In this first of two columns on grief, I discuss the inner and outer worlds of grief, factors that impact on how we experience grief, and how grief affects us. In my follow-up column next month, I will discuss strategies to manage grief, which can be used with clients or counselors who experienced a significant loss. Many of these coping strategies helped me before and after the loss of my wife of thirty years who died over ten years ago after a sixteen-month bout with cancer. In my follow-up column, I also discuss ways to help a loved one, friend or colleague who lost someone.
In one of the January editions of the Counselor Connection, Holly, a friend and colleague, a young mother of two daughters, shared her story of grief and mourning after the unexpected death of her husband. She described the impact of this loss on her emotional, social, family, and spiritual life. This insightful story conveyed her deep sadness and sorrow as well as the impact on her children of losing their father. Their lives changed in many ways, causing them to adjust to new realities of daily life. Most important, Holly shared what helps her manage grief and continue to grow as a mother and person. Her growth in the grief process was helped by the love and support of family, friends, and colleagues; her spiritual beliefs and connection to her Church; and participating in a grief group.
After losing my wife, I experienced a range of emotions and had to make adjustments in life so I have a personal perspective on the initial chaos such a loss can create, especially to a parent who also has to help their children deal with grief. I believe Holly has embraced and not avoided her suffering, accepts all of her feelings, appreciates the history and rituals shared during her husband’s life, uses the support of others wisely, and is doing the best she can to move forward in her life after losing her husband. She does an excellent job helping her daughters understand, accept, and adjust to being without their father.
Some of us experience “double grief,” in which we experience a range of emotions and experiences during a loved one’s terminal illness and movement towards death, especially if we are a major caretaker, as well as a loss after their actual death. Both are painful, as they should be when we love another person.
Grief can also be experienced from the following:
- Loss of a loved one through separation, divorce or other reason
- Incarceration, because many people with addictions or mental disorders are in jails or prisons
- Loss of a pet
- Loss of a job or career
- A significant decline in physical or mental functioning
- An unexpected change in status and economic stability
- Loss of potential associated with disabling mental or physical conditions
I know a man who went through a long and complicated divorce settlement with his ex-wife, creating incredible emotional distress and other problems. During our discussions on grief and loss, I remember telling him that the type of loss he experienced was more complicated and difficult to deal with in some ways compared to the finality of losing a loved one through death. While my columns on grief focus on the loss of a family member or other loved one through their death, many of the ideas I discuss can be applied to other losses.
Bereavement, Grief, Mourning, and Posttraumatic Growth
The term “bereavement” refers to the objective situation that involves significant loss through death; “grief” is the psychological, emotional, and physical reaction to this loss; and “mourning” is the public display of grief (Stroebe, Hansson, Schut, & Stroebe, 2008). “Post-traumatic growth” is process of finding meaning in loss and making positive psychological changes. Examples include an increase in inner or personal strength, self-awareness, spiritual growth, appreciation of family or others, or change in perspective on life following a significant loss of a loved one or exposure to a traumatic event (Davis, 2008; Seligman, 2011).
We differ in how we experience and manage our grief based on cultural, social, personal, and spiritual factors such as the following:
Predeath or Prebereavement Factors
These relate to what we did (or did not do) during the course of a loved one’s illness and death, or the frequency and quality of contact with them during their life. Feeling exhausted and having a breakdown during caretaking are associated with guilt after the death of a loved one, whereas positive views of caretaking and optimism are associated with greater relief after death and less depression (Schultz, Boerner, & Hebert, 2008).
Our Relationship with the Person We Lost
Reactions to the loss of a young child or lifelong spouse are likely to be different than that of loss of a family member with whom we did not feel close. More intimate relationships are more likely to be associated with stronger grief reactions. I was more connected to my mother throughout my life than my father, and thus had a stronger emotional reaction when she died. I know of situations in which adult children have chosen not to attend a parent’s funeral due to the accumulation of years of resentments and other negative emotions.
Whether Multiple Losses Occurred at the Same Time
We often hear on the news tragic stories in which multiple family members die in a house fire or auto accident. A colleague lost her six-year-old daughter and sixty-one-year-old mother at the same time when they were struck on a sidewalk by a car driven by a drunk driver. In my early months of grief, I recall her sharing her story of grief and loss, and the strength she experienced over time, which enabled her to show compassion to me.
How the Death Occurred
We lose loved ones in many expected and unexpected ways from acute and long-term illnesses, accidents, natural disasters, wars, suicides or homicides. With addiction, we lose loved ones through overdoses and medical conditions caused or worsened by addiction or poor health care habits. The lifespan of individuals dependent on alcohol or drugs is reduced significantly. Some of us lose loved ones with mental illness through suicide. While all of these produce grief, some may create a depth and intensity of emotion that is beyond description, such as cases involving young children, brutal murders, tragic accidents or losing a young son or daughter killed in combat.
Our Experience with Prior Losses
Not having worked through previous losses, even from many years ago, can affect how we deal with a current loss. In some cases, multiple losses can occur in a short period of time, intensifying the impact. A couple I know lost two of their five adult children in a two month period, one from a terminal illness that was anticipated, and one from a heart attack that was not expected.
Mental Health and Substance Use
Prior mental health conditions such as anxiety or depression increase the risk of depression or emotional strain following the loss of a loved one. If an active alcohol or drug use disorder exists, there is a risk of using substances to avoid or escape emotional pain.
Access to a Support Network
A supportive social network—family, friends, community—can have a positive impact on recovery from illness and issues like grief. The Twelve Step programs of recovery begin Step 1 with the word “we” to convey the importance of not trying to recover alone. Support from others can help us manage our grief. Lower support from family or friends during caretaking is linked to poor mental health including depression.
Coping Skills to Deal with Emotional Distress
Coping skills such as talking with others, sharing feelings of loss and personal anguish, engaging in family, social or religious activities with others, or using self-soothing strategies can help us better manage a specific period of distress. Some people are more resilient or better than others soothing themselves when feeling distressed.
Living with a loved one who died after we were closely connected on a daily basis may result in a different grief reaction than that of someone we saw infrequently due to living apart or psychological detachment. In some instances, there can be a significant financial impact from losing a source of income for the family, a lack of an insurance policy, will or estate plan for the deceased, or their failure to update these documents. Financial problems can contribute to frustration and resentment, and make it harder to work through grief. I am aware of several cases in which people who divorced or ended partnerships did not change beneficiaries on their insurance policies, retirement accounts, and other assets. This often left their families to deal with financial chaos.
Some deaths affect a large number of people. For example, over a year ago, one of our department’s young psychiatrists and her sister, a teacher, were both brutally murdered in the apartment they shared. Their parents, siblings, nephews and nieces, and many colleagues were shocked and devastated by this senseless murder of two vibrant, young, caring professionals. While their parents have a large family with five other children and many grandchildren, the loss of these two wonderful adult daughters left them with an intense level of sadness they are likely to experience for the rest of their lives. While they are living with their suffering as best they can, they feel an emptiness caused by these unexpected losses. Additionally, they cannot help but wonder why anyone would commit such an awful crime against innocent people.
The Inner World of Grief
Most of us work through our grief over time regardless of how we feel at first. Even those of us who felt we lost part of ourselves and had to search for meaning in our life after our loss eventually heal. Many of us eventually experience psychological or spiritual growth. Our initial reactions vary with our long-term reactions after we adjust to changes in our daily life and work through our grief.
Emotions experienced when we lose a loved one can include anxiety, anger, sadness, depression, loneliness, regret, emptiness or despair. In cases in which a loved one died after a long-term illness, we may also experience relief as well as guilt for feeling this way. Our emotions can be felt at any time with nothing triggering them. Or, they can be triggered by thoughts, memories, anniversaries or other occasions, or objects or experiences associated with them, such as clothes, jewelry, items they collected, things they enjoyed such as a TV show, music, a trip or place or something they liked to cook or eat. Some of us avoid our emotions or run away from our suffering, neither of which is good for our well-being. Embracing and living with suffering is an important part of living with our grief and healing over time. Unfortunately, well-intentioned family or friends often try to take us away from or push us through our suffering. They hate to see us hurt, even though this is a part of our healing process, so they do things to try to take it away. Their intentions are usually good, but these actions are not usually helpful.
In a small percentage of cases, complicated or traumatic grief is experienced after a significant loss, especially if the death was unexpected, sudden, and violent or by suicide. This type of grief may show in persistent or chronic feelings of depression, guilt, anger, bitterness or loneliness, trouble functioning in daily life, intrusive and upsetting memories or thoughts of the lost loved one, yearning for this person, trouble accepting their death, detachment from others, nightmares and even suicidal thoughts or wishes to die (“Coping with,” 2010).
There are also instances in which a person becomes fixated on seeking revenge or justice for the untimely death of a loved one from an accident caused by another person, medical malpractice, a drug overdose or murder. For example, a parent who lost a child from a drug overdose may direct their negative feelings towards the drug dealer who sold their child drugs or the doctor prescribing medications their child overdosed on. Organizations such as Mothers Against Drunk Driving (MADD) were started by those who lost children, and made a commitment to use their grief as a way to educate and support others, or work to change laws such as the legal limit for intoxication.
The Outer World of Grief
Our relationships and lifestyle may change in small or major ways after we lose a loved one. We may become the main caretaker, provider or mentor to our children after losing a spouse. We may take over the family budget, plan family events or vacations, shop for food and prepare meals, make sure the children get ready for school and do their homework, and get medical and dental care. Or, we may have to find a new place to live as result of lost salary of the spouse who died. Situations involving loss of income or little or no life insurance can contribute to financial pressures not experienced when the spouse was alive. After losing my wife, it took time for me to organize and attend to the tasks of raising children alone and running a household.
If we lose one parent, we may need to provide emotional, financial or practical help to the surviving parent. Some elderly parents and grandparents living in their homes do not drive or cannot drive due to medical or visual problems. They may need to be driven to medical appointments and to shop for food.
We may become closer or more distant to other family members after losing a parent or other loved one. After losing my wife, I became more connected to one of my brothers. We went from occasional contacts to meeting regularly for social or family events, which became important and helped me adjust to my new life.
Sometimes death brings out an ugly side of human nature and behavior such as family members squabbling over money, possessions or the estate of the member who died. Some families are torn apart from greed or different views on who should receive what from the estate.
Our relationships, social life, and ability to function at work can be affected by our grief. At times, school or work can provide us a temporary respite from our grief. At other times, we may be reminded of our loss as friends or colleagues ask about what happened, or how we (and our children if we are parents) are doing.
Living with and working through grief requires an acceptance of our loss and the impact of it on our daily lives. Working through our pain and adjusting to a new life can take time. There is no set time limit as each of us has to go at our own pace. In my follow-up column next month, I will discuss strategies to live with grief, many of which are adapted from Grief Journal: Living with the Loss of a Loved One, which a colleague and I wrote (Daley & Douaihy, 2013).
“Coping with Grief and Loss: A Guide to Healing.” (2010). Boston, MA: Harvard Health Publications.
Daley, D. C., & Douaihy, A. (2013). Grief journal: Living with the loss of a loved one. Murrysville, PA: Daley Publications.
Davis, C. G. (2008). Redefining goals and redefining self: A closer look at posttraumatic growth following loss. In M. S. Stroebe, R. O. Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 309–26). Washington, DC: American Psychological Association.
Schultz, R., Boerner, K., & Hebert, R. S. (2008). Caregiving and bereavement. In M. S. Stroebe, R. O. Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 265–85). Washington, DC: American Psychological Association.
Seligman, M. E. P. (2010). Flourish. New York, NY: Simon & Schuster.
Stroebe, M. S., Hansson, R. O., Schut, H., & Stroebe, W. (2008). Bereavement research: Contemporary perspectives. In M. S. Stroebe, R. O. Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 3–25). Washington, DC: American Psychological Association.