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Death, Dying & Grief

Death is a universal part of life. Still, knowing that death is natural often does not remove the shock and pain that we may feel when we experience the loss of a loved one or face death ourselves. Instead we may experience grief, a complex process that may involve a variety of emotional states, such as numbness, disbelief, separation anxiety, despair, sadness and loneliness (Santrock, 2019). Grief may manifest in a variety of ways, which will look different from person to person, but the experience of grief is normal.


Types of Grief

Below is a list of types of grief. Click them to read their respective definitions from the Encyclopedia of Death and the Human Experience (Bryant & Peck, 2009).

Normal grief

In the course of the normal grieving process, the grief symptoms gradually reduce and the bereaved person begins to accept the loss and to readjust. Some of the symptoms may return briefly on death anniversaries, birthdays, or other important occasions related to the deceased; this return of symptoms is considered normal. It is generally agreed that the average period of time for normal grief in American society lasts from approximately 12 to 18 months. If one's grief-related behaviors continue beyond this time frame, the grief may be considered unresolved, complicated, or pathological. However, in certain losses such as loss of a child, this process may be expected to last 4 or more years.


Anticipatory grief

The dying patient's anticipatory grief has two components: anticipating his or her own death and feeling responsible for the burdens and sadness of loved ones caused by the impending death. While the anticipation of death or profound decline of mental or physical health is very disruptive, it can be beneficial as well, because it cushions people to absorb the loss and complete unfinished business. The patient and the loved ones have time to prepare for death and say good-byes. However, anticipatory grief does not replace the grief felt after the death. In fact, the bereavement process cannot be completed until after the death, even though many tasks of bereavement are completed while waiting for the death to occur.


Unanticipated grief

Sudden or traumatic deaths lead to unanticipated grief. Because of the sudden nature of loss, often the bereaved are unable to fully experience the normal grief reactions. Instead they may suffer from extreme feelings of bewilderment, anxiety, self-reproach, and depression, thereby making the recovery complicated. Because of the unexpectedness of death, there may be many regrets and loose ends identified. The bereaved may feel responsible for not preventing the death or may have a significant amount of unfinished business with the deceased, leading in turn to increased anger directed toward others. The prolonged grief experience is further intensified by their need to understand why the person died and the search for the meaning in death. The unpreparedness often leaves the bereaved feeling vulnerable and out of control. Their symptoms are similar to those identified as accompanying post-traumatic stress disorder and often require immediate intervention. If intervention is delayed, the symptoms might become chronic and more difficult to treat.


Disenfranchised grief

Sometimes people experience losses that are not considered significant, socially recognized, or publicly mourned. Such losses lead to what is called disenfranchised grief. Some examples of situations when disenfranchised grief may occur are aborted or miscarried pregnancy; stillbirth; disappearance of a loved one; death from AIDS; death of someone with whom the relationship is not sanctioned or recognized by the society, such as same-sex partners or extramarital lovers; or a past relationship, such as an old boyfriend or an ex-spouse. The disenfranchised grief may also be experienced by those who are considered incapable of grieving, such as persons with developmental disabilities or children. This kind of grief can also create problems in the workplace. Because of the limited opportunities to formally express the feelings of grief in nontraditional losses, disenfranchised grief often takes longer to resolve than the grief due to traditional losses such as losing a parent, spouse, child, or friend. The bereaved also may require professional help to complete the bereavement process.


Complicated grief

All cultures contain normative expectations pertaining to normal grief reactions. These expectations are represented by the types of clothing, bereavement rituals, mourning behaviors, and acceptable length of time for mourning. Failure to meet one's cultural expectations for bereavement and mourning is often labeled as complicated, unresolved, or pathological grief. Grief can also become complicated if the progression toward resolution is disturbed or not attempted at all. In some cases, the bereavement becomes prolonged with intense grief symptoms that interfere with one's ability to function, whereas in others, it may appear as a complete absence of grief. The intense overwhelming grief symptoms of earlier stages become abnormal due to their persistence and duration. Even though others will recognize the prolonged and self-consuming nature of a person's grief, often the bereaved remains oblivious and unable to recognize the complicated nature of his or her grief. However, those few who are aware of their problem feel powerless to address it. There are many similarities in symptoms between complicated grief and some psychological disorders, such as major depression, anxiety disorders, and post-traumatic stress disorder. Usually the unresolved issues of a relationship are the predisposing factors for complicating the grief process for the bereaved.


Chronic grief

When the bereaved continue to exhibit normal grief reactions for an extended period of time without coming to a satisfactory resolution, the grief becomes chronic. It appears to be an attempt on the part of the bereaved to keep the deceased alive by continuing the intense grieving process. The bereaved fail to complete the tasks involved in the process of mourning and fail to adjust to their environment without the presence of the deceased. The intense grief reactions that would be appropriate in the earlier stages of bereavement linger. These excessive and disabling grief reactions keep the bereaved individuals from returning to normal life. Their intense preoccupation with the deceased may manifest in frequent visits to the grave, their conversations centering around the deceased, continual sorting and arranging the possessions of the deceased, and keeping the room and possessions of the deceased as if the deceased were coming back. An ambivalent or dependent relationship with the deceased is usually the source of chronic grief. Those who experience chronic grief and cannot come to a satisfactory resolution are at greater risk of physical and mental illnesses. There is also a high risk of suicidal behavior.


Absent or delayed grief

Unlike the normal grief pattern, some people who lose a loved one may show absence or delay of normal grief symptoms. The delay in symptoms may last for months or years. They behave as if the death of the loved one did not occur or they could handle the loss without being emotional about it. However, a price is exacted for this denial and repression. At some later date, a full grief reaction may be elicited by a somewhat minor loss or even someone else's loss. Or the bereaved may experience a flood of emotions at the least expected times for which they have no understanding or explanation. Often the absent or delayed grief results from either a traumatic nature of the death or the inability of the person to take time to grieve the loss, either because of obligations at the time of death or the person's perceived inability to deal with the loss at the time the death occurred.


Inhibited or distorted grief

When grief is inhibited, individuals might be able to experience loss of some aspects related to the deceased but engage in denial of others. Few signs of grief may be demonstrated at the time of death, but later psychosomatic symptoms may develop or moodiness may set in as the bereaved becomes irritable and/or short-tempered. Some bereaved persons may distort the experience of grief by exaggerating one or more normal grief reactions, such as anger or guilt. They may also appear to be consumed by one or more extreme emotions. Complaints of headaches, heart palpitations, anxiety, and depression are common symptoms, as are displaced anger and hostility. These complications are experienced more intensely and frequently than normal grief reactions are experienced.


Masked grief

Sometimes bereaved individuals might experience somatic or psychological symptoms or a maladaptive behavior, which at first does not appear to be related to the loss. Unable to recognize the relationship between the symptoms experienced and their repressed feelings about the loss, the bereaved may develop symptoms similar to those of the deceased, while at other times experiencing unexplained depression or paranoia. Repressed grief may also be acted upon through a maladaptive or delinquent behavior, such as promiscuity, drinking, gambling, and other self-deprecating behaviors.


Attitudes Toward Death Through the Lifespan

While death is universal, attitudes toward death are likely to differ throughout the lifespan. For example, young children lack context and understanding about death and are likely to be puzzled and consider death to be like sleeping, expecting someone who is dead to simply reawaken (Santrock, 2019). Research shows that age 9 is around the time when children understand death to be universal and irreversible (Santrock, 2019). As children age into adolescence they begin to experience the impact of death more in their lives and develop personal philosophical views to make meaning of life and death (Santrock, 2019). This continues into adulthood.  


Stages of Dying?

Many people may be familiar with Elisabeth Kübler Ross and David Kessler’s proposed five stages of dying: denial and isolation, anger, bargaining, depression, and acceptance (Santrock, 2019). However, research suggests that these stages are not experienced as a linear sequence, and rather it may be more accurate to list them as some of the potential reactions to dying (Santrock, 2019.)


Do you need help with grief? Are you struggling to move forward with grief in your own life? You may find it helpful to try some of these suggestions adapted from the American Psychological Association (n.d.)

Talk about the death of your loved one with friends, family, or a therapist.

Accept your feelings. A variety of emotional responses to death are normal. It may be painful and uncomfortable at times, but it is okay to feel what you are feeling.

Take care of yourself. Resting, eating well, and exercising are important ways to take care of yourself while you grieve.

Reach out and help others dealing with the loss. Looking outside of our own loss can help connect us with others and make healing and coping easier for both sides.

Remember and celebrate the lives of your loved ones.

Click here for a variety of resources authored in part by David Kessler, an expert on grief and the coauthor with Elisabeth Kübler-Ross of On Grief and Grieving. Resources cover a variety of topics such as helping children cope with tragedy, dealing with pain, and the rights of the dying.


REFERENCES

American Psychological Association (n.d.) Grief: Coping with the loss of your loved one. Retrieved from https://www.apa.org/helpcenter/grief

Bryant, C. D. & Peck, D. L (2009) Encyclopedia of death and the human experience. Thousand Oaks, CA: SAGE Publications.

Resources. (n.d.). Retrieved from https://grief.com/resources/

Santrock, J. W. (2019). Lifespan development (17th ed.). New York, New York: McGraw Hill Education.

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