I find, in my work, that the intensity of grief depends on many different factors. Grief varies between young and old and between cultures and religions, and depends on the levels of existing dysfunction and on the nature of death (if the death was expected or sudden). It depends on previous experiences with death and attachment styles, and, of course, interpersonal factors play a very important role, as well. Grief also depends on the personality of the bereaved and the type of relationship the bereaved had with the deceased. Unprocessed emotions in that relationship, conflicts, repressed feelings, and unspoken words all come out in grief and weigh heavily upon the grieving person, often complicating recovery. It takes a long time and a lot of work to go through these feelings and identify those that cause pain.
In the chapter “Types of Losses”, I will talk about differences between the loss of a spouse, a parent, a child, a sibling, or a loss through suicide. I hope that some of the examples I present in this book will show you what type of emotional pain needs to be dealt with in the process of coping with grief.
Grief may be experienced not just after the death of a loved one, but can follow any form of catastrophic personal loss. This can include the loss of a job or income, the breakup of a major relationship or divorce, imprisonment, a diagnosis of infertility, chronic or terminal illness, the loss of a home from fire, a natural disaster and/or many other tragic events in life.
The stages of grief we go through to accept the loss and to reconstruct our lives are common to any catastrophic loss: denial, anger, bargaining, depression, and finally, acceptance. We will discuss each stage in the chapter “Stages of Grief”.
It is also important to note that grief can be anticipatory. In family members of terminally ill patients, this is a major factor leading to complicated grief in bereavement. Anticipatory grief can be defined as a reaction to an imminent and upcoming loss. It may manifest itself when the physical condition of the patient deteriorates and family members are faced with the necessity of final decisions and saying good-byes. I will discuss anticipatory grief in the chapter “Types of Grief”.
We will also look at disenfranchised grief (grief that cannot be publicly acknowledged and loss that cannot be publicly mourned). It can be as varied as the loss of a secret lover, losses of partners in gay relationships, or losing a family member convicted of a grave crime.
And, of course, there are situations where grief stops being a normal reaction and begins interfering with the life of the bereaved or starts haunting the grieving person. This is called complicated or pathological grief. It is very difficult to distinguish between normal and pathological grief, and the majority of bereaved people will manage to come to terms with their grief over time. However, there are some people who will experience an extreme overall reaction, persistent symptoms, or an over-intensive manifestation of one of the symptoms of grief. Why does that happen? Often it is because not all stages of grief have been processed, and because each of us is different and we all react to situations and events in different ways. In the chapter “Types of Grief”, I will explain how to know when grief has turned into a complication and when to seek professional help.
Grief is a response to the dissolution of an important bond. The deeper the attachment between the deceased and the bereaved, the stronger the grief reaction can be. Evolutionary scientists often explain grief as the need to maintain important bonds in families, social groups, and communities that we as humans form over the duration of our lives. We will look at some other explanations of the grief experience which have been formed by science in the last few decades. I find that it helps my clients to understand some theories behind grieving, to see how some of the emotions and feelings they are going through can be explained through the lens of scientific knowledge. In the chapter “Types of Grief”, I will briefly present some of the major theories that explain grief which I find helpful in my work.
In this book, I share many stories of grief, some of them real written with the permission of my clients and some of them fictional, inspired by the real life stories I witness around me.
I am very grateful to the clients who have shared their stories with me. They must remain anonymous, but I acknowledge that this book could not have appeared without them. All the names (and most details of their stories) have been disguised to preserve confidentiality. The emotions, though, remain intact and all stories reveal the extensive work that the bereaved had to go through to enable them to come to terms with guilt, self-reproach, and the pain of grief.
Chapter two. Myths and Truths About Grief
«While grief is fresh, every attempt to divert only irritates. You must wait till it be digested, and then amusement will dissipate the remains of it.»
The death of a loved one always brings sadness and overwhelming feelings of loss, loneliness, and despair. Before we proceed, I would like to explain a few terms used in this book, which are often confusing. Bereavement refers to the loss of a loved one. Grief is a reaction to bereavement: a severe and prolonged distress in response to the loss of an emotionally significant figure which may manifest itself in psychological and physical symptoms. Grief is what you feel inside. Mourning is what you show outside, it is the external display of grief. Mourning is crying in public, wearing black clothes (common for widows and other close relatives, in many cultures), and avoiding events.
But if someone does not mourn their loss publicly, doesn’t cry, or doesn’t want to talk, this does not mean that the person doesn’t experience grief. What you show and what you feel can be two different things. Grief will usually present itself through psychological and physical symptoms. I emphasize, again, that many feelings of grief may be hidden, and a grieving person may only share a part of what they feel inside.
Symptoms of grief can be divided into affective, behavioral, cognitive, and physiological (or somatic) manifestations.
Affective symptoms may include depression, despair, anxiety, guilt, anger, disbelief, numbness, shock, panic, sadness, anhedonia (loss of ability to enjoy pleasurable activities), and feelings of isolation and loneliness.
Behavioral symptoms may include agitation, fatigue, crying, change in social activities, absent-mindedness, social withdrawal, or seeking solitude.
Cognitive symptoms may include preoccupation with thoughts of the deceased, lowered self-esteem, self-reproach, helplessness and hopelessness, inability to believe in the loss, and problems with memory and concentration.
Physiological symptoms may include loss of appetite, sleep disturbances (feeling lethargic or not being able to sleep through the night), loss of energy and exhaustion, physical complaints similar to those the deceased had endured when alive, drug abuse, and susceptibility to illness and disease.
Grief may also lead to spiritual emptiness and pessimism.
Grief symptoms can be overwhelming and distressing. However, it is important to accept them and not avoid them. It is helpful to keep in mind that all of your symptoms and reactions are common and natural, and that you are not alone.
Grief as a reaction to an immediate loss can present itself in two forms. The first one is protest, defined as a preoccupation with loss, the feeling of pain, agitation, and tension, and accepting the possibility that the deceased may reappear. The second is despair, defined as the opposite of protest and characterized by depression, persistent sadness, and a withdrawal of attention from real life. Protest and despair may come and go in phases. Often protest sets in first and then despair takes over. In both the protest and