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Complicated Grief

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Why write about grief during just prior to the holidays? This is an excellent question! The reason is that the holidays can be difficult for those who have lost loved ones. The holidays tend to bring on nostalgic feelings for those who have died. Even worse, if the death has been recent, the holiday season can bring about feelings of grief, loss and sadness. This is one reason for discussing grief at this point. There are other reasons:

Have you noticed that no one ever wants to talk about death, loss and grief? OK, so it’s not the happiest topic in the world. However, death has this habit of happening and of touching the lives of every person on earth. There seems to be some superstitious fear that if we talk about death we might increase the risk of it happening. As Americans, we also seem to share the belief that if we do not discuss or think about death, it will not happen. A brilliant book about this was written many years ago by Ernest Becker called The Denial of Death. Becker wrote the book while he was dying of a terminal disease. He points out that we try to convince ourselves that death does not happen.

Non existence is too overwhelming a thought and, so, we move through our lives denying the fact that it comes to all of us. Even more, we Americans react to death as though it was someone’s fault and could have been avoided. When a tragedy occurs we look for someone to blame.

We have also made death alien or foreign. During most American funerals family and friends follow the hearse to the cemetary where more words or prayers are said. Everyone then leaves and the burial crew lowers the coffin into the ground and fill the grave. I was recently talking to someone from Eastern Europe who described how, at the funeral of a friend, how the family buried the coffin themselves. Grave diggers may build the grave but family does the rest of the work themselves.

Becker points out that we are so focused on ourselves that we believe that death will come to other people and not to ourselves. We cling to the notion that other soldiers will die in war and not ourselves. We mistakenly think that others will be caught in terrorist attacks and not ourselves. We hear about and read about tragedies through the faulty notion that these things can only happen to others and will never touch our homes. Behind all of this is the totally narcissistic idea that we are immortal. The problem is that death does come, it does visit and it does interrupt our lives. Then, we are confronted with grief.

When a loved one dies the reaction is grief. No only do people tend to fear death but they tend to fear those who are grieving. It is as though the grief of another person brings about the uncomfortable reminder that death is always close and intimate fact of life.

Grief is a normal reaction to the loss of a loved one.

The experience of grief includes:

1. Crying.

2. Vivid dreams of the lost person as though they are still alive.

3. Thinking and believing that the dead person is still alive.

4. Self blaming for the death.

5. Anger that the dead person is gone.

6. Ruminating about the dead person.

7. Depression.

These experiences or "symptoms" of grief are considered normal and do not require psychotherapy.

However, if the symptoms persist and become crippling of the individual’s ability to function then treatment is called for. It is difficult to define a "normal" amount of time for the grieving process. Many religions define the mourning period for a period of one year with the most intense mourning taking place anywhere from the first week to the first month. During that first year after the loss of the loved one grief reactions tend to slowly diminish in intensity.

Joan Didion wrote a brilliant autobiographical book about her experiences after the death of her husband. This sensitive book, which is not depressing but is written with great insight and sensitivity, is well worth reading and is entitled The Year of Magical Thinking. During the year after the death of her husband she reminisced about the events of the previous year as each day went by. Sometimes she thought about what she might have done differently in order to have prevented his death. Other times, her memory went back deeper into the past, when their daughter was a child and they lived near the ocean in Massachusetts. At times she felt angry with him for having died, at other times she imagined he was alive and at yet other times she recalled some of his criticisms of her and whether or not she could continue on without him.

For those who experience complicated grief there is no diminishment of the mourning process and the individual cannot seem to move beyond the loved one’s death. The people stuck in complicated grief seem to desperately yearn for the dead person. They never seem to stop crying, begin to wish for their own death and become symptomatic of someone who is suffering from Major
Depression sometimes with psychotic symptoms of hallucinations. In these cases there can be a real risk of suicide and mental health treatment is necessary.

What Causes Complicated Grief?

There are many explanations for complicated grief and there are many reasons for why it occurs:

1. People who tend to be depressed have a greater vulnerability to complicated grief.

2. An unexpected and violent death can cause complicated grief. Relatives lost in auto accidents, war, were the victims of violent crimes are among those who are defined as unexpected and traumatizing deaths.

3. Parental loss of a child is always deeply traumatizing, leaving the family in a state of shock and in which parents are vulnerable to depression.

4. The more complicated the relationship to the dead person was, the more difficult the mourning process. In other words, parents who were abusive, angry, intrusive and difficult can result in the surviving children having a hard time working out their feelings of loss.

5. When death is violent and unexpected the surviving relatives may experience Post Traumatic Stress Disorder.

These are just a few of the reasons why a death may be experienced as traumatic or extremely depressing beyond normal grief. Under these circumstances psychotherapy is definitely called for and people should not hesitate to seek help and work through their feelings. In some of these cases anti depressant medication may be necessary.

Reprise:

So, why discuss death and grief just prior to the holidays? Why not? Death exists. It even happens to people during the holiday season. The idea is not to "deny death" but to make the most of our lives while we are alive.

What are your thoughts and feelings about this topic?

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