Grieving is a painful and sometimes long process, but it can be overcome with the right steps taken at the right time

Grieving is painful, and not only for the person grieving, but for the griever's loved ones, family and friends. Unfortunately in modern society with its emphasis on speed and efficiency, some well-intentioned individuals who otherwise sympathize with the grieving person, may unconsciously put pressure on the griever to 'get on with life' and put "closure" on the loss within an unrealistic time frame.

However the reality is that grieving is a natural process which cannot be rushed: the griever has to grieve at their own pace. Also each individual grieves in their own particular way which may seem unusual to the observer. To help the griever involves acceptance of the fact that grieving is a necessarily painful, lingering, and messy process. The purpose of this article is to provide some guidelines about grieving and how to provide emotional support so that the grieving person can travel through the natural path of grieving unhindered by unnecessary obstacles.

What is grieving?

From a psychological point of view grieving is the experience of intense sorrow following a loss. The loss can be severe for example the death of a person who played an important role in the griever's life. The death of a child is thought to be one of the most intense losses one can experience. There is a wide range of people and things whose loss can induce grief including loss of job, rejection by a loved one, or death of a pet. What all these losses have in common is that without them the griever's usual life experience and habits are changed irrevocably. The adaptive purpose of grieving is to enable the person to re-establish their equilibrium and restore or even increase positive meaning and equanimity in their life.

The Stages of Grief

This video is a light hearted but true to the point take on the stages of grieving.

Considering the universality of loss in human life, it is surprising how relatively little is known about the grieving process. One of truly great contributions was the research of Dr. Kubler Ross, a psychiatrist, who was one of the first to systematically carryout observation of terminally ill patients.

Her 1969 book, On Death and Dying, described five typical stages that such patients went through in their grieving of their own life coming to an end. Kubler Ross went on to study a variety of other types of loss including loss of a loved one, job loss, rejection in a romantic relationship, infertility and so forth. Her research suggested the five stages of grief occurred for loss in general. She also acknowledged that often the person could cycle through each of the stages more than once e.g. they may switch from the depression stage back to the denial stage for a short period of time.

Although proposed over 40 years ago, the Kubler Ross stages still remain helpful to therapists and the family of someone grieving a loss. One of the most important benefits of this stage model is that it gives the loved ones of the griever realistic expectations of the wide range of emotions to be expected in normal grieving. The five stages, which can be remembered by that acronym DABDA are:

Denial. On first becoming aware of loss, the person may enter a state in which they deny the loss. For example, a woman on hearing of the death of her husband in a work accident may start vigorously cleaning her house. In effect she is avoiding the painful reality. However, this avoidance can be adaptive in that gives her time to mobilize the psychological and emotional resources she needs to grieve. Therefore one should not try to pressure the griever to face the reality of their loss by talking or writing about it (Stoebe et al 2002). Anger emerges when denial has served its purpose and the griever can allow full consciousness of the loss which triggers this strong negative emotion. It is a very basic kind of protest response often accompanied by the thought that this loss was not fair and asking who was to blame for the loss and who should be punished. Bargaining is the third stage. The grieving person is attempting to regain what has been lost by typically bargaining with God. For example they might say "dear God just bring back my child and I will be the perfect mother." Depression emerges as the person slowly realizes that all of these attempts are futile and that they not face the inevitability of their loss. This depression is different from the crying and protests and other emotions which occur acutely in the initial stages of grieving. It is allowing oneself to face the reality of the loss and face the accompanying deep sadness and other negative emotions Acceptance begins when the griever concludes they have cried and mourned enough and decides they are ready to move on to begin the painful but necessary acceptance of the reality of the loss and slowly begin the process of recovery and re-entry into normal everyday life. Often the outcome of grieving is psychological and emotional growth: a re-structuring of the grieving person’s life so that they become deeper, wiser, more tolerant, more resilient and a more loving human being.

How Can You Tell the Difference between Normal Grief and Clinical Depression?

It is to be noted that this stage theory of Kubler Ross involves a stage of depression. This brings up the question of how can the family, loved ones, and friends tell whether the griever is experiencing what could be called normal sadness or if for some reason has become abnormally or clinically depressed which could require professional assistance. Fortunately, this problem has been researched and the handbook of the American Psychiatric association has come up with a series of differentiating characteristics (DSM-V, p. 161) as indicated in Table 1.

Normal grief Clinical depression Individual feels "emptiness and loss" not just sadness and is trying to figure out how they can put their life together again Person feels profound sadness, cannot anticipate happiness or pleasure returning, and often does not know the cause of their depression Sadness slowly decreases with time but with pangs of acute sadness triggered by reminders of the loss Sadness more constant and chronic and often not (consciously) tied to any specific thoughts There may be short periods of relief from sadness, as positive thoughts and feelings emerge about the loss e.g. recalling good times together Sadness and misery is relentless and constant over time Self esteem is usually preserved Feelings of worthlessness and self-loathing are frequent Sometimes guilt feelings about not loving the lost person or not protecting them. Death ideation in grieving is about joining the deceased in the hereafter. There may be suicidal ideation because of feelings of worthlessness and powerlessness and hopelessness.

What can you do to help the grieving person?

Educate yourself about the grieving process; there are many online websites devoted to this topic (See Resources). In particular read about the stage theory of grieving.

about the grieving process; there are many online websites devoted to this topic (See Resources). In particular read about the stage theory of grieving. One important healing factor is that the grieving person have access to a positive social support system usually family and close friends.

system usually family and close friends. The persons providing emotional support to the grieving individual may empathize deeply with the strong and usual negative feelings of the griever. If so they must watch for their own level of emotional distress; they cannot help if this is too high. Practicing stress management including getting emotional support from other members of the support team will help prevent grief fatigue. It may be necessary for them to get assistance from a mental health professional as a loss in to any member of the family may upset the usual functioning of the family in complicated ways.

including getting emotional support from other members of the support team will help prevent grief fatigue. It may be necessary for them to get assistance from a mental health professional as a loss in to any member of the family may upset the usual functioning of the family in complicated ways. Allow the griever to experience each of the stages even though it is distressing to witness. Understand that painful and difficult processes such as denial, anger, bargaining, and depression are natural and necessary parts of the grieving process. Remember that it is natural for the grieving person to become unreasonable, illogical, or irritable at times.

even though it is distressing to witness. Understand that painful and difficult processes such as denial, anger, bargaining, and depression are natural and necessary parts of the grieving process. Remember that it is natural for the grieving person to become unreasonable, illogical, or irritable at times. Allow the griever to pass through the stages and emotions at their own pace . There is evidence that even in normal grieving there is a range in how long grieving takes from months to years.

. There is evidence that even in normal grieving there is a range in how long grieving takes from months to years. Allow the griever to grieve in their own way . Some benefit by talking or even writing about their grief while others do not (Stroebe et al, 2002; Stroebe et al, 2006). For example recent research indicates that attachment style (the habitual way a person orients to intimate others) influences the kinds of support that are useful for them (Christiansen et al, 2013). Therefore it is best to let the griever decide how they want to grieve and encourage and support their efforts.

. Some benefit by talking or even writing about their grief while others do not (Stroebe et al, 2002; Stroebe et al, 2006). For example recent research indicates that attachment style (the habitual way a person orients to intimate others) influences the kinds of support that are useful for them (Christiansen et al, 2013). Therefore it is best to let the griever decide how they want to grieve and encourage and support their efforts. However if you feel that the grieving person is having difficulty resolving their grief gently and calmly and with love suggest to them to visit a mental health professional. If they refuse initially, as they probably will, gently bring it up later leaving the name and telephone of a therapist experienced in grieving for them to call.

Concluding Remarks

Remember that there is no fast lane to grieving, no magical cure, and no softer easier way to grieve. Loss is inevitable in life and is followed by a period of grieving. As Queen Elizabeth II said "Grief is the price we pay for love." If we attempted to avoid grief by giving up all our loves in life: love of people, love of pets, love of our careers, and even self-love, what kind of life would we have? It is our deep connection with others that makes us human.

Still there are some things we can do to help make the path of grieving free of unnecessary difficulties. We can be there for the grieving person and offer our love and support consistently despite the occasional negative emotions that may emanate from the grieving person as they plumb emotional depths. To better withstand the stress of helping the griever educate yourself about grief. Learn the various stages of grief so that you are not surprised by the variety of emotions that can take place in perfectly normal grieving. Finally, and probably most importantly, be aware that each of us grieves in our own idiosyncratic way and that this uniqueness must be respected if you are to be helpful to the grieving person.

References

American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). Arlington, VA: American Psychiatric Publishing.

Christiansen, D. M., Elklit, A., & Olff, M. (2013). Parents bereaved by infant death: PTSD symptoms up to 18 years after the loss. General Hospital Psychiatry, 35(6), 605-611.

Kübler-Ross, E. (1970). On death and dying. New York: Collier Books/Macmillan.

Stroebe, M., Stroebe, W., Schut, H., Zech, E., & van den Bout, J. (2002). Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies. Journal of Consulting and Clinical Psychology, 70(1), 169-178.

Stroebe, M., Schut, H., & Stroebe, W. (2006). Who benefits from disclosure? Exploration of attachment style differences in the effects of expressing emotions. Clinical Psychology Review, 26(1), 66-85.

Resources

Australian Centre for Grief and Bereavement provides a variety of online resources on grieving and losses of various kinds.

The Harvard Medical School Family Health Guide section on grieving is excellent.