Loss – what does it mean to you, what does it mean to the people you are helping? It likely means many things, because loss will be contextual and personal, but what happens when love, health, companionship, career or opportunity whatever their category and classification, dissolves under the interminable forces of time and change, be it by acts of sabotage, obfuscation, entropy, death or by some other, obscure or deliberate demise?

Consider; how do you moor yourself to the fact that even the most beautiful, most singularly gratifying things in life are merely on loan from the universe, granted to us for the time being?

Consider; How do you provide support and assistance to the person presenting with ill health for whom unresolved loss and the associated changes in their function and wellbeing are interminably linked?

One proposal suggested over two thousand years ago, by the great Stoic philosopher Epictetus (c. 55–135 AD) argued that the antidote to disorientating and disabling grief associated with loss is found not in hedging ourselves against prospective loss through artificial self-protections but, when loss does come, in orienting ourselves to it and to what preceded it differently — in effect training ourselves not only to accept but to embrace the temporality of all things, even those people, projects, health status and security we most cherish and most wish would stretch into eternity, so that when these and the love associated with them does vanish, we are left with the irrevocable gladness that it or they had entered our lives at all and animated them for the time that it did.

These concepts are challenging, difficult and yet potentially liberating. For presenting the notion, the concept and the beautiful simplicity of the reality can help people step away from their grief, their affect and their loss of vitality. In effect you can construct a path to help your patients or you step away from paralysing devastation and instead unwind their position to one more aligned to a state summarised (and edited by us) by Abraham Lincoln as a ‘sad sweet feeling embedded in the emotional centre of the heart’.

In effect helping the person to understand, embrace and retain the positive memory and discard the pain of loss.

The state of loss is unique to each and if you have experienced it, you as well as those you are helping are very unlikely to have been able to anticipate the intense feelings linked to grief, its disabling and mood changing consequences and subsequent impact on decision making and health and wellbeing. For grief is a liquid consequence of loss, by which we mean like a mass of water it is obvious in nature but entirely shaped by the landscape it is flowing over. If you can assist your patient by working on the underlying metabolic, immune and other disorders the outcomes may change the landscape and evolve the shape, but if their emotional patterns are not evolved then the outcomes will be less than those sought or desired. How do you engage and support people to re-define their relationship with loss? Do you consciously seek entanglement, avoid the issue, or allow the process of discovery and personalisation of care to present opportunity?

It’s worth noting that research conducted over the past two decades has revealed that grief, a common phenomenon experienced by many people associated with loss, is rarely experienced as a steady progression from high acuity (intensity) to eventual resolution. Instead of this single path, four distinct trajectories are supported by empirical data: resilience, chronic grief, depressed-improved, and chronic depression.

Furthermore, a small subset of individuals never fully integrate the loss into their life, and continue to experience severe disruption in daily life many years after the loss event, a phenomenon known as Complicated Grief. Understanding this is crucial for informing you of best practices when helping those suffering from loss in the process of assisting health resolution.