The loss of a loved one is one of the most devastating, life-changing events a person will go through. Every year about eight million Americans experience the death of a close family member, which may cause a disruption in their life patterns for up to three years.
In our fast-moving world, it is evident that people do not take enough time to properly grieve. While over 90 percent of American companies grant official time off for bereavement, most have established a mere three days as the formal bereavement period.
Although the grieving process is difficult to go through, it is necessary to experience certain steps in order to properly heal and move on with your life. This purpose of this article is the following: to define some common terms on the topics of grief and bereavement; to discuss the stages of grief, factors that may interfere with the resolution of grief, and possible physical and psychological manifestations of grief; and to explain the reasons why one may need bereavement/grief counseling, as well as the benefit of support groups.
Actual loss– The physical death of a person and, as a result, the absence of the connection that existed.
Grief– One’s personal experience of loss. Grief is multifaceted and can literally affect all areas of life: spiritual, psychological, behavioral, social, and physical. The goal of grieving is to come to terms with the unexpected changes in your life. Grieving is tough. It takes work and determination to get through it. Although doing that work is painful, it is absolutely essential.
Mourning– It is the public expression of grief and the societal process by which we adapt to loss. Examples of mourning include funeral and memorial services, flying flags at half-staff, temporarily closing a place of business in honor of a person who has died, and many other rituals that help us feel as if we are doing something to recognize our loss.
Bereavement– The period after a loss during which mourning occurs (usually a relatively brief time) and grief is experienced (often for a much longer time).
Stages of Grief
Grief is a process that cannot be bypassed, hurried, or rushed; it must be allowed to happen at its own pace. We do not go through grief and come out the other side as before the loss. Grief changes people.
Experts differ on the number of stages of grief. For example, some experts outline four stages, while others, such as Elizabeth Kubler-Ross, outline five. However, the stages are not absolute, because each person’s grief is unique. For the purposes of this discussion, we will review the four stages of grief that many people experience. Keep in mind that people travel through these stages in different ways, in different orders, and for different lengths of time.
Denial, shock and disbelief: This initial phase, which may last from a mere few seconds up to 6 weeks, is marked by numbness, disbelief, and, often, alienation from others. The loss may be intellectualized and dealt with on a “rational” level, as opposed to a “feeling” level. This is the stage many people are in at the time of the funeral.
Awareness, anger and bargaining: This next stage is an emotional and suffering phase that resides in the heart. At the same time that the supportive chemicals (e.g., adrenaline) released in response to the stress of our loved one’s death are beginning to decrease, and the support of friends is lessening, the impact of the person’s loss is beginning to be truly realized. The onset of this stage often occurs two to four weeks after the death, and the pain we experience continues to increase until it peaks about three to four months after the death. Typically, this is the longest phase. Strong emotions, such as anger, fear, and guilt, may be experienced. Bargaining thoughts (e.g. “I’ll do a better job if my loved one ‘comes back…'”) is often part of this stage.
Depression: We desperately want everything to be the same as it was before the loss. This unachievable desire, simultaneously so natural and so understandable, may elicit depression.
Reconciliation and recovery: The final stage resides in the gut. Frequently, it is several months before we overcome the most severe emotional stress, and it can take at least a year to work through the grieving process. We must weather the “series of firsts” (e.g., birthdays, anniversaries, holidays, date of the loved one’s death) without the person who has died.
Factors That Can Interfere With The Resolution Of Grief
There are certain factors that may affect healthy progress through the stages of grief. Accordingly, attempting to avoid these factors will help the bereavement process:
- Not dealing with emotions- Sweeping emotions under the rug does not make them go away. They’re still there, needing resolution.
- Overactivity leading to exhaustion- This serves as a distraction and may lead to focusing on other things, but it doesn’t help the real issues of grief to be experienced… and worked through.
- Use of alcohol or other drugs- They mask the symptoms, ones that need to be resolved as part of the grief process.
- Unrealistic promises made to the deceased- This is similar to what’s experienced during the bargaining stage, where feelings of disappointment and despair are allowed to interfere with recovery.
- Unresolved grief from a previous loss- This can complicate the recovery from this loss. Dealing with each loss, separately, is more advantageous.
- Judgmental relationships- People who tell you what you should do, how you should feel, and when, can make it difficult for you to go through your own unique process.
- Resentment of those who try to help- This can focus your emotion in less productive directions, instead of working through your own emotions of grief.
Physical And Psychological Manifestations Of Grief
Grief can manifest itself in many different ways. It is important to recognize these symptoms can be caused by loss and may interfere with everyday functioning.
Physical manifestations of grief may include:
- Loss of appetite
- Changes in weight
- Trouble falling asleep or staying asleep
- Chest pain
- Hair loss
- Gastrointestinal distress
Although these are common symptoms of grief, a medical professional should be contacted if you feel any of these symptoms too often.
Psychological manifestations of grief may include:
- Emotional swings
- Impaired concentration
- Lowered self-esteem
- Hallucination that the deceased person is present (visual or auditory)
- Feelings of unreality, numbness, denial
- Searching for the deceased
- Making progress and then suddenly feeling worse, without an obvious trigger
- Suicidal thoughts (be aware: thoughts of suicide may occur in up to 54% of survivors, and may continue up to 6 months after the death, but don’t mean that a survivor is actually planning suicide. Rather, they often relate to the feeling of “just not wanting to go on” without their loved one.).
- Depressive illness
- Depressive illness, not to be confused with the common situational or “reactive” depression caused by a loved one’s death, can occur in approximately a quarter of survivors during the first year after a death
- Symptoms of depression typically begin after 1-2 months of bereavement, last for several months after the loss, and are often constant.
- Depressive illness is associated with prominent thoughts of suicide, profound changes in appetite or sleep, or substantial decreases in function.
Although these are common symptoms of grief, a medical professional should be contacted if you feel any of these symptoms are affecting your life and impeding your progress.
Bereavement Counseling involves the services of a mental health professional to assist with going through the normal grief stages in order to reach a healthy conclusion and accept the reality of the loss. Although it is acknowledged that the loss of a loved one creates a “void,” one of the aims of grief counseling is to help the bereaved person to release the emotional pain related to the loss throughout their life. Acknowledging this and working through the pain reduces the likelihood that there could be lingering interference with daily activities along with prolonged physical and psychological problems.
Not only can mental health professionals help to guide individuals through the grief process, they can be beneficial, even necessary, in assisting individuals to cope with situations that may be unique for them, such as:
Disenfranchised grief— This occurs when someone experiences a loss that cannot be openly acknowledged, publicly mourned, or socially supported. One example would be the loss experienced by someone who was having an affair with a married person who dies. Because the usual opportunities for mourning may not be readily available, disenfranchised grief is harder to work through and may be prolonged.
Complicated grief— This is delayed or incomplete adjustment or adaptation to one’s loss. In complicated grief, there is a failure to return, over time, to pre-loss levels of functioning, or to the previous state of emotional well-being. Grief may be more intense in younger people, women, and persons with limited social support, thus increasing their risk for complicated grief. Complicated grief may increase the need for support services and professional assistance.
Bereavement /Grief Support Groups
In addition to the role of mental health services for some people, a very effective method in helping people grieve a loss is a bereavement support group. Because these groups offer a safe place for people to do the work of mourning, support groups encourage participants to reconcile their losses and go on to find continued meaning in life and living. Attending a support group facilitated by a skilled leader often brings comfort and understanding beyond many people’s expectations.
Support groups help grieving people by:
- Introducing them to others who have had similar experiences, thoughts and feelings.
- Offsetting the sense of isolation that many experience.
- Providing emotional, physical and spiritual support in a safe, nonjudgmental environment
- Allowing them to explore their many thoughts and feelings about grief in a way that helps them be compassionate with themselves.
- Encouraging group members to not only receive support and understanding for themselves, but to also provide the same to others.
- Offering opportunities to learn new ways of approaching problems.
- Helping them trust others and bond again in what, for many in grief, feels like an unsafe, uncaring world.
- Giving them the forum to search for meaning in life and death
- Providing a supportive environment that can reawaken their enthusiasm for life and give them hope for healing.
In short, as group members give and receive help, they feel less helpless and are able to discover continued meaning and purpose in life. Feeling understood by others helps to bring down barriers between mourners and the world outside. This process of being understood is central to being compassionate with oneself as a grieving person. The more people are compassionate to mourners from the outside in, the more mourners are capable of being self-compassionate from the inside out.
Our mourning-avoiding culture often forces bereaved people to withdraw from insensitive friends and family or to adopt ways of avoiding the painful, but necessary work of mourning; support groups which instead foster the experience of trusting and being trusted, can do wonders in meeting the needs of bereaved people. In an effective support group, members can achieve a balance between grieving and receiving, between independence and an appropriate, self-sustaining dependence. The group provides a safe harbor where hurting people can pull in, anchor while the wind still blows them around, and search for safe ground on which to go on living.
Grieving is one of the most difficult, yet unavoidable, processes that people have to go through. Understanding what is involved and why, and recognizing that there can be a “re-emergence after going through the tunnel,” can serve as a beacon of hope during a very emotionally painful time.