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Complicated Grief

What is complicated grief?

Although only a minority (around 10-15% according to research) of people experience complicated grief after a loved one dies. Those of us who do need the help of a grief therapist.

Complicated grief is characterized by chronic mourning, delayed mourning, exaggerated mourning,and/or masked grief reactions.

There is no timeline for grieving the loss of a loved one. Everyone is an individual and no one’s loss is identical to yours. There are not even verified averages, but if a person reports that they still can’t function well and can’t get back to some semblance of normalcy five years after a death, they would appear to be in a state of chronic mourning. Similarly, the parent who keeps the dead child’s room untouched for decades, or the widow who refuses to get rid of the dead spouse’s clothing.

Delayed grief occurs when a person is in a situation where they cannot work through the mourning process until later. A soldier who witnessed the deaths of his comrades can’t stop to grieve. The young mother who lost her older children and her spouse in a car accident has to continue to be a parent to the child who is left. And, some people feel the necessity of not showing emotions, keeping a stiff upper lip, and so suppress their grief. But grief doesn’t go away unless we work through it; so, the intense feelings of fear, sorrow, sadness, and confusion will rise up later and often unexpectantly.

It's hard to say what makes for exaggerated mourning. There are such differences between individuals and cultures in that regard. When I was a hospital chaplain, I’d sometimes be called by a nurse because a bereaved family was “freaking out.” African-American and Latin families tend to be more expressive in their grief than those from a northern European background. It’s normal to find people wailing loudly, falling on the floor, and collapsing into chairs. It makes the Anglo folks uncomfortable, but it’s perfectly normal, healthy, and not at all inappropriate. Usually, the intense outbursts of emotion subside within an hour.

There is, however, such a thing as exaggerated grief. When a bereaved person becomes clinically depressed, develops a diagnosable anxiety disorder or phobia, or full-blown PTSD, they are experiencing a form of complicated grief that requires therapeutic (and often psychopharmaceutical) intervention. There’s an intergenerational history of depression in my family, so it’s not surprising that when my son committed suicide (which by itself triggers complex mourning) I plunged into clinical depression. Antidepressants and therapy were the key to a state of recovery.

Grief feels like depression and shares many of the same emotions, but clinical depression won’t go away on its own. Usually, it won’t go away even with counseling. Clinical depression typically responds to a combination of medication and psychotherapy. It’s normal to feel lost and hopeless after a loved one dies. Still feeling that way and being unable to cope with normal tasks of daily life many months after the death indicates complicated grief. Even hallucinations are normal after a death. Many people report a “visit” from the lost loved one or hear their loved one’s voice occasionally. That’s normal. But ongoing hallucinations, or hallucinations that are terrifying, are abnormal.

By masked grief reactions, we mean symptoms that we don’t recognize as tied to the death of our loved one. Some people develop physical symptoms; others develop maladaptive behavior like abusing substances or the onset of an eating disorder. Intense grief of any kind, and complicated grief especially, can cause physical ailments to flare up. Losing a loved one causes tremendous stress on the body. Cardiac, pulmonary, and any underlying diseases, may flare up and require medical intervention.

What causes complicated grief?

Causes of complex grief include relational issues, uncertainty concerning the loss, societal stigma, lack of psychological resilience, and negating the loss. Sudden death, multiple deaths, death by suicide, violent death, death that results in no physical body, and murder almost always trigger complicated mourning.

Some of us find ourselves in complicated grief because of relational factors. We may have had an ambivalent relationship with the deceased. If the deceased was abusive, we may not be able to grieve. Some people are highly dependent on the one who died and can’t function without them.

An uncertain loss, like a soldier reported missing in action, or having a loved one reported missing in the wilderness, or disappear in a foreign country often triggers complex mourning. In such cases, there is no closure. The bereft are left not really knowing if their loved one is dead or alive, or what happened to them.

Suicide and murder almost always cause complicated grief. There’s often a societal conspiracy of silence around such deaths and stigma attached to them. Having a loved one murdered can lead to an inability to let go of bitterness and anger and cling to a desire for revenge, which, in the long run, does nothing to ease the pain. Others may blame the victim for being in the wrong place at the wrong time, or for hanging out with the wrong kinds of people. Survivors of suicide often feel guilty. Why didn’t I see this coming? What could I have done to prevent this? Was he trying to hurt me? Is there some hidden insanity in the family?

Grief often occurs with the loss of a pregnancy, even if an abortion was chosen. Most women who make that choice do not do so casually. Their loss may produce a complicated grief that is exacerbated by a kind of societal negation – others too often will not speak of the loss, pretending it didn’t happen, leaving the bereaved to mourn alone.

Generally speaking, those without a social support network have a harder time processing loss than others. Low self-esteem or poor coping mechanisms complicate loss.

Whereas uncomplicated mourning can often be mitigated with the help of family, friends, and support groups, complex grief requires therapy, preferably from someone who is both trained professionally and has personal experience with losing a loved one. Such a person can walk with us through the grieving process and help us reach a place of wholeness.

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