Understanding Grief
November 2004
Berkeley Wellness Newsletter

In 1864, in his letter of condolence to the mother of five sons, all of whom had been killed in battle, Abraham Lincoln spoke of the inadequacy of any words to "beguile you from the grief of a loss so overwhelming." And though millions of words have been written on the subject of grief since then, comfort is often hard to come by. Grief is universal, but it is also very individual and specific--which may be why psychiatrists and psychologists have had a hard time dealing effectively with it. How people express grief is influenced by culture, religion, and personality. Some mourn publicly; others withdraw. Some search for meaning--what did the life of the lost person mean, why did death come now? Others never ask these questions. Some people want to talk about how they feel, others do not. Grieving over a loss is normal and necessary, and most people do not require psychiatric help to get through it. Indeed, they may do better on their own.

Grief, simple and complicated
One worry that arises after a death is what will happen to the survivors? How will the widow or widower go on? Will grief itself turn out to be fatal? We may laugh at old novels or plays in which people die of a broken heart, and yet anyone who has felt the anguish of deep grief knows it can be damaging, if not actually fatal. These days, though, we rarely speak of broken hearts and instead approach grief almost as a disorder. New classifications have been devised: one of these is called "complicated grief" or "traumatic grief," which goes beyond the grief that most people feel. It may involve intense yearning for the lost person and periods of weeping. It may last many months, and though it often resembles depressive illness, it does not usually respond to antidepressant drugs. It can have devastating effects on health.

In some people, particularly those who have lost a spouse or loved person because of a violent act such as suicide or murder, grief can even progress to what's known as post-traumatic stress syndrome, a true psychiatric disorder. Many survivors of the disasters of September 11, 2001, have needed treatment for this disorder, which may involve nightmares, deep depression, and memory loss.

Resiliency and the lack of it
Even in "normal" grieving, a person's physical and mental health may be affected. Many studies have looked at older people suffering the loss of a spouse. Recently, in Health Psychology, a study of over 55,000 older women (some with living husbands, some widowed) found that though losing a husband adversely affected mental and physical health, the women tended to be resilient and to recover from the loss as the months went on. Their successful strategies could be explained in many ways. Some sought professional help or social support in the community; some learned more positive ways to cope; some had been caring for a sick or disabled spouse and now realized that life would at least be less stressful. As a team of psychiatric researchers in Holland observed in another context, "the bereaved have to cope with this loss in their own time and their own way."

Each person is different and needs different things. If you find yourself threatened not only by loneliness but by the loss of financial security or status in the community, or if your spouse paid the bills and balanced the checkbook or did other tasks you aren't prepared to take on, those will be negative factors. If the death was expected, grief may be more manageable than if it was a shock. If you have friends and family to comfort you, that will help. If the person you lost was beloved by many, that can also be a plus. Some people will benefit from counseling, others simply may need a responsive, sympathetic listener. Others may need something else--a change of scene, a change of residence.

But what about the person who experiences traumatic grief and does not seem to get better? Signs of this might include a feeling of numbness, disbelief about the loss, constant yearning for the lost person, and a fragmented sense of security and trust, as well as nightmares, insomnia, and loss of appetite.

Curiously enough, though counselors and psychiatrists trained to treat deep grief abound, no one is sure just when grief crosses the line from normal to pathological, or what to do about it if it does. People with psychiatric disorders, those who have suffered more than one loss or misfortune, and those without close friends or relations may be the most vulnerable and most in need of counseling. But recent studies have cast some doubt on the effectiveness of psychiatric treatment for most grieving people. A comprehensive review of the research from the Center for the Advancement of Health concluded that most people don't need grief therapy or benefit from it, and that in some cases it can make matters worse. Some experts think that grief counseling in its present form--often short-term, involving eight to twelve sessions--may not work very well. Perhaps people need more therapy, or need it at a different time.

If you are dealing with your own grief or trying to comfort someone you love, here are a few pointers:

  • Giving voice to grief is, for most people, part of healing. It is human, and normal, to weep, to talk, to remember.
  • Find someone to confide in. Some people (not all) find writing things down is constructive and consoling. You might write a letter to the person you've lost. You might write to an old friend. Many people take comfort in answering condolence letters, or writing to say thanks for memorial gifts and flowers.
  • Remember that mourning may take many forms and continue over many months or even years. Sometimes emotional healing can begin to take place without your realizing it.
  • If a death has been long expected, you may not experience deep and prolonged grief. This in itself causes suffering for some people, but it's nothing to feel guilty about.
  • If you're helping a bereaved friend or relative, it's probably best just to listen and answer specific questions that they ask. Avoid such advice as "time heals" or "try to get out and do something."
  • If you are truly overwhelmed and cannot seem to pick up and go on, have persistent nightmares, or fall into depression, do seek help. A support group may be helpful. If you need ongoing counseling, your family physician might recommend a psychiatrist or other counselor for you.