Grieving after the death of a loved one: stages and advice from a psychologist

Psychologically, death is difficult to accept. Although the relatives of the deceased understand with their minds that they can no longer return their loved one from oblivion, their hearts still cannot believe in the sudden death. It just seems that a member of the household will wake up, leave his room, start a familiar conversation... And then you have to catch yourself with these thoughts, make sure that the reality is more than harsh.

When studying the phenomenon of accepting the death of a loved one, psychologists distinguish five stages. To one degree or another, everyone who has experienced an irreparable loss goes through them. Each of them has its own time period. If the next stage of accepting death is delayed for some reason, then you should be alarmed. Perhaps you or someone else who is stuck on it needs help from a third party. Ignoring such symptoms is fraught with a protracted crisis.

Stages of grief after the death of a loved one

2021-02-25

The content of the article:

Stages of accepting grief in psychology Post-traumatic stress - applicable to the death of a loved one Natural reaction to grief Pathological reactions How long to grieve - what does “too long” mean Getting out of grief Is it possible to be prepared for the death of a loved one Allow yourself to move on Help someone else cope with grief “Diary of memories”

No matter how hard you try, you cannot prepare for the death of a loved one, even if he is terminally ill. In essence, this is a biological event, the natural end of life. But we experience deep grief that breaks our hearts and changes our lives. And they deal with it differently.

But when we lose loved ones, we all go through certain stages of grief. Because every loss inevitably triggers the grieving process. Knowing all its stages will help you come to terms with reality and help others cope with grief.

Some people, after grieving for a week, return to their usual routine. Others cope after six months. For some, 20 years is not enough to come to their senses. For them, even one reminder is stress, which often turns into a pathological state.

Stage 5 – Resumption. Duration: until the second anniversary

A year without a loved one becomes a kind of milestone in the life of the bereaved. Now in his memories he focuses on three periods:

• cases from the year before last when the deceased was in good health;
• instances in the past year when the bereaved experienced a loss acutely;
• cases this year when the death of a loved one is perceived as a fact that happened.

In the second year, the mourner may experience in a mild form the same emotional impulses as a year ago. However, now it is easier for him to admit, understand and accept what happened. He knows how to deal with his aggression and guilt, tears and moments of quiet joy. If necessary, you can arrange a kind of mini-remembrance in one of the cafes in St. Petersburg. The event can be timed to coincide with Radonitsa, Parents' Saturdays, or the birthday of the deceased. The mourner simply needs to be in the circle of those who can remember the deceased with a kind word, look through photographs together, and watch videos shared with the deceased.

Stages of accepting grief in psychology

Oddly enough, psychologists believe that grief is a necessary process. There is no need to divert the attention of the mourners from a difficult life situation. They must cry, experience all the emotions that accompany bereavement, and go through the inevitable stages of grief. And here it is very important to support those who received sad news or experienced an event, but did not fully accept the fact.

Support will help them not to break down, return to life faster and with less losses - even if it is divided into “before” and “after” for them - and let go of grief. To do this, relatives need to understand at what stage of mourning their loved one is now. Psychologists identify 5-7 most common stages. However, each of them can last differently.

Shock

. The most common emotion. It is experienced in different ways. Some, having closed themselves off, hide the things of the deceased, because the slightest reminder of him causes severe suffering and pain, or they do not change anything in his room. Others, having fallen into a stupor, remain silent or cry, forgetting about food, children and work. Still others are isolated or actively involved in funerals. But emotion is saving, because... is a kind of self-defense. Unless, of course, it drags on for a long time and does not turn into depression, for example.

Negation.

Non-acceptance of death, protest can begin earlier than shock, go in parallel with it and other stages, or appear later. But the death of a loved one is denied in different ways. To the point of categorically challenging a tragic fact, postponing the funeral (“Let him stay a while longer, we’ll have time to bury…”) or behavior that is illogical in relation to the deceased (setting the table for him, putting his things in bed, “noticing” him in the crowd, etc.). Why is this and why, why him and not me - these and other questions and guilt do not leave after the death of a loved one. “Survivor guilt” is a psychological term for this difficult feeling. It manifests itself especially clearly after the death of the closest people. In order for an awareness of the situation to come and the reasons for their departure to be found, the person exposes himself, remembers how he was rude or upset the deceased, did not ask for forgiveness, etc. Unfortunately, some live with this for years.

Anger

. The grieving person unleashes his anger and aggression on many, alternating with denial and shock. He grieves that he is alone in his misfortune, that no one helps or sympathizes with him. He quarrels with friends, colleagues, family. Angry at himself. Swears at Heaven. And he even switches to the deceased, whose death supposedly destroyed the rosy plans. Yes, it’s a bad state, but it’s better than withdrawing into oneself. After all, all accumulated negative emotions spill out through anger.

Bargain

. This reaction to what happened is an escape from pain. The grieving person seems to be trying to make a deal with the given. He plays out different situations, often associated with an obsessive “if only”. (“If I do such and such, it will bring him back...”, “If I were there...”, etc.), and tries to answer. Yes, the stage is exhausting, and let him bargain. After all, this helps not only to realize that the dead do not return, but also to survive what happened and regain a sense of control.

Sadness

or depression. It usually replaces the previous stages. It’s difficult for those who withdraw into themselves and don’t show emotions in public. Exhausting himself from the inside with a feeling of sadness, emptiness, losing control over himself, a person no longer believes that he can return to normal life. He doesn't need sympathy. He's gloomy. Avoids any contact. By suppressing feelings, he accumulates negative energy and feels even more unhappy. Psychologists note that alienation is natural during the period of grief, but prolonged alienation is dangerous.

Adoption

. Time passes, and the understanding that the dead will not return has appeared. But if someone manages to accept grief at the very beginning, then someone, after the second or fourth stage, comes to terms with the grave loss. The main thing is that, having received the necessary support, a person gains clarity and a feeling that he can pull himself together and direct his life in the right direction. All the experiences that have taken possession of him up to this point will gradually weaken. And the mourner himself will feel relief and will gradually restore the destroyed social connections, make new ones, etc. Again, this takes a different amount of time for everyone because everyone experiences grief differently. Believers experience grief differently, knowing that death is a transition to another existence.

What else is important? All this is a generalized behavioral model. No one can say how long this or that stage will last. On average, experts say, it takes one and a half to two years to get through the situation normally. Moreover, a person can live in two dimensions - either return to the past, where his loved one was and where he died, or live in this time.

Another question is how not to cross the dangerous line - when the post-traumatic state, in which people often self-destruct, turns into a clinical pathology.

Stage 3 – Adaptation. Duration: up to six months

The first six months there is a process of adaptation. It’s as if a person is learning to live without the deceased. And since the steps are painful, during this period you can often observe a change in mood. A quiet and calm existence can be interrupted for 2-3 days by obvious aggression and anger towards the deceased. In the first six months, you can hear accusations against the deceased, accompanying circumstances, or third-party people allegedly responsible for the death of a dear person. All this - guilt towards the deceased, anger at him, oneself and others should be considered natural reactions. There is no need to be ashamed or afraid of them. If there is a person with whom you can discuss these phenomena - a St. Petersburg psychologist, a relative or a close friend - it is better to do so. Recognizing the normality of such phenomena is the next step towards accepting the death of a loved one. Playing out such scenarios over and over again gradually distances the deceased from the world of the living, and the realization comes that he is already in other worlds.

Post-traumatic stress – applicable to the death of a loved one

Psychiatrists and psychologists talk about two types of reactions to acute grief in people after the death of a loved one.

Natural reaction to grief

It is generally accepted that if loved ones worry “too much,” then there is “something wrong” with them. No, they're fine. It makes those around them uncomfortable. It would be strange if a person, having received terrible news, would smile, and not be sad, not grieve. “Normal” grief (and there is such a term in psychology) consists of the following reaction:

• physical suffering (tightness in the chest, weakness, spasms in the throat, etc.);
• behavioral problems (hurried or slow speech, inconsistency in actions and thoughts, loss of interest in everything, insomnia, etc.);
• cognitive signs (confused thoughts, self-doubt, problems with attention);
• emotional symptoms (feelings of guilt, loneliness, helplessness).

Pathological reactions

Where does normal grief end and complicated grief begin? Where the death of a loved one is experienced too hard and for a long time (people get stuck, fixating on one state) or where grief destroys those grieving or those around them. Then note:

1. stupor;
2. paranoid reaction to loss;
3. rash decisions;
4. health problems that are life-threatening or severely harmful.

In a situation that could lead to death from grief, you should seek help from doctors, psychologists or psychotherapists.

Stage 4 – Consolation. Duration: until the first anniversary

At the fourth stage, when a person has learned to live without the deceased in everyday matters, peace comes to the soul. Quiet, calm memories and leafing through photo albums no longer bring tears. New cases from the past come to mind. The negativity when thinking about the deceased goes away, all that remains is a quiet recognition of the fact that a loved one has died.

Otherwise, this period can be called “light sadness.” The mourner seems to be nostalgic for past times, but accepts life as it is. This is largely facilitated by the situation, which often remains the same as it was during the life of the deceased. At the same time, past experiences are now perceived more calmly, with a certain quiet joy and peace.

How long to grieve – what does “too long” mean?

Grief lasts differently for everyone. On average, shock and denial of loss takes from a day to several weeks. Many return to their business after 2-5 weeks. But after the loss of those closest to them, relatives begin to show signs of acute grief from the loss. They experience longing, grief, and anger for a very long time. The period of helplessness lasts 3-12 months.

Too long is when someone is stuck grieving for up to six months. Some people do not get out of their state even by the anniversary of the funeral, and even after dozens of years.

Signs when you should seek help

Here are a few signs that you should seek help from a psychologist, and possibly a psychiatrist, to prescribe antidepressants. These signs are normal for the first stage of grief, but if more than six months have passed and they do not go away and/or increase, you should seek help:

• When you can't cry at all. Tears are needed not only for psychological release, they remove stress hormones from the body; if you lock up emotions and do not give them a way out, this can in the long run lead to serious physical diseases such as heart attack, stroke, problems with the digestive system, chronic muscle pain .
• You have a constant loss of energy and low mood. As we said, for the first stage of grief this is absolutely normal and natural, but as time passes, strength and mood should gradually return to normal levels. If this does not happen, this condition may indicate depression and require the use of antidepressants.
• The dream has changed. You are haunted by insomnia or, conversely, irresistible drowsiness. It could also be a sign of depression
• Appetite has changed. Refusal to eat or the inability to stop eating is also a symptom of depression.
• Social isolation. At first, withdrawal and reluctance to communicate are normal, but over time, persistent refusal of society, especially if you previously liked to be in company, is a reason to talk about it with a psychologist
• Refusal to take care of yourself is also a sign of depression
• Suicidal thoughts. If you clearly understand that life will never be the same and the best way out is to end it once and for all, immediately consult a psychiatrist.

Important If trouble has befallen your loved one, and you observe any of the above in him, convince him to seek help.

Way out of grief

The person is forced to accept what happened. But grieving is a long process. It must be lived to the end in order to realize not only the loss itself, but also that it is time to return to life, to return to yourself. Therefore, we need to get together and at the same time:

• think about yourself and your health;
• give vent to your feelings and emotions through, for example, creativity, tourism, etc.;
• do not set boundaries for grief;
• do not delve into the past;
• be distracted by the living (children or parents, relatives and friends);
• accept outside support.

Fifth stage – Repetition of all stages

This stage continues until the end of the second year. The anniversary of death revives the pain of loss with renewed vigor, but the skill of managing grief has already been formed and experiencing outbursts of grief is much easier. After 1.5 years, a feeling of guilt towards the deceased may again arise, so during this period it is worth turning more to the bright memory and pleasant memories, you can arrange a dinner for loved ones, relatives and friends of the deceased.

And even if all stages have been completed, the person may need your sincere help and moral support.

Is it possible to be prepared for the death of a loved one?

Is it possible to be prepared for a stunning tragedy that leaves scars on the soul for life? You don’t get used to death, especially if it’s your first time or even if you know about its inevitability. But psychological preparation is possible.

1. It is advisable to spend more time with a terminally ill person. Let him talk about what is important to him. If he is unconscious, talk in front of him about what has not yet been told to him, etc. He can hear you.
2. Convince a relative whose work involves a risk to his life to move to another place. But if his work is important to him, just be with him more often.
3. With elderly relatives, like with all people, this will also happen. This must be taken as a given. Pay more attention to them, listen to their stories, take an interest in their lives, give advice.
4. Death is always unexpected. But you have to accept the fact. And the sooner, the easier it will be to recover from the blow. Pray for the repose of the deceased, talk about him with those who knew him, apologize to the deceased, tell him everything you would like to say during your lifetime.

Stage 2 – Rejection. Duration: about 40 days

The second stage lasts a little over a month. It is not surprising that in Orthodoxy this period of accepting death is associated with 40 days. Rejection of what happened is the main feature of this time period. It is difficult for a person to realize that a loved one has left him. This is why various types of hallucinations are frequent - auditory, visual, tactile. Even a similar smell, when going through the things of the deceased, begins to restore pictures of the past in the subconscious. As if the deceased was about to enter the open door, returning from a store in St. Petersburg.

Often at this stage there are dreams with the deceased. Moreover, they are so real that the living person cannot come to his senses for some time after waking up. This kind of reaction is quite natural for a person experiencing grief. And the closer and dearer the deceased was to the mourner, the stronger the pain of loss will be felt.

Allow yourself to move on with your life

The living have no alternative. We must live on, building a new life and way of life in which the deceased no longer exists. But how to start enjoying life again! Is it really possible to become happy or fall in love again, because the memories are so fresh, and grief and guilt do not leave you?

We need to start helping ourselves get over what happened. It is important to understand yourself, forgive yourself, decide on your attitude towards the deceased, build your life and become happy.

• Don't feel sorry for yourself.
• Don't dwell on grief.
• Don't forbid yourself to live. There will be no second life, so enjoy it now.
• Don't be ashamed of happiness. Give it to others.
• Don't be afraid to love. Those who left this world definitely want you to live long and be happy.
• Help others by giving them some of your warmth.
• Once you admit your mistakes, apologize to those you have wronged and make amends.

All this, when the grief of loss is mourned, accepted and fully experienced, will help fill life with new colors. After all, the main assistant is time.

Help someone else cope with grief

Helping people survive a tragedy is not so easy, but it is possible. It is important to know how to help, what to do at each stage of grief. Without support and sympathy, it will be difficult for the grieving person to get through the dark period of life.

1. If you are delivering terrible news, be close to him. Don’t speak right away, prepare first. And don’t leave him alone with a sedative at the ready.
2. Don't leave him if he wants to tell his friends and family this news.
3. Provide assistance in organizing the funeral and everything connected with it.
4. Help in going through all stages of grief, find sincere words, making it clear that the mourner is not alone and that a reliable shoulder is nearby.
5. Don't pretend nothing happened. Just support - in word and deed.
6. After a temporary period of relief, pain and sadness may return. Try to be around more often, if the person wants it, talk to him about something neutral or about the deceased, but don’t force him to say or do something against his will.

The main thing is to respect the mourner's right to all his reactions caused by death, even if he starts breaking dishes. You need to throw out your grief and cry!

How to cope with loss and grief

Grief is a natural reaction to loss. This is the intense emotional process of suffering that a person experiences when something or someone who is loved or very important is taken away from him. Loss can affect not only another person, but also categories such as health, abilities, prospects, hope, freedom, work, funds, home or homeland. Almost every person goes through losses and the grief associated with them, each time learning to live anew, without what was so dear to them. Gradually, the pain becomes less and less, the grief decreases, and the person who has coped with the experience of loss begins to live again, rejoicing in what he has, what he can still gain, or simply from the awareness of the fact of his existence in this world.

But, in the beginning, people in a state of grief feel that the pain of loss can be insurmountable. A person in this state may experience complex and unexpected emotions: from shock or anger to disbelief, guilt and deep sadness. The pain of grief can also undermine physical health, making it difficult to sleep, eat properly, and think properly. Severe grief can manifest itself in a rich range of negative bodily manifestations, which usually come in periodic attacks (lasting from a quarter of an hour to a little over an hour). During attacks of grief, a person feels that he does not have enough air, he breathes quickly, constantly sighs, a “lump rolls up in his throat,” a “pulling emptiness” is felt in his stomach, muscle strength is lost (exhaustion and exhaustion), while the body feels like “ binds,” and the soul experiences almost physical pain and tension. During attacks of grief, certain changes in consciousness may occur: a feeling of unreality of what is happening, as if it were a “movie” about someone else, the effect of observing oneself from the outside, a feeling of “emptiness inside,” dullness or absence of emotions, disorganization of purposeful activities. In some cases, visual, auditory or combined illusions may arise - a person will “see”, “hear” or “perceive” in another way the presence of the object of loss. It is also possible to identify oneself with the deceased when the mourner takes on individual traits and characteristics of the deceased. In relationships, most often, the person experiencing grief increases the distance and sharply reduces the intensity of interaction, although at certain stages of grief the opposite effect is possible. When communicating, irritability and hostility may appear. Feelings of guilt often arise.

Grief attacks are more common from time to time, especially when someone or something suddenly reminds you of the loss.

And all this is a completely normal reaction to loss: and the greater the loss, the greater the grief will be.

What Causes Grief?

Coping with the loss of someone or something you love is one of the biggest challenges in life that the vast majority of people go through. The death of a loved one is usually the cause of the most severe grief, but any other loss or bereavement can also cause it:

• Divorce or breakup
• Loss of health
• Job loss
• Loss of financial stability
• Artificial or spontaneous termination of pregnancy
• Retirement
• Death of a pet
• Loss of a cherished dream
• Serious illness of a loved one
• Loss of friendship
• Loss of security
• Selling a family home
• Loss of freedom
• Loss of abilities, skills

Even minor life losses can cause feelings of grief. For example, grief can overwhelm a person when moving to another city or country, after graduating from an educational institution, or when changing jobs. A loss that can cause acute grief does not have to be irrevocable, such as death. Severe grief can be caused by even a temporary loss, not only real, but even imaginary.

Whatever the loss, it is always very personal, so there is no need to be ashamed of your feelings and believe that you can only grieve about the death of loved ones. If a relationship, a pet, or even a certain situation was important, then it is completely normal to grieve a loss that a person feels so strongly about.

However, whatever the cause of grief, there are healthy ways to cope with heartache that, over time, can ease the sadness and help you come to terms with the loss, find new meaning, and ultimately move on with your life.

The grieving process and the work of grief

Grief is only an individual experience: there is no right or wrong way to grieve. How a person grieves depends on many factors, including personality strength, coping styles, life experiences, faith, and how significant the loss was. The grieving process itself takes time, as healing occurs gradually and cannot be accelerated. Some people begin to feel better within a few weeks or months of their loss, while others continue to grieve for many years.

The process of normal recovery after loss is ensured by the so-called “grief work.” This is a kind of psychological adaptation of a person to a new life in conditions that have objectively or subjectively changed for him, liberation from a state of dependence on what was lost, the formation of new goals and new relationships. The process of grief work performs a number of psychotherapeutic tasks:

1. Helps you accept the reality of loss at the level of feelings (not just with your mind).

2. Helps to survive pain so that it does not transform into painful symptoms.

3. Creates a new identity for a person, helps him find his place in the world.

4. Promotes the transfer of energy from holding losses to the creative aspects of life.

Stages of the normal course of grief (according to Elisabeth Kübler-Ross, 1969)

The model was made famous by Swiss-American psychiatrist Dr. Elisabeth Kübler-Ross, who described her in her 1969 book On Death and Dying, which was inspired by her work with terminally ill patients. These stages are only a reflection of how people typically cope with illness and death, not a reflection of how people grieve. Moreover, this model was described back in the 1940s by such authors as Erich Lindemann, Colleen Murray Parks and John Bowlby. In a book co-written with David Kessler and published posthumously (D. Kessler. Finding Meaning: The Sixth Stage of Grief. Simon and Schuster, 2019), Kübler-Ross expanded her model to include any form of personal loss, such as the death of a loved one, loss of a job or income, relationship breakup or divorce, drug addiction, incarceration, the onset of illness, an infertility diagnosis, and even minor losses such as loss of insurance coverage. Kessler also proposed "Meaning" as the sixth stage of grief and reiterated that the stages of grief are not a linear graph that may have a "norm."

1. Shock + Denial: The shock of the loss suffered and the denial to believe in the reality of what happened can last from a few seconds to several weeks, on average 7-9 days.

“This can’t happen to me.” This phase of disbelief in the reality of the loss, the desire to return the deceased and denial of the irrevocability of the loss can last longer than the first shock stage. In the immediate aftermath of a loss, it can be difficult to accept what happened. The person may not believe that the loss actually occurred or may even deny the truth. A bereaved person may even think that he sees the deceased in a crowd on the street or hears his footsteps in the next room.

2. Anger (aggression): “Why is this happening to me? Who is guilty?". This stage lasts up to 6-7 weeks from the moment of loss, although being stuck in this stage can continue for years. It is expressed in the form of indignation, hostility towards others, in blaming oneself, relatives, friends, and the attending physician for the death of a loved one.

3. Bargaining: “Make sure this doesn’t happen, and in return I will ____.” At this stage, the work of mystical thinking is manifested, faith in miracles is strong (which is actively used by priests, sorcerers, mediums, etc., exploiting grieving people), the hope of somehow returning the deceased does not disappear, and the mourner “meets” him or leads him act as if he were about to appear. You can find statements from children: “if I behave well, he will come back, etc.”

4. Depression: “I’m too sad to do anything.” About six months after the loss, the stage of depression begins. Particularly painful are periods associated with loss (holidays, birthdays, common dates), and everyday difficulties. At this stage, awareness of the loss begins, so melancholy, withdrawal into oneself, and a pessimistic view of the future appear. Deep sadness is probably the most common symptom of grief. The bereaved may experience feelings of emptiness, despair, sadness, or deep loneliness, cry a lot, or feel emotionally unstable.

Often there is a feeling of guilt . A person may regret or feel guilty about something they did or didn’t do or didn’t say. It is not uncommon to feel guilty because of the sense of relief experienced when a person has died after a long, serious illness. It is possible to feel guilty that something was not done to prevent the death, even if it could not have been prevented at all.

A significant loss can cause a lot of anxiety and fear. The person may feel anxious, helpless, or uncertain. There may even be panic attacks. The death of a loved one may raise concerns about one's own mortality, facing life without that person, or responsibilities that will now have to be dealt with alone.

This stage accounts for much of the work of grief, and suicidal thoughts and behavior may arise during this stage.

5. Acceptance: “I have come to terms with what happened.” Acceptance includes not only coming to terms with the loss, but also understanding that with the loss, one’s own life has not lost its meaning. During this period, physiological functions and professional activities are restored. The person gradually comes to terms with the fact of loss. He still experiences grief, but his attacks are becoming less frequent and less intense.

6. Meaning (D. Kessler): the stage of finding hope and new meanings in life.

Anyone who experiences such experiences needs to know that all reactions are completely natural, and that over time the grief will lessen and pass. However, not everyone who grieves will have to go through all these stages—and that’s okay, too. Contrary to popular belief, a person does not need to experience every stage of grief work in order to heal.

Kübler-Ross herself, in her last book before her death in 2004, said this about the five stages of grief: “... there is no typical reaction to loss, because there is no typical loss. Our grief is as individual as our lives.” In fact, some people resolve grief without going through any of these stages, or by skipping stages. Therefore, you don’t need to worry about going through them clearly and sequentially and about what you “should” feel at each stage.

Disruptions to the normal functioning of grief

If the normal process of grief is disrupted, for example, when a person tries to avoid difficult experiences, does not want to come to terms with the loss, then the duration of stay in a state of grief can be significantly prolonged, and grief can take on a pathological form, and instead of gaining hopes and new meanings, the person may find himself and a severe crisis. Existing myths about grief play a significant role in the formation of pathological grief:

Myth: Heartache will go away faster if you ignore it.

Fact: Trying to ignore your pain or stop yourself from expressing it will only make it worse in the long run. True healing requires accepting your grief and actively dealing with it.

Myth: It is important to “be strong” in the face of loss.

Fact: Feelings of sadness, fear, or loneliness are normal reactions to loss. Crying is not a sign of weakness. There is no need to “defend” your family or friends by being brave. Only acknowledging and expressing your true feelings can help everyone.

Myth: If there are no tears, then there are no regrets about the loss.

Fact: Crying is a normal reaction, but not the only one. Those who don't cry can feel pain just as deeply as others. They may simply have other ways of showing it.

Myth: The mourning period should usually last about a year.

Fact: There is no specific time frame for the grief process. How long this will take depends on the individual.

Myth: Moving on with your life means forgetting about your loss.

Fact: Moving forward means accepting the loss, but it is not the same as ignoring or “forgetting.” A person can move on with their life and hold on to the memory of someone or something they lost as an important part of themselves. In fact, as people move forward in life, these memories can become an integral and important part of the self.

Painful (pathological) grief reactions

Grief is a normal process that helps restore personal integrity after a bereavement. However, if the normal grieving process is prolonged, grief can become a “disease” and its healthy function of processing psychological trauma and adapting to new living conditions can be disrupted. In this case, the person who has experienced the loss is, as it were, “delayed” at a certain stage of the work of grief. Most often this occurs at the stage of acute grief (loss syndrome).

Complicated grief. The sadness of losing a loved one never completely goes away, but it should not remain the focus. If the pain of loss is so constant and intense that it prevents you from resuming normal life, you may have a condition known as complicated grief. Complicated grief is similar to a state of intense grief. In this state, one may have trouble accepting death long after it has occurred. Or the sufferer is so preoccupied with the person who has died that it disrupts his daily life and undermines his relationships with other people.

Symptoms of complicated grief include:

• Intense longing and longing for a deceased loved one
• Intrusive thoughts or images of a loved one
• Denial of death or feelings of disbelief
• Fantasies that the beloved is still alive
• Searching for a deceased loved one in familiar places
• Avoiding things that remind you of your loved one
• Extreme anger or bitterness over a loss
• Feeling that life is empty or meaningless

If the death of a loved one was sudden, violent, or otherwise extremely traumatic, complex grief may manifest as acute stress disorder or post-traumatic stress disorder (PTSD). If extremely distressing experiences do not subside within 72 hours, you may have developed an acute stress disorder that requires help from a mental health professional. If more than 30 days have passed, and the symptoms have been joined by nightmares, excessive reactions (aggression), dulling of emotions, strange sensations of falling out of the world, time or body, memory and attention disorders, constant returns to images of the lost, cravings for alcohol or medications, then Acute post-traumatic disorder may have developed. PTSD always requires the help of a doctor to prevent the disease from becoming chronic.

Delaying the grief reaction. This situation is possible when the loss finds a person in the process of a very responsible job or function, the need to help others who are less resilient. In this case, the grief reaction occurs, but later, when the dominant situation is resolved. In this case, the grief reaction can catch a person “out of the blue” at the most unexpected moment for others, sometimes years after the loss.

Chronic grief. In this case, the psychological trauma is not processed, or it proceeds too slowly. Acute grief syndrome in such cases can occur even years later when reminded of the loss.

Distorted grief reactions. Losses are an integral part of the life of almost every person. However, bereavement can destroy the protective illusions of control and safety of life, blur personal boundaries, which leads to the transformation of the process of grief into the development of illness: These options include:

• Hyperactivity, search for thrills and risks, sometimes even fatal.
• The appearance of symptoms of the disease, repetition of dangerous situations that led to the death of a significant person.
• The appearance of psychosomatic diseases (asthma, peptic ulcer, hypertension, ulcerative colitis, tumors, diabetes mellitus).
• Social isolation, aggressiveness, paranoid tendencies.
• Self-destructive behavior, self-punishment leading to agitated depression with a risk of suicide.
• Conflicted (exaggerated) grief. Most often it is characterized by a distortion towards increased feelings of guilt and anger, which can form a pathological vicious circle of reactions that do not allow one to process the loss. The exit from the state is likely to involve a stage of euphoria, which turns into depression.

Suppressed or absent grief. In this case, symptoms of grief may not be externally observed. In this case, a person can completely deny the loss or mask his experiences. In these cases, suppressed or denied experiences often manifest themselves in the form of psychosomatic diseases, including acute ones.

Distorted, painful forms of grief reactions most often require psychological and sometimes psychiatric help. However, they pass, and grief returns to its normal course, which over time adapts a person to a new life after a significant loss.

How to cope with loss and subsequent grief?

Although the grief of loss or loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and ultimately find a way to put yourself back together from the pieces so you can move on with your life.

Acknowledge your pain. Accept that grief can bring up many different and unexpected difficult emotions. Understand that your own grieving process will be unique. Seek personal support from people who care about you. Support yourself emotionally while taking care of yourself physically. Know the difference between grief and depression.

Look for support! Experiencing heartache during grief can often make you want to withdraw from other people and withdraw within yourself. But personal support from others is vital to healing from loss. Even if you don't feel comfortable talking about your feelings under normal circumstances, it's important to express them when you're grieving. Although sharing your grief with someone can make you feel better, it doesn't mean you have to talk about your loss every time you interact with friends and family. You can get support even just by being close to those who care about you. The main thing is not to isolate yourself.

Reach out to friends and family members. It's time to rely on people who care about you, even if you usually pride yourself on being strong and self-sufficient. Instead of avoiding them, spend time with them and accept the help they offer. People often want to help but don't know how, so tell them what you need - whether it's a shoulder to cry on, help with funeral arrangements, or just someone to talk to. If you don't feel like you have someone you can connect with regularly in person, it's never too late to make new friends or get involved in bereavement therapy groups.

Please note that many people feel uncomfortable trying to comfort the bereaved. Grief can be confusing and sometimes frightening for many people, especially if they have not yet experienced a similar loss themselves. They may not know how to comfort you and end up saying or doing the wrong things. But don't use this as an excuse to withdraw into yourself and avoid social contact. If a friend or acquaintance contacts you, even if it is incorrect or incorrect from your point of view, it is only because they care.

Find comfort in faith. If you follow a religious tradition, do not deny yourself the comfort that its mourning rituals or fellowship with your faith brothers and sisters and spiritual director can provide. Spiritual activities that are meaningful to you—such as prayer, meditation, or going to church—can bring comfort.

Join a support group . Grief most often gives rise to a deep feeling of loneliness, even when there are loved ones nearby. Sharing your sadness with others who have experienced similar losses can help you get your life back on track.

Talk to a specialist. If your grief seems unbearable, find a mental health professional with experience in grief counseling. An experienced psychologist can help you cope with strong emotions and overcome obstacles to your healing.

Using social media for support . Memorial pages on Facebook and other social media have become a popular way to inform a wide audience about the passing of a loved one and seek support. These pages not only allow you to share practical information such as funeral plans, but also allow friends and family to post their own condolences and memories. Reading such messages can often bring comfort to those experiencing loss. For privacy reasons, it is better to make such groups or pages private.

Take care of yourself while you grieve. When you're grieving, it's more important than ever to take care of yourself. Severe stress can quickly drain your energy and emotional resources. Taking care of your physical and emotional needs will help you get through this difficult time. The mind and body are closely connected. When you feel healthy, you cope better emotionally. Combat stress and fatigue by getting enough sleep, eating right and exercising. Don't use alcohol or drugs to numb the pain of grief or artificially elevate your mood.

Face your experiences. You can try to suppress your grief, but you can't avoid it forever. To heal, you must acknowledge the pain. Trying to avoid feelings of sadness and denying the loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse and other health problems.

Express your feelings in tangible or creative ways . Write about your loss in a journal. If you've lost a loved one, write a letter saying all the things you never should have said, and create a scrapbook and photo album dedicated to the person's life. You can continue the work started by the departed, or do what he wanted to do, but did not have time.

Try to maintain your hobbies and interests. Returning to activities that bring you joy and bring you closer to others can help you come to terms with the loss and help the grieving process.

Personal boundaries. Don't let anyone tell you how to feel and don't tell yourself how to feel. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Allow yourself to feel whatever you feel without embarrassment or judgment, accepting yourself as you are. It's okay to be angry, scream at the skies, cry a lot, or not cry at all. It's also okay to laugh, find moments of joy, and let go of loss when you're ready.

Plan to meet grief triggers. Anniversaries, holidays and memorials can awaken memories and feelings. Be prepared for emotional turmoil and know that this is completely normal. If you share a holiday or memorial event with other relatives, talk to them in advance about their expectations and agree on strategies for remembering the deceased.

Let go of the loss. In case of prolonged denial of the fact of loss, fixation on the lost, the Founder of Gestalt therapy, Fritz Perls, developed a five-step scheme for saying goodbye to the departed person:

1 . Acceptance of the fact of loss. Many, being completely healthy adults, do not agree to admit that what happened really happened: that this person really died, that he really moved to live in another country, that the divorce really happened, that his job was lost, etc. . Thus, the psyche tries to protect itself from trauma. It is necessary to face the facts of loss and acknowledge them. Although this is scary, the result will bring relief, as grief that has been stuck in denial can finally continue its healing work.

2. Unfinished business. Unfinished business often gets in the way of letting go of a loss. Analyze what prevents you from saying goodbye to the departed. All these things can be completed in your imagination or played out in reality. Sometimes you need to talk seriously about something, express some feelings, go fishing with him or go to some special place.

3. Farewell ceremony . When all the unfinished business is completed, and you are ready to say goodbye for real, you can imagine or perform a farewell ceremony or ritual, the result of which should be a final recognition and farewell: “You are dead. Goodbye!" Let him go, allowing him to find peace and happiness in another life.

4. Mourning. After saying goodbye, try to cry all the tears you can. It is good and natural to cry, it helps the work of grief to heal your soul. If tears do not want to appear, try a paradoxical tactic, telling yourself that you will not allow the tears to flow, by doing everything in your power to prevent their appearance. Usually, holding back tears ends in soul-cleansing crying.

5. Greetings to today. After mourning, you can move on to a new life and today's affairs. Friends or members of a therapy group can help here. Here you will need distracting activities and conversations, rest, self-care, and, importantly, care for other people. You can even hold an imaginary ceremony to welcome the present day. Imagine a new day, so fresh and sunny, washed by the rain, and welcome it by opening your arms to it...

Difference between grief and depression

It's not always easy to differentiate grief from clinical depression as they share many symptoms, but there are ways to tell the difference. Remember that grief can be a rollercoaster ride. It includes a wide range of emotions and a mix of good and bad days. Even when you experience grief, you will all have moments of pleasure or happiness. With depression, the feeling of emptiness and despair is constant. Other symptoms that indicate depression, not just grief, include:

• Intense, pervasive feelings of guilt
• Suicidal thoughts or preoccupation with death
• Feelings of hopelessness or worthlessness
• Slow speech and body movements
• Inability to function normally at home, work or school
• The ability to see or hear something that is not there

Can Antidepressants Help Grief?

As a rule, ordinary grief does not require taking antidepressants. While medications can relieve some of the symptoms of grief, they cannot address the root cause, which is the loss itself. In addition, by easing the pain that needs to be overcome, antidepressants delay the process of grief and only delay the moment of healing.

When to Seek Professional Help for Grief

If you are experiencing symptoms of severe grief or clinical depression, see a psychiatrist right away. If left untreated, severe grief and depression can lead to significant emotional damage and life-threatening health problems. But treatment can help you get better. Contact a mental health professional if you:

• Feel like life isn't worth living
• Do you want to die with your loved one?
• Blame yourself for the loss or for not being able to prevent it
• Feeling empty and isolated from others for more than two to three weeks
• Find it difficult to trust others after a loss
• Unable to carry out your normal daily activities

If it may be difficult for you to cope with existing problems on your own, you can always seek professional psychological help.

Andrey Demkin