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Sunday, November 02, 2008

Good Grief: What’s Normal and When Should You Seek Help?

It is quite normal to be sad and upset when someone that we care about dies. The term grief describes a person’s emotional reaction to the death and mourning describes the cultural and social expectations and behaviors that surround the event (attending a funeral service, for example).

While each person experiences grief in their own unique way and there is no one “right” way to grieve, therapists generally encourage grieving individuals to feel their grief, rather than deny it. Experiencing the feelings of sadness instead of avoiding them, talking about these feelings with others and finding meaning in a life where the loved one is no longer present are all part of what is called the grief process.

Normal Grief

The steps above outline a “normal” grief process. In normal grief, the initial intense feelings associated with grief and bereavement–intense sadness, a profound sense of loss and a deep yearning for the loved one–subside and become manageable within a few weeks or months. Interest in life returns and the bereaved person gets back to the tasks of daily living. Formerly overwhelming painful feelings subside and thoughts of the deceased cease to dominate the person’s life.

Abnormal or “Complicated” Grief

However, approximately 10-20% of grieving people do not experience “normal” grief. For them, the grief process is prolonged and/or intensified. They often experience anger and resentment about their loss and have difficulty accepting the reality of the death. In 2001, a set of twenty questions, called the Inventory of Complicated Grief, was developed by leading psychiatrists to distinguish complicated grief from normal grief. The symptoms of complicated grief fall into two categories: 1) feelings related to separation distress (longing and searching for the deceased, loneliness, preoccupation with thoughts of the deceased) and 2) feelings related to traumatic distress (disbelief, mistrust, anger, shock and detachment from others).

When to Seek Help

Grief is generally diagnosed as “complicated” when it has lasted for more than six months and at least four of the following symptoms occur several times a day. The symptoms must also be intense enough that they are distressing and disruptive to normal life activities:

• Trouble accepting the death
• Inability to trust others
• Excessive bitterness or anger related to the death
• Uneasiness about moving forward (making new friends, taking part in
daily activities)
• Numbness or detachment from life
• Feeling that life is empty or meaningless without deceased
• Sensing that the future is bleak or holds no meaning
• Abnormal agitation, jumpiness or irritation

A bereaved person fitting the above criteria would be considered at risk for complicated grief and should seek professional help for managing their grieving process.

Rita Milios, MSW, LCSW, "The Mind Mentor," is a psychotherapist, author and workshop leader from Hudson FL. Her most recent books include "It Was Just Awful," a book for children experiencing traumatic grief, and the "It Was Just Awful Companion Caregiver/Counselor Workbook."

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Blogger Elaine Williams said...

While I find most of your article very helpful, putting a 6 month timeline on "normal" grief symptoms is short sighted at best. For those who have never gone through the devastating loss of a spouse or a child, it's almost impossible for you to "get it". Sorry, but sad reality. People can sympathize and empathize, but it is NOT THE SAME.

Some people do bounce back, seemingly, in 6 months, but in siting my own experience, and I consider myself a well adjusted, compassionate and strong woman...I am a widow of almost five years and at 6 months I was just getting started on my grief journey. Until about the 3 year mark I was still having trouble adjusting to life without my spouse, being alone, raising three boys and everything that goes with widowhood. Yes, the feelings of abandonment, fear and distress ease with time, but please don't put a 6 month timeline down as starting to feel a bit better, because in most cases it simply is not true. I wish you the best.

5:48 AM


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