Grief, the universal reaction to loss, affects everyone. Death being inevitable, the loss of significant people in our lives is bound to occur. The grieving process, therefore, is both a normal and natural one. Although painful, it is a necessary process and the intense emotions that accompany grief are an unavoidable part of helping us heal.
Grief, though it may be universal, is different for everybody. While most people experience a range of recognisable reactions and emotions, no two people will be affected the same. Whereas some people endure a period of sorrow and numbness, others may experience guilt or anger. Whatever grief brings, everyone copes with these emotions in their own way. There is no ‘normal’ or ‘right’ way to grieve; no standard timeframe for the process; no correct order in which to experience feelings; and the intensity of feelings varies from person to person.
One approach to processing grief is the Kübler-Ross 5 Stages of Grief Model; the stages being denial, anger, bargaining, depression, and acceptance. This model was thought to be linear; that is, each stage had to be processed before moving on to the next. According to Kubler-Ross this was something of a misinterpretation of her theory, stating before her own death that she no longer believed them to be linear. Instead, grief is chaotic, the stages scrambled, and it is rarely straightforward.
We all grieve in our own way and in our own time, and people find different ways to express their grief. For some grieving may last months, for others years. Though grief may never disappear entirely, for most people the intensity of feeling subsides over time. However, while grief is a normal—albeit difficult—transition, for some people there is a more complicated reaction. For some individuals there is, even after a significant amount of time has passed, no improvement at all. In such cases, feelings of loss prove debilitating which – over the long-term – can be detrimental to both physical and psychological well-being. One term for this phenomena is ‘complicated grief’; that is, painful emotions so severe and long lasting that recovery seems impossible.
Though the causes of complicated grief are myriad, a typical underlying cause is that the individual – for whatever reason – is unable to process his or her feelings. Complications can arise from our immediate environment; for example, there may be children to look after, or a career to resume. While the practicalities of life must be attended to, in some cases they don’t afford us the time to grieve. The processing of emotion requires space and so the too-busy-life can prove an external obstacle. There can also be internal obstacles. Complicated grief can arise, for example, from overuse of drugs or alcohol which similarly impedes feeling, again delaying the natural process.
Another cause of complicated grief may lie in the nature of the relationship between the bereaved and the deceased. This can happen when an intensity of one feeling – say anger – acts as an obstacle to the working-through of other feelings. Other complications include not having a sufficient support network; when the individual experiences ‘survivor guilt’; if they have an insecure attachment style; and so on.
Is there a time limit on grief?
In certain traditions, mourning rituals were more clearly defined and heavily codified. The Catholic Church, for example, still officially distinguishes between three types of mourning; heavy, half, and light mourning. Each category lasts a certain duration, even including a prescription for the correct type and colour of clothing to be worn at each stage. According to this model, the time limit for mourning has shortened. Heavy mourning, for example, was reduced from one year to three months. The total mourning period was reduced, first from six to two years, and then reduced again, currently resting at one year; a reflection, perhaps, of the faster, more economically driven times we live in.
The medical model too has begun to prescribe time limits beyond which grief may be considered complicated. The psychiatric diagnostic manuals – the DSM-V and the ICD-11 – recently introduced categories for complicated grief. In 2013, the DSM introduced a diagnosis of Persistent Complex Bereavement Disorder; in 2018, the ICD introduced Prolonged Grief Disorder. The criteria for both can be found by clicking on the links.
One marked difference between the two is the time after which continuing grief is considered a disorder. The DSM states symptoms must persist beyond 12 months, while the ICD opts for a mere six months. Such diagnoses are necessary in those countries where a diagnostic code is required in order to be prescribed medication or to qualify for insurance, so, one could argue, from the perspective of this model, a time limit has to be set somewhere.
I make no claim for the primacy of either the Church or medical model, rather I use these examples to show the seeming arbitrariness of time limits on grief
A different approach:
A different approach comes from the Centre for Complicated Grief which categorizes the typical trajectory of grief as having two phases; acute and integrated.
Acute grief occurs in the early period after a loved one’s death and includes the intense feelings we often associate with grieving; sadness, guilt, anger, or numbness. Grief dominates the life of the bereaved person and activities are usually focused on doing or not doing things to try and deal with the loss. Also typical during this phase are insistent memories of the person who died, as thoughts about them are never far from our minds.
The second phase, integrated grief, is a form of grief in which thoughts, feelings and behaviours related to the loss are integrated into our ongoing functioning. There remains a place our life for grief, but it no longer dominates. This integrated phase is longer-lasting form of grief, wherein the loss is both acknowledged and holds an appropriate space our lives, but we are able to get on with other aspects of living.
According to the CGC model, if someone can’t work through these stages they may be suffering from complicated grief, which it defines as a persistent form of ‘intense grief in which maladaptive thoughts and dysfunctional behaviours are present along with continued yearning, longing and sadness and/or preoccupation with thoughts and memories of the person who died. Grief continues to dominate life and the future seems bleak and empty’.
Worden’s Four Tasks
How then do we get beyond complicated grief? Of course, this depends on individual circumstances and the route to integration will be different for everyone. However, there is one model that provides a useful general approach; William Worden’s Four Tasks of Mourning model from his book Grief Counselling and Grief Therapy.
Worden suggests there are four tasks to be accomplished in order for the grieving and mourning processes to be completed. The model is a flexible one and can be adapted to any individual’s situation. There is – grief not being linear – no specific order for completion, and it is possible to move backwards and forwards between the tasks. Nor does Worden posit a timeline for completion, going as far as acknowledging that it may be necessary to revisit specific tasks over the course of a lifetime.
Let’s take a look at each of the four tasks in detail.
Task 1: Accepting the reality of the loss
The first task – both simple and complex – involves coming to terms with the end of the person’s life. It is not uncommon, following a loss, to experience shock or disbelief and so – in an attempt to avoid the pain – we may pretend that the death hasn’t really happened. We might expect our loved one to walk through the door, or to be on the other end of the phone when it rings. The first and simplest ways of accepting the reality of the loss include going through the rituals of the funeral and mourning, or speaking and thinking about the person in the past tense.
On a more complex level, there is an acceptance of the reality of the significance of the loss. For example – though we may have begun to speak about someone in the past tense – we might downplay the significance of our relationship with that person, thereby denying the impact the loss is having. This task is not fully accomplished until we accept the depth of the relationship and confront the full impact of the loss.
Another common struggle with this task is around acceptance of the mechanism of the death. If the death seems somehow unfair; for example, whether the deceased lived a full life or died young could complicate this task. Similarly, a death by suicide, overdose, or other stigmatised death can – if we are unable to accept the reality of how the person died -also present challenges to accomplishing this task.
Guilt can also get in the way of this task’s completion. To some people ‘acceptance’ implies agreement or approval, to others the severing of ties with the past; beliefs which complicate the task. Acceptance, however, doesn’t have to mean either of these things; instead, it can mark the moment when we are ready to begin the journey of healing.
Task 2: Working through pain and grief
Grief brings up with many emotions; from sadness to loneliness, despair to emptiness, anger or guilt; blame or shame; and countless others. Emotional turmoil not being a one-size-fits-all model, Worden acknowledges that each loss means working through that range of emotions particular to the individual. The danger lies in disavowing our feelings, thereby avoiding them. This can occur for many reasons.
Perhaps the feelings are so intense they become intolerable, or maybe our lives have been such that we haven’t yet learned how to properly process our feelings. This danger can be exacerbated by society’s discomfort with the feelings that accompany grief, perhaps making us feel like we shouldn’t acknowledge difficult emotions. Denying – or being denied – our feelings in this way means this task goes unfinished.
Whatever emotions may be present, it is important to acknowledge, talk about, and understand them. We must be patient, allowing ourselves to experience all of these feelings in order to properly process them. We should, Worden states, express – rather than avoid – these emotions. Being open about them, we will be better able to work them through.
Task 3: Adjusting to the new environment
The third task involves adjusting to an altered environment, one from which the loved one is now gone. This task can mean different things to people depending on the relationship with the person who has died, as well as the roles impacted by the loss. This readjustment happens over an extended period of time and may require several different types of adjustment; internal, external, and spiritual.
For example, a widow or widower may need to learn a new array of skills; ranging from bill paying, cooking, or taking care of the home. This aspect of the task takes into account barriers to grief that are tangible and not just emotional: such as finances, companionship, or child care arrangements. There may be other external, environmental changes, such as living alone, or doing things alone. There may be internal changes; for example, the more difficult task of redefining our identity now that the other person is gone.
This task can also mean adjusting to a new spiritual environment, which may have been altered by the experience of death. Adjustments may occur as we grapple with existential questions about purpose and meaning without the other person in our life.
Task 4: Finding a connection with the deceased while moving forward with life
This last task can take a long time and be one of the most difficult to accomplish. This task includes finding an ongoing and appropriate emotional connection with the person who has died, that at the same time allows us to move on with life. Again this task can mean different things to different people, Worden lays out a general template for its completion. We must allow space for thoughts and memories of the deceased, while at the same time engaging in activities that are meaningful to us. This can include finding new activities that are enjoyable to us, or finding new relationships.
For Worden, not to accomplish this task is not to live. Life did not stop when the person died and it is important we continue to live our lives with a sense of purpose and meaning. Though the relationship with those we have lost will continue to evolve, they will always – through the emotional connection established – be invited to remain a part of our lives.
We can’t change the fact that our loved ones have died, but we do have a choice in how we respond to their death. Initially it seems appropriate to choose to stay wrapped up in sorrow which may be the strongest, most tangible connection we have to our loved one. By embracing the overwhelming pain we will eventually learn from it. Then, when we are ready, we can choose to find a new way forward in life whilst integrating the profound love we feel for our loved one. By maintaining an emotional connection with the past, grounding ourselves in the present, yet also keeping an eye on the future, we can begin to discover what matters most to us. By inviting more of this into our lives we can eventually find our way back to joy and happiness.
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