Bereavement and Loss are a natural part of living. It is a universally experienced life event and one of lifes most challenging experiences. The loss of a loved one can result in what feels like intolerable psychological and physical reactions. Feelings of intense loss are common when we enter the painful grieving process.
Normally grief begins with an almost indescribable intensity that usually decreases over time as we draw upon our internal and external resources. Over time we begin to adjust and comprehend a life without the person who we have lost. The feelings from the loss begin to ease and although they are missed, we can gradually return to our life. Acute grief can take a foothold and becoming chronic, resulting in a condition known as Complicated Grief or Complicated Bereavement Disorder. Rather than processing and moving through the loss, the feelings remain or even get worse over time.
All symptoms of grief are normal when experienced directly after a loss no matter how upsetting they are. Grieving is natural and it is expected to be pervasive and intense. Feelings of deep grief are not a sign of emotional or psychological imbalances.
However, if symptoms persist and show little sign of improvement even if improvements are fleeting, it might be possible that a more persistent and complicated grief is present which requires professional support.
Signs of Complicated Grief:
• Intense emotional pain (sadness, guilt, denial, blame, anger, numbness, inability to feel positive emotions, feeling lost, unable to accept the death)
• Obsessive thoughts about the departed person expressed through speech and behaviour
• Intense feelings of loneliness or emptiness
• Feelings of hopelessness and despair about life in general
• Irritability and emotional dysregulation
• Excessive avoidance of reminders of the loss
• Lack of hygiene and attention to personal appearance
• Sleep problems (insomnia or sleeping at odd hours)
• Withdrawal from social interactions and activities previously enjoyed
• Inability to manage daily affairs (work, school, parental, financial)
• Behaviour that seems impulsive, reckless and potentially dangerous.
• Worsening of any pre-existing mental health conditions (PTSD, anxiety, depression, substance abuse, etc.)
• Talk of suicide or actual suicide attempts
These symptoms represent normal responses to grief within the first months of loss. It is only when these symptoms persist for six months or longer or they continue to get worse that complicated grief may have taken hold. Professional therapeutic support provides support towards resolution and acceptance. Psychotherapists can help those suffering to better manage their feelings so they can move forward with their life in a way that honours the memories of the ones they have lost.
Research on complex grief has outlined a number of specific factors that make one more vulnerable to developing complicated grief. Some of these factors include:
• Previous history of mental illness, especially depression or post-traumatic stress disorder (PTSD)
• The death was shocking, unexpected and premature, e.g. suicide, murder or car accident
• The death is seen as being preventable
• Experiencing more than one death in a short period of time as in the case of the Covid-19 pandemic
• A strong dependency on the person who died
• Nature of the relationship
• Witnessing the death or suffering alongside the deceased person if they died following a protracted illness
• Social circumstances and resources available following death
The recent COVID-19 pandemic has greatly impacted peoples ability to effectively grieve the loss of their loved ones during this time. An important part of bereavement is the rituals that help us process our loss. These rituals include preparing a funeral and the act of gathering with family and friends. The pandemic has limited the opportunities for death rituals that help people through this very difficult time
Social distancing and limitations on gathering, have left many people relatively or even entirely alone to process their loss. This might also have prevented being with the dying in their final days and hours. Denied the chance to say goodbye is a further tragedy and torture. Funerals are likely to have been smaller than expected, the usual rituals of grief, changed or unavailable altogether.
With the loss of our grieving rituals and social support networks that help us all transition through grief, it can be helpful to reach out for professional support if you or a loved one is suffering. Talking through your distress to someone who really listens can be comforting and offer relief from symptoms. Since grief is often experienced as uncomfortable and awkward in our culture there can be a feeling that we are not grieving properly or at the right speed. Perhaps returning to work, school or normal activities feels impossible. It can be hard to understand how those around us get on with their lives while grief leaves us feeling overwhelmed.
Whatever your experience, your distress is valid, and your loss is real. Therapy can help you process the loss and start to recover.
Eisma, M. C., Boelen, P. A., & Lenferink, L. (2020). Prolonged grief disorder following the Coronavirus
(COVID-19) pandemic. Psychiatry research,288, 113031.
Johns, L., Blackburn, P., & McAuliffe, D. (2020). COVID-19, Prolonged Grief Disorder and the role of social work. International Social Work, 63(5), 660-664.
Shear M. K. (2012). Grief and mourning gone awry: pathway and course of complicated grief. Dialogues in clinical neuroscience,14(2), 119-128.
Simon N. M. (2013). Treating complicated grief JAMA, 310(4), 416-423.