General Loss and Grief Issues
Q. What is meant by the words Loss and Grief?
People usually use these words when talking about issues involving death and dying. However, we all experience losses every day eg when we go to work, we lose the chance to relax at home. Sometimes we can feel some grief over this loss as we try hard to function in work mode. Some losses are more serious than others eg losing a job can be more serious than losing a magazine, changing partners can be more serious than changing clothes. In fact, all changes involve some loss.
So the ways we respond to losses vary, depending on how seriously we perceive the loss to be. Grief is our response to loss, and so we grieve in different ways depending on
– how serious we perceive the loss to be,
– our personality,
– our history of losses, and
– our history of grieving.
Q. Don’t we all grieve in the same way, going through five stages of dealing with loss?
This widespread idea is based on the pioneering work of Elisabeth Kubler-Ross. For many years in Western society, death and mourning were taboo subjects and not freely discussed. Grieving over an important loss was considered a private activity, not to be shared or discussed. In 1969, Elisabeth Kubler-Ross broke through the taboo and made the issue of death and dying a public issue by the publication of a book. From her work with terminally ill people in hospitals, she generalised a stage theory which stated that the dying go through the stages of Denial, Anger, Bargaining, Depression and Acceptance. This theory was then generalised to all areas of Loss and Grief. It thus came to be believed that dealing with any serious loss (eg accidental death, divorce, unemployment) required each person to pass through the five stages.
However, it is now widely accepted that this theory is much too simplistic and is now viewed by many experts as only applying to some people. Reasons for this change in attitude include:
· Bereavement or a terminal illness is a choiceless event which happens to us, and can leave us feeling powerless. Our response depends on whether we respond passively as victims to feeling powerless, or if we respond in other ways. A stage theory perpetuates an idea of victimisation by saying that victims/survivors are passively swept along through stages of emotional responses, waiting to come out the other end, and can do nothing to actively deal with the process.
· Stage theories also lead people to feel that some forms of grieving are abnormal. In fact, there are a wide variety of ways in which people respond to important losses.
· Finally, a stage theory focuses on the experience of the isolated individual, by assuming that the survivor or the terminally ill person is not part of a system of interconnecting individuals with its own norms and values. If we are to understand people’s responses to loss we must see them as an individual-in-context. Patterns of grieving are influenced by personal experiences, as well as gender, family, social, religious and cultural factors.
Q. So how long should one grieve over an important loss?
Researchers have shown a marked disruption in a survivor’s level of functioning for months and subtler consequences can exist for the rest of the survivor’s life. Difficult times usually recur, especially during holidays, anniversaries and birthdays. There is no specified time for grieving. A significant loss is a life-changing event. We are never the same again!
Q. Are there different types of losses that produce differing grieving patterns?
Current writers describe three types of losses which produce different grief responses. However, these three types of losses can be inter-related.
– “Normal” loss (with its wide range of possible expressions);
– Complicated loss, eg those involving accidental death, rape, death of a child, many deaths in a short time (eg AIDS, heroin usage amongst peers), or a survivor unable to mourn because reliant on alcohol/drugs or prescribed medications;
– Non-finite loss related to expectations often being raised and not achieved eg living with a child growing up with a disability, living with a drug addict, chronic illnesses, being part of a step family. The resultant grief often results from comparison to pre-existing stages or to peers.
Q. Why is loss and grief typically such a difficult area for people to deal with?
There are many reasons. One important reason is that we may experience a major loss at one time in our lives, but then do not grieve in a way that is appropriate for us. This may be for a variety of reasons eg family norms about what is acceptable. That unexpressed grief then stays bottled up inside. The next loss then connects us to the difficult feelings from the first loss, becoming even more difficult to manage. Many people contain a lot of unexpressed grief. Grief is the natural response to loss and needs to be allowed a form of expression. When it is not expressed grief then becomes difficult to manage.
Q. So if there are no defined stages of grieving, what’s it all about?
Central to the grieving process is the task of “relearning the world”, a world that has been forever changed by the loss. Loss confronts us with choices and tasks as we attempt to rebuild a life whose meaning is deepened by
– our continuing awareness of that which we no longer have,
– our renewed appreciation for that which we do, and
– our appreciation for what we have experienced before the loss occurred.
These tasks will be approached differently depending on the unique resources of a particular survivor and the distinctive nature of his or her loss. They are not accomplished in any order, nor are they ever finished because loss is a constant part of life. Dealing with loss involves:
– Opening yourself to the pain – allowing oneself to feel whatever feelings arise (“honour your feelings”) and to find safe ways to express them, as well as safe people to express them with. Pretending there is no problem won’t make it go away. Common responses that may be experienced by the survivor and his/her immediate system are: shock, disbelief, denial, anger, depression, happiness, bargaining, apathy, guilt, fear, resignation, grief, relief;
– Questioning your beliefs and assumptions – about invulnerability, fairness, religious beliefs;
– Feelings of blame, guilt, need for relationships. This process helps us find a personal meaning that can help us become “sadder but wiser”. We can renew priorities, resulting in a clearer sense of what is important;
– Reinventing yourself – rebuilding an identity appropriate to our new role, while establishing continuity with the old. Identity is social, rather than exclusively personal. Identity can be thought of as a web of connectedness, which links us with persons, activities, and places. Death and loss tear the vital strands of connection that define who we are, and we only effortfully and gradually repair them by re-establishing other forms of connection to that which we had lost, as well as to the new world into which we are thrust.
This can partially be summarised by the Serenity Prayer:
“God grant me the serenity to
accept the things I cannot change,
the courage to change the things I can,
and the wisdom to know the difference”.
This last section was adapted from:
Chapter 4 of “Lessons of Loss: A Guide To Coping” – Robert A. Neimeyer
Chapter 10 of “What to do when they say “It’s cancer” ” – Joel NathanLeave a reply