When starvation and war reach the large-scale proportions we now see in Somalia, normal human reactions to death are dwarfed by the enormity of the tragedy. But while the struggle to survive may mute the emotions of grief, it does not entirely erase them.
In addition to all their other hardships, Somalians are facing an overwhelming collective grief, complicated by the chaotic conditions around them. A recent report by Physicians for Human Rights and Africa Watch describes the psychological and emotional toll of so many deaths and the chaotic conditions in which they occur:
"Somali tradition dictates great respect for the dead. While there is no elaborate funeral, a person's death should be followed by 40 days of mourning, after which ceremonies are held to commemorate that person's life. As in all societies, the fulfillment of these practices serves important social and psychological functions for the bereaved.
"In Mogadishu today, death has become commonplace. The dead are buried hurriedly, usually in shallow graves. The grounds of the hospitals, the yards of houses and street corners are filled with shallow unmarked graves.
"Of equal or greater significance, the traditional period of mourning cannot be observed; the lack of security makes it difficult for relatives and friends to visit and comfort the close family by sharing their grief, and only the most perfunctory prayers are said for the deceased, if any.
"Not only are the traditional networks of social support for the bereaved not functioning, but the bereaved themselves feel a burden of guilt toward the dead for failing to fulfill their customary obligations. Many of the survivors will have been bereft of not just one close friend or relative, but many."
The report suggests that this combination of the disruption of traditional structures of social support and the guilt imposed on survivors who are unable to give due respect to the dead can produce another affliction: the widespread occurrence of what the report calls pathological grief.
In this country, bereavement counselors prefer to talk about "complicated" grief, rather than terming it pathological. But under the extreme conditions in Somalia today, pathological seems appropriate.
Whether complicated or pathological, grief that is not allowed to follow normal patterns can result in various kinds of problems. As the report suggests, it can be expressed in "chronic depression, somatic complaints such as severe headaches and body aches, loss of confidence in oneself and others, social withdrawal, lethargy and attempted suicide."
Common sense suggests that these symptoms will have wider repercussions, making the task of re-establishing some semblance of orderly government even more difficult.
There are ways to ease pathological grief. The report suggests that communal mourning ceremonies could play a helpful role, pointing out that in this part of the world, a similar function is played by monuments such as tombs commemorating "the unknown soldier," or by special memorial days.
The scale of devastation in Somalia prompts the question of whether any amount of mourning would be adequate to the losses people are suffering -- the loss of children and adults, of whole families, of entire villages, of even any sense of civilization. Somalians aren't faced only with mourning the dead, but also with mourning a country which is tearing itself apart.
In different forms, that tragedy is occurring elsewhere as well, notably in countries that once made up Yugoslavia. Where there is war there are always unbearable levels of grief -- grief that is by definition complicated and even pathological.
Grief may not always be as visible as other wounds of war. But it can hurt just as much.
Send your comments and questions about death and dying to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore, Md. 21278.