IN THE RING OF LIFE: UNDERSTANDING GRIEF I

Grief may be considered as intense sorrow and emotional pain usually associated with the death of a loved one. It is characterised by a whirlwind of emotions such as yearning or longing for the deceased, preoccupation with the deceased and circumstances of the death, anguish or guilt. Grief is part of the experience associated with death, an existential phase of life which can affect anyone; however, every individual’s response to grief may differ. The first part of this two-part series on ‘Grief’ discusses grief and how to identify and understand prolonged grief as a disorder which may require professional intervention. The second part (in a subsequent post) will explore what to do when offering support to individuals who are grieving.

According to the American Psychiatric Association (2013), prolonged and complicated grief reaction is termed persistent complex bereavement disorder. The symptoms include difficulty accepting the death, disbelief or numbness, difficulty in reminiscing positively about the deceased, bitterness or anger, maladaptive self-appraisals associated with the loss (e.g., self-blame), excessive avoidance of stimuli reminding one of the loss, a desire to die and be with the deceased, difficulty trusting other people, feeling alone or detached from others, feeling that life is empty or meaningless, confusion about one’s role and diminished identity and difficulty pursuing interests or making plans for the future.

The symptoms raise concern in cases where they cause clinically significant impairment in social, occupational, or other important areas of functioning. Additionally, reactions which are out of proportion to or inconsistent with cultural or religious norms should be enough reason for worry about such persons in grief. The patterns of grief may be classified as;

• Inhibited or absent grief: persons show little evidence of the expected separation distress, seeking, yearning, or other characteristics of normal grief.

• Delayed grief: symptoms of distress, seeking, yearning, etc., occur at a much later time than is typical.

•  Chronic grief: emphasises prolonged duration of grief symptoms.

• Distorted grief: characterised by extremely intense or atypical symptoms of grief.

In 1969, a Swiss psychiatrist named Elisabeth Kübler-Ross introduced her five-stage grief model in her book, On Death and Dying, as denial, anger, bargaining, depression and acceptance. However in 2019, some critics of the model introduced an additional component of the model in the book Finding Meaning: the six stages of grief by the renounced grief expert David Kessler with Elisabeth Kübler-Ross as a co-author. They expound on the six stages of grief as denial, anger, negotiation or bargaining, depression, acceptance and finding meaning.

Denial refers to the state where the individual feels numb after the death of a loved one. This may be due to the shock or disbelief about the loss. Some individuals may report feeling the presence of the deceased as well as seeing or hearing from the person. Denial serves as a coping mechanism to deal with the immediate shock and pain of the death event. It also helps curb the perhaps devastating full impact of the magnitude of loss.

Anger is a reaction to the considered cruelty and finality of death in separating the departed loved one from the individual. Anger may be directed at the deceased, others or self. The pain and somewhat burden which accompanies loss makes it difficult to cope without anger. Anger is often accompanied by the thoughts and questions like ‘why me?’, ‘life is not fair’ etc. but is considered useful in reconnection after the isolation the individual experiences during the stage of denial.

Bargaining or negotiation involves a situation in which the bereaved starts making promises or deals with themselves or a supernatural being with the hope of reversing the death or certain events that occurred prior to the death. There is wishful or magical thinking in the belief that the dead can come back to life. It is characterised by ‘what ifs’ and ‘I wish’, where the individual expresses longing on what could have been done differently. There may be some emotions of guilt on taking responsibility for the loss. While this may be painful, it is therapeutic and gives room for healing and confrontation of the loss.

Though depression is a mental health condition, in times of grief, it is a normal state. The overwhelming nature of loss causes the one who is grieving to feel hopeless and lost leading to likely withdrawal from life, numbness, live in a fog, not have energy for any activity or confront life. Depression in this context involves sadness and very intense pain associated with the loss. The depressive symptoms may come and go over many months or year but for most people, the feelings may decrease overtime.

Acceptance is the period during which the pain associated with the grief somehow passes or reduces in intensity. The individual accepts that the person has truly died and would not return thus they learn to live without them. The acceptance period is not particularly moving on but an acknowledgment that indeed the loved one is permanently gone from the physical world. The individual who is grieving may continue to experience the other stages alternatively here.

Finding meaning relates more to remembering the deceased with love more than pain. To find meaning is to translate the emotions of loss into a deeper state than merely finding closure and moving on. It includes wielding hope, inspiration and finding peace in a time of suffering and pain to rebuild your life with your departed loved one still at heart in a positive sense.

Grief may be experienced profoundly in the period of about twelve (12) months of loss but some individuals are unable to heal and continue functioning after they experience the loss. They become fixated in some of the stages discussed above and may be unable to find meaning in life or function properly in society.

While there is no set time duration for one to end the time of grief, it is crucial for one to find meaning and rebuild his or her life at a point. However, it is necessary to seek some sort of professional counselling when one experiences grief especially in cases where the bereaved is young, unable to cope or face life in a purposeful manner after a period of time or experiences severe trauma due to the loss. The support could be secured through the services of a trained counsellor, psychologist or psychiatrist. There is no shame in seeking expert support to deal with the overwhelming emotions that accompanies grief.

The second part of this series will highlight appropriate ways to offer support to individuals being family members, colleagues, or acquaintances who are experiencing grief.

Bibliography

American Psychiatric Association (2013). Diagnostic Statistical Manual of Mental Disorders, 5th Edition DSM-5TM, American Psychiatric Publishing.

Bonanno, G. A. (2004). Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 59 (1): 20-8.

Kessler, D. & Kübler-Ross, E. (2019). Finding Meaning: the six stages of grief. Ebury Publishing.

Kübler-Ross, E. (1969). On Death and Dying. Routledge.

Prigerson, H. G. & Jacobs, S. C. (2001). Perspectives on care at the close of life. Caring for bereaved patients: "all the doctors just suddenly go". JAMA. 286 (11): 1369-76.

https://www.mariecurie.org.uk/help/support/bereaved-family-friends/dealing-grief/stages-of-grief