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January 9, 2015 at 8:39 AMComments: 0 Faves: 0

When Is Grieving Abnormal?

By Jeffrey VanWingen M.D. More Blogs by This Author

“The reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.”   -Elizabeth Kubler-Ross

It's difficult to put into words exactly what grieving is, but I have grieved and counseled those grieving and can best sum it up as an unpleasant individual journey in the wake of loss.

I hear things like, "I wake up every day feeling like I have been kicked in the gut," or "I am always wanting the one thing that I can't have," or "I just need to be alone with my pain."  The books tell us that grieving is a natural human process. As a physician and often as a friend, however, I can recognize the red flags that things are outside of these boundaries. 

In this blog, let's explore normal vs. abnormal grief in hopes that we humans may endure this process, capturing the potential for growth and addressing potentially destructive attributes. 

What The Books Say

In understanding the process of how we deal with loss, it is important to clarify the language that gets so loosely used around this topic.

The term "bereavement" is the situation itself, experiencing the death of someone close.

The term "grief" is our response to this loss. It is not simply the emotions experienced, but the whole response, physical and emotional. Grief, in a sense, is an involuntary product of the brain's response to a world that is altered so profoundly by a loved one's death. As they evolve, grief symptoms are considered adaptations to a person's process of loss.

Somewhere along the line, it was declared that this grief process typically takes a full year, though this seemingly finite "end product" has never been described.

Examining the grieving process in an individual is like looking at a cloud -  no two clouds are quite the same and even individual clouds change and evolve significantly over time. As such, leaving grief loosely defined as "a response" to loss suits the purpose to encompass what we might expect to observe.  

Still, as we experience grief and support those grieving it is important to recognize typical grief suitable for the typical grief platitude, "You are grieving; it just takes time."  And more importantly, it is essential that we identify the red flags that there might be something more to this response, something potentially harmful.

Healthful Grief

Grieving people are hurting people. In the realm of grief are a number of emotions that could be described as typical.

  • Sadness: Grieving people are obviously sad.
  • Isolation: Along with this sadness, strong emotions may be evoked or a person may feel more adaptive in withdrawing socially.
  • Anxiety: Feelings of anxiety are common, especially over the logistics of navigating life without their loved one.
  • Anger: Anger may also exist, toward the situation or even the deceased. 
  • Guilt: Guilt, shame and vulnerability often cloud a grieving person as they come to terms with the loss. Some of this guilt may surge as rays of happiness come back in during the process. 
  • Thinking About Your Own Death: It is not uncommon, especially during the acute grief phase that the grieving person longs to be with their loved one, bringing in thoughts of their own death.
  • Talking to The Deceased: Some people cope with their loss by talking to the deceased as they complete daily tasks once shared with the deceased or posing questions as they would prior to their loved one's passing. 

These emotions and responses are common and very reasonable in typical grieving.

Abnormal or Worrying Grief

The term for abnormal grieving is "complicated grief." Often this rests with clinical depression, known by professionals as major depression. 

Can Not Imagine Recovery or Happiness: Most all persons who are grieving maintain insight into their situation as the shock of acute grief resolves. They are able to see the light at the end of the tunnel so to speak, especially when outside the consideration of their loss. In complicated grief with significant depression, a person is unable to consider or anticipate happiness in a fashion that is consistent, aside from the expected "ups and downs." 

Unable to Smile or Joke: Typical grief most often shows a trend of improving mood over months whereas complicated grief shows consistent and pervasive depression of mood. In typical grieving, persons are able to express warmth, a smile or humor. Consistent inability to express these "respite emotions" should raise concern. 

Inconsolable: Grieving persons are able to receive consolation from people they care about. Further, their self esteem is preserved despite grief. A person who consistently is unable to be consoled or who exists in feelings of worthlessness or self-loathing should raise concern. 

Suicidal Thoughts: Finally, suicidal thoughts, beyond a fleeting lament, should be taken seriously, especially when combined with other features of complicated grief.

What Can You Do?

For someone who is grieving, there is nothing better than a good friend who will offer their time, their ear and their patience. This is especially true after the acute grief phase and after the flowers are gone and meals stop showing up.

I often make it a point to mark my calendar to give a call to those whom I know are grieving a few weeks after their loss. Consistent contact is even better. Sometimes this requires an effort, especially with those who "don't want to be a burden."

As a friend, stay tuned into the aspects of typical grief vs. complicated grief.  Be keen on the ability to laugh or smile at your prompting. If you suspect that complicated grief exists, have an honest conversation with your loved one and encourage them to seek help with a professional such as a grief counselor or their primary physician.

For more tips, please check out a blog I previously posted "Being There: The Seven Keys to Comforting a Friend." 

Grief is one of life's unpleasant attributes. Life yields death and when it is close to us, we are left to grieve. Grief is a unique, individual process. While most all accomplish this process in a healthy, albeit painful fashion, grief can become complicated. Identifying these abnormal features can help divert the process and prevent harm.

 Live, and live well.

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