Grief, Loss, & Bereavement

Overview of Grief, Loss, & Bereavement: Grief, a deep feeling of sadness over a loss, is one of the most difficult experiences a person can have. During the grief process, we may feel hopeless, out of control, dead inside, empty, pained, afraid, angry, or just about any other painful emotion one can name.

Just about everyone experiences grief at least a few times in life. The only way to avoid grief is not to care about anyone or anything, or to bury one’s feelings with drugs or other distractions when a loved one leaves or dies, when we have a serious medical condition, when we lose a job or other opportunity, when we fail, or, for whatever, when we are missing something we need or want very badly. We can feel and deal with the grief, or we can choose to avoid it by many means. Yet even then, grief sticks around, showing up as depression, anger, anxiety, fatigue, or even physical illness.

In other words, there really is no around grief – but there is a way through it. While avoiding grief will only prolong and worsen suffering, facing it, with the help of friends, family, and, if necessary, a support group and/or therapist, often turns out to be a healing, enlightening experience – even though it will never, of course, be a fun one.

The Medical Model and Grief, Loss, & Bereavement: Everyone deals with grief differently. Many people are familiar with the 5 stages of grief identified by Elisabeth Kübler-Ross in 1969. The stages are:

• Denial – Refusing to accept the reality of the situation

• Anger – Blaming people, or God, or oneself for the loss.

• Bargaining – Trying to make deals with God or other people in an irrational attempt to change what cannot be changed

• Depression – Giving up hope of happiness, and being unable to focus on anything but despair over the loss

• Acceptance – the ability to feel sadness while continuing to live one’s life and, slowly, feeling at peace about the loss

Another very apt model was developed by Roberta Temes. She identified three stages of grieving:

• Numbness (mechanical functioning and social insulation)

• Disorganization (intensely painful feelings of loss)

• Reorganization (re-entry into a more 'normal' social life)

It is important to know that these stages may not occur in the order listed above, and that some may not occur at all for a certain person at a certain time. What the list tells us is that different feelings and stages of grief are typical for human beings dealing with loss; whatever you feel, whenever you feel it, it is probably fairly normal and not a cause for additional concern.

So when is grief abnormal, and a cause for concern? When it lasts more than a few months, and when it interferes with work, school, or relationships in a significant way.

Diagnostic and Statistical Manual of Mental Disorders (DSM): The DSM identifies “complicated bereavement” as a diagnosis, as well as certain adjustment disorders as a possible manifestation of grief. Depression itself may also stem from an extended grieving process.

Case Examples of Grief, Loss, & Bereavement:

Rhonda, 57, had a sudden breakdown, stopped working, became anxious and depressed, and sought therapy. A full history revealed she had been the sole caretaker for her sister, who had been ill for years and required near fulltime assistance. During the time of the illness, Rhonda’s parents had both died of natural causes. Rhonda realized she never had time or emotional energy to mourn her parents’ death, and in fact resented her sister, who had died a year previously, and not mourned her death either, for which she felt terribly guilty. She had also been so caught up in her family duties, she had had little time to develop other pursuits. Allowing herself to face the great feelings of sadness and loss slowly dissolved her anxiety, and after a time of rest to fully grieve, Rhonda could return to work and, with the support of a therapist and a close friend, begin to build a full life.

Nancy, 25, is extremely depressed and angry after her brother dies in an accident. She blames him, her parents, the college her brother attended, and sometimes, herself. She cannot seem to imagine what life will be like without him. Even thought they didn’t always get along, she loved him and always imagined they’d be closer as they grew older. His presence in her life comforted her more than she knew. Now, she felt completely lost. In therapy, Nancy was able to process thoughts and feelings about her brother and her family that she’d never been aware of. Her therapist helped her clarify her beliefs about death, family, love, change. Nancy was able to identify all the qualities she loved in her brother, and ways she might honor those traits in her own life. She began to see her brother in herself and in her parents, and was able to work towards some kind of acceptance.

Therapy for Grief, Loss, & Bereavement: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of grief and loss. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for grief and loss or any other issue, it is helpful to familiarize oneself with these elements.

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Grief, Loss, & Bereavement Article Summaries