We often think of grief as the psychological response to loss but it is certainly more like a full-bodied response, especially for the bereaved person (i.e., a person who is experiencing the death of a loved one). In this regard, grief has been described as ‘Passionate Sadness’ (McKissock & McKissock, 1988) and the ‘form love takes when someone we love dies’ (Shear, 2016).
Grief is an inescapable part of life and an important part of the human (and mammalian) condition. The amount of ‘pain’ experienced is generally commensurate with the degree of loss and therefore the degree of love and attachment we feel for the person we have lost.
The loss of a loved person is the most obvious form of loss but there are numerous types of losses as we know (e.g., career loss, financial loss, lost outcomes, loss of friendships/relationships, loss of fertility, loss of hope, loss of health/independence, the aging process, loss of ‘a future’, loss of one’s dreams for the future, loss because life didn’t turn out how we had planned!).
Grief is so closely tied up with what it is to be a human being living in a changing and imperfect world. There might be many micro-moments of grief throughout life (ie., disappointments) and there are more distinct and painful grief experiences within our life-time (ie., losing a loved person or a pet).
There are many models of grief and bereavement, different therapists emphasise different ‘tasks’ or ‘phases’ involved in grief work. They all understand grief to involve a painful emotional adjustment which takes time and with no specific time limit. This appears to be universally true, although each person’s grief experience will be unique. Grief is indeed a universal experience but there are very unique aspects to each and every loss. When someone close to us dies, our entire emotional and social landscape is changed. The way we grieve will be influenced by a myriad of factors. Therefore we cannot compare people as each person’s individual history will influence the course and nature of their grief.
During the initial weeks and months, the bereaved person may be very preoccupied with the most recent memories of their loved one (eg, remembering them being sick and other ‘death-related’ memories). Over time, there is usually a gradual return of more distance memories of the person, including both positive and neutral memories. This process tends to occur naturally.
Acute grief is not a disorder or a psychiatric condition, although there may be many ‘symptoms’ which are synonomous with depression or PTSD. The acute phase of grief is the initial intense response to the loss which encompasses an array of internal experiencing and outward behaviours. It is important not to pathologize grief itself.
The acutely bereaved person can experience: shock, disbelief, emotional numbness, panic, fear, insecurity, confusion, sleep and appetite disturbances, physical pain, sadness, sorrow, intense emotions, longing, disengagement from ongoing life, insistent thoughts of the lost person and many others. Acute grief is generally ‘time limited’ (in that these intense feelings and experiences naturally subside over-time – they become less intense). Acute grief does tend to come in waves and bursts.
The process of so called ‘normal grief’ is marked by movement towards acceptance of the loss and a gradual alleviation of the initial ‘symptoms’ of acute grief – as well as the ability for continued engagement in daily life. However, this transition takes time and is not linear. It is normal for the emotional pain of grief to be felt sporadically, with some days experienced as deeply sorrowful and painful and other days experienced as calm with an absence of intense negative emotion.
The acute grief gradually transforms into integrated grief (i.e., a grief that we live with and grow around). The grief remains within us – it never goes away or ‘resolves’ as such, however we are able to integrate it into our life’s, who we are and our future. We are essentially able to see our lives and live our lives without the lost person being in our life as they once were. Integrated grief often involves finding a new way to relate to the lost person. Many people find a way to continue a special bond with the lost person and this is a very useful and healing concept. The process of integration also involves finding new meaning, a new or renewed sense of purpose and some new life goals for ourselves.
Mostly, grief is processed in a way whereby the bereaved person moves and changes with the grief and all the life changes that have resulted from the loss (i.e., life after the loss of a loved one). We know that someone is ‘processing’ the loss, if they are generally non-avoidant of the pain (most of the time). The term, “the only way out is through” is a very apt sentiment when it comes to grief. So non-avoidance and allowing oneself to feel all the emotions and pain of the loss is paramount to ones ability to accept the loss, process the loss and integrate the loss into their life.
Recent epidemiological studies suggest that complicated grief (also referred to as prolonged grief disorder and persistent complex bereavement disorder) affects about 10 – 20% of bereaved individuals (see Shear, 2015). These people’s grief does not appear to evolve over time and they continue to experience distressing acute grief symptoms for a prolonged period. They will also feel as though they are stuck in their grief and admit to feeling unable to cope with the loss.
Grief does not evolve because of ‘complications’ that impede and stall the mourning process.
- There is some interference with acknowledging the finality or complications of the death
- There is a problem envisioning living life without the deceased person
- And so the’ working model’ of this person, and the relationship with them is not successfully revised.
Simply put, the grief becomes complicated because the person unwittingly blocks the emotional processing necessary to integrate the grief. They do this because the reality of the loss is simply too painful and catastrophic that they cannot allow themselves to fully feel it and acknowledge all its ramifications (eg, secondary losses, changes to life as they know it). Thoughts, beliefs and behaviours can get in the way and actively block the experience of grief, stopping the person from feeling the pain of the loss and blocking acceptance of the new reality. The lost love-one is still very much the focus of the person’s inner world (unlike inhibited or delayed grief where the person has shut down most of the thoughts etc of the deceased person). Here the person is thinking and ruminating on their lost loved one and the circumstances around the death, lots of thoughts and cognitions around “what if…” “if only I…..” “if only they….”. Regret, guilt and blame are very common cognitions. There may be a feeling of having ‘failed’ the lost person – especially if the loved one is a child of the bereaved person. These complex cognitions and beliefs and the person’s preoccupation with them, keep the person from actually doing the work of emotionally processing the loss. These complex thought processes, inhibit emotional processing. These cognitions are akin to secondary layers of emotional suffering (ie, self-blame, seeking an answer, guilt, anger at the actions of another person or towards the deceased person).
Components of complicated grief:
- Thoughts and ruminations often related to: care-giver self-blame; guilt (very complex and has several dimensions/types; negative thoughts about the grief itself (inner critic/no self-compassion) and how they are grieving; regret etc….
- Unhelpful Behaviours: either distinct ongoing avoidance of reminders or constant over-engagement with reminders
- Emotion dysregulation: Over or under-engagement with emotional material/emotions; not taking respite from painful emotions (not allowing self to experience positive emotions)
- Inadequate restoration processes: lack of sleep; nutrition; exercise; positive emotions
- Lack of emotional/social support or contact with active egregious influences
- There may also be a co-occurring psychological disorder that needs treatment
Therapy can and does help!
Treatment for complicated grief can include experiential interventions like chair-work and imaginal dialogues. These methods have proved to be highly successful at helping people resolved painful emotions and beliefs tied up with the loss.
Don’t hesitate to seek therapy to help you deal with the trauma of the death of a loved one. There is also no time limit for grief. It is common for people to suffer from loss feelings and sometimes complications years and decades after the loss of a loved person.
Whether you are experiencing complicated grief or not, therapy can assist people to integrate their loss and work through and heal from the intense emotional pain of grief. It is never too late to seek help for any kind of loss.