Grief is not a mental illness. It is something that happens to all of us at some point in our lives and is very much part of the normal, if painful at times, human condition. However, although grief may not start off as a mental illness, if left untreated or not dealt with correctly, it does have the potential to lead into behavioral issues, mental illnesses, and even substance abuse.
Dr. Elisabeth Kübler-Ross’ groundbreaking book, On Death and Dying, is one of the most referred to models of grief and is still used by therapists and grief counselors the world over. In it, she describes a process that follows a linear five stages of grief: denial, anger, bargaining, depression, and finally acceptance[1].
While the work of Kübler-Ross has helped many individuals deal with loss or the death of someone close, our contemporary understanding of grief has evolved. We now understand that grief rarely follows these linear stages, but most of us still need to move through these stages of grief.
Since Kübler-Ross’s model, many scholars have attempted to create lists of tasks, objectives, and stages one would need to move through during the grieving process. In 1994, Jeanne Katz and Moyra Sidell outlined their own three stages of grief as[2]:
- Shock and Disbelief
- Pining
- Reorganization and Reintegration
- William Worden’s book, Grief Counselling and Grief Therapy, summarizes the Harvard Bereavement Study (The Omega Project) and concludes that in order for grief to be resolved, one would need to move through the following four key stages[3]:
- Accepting the loss as a reality
If a loss is unexpected, the shock can be profound. When something as enormous as death is experienced, one may have a particularly difficult time believing it to be true if it has come as a surprise. The denial can be mitigated if those who are grieving are able to see a body, especially if it’s in an environment designed for them to bid their farewells, such as a funeral home or parlor. Funeral ceremonies are also held because the loss is made more real when we are able to share it with others close to us and to the deceased.
- Sitting with the pain and the grief
Colin Murray Parkes developed a theory of psychosocial transitions that explained the challenges that occur during the process of loss[4]. In his theory, he posits that, “[t]he most characteristic feature of grief is not prolonged depression but acute and episodic “pangs,” or episodes of severe anxiety and psychological pain. Murray Parkes calls the reality that we all live in the “assumptive world.” If something out of the ordinary happens, such as an unexpected loss of a loved one, we become disorientated before we move into grief. Murray Parkes states that disorientation will be followed by feelings of despair, guilt, loneliness, and anger. Though these emotions are often overwhelming, if we are able to sit with them and process them in a productive way, he believes we eventually learn to reorganize our assumptive world in a way that allows us to function again while accommodating the loss.
- Re-adjusting to life without the deceased person in it
Life is changed irrevocably when we lose someone we love. An essential part of the grieving process is to adopt new roles and tasks in order to re-adjust to the new landscape. Instead of withdrawing from life, as may be the desire, the bereaved must try to adapt to new daily routines. It’s important during this time that support is offered from other people close to the bereaved.
- Starting new relationships
Although this will often feel impossible early in the grieving process, many of us can, and do, reconnect with life after a time. Reconnecting with life means reconnecting with people and forming relationships or re-joining relationships that were put on the back burner during the early grieving process. For the natural progression to occur between Steps 3 and 4, there needs to be unfaltering support and encouragement from those close to the grieving person. To fully return to a connected life, grieving people must accept the vulnerability that comes with loving and being connected to others. We would not be in a position to mourn or grieve if we had not felt that connection in the first place. Memories of the lost loved one will remain as part of the tapestry of the fabric that is their lives.
Children and Grief:
Children and adolescents can be extremely disturbed by grief. Losing a parent or other close family member can trigger such emotions as guilt or anger. If these are not addressed, children may experience states of depression, restlessness, or social withdrawal. They may also act out with certain negative behaviors.
Children are often excluded from attending funerals or from being informed when a family member is critically ill. Looking again at Colin Murray Parkes assumptive world theory, not informing a child about a critical illness, so that a death comes as a shock rather than something expected, can be damaging to a child. Equally, not allowing them to attend a funeral can keep them in the state of denial for much longer and force them to remain separated from the collective, healing grief of other loved ones.
An incomplete or improper handling of grief in childhood can lead to increased vulnerability to substance abuse and mental health issues later in life. The support a child has during this process is critical to ensuring that the impact on the child is as mitigated as possible. School, especially for students who have a strong support network of peers and adults, can provide essential comfort during this time. Without a support network in place, what may have been a tragic but inevitable part of the circle of life may well develop into a source of trauma which, as we know, can yield far more serious consequences in later life.
For more information on treatment, contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.
Sources
[1] Kübler-Ross E. On Death and Dying (Routledge, 1969).
[2] Katz, Jeanne and Sidell, Moyra, 1940- Easeful death : caring for dying and bereaved people. Hodder & Stoughton, London, 1994.
[3] Worden J. Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (Springer Publishing Company, 1991).
[4] Parkes, C. M. (1988). Bereavement as a psychosocial transition: Processes of adaptation to change. Journal of Social Issues, 44(3), 53-65.
