Grief and loss is the traumatic emotional response to the intense feelings experienced after the death of a loved one, separation or divorce, the suicide of someone close, the loss of safety or predictability in our lives, physical incapacity as a result of disability, the loss of a pet, the loss of your home, the end of a career and loss of a community or homes due to a disaster or any other individual response to the experience of grief and loss. Where loss is permanent many will find their symptoms and experiences change and evolve over time, as we learn to adapt to the change grief can force on our lives.
Although the impact of grief and loss affects us all very differently, there are some common responses such as:
- Separation Distress (helplessness, pain, disruption).
- Traumatic Distress (shock, feeling overwhelmed, the experience not being linked to any meaning, intrusive thoughts, feelings and thoughts that you are on an emotional rollercoaster).
- Helplessness (feeling paralysed and the thought and/or feeling that you do not have control)
- Guilt, remorse and shame
- Anger and denial
- Melancholy, crying, sadness and depression
- Yearning to change the past or the future
- Loss in concentration
- Ruminating over the loss
- Social withdrawal and isolation
- Increase dreaming and nightmares
- Insomnia and general sleep disturbances
- Muscle tightness and tension
- Increased or decreased in eating patterns
- Rage or anger
- Restlessness and agitation
- Avoidance of places and people that can trigger memories of the loss
- Treasuring and unable to let go of objects associated with the loss
- Changes to faith and spiritual beliefs
While grief can be used to describe any emotional or psychological feelings following any form of loss (divorce, career, relationships, job, homes and property for example), bereavement is a specific type of grief related to someone dying (including pets).
Acute grief is experienced soon after loss and can be emotionally overwhelming and cognitively consuming. You may feel longing, deep melancholy and have ruminating thoughts and memories of the person, pet or event that caused your grief. In acute grief you may find that you try and keep yourself busy and fill your days with activities and distractions as a way of managing and coping. Although transient, acute grief is still emotionally painful everyday life starts to resume, you may find that you find yourself in more of a routine and at times feeling happier, laughing and talking about memories with warmth instead of sorrow.
You begin to accept the loss and find understanding, compassion and often forgiveness towards the person or event. This is the phase of grieving where we often find ourselves making some form of meaning about the loss.
Integrated grief occurs where the thoughts and feelings you have been experiencing begin to integrate into your normal functioning. The profound loss fades into the background and you may experience mixed emotions of both happiness and sadness when remembering the person or event. This blended feeling can continue for years but is not overwhelming or overtly distressing.
The meaning or learning emerging from the acute grief can now help you make changes in your own life, with possible shifts in priorities and a renewed sense of wellbeing. It is often being able to sit with the reality of the death or end-point of the grieving process that most people reach.
Complicated or prolonged grief
Complicated or prolonged grief is a persistent form of intense grief where you have been unable to restart your life integrating the loss. Instead of positive thoughts and feelings emerging, your thoughts may be stuck in a dark, sorrowful place. Some may describe this time as being emotionally paralysed and unable to think past the grief and loss. Feelings of being lost and alone are dominant. Confusing and more extreme thoughts and behaviours, which may or may not be linked to the experience are common, along with ongoing longing for the past and an overwhelming sadness.
You or others might notice a fixed preoccupation with thoughts and memories of the person who died or event. Your viewpoint may see your future as empty and hopeless. You may experience irrational beliefs such as the deceased person might reappear.
Common symptoms of complicated grief
- Strong commitment to avoiding places, people or events that will remind you of the loss or force you to accept the loss
- Fear of ‘letting them/it go,’ forgetting them/it or a sense of betraying them by moving on with your life and finding happiness again
- Intense feelings of anxiety or fearfulness that you may or will lose control
- Disruption to your identity, you will ‘never’ be the same person. A before and after version of self
- Excessive guilt or anger or regret
- Inability to accept or believe the loss
- Moral outrage, a sense of great unfairness
- Ruminating thoughts about the loss and the life before the loss
Disenfranchised grief can be described as grief which is experienced when the loss is not or cannot be openly or publicly acknowledged. What he means is that how each of us grieves and what we deem acceptable to grieve about, is highly subjective. Because of this culturally, religiously and socially some experiences of loss, will be seen as unacceptable in the eyes of others and society.
In other words, the right to grieve is defined by a social and moral viewpoint and in this way we deny people the right to experience loss by disallowing the loss, either overtly or covertly.
It is believed disenfranchised grief related to:
- When the loss isn’t seen as worthy of grief (retirement, moving homes or any loss not related to death)
- The loss is morally questioned by others (affairs, betrayals)
- When death is ‘blamed’ on the person (suicide, risk taking behaviour or substance abuse)
- When we do not recognise others as having a right to grieve (ex-partners, acquaintances, fans and work colleagues)
- When how we grieve is seen as inappropriate or unusual (the lack of external emotional responses or if we are too emotional)
- Death of someone in a ‘stigmatised’ peer group (a gang member, someone else using or selling drugs, etc)
- Loss of faith or religious identity
- ‘Circumstantial infertility’ (wanting a child but not having a partner with whom to have a child)
- Loss of identity or sense of self
- A foster child being reunited with biological family
- Feeling abandoned by a parent who is involved but distant after a divorce
- Not having a ‘good’ relationship with a parent, sibling, or another family member
- Death of your treating doctor or therapist
Adapting to loss
Adapting to loss is our ability to accept the reality of what has happened, and the loss experienced in our lives as a result. We start to move forward and adapt to the changes in our lives and with our relationships that have been impacted by grief.
Associated Trauma is where the grief and loss have triggered a traumatic reaction. Frequently grief and loss trauma present as flashbacks or nightmares, painful memories that create strong emotional responses and a range of self-protective behaviours that may be unhelpful to recovery (such as social isolation and avoidance, substance abuse or risk taking behaviours).
Complicated grief and the loss of a partner
It is very difficult to lose a deeply-loved life partner. Romantic partners are often our most important source of comfort and support. They are people who share our achievements and our happiness. They soothe us and help us problem-solve when things are hard and we do the same for them. In other words, life partners take care of each other in a special way. Loss of such a person can trigger intense feelings of grief.
Many people lose a spouse or partner each year and as a result there are many widowed older adults across our community nationally. Despite these large numbers, widowhood is often a lonely and very painful experience. There are many reasons why it is so difficult to lose a romantic partner. For example, coming home to an empty house, having a feeling of deep longing for the comforting companionship or the warmth and pleasure of a loved one’s touch, or missing the person so much that it feels like physical pain. Bereavement may bring marked curtailment of social life because of not being invited to events with other couples, or finding these events too uncomfortable to attend. The loss might trigger feelings of being cheated or robbed of dreams or plans for the future. Nevertheless, in spite of the difficulties, most people find a way to endure the painful experiences and restore the capacity for joy and satisfaction in their lives. Some people don’t. If there is something troubling about when, how, or why the death occurred, or if something occurs after the death that is troubling, a bereaved person’s attention can be captured, diverting them from coming to terms with the death and leaving them stuck in acute grief.
Some bereaved people believe that they can’t find a pathway forward into what seems like a dark and menacing future without their loved one. Others feel that grieving intensely is the only way to honour the person who died, or the only way to stay connected to that person. When issues like these take hold, acute grief can go on and on with little respite. This is complicated grief.
Complicated grief after the death of a child
The death of a child is one of the most difficult experiences a parent can have. Taking good care of their children is almost always the most important thing in a parents’ lives. A child’s death triggers feelings of caregiving failure even when it’s really not true. Self-blaming thoughts are virtually universal after a child dies. However, if a parent gets caught up in these kinds of thoughts, this can derail the adaptation process and lead to complicated grief. The highest rates of complicated grief occur in parents whose children have died. Intense emotions like sadness, anger, guilt and despair invade the lives of parents coping with a child’s death and these may be difficult to regulate. Life is transformed and may seem empty and confusing. Answering a simple question such as “How many children do you have?” is suddenly a problem. Bereaved parents typically wrestle with difficult questions such as “Why did this happen?” or “Why didn’t I prevent it?” or, sometimes, “Why was my child so reckless or negligent?” These kinds of thoughts and feelings contribute to development of complicated grief and need to be resolved in order for grief to find a place in a parent’s life.
A bereaved couple may find themselves unable to support each other after a painful shared experience. Their different ways of grieving may seem jarring to each other. One parent may long to talk about the child and their feelings, while the other parent may feel determined to avoid these very discussions. Conflicting needs can deprive a couple of the support they need from each other causing stress in the relationship and adding to the pain of the loss. A parent may cherish memories of the child or long for the memories they had hoped to build. Parents may wonder if it is right to feel joy after the loss of a child. They may question whether restoration of a happy, satisfying life is appropriate since their child has been deprived of these joys.
Those who can’t imagine a meaningful life or find a way to restore their sense of purpose, joy and satisfaction may be suffering from complicated grief. If so, complicated grief treatment holds the promise of help.
Complicated grief after suicide
Suicide is a very painful way to lose a loved one. Although it is a leading cause of death many people struggle to understand the complexity of suicide. When someone dies by suicide, survivors often feel uncomfortable talking about it. They may worry about how others will react and about how they will be seen by others. This can leave a suicide survivor feeling very alone.
A suicide death is a very difficult way to lose a loved one. Survivors often blame themselves even if they know it isn’t rational. Sometimes they personalise the suicide and feel abandoned or rejected. Surviving loved ones can be plagued by unanswered questions about the death, worried about how they might have let their loved ones down, or focused on all the ways they could have prevented this from happening. They sometimes feel a sense of shame or guilt by association. They may think others see suicide as wrong and that they have done something wrong because they were close to the deceased person. Focusing excessively on how or why a person died can complicate grief and prolong the healing process. People need to resolve these difficult questions in order to adapt to their loss.
People with complicated grief who have lost someone to suicide have symptoms that are very similar to people with complicated grief after other losses.