Being with grief

Welcome to this space dedicated to the topic of grief. If you've arrived here, you might be experiencing deep sadness, confusion, overwhelm, or a sense of numbness following a sudden loss. Loss doesn’t have to mean bereavement, it can encompass various types of endings or transitions like relocating (especially internationally), the conclusion of a job or a specific career, or the very emotionally painful end of a relationship. You might be grappling with questions such as, "When will I stop feeling so awful?" or "How long will I require bereavement or grief counseling?" As a general guideline, the initial half-year after the loss, particularly if it was sudden, often involves a period of shock accompanied by understandably intense sadness. Although challenging to cope with, this response is a normal part of the process. This understanding is why many bereavement counselling organizations typically recommend waiting 6 months after the event before commencing counselling, as it's around this time that the potential for more complex grief disorder to emerge becomes apparent.

According to Bowlby, how we deal with loss relates to attachment dynamics. However almost all grief theory states that the pain and suffering must be experienced in order to heal and resolve the loss event. (Humphrey, 1996)

This statement sounds so simple, but for many, in my experience as a bereavement and NHS counsellor, simply sitting with a huge loss feels excruciating and unbearable. Many will try and escape this feeling either by normalising, (e.g ‘Just getting on with it’), intellectualising, minimising or avoiding feelings by ‘staying busy’, drink or drugs.

There is another way through.

You can face your loss, and you can do it with support. Giving yourself a little time each day to grieve if it comes up for you can be an incredibly efficient way of processing grief. You don’t have to force it, but neither do you have to ignore it. If it comes, let it. The following is written from my own experience of a really deep loss process :-

1. Surrender Yourself to Sadness
   If you're in a safe and comfortable place where you feel protected, let the tears come. Don't suppress them and don't force them. Crying is good for you and lowers the blood pressure and pulse. If you're not at home, and the tears feel inconvenient, give yourself permission to find a loo or a safe place to give yourself a few moments. You are doing your body a massive favour by efficiently processing your grief. Feelings can be very intense so give yourself breaks; phone a friend, go for a stroll, be kind to yourself.
   
   The only way is through and you'll most likely feel much better afterwards. Learning to feel your own sadness can lead to a deeper sense of calm and inner peace. This may seem counter-productive toward happiness, but it is extremely therapeutic and builds resilience.
   

2. Allow yourself to feel held by the master of Mindfulness
   Jon Kabat Zinn has written many things on Mindfulness and this 45 minute guided body scan meditation. is simply great if you're having trouble sleeping, or you are experiencing fear or terror of being alone.
   

3. Yoga for grief
   Sometimes the body just wants to move and breathe through the grief if it feels a little stuck. If you have a spare hour, this grounding and nurturing practice class by yoga teacher Leila Sadeghee on Movement for Modern Life takes you through and out the other side. You can subscribe for 14 days for free to access the classes.

Many clients who present themselves for counselling have issues of loss and isolation that go far beyond their present situation. Some have past losses representing repressed or unfinished business that needs to be addressed, often before the current loss can be processed. The inclusion of Prolonged Grief Disorder in the DSM therefore has had many benefits. It is now an identifiable diagnosis with agreed upon terminology which helps grievers reduce their sense of misunderstanding and isolation.

Prolonged Grief Disorder (Prigerson et al, 2016) is a distinct set of symptoms, that continue for a period of 6 months after the loss event, or their first appearance. They include separation anxiety and powerful pining to be reconnected with the deceased, confusion about one’s role in life, avoidance of reminders of the loved one, inability to trust others, bitterness or anger surrounding the loss, difficulty moving on, numbness and shock, and a sense that life is meaningless. This overwhelming and debilitating reaction has potentially life threatening consequences as individuals diagnosed with Complicated Grief (or Prolonged Grief Disorder as it’s known in the DSM) have a statistically higher chance of committing suicide as well as cancer, heart disease and sleep disturbance than those with a normal grief reaction.

Prolonged Grief disorder occurs when the normal grief process has been suppressed. The suppression may be deliberate or unconscious. It may be the result of people wishing to maintain a social convention of appearing stoical, or simply because they do not wish to upset others by an overt display of grief, or because they are naturally undemonstrative individuals. The result is the same whatever the cause may be. The grief work is delayed and the bereaved are unable to deal with the full distress of their loss and therefore fail to loosen their links with the deceased. This postponement of effective grieving may span a few weeks or many years. Eventually the reality of the loss may be accepted when another less significant bereavement or loss occurs, or at a date that is particularly associated with the deceased. Delayed grief reactions can therefore be expected when there has been no marked distress after an important losss. Lindemann (Grief, 2014) pointed out that despite the apparent lack of response, certain subtle changes occur which point to the presence of an unresolved grief reaction. He called these less obvious changes ‘disorted grief reactions’.

There are many psychological models of bereavement; John Bowlby’s attachment theory (1969-80), Kubler Ross’s five stages (1969), Colin Murray Parkes
psyhco-social elaborations (1972), Worden (1991), Silverman and Klass (1996) and Stroebe and Schutt (1999). Various attempts have been made to classify the grief process, however Bowlby is arguably the most widely accepted model and formed part of my training at the excellent charity Caris Bereavement Services, which offers free counselling to bereaved people in the borough of Islington.

The vast majority of friends and family members roughly 80-90% adjust fairly well to the death of a loved one. This is not to say that most bereaved people don’t feel intense pain, sadness and distress at their loss, and that they miss the person who has died profoundly, but there is an important distinction between uncomplicated and complicated grief, in that the former are able to move through the stages of grief, and the latter get stuck in at a stage, or fall off the grief wheel,(Fig.1 below) altogether.

The grief wheel below, (Fig.1) is loosely based on Bowlby’s grief model and while each person has an individualised response to their specific loss, the process of ‘resolving’ their loss is based on this cycle. I find that showing clients this grief wheel is often useful as they can locate themselves and know that their experience is normal even though it might feel unbearable.

Work of bereavement is not linear, it is cyclical in nature, with many painful returns to the beginning to start the process once more. Tailspins back to an earlier stage of grief are an inherent aspect of the bereavement experience. The good news is, however, that if you’re on the grief wheel you’re headed for recovery. (Shear, Ghesquiere, and Glickman, 2013)