Bereavement and loss
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Grief is ordinarily characterised by intense mental suffering and distress, deep sorrow and painful regret. Initially, the bereaved experiences shock and numbness and denies that the loss has really happened. This incomprehension soon gives way to, or alternates with, bewilderment and weeping, despairing acknowledgement of the loss with constantly returning thought and memories of the deceased.
Always remember that you are not alone and that you can get help.
In addition to mental pain, the bereaved will usually exhibit physical reactions – tight sensations in the throat, weakness, feelings of emptiness, exhaustion, decreased appetite and insomnia. Anxiety and tension are prominent symptoms in the early period following loss. There may be agitation and restlessness, 'hand-wringing' and an appearance of confusion and puzzlement. There is a marked tendency for these emotional states to come over an individual in waves which come and go more frequently at the beginning of a period of bereavement and then less and less frequently. Mention of the loss may trigger these episodes of intense emotional suffering and for this reason the bereaved person may at times reject discussion and even comfort. The person though is perhaps attempting to sustain denial and avoid the painful state that comes with the recognition of loss. If family members and friends can be aware of this they will be less likely to withdraw from the bereaved and more likely to sit quietly with the person to share the grief.
Words at this time are less important than supportive presence.
Painful yearning and loneliness for the loss object is also prominent. The bereaved person may weep tearlessly and experience a sense of emptiness. When the waves of powerful emotion subside, there will be increasing periods in which the bereaved appears to be 'himself' or 'herself'. Sexual desire and the capacity for any pleasure are often diminished during the early period of bereavement.
Feelings of unreality about self and others are frequently experienced in the acute stages of grief. Illusory phenomena may occur in which people appear vague or smaller than usual. The bereaved may sometimes think for example that they hear footsteps or the voice of the dead person. There may be momentary feeling and perception of the deceased presence even though they are, at the same time, recognised as illusions. The mental image of the deceased preoccupies the bereaved. In some cases, it is as though the lost person was still present and adds somewhat to the denial of the loss. The bereaved may express fear of losing emotional control and mental faculties and many are frightened by the intensity of their own feelings. Early on the person may have terrifying nightmares and sometimes dreams of the dead person which can be comforting.
Guilt feelings are frequently present in the acute stage of bereavement. The bereaved person will recall instances in which he or she failed the deceased in some way. This can be characterised by such expressions like 'If only I had said to him I was sorry…' Memories of arguments, disappointments, infidelities, negligence, impatience and anger can come sharply to the fore. If the deceased has suffered a long and painful illness his or her family and friends may experience relief that the person has died but at the same time shame and even guilt over this relief. The idea that you have your good health, life and perhaps pleasure in new relationships can be an additional source for guilt feelings.
Excessive religious devotion, ritual involvement and compulsive behaviour (always washing, cleaning, straightening things up) in the bereavement state can indicate unconscious guilt.
Anger can also be around for the person not remaining alive and for leaving you feeling the way you do. This can be difficult for the person to accept in themselves or to admit to relatives and friends. This stage of anger is present in everyone who goes through this process. Some bereaved individuals become angry and blame others for the loss as a way of coping with their own painful feeling state. As throughout this process it is important an individual receives understanding and non-judgmental support as they struggle with these feelings.
Depressive symptoms may occur in grief without necessarily indicating clinical depression requiring medical or psychiatric treatment. Insomnia, anorexia, weight, inability to concentrate, restlessness, hypersensitivity, sadness, weeping and self-reproach are, as mentioned, common in normal grief. If they persist beyond several weeks (keeping in mind that there is no such thing as a normal time period for grief and mourning) they may be regarded as possible indicators of more serious pathology. (You may wish to look under the section on depression in this website).
Feelings of numbness may reflect a deep identification with the dead person and for a brief period give the impression that the bereaved person has experienced a total loss of feeling. They may well respond to people in the community who reach out with their support. Identification with the deceased or lost object may also be shown in unconscious imitations of certain gestures or habits of the deceased. It may appear strange but this is acknowledged as a normal part of the bereavement journey.
Helplessness may be expressed both in terms of not having been able to save the person from death and not being able to live without the deceased. Statements like 'I would be better off dead' or 'it should have been me' express this helplessness and guilt. It is as if death could be a relief from the mental pain a bereaved person is suffering. Fleeting suicidal thoughts such as these need not be confused with the more persistent suicidal ideation of severely depressed individuals. (See under 'Suicide' on this website).
Absence of emotion immediately following loss may represent temporary shock, numbness or denial. Grief may be postponed until it can no longer be avoided, for example at the funeral service or burial where it may then flood out sometimes uncontrollably. This is most often observed in those bereaved who must attend to certain duties at the time of the death. Responsibilities in business or as head of the family may combine with the individual's sense of having to appear 'strong' and result in delayed or inhibited grief.
There is also the person who 'hides' their grief publicly and grieves secretly in the privacy of home. A mask is worn. This limits the degree to which a person can express grief or receive support. A person can consciously control themselves in public and maybe even feel ashamed of feeling as deeply as they do about the loved person. These people can often be seen as strong but not cold often expressing their feelings by caring for others.
The duration of grief is variable and may range up to six months or a year. The acute phases should be over within two months. The progress of grief can be judged in terms of whether there is a gradual return to the level of functioning prior to the loss. Of course it can be expected than when faced with reminders of the deceased (such triggers like pictures, songs, smells, and meeting friends) temporary upsurges of grief will occur even months and months later. Another indication of recovery from grief could be when new relationships are established or interest expressed in other events and activities. Particularly important for recovery from grief is the return of full capacity for pleasure without shame or guilt which may have been present at an earlier stage.
Chronic grief
The condition of chronic grief is one of persistent mourning. Some individuals arrange their environment after the loss to reflect no change in life pattern. It is as if a way of life was enshrined at the time of loss and the return of the deceased is awaited. Such response represents a denial of the reality of the loss, and aims to protect against the intense suffering its acknowledgement would bring. The chronic 'mourner' is guarding against anticipated guilt and depression by doing certain things which deny the loss. This response can be observed in parents whose child has died and who leave the bedroom untouched for a long period of time. Parents of servicemen killed in a war occasionally display such behaviour. It may be especially difficult for a parent to accept the loss of a child as the child has represented a central function in the life of the mother and father.
The following are components of grief which a person can journey through at one time or another. There are many different theories around stages of grief. Generally they can be itemised as follows:
- Shock
Numbness, apathy, abnormal calmness, mechanical responses - Denial
Particularly after a sudden death - Depression
Helps to cry - Guilt
Negligence, harm, self-blame, not loving or caring enough - Anxiety
Reality of loss, panic for future without the person - Anger / Aggression
Can be difficult to admit if the bereaved had a good relationship with deceased - Reintegration
Letting go, acceptance, moving on.
It is always insensitive to say to those who are bereaved 'you'll get over it in time'. If the loss is of someone close – partner, wife, husband, friend or child – they will never get over it no matter what support is in place. To say that 'life must go on' or 'come now it's been 6 months since the funeral…' should be avoided, as should any suggestion that the deceased person had a long enough life and had a 'good innings', or if they had continued to live they would have been in terrible pain. It is so difficult for any of us to fully understand someone's pain and sorrow as they hurt from a loss. It is so important that we treat the individual with compassion, empathy and a definite lack of judgement. In this way we prize the individual as just that, someone who is different from all others who needs their own time, however long, to be allowed to heal and ultimately to move forward to a different and changed place in the absence of their loved one.
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