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Common to human experience is the death of a loved one. While the terms are often used interchangeably, bereavement often refers to the state of loss, and grief to the reaction to loss. Losses can range from loss of employment, pets, status, or possessions, to the loss of the people nearest to us. While different bereavements may have different circumstances and intensities, nearly all involve some similar processes.
Some researchers such as Dr. Elisabeth Kübler-Ross and others have posited sequential stages including shock and numbness, denial, anger, depression and resolution. As research progressed over the past 40 years, many who worked with the bereaved found stage models too simplistic and instead began to look at processes, dynamics, and experiences common to all. Bowlby, a noted psychologist, outlined the ebb and flow of processes such as Shock and Numbness, Yearning and Searching, Disorganization and Depair, and Reorganization. Bowlby and Parkes both note psychophysiologic components of grief as well. Included in these processes are:
Feelings of unreality, depersonalization, withdrawal, and an anesthetizing of affect. These feelings often occur early in grief, and may be a self-protective way of getting through the facts of the death. Persons often remark on how someone appears stoic or strong when they are actually in shock.
The grieving person tries to locate the lost person. Normally this is a functional endeavor, as the 'lost' person is found, but in bereavement the searching is fruitless. This process has also been referred to as 'pining'. Common reactions include feelings and even cognitions of 'seeing' the deceased for fleeting moments, hearing the door at the time they used to come home, or even incorrectly 'finding' the person, for example in a crowd, although intellectually realizing this is not so. Actually feeling that one 'sees' or 'hears' the deceased ranges in report from 90% in oriental cultures to 10-15% in western cultures, although this may be more a factor of reporting bias than of actual experience. This process appears to be an attempt of the person to cognitively and emotionally begin to let go, by coming to terms with the reality of the loss.
These are the processes we normally associate with bereavement, the mourning and severe pain of being away from the loved person. There are no easy answers to assuage this difficult experience: it must simply be endured, although it may take years of all of the above experiences overlapping, waxing and waning before the last process takes place.
Reorganization is the assimilation of the loss and redefining of life and meaning without the deceased. Many times, in widowhood, one is so much a part of their spouse, that new definitions of identity must take place for healing. For the elderly after a lifetime of defining themselves in terms of their marriage relationships, this may take the rest of their lives.
Many studies have looked at the bereaved in terms of increased risks for stress-related illnesses. Colin Murray Parkes in the 60s and 70s in England noted increased doctor visits, and real illnesses such as colitis, breathing difficulties, and so forth in the first six months following a death. Others have noted increased mortality rates (Ward, A.W. 1976) and Bunch et al found a five times greater risk of suicide in teens following the death of a parent. Grief puts a great stress on the physical body as well as on the psyche, resulting in wear and tear beyond what is normal. Further, grief is often accompanied by crying, lack of sleep, loss of appetite, and ceasing to care for one's physical and emotional wellbeing. All these can contribute to a predisposition for illness in bereavement, a finding which has been replicated often since the Lindemann studies of the Coconut Grove fire survivors in 1944. Other problems in social relations may arise: there is for example an increase of divorce following the death of a child, and children may exhibit signs of delinquency, rage, introversion or other problems. Further, grief can insidiously work in family relationships as individual members sort or act through their feelings about the death. The risks following a death in the family are as great or greater than for any other traumtic life event.
While the experience of grief is a very individual process depending on many factors, certain commonalities are often reported. Nightmares, appetite problems, dryness of mouth, shortness of breath, sleep disorders and repetitive motions to avoid pain are often reported, and are perfectly normal. Even halluncinatory experiences may be normal early in grief, and our usual definitions will not suffice, necessitating a lot of grace for the bereaved. Abnormal responses almost always are a function of intensity and timing: a grief that after a year or two begins to worsen, accompanied by unusual behaviors, is a warning sign, but even here, caution must be used; it takes time to say goodbye.
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