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“Relational loss, death, and mourning are all part of life and human relationships - however, to find the “right” words to support someone who is grieving is not easy. Sometimes people do not have words for what they feel - to find words and a balanced depression of feelings, including emotional pain, anger, resentment, appreciation, and love is part of the process” (Psych Lead, Lea M. Schäfer)
Dealing with grief and loss is a deeply personal and emotional experience. Losing someone or something meaningful can be greatly destabilizing, it may feel like everything is hopeless and will never be the same again. Grief is a natural response to a significant loss or negative change, typically associated with the death of a loved one, but can also be triggered by other types of losses, such as a breakup, job loss, or a major life transition. It is almost always a complex and painful process. Though grief is most often associated with sadness, it is not uncommon to experience a range of emotions including guilt, anger, denial, blame or even shame before memories fade or positive emotions start to return.
Coping with grief can be a drawn-out process, which has been referred to as ‘grief work’ by the psychiatrist and researcher Erich Lindemann (Lindemann, 1944).
However, it is important to acknowledge that first of all, everyone deals with grief in their own way, and that it is, initially, a natural and healthy reaction to an event that has thrown you off balance. To lose someone is hard.
Below you find the so-called “dimensions of grief”. This overview by Stroebe et al. (2007) gives you a better sense of how grief can affect you not only on an affective (your emotional state), cognitive (beliefs and thoughts), and behavioral level (affecting your actions) but also on a physiological-somatic, immunological and endocrine level (influencing the workings of your body), which may be less obvious.
The dimensions of grief
For a long time, it was thought that grief goes through pre-set phases, as first introduced in the Stage Model by Kübler-Ross in 1969. This model consists of five stages: denial, anger, bargaining, depression, and acceptance (Kübler-Ross, 1969). Kübler-Ross's model was ground-breaking in its time, as it highlighted the emotional and psychological experiences of individuals who were facing death or coping with the loss of a loved one. However, the model has been criticized by some experts for oversimplifying the grieving process and implying that grief wanes through a linear and predictable process.
Many experts today make use of the Task Model of grief work, developed by William Worden in 1991, as a more nuanced and flexible framework for understanding the grieving process. According to the Task Model there are four phases or "tasks of mourning" which one must complete in the grieving process (Worden, 2018). These tasks are:
1. Accepting the reality of the loss: This involves acknowledging the reality of the loss and coming to terms with the fact that the person or object is no longer around.
2. Experiencing the pain of grief: This involves experiencing and expressing the emotions associated with the loss, such as sadness, anger, and guilt.
3. Adjusting to the environment without the deceased or lost object: This involves adapting to a new reality and finding ways to live without the person or object that was lost.
4. Finding an enduring connection with the lost person or object while moving on: This involves finding ways to honor the memory of the lost person or object while also moving forward and creating a new life for oneself.
The Task Model allows for a more individualized and complex experience of grief, as it recognises that individuals may move through these tasks in different sequences, experience them differently, or most importantly revisit them at different times. Additionally, the Task Model underscores the idea that grieving is a process that takes time and effort, rather than a fixed set of stages that one must pass through passively. There is no such thing as the grieving process. Grief is a universal response to loss but is unique to every individual. It is a profoundly individual process.
The experience of grief is influenced by a complex interplay of situational (e.g., cause of loss), intrapersonal (e.g., personality, coping style), and interpersonal (e.g., social support, culture) factors (Stroebe et al., 2006). For example, the sudden and unexpected death of a loved one (situational factor) may result in a more complicated grief reaction compared to a death that was anticipated (Stroebe et al., 2007). Intrapersonal factors such as high self-esteem or a secure attachment style in relationships to others have shown to promote resilience and lower the risk for prolonged adverse health outcomes (Stroebe et al., 2007). Furthermore, culture plays an important factor in what grief looks like - different cultures have unique beliefs, values, and rituals surrounding death and mourning, which can impact the way individuals cope with loss or the length and intensity of the grieving process. Some cultures may encourage stoicism and discourage overt displays of emotion, while others may promote more expressive and communal forms of grieving. For example, traditional Navajo Indians show limited mourning, whereas the Japanese typically engage in excessive mourning and remembering (Stroebe & Schut, 1998).
When an individual experiences intense, prolonged, and debilitating grief that does not lessen with time, exceeds 6 months and interferes with daily functioning, social relationships, and overall well-being, we talk about so-called ‘prolonged grief disorder’. It includes symptoms of a persistent sense of disbelief or denial, intense longing or yearning for the deceased, intense feelings of guilt or self-blame, difficulty accepting the reality of the loss, and a sense of emptiness or meaninglessness - with symptoms clearly exceeding expected social, cultural, or religious norms of one’s culture and context (American Psychiatric Association, 2013). A closer look at this diagnosis furthermore underlines how culture and society shapes one’s grieving process and what may be understood to be “normal” grief. If grief becomes overwhelming or persistent, it is essential to seek professional help.
Experiencing loss is an inevitable part of the human experience, and it is important to remember that grief is a natural and normal response to loss. While there is no one-size-fits-all approach to grieving, it is possible to find hope and resilience in the face of loss. Every individual's experience of grief is unique, filled with bumps and potholes, and shaped by personal, cultural, and social factors. It is important to recognise that there is no set pattern of specific reactions in adapting to loss and that every model of grieving is a simplification. However, it is also important to acknowledge that most individuals who experience grief eventually find a way to overcome the loss and see value in life despite their loss. It is even conceivable that a person will see more rather than less meaning in life as he or she comes to view the lost object as having given their lives a particular value. For those who are struggling with overwhelming or persistent grief, seeking professional help can provide valuable support and resources. Ultimately, while the experience of grief can be difficult and painful, it is possible to find new meaning and purpose in life after loss and to build resilience in the face of adversity.
Sources:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
Kubler-Ross, E., & Kbler-Ross, E. (1969). On death and dying (Vol. 1). New York: Macmillan.
Lindemann, E. (1944). Symptomatology and management of acute grief. American journal of psychiatry, 101(2), 141-148.
Stroebe, M. S., Folkman, S., Hansson, R. O., & Schut, H. (2006). The prediction of bereavement outcome: Development of an integrative risk factor framework. Social science & medicine, 63(9), 2440-2451.
Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), 1960-1973 (Dimensions of Grief. Figure 1).
Stroebe, M., & Schut, H. (1998). Culture and grief. Bereavement care, 17(1), 7-11.
Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), 1960-1973.
Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner. springer publishing Company.
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