This is my first entry in my website about a topic that I am quite familiar with, both personally and professionally. The experience of grief. This is a psychology “blog” with my thoughts and observations regarding the suffering brought about by grief, but also about resilience in the human experiences when dealing with the inevitability of life. I am hoping to engage in a dialogue not only with psychologists but with all who may read my article “blog”, and wish to share their feelings and experiences. I would like very much to hear your specific experiences.
FINDING MEANING IN OUR GRIEF
By Carmen Inoa Vazquez, Ph.D., ABPP
“Did you say: Finding meaning after losing someone you love?”
This is a question that I have often been asked by my grieving patients, and by many of my friends, who have experienced a loss. This is an understandable question to ask because when someone we love dies, we suffer and we hurt. It seems inconceivable to see meaning in any way connected to losses, particularly when we are talking about the loss of someone we love. The most appropriate answer to this question became clear to me when I realized that the definition of “meaning” could have different understandings for different people. It also became clear that it was important to have a uniform definition that could be shared by grievers.
Let’s first look at some useful definitions that hopefully will also place us on the same page when engaging in the language of grief.
In other words:
It is important to be on the same page with grievers –
DIFFERENT TYPES OF GRIEF:
Let me first acknowledge that in fact, the literal translation of grief in Spanish is “duelo”, which means “pain” or “hurt”. We can all connect to that feeling, with variations across individuals. Let me further acknowledge that the experience of grief, which is an emotional reaction to the loss of someone we love, whether a family member, spouse, sibling or dear friend, is always painful, full of sadness, confusion, disbelief and anger. But this same experience can also present for us an opportunity to adapt, to learn to live without that someone we love so dearly, and to find new ways that help in the day to day demands of life on an ongoing basis.
The experience of loss and adaptation is known to me first in my own personal experience. I lost my first husband after twenty seven years of marriage. I also have been helping people who have sustained the loss of a loved one, and although I cannot ever feel what they are feeling, I can still get a pretty clear picture of their emotions thorough their own narrations. Having an attentive listener to a narrative that can include strong feelings heavily affect the content and nature of the memory narrative being offered and help with:
Unfinished business, Expressions of Anger/guilt and at times a Sense of Relief.
- It is important to tell your story. Storytelling is a form of narrative that sheds light into the dynamics of the person and can serve as a vehicle of transformation and integration. Providing a narrative of one’s loss helps to gain an understanding of feelings that may not be deemed acceptable to many and particularly when these emotions are deemed inappropriate within the group or faith affiliations.
- But the sharing of a narrative should be done with someone who understands and can handle the intensity of grief feelings. For example, anger. How could one be angry at God? Or, how could one be angry at the person who leaves us? These feelings, if not understood, could be deemed irrational by those who lack familiarity with the subject, but it is very important to remember that they are so common and so normal during the grief process.
- A narrative approach could be and should be culturally consonant. For example, it comes to mind that within the traditional Latino culture the “testimonio or testimony has been used throughout the years. This is a narrative technique, developed in Chile in response to political atrocities and incorporated into traditional trauma therapy, that is believed to lead to healing aspects of a painful past of traumatic experiences and to allow an answer to come into sight (Comas-Diaz, 2006), Vazquez, Rosa, 2011.
- Besides a reaction to a loss of someone we love, grief can also be defined as a reaction to other losses, such as losing important possessions in a hurricane, a tsunami, losing a job, a divorce, a miscarriage and last but not least, the death of a dear pet. As such, it is safe to say that many people reading this blog have and will have experienced losses and the resulting grief.
- In order to be on the same page with our understanding of grief, let’s share the following definitions:
Grief - Grief in General could be defined as a manifestation of emotions that include sadness, agitation, and mental pain or despair associated with a loss: physical; psychosocial/symbolic.
Bereavement - (objective/state of having suffered a loss), Grief is the reaction (primarily emotional/affective), and Mourning is the public display of grief. Although quite often you will see that the terms are used interchangeably creating confusion in the interpretation of the literature.
Uncomplicated, Complicated, Disenfranchised Grief - Therese Rando (1993) views grief as a possible normal process where individuals eventually move on with their lives and learn to live with the loss, but this process can also become complicated and maintain unresolved issues or what used to be called Complicated grief, which now is defined as: Persistent Complex Bereavement Disorder in the DSM-5. And,
Disenfranchised Grief, that is when the griever’s loss is not considered important enough to be expressed openly, as for example in the death of a beloved pet, losing a family member who was involved in a gang or who overdosed on drugs, drank herself/himself to death or has suffered a miscarriage or opted for an abortion.
Anticipatory Grief – is a concept originally related to impending grief due to death. It was first introduced by Lindemann (1944) in his article entitled, “The symptomatology and management of acute grief,” addressed the behavior of soldier’s wives during World War II, who showed all the manifestations of grief, but prior to the actual loss. The feelings associated with anticipatory losses do not occur uniformly in all individuals, and there is no indication that experiencing grief before the actual occurrence will change the intensity of duration of the grief after a death. However, it is believed that grief that follows an unplanned death is different from anticipatory grief. It is possible that having time to plan and deal with unfinished business might have a less intense impact than sudden death for some people, but reactions can also vary according to individual differences.
- Termination of relationships, illnesses, and the inability to function due to poor health, unemployment, school failures, and traumatic accidents—can also exert psychological impact that manifest in feelings of sadness, anger, helplessness, guilt, and despair (Murray, 2000).
DIFFERENTIATION BETWEEN GRIEF AND DEPRESSION
The figure below was a reproduction given as pharmaceutical advertisements to Doctors a few decades ago by the Schering Company for the drug Etrafon used in the treatment of Depression & Anxiety. It is a reproduction of an ancient Mexican figure, and is entitled “Portrait of Depression / Anxiety, Nayarit, Mexico—C. 400-800 A.D.”. I keep this figure in my office because it clearly represents deep emotions throughout cultures and times. Schering Pharmaceutical 2 Figures for Etrafon Depression Medicine Mexico Reproductions.
Grief is different than depression, but depression can be part of the grief experience. Although depression can be present in the grief process, it is a different emotion. Stroebe and Stroebe’s (1987) make a differentiation between depression and grief. They indicate that these two constructs should not be mistaken as one and the same. Per the definition of “normal” depressive grief, individuals may experience increased dependency, changes in interpersonal relationships, sadness, reduction of activities, and lack of energy, but they are able to relate to others and express their feelings, socialize, laugh in appropriate situations, and move on with required tasks (Rando, 1993). The presentation of depression in the grieving person, on the other hand, differs from a “normal” reaction to grief because it is characterized by an ongoing process that requires an exploration of personality factors and the personal meaning of the loss to the individual.
HOW TO FIND MEANING IN GRIEF:
By now it is possible that you are wondering how you can find meaning after your loss. What is meant by “finding meaning” within grief therapy refers to the potential for transformation of the present narrative of one’s life. This is keeping in mind that the silhouette of our experiences is defined by our personal stories, which are always unique in the sense that they are ours. Ask yourself: What can you relearn in your own specific situation. Can you have a new narrative? And if so, how? Relearning is the key to adaptation.
With the above caveats in mind then let’s look at what is meant by “finding meaning or meaningfulness” after a loss and as part of the process of grief. It would be important to say that when people refer to “finding meaning” in their lives, they often refer to overcoming obstacles related to some adversity or disability, as well. When it relates to grief, it is also known that “a substantial number of people also report substantial post-traumatic growth (PTG) in the long-term wake of loss” (Neimeyer, 2014, page 9). On the other hand, there are circumstances that complicate the experience of grief and the individual finds herself or himself in the midst of what is now called: (Persistent Complex Bereavement Disorder – PCBD) in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Revision (DSM-V)l, but used to be called Complicated Grief. That is a type of grief that might benefit from seeing a therapist.
THE USEFULNESS OF GRIEF THERAPY:
The first thing to keep in mind is that a majority of people experiencing grief, do not need to see a therapist. In fact, between 80 and 90% of bereaved individuals experience normal grief. (Prigerson,et al. 2008). There will be pain within grief, and that is normal. The pain reaction experienced after a loss is not to be avoided. It is recommended that the emotional pain be acknowledged and owned. This might sound counterproductive since the resolution of grief is often considered after the initial reactive pain subsides. This is not equivalent either to the euphemism that says “no pain, no gain” often associated with physical exercise. The relevance of staying with the pain has been referred on emotion-focused therapy for trauma (EFTT) (See Resolution Through Sadness and Grief, Palvio and Pascual-Leone (2010). EFT is an approach that is used in couple’s therapy (Johnson Hunsley, Greenberg, & Schindler, 1999) that proposes the full expression of emotions, such as anger, fear, guilt and shame can be beneficial in the resolution of conflicts among couples. But the narrative of grief doesn’t only refer to loss and pain it also contains positive memories that by definition explain why someone is missed so dearly. It is the holding to those positive experiences that can help the bereaved to move on in life. This is not a linear process since people will feel both sad and good experiences fluctuating throughout their lives once they lose someone they love. So it is important to remember that everyone is unique in their experience of grief and one must move at one’s own pace. This is very important to remember because different people have different manner of manifesting their sadness including the amount of time that is required to be able to move on.
It is often the case that talking to a dear friend, or family member can be very helpful, but because we all have different needs and time frames to move on with a loss, it is important to remember that sometimes people can be very well intended but cannot be helpful. Many friends and relatives have the best of intentions, but some of the advice is not what a griever may find helpful. Many patients have shared with me when well meaning friends and relatives, in an attempt to help them in their suffering during grief, using phrases such as: “get over it, you need to go on with your own life”. “you will get pregnant again”. It is only a cat”, or “You have been suffering for too long now, get over this.” As one of the many responses used by well intended people. These comments often create the opposite of what is intended. People either feel that there is something wrong with them or tend to pretend that they are doing fine when they are not. I help my patients understand that there is no comparative way of expressing or feeling grief. Everyone is different and although there are certain guidelines that tell us that a grief should be processes within a certain amount of time, in reality, reactions vary from person to person and from culture to culture. People will move on with the loss of their loved ones, but there are always reminders around anniversaries, holidays or celebrations that include a member of the family or friend, who is no longer alive.
POINTS TO REMEMBER:
I have been planning to write this post for a while based on my experience and interest in grief and grief therapy. This experience has afforded me the opportunity to help many grievers in my career. I have shared my work through writings (books, workshops, entries in encyclopedias, chapters) and through other modes of communication, but the catalyst to write this “post” was a conversation held with a dear friend who had lost her partner of a life time. I understood so many of her reactions to be “NORMAL”, but she was devastated and confused by having such feelings simultaneously. She did not understand the normalcy of her paradoxical experience. This confusion added to her suffering unnecessarily
I hope you found this helpful and that you gained some understanding of your grief or how to help those suffering from grief, I invite you to share your thoughts and to establish an ongoing communication which I hope will be mutually helpful. Let me hear your feelings whether personal or professionally.
I would like to leave you with the following:
- Do not compare your bereavement to anyone, including close members of your family.
- Do not rush yourself to act in a way you do not feel in order to appear “normal” to others. No need to fulfill anyone’s expectation. Sometimes, the group of the culture adds pressures that should not be allowed. We will talk more about this topic later.
- There is no right or wrong way to experience grief.
- There is no linear way to experience grief: one day you may feel happy, the next you may feel terribly sad.
- Do not forget that initially you may think that you will never find the energy to go on. Give yourself time, be patient with yourself.
- Do not forget that there are bad and good memories related to the people we love, including the ones that have died. These are “normal”, and eventually only the good memories might exist.
- Do not forget that some of your friends or loved ones might not be able to listen to you regularly. This is also normal, especially if they are grieving themselves.
- Do not forget that it is OK to feel anger toward the person that leaves us.
- Do not forget that is it OK to feel abandoned by God. It is normal to feel that way.
- Lastly, do not forget that there might be a point when you do not need to carry the “pain and suffering” alone, You may wish to seek professional help, the same as you will do with physical problems, such as diabetes, heart issues and others. We do not have to be experts in every areas and seeking professional help might be a very productive decision.
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Diagnostic and Statistical Manual of Mental Disorders– Fifth Edition (DSM-5)
American Psychiatric Association, Washington, D.C.
Lindemann (1944) “The symptomatology and management of acute grief,”.
Murray, T. (2000). Loss as a universal concept: A review of the literature to
identify common aspects of loss in diverse situation. Journal of Loss and
Trauma, 6(3), 219-241.
Neimeyer, R. (2014). Good Grief . New Therapist March/April 2014.
Palvio, S. Pascual-Leone, Antonio (2010). Resolution Through Sadness and Grief,
In Emotion-focused therapy for Complex trauma: An Integrative approach,
(pp. 253-274). Washington, D.C.
Prigerson,et al. (2009). Prolonged grief disorder: Psychometric validation of
criteria proposed for DSM-V and ICD 11. PLoS Medicine, 6(8), 1.12.
Rando, T. (1993). Treatment of Complicated Mourning. Champaign, IL:Research
(Johnson Hunsley, Greenberg, & Schindler, 1999),
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physical consequences of partner loss. New York, NY: Cambridge University Press.
Vazquez, C.I, Rosa D. (2011). Grief Therapy with Latinos: Integrating
Culture for Clinicians, Springer Publishing Company. (Prigerson,et al. 2008).