Chapter 4

HOW WE HEAL

© 1994 Donald E. Watson

We often hear that time heals all wounds. Coping with crises would be easy if this adage were true. But it isn't. Believing that time heals is like believing that time makes breakfast. Except for one big difference: If you wait for time to make your breakfast, your stomach could growl until lunch. If you wait for time to heal your psychological injuries, you could ache for the rest of your life.

The truth is, healing requires mental work--grief work. Like any other kind of work, grief work is active, not passive. It requires effort. It demands our attention, our energy, our reasoning, our reality testing, our planning, and our actions. And it requires time.

About the World-Image

The main task in grief work is updating our world-image. Our world-image is our mental image of the world; it is like a mental map that depicts the world as we imagine it to be. This map represents our self-image, and everything else we perceive, including our relationships with each of our treasures.

Because we rely on our world-image to successfully navigate through life, we can safely chart our life-course only if it reliably represents the real world. And because the real world changes significantly with a major loss, we must update our mental maps to correspond to reality.

In short, grief work is like map-making. Map-making requires attention to reality, so we must use our mental skills of reasoning and reality testing. That's why we can't heal if we try to cope with our losses by using denial or other mental habits that distort reality.

The remainder of this brief chapter describes the world-image further. Understanding the world-image can assist you in learning the skills of grieving. However, if you are suffering from a recent loss, you may find it difficult to concentrate on the material in this chapter. If so, don't be concerned: Though the following information is helpful, it isn't necessary for learning how to heal. You can return to this discussion later, after you have regained your ability to concentrate.

Bonding and the World-image

When we identify "ourself," we are referring to our self-image. This image defines ourself in terms of internals--that is, our mind and body, and everything else that is contained within the imaginary boundary around ourself. We say that these internals belong to us, for example, "my" arm, "my" anger, and "my" dreams.

We also create other kinds of internals though the process of bonding. We bond with others by forming emotional attachments between them and ourself. Of course, this doesn't mean that we stick to them physically. It means that we bring that person's image into our self-image. That is, we merge images of external persons into our self-image, where we thereafter perceive them as internals. This process is appropriately termed internalization. (Internalization is discussed further in the next chapter as the mechanism for forming our consciences.)

In reality, internalized people, as well as other kinds of treasures, remain external to us. Yet bonding makes them seem to be parts of ourself. That's why our treasures seem as much our possessions as our mind and body. We refer to them as "my" spouse, "my" son, or "my" career. We don't actually possess these things, but we own our mental images of them; these images are truly ours.

Our entire collection of images--internals, externals, and the combinations we form by bonding--makes up our world-image. Because of bonding, we never completely distinguish between internals and externals. Besides, our world-image is itself internal, and it merely represents the externals.

Because we are able to bond, we can experience intimacy by mentally blending another person into our self-image. This produces the wonderful feeling of love. However, love does not generate wonderful feelings when we lose a loved one. Wrenching one of these parts from our self-image is painful, like tearing off an arm or leg. It can also make us feel as though a part of ourself has died. Of course, we realize that this isn't literally true. Yet, for awhile, it seems to be true, for the loss obliterates a large region of our self-image.

Since we can also bond to other externals (such as our careers, objects, and dreams), losing one of these treasures is also painful. And it can be frightening, because any major loss means losing familiar landmarks, internal and external. This, in turn, creates distortions in our mental navigation charts, and this misleading information puts us at risk for further injuries until we redraw our maps through grieving.

Since our world-images aren't accurate after a major loss, they allow us to recognize, not only real things, but imaginary things--phantoms. In fact, our mental references are themselves mere abstractions, and they don't necessarily identify themselves as real or imaginary things. We must use our reasoning to distinguish fiction from reality. In other words, we perceive the world, not as it actually is, but the way it is depicted in our minds. That's why, to a child who imagines ghosts, a shadow or a strange sound really is a ghost.

The World-image After a Loss

Immediately after a major loss, our mental map is no more realistic than a child's vivid imagination. That's because the world has changed, but our world-image hasn't. When we lose a treasure, the real world changes radically: A treasure that was once an integral part of our real environment is suddenly absent. However, our world-image doesn't instantly change to reflect this loss. Our lost treasure is still on our map, and we continue to expect our senses to confirm its presence. But they don't. Yet, we continue to rely on our obsolete mental map, denying the loss. This is the mechanism for the denial that occurs immediately after a loss.

When our eyes don't see what we expect to see, and our ears don't hear what we expect to hear, a disparity exists between "what is" and "what we expect." This tension causes our pain and distress immediately after a loss. We close this gap by performing map-making work--grief work. By grieving, we redraw our inaccurate world-image to conform once again to the real world. And once we have eliminated the disparity, our distress stops.

On the other hand, if we don't re-draw our world-images to correspond to reality, the disparity between "what is" and "what we expect" can extend our pain indefinitely. Indeed, by relying on an obsolete mental map, we are likely to make things worse: We can stumble over a cliff that our map doesn't show.

Some people resist redrawing their world-images by harboring the belief that the real world will eventually change to conform itself to their maps. This type of denial is disastrous, of course, because the real world never changes merely to grant our wishes. Instead of restoring their lost treasures, people who use denial stand to lose even more: their health. That is, whether they use the mental habit of denial, or reinforce their denial with alcohol or other drugs, they risk falling into long-lasting distress after a crisis: depression, physical illness, and ruined relationships. The only way to prevent such losses is to perform the work of grieving.

Phantom Limbs and the World-Image

The "phantom limb phenomenon" is a familiar example of how the world-image changes after a loss. Normally, people who lose a limb to amputation continue to "feel" their limb after it is gone. This phenomenon seems mysterious: The question is, "How can we feel a part of our body that isn't even there?"

This mystery is solved by explaining phantom limbs in terms of the body-image: Amputees perceive, not their real body, but their body-image--their mental map of their body. That is, rather than believing their senses of sight and touch, they read and believe their mental map, which still depicts the limb. This perceived image, this imaginary limb, is the phantom.

Phantom limbs normally fade in a few days or weeks. This process concludes when amputees erase the image of the limb from their body-image. That is, they redraw their body-image into a realistic mental map that doesn't show their limb.

A few amputees, however, continue to experience pain in their phantom limb long after their real limb is amputated. Almost always, the pain resembles the pain they had experienced before the operation--the pain associated with the disease that forced the amputation. The question here is, "Why doesn't the phantom disappear?"

The answer is straightforward: "Because the amputees block their grieving." They redraw their body-image, not to erase the limb, but to include the pain. Indeed, many people who suffer phantom pain say they have "learned to live with the pain." This common expression is unfortunate, for it reinforces the pain, making it chronic.

Dr. Donald W. Schafer, a widely recognized authority on chronic pain, explains phantom pain this way: "If people believe they must live with their pain, their unconscious minds conclude that they can't live without the pain. Naturally, they cling to their pain because they believe they need it to survive. Also, by keeping the pain, they can continue to deny that they have lost their limb: They reason, `If it hurts, it must be real.' Of course, these beliefs aren't reasonable, but this doesn't prevent people from holding them in their unconscious minds. We know they do this, because amputees with phantom pain dream of their bodies with their limbs intact."

In addition to denial, people who suffer phantom pain block their healing by misusing another mental habit: They somatize. That is, they focus on the pain as though it were a somatic, or physical, phenomenon. In fact, it is a psychological injury that requires psychological healing. (Mental habits, including denial and somatization, are discussed further in Chapter 9, "The Skills of Healing.")

Phantom pain is an equivalent of chronic depression. Some people who suffer from this kind of pain find relief from antidepressant medication. However, most of them lose their phantom pain only after they learn to grieve for their loss. Because hypnotherapy facilitates updating the body-image, it is a very effective method for helping people with phantom pain.

Other Phantom Treasures

Phantom phenomena are not limited to limbs. Every image in our world-image, including the image of each of our treasures, is a phantom. We don't usually recognize this until the real world changes, and exposes the phantom as a mere mental image.

Before my son, Scott, died, I perceived that he was as much a part of me as my right arm. My world-image held his likeness, his talents, his mannerisms, his sense of humor, and his many other facets. When he died, the part of the real world that corresponded to his region of my world-image was abruptly empty.

Scott's position in my world was enormous. When he died, his vigorous, living self was replaced with a silent, dark cavity. Wanting to avoid facing this emptiness, I looked inward. There, Scott's usual position in my world-image drew my attention like a black hole.

For awhile, I could sense his presence. At times, I imagined that I heard his laughter or his music when the house was actually silent. I was perceiving my distorted image of the world, of course, not the real world.

The Scott that I sensed was my phantom son. I knew this, and I felt sadness when I realized that I was merely imagining his presence, and that my real son was gone forever. I felt pain because my world-image didn't accurately mirror the real world. Moreover, my expectations failed. I had expected my son's presence to comfort me on my deathbed as my presence had comforted my father. If I had been dying before my world-image changed, I would have flailed desperately in disbelief and perplexity because I would have expected him to be there.

The black hole didn't allow me to escape until I had redrawn my world-image to show a world without Scott. As my healing proceeded, Scott's usual region in my world-image receded, and a new region came into view, a place on my map that is occupied by memories of my lost son. I know well that they are memories of Scott, not Scott himself. I no longer expect him to appear, and I have directed my attention to other areas of my world-image. These new areas represent my new life, my new treasures, and my new dreams.

REMEMBER: