I see a lot of people who are worried they are not grieving “properly”. Sometimes they have been told by someone else that they are grieving for too long. Other times they see how other people appear to be coping with their grief and feel they are not grieving that way so are not grieving properly.
Grief researcher and theorist William Worden defined complicated grief as “the intensification of grief to the level where the person is overwhelmed, resorts to maladaptive behaviour, or remains interminably in a state of grief without progression of the mourning process to completion.”
He identified what he considered were 4 particular “tasks” of grieving.
These are:
- Accepting the reality of the loss
- Working through the pain of grief
- Adjusting to the environment in which the deceased is missing
- Emotionally relocating the deceased and moving on with life.
This is not a perfect definition or description of grief, but it covers a lot of what happens in grief.
According to Worden, if one of the above tasks was not able to be navigated successfully, then grief would become complicated. It would either be
• prolonged. This is where the person is aware their grief is not resolving many months or years after the loss event
• delayed. This is where the person’s emotions are not able to be expressed. This can happen even if they had an emotional response at the time of the loss.
• Exaggerated. The grief is so severe that the person suffers from excessive anxiety, depression or anger and this impairs their normal functioning.
• Somatic (body) or behavioural symptoms. Often the person is not aware these symptoms are caused by unresolved grief.
Another theorist, Therese Rando, defines complicated grief as “given the amount of time since the death, there is some compromise, distortion, or failure of one or more of the processes of mourning”.
She identified 6 tasks of grieving. They are:
- Recognise the loss
- React to the separation
- Recollect and re-experience the deceased and the relationship
- Relinquish old attachments to the deceased and to the old world.
- Readjust to the new world without forgetting the old.
- Reinvest energy in the present life.
She noted a number of risk factors for complicated grief:
• Sudden or unexpected death.
• Death from a lengthy illness
• A perception the death was preventable.
• The relationship with the deceased was an angry, ambivalent or dependent one.
• Unresolved grief from other losses
• Loss of a child
• A lack of social support
Grief theorists agree that the “goal” of grieving is creating a new relationship with your loved one that includes them in your continuing life.
If you are grieving “normally” you will experience distressing moods and turbulent thoughts but you will be able to tolerate them and return to some sort of equilibrium. If you are experiencing complicated grief the moods and thoughts will be extreme and will impair functioning to the point where you cannot achieve equilibrium. Of course, this does not apply if you experience this in the first weeks and months after being bereaved.
Two other theorists (Stroebe and Schut) more recently proposed a model where the bereaved person alternates between coping with the loss and making changes in their life to adapt to that loss. That is often described as “loss orientation” and “restoration orientation”. If those processes are out of balance then grief will become complicated.
More recently, it has become standard to describe the final task of mourning as that of seeking meaning in the loss. I see that as being an aspect of finding a way to move on with life.
Things have become complicated by the inclusion in the DSM (a diagnostic standards manual that describes “psychological disorders”) of complicated grief. It is described as depression. There is the suggestion it could be present as early as a month after the death of the loved one. In my experience, and that of most grief practitioners and researchers, that is too soon to be pathologising a person’s grief.
The 7 things the DSM considers are symptoms of complicated grief are:
- Unbidden memories or intrusive fantasies related to the lost relationship
- Strong spells or pangs of severe emotion related to the lost relationship
- Distressingly strong yearnings or wishes that the deceased were there
- Feelings of being far too much alone or personally empty
- Excessively staying away from people, places or activities that remind the subject of the deceased
- Unusual levels of sleep interference
- Loss of interest in work, social, caretaking, or recreational activities to a maladaptive degree.
These symptoms are experiences of normal grief. The use of the word maladaptive is open to interpretation.
This perception of normal grief experiences as pathological and problematic have meant many people are being pressured to move on quickly from their grief or feel there is something wrong with them if they experience normal grief.
This is where I often work with people to help them see their experience as normal, not pathological, and enable them to move forward with life.
It is okay to remember things frequently. Your life is full of so many things that trigger memories that it would be more worrying if you did not remember things.
As for fantasies about the now lost relationship. Fantasy if a common coping mechanism. As long as you are aware it is a fantasy.
Strong emotions are quite normal as well. Neuroscientists have found that neurological connections to a loved one have to break down and new pathways have to be created. This takes time, commonly considered to be about three months or longer. There are many symptoms of this process including pain, extreme tiredness, confusion, memories that pop up, volatile emotions and so on. You may also find it hard to concentrate. Being with people may also be very tiring and hard to do. The result may be that you spend a lot of time alone and avoiding people. Sleep will definitely be disturbed, as will your general level of interest in life.
So if you experience these things talk to a specialised grief and loss counsellor. You can be reassured of this.
One last thing to mention. Many people report changes in appetite. That is okay. If you are not hungry and don’t eat, and you notice you are losing weight, then it is a good idea to see a counsellor and your doctor. It may be that for a short while you may need to ensure the food you eat is more nutritious to compensate for the lack of food. Similarly, you may find you are excessively eating and putting on weight. If it bothers you, then seek help. If you suffer from Diabetes then your eating patterns may cause problems with your health and it is advisable to consult your doctor about this.
Grief is hard and there are many ideas about what “normal” looks like. Of course we all know that is a setting on many appliances but doesn’t exist in life. If you are ever not sure, it is a good idea to see a grief counsellor.
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 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