Dr. Mohammad Akmal Makhdum is a Psychiatrist originally hailing from a family of renowned academics in Pakistan. His father was responsible for establishing Pakistan’s first psychological care center. Dr. Makhdum’s journey has included a college education from the University of Cambridge and Membership of the Royal Court of Psychiatrists. Dr. Makhdum has established his detox and rehabilitation center and was active in the training of the United Kingdom’s psychiatrists and mental health professionals.
The following is a personal story shared by Dr. Makhdum about the loss of his wife to brain cancer. He hopes that by sharing a professional psychologists’ impression of grief, he can lend support to others going through the loss of a loved one.
A Personal Roadmap
Dr. Makhdum says that there is no real roadmap of grief. It is unique for every human being. Dr. Makhdum has found that traditional literature typically describes what humans think and emote and describes those thoughts and emotions in black and white. Dr. Makhdum says that there are no real stages in grief, and many stages merge, overlap, and occur in a merged and confusing manner.
Dr. Makhdum has had the opportunity of experiencing grief in Eastern societies, that have gone far back in history in establishing rituals and traditions in grief. Western grief is fixated in the Victorian era; the black clothes and hearse, subdued emotions, calm, stoic, dignified, and quiet — a solemn and short affair. Eastern societies, especially societies in Pakistan and India, have a more prolonged and ritualized process of grief.
Some 40 years ago, grief was spread over a year in rituals that would be weekly, starting with burial, traditional wailing and beating of thighs and arms. The women of the household would ritually wail and cry in rhythmic tones about the deceased; they would repeat what the deceased used to say or do or aspired to or hoped. Each woman who would visit the house for condolences would mourn in a loud wailing chant with the loved one, while in a close embrace.
Members of the deceased’s household would not be allowed to cook, and food would be prepared and provided for by relatives and close friends who would eagerly and willingly volunteer. It is done to ensure that the grieving family does not get distracted from their acute mourning time and become preoccupied with daily chores of cooking and cleaning. Close friends and family would take over the running of the house, freeing the family members of the deceased to mourn in total focus and attention.
The third day after death is a formal prayer day that everyone attends. Depending on the number of mourners, attendance can be in the hundreds. All are invited for a meal, whose costs and arrangements are also shared by relatives and friends, who believe that it is a good deed ordained as a virtue. No one feels compelled, and only willing volunteers are allowed to do this. Sometimes when the numbers are high, and the expected costs are also high, then all family members, relatives, and friends combine in sharing expenses. On that day, all day, the house is open to visitors who come, pray for the deceased, and either sit until the collective prayer is said at sunset or leave if they are unable to stay. At sunset, a collective prayer is said for the deceased, for salvation, high status in the hereafter, and for the forgiveness of sins.
Then, each Thursday, friends, and family would once again gather, pray together, and leave. For forty days after death, all meals are brought in by friends and family on Thursdays. The purpose is that the family should not feel the burden of expense and should not spend time arranging food for others when they should be focusing on their grief. The other is an affirmation that the family and friends are always there for support.
It is customary for close friends to visit and support the family of the deceased daily. They ensure that the grieving family and loved ones are supported and are aware that they have the physical and emotional support of the extended family and close friends.
Some decades ago, when there were larger combined and joint families, older relatives were alive, and life did not seem so overwhelming in terms of time, this routine would carry on for up to one full year. And at the end of the year, mourning would be formally over. In many families, no one would arrange marriage ceremonies or parties for at least six months. Some families insisted that no marriages were planned for one year, and no one would attend from the grieving family. The older generation condemned anyone who violated that tradition. As modernity has set in, that one-year mourning gradually shrank, from twelve to nine, then to six, then three and now to forty days. But, even those forty days are also not so stubbornly adhered to in regards festivities planned.
For forty days, no one would listen to songs, watch television, or celebrate any birthdays in the family. Visiting the grave every day is another tradition that is adhered to, but it is also shrinking regarding time. Initially, it was forty days that one was to visit the loved one’s grave and say a prayer. Many times, people would also hire priests to go and pray for hours, for forty days. Nowadays, it is about a week that people visit the grave and sometimes not even that long.
Dr. Makhdum assesses that Eastern societies that are far older in terms of continuous history and living traditions, many going back thousands of years, have got the process of grieving right. They have a more humane and collective, supportive, and sensitive approach to grieving.
Grieving is individual, but the individual needs support; confusion overwhelms in grief, but rituals give structure and a degree of form to grief. It is making grief structured and controlled. One is expected not to suppress, but to openly and loudly expressed. If you want to scream, you scream. If you’re going to lament loudly, you shout out your laments. If you feel like stamping your feet in agony, you do that. The suppression of grief is not the eastern way of grieving.
Dr. Makhdum, while living in the West and being a traditional and historic part of the East, needed to use both methods: Eastern and Western. He felt that he needed to make grief an experience that would make him complete in grieving for his loved one.
Dr. Makhdum said that his “grief became the path with which I was linked to my loved one. In this case, my beloved wife Farah, who died at a young age of Glioblastoma Multiforme grade 4. I grieved for my father for many years. Then for mother, for many years, and this enrichment of recalling them, and being faithful to their memory that grieving gave me, was an experience that I developed for myself while grieving for my beloved parents. Losing my wife is like shattering of life, and while I grieve for her, it seems that this process links us again while we are physically apart, but I feel a physical closeness to her when I am actively grieving for her.
When one can make grief a process of love and expression of fidelity to the beloved’s memory, I believe then grief becomes a nurturing process that makes grief evolve a sense of loyalty and continuity rather than painful loss and darkness. I found that in my case.
Farah’s death is too recent for me to fully begin to cope and find a path through the hurt and cloud that has descended on my existence, but the grief process that I developed for my parents was regular moments of active remembrance; active recollection of happy and sad times; active exhortation of missing them and longing for them, that they could see what I had done, or what my children had achieved or that they had a great-grandchild. These were solitary rituals. As I stated earlier, this is something for the individual to create and perform and do and undergo. It is not a collective process. I did on my own, sometimes driving away to a solitary place, sometimes on their graves.
It is my experience that grief is as much part of life as life itself. We never prepare ourselves for grief. Older civilizations have evolved processes of grief that give grief some structure, and one can contain one’s emotions within that framework.
In my evolution in grief and dealing with grief, I believe that it is a statement of love, loyalty to the memory, fidelity to celebrating the beloved, by regular and periodic mourning, loudly, in solitude, weeping and wailing, actively talking about them and talking to them, and telling them how you have felt without them and how you feel about them, and long for them and yearn for their presence, the sound that you want to hear from them, calling you, the loving touch, the warm embrace.
As I said, this is an individual process. It can be short or long. It may be less loud or more. But it is essential to create a unique method of rituals of remembrance and recollection. To express what one feels and express that to one’s self, vocally, if not to others. Sometimes one cannot know one’s feelings unless one utters those from one’s mouth, so one’s ears can hear them and deal with them. In grief, the primary therapist is one’s self.”
Dr. Mohammad Akmal Makhdum reassures loved ones that there is no shame in surrendering to the process of grief, and it can be a process that keeps one fully anchored in reality and guides one into a better future.