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When my mother was diagnosed with Lewy Body Dementia, it was the most difficult time of my life. Not only was I dealing with her care, but I was anticipating her slow, inevitable decline and death. I was living in a kind of betwixt and between, trying to balance caring for her, my young children, and my patients, while feeling palpable grief for what I was about to lose……Continue reading…
By Jill Suttie
Source: https://greatergood.berkeley.edu/
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Critics:
Grief can be experienced in a variety of ways. Crying is a normal and natural part of grieving. Crying and talking about the loss is not the only healthy response and, if forced or excessive, can be harmful. Lack of crying is also a natural, healthy reaction, potentially protective of the individual, and may also be seen as a sign of resilience. Grieving people are also likely to become anxious.
Some grief responses or actions, called “coping ugly” by researcher George Bonanno, may seem counter-intuitive or even appear dysfunctional, e.g., celebratory responses, laughter, or self-serving bias in interpreting events. Some healthy people who are grieving do not spontaneously talk about the loss. Pressing people to cry or retell the experience of a loss can be damaging. Genuine laughter is healthy.
When a loved one dies, it is not unusual for the bereaved to report that they have “seen” or “heard” the person they have lost. Most people who have experienced this report feeling comforted. In a 2008 survey conducted by Amanda Barusch, 27% of respondents who had lost a loved one reported having had this kind of “contact” experience. These experiences are correlated with pathology like grief complications.
The four trajectories are as follows:
- Resilience: “The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning” as well as “the capacity for generative experiences and positive emotions”.
- Recovery: When “normal functioning temporarily gives way to threshold or sub-threshold psychopathology (e.g., symptoms of depression or post-traumatic stress disorder, or PTSD), usually for a period of at least several months, and then gradually returns to pre-event levels”.
- Chronic dysfunction: Prolonged suffering and inability to function, usually lasting several years or longer.
- Delayed grief or trauma: When adjustment seems normal but then distress and symptoms increase months later. Researchers have not found evidence of delayed grief, but delayed trauma appears to be a genuine phenomenon.
Continuing bonds is a bereavement theory that suggests that maintaining a lasting connection with a deceased loved one is a common part of grieving, rather than a hindrance to “moving on”. In the recent times, both psychological literature and popular culture view ongoing bonds with the deceased as pathological in grief. According to the dominant model, the purpose of grief is to let go and move on.
Toward the end of the 20th century, Dennis Klass, Phyllis Silverman, and Steven Nickman developed a prototype of grief that includes continuing interactions with the dead, while remaining “open to both the positive and negative consequences of this activity”. Among the various instances of continuing bonds include sensing the presence of the dead, maintaining connections through physical objects, having a belief that the deceased influences thoughts or events.
Consciously integrating the deceased’s characteristics into personal or group identity. While the intensity of these bonds may subside, they often persist in some form throughout a survivor’s life. Attempting to completely leave the deceased behind would itself constitute a denial of reality, as relationships naturally persist and shape ongoing experiences and identities.
Meanwhile, maintaining bonds generally does not imply a failure to accept the permanence of the loss or the physical separation. Continuing bonds have been observed across diverse cultures and historical periods, reflecting the significant cognitive and emotional investment humans consistently place in their relationships with their departed loved ones.
Aside from this age-long cultural recognition, 20th-century psychological theories significantly diverged from these traditional views, claiming instead that severing ties with the deceased was very vital. The emergence of continuing bonds theory marked a major challenge to these prevailing ideas, prompting a reevaluation of what constitutes normative grieving. Prolonged grief disorder (PGD), formerly known as complicated grief disorder (CGD), is a pathological reaction to loss representing a cluster of empirically derived symptoms that have been associated with long-term physical and psycho-social dysfunction.
Individuals with PGD experience severe grief symptoms for at least six months and are stuck in a maladaptive state. An attempt is being made to create a diagnosis category for complicated grief in the DSM-5. It is currently an “area for further study” in the DSM, under the name Persistent Complex Bereavement Disorder. Critics of including the diagnosis of complicated grief in the DSM-5 say that doing so will constitute characterizing a natural response as a pathology, and will result in wholesale medicating of people who are essentially normal.
Shear and colleagues found an effective treatment for complicated grief, by treating the reactions in the same way as trauma reactions. Complicated grief is not synonymous with grief. Complicated grief is characterised by an extended grieving period and other criteria, including mental and physical impairments. An important part of understanding complicated grief is understanding how the symptoms differ from normal grief.
The Mayo Clinic states that with normal grief the feelings of loss are evident. When the reaction turns into complicated grief, however, the feelings of loss become incapacitating and continue even though time passes. The signs and symptoms characteristic of complicated grief are listed as “extreme focus on the loss and reminders of the loved one, intense longing or pining for the deceased, problems accepting the death, numbness or detachment …
Bitterness about your loss, inability to enjoy life, depression or deep sadness, trouble carrying out normal routines, withdrawing from social activities, feeling that life holds no meaning or purpose, irritability or agitation, lack of trust in others”. The symptoms seen in complicated grief are specific because the symptoms seem to be a combination of the symptoms found in separation as well as traumatic distress.
They are also considered to be complicated because, unlike normal grief, these symptoms will continue regardless of the amount of time that has passed and despite treatment given from tricyclic antidepressants. Individuals with complicated grief symptoms are likely to have other mental disorders such as PTSD (post traumatic stress disorder), depression, anxiety, etc.
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