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The Nature of Grief

 

 "The deeper that sorrow carves into your being, the more joy you can contain. Is not the cup that holds your wine the very cup that was burned in the potter's oven?"
  
      -- Kahlil Gibran (1883-1931)
                                                      

This piece aims to look at some of the various models that help explain the different stages of grief and tasks of mourning a bereaved person may go through. It will also look at how therapy can facilitate the person who is bereaved move through and hopefully complete their process of mourning.

At this point, I also think it would be useful to offer an interpretation of the two terms that are often used interchangeably: grief and mourning. 

Grief is the collection of emotions felt after a loss. It includes denial, shock, pain, confusion, and isolation. These feelings help us process loss. Grief is normal after the death of a loved one. Mourning is the outward expression of grief. It is the process which occurs after a loss. Examples of mourning include visiting the gravesite of a loved one on special dates, keeping a journal or making a photo album of the deceased. All of these expressions are normal and it’s important to remember that mourning is a very personal expression of grief. There is no right or wrong way to do it and the process takes time.¹

In our hearts, we all know that death is a part of life. In fact, death gives meaning to our existence because it reminds us of how precious life is. All our lives we are living in relationship. We are forming strong bonds of caring, affection and love with other people. Because we depend on other people, because they do matter, they occupy a special place in our hearts. We are not solitary and the price we pay for this attachment is vulnerability; the greater potential for loss.

Losing someone we love is very painful. After a significant loss, we can experience all kinds of difficult and surprising emotions, such as shock, anger, and guilt.  Sometimes it may feel like the sadness will never let up. While these feelings can be frightening and overwhelming, they are normal reactions to loss. Accepting them as part of the grieving process and allowing yourself to feel what you feel is necessary for healing. Through the process of mourning we can gradually accept the loss. There may always be a sense of sadness when we think of the person we have loved and lost, but eventually it will be a different kind of sadness – a sadness without the intense pain, that allows us to engage and invest in life again.

There are various models that describe the mourning period.  Many describe mourning as a series of stages or phases.  Of these, the most well known is an adaptation of Elisabeth Kübler-Ross’ five stages of coping with dying.  She originally proposed that dying people go through stages of denial, anger, bargaining, depression, and acceptance.  Some writers took those same stages and proclaimed that they applied to mourning. 

Denial: “This can’t be happening to me.”

Kübler-Ross explains that this does not literally mean that we don’t know that our loved one has died. It means that we may come home and find it impossible to fathom that our loved one will never walk through the door again, or we will never hear their voice on the phone again. Even though we may say that we can’t believe our loved one is dead, it is only an initial way of our psyche of coping with something that is too much. To fully believe at this stage would be too much.

Anger: “Why is this happening? Who is to blame?”

Anger can present itself in many different ways. You can be angry at your loved one for leaving you, for not taking better care of him/her. You can be angry with yourself, that you didn’t see this coming or that you didn’t take better care of your loved one, angry that you couldn’t stop it happening, angry that you are now left behind to grieve alone. You can be angry with a God that could allow such a thing to happen to someone you love. Anger doesn’t have to be logical or valid. Kübler-Ross tells us that feeling our anger without judging it or trying to find meaning in it, will enable it to dissolve and subside so that the healing process can continue.

Bargaining: “Make this not happen, and in return I will ____.”

After a loss it is not unusual for some to try and bargain with God. It might be promising to devote your life to helping others if you could just wake up tomorrow, and have all this as a very bad dream. Bargaining can be a seen as a rest from the pain of loss. You may know that the bargaining won’t work, but it at least can give you momentarily relief from the reality of a life without your loved one. Eventually we move through this stage and the mind realises the reality that our loved one is gone and no amount of bargaining can bring them back.

Depression: “I’m too sad to do anything.”

Once it becomes clear that anger and bargaining are not going to reverse the loss, people may then sink into a depression stage where they confront the inevitability and reality of the loss and their own helplessness to change it. During this period, grieving people may cry, experience sleep or eating habit changes, or withdraw from other relationships and activities while they process the loss they have sustained. People may also blame themselves for having caused or in some way contributed to their loss, whether or not this is justified.

Acceptance: “It’s going to be ok – I’m going to be ok”

Finally, it is hoped that people enter a stage of acceptance, where they have processed their initial grief emotions, are able to accept that the loss has occurred and cannot be undone, and are once again able to plan for their futures and re-engage in daily life.²

Other key workers in the field of bereavement such as, John Bowlby and Colin Murray Parkes proposed descriptions of the various phases that a grieving or bereaved person may experience following a loss. Their four phases of grief, phases of bereavement or phases of mourning (Numbness, Yearning, Disorganisation and Despair and Reorganised Behaviour) are also one of the many models used by researchers to try and describe the grief response to a loss.³

Whilst recognising all the various stage and phase models, my personal favourite (other than Kübler-Ross) for understanding the mourning process and how to complete it is the concept of the “Tasks of Mourning” introduced to us by J. William Worden in his book Grief Counselling and Grief Therapy. Worden believes that by using the concept of “Tasks” or “Grief Work”, it has the advantage of characterising mourning as an active process requiring decision-making participation by the bereaved person, as opposed to a certain passivity suggested by phases or stages that a mourner just passes through.⁴

Worden’s Tasks are as follows:

  1. To Accept the Reality of the Loss – Coming full face with the reality that the person is dead and will not return is the first task that needs to be completed. This task requires not only an intellectual acceptance, but also an emotional one. Without accomplishing this, Worden suggests we will not be able to continue through the mourning process.
  2. To Work Through the Pain of Grief – Grief is painful, physically and emotionally. It is important to acknowledge and feel our pain and not deny or avoid its presence. To deny this pain may lead to some form of depression later on. It may also require therapy at a later stage to help complete this task.
  3. To Adjust to an Environment in Which the Deceased is Missing – This may require coming to terms with living alone, raising children, managing finances and developing new skills depending on the roles played by the      deceased. It may also require adjusting to a new sense of self, maybe gaining or retrieving back a new or lost sense of identity.
  4. To Emotionally Relocate the Deceased and Move On With Life – While the bereaved may never be compelled to totally give up on the relationship, the goal is to find an appropriate place in their emotional lives for the deceased. This requires a letting go of attachments so new relationships can begin to form.⁵

As Kübler-Ross explains to us that her phases are:

“.......tools to help us frame and identify what we may be feeling, but they are not stops on some linear timeline in grief. Not everyone goes through all of them or goes in a prescribed order”. 

 Worden also says “The tasks of mourning need not be worked on in a linear fashion, but can be revisited and reworked intermittently over time”. 

Worden then goes on to suggest, that when a counsellor is working with a bereaved person it is also important for them to understand what he calls the second part of the mourning process – the Mediators of Mourning. He stresses that it is necessary to consider these mediators when trying to understand an individual’s reaction to their loss:

1. Who the Person Was – Relationship between deceased and survivor.

2. The Nature of the Attachment – Strength/Security/Dependence/Conflict.

3. Mode of Death – Natural/Accidental/Sudden/Suicidal.

4. Historical Antecedents – How previous losses were grieved.

5. Personality Variables – Coping Style/Cognitive Style/Assumptive World/Age/Gender.

6. Social Variables - Support Availability/Social Roles/Religious and Ethnic Expectations.

7. Concurrent Stresses – Changes/Crisis that arise following a death.⁸

Lily Pincus in her book Death and the Family concurs with Worden when she says

“There are many factors which influence responses to bereavement, such as mode of death, timeliness, precious warning and preparation for bereavement, but the key factor seems to be the relationships, the interactions that existed between the surviving and the dead”.⁹

For some people therapy is necessary and can help a person complete the grieving process or tasks of mourning. Worden explains to us that the goal of grief therapy is somewhat different from the goal of grief counselling. Grief counselling helps facilitate the tasks of mourning in the recently bereaved in order that the bereavement process will come to a successful termination. In grief therapy the goal is to identify and resolve the conflicts of separation which preclude the completion of mourning tasks in persons whose grief is absent, delayed, excessive, or prolonged.¹⁰

Either way, the therapist can help by creating a safe place where Lily Pincus tells us, the first therapeutic task is to give sanction to mourning.¹¹ In other words, therapy needs to essentially give the client permission to grieve, permission that society in general does not often allow. The need to talk, to be listened to, to have their pain witnessed and held is part of the healing. It can also help reinforce that their loss really mattered.

When a climate of trust is in place, therapy can also help the bereaved person move through their process by:

  • Increasing awareness of the reality of the loss.                                                                  
  • Facilitate the feeling and expression of the pain of loss
  • Deal with emotions or lack of them stimulated by memories.
  • Resolve any “unfinished business”.  
  • Acknowledge the finality of the loss.
  • Deal with the fantasy of ending grieving.                                                                                    
  • Help to say a final goodbye.¹²

In conclusion, I think it is fair to reiterate, that there is no right or wrong way to grieve. How we experience and travel through our grief, is as unique to us as our fingerprint. The important thing to remember is that we must allow ourselves express our grief in order to start to heal and find a new beginning. The most profound and creative gift our grief can eventually offer us, is the reminder of our ability to love deeply.

Róisín Matthews February 2010

 

References

  1. http://dying.about.com/od/thegrievingprocess/a/griefprocess.htm
  2. Elisabeth Kübler-Ross, (2005) On Grief and Grieving, Simon & Schuster Inc.,   Chapter 1.
    1. Colin Murray Parkes, (1972) Bereavement: Studies in Grief in Adult Life, Tavistock Publications.

John Bowlby, (1961) Processes of Mourning. International Journal of Psychoanalytical Self Psychology; 42:317-339.

  1. J. William Worden, (2003) Grief Counselling and Grief Therapy, Brunner-Routledge, p26.
  2. Ibid, Chapter 2.
  3. Elisabeth Kübler-Ross, (2005) On Grief and Grieving, Simon & Schuster Inc., p7.
  4. J. William Worden, (2003) Grief Counselling and Grief Therapy, Brunner-Routledge, p37.
  5. Ibid, p38-45.
  6. Lily Pincus, (1997) Death and the Family - The Importance of Mourning, Faber and Faber Ltd, p24.
  7. J. William Worden, (2003) Grief Counselling and Grief Therapy, Brunner-Routledge, p51.
  8. Lily Pincus, (1997) Death and the Family - The Importance of Mourning, Faber and Faber Ltd, p254.
  9. Dublin Counselling and Therapy Centre, Bereavement & Grief 2, Training Handouts Year 2.

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