday lives. Who among us hasn't "said it with flowers", or cleaned the house as a way of achieving a psychological spring clean? They are familiar and spontaneous gestures, like the lighting of candles in the dark.

The pity of it is that we don't transfer this instinctive knowledge to the world of mental health. Many of the finest theorists in the psychoanalytic tradition wrote about our capacity for self cure when we are given the necessary space and time (I am thinking of Milner, Winnicott, Bion and Jung), yet in Britain alone about 25 million prescriptions for anti-depressants are written out each year. As requests pour in for repeat prescriptions, will our need for a different response to the signs and symptoms of bereavement be heard? Or, for too many of those suffering the pain of acute loss, will the chance of finding within themselves the seeds of their own recovery remain an unrealised, because unrecognised, possibility?

elizabeth.meakins@blueyonder.co.uk

Elizabeth Meakins is a psycho-analytic psychotherapist in private practice. None of the clinical material above refers to specific individual cases