What is grief?
Grief can be used to describe the emotional, cognitive, functional, and behavioural responses to death or loss. There are different types of grief and it’s important to note that grief is different for every person, and can even vary for each person in response to different losses in their lives. It’s important to remind ourselves that grief is the universal, instinctual, and adaptive reaction to the loss of a loved one, meaning that it is generally a normative response and typically not a mental health condition.
Different types of grief include:
Uncomplicated Grief
It’s important that we recognize that grief is not a fixed state of being but rather a process that typically comes in waves of varying intensity of painful emotions. For most people, grief is never fully completed but rather the acute symptoms earlier on such as intense sadness and crying, preoccupation with thoughts and memories of the deceased person, difficulty concentrating, and relative disinterest in daily life begin to ease in frequency, intensity, and severity so that we can once again enjoy and seek pleasure in our everyday activities. A feature of uncomplicated grief is that the process isn’t only about pain but that there are also glimmers of positive feelings, such as relief, joy, peace, and happiness that emerge at times during the process allowing for the grief to integrate into our lives in a way that we can function again over time. Even though the grief has been integrated, this does not mean that we forget the people we lost, no longer feel sad nor miss their presence in our lives. Instead, the loss becomes integrated into autobiographical memory and the grief is no longer preoccupying or disabling. However, there may be periods when the acute symptoms of grief return such as holidays, birthdays, or anniversaries.
Complicated Grief
Acute grief, which is the initial painful response, and integrated grief, which is the ongoing adaptation to the death or loss are par for the course in uncomplicated grief as we have discussed above. Complicated grief however, which is sometimes also identified as prolonged, unresolved, or traumatic grief, often occurs when the above transformation to possibility and joy again doesn’t or can’t occur. Complicated grief is a bereavement reaction in which acute grief is prolonged, the pain of the loss stays fresh and there is sustained difficulty with making meaning again to life after loss. The bereaved person may describe it as feeling “stuck” as time moves forward but the intense grief remains. Symptoms include recurrent and intense pangs of grief, a preoccupation with the person who died, avoidance of reminders of the loss, a sense of disbelief regarding the death, intrusive thoughts related to the death and difficulty accepting the death. Complicated grief can have a significant impact and disruption to the person’s everyday life with impairment to daily routine and sleep disturbances being reported. People with complicated grief have a higher likelihood of also having major depression or post-traumatic stress disorder. It is strongly advised to seek clinical treatment from a mental health professional to support with suspected complicated grief.
Anticipatory grief
Anticipatory grief is the process associated with grieving the loss of loved ones in advance of their inevitable death. This type of grief is often found amongst people who have a loved one diagnosed with a terminal illness or when the person themselves is faced with a life limiting diagnosis that will likely lead to loss for them personally. While anticipatory grief can involve many of the similar symptoms of the grief experienced after the death of a loved one it does not replace the grief that occurs in the wake of bereavement. Symptoms of anticipatory grief can look like sadness, irritability, guilt, anxiety, and visualizations of the impending death or loss.
Disenfranchised grief
Disenfranchised grief can be defined as a loss that is not openly acknowledged or a mourning process not recognized socially after a loss. One can also self-disenfranchise as suppressing and not allowing oneself to grieve resulting in inhibited grief or absent grief. People who experience disenfranchised grief may experience many of the typical symptoms of grief such as feelings of sadness, despair, anger, and guilt, as well as physical symptoms such as difficulty sleeping and changes in appetite. These symptoms can be exacerbated when a person’s grief is not recognized by others and they don’t receive social support or have the systems in place to aide them. Circumstances that may go unrecognized that can lead to disenfranchised grief include a relationship breakup, a friendship breakdown, loss of a job, estrangement from a loved one, incarceration of a loved one, pregnancy loss, infertility, loss of a pet, loss of mobility or health to name a few.
What can support me to cope with the different types of grief?
Coping with grief, and different types of grief, is not a one size fits all approach, but below are some ideas of what can be helpful:
- Talk about your loss and feelings, try to not isolate yourself and reach out to those in your support network, whether they are informal supports like family, friends, spiritual leaders or formal supports like the GP, a bereavement support group, or a mental health professional.
- Get back to a routine and everyday activities when you can. Loss can have a ripple affect across our everyday routines and anxiety is likely to thrive in this loss of structure. Be patient with yourself if you have difficult days but trying to keep some sense of familiarity can be a helpful touch stone to ground yourself in each day.
- Ask others to be with you when you need support and accept practical and emotional help when they are offered.
- Find ways to keep a connection to the person who has died. This is unique to each person but things like photographs, telling stories, listening to their favourite music or visiting where they have been laid to rest can help.
- Remember that grief ebbs and flows and that certain life cycle events can bring a resurgence of grief so it can be useful to plan for important dates such as anniversaries, birthdays, and holidays.
Written by: Melissa Kearney, MSc Systemic Psychotherapy, Reg FTAI & ICP
References:
- Burke LA, Clark KA, Ali KS, Gibson BW, Smigelsky MA, Neimeyer RA. (2015). Risk Factors for Anticipatory Grief in Family Members of Terminally Ill Veterans Receiving Palliative Care Services. J Soc Work End Life Palliative Care, 11(3-4), pp. 244-66.
- Doka, K. (1987). Silent sorrow: Grief and the loss of significant others. Death Studies, 11, pp.455-69.
- Monk TH, Houck PR, Shear MK. (2006). The daily life of complicated grief patients – what gets missed, what gets added? Death Studies, 30, pp.77–85.
- Shear, K. (2012). Grief and mourning gone awry: pathway and course of complicated grief. Dialogues in Clinical Neurosciences, 14(2), pp. 119-128.
- Zisook, S., & Shear, K. (2009). Grief and bereavement: What psychiatrists need to know. World Psychiatry, 8(2), pp. 67-74.