psychotherapist tyler ong

helping you help yourself

Grief and bereavement: Loss of a loved one

on January 10, 2013

Grief is a complex collection of thoughts, feelings, and actions that arise in reaction to the loss of a precious object. In psychology, “object” does not mean an inanimate thing. “Object” refers to any entity, be it human or otherwise, that is infused or filled up with meaning and has a relationship with the target person. Notice that the definition of grief covers not only emotions, but also thoughts and behaviors. Grief is not merely a feeling. It affects how one thinks, behaves in everyday life, and relates to other people. Notice also that there must be loss for there to be grief. There is the pain of no longer being with a loved one. For there to be pain, there must first exist a connection – what we call “love” – toward a person. We are attached to that person so much so that their loss – even if it is only imagined – brings about a reaction of fear, sadness, and even anger. There can be no grief if there is no attachment. Thus, we have a stronger grief experience when we lose a family member than when we are seeing the death of strangers on the news.

Is grief normal?

Yes. Grief is a natural reaction to the severing of an existing bond with another person, animal, or thing. We invest so much emotional energy into that person, animal, or thing; and we also receive the interest of that emotional energy back into ourselves. This investment strengthens with time, and the longer one is invested, the more shocking and painful the loss of the invested person, animal, or thing becomes. Grief is the reflection of how much we have loved someone or something. But it is very important to remember that people exhibit grief in many, many ways. Your way of showing grief is not better than another’s way.

How is grief shown?

In the past, there were therapists, psychologists, and researchers who insisted that there was a “healthy” way to grieve. However, in recent times, we have discovered that there is no single way to grieve in a “healthy” manner. People grieve differently for different situations. One cannot expect the same grief reaction even among members of the same family. One member might cry by herself, alone and separate from the group. Another might show his grief by venting out anger. Still a third might look like he is not grieving, being rational and practical in dealing with legal and social requirements that come with death (for example, arranging the funeral, informing business and legal institutions of the death of the person, dealing with lawyers and creditors, etc.). Not one of them is considered to be healthier than the other. A whole book can be written about the different ways people have exhibited grief. Just because you see someone smiling in the funeral does not mean that she is not grieving, nor is the person who is crying loudly in her seat necessarily grieving healthily. Grief is a function of culture, personality, and connection to the deceased. It has also been found to be dependent on the type of death, cause of death, age of the deceased, age of the bereaved, and spiritual inclination. It is therefore a mixture of many factors. It is not accurate anymore to say that men tend to hold back their feelings, or that women tend to cry out in funerals. As gender variables become more fluid and continue to change in our society, so do patterns of grieving among the sexes.

Is there such a thing as abnormal grief?

Unfortunately, there is. There is something called “complicated grief”, a very vague and often misinterpreted concept among therapists and psychologists without proper training in grief and dying issues. Complicated grief has two aspects: the manner of grieving, and the time of grieving. Remember that grief is heterogeneous in manifestation. It is demonstrated in a wide variety of ways. In the same manner, the length of time a person experiences grief is also heterogeneous. In modern Western society, a person is expected to “get over” the death of a loved one a few weeks after the burial/cremation, and get back to living his or her life. In most traditional cultures though, there are varying lengths of time expected for mourning. This is further complicated by individual preferences and tendencies. Some people will grieve longer than others, and that’s just normal. However, there are some things that make grief a delicate topic among therapists:

1. Grief manifests in a very similar manner to clinical depression and other mood and psychotic disorders. In some countries, it is normal for the bereaved to report seeing the deceased in dreams or to see their spirits in waking life. In the Western part of the world, this would be an indication of psychosis. Therefore, therapists are required to be very thorough in balancing cultural and clinical aspects of the case. A wrong evaluation could lead to further complications down the road.

2. Some people in the midst of grief no longer take care of themselves or their dependents (for example, their kids). This is serious as this could lead to child neglect, and passive suicidality. There is a threat to quality of  life, which might spill over to other areas of functioning. For instance, work and school environments are most often affected. If grief dominates the entire life of the person, there might need to be outside help. People who manifest grief in this way risk having their children and elderly parents taken away from them as they could not even take care of themselves, how much more for dependents? Without proper jobs, they experience a very rapid decrease in quality of life through poverty and homelessness.

3. For some people, the manner of grief becomes dangerous to self and others. There have been times when grief was manifested in the form of rage towards existing loved ones, rage towards perceived perpetrator (for example, if the death was due to a crime), or even rage towards the self. Needless to say, this qualifies as threat to safety and security not only of oneself but to others as well. Many who experience this gradually lose a feeling of self-control and become impulsive and have a sudden change of behavior. Assessments of suicidality and homicidality are required.

Is there a need to see a therapist?

It depends. Research has shown that unless there is a traumatic event that surrounded the death, grief counseling is not really needed. However, it might help for the bereaved to talk to someone other than friends and family who may say or do things that can be insensitive. For instance, a common assurance from friends is, “He’s in a better place.” It sounds well-meaning but the hidden message there is, “Being with you is not the best place for him that’s why he had to leave. There is somewhere better than being beside you.” This can cause more pain and distress than what the well-meaning friend meant to impart. Many people are very, very uncomfortable around death. It reminds them that soon they too will die. They try to offset this discomfort by saying “comforting” or “assuring” things but most often it comes out wrong. Some people will see it as their responsibility to direct your life and organize your schedule without anyone asking them to. At first glance, this might be useful and practical especially when it is difficult to concentrate in the process of grieving. But over time. if this goes on, the bereaved will become dependent on that person, and the dominant one will soon resent the bereaved for being “clingy”. This would only confuse the bereaved person.

Remember to ask your therapist also what training and exposure he or she has in terms of grief counselling. This is not something that a therapist can just read from a book or two. There are unique types of death and correspondingly unique reactions. It becomes quite complicated to adjust to certain cultures and how they grieve and the role of religion in the grieving process. Ask if the therapist has had advanced courses in any of the following: death and dying, thanatology, gerontology, psychology of aging, grief and loss, grief counselling, psychology of religion, spirituality in counselling, and other related masteral or doctoral-level courses. If not, ask if the therapist is being supervised by someone who is trained in the above. It has been shown that untrained therapists can cause the same damage as well-meaning but insensitive friends and family members. Why? Because therapists are also human, and most humans are significantly (whether deliberately or not) ignorant about issues surrounding death.

On the positive side though, current researches have started showing that most people who have been exposed to high levels of grief and trauma tend to return to a normal level of functioning by themselves (meaning, without any help from professionals). It takes some people longer than others, but ultimately majority of the population studied (not just clinical populations) have proved to be surprisingly resilient. Resilience is a natural attribute found in all humans. It allows us to metaphorically pick ourselves up after we have had a psychological fall, dust ourselves, and move on. However, “moving on” does not mean that the bereaved must forget the deceased. When a loved one dies, it is only natural and normal that we remember them. After all, our very existence is an enduring legacy to their memories and lives.

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