I get this asked often by my friends and clients. So let’s unpack this a bit and see if I can help make sense of what grief is, what it looks like, and dispel some myths that we have about grieving.
Part of what makes grief so difficult to understand is that grief is viewed as a taboo subject in our western culture along with sex and money. Because we are uncomfortable talking about death and grief, many of us are unfamiliar with it and don’t really understand what grief is and what to expect as a griever. Secondly, death and loss are common human experiences, this doesn’t mean that they happen frequently on an individual level. This means that we often don’t have a lot of experience with grieving. So when we do experience a death or loss, we don’t necessarily feel equipped to manage the intense and long-standing effects.
To help us understand the grief experience, let’s start with the basics by outlining some definitions.
Grief-related Definitions
Bereavement refers to the time period after the death of a person. Employers often offer "Bereavement Days" as part of the time-off days which also include vacation and personal days. Bereavement days are offered so that employees can arrange funerals, wakes, and other cultural customs that are observed after a death. Too often people equate bereavement time off from work as an expectation of how long people will actually be grieving.
Grief refers to the process of experiencing the psychological, physical, behavioral, and social, reactions to the experience of loss. So, grief is understood as the inward experience of intense feelings. Mourning is understood as the outward expression of those intense feelings. It’s the public displays or visible expression of the intense feelings as well as cultural customs associated with bereavement such as wearing black and attending funerals and sitting shiva.
We don’t just grieve over deaths. We also grieve over a variety of losses. Loss can be physical (as in a death), social (as in a divorce), or economic (as in job loss), to name a few. We can also experience loss when our expectation of something doesn’t match up to reality. Other examples of losses that are not death include loss of independence as a result of old age, loss of trust in another, loss of identity, and Ambiguous Loss. Ambiguous Loss is a non-death type of loss in which there is no “closure” and grievers are left without a clear understanding of the facts. Pauline Boss outlines in her book, Ambiguous Loss (2009) that there are two types of Ambiguous Loss. One type is when a person is psychologically present but physically absent. For example, an absent parent who is no longer physically with the family and there is no contact with the parent. That parent remains a part of the family in the psychological sense. The remaining family may have questions and unresolved feelings that are never able to address with the missing parent. The other type of Ambiguous Loss is when the person is physically present but psychologically absent. For example, a loved one with dementia or Alzheimer’s is no longer psychologically the same person they were before they lost their memory but they are physically still present and appear to be the same person. Another example is when a loved one is so involved in substance abuse that they are not the same person psychologically as they use to be even though they are still physically alive. Grievers of ambiguous loss are left to navigate the feelings of grief as the whole person (both physically and psychologically) is not present. Those living with a chronic illness or who have survived a life-changing illness or medical trauma often experience ambiguous loss. They often grieve for the life they had or the body that they had.
Grief work is the term used to describe the work that grievers are doing when grieving. Grief work is the active engagement and participation of the griever to adapt to the new reality without the deceased or with the loss.
Grief is often confused with Depression. Grief and depression share some commonalities but are distinctly different in some key areas. In grief, the most prevalent feeling is that of emptiness and loss while in Depression the most prevalent feelings are sadness and hopelessness coupled with the lack of interest in anything that might bring happiness. In grief, the focus tends to be on thoughts and memories of the deceased or what was lost. Those who are experiencing depression often feel worthless or self-critical. It's important for a griever to work with a therapist if they feel like they might be experiencing depression.
Why do we grieve?
Grief is the natural adaptive reaction to a loss. According to Attachment Theory, we develop significant bonds and react strongly if they are broken. This attachment is rooted in our need for safety, security, and belonging. When a loss occurs we experience a disruption in getting those needs met often leading us to question our ability to safely navigate our world, question who we are, what our role is now, and how to be in the world without the loved one. Therefore the purpose of grieving is to adapt to life without the person or loss, to make sense of our new world, and continue to move forward with living. For example, after a woman experiences a pregnancy loss, she may wonder if she is a mother, will others acknowledge her role as a mother, how does she talk about her loss, and who will support her.
How does one grieve?
You may have heard of the 5 Stages of Grief by Elizabeth Kubler Ross. This theory was popularized for its simplistic and linear way of understanding something complex and unique. It became so accessible and popular because it fostered a sense that grief would be predictable, follow a prescribed path, and understandable. The common thought is, “I just need to get through these 5 stages and I will be done grieving”. Unfortunately, Kubler Ross never met for the theory to be interpreted in the fashion that it was. She never intended for the 5 stages to be sequential or finite. She understood that grievers would move back and forth between the different feelings and may skip some altogether. She had a more nuanced understanding that was ignored. In addition, the 5 Stages of Grief does not provide a real framework to help understand why we grief or what the grief work looks like. These can better be understood through Worden’s Tasks of Grieving and Neimeyer’s work on Meaning Reconstruction. The current understanding of grief is that it is NOT a preset of stages or a linear process where you do the first task and then on to the next. As Bruce Feiler explains in his book, Life is in the Transitions (2020) life doesn't happen sequentially or linearly. Life is messy and doesn’t follow a script. The same is true for grief. Below are the tasks that Worden has laid out.
Four Tasks of Grieving
Accept the reality of the loss- Grievers often experience feelings of shock, disbelief, and denial that the loss has happened. A common refrain heard is "I can't believe she's gone." This is especially difficult for those experiencing an Ambiguous Loss.
Experience the pain of grief- Grievers typically experiencing a wide range of emotions after a loss. These include feelings of anger, loneliness, emptiness, insecurity, and even numbness. These emotions can last a lifetime but grievers often report that the intensity of the feelings lessens over time.
Adjust to life without the deceased- Neimeyer’s work on Meaning Reconstruction is centered around this task. Grievers often reconstruct a personal narrative that answers the question, “Who am I now?”. Worden explains that there are three types of readjustments that grievers often make. Internal (personal meaning-making) as well as external (taking on new or different roles) and spiritual (answering "Why" questions)
Connect to the deceased while re-investing in living- Grievers learn to develop an enduring connection with the deceased while moving forward with life.
What does Grief Look like?
Below are two visuals often used to describe what grief looks like. What both illustrations emphasize is that the intensity of the grief experience will lessen over time but can be continued to be triggered. For some, it can be helpful to see a visual of what to expect as a griever even if the experience and triggers are unique.
How Can Grief Be Expressed?
We often think that grief is only expressed through emotions such as sadness and by crying. However, just as each griever is a unique individual so will be their grief expressions.
Emotional and cognitive expressions- These are the thoughts and feelings we have. These are typical grief reactions when we think of grieving: crying, feelings of sadness, loneliness, emptiness, thoughts like “I can’t live without this person.”
Physical manifestations- Grief can also be felt in the body. Grievers might feel similar physical symptoms that their loved one did when they died. They might experience physical aches such as stomach aches, headaches, or feel physically fatigued.
Behavioral expressions- Grievers can become quick-tempered or easily tearful. Grievers may also engage in behaviors such as building or creating memorials such as a garden or scrapbook.
Social behaviors and societal reactions- Grievers may find solace by connecting with others and sharing their loss story and having their experience validated by others. They may want to share their story and provide support to others by working on a cause related to the loss.
What is Healthy Grief?
The current research outlines that grievers who oscillate between a loss-orientation and a restoration-orientation experience a better quality of life and can integrate their loss into their life thereby moving forward with living. This is called the Dual Process Model of Grief. Loss-oriented responses include those expressions that are connected with Worden’s 1st and 2nd Tasks of Grieving that I outlined above, accepting the reality of the loss and experiencing the pain of the grief. Restoration-oriented responses include learning new skills, taking on new roles, and looking towards the future. These correspond to Worden's 3rd and 4th Tasks of Grieving, Adjusting to life with the loss, and re-investing in the future.
Is there a right or wrong way to grieve?
You can probably answer this on your own. No, there is no right or wrong way to grieve. The grief experience and expression is unique for each person. Many factors impact how a person grieves including their temperament, resiliency, their faith or spirituality, and community and family support. Grievers make meaning of their loss in different ways. Each griever has their own way of grieving. There is no right or wrong way. Instead, we can think of thoughts, beliefs, and behaviors as helpful or unhelpful.
Why is grief so difficult?
Some deaths follow the common linear model of the natural life cycle. For example, when a grandparent lives a long life and dies of natural causes. However, this is often not the case. Life is messy, unpredictable, and complicated. The following are factors that can make grief more difficult:
1. How the person died or the type of loss
Stigmatized death/loss- These are deaths and losses in which others make negative judgments about such as suicide, homicide, or drug overdose
Ambiguous loss- These are losses in which a person hasn’t died but is either physically or psychologically absent such as an absent parent or a loved one with dementia
Non-death losses- These are losses that do not involve death such as a divorce, losing a job, change in functioning such as living with a chronic illness, life after cancer treatment, or living with a physical impairment following an accident
2. Quality of the relationship
Disenfranchised Grief- The relationship a person had with the deceased is often not recognized and therefore the grief is left invalidated by others. For example, healthcare providers experience of grief when their patients die or the grief experienced following a pregnancy loss.
Ambivalent relationship- If there was abuse or conflict in the relationship, grievers may experience both relief and sadness over the death or loss.
How long does grief last?
There is no timeframe. Some grievers experience a decrease in the severity of symptoms by 6 months, others can take up to 2 years before they experience some relief in symptoms. It’s understood that grief never really goes away. You can think of it as the edges get smoother and more manageable. Grievers can learn their grief triggers and patterns and develop coping skills to manage the waves or pangs of grief.
Do I have to grieve? Do I have a choice? What would happen if I didn’t grieve?
Grief is a natural reaction. If we intentionally try to shut off our grief, it will find a way to manifest itself in other ways. It doesn’t go away no matter how much we try to ignore it, avoid it, stuff it, or cover it up. We can't experience healing, hope, or happiness if we don't grieve. There are no short-cuts or cheats. It’s often said that we must go through, there is no going around. This means, that grievers will need to find ways to allow their grief space and time to be expressed.
How do I know if I need professional help?
Grieving is a normal experience and can be one of the most difficult experiences a person can go through. It can feel overwhelming, confusing, and disorienting. It can be very helpful to connect with others in a grief support group. Grief Support Groups are usually led by peers who have experienced a loss and have worked through their grief. Grief support groups usually have a goal of allowing group members to share their feelings in a safe space to reduce feelings of isolation and to normalize the grief experience. It's often quite comforting to know others who have experienced a similar kind of loss and that others have had similar thoughts, fears, and feelings. Grievers often find it helpful to talk with others who won't judge them or tell them what to do but rather to just listen.
However, sometimes grief is complicated. Perhaps the relationship the griever has with the deceased was highly conflictual or the death was particularly tragic or the loss is disenfranchised or ambiguous. These kinds of losses are often quite difficult to manage. If a griever feels stuck in some aspect of the grief work then it may be useful to work with a therapist who specializes in grief. In addition, if after a year after a death or loss, a griever continues to experience the following then they would benefit from professional help:
experiencing persistent and invasive thoughts of the loss that disrupt daily activities
avoiding or feeling consumed by reminders/memories of the loss
unable to accept the finality of the loss
experiencing intense yearning for what/who was lost
feeling angry about the loss, numb or confused
developing distrust in others or isolating from others
suffering from physical symptoms similar to that experienced in the deceased’s final illness
feeling that life is meaningless and hopeless without the loved one
How do I get help?
When looking for a grief counselor or grief therapist, look for a therapist that specializes in grief. Grievers require a therapist who is both trained in treatment approaches that have been proven to help grievers and have extensive experience working with grief. I have over 13 years of experience and am a Certified Grief Counseling Specialist. I provide individual grief counseling and group grief therapy. Call me today to schedule a free, 15-minute consultation to learn more about how I can help.