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Healthy/Unhealthy Grief

Symptoms of Unresolved Grief 1

(Note: there are problems with use of the word “unresolved”)
These symptoms are considered normal during the acute stages of grief.
However the more symptoms that persist, the stronger the likelihood of unresolved grief.

  1. Over-activity without a sense of loss
  2. Emulating mannerisms or symptoms of the person who died
  3. Psychosomatic medical illness
  4. Changes in relationships with friends and relatives
  5. Furious hostility
  6. Lack of emotion
  7. Acts detrimental to social and economic existence
  8. Agitated depression with tension, insomnia, feelings of worthlessness, bitter self-accusation, need for self-punishment
  9. Continued daily searching—years later
  10. Inability to discuss the deceased without crying or having the voice crack
  11. Continued panic attacks, fear of choking, shortness of breath
  12. Minor event triggers full-blown grief reaction
  13. Preservation of the environment just as it was when the person was alive
 
Types of Unresolved Grief 1

  1. Absent Grief -- as if the death never occurred—complete denial or shock
  2. Inhibited Grief -- somatic complaints in place of grief reactions
  3. Delayed Grief -- grief reactions are minimal or absent at first; later there are full-blown   reactions  following a subsequent loss
  4. Conflicted Grief -- exaggeration of some aspects of the loss, while others are suppressed, e.g., extreme anger and extreme guilt
  5. Chronic Grief -- the bereaved person continuously exhibits intense grief reactions which aremore appropriate for early bereavement. The bereaved person keeps the deceased person alive with his/her grief.
  6. Unanticipated Grief -- occurs after sudden loss and is so disruptive that recovery is usually complicated.
  7. Abbreviated Grief -- a short-lived, but genuine form of grief. It may occur because of immediate replacement of the deceased or insufficient attachment to the deceased person, anticipatory grief may be a contributing factor.

Two Basic Reasons for Failure to Grieve
  1. The person is unable to tolerate the pain of grief.
  2. The person has an excessive need to maintain interaction with the person who died.
Examples of Reasons for Failing to Grieve
  1. Guilt—reviewing the relationship with the person who died brings up guilt
  2. Loss of extension of self—grief is avoided because it also means acknowledging the loss of a part of self
  3. Reawakening of an old loss
  4. Multiple loss
  5. Inadequate Ego Development—the bereaved person cannot handle overwhelming feelings of rage, frustration, depression, anxiety
  6. Miscellaneous: Belief that grieving = weakness. Belief that once crying starts = never stop. Letting go of the pain = letting go of my loved one

How Does Society Contribute to the Failure of Some People to Grieve?
  1. Fear of “prolonged” grief: wallow, incessant, clinging, stuck, never letting go
  2. Expectation of brief grief: CHARGE
  3. Disenfranchised loss
  4. Unspeakable loss
  5. Ascribed status of “the rock”
  6. Lack of social/community support
  7. The media’s presentation of the “perfect griever”

Two Ways that a Therapist Can Diagnose Complicated Grief 2
  1. The person will come with a self-diagnosis
  2. The person will come with a medical or psychiatric problem quite unaware that grief issues are at the heart of it.

What Society Needs to Realize
  1. There are thousands of individual differences in grieving
  2. Some people do well without griefwork
  3. Continuing bonds are normal
  4. For many people grief reactions never entirely go away
  5. Our job in supporting bereaved parents and siblings is to put up with “brain pain” by allowing people to be in pain (APTBIP).
 
What You Can Do to Help
  1. Tolerate individual differences = Grieving Style.
  2. Recognize the symptoms of unhealthy grief.
  3. Practice your approach.
  4. Contact community resources, find what they offer, get phone numbers, emails, fees.
  5. Meet one-on-one.
  6. Be gentle, low key, present your observations, say little, don’t argue, listen, listen, listen, listen.
  7. Finish with concern and referral information—then drop it.

         

1 - From Rando, T.A. (Ed.) (1986). Parental Loss of a Child. Champaign, IL: Research Press Company.
2 - Worden, J.W. (1991). Grief counseling and therapy: A handbook for the mental health practitioner. NY: Springer Publisher.