Our grief matters – loss,grief,and mourning in Black vertically infected HIV-positive adolescents

Mourning and Melancholia: ‘Zombies walking through life’

Nosipho, Ntombi, and Isisa live at a care-home for children affected and infected with HIV. Living at the care-home was experienced by all three of them as unbearably painful. Isisa was more open and forthcoming in talking about her negative feelings towards living at this institution – ‘the people here will not make you take your medication for a long time, I am very angry. I hate them’. Isisa expressed continued distrust of others throughout the interviews. The hostile feelings were quite powerfully enacted in the transference reactions between Isisa and the interviewer. Yet even as she expressed this deep hatred and anger that she felt towards the outside world, simultaneously, Isisa expressed a deep internal conflict and vulnerability at having to live as an orphan at the care-home and the fear and despair at the thought of having to leave the only place she has known since childhood as soon as she turns 18 years of age. Her painful vulnerability also showed in her deep grief when asked to talk about her mother. She broke into deep sobs and asked to not talk about her mother. Nosipho was already preparing to leave the care-home as she had turned 18. She expressed a deep anxiety at soon having to fend for herself. When talking about her future Nosipho expressed the same despair as Isisa and also deep anger at having no assistance to help her sustain herself in the outside world. I wondered at times during the interviews where Nosipho might be holding a deeper rage at being let down by the people who were supposed to protect and guide her, which Isisa was able to express more freely. The ‘outside world’ was something Nosipho felt unprepared and fearful of. Ntombe, similarly, spoke about living at the care-home as a difficult space to be in – ‘have to put on that mask of a happy person. If you don’t do that you are like disrespectful. You told, you forget where you come from, you think you are better’. All three were constantly reminded of their powerlessness and dependency on the environment of the care-home due to their HIV-positive and orphaned state. Feeling stripped of dignity, none of them had any deep sense of rootedness and belonging, only passing people and superficial friendships within the context of their daily existence.

Outside of the home, neither Nosipho nor Ntombi can return to their fathers. While their fathers are alive, they have largely been absent in their lives with no hope of any reconciliation. Ntombi talked with great depth of sadness about her dad – ‘He is also married. He has kids. He visits my cousins at home but he never bothers to ask about me and my sister. It is very sad (puts her head down and cries)’. Nosipho described herself as an orphan even though her dad is alive – ‘my dad just disappeared into thin air’. Isisa’s dad died when she was twelve years old and describes this time of loss as intensely painful – ‘I wanted to kill myself’. Isisa cried only once during the interviews, her anger being more visible through her glowing eyes when she did talk about her parents. Physically, her body remains stoic, like a massive oak tree rooted deep in the earth, not wanting to show any vulnerability to the world outside of her. There are multiple losses for all three. Isisa said with a resolute toughness, ‘I am having to get used to it because everyone dies in my family. I have experienced a lot of death in my family’. Similarly, for Nosipho and Ntombi, there have been continued multiple deaths in the family. Leaving the care-home hangs over them like a menacing ghost of loss and sorrow filled with the ambivalence of what it means to say goodbye to the place where they spent their childhood and adolescent years and the uncertainty of what is to come after.

Of significant importance for all three and also a major turning point in their lives was the loss of their mothers, their closest and most significant relationship before death. Nosipho was 9, Ntombi was 6, and Isisa was just 3 years old when their mothers died. Now in their later adolescent years, Nosipho (18), Ntombi (17), and Isisa (16), in remembering their mothers, continue to express deeply painful and continued unprocessed grief. The loss of their mothers remains a continued devastation that lingers in endless mourning, surrounded by confusion, sadness, anger, and hate. Ntombi offered these comments when asked to process her drawing of herself with her mother and in relation to HIV:

Ntombi at the moment of the long pause was unable to talk about her mother but instead deflected into a long narrative about missing her cousin back home in Kwa Zulu Natal, wanting to reach out to the cousin, being rejected by the family, and their anger at her very existence in their lives. Her mind slipped away from her mother but stayed rooted in feelings of abandonment, rejection, and her mother’s perceived anger towards her. When Ntombi was asked about the time around the death of her mother, she cried silently but deeply expressing a sorrow that remains unfinished, a terrible heartache that seemed to grasp both of us deep within our chests. The pain Nosipho expressed of having lost her mother lingered heavily throughout our interviews. She described herself as ‘a zombie just walking through life’. Nosipho has become relentless in blaming herself for the HIV infection. Here we see how tyrannical and relentless the self-reproachments were, deeply embedded in her unconscious mind:

Nosipho will not allow her mind to hold anyone outside of her responsible for being HIV-positive, instead punishing herself relentlessly through self-destructive guilt. Isisa carries her mother around inside of her as a heart full of holes. Her mind will not allow her to even project a human mother, only a damaged heart. Remembering her mother is unbearable.

There is an unyielding, unshakable intensity to the self-blame and guilt expressed by all three of them. Their narratives are littered with strong self-reproachment expressions of unprocessed and unconscious affective states, which they would have initially directed towards their lost loved one, but now turned inwardly, against the self with the intensity expected from unresolved guilt. For both Freud (1957) and Klein (1940), guilt in its unconscious form is key in both the process of mourning and melancholia and takes place solely in one’s internal intrapsychic world of unresolved conflicts. Not only Nosipho, but Ntombi as well as Isisa show an internal state of irresolvable guilt that feels intensely self-destroying. There is a refusal to acknowledge the loss, keeping the lost object psychically alive by introjecting it into the ego. Contradictory ambivalent feelings get turned into relentless punishment. The expectation would be for Nosipho, Ntombi, and Isisa to acknowledge, express, and let go of their attachments to their primary maternal deaths. The multiple other layers of losses – families, homes, schooling, friendships, their bodies as objects of grief, their bodies as objects of illness, safety, security, and belonging – would find a place in the process of grieving. The component of self-reproachment, a turning on the self in internalised anger, harsh criticism, self-blame, and the dictatorial superego that rages against the ego with merciless violence, is the focus of treatment. However, with this focus comes a foreclosure, an incomplete and irresolvable grief, forever trapping one in what psychoanalysts describe as a pathological state of being. It is here that I take a pause to question psychoanalytically informed theory and praxis complicity in keeping the process of mourning outside of structural elements and thereby creating a double foreclosure of grief.

For vertically infected Black HIV-positive children, ambivalence is a far more complex process (Patel, under review). I have argued, that for these children the essence of their diseased self and well as their raced self holds the struggles of a disease of signification as well as intergenerational raced embodiments. For a Black child who is HIV-positive, it is not only diseased bodies that become a site of mourning, but the black condition becomes one of mourning simultaneously (Patel, under review). Letting go of the guilt and self-recriminations would mean having to accept that the black maternal body did in fact pronounce a death sentence, threatening their very daily existence in a world where they as black children continue to suffer immensely. The continued reality of watching daily other losses either through the death of others or through knowing that the lives they so wish for cannot be attained, they are pulled back into a space of hate, rage, anger, aggression, and anxiety, a space that remains pathologised in the therapeutic setting.

McIvor (2012) puts forward a compelling argument that Klein casts a wider lens on mourning and painful unresolved guilt that allows us a space to think about not separating the intrapsychic processes from our political realities. Where Klein (1940) becomes useful is in her argument that the early paranoid-schizoid position is not only a scene of violent aggression and fear but also one of love and desire. The superego in this early paranoid-schizoid position is built up of various phantasies and experiences with the real and imagined object carrying within it the potential for melancholic persecution. In Kleinian terms, this position is not merely a temporary phenomenon to be worked through as a stage but a position that we are continually pulled into throughout our lives. The anxieties that accompany deeply felt losses will continually tug at us and draw us back into the persecution and attack and draw on our defences to fight against these threats. The litany of losses that are scattered across Nosipho, Ntombi, and Isisa’s young lives and the trauma of these experiences with the accompanying intensity of sorrow and sadness will no doubt pull them back into their earlier paranoid-schizoid position with its accompanying melancholia.

Far from this process being a pathology, Klein’s (1940) reading of our identities resulting not from a deferral of the self, but from positive identifications with ambivalent internal and external realities and objects is important for these children. In the more developed depressive position, the experience of loss is managed to make that loss more bearable and continued life possible. The work of mourning succeeds not through disintegration but integration of the subject, which will not eliminate our grief over, or grievances with others, but will make these grievances more realistic and our efforts to address them more reparative. In sum, mourning involves the acceptance of ambivalence through the integration of complex, multi-sided objects into the subject’s identity. For now, this process seems an impossible task for Nosipho, Ntombi, and Isisa as the deep unrelenting grief that they experience is severed from its historical context and mourning is turned into a private affair closed off from public consciousness. In other words, while Klein offers an inroad into the mourning subject as a platform that opens up an understanding of the political life of mourning the external is still kept out very vehemently in therapeutic practice. Here Langstaff (2016, p. 315) makes a compelling argument that,

if we understand our lives as a series of social entanglements, death ripples through various networks of sociality and causes pain. Sometimes we are moved on behalf of those we love who mourn more acutely. This entangled network of grief is a stark reminder that we are not singular insular beings despite capitalisms insistence.

Radical politics of loss and grieving: ‘The white world is perfect. That is what we are told from day one’

The distinction between the melancholic internalisation of loss and the externalisation embodied in the process of mourning is significant for the politics of loss and grieving (Lapping, 2019).

Orbeta (2021), using the analogy of the crow arriving at the death scene, writes about the complete desolation, anger, and feelings of abandonment that are brutal as the crow scavenges at the wounds of the dead. But as the internal world becomes dismantled with painful affect, becoming an uncanny experience, it is not only a sensory experience but one of the material worlds (Lapping, 2019). There is no singular loss, every loss contains within it a multiplicity of socio-political formations.

There is a consistency in the complexity of the adolescents’ experiences, not just in the sorrow of losing the loved object but also of the stigma, discrimination, rejection, and abandonment by family and communities who do not have the resources, be it emotional or material, to take care of their affective, emotional, or material needs. Far from being an individualised process, for these young HIV-positive adolescents there is a foreclosure in their morning process that pulls them back into the endless pit of melancholia. There is denial by the mechanisms of culture but also the culture that is situated within the political histories of both HIV and race in the South African context. In the unequal valuing of life and death, mourning is a contested space, Canham (2017) asks if mourning can be conceived of inexhaustive inventory of losses that has travelled through many generations. Nosipho, Ntombi, and Isisa have not only had to endure the suffering of multiple spaces of inexhaustive losses but also the intense marginalisation and dehumanisation that have come from living in black bodies. They also had to endure the violence of poverty, fractured families, desperate competing for resources, violence in their homes, and lack of interpersonal relationships and a preference for self-isolation. Ntombi as a child grew up in an informal settlement where living on the poverty line was a daily experience for her. She had to bear witness to the violence of the structural failures as a daily experience – ‘You know some people end up in jail for many years just because they tried to make a living. It hurts me seeing people on the street, Imagine, it [is] winter, it [is] this virus’. Nosipho feels completely alone. Feeling let down, abandoned, and punished by her family as well as the care-home. This keeps her in a depressive state of mind:

If I fuck up with my life there is no one that would catch. Here at this home (care home), they will rip me apart with horrible words if I had to fail at school. . .. Right now, I am in a regretful state of mind. I would have done so much more if I had the right support system. I feel trapped, I am suffering.

Similarly, Isisa has very little support from her family and community. She too has a history of both personal as well as structural violence – ‘My family use to tell me cruel things. First, they hated me for having HIV. They saw me as an outcaste’. Isisa is determined to work towards ending the violence experienced by women, something her mother had to endure in a family she describes as dysfunctional.

The outcome of mourning for all three is highly influenced by and located in the socio-political history of our country. Nosipho, Ntombi, and Isisa are not helped to mourn by the family, the community, and more importantly by closed-off public spaces which will not acknowledge their grief and sorrow. Even the orphanage where they live does not allow for a mourning process that is not isolated from family, wider communities, and the socio-political context. The aftermath of loss takes on a great deal of significance, a powerful reminder of our interconnectedness or disconnectedness (Rosbrow, 2019). There is a fight for survival, there is a fight for who gets to grieve and who does not get to grieve. Nosipho, Ntombi, and Isisa remain dislocated and severed from spaces and places, from a collective consciousness, rendering their mourning invisible and something that does not matter.

Here we come to understand a loss of another kind for Nosipho, Ntombi and Isisa, of racial dehumanisation, where the ghosts of long-ago histories continue to follow and haunt them. The loss of the maternal object overlaps with the sorrow of multiple other historical radical losses spilling into each other, producing an oppressive subjection that prevents mourning. Ntombi and Nosipho lament the disadvantages of living in their black bodies, talking about the power and privilege that come from white subjectivities. Both express a wish to attain some dignity and humanity that can be attained by being a white child which is articulated as being ‘in a perfect world’ (Nosipho). There is also an alienation from the self – ‘like [I] have to be someone [I] am not. I feel like that is what I do here just to fit in. You have to change and be like who you are not’ (Ntombi). Ntombi expresses sadness at having to think about being a black young person.

Butler (1997, 2003) describes this subjectivity as structurally melancholic. In other words, the individual psyche is infused with socially constructed melancholia and the working through of this melancholia gets prohibited and foreclosed through oppressive discourses. While Butler writes predominantly about gender and sexuality, the discourses around HIV and race continue to shape the collective psyche in the South African context threatening the subject with psychic dissolution. For Ntombi, Nosipho and Isisa, the mourning is not only in relation to the self and their primary and other lost objects, but this mourning is also deeply located in their raced experiences, subjectivities and identities. Their experiences allow us to become aware of how the identities of these three young people have been foreclosed in a system that cannot or will not engage in the therapeutic setting with structural melancholia. For Nosipho, Ntombi, and Isisa, their very existence as black children with a political history gets severed and thrown out, annihilated, with no space for private or public recognition through which the multitude of losses can be named and mourned. The prohibition of public mourning doubles the trauma of the loss (Butler, 2003). For now, Nosipho, Ntombi, and Isisa’s pain remains hidden from public eyes, their sorrow shrouded in foreclosed and prohibited silence, forgotten and suppressed, their hate, rage, anger, aggression, and anxiety constructed as melancholia to be treated in personal therapy as an intrapsychic failure.

Yet, the anger and rage are far from being a failure and herein lies the hope of searing ourselves from the depths of our grief. Butler (2003), in her article, violence, mourning and politics, expresses an outrage at the injustice of unbearable loss and the necessity of this outrage in political presence. Although the level of violations and the experiences of vulnerabilities differ across various intersectionality, the recognition of shared vulnerability can forge connections between those who are dehumanised in various ways (Butler, 2003). By protesting actively and publicly the foreclosure of Black rage that is constitutive of Black grief, lives that cannot be mourned fully can find a space for reparative love. Canham (2017, p. 6) makes a compelling argument that one must take into account the legitimacy of the burning rage and it is in the rage that we find both the destructive and liberating power, the ‘potential of Black rage lies in the promise of the expression of self-love – a psychological declaration or gasp of self-worth and defense against oppression’. The lack of rage in Black people is the same as being complicit in the crime of systemic black denigration. For Nosipho, Ntombi, and Isisa, their trauma has a double impetus as it resides and hides in a multitude of different ways through their raced subjectivity as well as HIV diagnosis, their anger visible but turned inwards as self-approachment and rage-hidden. This rage has the potential of healing for them. It has the potential to shield the self from internalising the damaging aspects of being Black children who live with a disease of signification and a journey through a life of raced dehumanisation. Black rage protects and preserves the dignity and self-worth, mitigating the impact of racial trauma (Stoute, 2022). Black rage also contains the superego aspects of what is right and the collective unconscious store of transgenerational traumas. The rage is recruited intrapsychically to counter the devaluing attack from the outside world (Stoute, 2022). There is a protective value of nurturing and mobilising Black rage as an adaptive and dynamic process for intrapsychic success. This offers an opportunity for psychoanalytically informed therapists to step out of the complicity of keeping the grieving processes for those who are marginalised within the boundaries of melancholia only to be treated on the couch. Furthermore, here is an opportunity, a promise of space, within the practice of psychoanalytic work in South Africa and indeed globally, to engage with the invisibility or non-being of children like Nosipho, Ntombi, and Isisa. By refusing to erase the grief, anger, sorrow, and mourning from expression as a public outrage and by refusing to pathologise such public outrage, the lives and experiences of Nosipho, Ntombi, and Isisa will not be obfuscated.