By Therese A. Rando, Ph.D., BCETS, BCBT
The path of grief is different for all of us...we all follow our own path.
Someone you love has died. This presents you with one of the most challenging experiences any human being can face-dealing with the loss of your loved one. In this article, you will learn about your grief (living through your reactions to the loss of your loved one) and your mourning (making the necessary adjustments to finally integrate that loss into your life).
Learning how to grieve in a healthy way and how to mourn so that you can learn to adjust to life in the absence of your loved one is not a simple task. It often requires more work, takes more time and is more impactful than most people anticipate. These 12 principles will help you better appreciate the true realities of your particular grief, respond more effectively to what you encounter in it, and have more appropriate expectations of yourself along the way.
Principle #1: Grief is personal and unique.
Your grief is as personal and unique as your fingerprint; no one else will have the same grief experience as you and there is no "right" way to respond to loss.
There are literally 37 sets of factors that influence anyone's grief. They combine to make your particular loss different from everyone else's-even different from others in your own family who are mourning the loss of the same person! Even though one person has died, you and each of the people you are mourning actually experience different losses. This is because no one person can have the exact same relationship with another person, and it is the loss of that specific relationship that is mourned when the person dies. In addition, it is because no 2 people bring to a situation the same strengths and weaknesses, the same past experiences, or the same social and cultural conditioning.
Everyone's grief is determined by:
- The nature and significance of their particular relationship with the person who died.
- Your own personal characteristics and life history.
- The specific aspects of their loved one's death.
- The social situation surrounding them.
- Their physical condition.
Taking into account all the things that determine a person's reactions, you can see why there is absolutely no way someone else can grieve or mourn in the same way you do. For this reason, there is also no one right way to respond to loss. While there are some common processes that people must go through to learn to live healthily with a major loss, everyone will approach it in this unique way.
Suggestions:
- Don't let anyone tell you how you should live your grief and bereavement.
- Be careful about comparing your experiences with those of others.
Principle #2: You are dealing with more than one loss.
With the death of your loved one, you suffer much more than a single loss. Losses that accompany or develop as a result of your loved one's death are known as secondary losses.
They are not necessarily secondary in terms of their importance to you, only in terms of their dependence on your loved one's death. Secondary losses, like any other loss, can be physical (e.g., the loss of a home because you can no longer afford it) or psychosocial (e.g., the loss of a relationship). Part of grieving for your loved one means identifying and grieving the inevitable secondary losses that develop for you as a result of your loved one's death.
Secondary losses:
- The loss of roles your loved one played specifically for you (e.g., spouse, best friend, sexual partner, confidant, confidant, cook, parenting partner, travel companion).
- The loss of meaning and satisfaction from the role you played in your loved one's life.
- The loss of all the hopes and dreams you had for and with that person.
Secondary losses in your assumed world.
It is important to note that secondary losses can also occur in what is known as your assumed world. This is the unique set of expectations, assumptions and beliefs you previously held about life, the ways it works, spiritual matters and the existence of your loved ones. With the death of your loved one, you lose all assumptions, expectations and beliefs that were based on your loved one being alive (e.g., "she will always be there for me if I need her" or "she will make me a grandparent").
Other more general, but very important, elements of your assumed world that do not concern your loved one's existence may also be undermined or violated by your loved one's death. For example:
- your belief in God
- your security in the world
- your expectations about life being predictable and fair
These are additional secondary losses that you must deal with beyond the loss of that person.
Suggestions:
- Over time, identify the secondary losses that come to you as a result of your loved one's death so that you can grieve them-they are part of your grief.
- Work to revise your assumed world to the extent that its elements are no longer valid or have been shattered by the death of your loved one.
Principle #3: Don't underestimate your grief.
The depth and breadth of your acute grief reactions to the loss of your loved one should not be underestimated.
Any grief response expresses one or a combination of 4 things:
- Your feelings of loss and the shortcomings they cause (e.g., sadness, depression, guilt).
- Your outcome of the loss, and your desire to undo it and have it not be true (such as anger, "searching" for your deceased loved one, worrying about that person).
- The personal effects caused by the assault of this loss on you (e.g., fear and anxiety, disorganization and confusion, lack of physical well-being).
- Your personal behaviors stimulated by any of the above (including, but not limited to, crying, social isolation, increased drug and alcohol use).
You can live your grief:
- Psychologically in your feelings, thoughts, desires, perceptions, and attempts to cope.
- Through your behavior.
- In your social responses to others.
- Through your physical health.
Acute grief in the early days, weeks and months often comes as a surprise to the bereaved because it
- can be unexpectedly intense
- can make you feel very different than before
- it can overload your normal coping mechanisms
- can sometimes make you feel totally numb
- typically involves many more aspects of your life than you would have expected
For example, you may be surprised to discover that, although you may have assumed that you would have many emotional reactions to your loved one's death, you did not anticipate that you would have difficulty remembering what you needed to buy at the store or even how to get there. You may be surprised to find that your normally clear thinking has diminished, that your usual cheerful disposition has temporarily disappeared, that your concern for others has evaporated at this time, or that your decision-making abilities for now are gone. Work or personal activities in which you had been involved for years may seem strange and may require much personal effort, if you can muster it at all. These and an infinite variety of other reactions illustrate that with the death of your loved one, for a period of time, your world-and your experience of it-is more different than it has ever been before.
Suggestions:
- Remember that this is a process and not a state in which you will remain stuck. Give yourself permission to express your reactions in a way that works for you.
- Recognize that your reactions may be very diverse and different from what you had anticipated, often making you feel very different from your usual self.
Principle #4: Grief does not just affect your emotions.
Grief does not mean you will only be sad. It is a myth that grief affects only your feelings. Grief is a "whole person" experience, and you will probably notice that it affects most or all areas of your life. Some people may cope better in some areas than others (for example, you may be able to manage it when you are at work, while you may have more difficulty coping at home). However, there are many bereaved people who have difficulties in all areas of their lives.
It is also a myth that sadness is the only emotion you will experience. There are many other feelings that can come with the loss of a loved one.
Other feelings you might have include:
- anxiety
- helplessness
- feeling overwhelmed
- fear
- longing for your loved one
- anger
- impatience
- guilt
- depression
- frustration
- loneliness
- feelings of unreality
- abandonment
- fear of going crazy
- relief
You may also experience:
- disbelief
- confusion
- poor concentration
- disorganization
- feelings of unreality
- numbness
- obsession with your loved one
- tension
- avoidance of things associated with death
- intrusive thoughts and memories
- spiritual distress
- impaired concentration
- restlessness or agitation
- a sense of meaninglessness
Sometimes you may feel disconnected from other people you have been close to in the past. At other times, you may wonder "what's the point?" and wish to die as well. While these are not abnormal in the abstract, if you seriously consider suicide or do not adequately care for yourself in such a way that you are at risk of dying due to illness or injury, then you should seek professional help.
Behavioral changes
In addition, you can expect your behavior to be affected for a time. Among many possible reactions, you may find that you respond to others differently than you did before. Your behavior may be more disorganized and you may have little interest in things you previously cared about. You may cry or, on the other hand, not have the ability to shed a tear. He may have trouble sleeping and changes in his appetite; develop temporary problems in his personal, social and occupational functioning; and become physically exhausted or have specific medical symptoms that indicate stress, depression and anxiety. Lack of a sense of well-being is common. You should be aware that the loss of a loved one leaves you susceptible to illness and injury. As a result, you will need to be aware of yourself and take care of yourself, including adequate medical care.
Suggestions:
- Expect to be affected in all or many areas of your life.
- Make sure you have adequate medical care to treat reactions that are medical in nature and seek mental health care if you are being suicidal, self-destructive or if you are concerned that your reactions are abnormal.
###Principle #5: It takes time.
Your deep grief involves having to gradually learn the reality of the loss of your loved one, and appreciating that you cannot grasp that fact or its implications without sufficient time and experiences to "teach" you. Intellectually, you may know immediately that your loved one has died. However, it takes much longer to truly recognize this reality and internalize it in order to understand it.
24 hours a day, 7 days a week
Even if it is not a sudden death, but particularly when it is, you must learn that your loved one is no longer here, doing so through your experiences of coping with the world in their absence. This means that grieving and mourning focuses not only on your feelings, but also on your understanding that your loved one has died and making sense of that reality.
The Lesson
Each time you want and need to be with your loved one-to see, touch, hear, taste or smell that person-and are frustrated by your desire to do so, you "learn" once again that your loved one has died. In acute grief, each twinge of pain, each stab of pain when your expectation, desire or need for your loved one is not met, brings you another "lesson" that your loved one is no longer here. You wish to resist it and that the "lesson" is not true. Like a habit you don't want to give up, you don't want to stop having your loved one in your life.
Through time
After countless occasions of experiencing an unrequited need to be reunited with that loved one, learn to not need that person in the same way as before. This is not an all-or-nothing event. It is a process in which you have fluctuating abilities to grasp the reality of death. This occurs until at some point it becomes a permanent understanding for you, despite your wishes to the contrary.
Suggestions:
- Understand that much of the pain of your grief comes from having to continually "learn" over a period of time, that your loved one has died.
- Expect it to take several months, or in the case of a sudden death, a couple of years, before you can truly and permanently understand that your loved one is gone and understand the implications of that (in the meantime, you will fluctuate in your understanding).
Principle #6: Grief is not the same as mourning.
You need to do more to cope with the death of your loved one than simply express your feelings. While many people use the terms grief and bereavement interchangeably, they have different meanings and their distinctions have important implications for you.
Grief vs. bereavement
- Grieving is the process of living through your reactions to your loss.
- In contrast, mourning is what you do to cope with that loss that is in your life.
While mourning begins with expressing your grief reactions, it should include much more. This is because simply expressing feelings will not accomplish what you need to do-which is to make the internal and external changes necessary to be able to incorporate that loss into your daily life and learn to live with it.
Bereavement requires that over time you make a series of readjustments to cope with, compensate for and adapt to your losses.
To grieve, you will need to reorient:
- yourself in terms of your relationship with your deceased loved one (you have to move from a physical here-and-now relationship to an abstract relationship).
- yourself (you must make the changes that the death has made necessary in your assumed world and in your identity).
- to your self in the external world (you need to learn to live healthily in the new world without your loved one).
Healthy mourning also means relearning the world in the absence of your loved one and reconstructing meaning in your life in light of this death and what it has brought you. For all these reasons, simply expressing your grief without making the necessary changes to adapt to the loss in your life is simply insufficient to cope with a major loss.
Suggestions:
- Express your grief reactions, but recognize that there is more work to be done.
- Over time, work to make the necessary readjustments in your relationship with your loved one, in yourself, and in your ways of being in the external world so that you can integrate this loss into your life.
Principle #7: The circumstances of this death will have a profound influence on you.
One of the strongest elements influencing your grief and mourning is the type of death your loved one had.
The sudden death
To the extent that the death is sudden and unexpected, you will have a type of personal traumatization along with your grief. This comes from the death catching you off guard and unprepared. Such a death is often shocking, alarmingly disturbing and frighteningly distressing. It acts to increase the problems and distress you have with the loss, while at the same time temporarily diminishing your coping abilities and psychological functioning. Basically, you have more to deal with and fewer resources to help you cope.
In addition, the sudden death leaves you with:
- heightened emotional reactions
- no opportunity to say good-bye or finish unfinished emotional business
- increased disbelief
- a focus on what was happening in the relationship at the time of the death
- a tendency to obsessively revisit the events that triggered it
If you believe that your loved one's death was preventable, you may feel the need to determine responsibility and ensure appropriate punishment for those deemed at fault.
A life-threatening illness
Losing a loved one to a life-threatening illness brings its own issues to your grief. You may have suffered a special type of traumatization with separation anguish brought on by witnessing the death of your loved one. You may have even greater traumatization if you were exposed to terrible stimuli (such as sights, smells, sounds) during the illness or if you were faced with overwhelming emotions (such as anxiety, guilt, grief, depression, anger, helplessness) and/or conflicting demands (e.g., caring for your dying loved one while trying to take care of other family members).
If, during the illness, you had an understandable desire for it to end or if you prayed for respite and relief, after the death you may feel guilty if you do not appreciate the normalcy of this. The duration, course and specific demands of the illness may have drained you psychologically, socially, physically and financially. You may not know what to do with your life now that you are no longer the caregiver of a person who is dying.
Suggestions:
- If your loved one died suddenly, get help coping with the personal traumatization you experienced and the additional reactions you have.
- If your loved one died from an illness, develop an accurate appreciation of how the illness may affect those left behind and look for ways to rejoin the world if you spent much of your time caring for this person.
Principle #8: Your grief will not unfold in a fixed sequence.
Your grief reactions will not necessarily diminish consistently over time or end within a year, and they will not resurface once they subside. Despite popular ideas to the contrary, there is no standard series of stages through which your grief must pass. Certainly, some reactions precede others (e.g., if you do not recognize the reality of your loss, then you have nothing to grieve). However, for the most part there is no rigid sequence that unfolds. Along with this, it is not true that grief reactions necessarily decrease in intensity in a straight line over time.
The ups and downs
Depending on the circumstances of your loved one's death and your own bereavement situation, your grief can fluctuate greatly. You may have ups and downs, twists and turns, and absences and presences of different reactions as time goes on. Often, bereaved people may incorrectly believe that there is something wrong with them when they feel worse after feeling better for a while. Many times, this simply reflects that they are coming out of their shock, their growing awareness of the reality of death, or the fact that others are not offering support as they had before.
Because different bereavements have such diverse patterns, it is important to get accurate information before assuming that you are not normal because your reactions are not steadily decreasing.
There are 2 other myths about grief reactions.
**1. They should be over in a year.
There is nothing magical about the one year period that so many people incorrectly believe should mark the end of their grief. Their grief reactions will calm down when the time comes for them to do so in their particular situation, not just because 365 days have passed. For some bereaved people, this will have been enough time; for others, it will not have been.
**2. Once acute grief reactions go away, they will not return.
Even after your acute grief reactions have disappeared, there may be many times in the future when certain experiences catalyze what are called "subsequent temporary grief surges" or STUG reactions. These are brief periods of acute grief over the loss of your loved one that are stimulated by something that highlights the absence of your loved one and/or resurrects memories of the death, your loved one or your feelings about the loss. Everyone can expect to experience some of these after the loss of a loved one. While they can sometimes signal problems, very often they are simply part of normal life after the loss of a loved one.
Suggestions:
- Give yourself permission for your reactions to unfold without automatically thinking you are regressing if you feel worse after feeling better.
- Build into your long-term view that your grief reactions may last longer than a year and that there will be times, long after you have stopped grieving deeply, that your grief reactions will be temporarily resurrected by events in life. This is a normal part of living with the loss of a loved one.
Principle #9: Healthy grieving does not mean "letting go" of your deceased loved one.
In our society, there is a curious social phenomenon. On the one hand, we have relationships with dead people all the time. We learn about dead people in history, we are influenced by them in philosophy, and we are moved by them in the arts. We celebrate holidays to remember them, dedicate buildings in their honor, and visit museums to see how they lived. In virtually every aspect of our lives, we are in a "relationship" with the dead.
The double standard
Yet, on the other hand, we are told that we need to "live on" and "let go and forget the past." It seems that in Western society it is acceptable to have a relationship with a dead person as long as you do not know that individual personally. This is why you might be criticized for displaying a certain photograph of your deceased loved one, but it is permissible to have Princess Diana's face on a memorial plaque hanging on the wall. Clearly, there is a double standard.
You don't have to forget the person you loved and lost. To be in healthy mourning does not mean you have to cut all ties with your deceased loved one. The ties that should be cut, over time, are those that have bound you to your loved one when he/she was alive and those that connect living people to each other. For example, it is not appropriate for you to continually expect your deceased loved one to care for you now as he/she did in the past. You can have a healthy connection with your loved one, even though that person has died, as long as that connection is such that:
- you truly acknowledge the reality of your loved one's death and what its implications are for you
- does not prevent you from adaptively moving forward in your new life
How to have healthy connections with your deceased loved one:
- talk about that person
- act on his/her concerns and values
- think about him/her
- consider his/her feelings and perspectives on issues when actions are necessary
- identify appropriately with your loved one
- use tangible objects (such as photographs, videos, mementos, clothing, prized possessions or jewelry) to be a symbolic mark of their existence in your life
- pray to your loved one
- actively recall memories
- enjoy and appreciate life for having known and loved them
- take action to ensure that he or she is remembered and/or that something meaningful comes of his or her death
Suggestions:
- Discover healthy and personally meaningful ways for you in which you can maintain appropriate connections with your loved one, recognizing that others may think this is unhealthy.
- If it is important to you, find ways to take steps that can constructively keep your loved one's memory alive.
**Principle #10: Others won't understand.
Others will not necessarily understand what you are going through or know how to reach out and support you. Despite the fact that people have lost loved ones since the beginning of time, the human race is not always very effective at comforting and supporting grieving people. This means that even though you are the one grieving, and perhaps extremely overwhelmed and exhausted, you will often have to summon the energy to educate those around you about what you are going through and how they can be helpful to you. Also, because of the amount of misinformation about grief and mourning, you must help these people get rid of the incorrect ideas so they can include the more accurate ones.
This is not to discourage you, but to allow you to better understand why some people may not be doing what you need and why their expectation may be so inaccurate. Most mistakes made by others that hurt you come from a combination of people misunderstanding your experience and trying to protect themselves from knowing what is going on because it is too painful and frightening for them.
Suggestions:
- Ask for what you need from others.
- Don't expect others to know what your needs are and what your limits should be.
Principle #11: Don't ignore children.
Because children don't respond exactly as adults do doesn't mean they don't need to be given information about death or included in family activities and discussions about it. Consistently, people underestimate their children's needs when it comes to grief.
Incorrect assumptions about grieving children:
- They don't understand.
- They don't need to be involved.
- They can easily be ignored about it.
- They are relatively oblivious to the subtle and not-so-subtle distress of others.
- They do not think or care about death and what its implications are for them and their loved ones.
Too often, this results in children not receiving the necessary communication, information and support that could help them deal with their own and others' grief and bereavement.
While it is true that children are in many ways different from adults and require adults to respond to their grief needs according to their particular levels of development, it is also true that children and adults share many things in common. Among these are the need to have their losses acknowledged and to have the support and resources that can best help them cope with their reactions to the death of their loved one.
Educate yourself
It is beyond the scope of this article to educate in depth about the needs and experiences of grieving children. Suffice it to say that it is crucial that the adults caring for the children in your life are aware of the issue of childhood grief and respond appropriately to them. Otherwise, it could interfere not only with healthy grieving, but also with the child's healthy development in general. It is also critical for adults to know that one of the most important determinants of a child's grief and bereavement is how the adults caring for a child are affected by their own grief. For these reasons, it is important to seek information about grieving children and how to help them from a well-trained physician, clergy person, counselor, funeral director or educator. Often, reputable support groups also have this information.
Suggestions:
- Operate with the knowledge that children go through grief and bereavement, and that you need to find the most effective ways to support them.
- Appropriately include children in rituals (such as funerals, memorial services, and religious ceremonies), family activities, and conversations related to your deceased loved one, but be sure to do so at levels that are developmentally appropriate for their age.
Principle #12: Many bereaved people have the wrong idea about what "recovery" means.
Even if you are grieving and mourning in the healthiest way possible, there will always be an emotional scar that marks the loss of your loved one. Learning to live healthily with that scar is the best a grieving person can hope for. Like physical scars, the scar from the loss of your loved one reveals that there has been an injury, but it does not have to interfere with current functioning. Also, like physical scars, there may sometimes be pain (for example, if the scar is bumped or the weather is bad), but in general it does not hurt or throb.
"Recovery" is a relative term.
"Recovery" after the death of a loved one should be put in quotation marks to illustrate that it is a relative term. It does not mean a final closure where you complete your grieving and never resurface. There will be numerous times throughout your life when you have the reactions mentioned above and these may be appropriate and to be expected.
It is not closure.
Closings are for businesses and bank accounts. It is not for a major loss, where the heart and mind normally reflect the idea of forgetting our loved one and ultimately seek to learn to live with our loss and adjust our lives, accordingly, in the absence of the person who is gone, but remembered. This does not mean that you would have chosen this loss or that it would not have affected you, only that you no longer have to struggle with it. He takes it in the sense of learning to live with it as an inescapable fact of his life. Like many bereaved people, you can determine that something good will come out of your loss. This is another way of giving positive meaning to what has been a negative event.
Suggestions:
- Look for specific ways in which you can transcend this event. In other words, work to make something good happen.
- In short, integrate this loss and its effects into your life story in a healthy way, but make it a chapter, perhaps the biggest and deepest chapter, and not the whole book, as it can be when it initially occurs.
Recall that the Online course is now open: Bereavement Overcoming the loss of a loved one.
**About the Authors
Dr. Rando is a clinical psychologist in Warwick, Rhode Island, and clinical director of the Institute for the Study and Treatment of Loss, which provides mental health services through psychotherapy, training, supervision, and consultation. Since 1970, she has consulted, conducted research, provided therapy, written and lectured internationally in areas related to loss, grief, illness, death and trauma.
Dr. Rando holds a doctorate in psychology from the University of Rhode Island and has received advanced training in psychotherapy and medical consultation - liaison psychiatry at Case Western Reserve University School of Medicine and University Hospitals of Cleveland. Dr. Rando has published 70 works pertaining to the clinical aspects of thanatology and serves on the Editorial Boards of Death Studies and Omega.
Dr. Rando has received numerous awards for her contributions to the field of thanatology and has appeared on numerous television programs, including "Dateline," CBS "This Morning," "Today Show," "Good Morning, America," "CNN & Time," CNBC "Upfront Tonight" and "The Oprah Winfrey Show." He has provided commentary for The Washington Post, The Wall Street Journal, The New York Times, USA Today, Newsweek and US News and World Report, among many others.
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