Loss and Grief in the Context of Mental Illness

Taking a stance is concerned with a person’s capacity to relate to themselves, to others, and to the situation. This implies that there is always an existential aspect to illness. The existential relationship towards experiences of illness enables to relate to the consequences of the disease or disorder for a person’s life, to feel grief over the loss that comes with illness, and eventually to give meaning and value to those experiences. Whereas in the context of somatic illness a difference between the experiential aspect of illness and the existential stance towards it has been generally acknowledged (Carel, 2016), in the context of mental illness this distinction is more difficult to make. This is because mental illness is concerned with the psyche itself: it involves symptomatic changes in experience and behavior, including self-directed attitudes. In other words, a self-relational component is involved in mental illness (Glas, 2019). The implication of this is that the attitude towards the experience of illness is not ‘neutral’ but is influenced or colored by the mental illness itself. This can, for instance, be seen in the context of depression: a person who experiences depression relates to the depression in a depressive manner.

Despite the difficulty of distinguishing between what is intrinsic to the condition and a person’s stance towards it in the context of mental illness, it is important to carefully distinguish between the two. One of the reasons for this is that a more accurate specification of the existential stance in mental illness gives insight into the complex diachronic process that comes with the development of and recovery from mental illness. A possible way to address this issue is by considering aspects involved concerning loss and grief. In phenomenological psychopathology, much has been written about mental illness as involving profound and enduring alterations in experience (e.g., Fuchs & Röhricht 2017; Sass & Ratcliffe, 2017; Fuchs, 2013; Sass & Parnas, 2007). Those alterations can be understood in terms of a certain kind of loss. However, insights from phenomenological psychopathology have not been implemented in research on recovery. Personally defined recovery is concerned with recovering a life worth living by finding coherence, sense, and hope despite or even because of having symptoms (e.g., Van Weeghel et al., 2019; Barber, 2012). Similarly, in phenomenological psychopathology there is a lack of attention for experiences of recovery.

Bringing the available research on recovery and in the field of phenomenological psychopathology together, it can be argued that a distinction must be made between various aspects of the experience of loss in the context of psychopathology, as well as between the experience of loss and the experience of grief over loss from a self-relational, existential stance. A first aspect of the experience of loss is the loss that is intrinsic to psychopathology. This concerns the alteration of a certain way of being-in-the-world, which can be understood as involving a particular kind of loss, namely that of being part of a shared world (Ratcliffe, 2020; Ratcliffe, 2008). This can be distinguished from a second aspect of loss, which is directed at but not intrinsic to the experience of illness. This concerns the experience of loss that occurs as a result of and/or following on experiences of mental illness. This aspect often has to do with things or situations in the outside world (as experienced) that cannot be realized or that appear or have become impossible because of the confrontation with a mental disorder. In this context, one may think of the loss of connectedness with activities or practical matters, the loss of relationships, and the loss of dreams, longings, and expectations for the future (Buchman-Wildbaum et al., 2020; Muthert, 2007).

Both aspects of the experience of loss stand in a complex diachronic relationship with each other. For instance, it may be the case that a reduction of symptoms is necessary for someone to “regain” the experience of being part of a shared world. Only then may it become possible to realize what has happened and what has been lost within this shared world. A central element that may be helpful in further clarifying the relationship between those aspects, however, is the role of grief. If the experience of loss prompts a reaction of grief, the role of the existential, self-relational stance comes in. Taking an existential stance enables a person to relate to their own experiences and situation, thereby enabling to feel the experiences of loss as something to grief about. In this way, grief can play a central role in a person’s journey toward recovery.

References

Barber, M.E. (2012). Recovery as the new medical model for psychiatry. Psychiatric Services, 63(3),

277-279.

Buchman-Wildbaum, T. et al. (2020). Perceived loss among people living with mental disorders:

Validation of the personal loss from mental illness scale. Comprehensive Psychiatry, 96, 152146.

Carel, H. (2016). Phenomenology of Illness. Oxford University Press.

Fuchs, T. (2013). Depression, Intercorporeality, and Interaffectivity. Journal of Consciousness Studies,

20(7-8), 219-238.

Fuchs, T. and Röhricht, F. (2017). Schizophrenia and intersubjectivity. An embodied and enactive

approach to psychopathology and psychotherapy. Philosophy, Psychiatry, and Psychology, 24(2), 127-142.

Glas, E. (2019). Self-relatedness, psychopathology, and the context: The concept of disease. In G. Glas,

Person-Centered Care in Psychiatry. Self-relational, Contextual, and Normative Perspectives (pp. 44-61). Routledge.

Muthert, H. (2007). Verlies en verlangen. Verliesverwerking bij schizofrenie. Van Gorcum.

Ratcliffe, M., (2008). Feelings of Being: Phenomenology, Psychiatry, and the Sense of Reality. Oxford

University Press.

Ratcliffe, M. (2020). Existential feelings. In T. Szanto and H. Landweer (Eds.), The Routledge

Handbook of Phenomenology of Emotion (pp. 249-261). Routledge.

Sass, L. and Parnas, J. (2007). Explaining schizophrenia: The relevance of phenomenology. In M.C.

Chung, K.W.M. (B.). Fulford, and G. Graham (Eds.), Reconceiving Schizophrenia (pp. 63-95). Oxford University Press.

Sass, L. and Ratcliffe, M. (2017). Atmosphere: On the Phenomenology of “Atmospheric” Alterations

in Schizophrenia – Overall Sense of Reality, Familiarity, Vitality, Meaning or Relevance

(Ancillary Article to EAWE Domain 5). Psychopathology, 50, 90-97.

Van Weeghel, Jaap, et al. (2019). Conceptualizations, Assessments, and Implications of Personal

Recovery in Mental Illness: A Scoping Review of Systematic Reviews and Meta-Analyses. Psychiatric Rehabilitation Journal, 42(2), 169-181.