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Guide through Grief

Everyone experiences loss in life – loss of a loved one, health, jobs, relationships, dreams, status, homes, finances, innocence, trust, and more.

Grief is the natural response to loss, and the more significant the loss, the more intense the response may be. A loss can seem sudden and unexpected, or a long foreseen outcome. Regardless of the type of loss, understanding and embracing the grief process can help us heal and transmute such feelings of sadness, emptiness, and futility into a new paradigm of positive living.

Grief vs. Bereavement

Grief and bereavement are not synonymous terms but rather, correlated reactions to loss. Grief is the profound, emotional response to a loss of any kind, whereas bereavement is a form of grief specific to the death of a loved one.

(Note: While this guide is primarily for those in bereavement, the information applies to the overarching experience of grief, as well.)

Types of Grief

Normal grief

While there is no standard, typical, or average experience of grief, "normal" grief generally follows a somewhat predictable pattern of emotions and behaviors. Key indicators are a gradual alleviation of symptoms, the ability to take part in necessary daily activities, and movement towards acceptance.

"Some people seem to fade away, but then when they are truly gone,

it's like they didn't fade away at all." – Bob Dylan

Anticipatory grief

Grieving can occur before the death of a loved one or other loss. While anticipatory grief is similar to normal grief, a key difference is the element of hope – hope that the loved one may live longer than expected or survive altogether. While this can lead to even more internal conflict, leaning into the process offers unique opportunities for healing:

  • For the person who is dying, anticipatory grief can help them focus on what's most important to them, and address any unresolved issues. It can help the person find meaning, achieve closure, and feel at peace.

  • For friends and family members, anticipatory grief can also provide an opportunity to reconcile differences and attain closure.

  • For both patient and loved ones, it presents a chance to accept the inevitable, free each other of any expectations, offer assurances, and say goodbye. Ultimately, this makes the transition easier for all.

Complicated grief complex, traumatic, prolonged, chronic, or extreme grief

For some people, feelings of loss are debilitating and do not improve over time. Known as complicated grief, or sometimes called persistent complex bereavement disorder. Painful emotions are chronic and severe, making it difficult to recover from the loss and carry on with life.

Other forms of grief

Because of the individualized nature of grief, there are myriad other forms of grief that may require special attention, including abbreviated, absent, collective, cumulative, delayed, disenfranchised, distorted, exaggerated, inhibited, masked, prolonged, secondary, and more. A licensed therapist or grief counselor can help address particular needs.

Grief is a process to move through, not an affliction to be cured.


Symptoms, Stages, and Treatment

Symptoms Some of the signs of normal grief include:

Physically

  • Fatigue or restlessness

  • Inactivity or inability to stop activity

  • Difficulty sleeping

  • Pain and tension

Emotionally

  • Sorrow, crying, loneliness

  • Irritability, bitterness, anger, or guilt

  • Fear and anxiety

  • Numbness, emptiness, futility

Mentally/Cognitively

  • Attention centered on little else but the loss

  • Difficulty making decisions, confusion

  • Daydreams, flashbacks, or conversations with the deceased

Relationally/Socially

  • Lack of trust in others, isolation

  • Inability to enjoy life or recall positive experiences with the loved one

  • Impatience with others, preoccupation with own needs

Spiritually

  • Sense of separation from or a closer connection to God or Higher Power

  • Anger at God or Higher Power

  • Seclusion from a spiritual community

How the symptoms appear is different for each person, and can also vary for the same person during different phases of grief or when grieving various losses.

Stages Grief is a process, not a one-off event. We are never entirely over grief, but the more extreme highs and lows of acute grief felt at the onset lessen as we gradually accept the loss. Most grief experts agree that while "loss is forever, acute grief is not, a distinction that frequently gets blurred." (Tartakovsky, 2018) Awareness of the different aspects of grief may help weather the groundswells of emotion until the experience of grief becomes more like an occasional ripple.

One of the most common misunderstandings about the therapeutic concept of "stages of grief" is that we progress from one phase to the next until our grief is complete. The bereaved frequently report feeling "waves of grief" that come and go, often unpredictably.


Following are four widely accepted theories of what grief entails:

In 1969, renowned Swiss psychiatrist Elisabeth Kṻbler-Ross published the landmark book, On Death and Dying, based on her work with terminally ill patients. In it, she outlined the five stages of grief that people typically face upon a terminal diagnosis: denial, anger, bargaining, depression, and acceptance.

1. Denial – Denial is the messenger of limitation, letting us know how much we can handle at this moment. Like a safety guard for conscious awareness, through denial, we can protect ourselves from the external stressors that cause anxiety. Denial fades, and the healing process begins when we become stronger, better able to address the difficult feelings starting to surface.

2. Anger – Anger can be one of the least socially acceptable yet critically essential stages of grief. Anger can give us a temporary focus in what may feel like a free-fall of loss. We feel anger towards the disease or circumstances, the doctors, our families, ourselves, and the loved one who has died, and also God. Some find solace in knowing that the intensity of our anger is often equal to the depth of our love. When we allow ourselves to feel and express anger, the more it dissipates along with some of our deep-seated pains, fears, and frustrations.

3. Bargaining – By bargaining, we psychologically and emotionally seek to have life restored to what it – or who he or she was. We want to travel back in time to prevent the accident from happening, find the tumor earlier, or somehow choose a different path that could lead to a different outcome. If only… That is the mantra of bargaining, if only. Bargaining is a natural response to painful feelings, particularly guilt. If only I had… And through bargaining, we find the opportunity to dig deep and allow the underlying emotions like futility and powerlessness to rise for healing.

4. Depression – While bargaining is a perspective backward, grief-related depression places us square in the present moment. Feelings of emptiness emerge, and grief moves into our very core, deeper than perhaps we have ever imagined. Unfortunately, depression is commonly viewed as an unhealthy state of mind to snap out of or fix. It is a normal response to be depressed about the loss of a loved one, but it is abnormal not to experience depression after such devastation. Depression can feel like an overbearing fog of sadness, but with compassion and patience, the fog will lift in its own time and way, diminishing in intensity and frequency over time. Just as a fractured bone needs time to mend, so too does the broken spirit that knits itself together through the healing found in grief-related depression.

5. Acceptance – Acceptance is about comprehending the permanent, physical reality of our loss. It is not thinking or feeling that everything is okay. We will likely never be okay with the loss, but we can accept the reality and learn to live with it. Acceptance is a gradual process, coming forth in varying degrees as we adjust to our new normal with a part of us missing. Through acceptance, we reorganize and redefine our lives, our relations, and our roles. And instead of denying our feelings, we listen to our needs; we move, we change, we grow, we evolve.

Counselors and therapists have applied these five stages to myriad causes of grief, not just the terminal diagnoses as initially intended. Some professionals have expanded the five Kṻbler-Ross stages to include initial "shock and disbelief," and "reconstruction" as important steps to re-establishing normalcy.

More contemporary research offers a variety of theories that may provide a better understanding of grief due to other forms of loss with more effective results. For example, Dr. Sidney Zisook posits that there are four common elements of grief that appear in varying degree, depending upon the unique personality and circumstances of loss:

1. Separation Distress – The upset of separation triggers a myriad of feelings, including anxiety, anger, sadness, pain, helplessness, shame, loneliness, longing, and more.

2. Traumatic Distress - Emotional effects of this component include shock and disbelief, disturbances, and efforts to avoid intrusions.

3. Guilt, remorse, and regrets.

4. Social withdrawal – Avoiding pleasurable activities and people, isolation.

From a broader perspective, some grief therapists suggest a framework in which places the entire experience of grief in the context of re-establishing life after loss:

  • William Worden's "Four Tasks" are to 1) accept the reality of the loss, 2) to process the pain of grief, 3) to adjust to a world without the deceased, and 4) to find an enduring connection with the deceased while embarking on a new life.

  • Dr. Roberta Temes and Geoffrey Gorer teach that the bereaved must process through Numbness, Disorganization, and Reorganization to find a "new normal."

There are more theories easily searchable on the Internet. The important point is that grief is a process, a journey of healing, awakening, and assimilating that is never experienced in exact measure by any two people. Use what helps support the journey, not dictate what "should be" along the way. None of us are exactly alike, and the unique experience of grief reflects our distinct nature.

"Only the people capable of loving intensely can suffer a great pain, but this same need to love serves to counteract their griefs, and it cures them."

-Leo Tolstoy

Treatment

Depending upon individual responses and circumstances, we may be able to address grief on our own. However, grief left unrecognized, unprocessed, untreated, or repressed will likely lead to compounding complications such as increased anguish and anxiety, physical ailments, sleep disorders, functional impairment, clinical depression, strained relationships, substance abuse, and an increased likelihood of death from heart disease and suicide. Although we all follow different paths through the grieving process, the inability to move through the stages and adjust to reality after loss is indicative of more complicated grief. Treatment with professional grief specialists can help people come to terms with a loss and reclaim inner peace.

Self-help

  • Give yourself (and others) the time and space to process grief without judgment or expectation.

  • Be as kind, gentle, and compassionate to yourself and others as possible. Self-care and self-love are paramount.

  • Remember that grief is a process to move through, not an affliction to be cured.

Professional help and support

  • Grief counselors

  • Psychologists, psychiatrists, and psychotherapists

  • Physicians, hospice, hospital, and other healthcare providers

  • Faith-based, community, and other support groups

A combination of support may be the most effective route, with different sources addressing needs as they arise. For example, a local support group for young widows may provide the extra benefit of a community of others in similar circumstances. The most crucial factor in choosing appropriate help is to find the support that is most comfortable for you, thereby most likely in which you will engage.

Only through grief are we guided to face important truths, heal unbearable pains, and share profound love.

Gifts of Grief

There is extraordinary richness in grief for it requires us to dig deep and unearth parts of ourselves unknown or forgotten, dare to brave our darkest hours, and emerge transformed in ways we could never imagine or accomplish otherwise. Throughout our journeys of grief, we can garner life-changing gifts if we are willing to recognize and receive them as they appear. Commonly, people experience:

  • Relief – Respite from the stress of a difficult situation, of seeing a loved one suffer, of a prolonged outcome, of unwelcome feelings, beliefs, and circumstances.

  • Appreciation – Gratitude for the loved one and our relationship, of spiritual beliefs that guide us through these challenges, for our well-being, of life itself.

  • New perspectives – Clarity of what is and is not important, understanding of our place in the Universe, seeing the need to make changes, finding the courage to pursue our dreams.

There is power in our pain. While nothing can compensate for the loss of a loved one, we can gain immeasurable good through the gifts of their life as well as the process of our grief. Only through grief are we guided to face important truths, heal unbearable pains, and share profound love.

 

© Nancy Noack and Mighty Oak Ministries International, 2019. Unauthorized use and/or duplication of this material without express and written permission from the author and/or this site's owner is strictly prohibited.

 

References

American Cancer Society, “Symptoms of major depression and complicated grief.” Accessed online April 27, 2019.

American Cancer Society, “Coping with the loss of a loved one: The grieving process.” Accessed online April 27, 2019.

American Psychiatric Association, “Conditions for further study: Persistent Complex Bereavement Disorder.” In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed, 2013. Accessed April 27, 2019.

American Psychological Association: “Grief: Coping with the Loss of Your Loved One.”

Borchard, Therese J., “6 Tips to Help Summer Depression”. Last updated July 8, 2018.

Bronstad, Debbra, “Grief Symptoms”, 2018. Retrieved from https://www.stages-of-grief-recovery.com/grief-symptoms.html on May 1, 2019.

Doering, BK, et al, “Treatment for complicated grief: State of the art science and ways forward.” Current Opinion in Psychiatry, 2016.

European Archives of Psychiatry and Clinical Neuroscience: “An Attachment-based Model of Complicated Grief Including the Role of Avoidance.”

Hakimi, Michael, PsyD. Clinical Psychologist, Loyola University Medical Center.

Jordan AH, et al, “Prolonged grief disorder: Diagnostic, assessment, and treatment considerations.” Professional Psychology: Research and Practice, 2014, 45:180.

Mayo Clinic Staff, “Seasonal Affective Disorder (SAD).”

Mayo Clinic Staff, “What Is Grief?”

Mayo Clinic Staff, “Complicated Grief”

N., Pam M.S., "GRIEF," in PsychologyDictionary.org, May 11, 2013, https://psychologydictionary.org/grief/ (accessed April 25, 2019).

National Cancer Institute, “Grief, bereavement, and coping with loss (PDQ) – Health professional version.” Accessed April 27, 2019.

National Institute of Mental Health, “Depression”, 2018. Retrieved from https://www.nimh.nih.gov/health/publications/depression/index.shtml on February 27, 2018.

Shear, MK, et al, “Complicated Grief in Adults: Epidemiology, clinical features, assessment, and diagnosis.” New England Journal of Medicine, 2015. Accessed April 27, 2019.

Shear, MK, et al, “Complicated Grief in Adults: Treatment.” Accessed April 27, 2019.

Tartakovsky, M. “The Truth about Grief: The Myth of Its Fives Stages.” Psych Central, 2018. Retrieved on April 25, 2019 from https://psychcentral.com/lib/the-truth-about-grief-the-myth-of-its-five-stages/

WebMD Medical Reference, “Seasonal Affective Disorder (SAD), Reviewed by Joseph Goldberg, MD on February 9, 2017.

WebMD Medical Reference, “What is Normal Grieving, and What are the Stages of Grief?” Reviewed by Carol DerSarkissian on November 23, 2018.

World Psychiatry: “Grief and Bereavementt: What Psychiatrists Need to Know.”

 

Information on this site is designed to support, not replace, a physician, practitioner, or provider relationship. We regret that we are unable to answer any specific medical, physical, or mental health-related emails. Please contact your health care provider if you need specific questions answered


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