Grief: The Journey From Suffering to Resilience William F. Doverspike, Ph.D.

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770-913-0506 G rief is an emotional response to a loss. It usually involves several stages, which include denial, anger, bargaining, depression, and acceptance (Kubler-Ross, 1969). Although many people go through these stages in a fairly predictable order, there is considerable overlap among the stages. Working through the stages of grief can eventually lead to the positive outcomes of recovery, resolution, and resilience. However, these outcomes are like a distant shore when one is drowning in those first powerful waves of grief. In understanding the journey from bereavement and grief to resolution and resilience, it may be helpful to understand some of the processes involved. Bereavement refers to the state of being that results from a significant loss. It encompasses a wide range of reactions--emotional, cognitive, behavioral, physical, and spiritual. Grief refers to the internal process of regaining equilibrium. It requires reorganization on both emotional and cognitive levels, and includes a re-evaluation of spiritual concerns. Anticipatory grief refers to grief that occurs prior to the loss. While it does not prepare one for the loss, anticipatory grief does allow time for resolution of some issues. For this reason, the sudden death of a loved one is particularly difficult for the survivors because it does not provide any time for anticipatory grief. Mourning refers to the public expression of grief, including religious rituals, which can vary considerably by culture. Whereas the experience of grief is internal, private, and individualistic in nature, the process of mourning is more external, public, and cultural in expression.. Anniversary reactions refer to experiences of the grief response at certain significant times, even after there has been resolution of grief. In his classic article, Engel (1961) posed the question, "Is grief a disease?" Grief is not generally considered a disorder but rather is viewed as an adaptation to a loss. In this respect, the process of grieving is similar to the process of healing. It involves working through the stages of grief. The tasks of grieving include experiencing the pain of grief, accepting the reality of the loss, adjusting to an environment in which the loved one is missing, and withdrawing one’s emotional energy and reinvesting it in another relationship. Failure to complete these tasks can result in impacted grief, which is a prolonged type of grief associated with depression. Impacted grief can block further growth and development. For example, the absence of family or social support during bereavement can complicate the process of grieving. Some of the early warning signs of unresolved grief are as follows: Avoiding the funeral, not visiting the gravesite, or not participating in other rituals. Not being able to talk about of the lost loved one without experiencing intense grief. Experiencing an intense grief reaction triggered by some relatively minor event. Noticing that themes of loss seem to come up frequently in casual conversations. An inability or unwillingness to move material possessions belonging to the loved one. Feeling compelled to imitate or take on habits or personality characteristics of the loved one. Developing physical symptoms like those experienced by the deceased person before death. Developing self-destructive thoughts or, conversely, developing a fear or phobia about illness or death. Making radical changes in lifestyle, such as excluding one’s friends, family members, or activities associated with the lost loved one. Experiencing unexplained periods of sadness, holiday blues, or "anniversary depression." The resolution of grief requires accepting the reality of the loss, cognitively and emotionally, and reorganizing the facets of life in spite of the loss. However, resolution is not a return to the "old self." One never really returns to his or her former self. Instead, one incorporates the experience into what eventually becomes a new self. Reaching resolution requires working through grief, which takes time. As the old adage goes, "Time heals all wounds." Although the time required for healing may vary from person to person, the process of grieving involves several basic tasks (Bonanno & Kaltman, 1999). The tasks described below can occur in a more or less orderly manner, although there is considerable overlap among the tasks. Experiencing emotional pain of the loss. In the first sentence of A grief observed, published from the private diary of a husband whose wife had died, author C. S. Lewis (1961, p. 15), observed, "No one ever told me that grief felt so like fear." The pain and suffering of grief are not overcome by avoiding pain, but rather by experiencing and working through the pain. Although one’s first response to a tragic loss may involve numbness or feeling nothing at all, one’s first main task involves the simple but seemingly insurmountable task of experiencing the pain of the loss. Talking about the loved one and the death. Sooner or later, experiencing the pain of loss involves talking about the loved one who has been lost. It is often a story that must be told over and over again. Yet there is a painful paradox to grief. Sometimes the family and friends that one has counted on the most in life are not even available, yet acquaintances and even strangers that one does not count on at all may seem to be the most ready to listen. In any event, having contact with those who care, particularly those who also knew and cared about the loved one, facilitates the process of sharing. Integrating the positive and the negative. At first, the lost loved one may be idealized so that the survivor remembers only the positive, whereas life without the loved one may be empty, lonely, and bleak. There are many paradoxes in the experience of grief. For example, the most wonderful memories of the past suddenly become the most painful reminders of the loss. At other times, one’s recollection of difficult times in the past may bring an unexpected smile. As one continues to share the stories, and begins to experience a different type of life, the sharp contrasts of black and white will eventually merge into more realistic shades of gray. Eventually, the wonderful memories of the past can become comforting reminders of hope and joy. Accepting the reality of the loss. Although there is no timetable, the shock of losing the loved one will eventually start wearing off, and the reality of loneliness will begin setting in. In what has been described as one of the 10 most influential books ever written, Rabbi Harold Kushner emphasizes that the process of recovery involves getting over the why questions that focus on the past and the pain: "Why did this happen?" Instead, we need to ask the question that opens the door to the future: "Now that this has happened, what shall I do about it?" (1981, p. 137). As one continues to plod along the path toward recovery, taking small steps toward creating a new life again, acceptance of a new reality slowly begins to emerge. Finding meaning in the experience. Holocaust survivor and psychiatrist Viktor Frankl once wrote, "If there is a meaning in life at all, then there must be a meaning in suffering" (1969, p. 106). Frankl’s understanding of suffering was forged out of his survival of three years in four different Nazi concentration camps. Upon liberation from the death camps, when he returned to his native home of Vienna, he learned that his wife, his brother, and both of his parents had been killed in the camps. Frankl found redemption in suffering by finding meaning. In an interview shortly before his death at the age of 92, Frankl noted that he was still receiving an average of 23 letters each day, mostly from those thanking him for writing a book that changed their lives ("Frankl dies", 1997). Frankl’s lifetime achievement was not only his monumental book, but also the fact that his suffering was forged into an instrument of redemption that changed the lives of millions. His life is a story of redemption, the process of transforming suffering into a meaningful purpose in life. As Frankl concluded, "Suffering ceases to be suffering in some way in the moment that it finds a meaning" (1969, p. 179). Gradual lessening of the emotional pain. At first, the waves of grief are very powerful, often knocking one down in what may seem like a soul crushing defeat. Over time, the waves become smaller and smaller, while the periods of calm become longer and longer. Eventually, there will come moments when the waves are a gentle memory. The painful experience of grieving a loss can eventually lead to the positive outcomes of recovery, resolution, and resilience. Recovery involves the conscious process of working through the stages of grief. Resolution refers to the eventual outcome of accepting the reality of the loss, cognitively and emotionally, and reorganizing the facets of life. Resilience refers to one’s positive capacity to cope with future crises and even catastrophe. While many people complete the tasks of grieving on their own, the process of recovery can often be facilitated by talking with a psychologist who has training and experience in grief counseling. Although there are no short cuts, there are some effective ways of working through the stages of grief and discovering positive outcomes that are hardly imaginable when one is drowning in those first powerful waves of grief. References Bonanno, G. A., & Kaltman, S. (1999). Toward an integrative perspective on bereavement. Psychological Bulletin, 125(6), 1004-1008. Engel, G. (1961). Is grief a disease? Psychosomatic Medicine, 23, 18–22. Frankl dies at age 92. (1997, November). Monitor on Psychology, 28(11), 46. Frankl, Viktor E. (1969). Man’s search for meaning: An introduction to logotherapy. New York: Washington Square Press. Kubler-Ross, E. (1969). Death and dying. New York: Macmillan. Kushner, H. (1981). When bad things happen to good people. New York: Avon Books. Lewis, C. S. (1961). A grief observed. San Francisco: Harper.