Grief

Understanding Grief

Grief is a multifaceted response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to that loss.

The Nature of Grief

Grief is a natural response to loss. It's the emotional suffering one feels when something or someone the individual loves is taken away. Often, the pain of loss can feel overwhelming. One may experience all kinds of difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt physical health, making it difficult to sleep, eat, or even think straight. These are normal reactions to significant loss. But while there is no right or wrong way to grieve, there are healthy ways to cope with the pain that, in time, can ease the sadness and help one to come to terms with loss, find new meaning, and move on with life.

Stages of Grief

The Kübler-Ross model, commonly known as the five stages of grief, is a theory first introduced by Swiss psychiatrist Elisabeth Kübler-Ross in her 1969 book, "On Death and Dying". The stages, popularly known by the acronym DABDA, include: Denial, Anger, Bargaining, Depression and Acceptance.

Denial

Denial is the first of the five stages of grief. It helps us to survive the loss. In this stage, the world becomes meaningless and overwhelming. Life makes no sense. We are in a state of shock and denial. We go numb. We wonder how we can go on, if we can go on, why we should go on. We try to find a way to simply get through each day. Denial and shock help us to cope and make survival possible. Denial helps us to pace our feelings of grief. There is a grace in denial. It is nature’s way of letting in only as much as we can handle.

Anger

Anger is a necessary stage of the healing process. Be willing to feel your anger, even though it may seem endless. The more you truly feel it, the more it will begin to dissipate and the more you will heal. There are many other emotions under the anger and you will get to them in time, but anger is the emotion we are most used to managing. The truth is that anger has no limits. It can extend not only to your friends, the doctors, your family, yourself and your loved one who died, but also to God. You may ask, “Where is God in this?"

Bargaining

Before a loss, it seems like you will do anything if only your loved one would be spared. “Please God, ” you bargain, “I will never be angry at my wife again if you’ll just let her live.” After a loss, bargaining may take the form of a temporary truce. “What if I devote the rest of my life to helping others. Then can I wake up and realize this has all been a bad dream?” We become lost in a maze of “If only…” or “What if…” statements. We want life returned to what it was. We want our loved one restored. We want to go back in time: find the tumor sooner, recognize the illness more quickly, stop the accident from happening…if only, if only, if only. Guilt is often bargaining’s companion. The “if onlys” cause us to find fault in ourselves and what we “think” we could have done differently. We may even bargain with the pain. We will do anything not to feel the pain of this loss. We remain in the past, trying to negotiate our way out of the hurt.

Depression

After bargaining, our attention moves squarely into the present. Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever. It’s important to understand that this depression is not a sign of mental illness. It is the appropriate response to a great loss. We withdraw from life, left in a fog of intense sadness, wondering, perhaps, if there is any point in going on alone. Why go on at all? Depression after a loss is too often seen as unnatural: a state to be fixed, something to snap out of. The first question to ask yourself is whether or not the situation you’re in is actually depressing. The loss of a loved one is a very depressing situation, and depression is a normal and appropriate response. To not experience depression after a loved one dies would be unusual. When a loss fully settles in your soul, the realization that your loved one didn’t get better this time and is not coming back is understandably depressing. If grief is a process of healing, then depression is one of the many necessary steps along the way.

Acceptance

Acceptance is often confused with the notion of being “all right” or “OK” with what has happened. This is not the case. Most people don’t ever feel OK or all right about the loss of a loved one. This stage is about accepting the reality that our loved one is physically gone and recognizing that this new reality is the permanent reality. We will never like this reality or make it OK, but eventually we accept it. We learn to live with it. It is the new norm with which we must learn to live. We must try to live now in a world where our loved one is missing. In resisting this new norm, at first many people want to maintain life as it was before a loved one died. In time, through bits and pieces of acceptance, however, we see that we cannot maintain the past intact. It has been forever changed and we must readjust. We must learn to reorganize roles, re-assign them to others or take them on ourselves. Finding acceptance may be just having more good days than bad ones. As we begin to live again and enjoy our life, we often feel that in doing so, we are betraying our loved one. We can never replace what has been lost, but we can make new connections, new meaningful relationships, new inter-dependencies. Instead of denying our feelings, we listen to our needs; we move, we change, we grow, we evolve. We may start to reach out to others and become involved in their lives. We invest in our friendships and in our relationship with ourselves. We begin to live again, but we cannot do so until we have given grief its time.

Grief and Culture

Cultural responses to grief can vary widely. In many cultures, grief is expressed through rituals. These rituals can serve to acknowledge the loss, support the bereaved, promote community cohesion, and ensure continuity of traditional beliefs and values. Rituals can also provide a sense of control over uncontrollable circumstances and enable people to make sense of loss within their cultural belief system. In some cultures, grief is expressed through physical or somatic symptoms, rather than through verbal expression of feelings or emotions.

Grief and Religion

Religion can also play a significant role in how a person grieves. Many religions have rituals for mourning which can provide a way to express grief and find comfort. For example, in Judaism, the practice of sitting Shiva provides a structure for the bereaved to receive visitors and express their grief. In Christianity, funerals and memorial services provide an opportunity for the expression of grief and support from the community. In Islam, the practice of mourning includes specific prayers and readings from the Quran. These religious practices can provide a framework for understanding and dealing with loss.

Grief Counseling

Grief counseling is a form of psychotherapy that aims to help individuals cope with grief and mourning following the death of loved ones, or with major life changes that trigger feelings of grief (e.g., divorce, or job loss). Grief counselors believe that everyone experiences and expresses grief in their own way, often shaped by culture. They believe that it is not uncommon for a person to withdraw from their friends and family and feel helpless; some might be angry and want to take action. Some may even experience severe depression. Grief counselors know that patients can use counseling to attempt to make a healthy adaptation to loss.