Loss

Graphics courtesy of ReimagineOpens in new window Bereavement is a state of sorrow over a loss or death of a loved one; to be bereft is to be left alone or to experience a loss. According to Merriam-Webster, grief is distress caused by bereavement (by experiencing loss).

There are many ideas about the grieving process, among them are theories about grief occurring in phases or stages. In 1961, British psychiatrist John BowlbyOpens in new window described three stages of grief based on young children’s reactions to separation from parents:

1. protest,
2. despair, and
3. detachment.

Later he refined his stages and added a fourth to his theory of grieving in adults:

1. numbness and disbelief,
2. yearning and searching,
3. disorganization and despair,
4. and finally reorganization or recovery from bereavement.

In 1969, Swiss-born psychiatrist Elisabeth Kübler-RossOpens in new window published On Death and Dying, which suggested that there are five stages when facing one’s own terminal illness:

1. denial,
2. anger,
3. bargaining,
4. depression, and
5. acceptance.

Kübler-Ross’s five-stage model has gained popularity, has been extended to dealing with any sort of loss (including death of a loved one), and has been incorporated into many mental health practitioners’ treatment practices. However, most researchers now recognize that the five-stage model lacks empirical support.

Responses to loss may include many different reactions, including those in the five-stage model. Reactions may occur in many orders or combinations and may vary depending on the bereaved person’s mental state and circumstances (Archer, 1998).

Grieving is a normal process; it is an individual, unique, and highly personal experience. Depending on social context and personal experience, grief has potential for both personal deterioration and personal growth. Unless symptoms of grief become debilitating, causing significant distress over a prolonged period of time, grief will resolve on its own, without the need for intervention from a mental health practitioner.

Complicated grief, on the other hand, does benefit from therapy. According to Australian psychologist Judith A. Murray (2001), complicated grief is more likely when the bereaved individual loses a child (including an unborn child), has an intellectual disability or other mental health disorder, sustains multiple losses simultaneously, sustain losses that occur through trauma or violenceOpens in new window, or experiences a sudden loss (without time to prepare).

Circumstances surrounding a loss—including cultural, social, and family contexts—influence the stress accompanying the grief reaction. For example, the response to a suicide may be different among members of cultures or religions that consider suicide a sin versus those that consider suicide an honorable action. Loss may threaten a person’s sense of safety, security, and control (Murray, 2001).

Grief may be accompanied by many symptoms, including depression, somatic symptoms (physical illness), and a higher risk for suicide.

John Bowlby’s work on attachment theory showed that even people who cannot fully understand the finality of death (e.g., young children and individuals with intellectual disabilities may have a more complex grieving process, with a higher risk for emotional disturbance (e.g., sadness, anger, anxiety) and behavioral disturbance (e.g., irritability, lethargy, hyperactivity; Brickell & Munt, 2008). Multiple losses, which can complicate the grieving process, may affect individual’s health, marriages, employment, finances, and emotions (Mercer & Evans, 2006).

Ambiguous loss—such as when a loved one is missing or is presumed to be dead but no body has been found—freezes the grieving process. This can occur in the context of an abduction or a soldier who is missing in action. It can be especially difficult if some family members are still holding out hope that their missing loved one will be found, while other family members want to accept the loss to move forward with their lives.

This type of ambiguity can be emotionally devastating for individuals as well as putting a great strain on families and relationships. Closure is impossible; family members have no choice but to live with uncertainty (Bossk, 2007).

For example, caregivers of family members with dementia or terminal illness know that their loved one is expecte to die but may not know how soon.

Anticipatory loss may be accompanied by a complex mix of emotions, including sadness, anger, and feeling overwhelmed, tired, trapped, guilty, and relieved. Individuals anticipating loss may be feel powerless in the face of the loss (Green, 2006).