When grief becomes complicated

Explaining Complicated Grief

Grief, even acute grief, is a natural response to loss and is different for everyone.  How we grieve largely depends on the nature of the loss, our personality, prior experiences of loss, beliefs, gender socialization and cultural norms and so on.

For most people, grief intensity is lower after six months.  It does not mean that their grief is over, but that is has become better integrated and no longer stands in the way of ongoing life.  There are certain thoughts and feelings that are predictable in the journey of grief, such as sadness and yearning and frequently thinking about the lost person, particularly in the early days.    A bereaved person can feel like their world has been turned upside down and they are often find it difficult to concentrate, or focus on anything or even care about anything other than their loss.  They may need or want other people around them either more or less and find it hard to engage as they might have before.   Grief hurts, but as painful as it is, it is Nature’s way of giving us time to mourn if we let it.

The Importance of Mourning

Over time our grief changes.  At the start it can be very frequent and intense but as time goes on, it becomes re-shaped and integrated.  The loss is permanent and so is our grief but it becomes quieter and we begin to remember our loss but in a way that doesn’t unduly upset us, most of time anyway.

Research tells us that this process of integrating our loss is about moving in and out of it, whereby sometimes we are in the loss and sometimes we are just getting on with our ‘new’ life.  In essence, we turn into our grief and then we turn away from it and we call this ‘dosage’. Again, this is over time and can be accompanied by thoughts such as ‘will I ever get over this?’ and feelings such as guilt for having not thought about the lost person all day as if not having thought of them meant something bad.  It is merely a natural way of learning to live with what has happened.   The bond we have with the lost person is permanent anyway.  We will never forget them because our brains are hardwired that way.  We don’t “let them go”.  Instead, we create memories of them as a way to stay connected and this can be a comfort.

In death and bereavement, there is practical side to mourning too as we adjust to changes that have occurred as a result of the loss.  This can range from household tasks, finding ways to spend our time or finding someone new as a confidante.   We also need to figure out ways to go back into our memories and feelings about the person who has died, including their death and rethink thoughts that might be very painful.  It is not easy but again over time, we do find ways to do it.

When Grief Becomes Complicated Grief

There is both a practical and an emotional response to loss as outlined above and they are all perfectly natural.  However, in about 10% of all grieving, people will find that they cannot accept the reality of the loss, even though they know it has happened.   They see their grief as a problem and a block to them ‘moving on’ instead of something normal.   Their self-care and caring about anything is limited (although this is natural for a while, with complicated grief, it endures).   The feeling of grief might remain intense for some people and their sadness and yearning leave them believing they will never be happy again.  It is common for them to describe their grief as ‘stuck’ and this is what is called Complicated Grief  (CG).  Mourning is a natural healing process but with a person who has CG, it is like a wound has become infected and will need treatment for healing to occur.

How Thinking Can Complicate Grief

There are certain thoughts and feelings that can feel like poking at the wound, making it worse instead of better.   Thoughts such as “I wish we had”  or ‘If only ….” can lead to rumination (when the focused attention is on the symptoms of distress, and on its possible causes and consequences, as opposed to its solutions).  This is quite different to thinking about your loss in a way that helps us to make sense of it over time.  Rumination, on the other hand, is an avoidance of the reality of the loss.   The energy that goes into ruminating keeps us stuck.

Other Symptoms of Complicated Grief

Other symptoms common with CG are excessive staying away from any reminders of the death, such as avoiding going to places where you would once go together, not going through their belongings for sorting out, keeping things just as they were when they were alive.  It is understandably a way to avoid pain but the reality is that grief is painful and we do need some dosage of pain in order to make meaning that will help us to integrate it.   The instinct might be that if we avoid anything painful it might just go away of its own accord but we end up carrying it anyway.  It can isolate us from others and affect our health and well-being in the longer term.

If you feel you might have CG and you have been bereaved longer than six months, it is possible to have it assessed professionally.

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