The Grieving Process
I am often asked the question about what is “normal” from clients who have experienced a loss. It is a natural question to wonder how your grief might compare to others’ grief, what constitutes “normal” grief, and what might indicate the need for help in the process.
Many have heard of the stages of grief in the Kübler-Ross (1969) model: denial, anger, bargaining, depression, and acceptance. Denial involves feelings of disbelief, shock, and blocking out the loss experience. Anger might be expressed toward others, including the individual lost, oneself, and the world, or even toward God or a Higher Power for those who are religious and spiritual. We might also try to bargain with ourselves, God or a Higher Power, or begin to question what could have prevented the loss. Depressive feelings might set in, such as sadness, mourning, loss of interest in activities, wanting to isolate, or questioning meaning. Acceptance is the final stage, in which we acknowledge and make peace with that loss. Other common feelings during a loss experience might include confusion, a sense of relief, or even a sense of awe and wonder about the world.
While many individuals do experience the thoughts and feelings associated with the stages in the Kübler-Ross (1969) model, they do not necessarily do so in that order, nor do they experience all of the stages. The grieving process is unique to each person, and there is not necessarily a standard way to grieve. In some cultures, people readily publicly declare and display their grief feelings. In others, there is a quiet solemnity, and a person is considered “strong” who does not publicly express feelings. How we grieve, and the stories we hear about grief and loss are affected by our past loss experiences, our family reactions to the loss, social learning, feedback from others in our community, our faith or spiritual beliefs, and other factors that make up our worldview (Zamore & Leutenberg, 2008). The way that we grieve might also be impacted by the type of loss we are experiencing and the circumstances surrounding that loss.
Types of Losses and Grief
Grief reactions are not only common when we lose a person through death, but also in a variety of other circumstances (Zamore & Leutenberg, 2008):
- Failed business ventures
- Financial security
- Mental Ability
- Physical Health
- Plans, hopes, and dreams
- Role in life
- Sense of safety/security
- Pregnancy loss
Sometimes grief can become “disenfranchised grief” which refers to experiences that may not be commonly acknowledged, socially accepted, or validated. Some examples might include the loss of a former spouse, miscarriage, inability to have children, not having met a person in your family who passed away, a prior estranged relationship with the deceased, or even losses associated with the stigma surrounding mental health (Zamore & Leutenberg, 2008). In these circumstances, the mourning process might feel different than ones in which greater public acceptance is normally given. Individuals experiencing these types of losses might feel more socially isolated in their grief, and again, question what is “normal” in the process.
So what is normal? How do we know when we might need some help in our grieving?
In answering this question, it may help to view your grieving process as a pathway to a “new normal” that can be constructed (Zamore & Leutenberg, 2008). That path may involve some “stuck points” that are difficult to overcome.
The loss experience can have a ripple effect such as feeling that a part of ourselves are lost, losses of self-confidence, losses of future hopes and dreams, and changes in our family structure and social relationships. Any combination of these losses might lead to a point in which we feel “stuck” in our grief, and unable to adapt and find a “new normal.” A loss of faith, spirituality, or sense of meaning can further complicate the process. If the loss was surrounded by trauma, this might also contribute to a “stuck point.”
When feelings of anger, sadness, numbness, and loss of meaning persist beyond a tolerable point and seem to be preventing you from enjoying a healthy and productive lifestyle, this is also an indication of a “stuck point.” Sometimes, these stuck points can lead to what is known as “complicated grief” and/or clinical depression. The latter is different from more typical grief processes in terms of the intensity and duration of these feelings, as well as ongoing anger/disbelief about the loss, a constant focus on the loss, and a constant and intense yearning for the lost one. Remember, we may always yearn for our lost loved one, but the inability to continue meaningful activity in our life, persistent feelings of depression in their absence, and experiencing little change in our initial grief reaction as time goes on are indicators of the need for clinical intervention.
Research also suggests that grief can look like depression in terms of sadness, tearfulness, appetite and sleep disturbances, and fatigue (Friedman, 2012). However, loss of self-esteem, feelings of worthlessness, and suicidal ideation are generally more associated with clinical depression (Friedman, 2012).
Okay, but just how long is all of this supposed to last?
That is a difficult question to answer, and one that has been debated. Generally, the symptoms of acute grief are lessened over time. How you are feeling one week after the loss will look different from 6 months after the loss when you are healing. While you may experience a return of more intense moments of grief even after a period of time has passed, these moments will reduce in intensity and frequency, and some positive feelings, a sense of hopefulness, and a sense of regulation in your mood and activity level will increase over time.
As you reach your “new normal,” you may find that the help of family, friends, and individual or group therapy can facilitate this process. While you may need some solitary time to heal and reflect, allowing for a balance of social time and meaningful engagement with others will give your mind and body time to heal and rejuvenate.
Some individuals find that developing healing or commemorating rituals helps them in the healing process. For example, rituals of affirmation might include giving yourself permission to grieve or even setting a time/place/date to allow for grief. Commemorating rituals might include visiting the burial site, looking through photos/videos or sharing mementos with family, creating a memento of your own, or spending time in quiet reflection on anniversaries that remind you of your loved one.
Remember that as you are healing, it is normal to feel a variety of emotions. Acknowledging and affirming what is happening within yourself is part of the journey. Realizing that your grief is unique can also help facilitate healing, as well as taking it “one day at a time.” Remember that self-care is important, and you may feel emotionally and physically drained. As with any time of stress in our lives, sleep, eating, and exercise habits make a difference. The four primary tasks of healing from a loss are accepting the loss, feeling the feelings, adjusting to your “new normal,” and moving forward (Zamore & Leutenberg, 2008). You can choose to move toward your grief and allow it at a pace that feels comfortable to you. This means that you can find a balance between accepting it as it unfolds, and also “shelving it” for awhile and engaging in distraction or self-soothing when it becomes overwhelming.
In moving toward healing, you may find the skill of radical acceptance (Linehan, 1993) to be helpful in the process. Radical acceptance is accepting what is, even if we don’t like it, even if we are suffering, even if it feels unfair. It involves a commitment to acceptance that you may need to make several times, and sometimes even just starting with a willingness toward acceptance. It is a radical feat, but not impossible, and support is available to you here at BWG to help you in your healing process.
Elena Zagarskas, Psy.D.
Post-doctoral Psychology Fellow