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Grief: what you should know

Losing a family member or friend brings on the universal phenomenon of grief, mourning or bereavement in the survivor. Grief is the normal process of coming to terms with the loss.

For grief-related resources in Pittsburgh, please see the end of this page.

Grief is not a disease but it can become one. Grieving individuals are at greater risk for infections, cardiac problems, more frequent doctor visits, alcohol abuse and depression. In fact, research has shown that if left untreated, depression that follows grief can still be present two years later.  Another problem occurs when grief is blocked, and "traumatic grief", similar to post-traumatic stress disorder, can develop.  This page is primarily devoted to the understanding of traumatic grief. 

WHAT IS GRIEF?

Grief is the painful emotional state that occurs following the loss of a close friend or family member. As human beings, close relationships regulate our physical and psychological well being. In other words, our relationships can affect our bodies as well as our minds. Therefore, when someone close to us dies, both our bodies and minds react to the loss as a threat. Grief is the natural way of coping with this threat. The grieving process helps us to adjust to life without the person who died. 

"While grieving, most people withdraw from the world and turn inward."

While grief is not the same for every person, there are certain things that most grieving people have in common. During a grieving period, the bereaved person is often preoccupied with the deceased, often yearning, longing and searching for him or her. Many grieving people also experience a host of painful emotions that can sometimes be very strong and persistent. While grieving, most people withdraw from the world and turn inward. Although these experiences - preoccupation, social withdrawal and even the painful emotions – are difficult, their purpose is to make a transition to life without our friend or family member. As this transition progresses, the intensity of grief subsides.

The other positive aspect of the grieving process is that it allows the bereaved person to take comfort in memories instead of just feeling the pain associated with the loss. This helps keep a permanent sense of connection to the person who died. 

"It is important to understand that when the intensity of grief diminishes, it does not mean that the bereaved person cares less about the person who died, or that they are betraying the memory of the deceased."

In sum, grieving helps bereaved people accept the death, re-engage in their own lives, and keep the deceased person close by. It is important to understand that when the intensity of grief diminishes, it does not mean that the bereaved person cares less about the person who died, or that they are betraying the memory of the deceased. In other words, it is possible to honor and respect a person who died, to have happy, comforting memories of them, and also to be free to find satisfaction and pleasure in a life without the deceased, including having other meaningful relationships.

Strong feelings of sadness and loneliness almost always occur following the death of a close friend or family member. Fear and anxiety are also common since death is frightening to many people. A lot of people also experience feelings of resentment, anger, and guilt. Experiencing any and/or all of these emotions following the loss of a friend or family member, is perfectly normal. However, some people find that these feelings are very strong and/or persistent, and are accompanied by certain types of disturbing ideas that seem to inhibit the natural process of gradual diminishing grief intensity. Another way of saying this is that the bereaved person becomes "stuck" in the grieving process and grief intensity remains high. When this happens the bereaved person, in a sense, loses their own life as well as that of the person who died. 

We call this condition in which unmanageably intense and/or persistent grief symptoms occur, Traumatic Grief. Traumatic Grief symptoms signal that something is blocking the resolution of feelings related to the loss.

WHAT ARE THE SYMPTOMS OF TRAUMATIC GRIEF?

For people experiencing Traumatic Grief, the death of their friend or family member has come as a shock, producing a form of trauma reaction. The sense of shock may occur even when the death is expected and follows a long illness. Shock is almost universal following a sudden, unexpected death.

 The grief trauma reaction has a number of typical components or symptoms, outlined below.

The problem with all mental disorders is that there is still some stigma attached to the idea of having one. 

"Currently Traumatic Grief is not considered a mental disorder. However, we believe this is unfair to people who suffer from this condition."

We disagree strongly with the idea that people with mental disorders are morally or personally defective. Currently Traumatic Grief is not considered an official mental disorder. However, we believe this is unfair to people who suffer from this condition. It means that the condition is not widely recognized, treatment not well developed, and insurance companies not likely to acknowledge that it exists. One reason we consider Traumatic Grief an illness is that there is evidence that physical changes, as well as psychological ones, occur. Another is that the symptoms of Traumatic Grief are not really under the bereaved person's control.  

WHAT CAUSES TRAUMATIC GRIEF?

Traumatic Grief occurs following the death of someone important to the grieving person. The way the person died does not determine whether there is Traumatic Grief. Sometimes Traumatic Grief happens after a prolonged death. Other times it occurs after a sudden unexpected death. The person who died may have been very young, very old, or somewhere in between. Depending on the circumstances of the death, the nature of the relationship between the bereaved and the deceased and other factors, the likelihood of developing Traumatic Grief will vary. The symptoms and course are unique to the person, but there are some general and very notable similarities.

"Sometimes Traumatic Grief happens after a prolonged death. Other times it occurs after a sudden unexpected death."

You might wonder, what gets people stuck? There is no one answer to this question, but we think several kinds of things can block the coping process associated with the death of a friend or family member. As noted above, if a person is psychologically run down (e.g., under stress) or has a vulnerability (e.g. already suffering from anxiety or depression or another psychiatric condition, having problems in an important relationship or experienced previous losses) this makes it more difficult to cope with the loss. Anything that causes the person's defense and coping skills to be weakened, or some specific vulnerabilities, makes grieving more difficult.

Another reason people get stuck is that they have the belief that they must continue to suffer. This belief may be stem from an idea that the end of grief means permanent loss or separation. Furthermore, the bereaved may feel that it may seem selfish to feel okay after someone close to them has died, or that they are abandoning or betraying their friend or family member if they stop grieving. Sometimes suffering seems like a way to share in the suffering of the person who died, and feel closer to the person. Sometimes there is anger or outrage about the death and the person may have a secret feeling that their own continued suffering is proof of how much damage has been done. None of these ideas is bad or "sick" or wrong. The only problem is that they can block the resolution of grief. The natural tendency to grieve until there is a successful readjustment takes over and the grief symptoms further intensify. This can be compared to the infection that occurs when the body's natural defenses keep trying to rid a person of a potent harmful organism, and in doing so, become symptoms themselves. If the death of an important person seems too terrible, the natural reactions to loss also become symptoms that interfere with other functioning, instead of helping.

However it happens, once the emotions of grief (e.g., sadness, loneliness, fear, anger, guilt, etc.) become extremely intense, they may seem unbearable. It is normal to try to avoid very intense feelings that seem intolerable. To try to cope, many people will avoid talking about the person who died or looking at photographs. They may also avoid activities or situations that remind them of the loss. Sometimes a bereaved person has the idea that others might feel uncomfortable seeing them very emotional, so they try to protect these others by remaining silent. Some people believe that distracting themselves is the best way to cope with the loss. Avoidance and distraction are perfectly normal and understandable ways of coping with very strong and unpleasant feelings, and they do help, but usually only in the short run. Unfortunately, feelings associated with very painful experiences usually do not go away by avoiding or ignoring them. Instead, they remain in your mind - a little like a field of land mines, buried under the surface, but still active. If they are triggered, the intense emotions "explode out". In addition, there is usually tension from knowing that these feelings are present under the surface. This tension, combined with the unpredictable outpouring of emotions, means that when there are hidden feelings, they tend to affect a person's whole life.

"When someone close to us dies, we must go through a healing process as well."

Traumatic Grief can also be compared to the process one undergoes when recovering from an injury or wound. If a person is in an accident or is injured in some way, their body needs to repair the injury. For example, if a person has a cut on her or his finger, the cut must heal, and it will usually hurt for awhile. When someone close to us dies, we must go through a healing process as well. If a wound became infected, the healing process may not occur as it should and thus, we would seek professional advice to heal the wound- leaving as small a scar as possible. Likewise, when the grieving process is blocked we cannot heal properly and thus may need additional treatment. In both cases, the necessary procedures may be painful, but are necessary in order to allow the healing to occur.

The important thing to realize is that when a person is having a lot of trouble accepting a loss and/or finding pleasure and satisfaction in their own life, there is a problem, and it is usually necessary to get outside help.  

For those in the Pittsburgh area, the University of Pittsburgh offers an evaluation and possible management for Traumatic Grief, as part of an ongoing research study. 

Also for those in the Pittsburgh area, you can reach the Good Grief Center, a bereavement support center: www.ggconline.org

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