What is Prolonged Grief Disorder and Do I Have It?

If you have ever experienced the loss of someone or something that was important to you, then you will know that grieving a loss is never simple.

For starters, grief hurts. A lot.

You will think your pain is settling down then something will trigger a memory and you are caught up in that pain again.

There will always be pain.

There will never be a time that it doesn’t hurt.

But for most people you learn to live with that pain and still function.

It is when grief continues and you can’t function well that grief can be considered to have become stuck and may need help to be able to function well in life.

This is what is known as Prolonged Grief Disorder.

Who Gets Prolonged Grief Disorder?

Anyone can suffer from Prolonged Grief Disorder.

Some people are more vulnerable to being affected this way. If you were particularly close to the person you are grieving, you will be more likely to be affected.

If you suffered from depression before experiencing this grief that may make you more susceptible.

If the death was sudden, traumatic or due to suicide it can also be more likely to happen.

It is important to acknowledge that Prolonged Grief Disorder is not just something that happens when someone dies, it can also happen with a job loss, the loss of a house, the loss of a country, the loss of a body part, the loss of a relationship, and so on.

Is There Anything I Can Do To Prevent This Happening?

It is really important that you give yourself space to acknowledge what has happened and allow yourself time to experience those feelings.

Don’t be pressured by other people to “get over it”. Don’t allow the expectations of others to force you to push your feelings aside and not process them.

Do recognise you will hurt for a long time. It is likely that before you are finished the worst part of grieving you will be fed up with being so sad. That is a good sign. It means you are getting ready to learn how to live with this pain.

Be willing to get help. See a counsellor, join a support group, use the support of understanding friends and family. Be prepared to experience your grief.

How Do I Know If I Have Prolonged Grief Disorder?

The first thing to remember is that no attempt is made to diagnose Prolonged Grief Disorder until at least 12 months has elapsed since your bereavement.

I have had people come to see me who are struggling to process the death of a loved one over a year ago, but then tell me another close family member only died a few months ago. If you have two major bereavements that close together, expect to be dramatically affected. You are not suffering from Prolonged Grief Disorder. You most likely need support, but you are not suffering from Prolonged Grief Disorder.

This is the criteria for an official diagnosis of Prolonged Grief Disorder:

• The bereavement occurred at least 12 months ago.

• You need the above plus at least three of the points below.

• You have lost your sense of who you are,

• You struggle to believe the person is dead,

• You avoid reminders that the person is dead,

• You are still experiencing intense emotional pain (sorrow, anger, bitterness for example) related to the death,

• You are having trouble getting back to work or social involvement,

• You feel emotionally numb,

• You feel your life is meaningless,

• You feel intensely lonely or feel totally detached from life.

If you feel this may be you then it is helpful to see a specialist grief counsellor.

What About My Children?

Children will grieve differently to adults. How they grieve will depend on their developmental stage and each new developmental stage will include a new period of processing more grief.

Another issue for children is the reaching of life stages where the one who has died may have been expected to be present. This is a fresh reminder of their absence and will include a new period of processing more grief.

Teenagers are included in this as their brains are still developing.

What you may see in children is:

• They may wait for their loved one to come back. This is particularly so with small children who have trouble understanding the concept of death.

• They may be frightened other people in their life may die too. With the death of someone in their life their sense of safety is disrupted and will take time and possibly assistance to regain.

• They may develop separation anxiety and not want other people to be away from them.

• They may think they just have to complete some task in order for their loved one to be alive again. This is known as magical thinking. Children can find it hard to understand that things happen in life and they cannot control them.

• Acting out behaviours that may not appear to be related to the loss. You may expect your child to cry or be sad. But what if they become angry and combative? Or they adopt destructive behaviours? Or they act like they don’t care about anything? There are many different behaviours you may see as your child tries to process these unfamiliar and overwhelming emotions.

If your child/teen is exhibiting behaviour that may suggest they are not coping with their loss it is helpful to arrange an appointment with a specialist child counsellor. Later teens are okay with a specialist grief counsellor but I would recommend a specialist for your younger children.

How To Treat Prolonged Grief Disorder.

There are many different therapies that work well with Prolonged Grief Disorder. In my work I use talk therapy, sand play, painting, movement, journalling, writing, poetry, therapeutic cards to name a few.

Please note that there is no medication treatment for this disorder. You need to process what has happened and medications do not facilitate that.

Can I Help?

If you would like to talk to me about how I can help you with your grief, whether prolonged or not, please contact me on 0409396608 or nan@plentifullifecounselling.com.au

If you would like to learn more, I write a regular newsletter with helpful information, tips, information on courses, and the occasional freebie. At the moment I have a free mindfulness meditation for anyone who signs up to my newsletter. This meditation offers a way to safely explore your feelings and learn to be okay with them. If you would like to subscribe please click on the link here: http://eepurl.com/g8Jpiz

Denial And Saying Goodbye: Two Difficult Aspects Of Grief To Navigate.

In learning to live with the loss of someone you love, two of the most difficult aspects of that loss are often the ones people get stuck in.

The first is being able to accept the reality of your loss. This is often referred to as Denial of the loss, but it is a misnomer.

The second is being able to reach a point of acceptance, often referred to as the Good Bye.

Denial

When I use the word denial, I am not referring to you refusing to accept your loved one is dead. Denial is referring to the sense of unreality around the death.

The death of anyone you love is incredibly hard to conceptualise. Your brain just can’t handle the enormity of what has happened.

Additionally, your brain is still hard wired to connection with the person who is dead. How can you comprehend that person’s death if your brain is still searching for that connection?

What Denial Feels Like

When you are trying to comprehend the death of someone you are quite likely to feel numb. You may be paralysed with shock.

You may feel the world has lost all meaning. You may feel overwhelmed. You may feel life is not making sense.

Earlier I talked about the enormity of what your brain has to take on. This protects you from overwhelming emotions and allows them to be titrated as you are able to cope with them.

A Personal Experience

I remember the unreality of my grandmother dying. It was the first time I had encountered death and I couldn’t get my 12 year old mind around it.

I remember asking myself what death meant. From my perspective it would mean she would never ring us again. There would never be the jokes about how loud she was on the phone (a result of a husband with very poor hearing). It would also mean I would never be able to visit her again, or hear her talk, or see her. It would no longer be Nanna and Pa. It would just be my grandfather on his own. I felt like a massive hole had opened in my life and I didn’t know how to fill it.

When You Aren’t There To Say Goodbye

When my grandfather died I was 19 and had seen a lot of death as a student nurse. I wasn’t there when he died and could only comprehend he was dead when I went to see his body. I just needed to see him.

Everyone has their way of comprehending the death of someone they love. It is a lot to get your head around.

Accepting Means Letting Go

In all my years as a nurse, and as a counsellor, I have never met anyone who didn’t want to believe. They struggled to comprehend, most definitely, but they never denied the loss.

However, some people struggle to let go of the one who has died. They hold on to the person’s possessions, they avoid places that remind them of the person who died, they refuse to visit the grave or release their ashes.

These can all be signs of being stuck in denial. This comes under the term Prolonged Grief. It is where the grief process gets stuck in one area. This is when professional grief counselling is important.

How To Look After Yourself

If you find yourself in the awful situation of losing someone you love, be gentle with yourself. Don’t rush to acknowledge the grief and run on as though nothing has happened.

Allow yourself time to sit with the reality of what has happened and let that reality slowly sink in.

Be ready to let go of their belongings at a time that is right for you. Some rush to do it, others hold on to them for a long time. Be okay with taking your time to attend to those tasks.

Be prepared for the fresh grief as you attend to the handing over of belongings, visiting the grave site, spreading the ashes and all the other tasks that need to be attended to when someone dies.

Be ready to open your connection to your loss and face your feelings about it. Don’t hesitate to seek help if you need someone with you at those stages.

Acceptance: The Act Of Saying Goodbye.

It can be very hard accepting the death of a loved one when their death was particularly traumatic for you.

I have seen many people stuck in the horror of the pain experienced by their love one. For others the stuckness comes at the speed with which the person went from living to dead.

Their age also is a factor and your relationship to them. I have spoken to many parents trying to comprehend the death of their child because that death is out of the natural order of things. You are supposed to bury your parents and your children are supposed to bury you. But when it happens out of order with you burying your child, that is so hard to comprehend.

If the one you love died a long way away and you weren’t able to see them before they died, or you couldn’t be at the funeral, then it is hard accepting the death. Not only that, it is hard to comprehend the fact of their death when all you have is words spoken over a telephone or contained in an email.

A Personal Experience

When my husband’s Aunt died we were living on the other side of the world. I found a days old email in an unused email account stating she had died. It was a shock to both of us. We never knew when she was buried. It took years to learn what caused her death. It was hard for my husband to understand she had died.

It wasn’t just this Aunt. When he was a child another Aunt died. His parents decided he was too young to see her before she died or attend her funeral. He was about 10 at the time. He grieved for the fact he never had the chance to say goodbye.

Many years later another Aunt died and he was in a position to go to the funeral. We decided he would go and grieve for the Aunt who died when he was a child, for the Aunt who died when we were living overseas and this Aunt who had just died. It was an important opportunity for him to accept and say goodbye to all these women who had meant so much to him in life.

When Death Is Difficult

Another way the good bye can be delayed can be when the person who dies has died a difficult death. I have worked with many people who are stuck in the pain their loved one suffered. Acceptance of the death can be hard because the one left behind finds their death too traumatic to accept.

When a death is traumatic like that it can be very hard to move past those painful last hours. I often find helping the person to switch their focus to their earlier life with the person can be really helpful. Remembering the happy times, before the trauma of their death, can switch the focus to the person and their life, rather than the moments of their death.

When someone dies, you are saying goodbye to every moment you had together, not just the moment of their death. When you are caught up in their death, it can be hard to remember that.

Can I Help?

If you would like to talk to me about how I can help you with any aspect of your grief, please contact me on 0409396608 or nan@plentifullifecounselling.com.au

If you would like to learn more, I write a regular newsletter with helpful information, tips, information on courses, and the occasional freebie. At the moment I have a free mindfulness meditation for anyone who signs up to my newsletter. This meditation offers a way to safely explore your feelings and learn to be okay with them. If you would like to subscribe please click on the link here: http://eepurl.com/g8Jpiz

Seasons of Grief

You sit in your grief
Frozen
It is as though an icy reminder of winter has invaded the autumn
You suddenly find yourself in.

You sit in the icy numbness.
Then the numbness passes.

And you are tossed around by the autumn winds
Blowing their cold breath
Causing all to hunch forward and rush to shelter.
Leaving you alone in your grief.

You stand there
In the midst of the swirling leaves
Reds, oranges, yellows and brown.
Echoing your own swirling emotions
And you long for the time when you felt only numbness.

Then you sighed
And settled in for the long haul of the winter of your grief.
The days when it was icy and still.
When snow muffled every sound
And the world seemed deserted.

Just you and your pain.

As you stood on the edge of the ocean.
Antarctic blast hitting you with its icy needles
The waves whipped to a frenzy by winter storms
You remembered that all healing comes in waves.

The intensity varies.
Sometimes you can feel almost normal.
Other times you feel like you can’t go on.
You are out there in the white caps
Drowning.

And then you realise you will heal
Eventually.
You look around and notice the gradual budding of leaves at the ends of branches.
You look at the ground as tiny flowers emerge from their bulbs.

The wind comes warm and you dance in the beauty of it.
Then the wind blows cold and you are back in the thundering waves
Drowning.

Be okay to feel what you are feeling.
To feel those exhilarating days of warm breezes
And those terrifying days of drowning.

Allow it to take time.
Don’t rush.

You will be fed up with grief
Long before it is finished with you.

Allow the pain.
In that pain is growth.
In that pain is the way to learn how to live with your loss.

A day will come when you will stand on the edge of the ocean
The sun will dance on the gentle waves
A warm wind will gently caress you
And you will feel at peace.

Nan Cameron 24/7/2023

Can I Help?

If you would like to talk to me about how I can help you with your grief, please contact me on 0409396608 or nan@plentifullifecounselling.com.au

If you would like to learn more, I write a regular newsletter with helpful information, tips, information on courses, and the occasional freebie. At the moment I have a free mindfulness meditation for anyone who signs up to my newsletter. This meditation offers a way to safely explore your feelings and learn to be okay with them. If you would like to subscribe please click on the link here: http://eepurl.com/g8Jpiz

The Extra Support Needs Of Traumatic Grief

Recently two incidents at sea where people were killed have been mentioned in the media. One was the death of 5 people in a submersible craft deep sea diving. The other was around 600 refugees fleeing war and persecution whose boat sank with the loss of around 500 lives.

For the submersible, the media reports stressed that they would have been dead in an instant, not aware that they were dying. No one talked about the slow drowning death of the mainly women and children trapped inside the sinking refugee boat. Their death would have been one they were fully aware was happening.

It was more comforting to think that they people killed in the submersible died quickly, unaware they were dying. It is horrible to think of the refugees and their slow drowning death.

Your Loved One Has Died a Traumatic Death

When your loved one is killed in an accident, murdered, died lost in the bush or desert, suicided, grief becomes complicated by the way they died. You are mourning two things, the loss of their life, and the traumatic way they died. It makes a difference to the way you grieve.

As well as being traumatic, suicide is a unique bereavement so I will address that in another blog post.

How do you cope with knowing your loved one was killed in an accident? Or worse, was killed deliberately? Were they aware they were dying? What was going through their mind? Did they suffer? Were they calling out to you for help or support?

How Society Thinks You Should Grieve

There are many ideas in our society about how you should grieve. Some, particularly if they are based on personal experience, are valid. Others are completely wrong and cause great harm to those who are grieving.

Much of how we grieve is learned from childhood experiences with grief.

Death As An Existential Concept

I am often called to conduct critical incident debriefs. When I talk to people I always seek to find out about their previous experience with grief, and any customs they practice after the death of someone they know. I also seek to identify those for whom the death I am debriefing them over is the first time they have encountered death.

Death is a massive existential concept. It takes a lot to comprehend its meaning and place in our lives. It is the great certainty of life but also the great unknown. It is something we tend to ignore, until we are confronted by it.

I remember my first encounter with a person dying. It was my grandmother and I was 12. I remember asking myself what death was. For me at the time it meant my grandmother would not ring us up anymore. We would never visit her again. I would never be able to learn more from her. She would not be there.

Other people report different meaning making around death.

Always, there needs to be understanding and patience for those who have never encountered death before.

The Meaning of This Death In Your Life

When I work with the first time bereaved, I always try to help them explore the meaning of this death in their life. I also let them know it is okay to have a multitude of feelings. Such as being confused, to feel it is unreal, to feel angry, sad, numb, restless, frightened and so many more things.

One thing I always work to dispel with people is that idea of grief being one of stages. This idea became popular in the early 70s when Elizabeth Kubler-Ross published a book “On Death and Dying”. I remember reading it in the years after my grandmother died. I found it didn’t match my experience at all. When I became a nurse I found it was more applicable for people who were dying than those who were bereaved. I later found out there is a reason for that. The book was aimed at those who were dying, not at those who were bereaved. The book was embraced as being about bereavement and that has been hard to shake.

Since that time there has been much research which has been more applicable for those who are bereaved. None of these research findings list “stages” as being part of the grieving process.

However, the idea of stages still persists. I still have people come to see me who are concerned because they are not following the stages. They have either formed the idea themselves they must follow stages, or they have been told by others they must follow stages.

What Is Known About Grief?

Grief is a total body experience.

We not only emotionally experience grief. It is there in our thoughts, actions, physical sensations as well as emotions. Grief is physically experienced by our brains as neural pathways in the brain are removed and the remnants altered.

As the core of grief is sadness. There is often disbelief, a sense of unreality, anger, fear, brokenness, confusion, hyperactivity, shut down, crying, numbness, guilt, regret, disbelief, lethargy, loss of appetite, feeling overwhelmed, unable to make decisions, and many more. Moods are unstable and change frequently. Any little trigger can throw you back into deep grief.

The intensity of grief will slowly abate. Most people find that after 18 months to 2 years they are feeling their pain less intensely. In the initial stages of grief, it is hard to focus on anything other than the grief. Although you can if they need to, it is often exhausting to do this. Sometime after a few months it becomes easier to put the grief aside to attend to other things.

This is how grief plays out normally.

What happens when the death is traumatic?

Many of the experiences of grief are amplified in traumatic grief. Some of that is due to your body’s defence systems being activated. You may feel combative as your body tries to fight its way out of the situation. Or you may feel agitated and want to run away. This is your body trying to run from a situation it judges you cannot fight. Or you may feel like you are frozen as your brain tells you there is no escaping this terrifying situation.

Traumatic grief leads to more frequent, more intense reactions. Many people report visions of their loved one being hit by a car, stabbed in a fight or whatever caused their death. They may envisage their loved one lost in the bush (if that is how they died), they may experience the horror of imagining their loved one giving up hope of being found alive. All this is heartbreaking.

The pain of losing a loved one in traumatic circumstances is more intense. The idea that someone or something else has caused your loved one’s death adds an extra layer to your grief. The if only’s are very powerful in this type of loss.

Your World View Changes

All grief causes your world view to change. But traumatic grief has a much deeper impact on your world view. The type of traumatic grief will influence the change in your world view. There is a difference to way you will process death due to, for example, a car accident, murder, faulty equipment, and being lost in the bush.

The manner of traumatic death can also impact on the type of support you will receive. One person I saw some years ago lost her son when he was stabbed. She found that people were judgemental about what he was doing out at night in a party area. Did he have a knife too? Was he drunk? Was he looking for trouble? Did he deserve to be grieved if he contributed to his death by being in a party area?

The Blame Game

When a person dies they die. There is no blame. We all make errors of judgement. For your loved one this may have resulted in their death. It doesn’t make you any less deserving of the grief you are experiencing. Nor does it make their loss any less worthwhile.

Another person who came to see me had lost her sister in a car accident. Another driver changed lanes directly into her car and wiped her out. People questioned if it was her driving skills that contributed to her death, this despite the fact the other driver was clearly in the wrong and admitted it.

Fewer People Are Willing To Offer Support

Many of the people I see who lose a loved one traumatically find that they receive less support. Or there is a lack of understanding of the more intense nature of their grief. There is often a lack of support from other people, who will often avoid the grieving person because they don’t know how to respond to their grief.

If you are experiencing traumatic grief, know that your experience is likely to be more intense and last longer. Be gentle with yourself. Don’t push yourself to “get over it” quickly. If you have friends or others in your community who are supportive and seek to understand, keep in touch with them. Avoid the people who are unhelpful. Allow yourself the time you need to heal. If you need it, seek help from a grief counsellor.

Can I Help?

If you would like to talk to me about how I can help you with your traumatic grief, please contact me on 0409396608 or nan@plentifullifecounselling.com.au

If you would like to learn more, I write a regular newsletter with interesting information, tips, information on courses, and the occasional freebie. At the moment I have a free mindfulness meditation for anyone who signs up to my newsletter. This meditation offers a way to safely explore your feelings and learn to be okay with them. If you would like to subscribe please click on the link here: http://eepurl.com/g8Jpiz