Articles: Grief Process

On Grief

Loss is a universal experience. From the moment of birth and at each step along life’s journey, we experience the concrete losses of people, places and objects we come to cherish. But equally significant, albeit more immaterial, we experience loss as we surrender our youth, our hopes, our dreams or ideals, and as we confront life’s hard realities. 

Even though we rarely stop to consider it, life eventually requires us to relinquish every human relationship we hold dear, whether as a result of growing apart, moving away or as a consequence of the death of the other person or of ourselves. 

All change involves loss just as all losses require change.

Bereavement is a choiceless event. Few if any individuals would choose to lose those they love, just as few persons suffering other forms of major loss would invite what the fates have dealt them.  Grief after any loss is always an unwelcome experience. In this sense at least, we are victimized by loss, the unwilling survivors of tragedy or misfortune which we would have gladly avoided had we been given a clear choice.

But are we really victims after a loss? Sadly some traditional understandings of grieving have perpetuated this myth.  Some theories of the emotional aftermath of loss depict bereaved individuals as essentially passive. They must go through certain stages or some system of grief process in which they are essentially passive, over which they have little or no control, and over which is no choice. 

Admittedly, on one level this is true.  In most cases we did not have a choice over this loss, because if we HAD, we would have done something to change the outcome. We did not choose this, it is not what we wanted and we don’t like it. But we find ourselves unable to change what has happened, as much as we might like to.

 

According to many grief process systems, the person suffering a loss simply seems to have to wait, to “see it through” on the assumption that “time heals all wounds”. But I suggest the grief process involves many choices, with various possible options to approach or indeed to avoid. 

 

The key to understanding bereavement is the task of relearning that one’s world that has been changed forever by the loss.

A common denominator of most traditional theories of grief is the identification of a series of stages or phases of adjustment, beginning with the actual or imminent death of a loved one and progressing through various forms of emotional reaction until the bereaved individual achieves some form of recovery, reconciliation or some similar concept.

Stage models of the phenomenology of mourning can be traced to the work of Eric Lindemann who subdivided grief into the stages of shock-disbelief, acute mourning, and resolution. Perhaps the most influential of these theories is that of Elizabeth Kubler Ross, who focused on the emotional transition of 5 stages,  beginning with denial and progressing through anger, bargaining and depression before eventually coming to possible acceptance.  Most subsequent stage models of bereavement have drawn upon some combination of these two theories, which, in general assume avoidance, confrontation and reorganization as the main components.

Admittedly, simple “step-by-step” models are appealing for their clarity, a factor that has contributed to their widespread appeal among both professionals and laypeople striving to understand the complexities of loss.

However, grief is never that simple.  I have come to see that the bereaved do NOT passively negotiate a train of psychological transitions forced upon them by external events.  Following a loss, most people do not follow a predictable pattern or demonstrate the proposed stages, or even experience them in an identifiable sequence.  The sequence of responses and duration of emotional reactions to loss vary greatly between individuals and situations. Grief is unique to each individual person and specific situation.

I am starting to question whether the person’s emotional responses should be considered the primary focus of grief theory, or whether we should consider these as behaviors pointing to a search for meaning and other cognitive reactions. In other words instead of focusing on the reactions of grieving people and quantifying that, we need to ask the “Why” of these reactions and understand the meaning of the loss to that individual which they are “expressing” through their emotions and behaviors.

Several criteria seem to validate this conclusion:

 

  1. The reality of death or the loss is personal and unique for different individuals
  2. People need to be perceived as active in facing life challenges rather than being passive reactors to them.
  3. Any theory of mourning must encourage the elucidation of the personal meanings of loss, without subtly suggesting what constitutes “normal” grieving.
  4. Any theory should describe how one’s world is forever transformed by loss rather than suggesting a return to some pre-existing established state following “recovery” from the loss.

In other words, any good model of grief should not simply be reduced to a reestablishment of pre-loss patterns. Because life will never be the same again! That does not mean it cannot be good. It simply says that life has changed.

Every human being constructs a unique world of meaning.  We all make assumptions about how life is going to be in the course of daily living.  We are sustained by the network of explanations, expectations and enactments that shape our lives with others. 

These assumptions provide us with a basic sense of order regarding our past, familiarity regarding our current relationships and predictability regarding our future. Some experiences of loss fit our assumptions of the world’s expectations (such as in the appropriate death of an elderly relative after a life well lived, or the heroic death of a warrior who martyrs himself for cause we passionately support.

But some of our experiences invalidate these constructions or may stand as a novel experience for which we have no interpretation (for example, the suicide of a loved one, the chronic suffering and death of a young spouse, or the tragic death of a child due to the carelessness of a drunk driver.) 

These situations can challenge the adequacy of our most cherished beliefs and “taken for granted” ways of living.  It would not be unusual to hear someone in such a situation say. “I will never recover from this”, and indeed it is true, life as they have known it will never return to normal again. 

What this person has to do is to integrate the experience, and adopt new assumptions about their world.

Grief is a personal process that is inextricably connected to our sense of “who we are”.  Our personalities and dispositions are determined neither by our genes nor our environment, but by our own investment in those persons, projects and possessions to which we are bound by bonds of caring attachment.

We organize our identities and sense of self by building personal theories or interpretations of the experiences with which life confronts us.  When an event shakes our world and our sense of self we respond by trying to interpret the event in ways consistent with traditional theories and identities.  When these attempts fail and our most basic sense of self is assaulted, we lose our secure grip on familiar reality and are forced to reestablish another identity.

The implication of this for caregivers is that we need to recognize the more idiosyncratic meanings of loss, which will take us beyond hackneyed expressions of support or preconceived ideas of what a particular loss “feels like” to any given griever.  The particularity of loss prompts us to listen intently for clues as to the unique significance of the bereavement experience of each individual.  Counselors need to appreciate more deeply the extent to which losses can occasion profound shifts in the person’s sense of who they are. Thus grieving entails not only a process of re-learning a world disrupted by loss, but re-learning the self as well.

Clearly bereavement as such is a choiceless event in as much as few of us would choose to lose the person we love.  As such, we experience it as an unwelcome intruder in our lives, one who refuses to retreat despite our impassioned protests.  The power of death can leave us feeling helpless and overwhelmed, and we may feel ourselves to be pawns in a cosmic game that eludes our best attempts at understanding.

And yet to while the loss itself may be a reality we are powerless to avert, the experience of grieving may be rich in choice. At a basic level, we have a choice of whether to attend to the distress occasioned by the loss … a choice as to whether to feel and explore the grief of our loved ones absence, or to suppress our private pain and focus instead on adaptation to a changed external reality. 

So, grieving is something we do, not something that is done to us.  Grieving involves hundreds of concrete choices.  Some examples: whether to care for an ailing loved one or delegate the responsibility to others; whether to view the body of the deceased or not; whether to keep or dispose of the loved one’s possessions; whether to continue to live in a home shared with a loved one who has died; whether to ritualized the death in a funeral or memorial and if so in what fashion. 

Thus, far from representing some passive process of waiting out a series of predictable emotional transitions, grieving needs to be seen more realistically as a period of action. Life after a loss can keep people busy. It can be a time of accelerated decision-making to the point that the grieving individual may sometimes feel overwhelmed by the challenges posed.  Grief as an active process seems to correspond more closely to the experience of actual grievers and also gives more potential direction to grief therapists who can play a facilitative role in sensitizing clients to the many subtle decisions the face and in helping them sift through the implications of their conscious or unconscious choices.

Grief is the act of affirming or reconstructing a personal world of meaning that has been challenged by loss. To the extent that loss invalidates our assumptive world, it requires us to reconstruct the world again, to make sense and restore a semblance of meaning and direction, and interpreting a life that is forever transformed.

We all write a script for life. And while the details may change from tiome to time, we all want to think that life will be orderly, predictable, and go according to the script. If life is viewed as a script, any loss can be viewed as disrupting the continuity of this narrative. We have one of two choices: either we revise the plot and assimilate the loss into pre-existing frameworks of meaning, ultimately reasserting the viability of our pre-existing belief system; or we accommodate our life narrative to correspond more closely to what we perceive as a changed reality.  For example, the grieving individual who integrates the painful suffering and death of a spouse into a long held religious view, emphasizing God’s goodness, His will and purpose even in the midst of suffering would illustrate the former process; whereas the mourner, who is prompted by such a death to revise, challenge or even jettison their religious views would exemplify the latter. In other words, does this make sense according to what I believed about life before, or do I have to adapt my way of interpreting how life can be meaningful.

Both movements however are adaptive in the sense that they reaffirm or reestablish a broad narrative structure within which tragedy can be given personal meaning.

Feelings should be understood as signals of the state of meaning making efforts in the wake of challenges to the adequacy of our constructions.  In traditional grief theory, the emotions are typically treated is merely symptomatic, as problems to be overcome with the passage of time or the administration of treatment.  Another view is to see emotions as integral to a process of finding new meaning. 

In other words feelings have a function and are to be respected as integral to the process of meaning construction rather than controlled eliminated as unwanted byproducts of the loss itself or dysfunctional ways of thinking about it.

To consider a few examples: denial is often understood as an individual’s inability to assimilate the death event at a given point in time, but it can also be seen as our defense mechanism, delaying the unassimilable event until its meaning can be grasped in all of its painful clarity.  Anxiety represents the awareness that the death event lies largely outside one’s ability to explain addict and control guilt stems from the perception that one has behaved in a way contradicting one central structures of identity hostility can be viewed is the attempt to force events to conform to our constructions all of them.

 

 

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