Jacob Lund/Shutterstock
Source: Jacob Lund/Shutterstock

With Amanda Habermann, M.S., Sovereign Health

“In our hearts, we all know that death is a part of life. In fact, death gives meaning to our existence because it reminds us how precious life is.” – Author unknown, from Mental Health America (MHA). More proof of what early theologians proffered: We are a soul that lives in a body. Indeed one's brain understands the passing of life to death, but our emotions swell and cause our hearts to pound in echoing macabre in indignation of loss.

Bereavement after death

Death simply serves as a punitive reminder of one’s own mortality that we will one day perish along with those who have left us behind. Despite its inevitability, rarely are we adequately equipped to deal with the pain and emotional turmoil that follows an actual, a symbolic or an intangible psychological loss. (Other kinds of events can be equated with the loss of a loved one like the loss of a person’s sense of safety after he or she experiences a traumatic event.)

When we are “deprived by something or someone we valued,” which is typically the case when someone we love passes away, what follows is a distinct period of grieving, sadness and emotional distress that is called bereavement. Our coping mechanisms, cultural norms, support system as well as the circumstances of the death and our relationship with the deceased person may all play a role in how we react to a significant loss.  

Normal grief reactions

Bereavement and other types of losses (e.g., loss of health, identity, finances, etc.) can lead to intense periods of sadness, rumination about the loss and other problems that can be difficult to deal with. Grieving, or the outward physical, emotional and psychological expression of loss, can cause us immense emotional and physical suffering when someone or something we love is taken away from us.

“Grief can deplete you to such an extent that the slightest tasks become monumental, and what previously was easily achievable now may seem insurmountable,” wrote Therese Rando, Ph.D. Although sadness is often one of the intense emotional reactions that take over in our immediate response to losing someone we love, it is certainly not the only way that grief can manifest itself. Although everyone reacts to loss in different ways, we rarely are prepared to deal with the pain and emotional turmoil that result after we lose someone or something that is intrinsically valuable to us.

Grief is more than just sadness

Grief can manifest itself in the form of immense emotional and physical suffering, and we may experience anything from anger to denial, to guilt, to sadness and despair. Initially, people who experience grief may experience confusion, shock, and disbelief that their loved one has passed. However, after the initial shock has passed, highly distressful emotions can contribute to anxiety, extreme fatigue, crying fits, dreams and even nightmares about the deceased.

Grief manifests itself in a number of ways, not only sadness. Depending on the circumstances, even anger and rage may overcome us. We might find ourselves talking to or even cursing at the dead people we loved or “hated.” We might think, “How could you do this to me?” “Why did you leave me?” “Why were you so thoughtless?” “Why did you take the risks you did?” or “Why didn’t you go to the doctor?” Sometimes, it is easier to be mad than sad, since sadness, grief, and depression are psychological and even physiological states of powerlessness and vulnerability.

Anticipatory vs. traumatic grief

One day, we might wake up, and a loved one is diagnosed with a terminal illness, or we might discover that one of our loved ones only has a short time left to live. Anticipatory grief does not always occur when a death is expected, but it is a type of grief that happens before the person actually dies. Anticipatory grief helps to prepare us emotionally to deal with the loss that is to come. It gives us the opportunity to make amends, forgive and say “I love you” before it’s too late. Even though many people wonder how it can help to prepare us for the eventual loss of our loved one, it can lead to depressive symptoms in people who are susceptible to depression.

On the other hand, traumatic grief may be experienced in certain circumstances, depending on the traumatic nature of our loved one’s death. Traumatic grief is more likely to be experienced when we are faced with a sudden, violent and/or unexpected loss of a loved one. The experience of trauma and grief at the same time can turn our world upside-down.

It can be extremely painful to experience traumatic grief, as we may find that sentiments and triggers can easily remind us of our loved one. Especially when our loved one’s loss was sudden, we may find that thinking and remembering our loved one fuels painful memories and flashbacks that can make us re-experience our loved one’s death.

The experience of trauma and grief at the same time can obscure the resolution of our bereavement. As many of us try to hold onto our memories of the person or even tangible objects that are intrinsically valuable to us in fear that we might forget someone who meant so much to us, the normal remembering of the deceased can even end up complicating matters and even causing us more harm.

Dealing with loss

It was Bowlby (1969) who originally made his name by studying newborns and infants of parents who died in the Battle of Britain during World War II. These infants “failed to thrive” and later died despite receiving intensive nursing and medical care. Based on his work with infants, Bowlby recognized the importance of attachments with others and believed that the bereavement process is our natural response to broken attachment bonds.

Part of the reason that our experience of grief is so painful is because we must learn how to let go of our attachments following a significant loss. Attachments or bonds that we form with significant people in our lives continue to exist even in the absence of that person. In our protest of separation from our bond with our loved one, we may have anxiety and difficulty comprehending the loss, an experience known as numbing, which can lead to feelings of shock, denial or disbelief, especially when the death occurs unexpectedly.

Grief pangs: Yearning, disorganization, and despair

We may have “debilitating recurrent pangs of painful emotions, with intense yearning, longing and searching for the deceased, and preoccupation with thoughts of the loved one,” said Mary-Frances O’Connor and her colleagues.

Grief pangs, short temporary periods of very intense distress and yearning for the deceased, can spin us into an existential, emotional, relative emptiness. Despite being highly distressful, grief pangs serve the purpose of recovering and reuniting with the person who has left us. When we realize that we will not be able to recover the one we love, we go through a period of disorganization, and despair, during which we attempt to find ways to cope with our irreparable loss. 

Along with our significant loss, we may also feel as if we have lost a part of ourselves, and, in some ways, we did. Both tangible and intangible psychological losses, such as losing our sense of safety after something traumatic happens to us or changes to our identity, can be highly distressful. Eventually, we must learn how to reorganize our sense of self and rediscover our unique place in the world without our loved one.

Unresolved, complicated grief

Grief after someone we love dies can be overwhelming and even traumatic. Even though many people are able to successfully cope with and adapt to a loss, individuals who have lingering pathological or traumatic grief may need to seek professional services to overcome their emotional pain.

“Excessive and irrational grief” caused by mourning a loss was described by Freud (1917) as melancholy or depression. Whether the loss was actual or symbolic, he believed that unresolved feelings of guilt and other negative emotions stemming from the loss of someone we held dear could subsequently be directed inward toward oneself, which he called introjection.

Bowlby (1980) later suggested that the neurophysiological processes that produce changes in our affect, behavior, and cognition can be prolonged or amplified in the face of complicated or unresolved grief. The symptoms that arise during complicated grief reactions can be so severe that they may even resemble those experienced with major depressive disorder (MDD), anxiety disorder or post-traumatic stress disorder (PTSD).

Persistent complex bereavement disorder

Although the sadness and other emotions that stem from the loss of someone we loved may never completely go away, grief and sadness that remain severe, overwhelming and lingering may mean that we are stuck in mourning, a characteristic of complicated grief, and it can start to affect our functioning in daily life.

Grief during bereavement may itself induce such great emotional and psychological suffering that it can impact how a person functions in his or her life. For this reason, “persistent complex bereavement disorder” has been proposed as a condition that may warrant clinical attention in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013).

Recovering from bereavement

Although dealing with grief is a normal part of loss and bereavement, we can experience and cope with loss in different ways. Loss can bring us closer to people who are still in our lives and provide us with a unique opportunity to find out more about ourselves.

Eventually, the physical aching and pain subside after the death of a loved one. Our cherished memories of our loved one, and if they are family, our genetic inheritance and all of the implications therein, can sometimes stay with us for the rest of our lives.

“Confronting death need not result in despair that strips away all purpose in life. On the contrary, it can be an awakening experience to a fuller life,” said Irvin D. Yalom in his book, “Staring at the Sun: Overcoming the Terror of Death.”

About the Author

Ralph Ryback M.D.

Ralph Ryback, M.D., has taught at many institutions including Harvard Medical School. 

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