The horrific events that took place in the United States on September 11th have left tens of thousands of people traumatised and bereaved. Even for those of us without a direct connection to the victims, the images of aircraft slamming into the World Trade Centre and of workers jumping more than 100 floors to their deaths will remain with us for a very long time.
Bereavement, the process of recovering from loss, is a gradual and often painful experience. Dr Colm Murray Parkes has described four normal phases of mourning: numbness, yearning and anger, disorganisation and despair and, finally, restitution. The entire process can take up to two years.
Perhaps the best-known writer and speaker on bereavement, Dr Elisabeth Kⁿbler-Ross, described five stages of grief, especially in facing one's death. The first phase is denial. Next comes anger. The third phase is bargaining, when an attempt is made to change the reality of death; the person may promise "to be very good and never sin again" in return for being allowed to live. The fourth phase, depression, is when the person's anger is turned back on themselves. Finally, a resolution phase is a signal of acceptance of one's fate.
One of Kⁿbler-Ross's principal motivations to work on death and dying was her experiences of, and reaction to, the second World War. After the war, she said: "I personally saw the concentration camps. I personally saw trainloads of baby shoes, trainloads of human hair from victims of the concentration camps taken to Germany to make pillows. When you smell the concentration camps with your own nose, when you see the crematoriums, when you're very young as I was . . . you will never, ever be the same."
These experiences transformed Kⁿbler-Ross into one of the most influential humanists of our time. Her work has helped to create more humanity in our approach to death and dying.
Does her work have relevance to the aftermath of the terrorist attacks in Washington and New York? I believe it does. There are many rescue workers who will remove victims and, often, body parts from the wreckage. The discovery of a diary, a piece of inscribed jewellery, a hastily scribbled letter to a loved one - all will have a great impact on the grieving of those working at the crash sites.
For those of us more geographically removed from the events, the process of grieving has relevance. I was in Toronto, and like many others on the city streets on that fateful Tuesday morning, my first reaction was disbelief and denial. There was great fear also, as the skies filled with aircraft diverted from the US. Would one of them veer off and hit Toronto's landmark CN Tower?
Hotel bars quickly filled up with people anxious to watch CNN. In one of those serendipitous moments in life, I found myself sitting next to Jack Nicholson, watching the awful television images. I watched as denial became understandable anger: the actor's jaw worked silently and deliberately until, along with a group of fellow Americans, his anger exploded.
And so, within 90 minutes, I witnessed and experienced denial and anger. Acceptance is surely still a long way off, although some bargaining and depression will occur in the interim.
Unlike purely personal bereavement, there are some special features of national mourning. While personal grief can often be isolating, national and international mourners will be helped by shared images of loss. The images of death and destruction, while horrific, will help us to work through the grief. Pictures of funerals will trigger conversations about loss. The details of victims' lives and deaths will be replayed in our collective psyche.
This is the essential process of grieving: repeating again and again the images of, and feelings about, our loss until the mourning process is complete.
Hard as it may seem to appreciate in the initial phase of grief, personal growth can emerge from profound loss. It takes time and it hurts, but it can happen.
You can e-mail Dr Muiris Houston, Medical Correspondent, at mhouston@irish-times.ie or leave a message on 01-6707711 ext 8511. He regrets he cannot reply to individual medical problems
