Loss, Grief and the Emergence of Hope

Anybody who has gone through the pain of loss knows that grief and bereavement is often a dark and lonely path. Although the company of friends and family can alleviate some of the pain, the journey is essentially taken alone by the individual.

Psychiatrist Elisabeth Kübler-Ross is a major name in the area of grief and bereavement. In her book “On Death and Dying,” she outlined 5 stages that people often go through when encountering loss. These 5 stages are as follows:
1. Denial – “This is not happening to me.” “This is all a dream.”
This is often the initial state of disbelief we undergo when we are shocked by an unforeseen event.
2. Anger – “Why me?” “Who is to blame?”
This is a difficult stage with rather challenging feelings of resentment, envy and rage are pronounced. Oftentimes, grieving persons target certain persons or institutions as the source of their misery.
3. Bargaining – “Maybe a miracle will happen if I seek…” “If I prayed hard…”
This is the time when an individual tries to find various ways to try to soften the blow of one’s circumstances (e.g., prolong one’s life, find a miracle cure, act differently to change the expected outcome, etc.). This is a time of seeing if there is a way to get another chance at things.
4. Depression – “There is nothing I can do to change my situation.” “I am helpless.”
The eventuality of the inevitable dawns on the individual, and the person feels powerless. Much sadness and anguish is experienced at this stage.
5. Acceptance – “Everything will be fine.” “I can still do something with what I have.”
The individual faces the reality of his/her situation and makes appropriate decisions on what he/she wants for him/herself. Oftentimes, a person who has reached this stage also finds meaning in the significant loss, and bears some form of hope for themselves and others.

Although these stages were originally developed when people facing life-threatening illnesses were observed, I often find similar stages going on with people facing difficult situations in their lives. This can be anything from losing an object of some sentimental value to dealing with the reality of having a child with special needs. Even the loss of a dream can trigger this grief response. Whenever our hopes and expectations are not met, we perceive some loss and undergo emotional reactions as a result. Needless to say, our reactions are often proportionate to the size of the loss we actually experience and the meaning we place on this matter.

Interestingly, these stages of bereavement are part of a natural process that does not take special effort. When feelings are accepted as they come, this process happens spontaneously. It is a natural way that we let go.

Nevertheless, extreme feelings can lead us to behave in destructive ways. It is easy to see how extreme anger can cause harm on other people or oneself. With depression, the consequences are less obvious. For instance, a person going through extreme sadness might withdraw from any social contact and stop eating for many days. In such extreme instances, professional help (e.g., counselors and psychologists) might be needed to assist the person in facilitating the grief process.

Even as these stages are neatly defined and ordered, I often see that people grieve in different ways. Some people stay in one stage longer than others, and might need to revisit earlier stages along the way. So, the stages are not necessarily successive, but rather cyclical.

Although the bereavement process is a dark and lonely path, it is also one that can bring forth much meaning and hope in one’s life. This process can be likened to the lotus flower. This most beautiful of flowers emerges from the murkiest mud, and yet its appearance betrays these origins. Like the process of bereavement, the shining light of hope and meaning betrays its murky and dark origins.

Say what? Distinguishing Psychologists, Psychiatrists and Counselors

Whenever I meet someone new, one of the first questions that often get asked is what I do for a living. When I say that I am a clinical psychologist, a frequent follow up question is to clarify what someone in my profession actually does? Due to the fact that I am so often asked this question, I thought that explaining my answer in this blog might be quite relevant for the average Filipino.

So what is a clinical psychologist? Essentially, a clinical psychologist is a person who has at least a master’s degree in Psychology, and specialized in the area of clinical psychology. Many clinical psychologists, such as myself, actually have a PhD or a doctorate in clinical psychology. The education and training that we go through to obtain such a degree and title often includes the following: theories of personality and human development, assessment and diagnosis of psychological problems and mental illness, and various methods of counseling and psychotherapy. This training also includes research methods and techniques, and a prescribed number of supervised work seeing actual clients in a given setting.

In the Philippines, many clinical psychologists actually work in school settings, mainly teaching in universities.

One of the areas of work that distinguishes psychologists from other related professions is the fact that we are trained to develop psychological and personality tests. So, if you have ever taken an intelligence test or some personality test in school or when you were applying for a job, chances are, these tests were developed by psychologists. They are often also administered and interpreted by people trained in psychology.

So, what is a psychiatrist then? How are they different from (clinical) psychologists? Psychiatrists are primarily medical doctors who have specialized in the area specialty of psychiatry. They are trained in hospital settings, whereas clinical psychologists are primarily trained in the university setting. Like clinical psychologists, psychiatrists are adept at the assessment and diagnosis of mental illnesses. Many are also trained to do some kind of psychotherapy, or talk therapy. What psychiatrists do that clinical psychologists cannot do is to prescribe medication, and this is the clearest distinction between the two professions.

What about counselors? How are they similar or different from psychologists? The distinction between these two professions is a bit less defined, and can be quite controversial. In my humble opinion, there are really more similarities between these two professions than there are differences. Maybe one major difference is the kind of clients’ issues each of these professionals will be trained to tackle. Whereas counselors may tend to deal with more problems of living (e.g., grief and bereavement issues, career planning, etc.), clinical psychologists might be have more training in diagnosing and treating mental illness (e.g., clinical depression, anxiety disorder, etc.). I must say that I am more tentative about this distinction.

Currently, counselors are a licensed profession in the Philippines, whereas psychologists have only begun to regulate the professional practice in 2009 through the biggest professional organization in the country, the Psychological Association of the Philippines (PAP). There is a bill currently being read in the Philippine Congress, but there is no certainty when this will eventually pass as a law that will govern the practice of psychology in the country.

Breathing Right towards Psychological Wellbeing

You might all think that this is a strange topic that I am writing about. Now, why on this earth will I relate breathing with psychological wellbeing? Don’t we all breath anyway? If we don’t breath, we will die, right? So, what is this all about?

Okay, I am not really talking about just any kind of breathing.

Do you notice how your breathing actually reflects the emotional state and mindset you currently have? When we are nervous and tense, for instance, we tend to take short and shallow breaths. We take similar breaths when we are excited too. We run out of breath when we are taken aback or shocked over something surprising.

Now, have you ever observed how babies breathe? Babies are some of the most relaxed people, and there is something we can learn from them. Especially when they are asleep, they are very relaxed and peaceful. That’s something I’m sure all of us wants for ourselves. Notice that when they breathe, their abdomens expand as they inhale, and their bellies come down when they exhale. That’s how belly breathing (also known as abdominal or diaphragmatic breathing) looks like.

So, how is it done? Here are the simple steps:
1. You might want to put one hand on your belly and another hand on your chest. This will tell you which of these two are rising when you inhale and exhale.
2. Now, imagine that you need to blow out the flame of a big candle just in front of you. Do that twice so that you exhale most of the air in your lungs.
3. Right after you blow the second time, you will naturally need to take a deep breath. When you do, you will notice that your belly rises as you inhale. That’s a belly breath right there!
4. Just repeat the procedure for about 2 minutes (usually about 24 to 30 breaths) to relax yourself and feel better.
5. If you like, you can silently count to three when you inhale, and count another three when you exhale. Count at a slow pace that you would be able to say the following: one-one thousand-two-one thousand-three-one thousand.

The breathing exercise I just described to you is a good way to just relax yourself. You can certainly do this when you are feeling tense and anxious. You can also just practice belly breathing when you take a break from work or ending your day. It is a good way to just distract yourself from any thoughts or feelings by focusing on your breath. It is an inexpensive and natural way to just help you gain some calmness, even if your anxiety may not completely disappear.

Just like anything else, you will get better at this when you practice. So, I will encourage you to just do breathing exercises anytime during the day, whenever you have a couple of minutes to spare. You can do this standing up, sitting down, or lying down; whatever suits you when you have the time.

Breathing is such a basic way for us to help ourselves gain a better sense of wellbeing. That’s why I think it is so important to be conscious of how you breathe.

Introduction to This Blog

I am not a professional blogger. In fact, this is the first blog I ever put together. What I am is a Clinical Psychologist from the Philippines. My practice is in Quezon City, under the banner of PsychConsult, Inc. I am one of the founding directors of this group practice (see www.psychconsult.com.ph). Starting June 2010, I will also be a full time teaching staff of the Department of Psychology of the Ateneo de Manila University.


So, why did I decide to put together this blog? From among the many reasons I have in doing this, I guess they all boil down to why I really chose to become a clinical psychologist. I wanted to make a difference in people’s lives. As the practice of Clinical Psychology, doing academic research, and teaching have their pre-defined audiences, I figured that this medium has the potential of reaching out to yet another set of eyes and ears.

Now, who are my intended readers? I really wanted a blog for stake holders and consumers of mental health services in the Philippines. It is primarily for people who want to further improve their knowledge and quality of lives in the areas of psychological wellbeing. An inherent subgroup from this potentially large audience includes people who have various psychological concerns and would like to know more about them. For example, you might think that you are suffering from a mental illness or have been diagnosed as such, and would like to know more about it. Or you could have a relative or friend who was recently diagnosed and would like to understand more about it. You might have a child with special needs and struggle with this reality. Yet another group that I intend to write for includes both aspiring and established clinical psychologists, peers who would like to know my thoughts and struggles as I carrying out this profession in the Philippine context. In the end, it is for and about the Filipino audience, both in the Philippines and abroad, that I hope to be writing.

Now that I have explained why I have decided to put together this blog and to whom I hope to be writing, what are the sort of topics I will be covering in this blog? I intend the content of my blog to include one of the following:

1. Fostering and nurturing personal psychological wellbeing and mental health;

2. Highlighting information and online resources related to psychological wellness and specific disabilities and mental health concerns;

3. Discussing topics that aim to provide support for parents and family members of those who have specific disabilities or mental health concerns;

4. Elucidating common misconceptions about psychology and the applied field of clinical psychology;

5. Clarifying the role of the clinical psychologist; and

6. Narrating the struggles and questions of practicing this profession in Asia, and in the Philippines in particular.

I must say that I am quite excited to begin this new endeavor. I hope that I can be relevant to the needs of those out there who spent time reading blogs, and those I can encourage to begin to do so. If you can, do follow my weekly blog or check this blog every so often. Do give me feedback so that I can improve my blog over time. You can also suggest some topics or ask questions that you think I can cover, and I will try my best to entertain your request. Happy reading!