Grief and Bereavement Issues
It is a truism that in order to survive, people
require "air, food, water, clothing, and shelter". To this short list we should
probably add "relationships" because it is a rare person who is able to thrive
in the absence of intimate relationships with other people, places and things.
Grief is the negative emotion that we experience
when our important relationships are significantly interrupted or (more frequently) ended,
either through death, divorce, relocation, theft or some similar process. We don't tend
grieve for all lost relationships; only those that have become really important to us over
time - people we have strong connections to (family members, spouses, significant others,
and friends) and places and things we feel attached to (the house we grew up in, our
hometown, love letters, a watch that a grandparent gave us, etc.). We may have loved or
hated that person place or thing, but we feel grief when they (or it) are gone.
Grief starts when someone or something we care
about is lost to us. If a relationship with another person or cared-about thing can be
represented metaphorically by a bridge, grief starts when the bridge breaks and it is no
longer possible to get to the 'other side' where the cared-about other has been. Grief
ends when we have gotten past the acute need for the lost other person or thing in our
lives and are able to function normally without them. This doesn't mean that we stop
feeling sad when we think about older losses; it only means that we are no longer
significantly crippled by them.
Grief is a normal process. This being said, it is
also normal for people to grieve in very different ways. Some people grieve openly, while
others hide their feelings of distress. Some people grieve quickly, while others take a
long time to 'finish'. There is no 'right way' to grieve; each individual comes up with a
method of grieving that fits them.
Stages Of Loss
Even though everyone grieves in a slightly different way, there are regular patterns that
grieving people usually experience. Psychiatrist Mardi Horowitz divides the process of
normal grief into the following 'stages of loss'. These stages are typical, but they don't
occur for everyone, or always in this order.
- Outcry
People often get upset when they first appreciate that they have lost someone important.
They may publicly scream and yell, cry or collapse, or they may hold it inside and not
share it with others. Outcry feelings may be suppressed by the person who is feeling them
so that they are not felt too strongly, or they may spill out uncontrollably. In any
event, initial outcry feelings are hard to sustain and tend to not last too long.
- Denial <-> Intrusion
As people get a grip on themselves after the initial outcry, they will often enter a
period characterized by movement between 'denial' and 'intrusion'. This means that people
will experience periods where they distract themselves so thoroughly in other activities
and thoughts that they don't think about the loss, and also periods where the loss is felt
very strongly and acutely, perhaps even as intensely as the initial outcry stage. It is
normal for people to bounce between these poles of engagement and disengagement. People
may feel guilty when they realize they are disengaging from feeling the intensity of the
loss, but really it is a good thing that this happens. Distraction and disengagement break
up the intensity of feeling the acute pain of loss so that it is more manageable and less
overwhelming.
- Working Through
As time goes by (days, weeks), the movement between 'denial' (not thinking about the loss)
and 'intrusion' (thinking about the loss very intensely) tends to slow down and become
less pronounced, with people spending more time not thinking about the loss very
intensely, and less time being overwhelmed by it. During the 'working through' stage,
people think and feel their loss, but also start to figure out new ways to manage without
the lost relationship. Such 'new ways of managing' might include re-entering the dating
game (or just starting to think about it), developing new friendships and strengthening
existing ones, finding new hobbies, etc.
- Completion
At some point in time, the process of grieving is completed or 'completed enough' so that
life has started to feel normal again. While memories remain of what has been lost, the
feeling attached to the loss is less painful and no longer interferes all that much with
the person's life. Temporary reactivation of grief feelings may occur on anniversaries
important to the lost friendship (marriage and engagement dates, etc.), but these feelings
pass.
Prolonged or Pathological Grief
A number of conditions can make it harder for a person to successfully make it through the
grief process.
- Sudden losses are harder to deal with than ones that have been anticipated. With
anticipated losses, the knowledge that a loss will occur allows people to prepare for that
loss, both by feeling grief before the fact, and also by planning ways to minimize the
negative impact of the loss.
- The loss of a spouse, lover, child, parent or best friend is usually more deeply felt
than the loss of more distant relations and friends. This is because such central
relationships have long and deeply felt histories and an intensity of attachment that
cannot be replaced.
- The amount of support a grieving person can draw upon is critical to how successfully he
or she will get through grief. The more that friends, family and community are present and
supportive, and the more that the grieving person is able to accept offered support, the
better the outcome tends to be. Isolated people tend to have a harder time.
- The 'fairness' of the loss is also important. Losses that challenge a grieving person's
ability to believe that the world is predictable are harder to manage. It is easier to
accept the loss of an aged parent who has lived a full life than it is to accept the loss
of an innocent child. Death by disease tends to be easier to accept than death by random
senseless accident.
The term 'Pathological' Grief is sometimes applied to people who are unable to work
through their grief despite the passage of time. By labeling someone's grief as
pathological, a doctor is indicating that the grieving process seems to be delayed in
resolving and that professional help is indicated; no disrespect is intended to the
patient.
There is no set time frame within which grief is considered pathological. In North
America, however, a person might be judged as being stuck if they are still actively
grieving at 18 to 24 months after their loss. An unremitting 'overly intense' grief
process of shorter duration might also be labeled as pathological.
Getting Help
People struggling to work through a 'suck' or difficult grief process (whether labeled
'pathological' or not) ought to consider seeking professional treatment to help themselves
along. The treatments of choice for difficult grief are typically psychotherapy and
anti-anxiety and anti-depressive medications. In a typical psychotherapy intervention, the
therapist will both encourage the client to share feelings and thoughts about the loss,
and will encourage and challenge them to do things (such as to be a part of social
activities, to exercise, etc.) that will help themselves to reengage life and get better.
Antidepressant and anti anxiety medications are quite useful for managing extreme symptoms
associated with grief (extreme and unremitting sadness, anxiety, confusion, etc.).
However, since grief is not an illness so much as it is a life process, it is unwise to
rely purely on medicines as a way to manage the pain. In the best case scenario,
medications can speed the natural process of recovery; in the worst case, they can create
new problems (such as addiction to anti anxiety medications!).
Grieving is a painful and difficult experience to go through, but it is a normal reaction
to loss, and it does pass. If you, or someone you love is grieving at present, keep this
in mind. Don't be afraid to seek support and/or professional help.
* Horowitz, M.J. (1992) Stress Response Syndromes, 2nd Edition. Aronson
William W. Lee, Ed.D.
