By: David J Hermiz MD
“No one ever told me that grief felt so like fear.” C.S. Lewis
It seems we are not able to feel very much these days apart from a deep sense of loss. It is a loss that is as specific and acute as it is diffuse and chronic. We mourn as much for those we love who we have lost as for the familiarity of a world that we once knew that has washed away from us. That once familiar world we knew has broken to exist again only ever in memory.
We have found our internal selves fundamentally altered as well. Our behaviors, our beliefs and sense of agency, our connectedness to the world, our trust in our institutions, our relationships, and our sense of safety have been shattered, creating both an inner and outer world that is unrecognizable and alien. It has broken our sense identity, and it has robbed us of the meaning and purpose in which we define our lives.
As in all forms of grief, one becomes inwardly focused and withdrawn, isolated and disassociated from oneself and others. Our visual cortex processes and perceives the world differently, focused on identifying dangers and replaying trauma so to protect oneself from the mechanisms of loss. We become fixated on those mechanisms, causing us immobility and impairment. Because of the complexity and scale of this loss, the normal intensity of grief amplifies. It grows more complex, and it lingers longer. It becomes more destructive, and we are more apt to lose ourselves in it.
The nature of this type of loss leaves us resigned to accept loss itself as our closest companion. We then remain unable to believe in hope or in meaning, stayed in the mechanisms of loss. Grief can sublimate in many forms, from social isolation to anger and depression to maladjustment. The stages of grief are employed in a more frenetic, more random, and less healing manner. This is a trauma that is both universal and idiosyncratic, cascading often from generation to generation.
This type of worldwide societal loss and trauma occurs, perhaps, once every century, usually from a World War, a Holocaust or, in our case, a global pandemic. The effects of severe trauma experienced by patients suffering from PTSD approximates most closely this type of complex and intense loss. It is in working with my patients with PTSD that I have become more aquatinted with this type of loss and its effects, and our way forward.
It is in the conceptual understanding of PTSD that we can begin to understand the complexity of our collective trauma and loss over the last three years. It is with my patients, some of whom have suffered some of the most senseless and unimageable trauma, where I have simultaneously discovered the magnificent depths of human resilience and courage.
It is not that PTSD is curable. On the contrary, it is a chronic, life-long, and debilitating condition. What I find in my patients, however, over, and repeatedly is the courage to wake up every day and not be afraid of confronting what happened, of not looking the other way, of not repressing, of foraging to create a world again not devoid of meaning. It is hope that from the rubble of trauma, new life can emerge still.
It becomes apparent for any psychiatrist treating PTSD that the work is wholly not about the trauma itself nor the senselessness of human suffering. Trauma work is about courage, strength, resilience and finding meaning. Through that confluence, a hope emerges. It is not a hope of returning to once there were, as that it is known by any sufferer of PTSD to be impossible.
It is, instead, a hope that from a once fertile garden lay, that though fallen fallow, new life can emerge. Though this new life will be something wholly different and unrecognizable from what was once familiar, it will not be without meaning, purpose or life. It will be a life that is not coded by loss and trauma. It will be a life emerged anew from it, more durable and resilient because of it, life still.
Thank you to my patients who have taught me more about strength, life, resilience, and hope than anything I could ever offer to them.