Loss

Developmental, Cultural, and Clinical Realms

Salman Akhtar

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781000709872
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The experience of loss is ubiquitous in human life, but its nature and impact have great variations. When loss is phase-specific, expected, and accompanied by compensatory supplies, it can lead to ego growth. When loss is untimely, unexpected, and unaccompanied by environmental 'holding,' it becomes traumatic and needs clinical attention.

This edited volume brings together a distinguished cadre of international contributors in order to explain the multifaceted and nuanced nature of loss from a variety of different perspectives. These clinicians, administrators, and writers delineate the great variability in the setting, antecedents, and consequences of loss. Development-facilitating and development-impeding losses are addressed and so are the losses that seem inevitable as one moves from childhood through adolescence and young adulthood to midlife and old age. Loss experienced by institutional organizations and war-torn societies is also examined. The book's ultimate focus is clinical: it highlights the many technical dilemmas in working with grieving patients and offers therapeutic strategies aimed at ameliorating their anguish.

Loss: Developmental, Cultural, and Clinical Realms will appeal to psychoanalysts and psychotherapists both in practice and training from a variety of different backgrounds.

PART I

Developmental realm

1

THE DEVELOPMENT IMPEDING AND THE DEVELOPMENT FACILITATING ROLE OF LOSS IN CHILDHOOD

Ann Smolen

In this contribution, I will explore loss during childhood. I will focus on two types of loss: loss that is universal and essential and promotes emotional growth, and loss that overwhelms the fragile developing ego, often causing a fixation in psychological development. I will include clinical vignettes illustrating loss that promotes progressive development and traumatic loss that causes children to be thrown off course.

The word loss carries negative connotations. When we think of loss, some of the following phrases readily come to mind: (i) death of a child, (ii) many parents feel a sense of loss when their children leave home, (iii) some older adults suffer a gradual loss of memory, (iv) substantial financial losses suffered by workers if a factory closes down, (v) companies announcing a loss of three million dollars, and (vi) loss of life. These examples do not give the reader a sense of hope or that positive growth could be a result of loss. Therefore, I will begin with a discussion of the important losses that we all must experience in order to grow up relatively healthy.

Normative loss

To begin this discussion I assert that there are several undeniable losses that are facts of life: (i) our mothers and fathers will leave us, (ii) we will leave our mothers and fathers, (iii) we will suffer many emotional wounds that cannot be made better by parental soothing, (iv) mother’s love and/or father’s love is not for us alone, (v) little girls cannot marry their daddies and little boys cannot marry their mommies, (vi) we have to come to terms with love and hate, good and bad in everyone, (vii) every person has imperfections and weaknesses, (viii) every relationship is flawed, (ix) everyone we love will die, and finally (x) we will die.

From this list, we may discern that loss is part of life; it is universal and inescapable. We grow and develop through the experience of the many losses we must endure as we learn to leave and let go. Making use of “separation/individuation theory” (Mahler et al., 1975), we can gain an understanding of how in each phase of early development there are losses that promote progressive growth.

We begin this process of leaving from birth. When the newborn departs his perfect environment and is startled by that first gulp of cold oxygen, there is a loss. We do our best to make up for the loss of perfection – the womb – but that is impossible. If all goes well, the first several months of life consist of many blissful moments when the infant’s hunger pains or cold, wet, uncomfortable feelings are met and alleviated by an attentive and loving caregiver. This “symbiotic phase” (Mahler et al., 1975) is a time when the infant/mother dyad experience a feeling of oneness. There are fleeting moments of perfection as baby gazes into mother’s loving, adoring eyes while suckling warm, sweet breast milk; however, the symbiotic phase is far from perfect. The baby must wait for mother to attend to his needs. Even if it is only a few minutes, there is frustration in hunger pains or a wet diaper, or the need to be held. Baby learns that mother is on her way as his angry cries are met by a soothing voice assuring him that soon he will feel better. This is an example of one of our earliest losses that help the infant tolerate a limited amount of frustration while simultaneously knowing that he can trust that his needs will be met and it is well worth the short wait to once again be enveloped into another blissful moment. We do not remember the womb or the blissfulness of symbiosis, yet we never forget it. It is the stuff of fantasies, both conscious and unconscious, the stuff of religion, the stuff of fairy tales, and the stuff of falling in love. We must leave the symbiotic phase of development; yet, in reality it is never totally relinquished. There is always a yearning to return to the bliss that once was.

If there are problems in this phase, for example, if mother is drug addicted or depressed and unable to meet her infant’s physical and emotional needs, the infant may experience too much frustration. When mother is unavailable either physically or emotionally, “basic trust” (Erickson, 1950) does not develop and this has serious consequences for all further development. If mother leaves her infant too early, the cost of this loss may be too high. However, we must accept that mother always leaves her infant before the infant can know that she will return. Mother runs errands, goes shopping, takes a shower, and returns to work. Mother may take a vacation with father, leaving baby behind to be tended to by a nanny or grandparent, or she may give birth to another baby. Mother is not always there when her baby needs her. If these leavings are too frequent or too long in duration, the baby may be too deprived, which can cause annihilation anxiety, severe mental pain, and fear of falling forever with no one to catch him (Winnicott, 1971). The resulting psychic damage takes a long time to heal, and sometimes the damage is permanent.

Around 5 months of age, the baby begins to “hatch.” The baby (and mother) are no longer content to remain in a state of oneness. The desire to merge or continue in a state of oneness is enormous, but the urge to become separate is even stronger. The baby becomes interested in the sounds and actions around him and will turn away from mother’s breast to see what is going on. Not long after, he slithers off mother’s lap to the floor where he begins to venture away, leaving mother behind as he explores his environment. His explorations are brief as he returns to mother for a hug to gain the assurance that it is okay to set off to explore once again. This “early practicing phase” (Mahler et al., 1975) of development goes smoothly if mother allows her baby to crawl away without pushing him away, and she must be available for his return for his much-needed “emotional refueling” (M. Furer, cited in Mahler et al., 1975, p. 69), which allows him to once again venture out. As long as mother remains a “secure base” (Bowlby, 1969) which he can return to, the practicing baby will delight in playing alone in the presence of the mother (Winnicott, 1971).

CLINICAL VIGNETTE: 1

Many years ago, I ran a mom/baby group. It was extremely interesting to observe the mothers interacting with their babies as the babies entered early practicing and began to explore their environment. For example, Jane became anxious when her 9-month-old son Jacob crawled off her lap. She almost immediately grabbed him by his legs and dragged him back into her arms. Jane seemed angry that her baby would dare to leave her in this way. When I gently inquired into her feelings, she told the group and me that she was just keeping her baby safe. I speculate that Jane’s son received the message: You better not leave me; it is too unsafe a world for you to survive without me. Three years later, Jane contacted me asking me to see Jacob in therapy because he could not go to sleep at night, cried for hours when left at preschool or with a babysitter, was deathly afraid of dogs and cats, and experienced overwhelming tantrums when frustrated or disappointed. Jane gave Jacob many mixed and confusing messages. She was an extremely anxious mother, always worried that something dreadful would happen to her little boy, so she pulled him close, yet she also left him without saying goodbye, disappearing suddenly so she would not have to experience his sadness at leaving. Jane also could not trust others to care for her child and so hired and fired a succession of nannies. By the time I saw Jacob in therapy at age 4 and a half, he had attached to and lost five nannies. Jacob came to expect to be abandoned and so hung on for dear life. He expected to be betrayed, so he angrily fell into destructive tantrums, biting and kicking anyone who attempted to help him to regulate and calm. Jacob was stuck in his development and needed help to catch up. He could not let go of his mother because he had not internalized a good enough mother and was then, in turn, unable to develop object constancy.

Around 12 months (late practicing phase of development), the baby becomes upright and is now able to run away from his mother. He really does not want to run far and looks back anticipating that mother or father is chasing after him. In delight, he laughs and runs faster, hoping to be caught and hugged and kissed. During this “practicing phase proper” (Mahler et al., 1975), the baby is in love with his world. Very little upsets this baby. When he falls down, he seemingly bounces back up with little complaint; however, this sense of harmony is short-lived.

At around 16 months of age, the baby enters the “rapprochement phase” (Mahler et al., 1975), during which the toddler, no longer an infant, begins to realize that he is a separate person from his parents, with separate feelings and thoughts. He becomes painfully aware that he is no longer a baby and experiences a conflict. He yearns for those body memories of bliss when he was one with mother, yet he also demands to be grown-up. I think of the rapprochement toddler as the push-me-pull-you creature from Dr. Doolittle. We hear “Pick me up! NO! Put me down!” and “I do it! NO! You do it!” all within seconds of each other. The rapprochement toddler asks himself, “Should I go? Should I stay? How far may I go and remain safe?” It is within this optimal distance that the toddler is able to begin to psychologically stand alone. The rapprochement toddler begins to realize that the mother is not all good and there are limitations to love. This is a difficult loss, but needed in order to continue to develop well.

In addition to making use of the separation-individuation theory (Mahler et al., 1975), we must also keep in mind Freud’s (1905, 1908, 1915a) psychosexual phases of development. The rapprochement toddler is also smack in the middle of his anal phase of development. Toilet training usually begins around 24 months as the toddler is learning how to control his bodily functions. This is also the time of temper tantrums, which many parents call the “terrible twos.” Toddlers experience castration anxiety/body integrity and are easily overwhelmed with powerful emotions, which cause them to disintegrate into uncontrollable temper tantrums. If caregivers are understanding of the emotional turmoil the toddler experiences during these months (16 to 36 mos.), and help them regulate, these children are then able to integrate good and bad (not splitting) and will be well on their way to self-and-object constancy.

CLINICAL VIGNETTE: 2

In another mom/baby group that I facilitated where the children were between 18 months and 24 months, I had the opportunity to observe and help the mothers understand their babies’ rapprochement behaviors. This is a difficult time for many young mothers, especially when their baby, just a few weeks or months earlier, was so easy to be with. One mother in particular had difficulties and thought her 2-year-old was being disrespectful when she asserted her autonomy and replied “NO!” to many motherly requests. This mother also was not able to understand that her little girl’s temper tantrums were a communication that the child was overwhelmed with emotion and could not regulate her body or her affects. Instead, this mom felt her child was maliciously attacking and defying her authority and would punish her by locking her in her room. The other women in the group were alarmed and confronted this mother with their concerns. Unfortunately, she felt criticized and probably humiliated and left our group. I reached out to her, but to no avail.

When the rapprochement phase is handled well by parents who understand the conflicts their child is experiencing, the child is able to integrate their good self with their bad self; they are able to give up grandiosity and omnipotence and begin to internalize a good enough self-and-other object. The child gains a sense of a reliable self and a sense of his identity. When this phase is not dealt with well, later pathology may result. Such an individual would give myriad evidences of weak “object constancy” (Hartmann, 1952; Mahler et al., 1975; Akhtar, 1994) and, in severe cases, of a borderline personality disorder.

As the child enters into his Oedipal phase of development (3 years–6 years), wishes and deep longings run deep as the child is pulled into the dangerous erotic triangle involving him and his parents (Freud, 1909, 1924). In the earlier rapprochement phase, the child must come to terms with the loss of oneness with mother and the loss of omnipotent feelings of greatness as he realizes that everything is good and bad and every relationship contains love and hate. In the Oedipal phase, the little boy must realize that he will never marry mother and the little girl must come to terms with the fact that she will never marry father. There is a loss in accepting that I alone cannot obtain all of mother’s love or all of father’s love. Upon the arrival of his new baby sister, my 3-and-a-half-year-old grandson announced, “The baby will sleep in the bassinette, I will sleep here with you Mama, and Daddy can sleep in my room in my bed.” A few months later, he was having a lovely conversation with his mother:

M:	“I am so lucky to have you as my son, and your little sister is so lucky to have you as her big brother.”
C:	“And I am lucky to have you as my wife.”
M:	“But I am your mother not your wife.”
C:	“You WILL BE MY WIFE!!”

In latency age, children start full-time school. They begin to see that their parents are not all-powerful and/or perfectly knowing. In order to compensate for this loss and to make it bearable, the latency child falls in love with a special teacher, sports hero, rock star, and/or movie actor. It is also during this time that the child gets deeply engaged with the external, develops hobbies, evolves friendships (mostly of the same sex), and appears to be a paragon of conventionality (Sarnoff, 1976). He strives toward a sense of mastery which, in turn, helps point his energies toward leaving the nuclear family and looking outward. The group becomes important as the latency child deepens his self-definition. He develops a sense of who he is when not at home with mother and father.

In adolescence, peer relationships become prominent as teenagers assert their right to independence and separateness. This phase of development is also understood as a “second individuation” (Blos, 1967). The adolescent body is undergoing an enormous revision as hormones recalibrate, causing massive mood swings. The normal adolescent can go from ecstasy to anguish in a matter of seconds and back again. As brain development allows the adolescent to think more abstractly (Piaget, 1973), the normal adolescent enters into existential conversations about the meaning of life and death, but cannot remember his homework or to take out the garbage. At this point, the adolescent has already figured out that his parents are not perfect and possess many flaws; however, as the adolescent gets closer to leaving home for college, many parents appear to be wrong about just about everything. In some ways, this negative attitude helps the teen leave home. Separation guilt may occur consciously or unconsciously as the adolescent metaphorically kills off his parents, which in turn may cause acting out or high-risk behaviors that pull the adolescent back into the arms of his parents. Once again, the adolescent re-experiences a rapprochement crisis. No longer a cute little 2-year-old falling apart in the grocery store, but now in an adult body acting like a 2-year-old.

When the adolescent actually separates from his parents and leaves for college, there is a whole new array of losses that he must face. Just as the toddler must mourn his infancy, the adolescent/young adult who has physically separated from his parents enters into a state of grief with an intensity not known before. Childhood is mourned, which we often see in dreams. The act of mourning allows the person to accept his lo...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• About the editors and contributors
• Introduction
• PART I: Developmental realm
• PART II: Cultural realm
• PART III: Clinical realm
• References
• Index