Grief and grief counseling are two large topics. Today, rather than attempt – and fail – a systematic presentation, I instead focus on the aspects of grief most misunderstood and/or distressing to people experiencing grief, and describe ways of discussing grief with patients.

Grief Is an All-Encompassing Experience

The most common aspect of the grief experience is the emotional aspect. Emotions are indeed a central aspect of grief but not the only one. (I expand on the emotions of grief in the point below.) Here are other aspects to consider.

First, grief encompasses all aspects and functions of the organism, the body and mind. For example, it’s not uncommon that the most immediate and powerful experience of grief is a sensation – followed by an emotion – of the lost loved-one being ripped away from the grieving person’s body, very much as if a serrated instrument of torture tore out the center of their chest. Grief feels like physical pain, characterized by pressure as if from a huge weight, and burning. And then the sensation of absence.

Additionally, grief leads to many of the same neurovegetative symptoms experienced in depression: disrupted sleep, diminished appetite, anergia, and amotivation.

Second, grief encompasses the individual by changing their perception of, not only the present, but also the past and future. This means a person crosses over into a different reality. Imagine that all of one’s photographs, those already taken and those waiting to be taken in the future, change. Someone dies and all the grieving person’s photos – kept in drawers, on smart-phones, and in photo-albums – as if by magic, change.

One’s past experiences – especially those that included the loved-one, but not only – are seen in a new light. When a grieving person looks at photos from the past – or just remembers the past – and sees themselves together with their now lost loved-one, perhaps smiling or having the time of their lives, they see those past experiences in a whole new light.

And when the grieving person considers the future, what was previously imagined, either through explicit planning or through implicit expectations, is now wiped clean. Consider those photos-of-what-might-have-been and imagine them fading into gray.

The grieving person feels unmoored. When not experiencing intense sadness and loss, a stunned quality becomes evident, as if they were unexpectedly punched in the face. As I have written about in a post on trauma, when a terrible loss occurs, a person’s Reality Frame or Assumptive World, cracks. Losing someone you love is, after all, a type of trauma, one severe enough to change one’s perception of one’s relationship to the world, the past, and the future.

Grief Encompasses All Emotions

One aspect of grief that discombobulates people experiencing it is feeling all kinds of feelings, including ones that seem “wrong.” It’s ok and expected to feel sadness and loss, and maybe some anxiety or trepidation about the future. It does NOT seem so ok, however, to feel anger, disappointment, frustration, resentment, regret, relief, or envy. And the person may be surprised by the intensity of the guilt or shame that may develop. Additionally, it seems unexpected and extreme to lose – even if temporarily – one’s sense of meaning, purpose, connection to others, or faith.

And yet, all of these sensations, emotions, and thoughts can occur.

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Explaining Grief

Grief occurs in many circumstances. I’ve focused on death of a loved-one. But a person can grieve the loss of a relationship through rejection or betrayal. A person can grieve loss of a function, such as cognitive or athletic abilities, or mobility. Or, importantly for us as psychiatrists, a person can grieve the realization of a diminished future by developing a psychiatric disorder, such as schizophrenia or bipolar disorder.

Here are some ways to explain grief to a grieving person:

  • Losing someone does change everything, the past, the future, and the present.
  • It’s painful and scary and uncertain.
  • But it’s normal. It’s not a “mental disorder.” It’s our burden as creatures who make strong connections and love, and feel loss.
  • Also, we grieve because we are conscious of ourselves, of mortality, of the passage of time, of unfairness, of regrets, and many other aspects of our lives here on earth.
  • There is no need to make the grieving process worse by beating yourself up over uncomfortable sensations, feelings, and thoughts you might be having. They are common and everyone has something that comes up that makes them question their reactions.
  • Although the person you loved is no longer here, doesn’t mean you no longer have a relationship with them. You do. This means it’s common to have a conversation with them in your head. Some conversations, even with people we love deeply, are uncomfortable. No one is perfect, not you and not your loved-one.
  • There may be aspects to your relationship that were bad, or wrong, or painful, or just disappointing. The conversations you’re having in your head are a way to come to terms with all aspects of your loved-one, and of yourself, and of your relationship. It’s all one big rich confusing tangle of thoughts and emotions.
  • At some point you’ll notice that you no longer think about your loved-one or feel their absence all the time. For example, you may be at work or out with friends, and suddenly notice you haven’t thought about them for an hour or three. You may feel guilty about this, but this is normal too. Grieving is a process and how we experience it changes over time. When you’re not thinking about your loved-one or feeling sad all the time, doesn’t mean you love them less.
  • Are there ways you think can help you heal? That can foster a healthy continued relationship with the person you love who is no longer with you? Are there things you wished you had said but didn’t? Or things you did or didn’t do that you feel bad about? Or things they did that hurt you? Or things you particularly appreciate about your time together? If so, some people benefit from writing this down, as a letter to their loved-one. Or just speaking it out loud at the cemetery or their favorite place. There are many ways of coming to terms with your loss.

Thanks. I’ll focus in a future post about complicated and delayed grief.

Until next time,

Dr. Jack


Today’s Quotes

“We are all on a quest for answers, trying to learn the lessons of life. We grapple with fear and guilt. We search for meaning, love, and power. We try to understand fear, loss, and time. We seek to discover who we are and how we can become truly happy.”
– Elisabeth Kubler-Ross

“Where you used to be, there is a hole in the world, which I find myself constantly walking around in the daytime, and falling in at night. I miss you like hell.”
– Edna St. Vincent Millay