When Grief Doesn't Ease

Sometimes it feels as if your bereavement will never end. You feel as if you’d give anything to have the pain go away; to have the long lonely hours between nightfall and dawn pass without heartache. You are not the only grieving person who has longed for some measure of relief.

In the novel, My Sister’s Keeper, author Jodi Picoult wrote, “There should be a statute of limitations on grief. A rule book that says it is all right to wake up crying, but only for a month. That after 42 days you will no longer turn with your heart racing, certain you have heard her call out your name.”

No such rule book exists. Grief counselors and therapists tell us that the length of time it takes anyone to grieve the loss of someone they held dear to them is dependent on the situation, how attached you were to the deceased, how they died, your age and gender. So many variables exist and there’s absolutely no way to predict how long it will take for you to adapt to your loss.

The Difference between Normal and Complicated Grief

Research findings have led experts to come up with many differing categories of grief experience ranging from normal to complicated. Normal (or uncomplicated) grief has no timeline and encompasses a range of feelings and behaviors common after loss such as bodily distress, guilt, hostility, preoccupation with the image of the deceased, and the inability to function as one had before the loss. All are normal and present us with profound – and seemingly endless – challenges. Yet, Katherine Walsh says, “Over the course of time, with average social support…most individuals will gradually experience a diminishment of these feelings, behaviors, and sensations.”

So, how can you know if your bereavement is no longer within the range of normal? Ms. Walsh goes on to say, “While there is no definitive time period by which this happens, if an individual or members of a family continue to experience distress intensely or for a prolonged period – or even unexpectedly years after a loss – they may benefit from treatment for complicated grief.”

A Useful Model for Assessment: Worden’s Four Tasks of Mourning

There are certain tasks that when achieved during your bereavement, can successfully allow you to emerge on the other side of loss as a better, stronger, and more resilient individual. James Worden proposed these four tasks:

1. To accept the reality of the loss
2. To process the pain of grief
3. To adjust to a world without the deceased
4. To find an enduring connection with the deceased in the midst of embarking on a new life

Instead of focusing on your bodily discomforts, feelings, and common behaviors, this model allows you to better see where you may be stuck or stalled in the adaptive process. Fortunately, Worden also gives us a list of indicators advising that "any one of these clues in and of itself may not be sufficient" for a diagnosis of complicated grief. "However," he continues, "any of these…should be taken seriously, and the diagnosis of complicated grief should be considered when they appear."

12 Clues…12 Insights

While grief educators and theorists tell us that a diagnosis of complicated grief should not even be attempted until after the first anniversary of the death, if any one of the following symptomatic clues exists for longer than six months, you may want to consider grief counseling or grief therapy:

1. You cannot speak of the deceased without experiencing intense and fresh grief long after the loss.
2. A relatively minor event triggers an intense grief reaction.
3. Your conversations with others are littered with references to loss. In other words, loss is an ever-present motif in your world view.
4. You have issues related to your loved one's possessions. Keeping everything the same as before their death could indicate trouble just as tossing out everything right away can also be a clue to disordered mourning. (You also need to factor in your cultural and religious background)
5. You have developed physical symptoms similar to those of the deceased before their death. Sometimes these symptoms recur annually, on the anniversary of the death, or on holidays. An increased susceptibility to illness or the development of a chronic physical complaint can also be an indicator.
6. If you have made radical changes to your lifestyle, or excluded friends, family members, or even activities associated with the deceased, it may indicate unresolved grief.
7. A long history of depression, often marked by guilt or low self-esteem, can reveal disordered mourning. The opposite is also true: a person experiencing a false sense of happiness or elation could be experiencing unresolved grief.
8. A compulsion to imitate the deceased, in personality or behavior, can be a sign of complicated mourning.
9. Having self-destructive impulses or exhibiting self-destructive behaviors can be significant. These can range from substance abuse, engaging in self-harm, developing eating disorders and suicidal tendencies.
10. A sense of unexplained sadness occurring at a certain time each year (holidays, anniversaries, or birthdays) can also be a clue to unresolved grief.
11. Developing a strong fear about dying, especially when it relates to the illness that took the life of your loved one, is an important clue.
12. If you have avoided visiting your loved one's grave or if you are still unwilling to discuss the circumstances of their death, this could indicate complications in your bereavement.

There are many types of complicated grief; it can be delayed, masked, exaggerated, or chronic. Self-diagnosis is without purpose. A year after the death, if you feel your grief symptoms worsening, we advise that you seek a referral from your family physician for  professional grief counseling or therapy.

Sources:
Walsh, Katherine, Grief and Loss: Theories and Skills for the Helping Professions, 2nd Edition, 2012.
Worden, James, Grief Counseling & Grief Therapy: A Handbook for the Mental Health Practitioner, 4th Edition, 2009.