Grief and Grieving

We all, including our loved ones, are part of Life. We are complex creatures. Hundreds of thousands of things have to go right, every day, for us to be alive.

This makes us amazing, almost miraculous beings. But at the same time, it makes us vulnerable.

Some day, we will pass away. Some day our loved ones will do the same. As far as we know, we are the only species conscious of this painful truth.

This truth is so overwhelming that it could be paralyzing. We have to forget about it, at least consciously, to carry out our daily life.

But it is inevitable that at some moments of our life it will present itself, sometimes drastically and unexpectedly.

Love is a powerful force in our life. We love crucial members of our family, we love our dearest friends.

Love and grief are both sides of the same coin. We can't have one without risking the other. Grief is the link between love and loss, we grieve the loss of those we love.

Grief is a complex emotion. It varies widely among different people, both in the feelings involved and in their intensity.

The most frequent and significant feelings are strong pain, deep sadness, and an agonizing yearning for the lost loved one. But many other feelings can also be present, like anger, anxiety, numbness, emptiness, loss of meaning, despair, etc.

Even regret for "not having done enough" to avoid the worst, or relief, in case of a painful sickness preceding it, can be part of this complex set of feelings.

Some of these feelings, like extreme anxiety and numbness, predominate immediately after the loss, while some others might persist for a lifetime.

Other feelings are triggered by the "secondary losses" that follow the main loss. These secondary losses could be related to the past, like the loss of our previous "happy" identity, or the change of our social status, like becoming a widowed person, or an orphan. We could feel even self-pity and shame in these new social roles.

Feelings triggered by the "secondary losses" may also involve the future, the shattering of our hopes, expectations, and plans of a life together with the deceased person.

In the most extreme cases, everything that we previously took for granted about our lives feels destroyed: we are painfully forced to construct a `new normality' in which the deceased loved one plays no part.

Following the seminal and widely influential work of Elisabeth Kübler-Ross "On Grief and Grieving" (2005), grieving was put "on the spotlight" of mental health sciences, under a theory comprising five consecutive stages:

1. Shock and Denial: This is the first reaction to the huge loss. People can't accept it has happened, they are numbed and can even get delusional thinking the loss has not occurred.
2. Anger: After the first shock wanes, and denial becomes impossible to sustain, they become frustrated, and very angry. Typical thoughts would be: "Why her/him/me? It's not fair!"; "How/why can this happen ?"; "Who is to blame?", etc.
3. Bargaining: The third stage involves the hope that the individual can avoid a cause of grief. People can bargain or seek compromises, and build "what if scenarios" with thoughts such as "If If I had done X, it would have not happened", or "If I could, I would trade their life for mine".
4. Depression: It is characterized by the loss of interest in life and previously enjoyable activities, and the prevalence of thoughts like "I'm so sad, why bother with anything?"; "I'm going to leave soon too, so what's the point?"; "I miss my loved one; why go on?". People despair, recognize their own time limit and the impermanence of all things. They spend most of the time extremely sad and gloomy, and may become silent, refusing visitors and and any social activity.
5. Acceptance: In this last stage, individuals recognize that this is an inevitable part of life. Thoughts like "I can't fight it; I should prepare for it" prevail. It is characterized by a melancholic, calm, retrospective view, and a more stable condition of emotions.

This scheme of five consecutive stages has been widely influential, and the essential reference to all studies about grief. But at the same time, subject to much debate.

On one hand, it is widely accepted that it established the view that grieving is not only inevitable, but also a necessary process. Grieving is the human way of coming to terms with a huge, life-shattering loss.

On the other hand, it has been criticized because of its rigid arrangement in a sequence, and the rigorous definition of the feelings corresponding to each one, which might imply that there is a "right" way to grieve and deny space for other feelings and other ways of grieving.

As this model has somehow permeated the popular culture on the subject, the idea that the bereaved has to go to some definite phases becomes an expectation of those close to her/him, creating social pressure to someone that might be following its own genuine path, different from the "standard model".

If the bereaved fails to display any obvious signs of grief during the "normal process", or if their overt grief lasts more than, say, one or two years, they might be judged as behaving `abnormally'. They are often told then that they should be `over it by now'.

In reaction to this rigid sequence, extensive research has recently been conducted, and as a result, various other schemes have been proposed , in which different behaviors coexist in any sequence.

There has even been identified an "oscillation", back and forth, between looking back (grieving), and looking forward (building a new life).

In an upcoming Discussion we will address the relevance of all these concepts for Trauma.

Questions:

• What has been your experience with Grief in your life?

• What main feelings did you have while grieving ?

• What phases did you experience in your journey to recovery?