Stages of Grief

About a week and a half ago, I went to a talk that was being held by the American Foundation of Suicide Prevention.  It was called Complicated Grief: Bereavement after Suicide Loss and I thought it would be something that would be helpful in my grieving journey over the loss of Tiffany.  What I learned was something unexpected and eye-opening.

The lecture was given by Dr. Natalia Skritskaya, Ph.D. from the Center for Complicated Grief.  During the presentation, I learned that there are stages of grief.  There's acute grief and integrated grief, and along with both of those stages, is mourning.

The first stage or process of bereavement, acute grief, is defined as the initial reaction to loss, which differs from bereavement or mourning.  It may present physical symptoms such as shortness of breath and a tightness of breath in addition to emotional, spiritual and behavioral responses.

Acute Grief Responses

As one processes acute grief into integrated grief or abiding grief, the deceased can easily be called to mind, often with associated sadness and longing.  During the transition from acute to integrated grief, usually beginning within the first few months of the death, the wounds begin to heal, and the bereaved person finds his or her way back to a fulfilling life.  The reality and meaning of the death are assimilated and the bereaved are able to engage once again in pleasurable and satisfying relationships and activities.  Even though the grief has been integrated, they do not forget the people they lost, relinquish their sadness nor do they stop missing their loved ones.  The loss becomes integrated into autobiographical memory and the thoughts and memories of the deceased are no longer preoccupying or disabling.  Unlike acute grief, integrated grief does not persistently preoccupy the mind or disrupt other activities.  However, there may be periods when the acute grief reawakens.  This can occur around the time of significant events, such as holidays, birthdays, anniversaries, another loss, or a particularly stressful time.

Grief & Bereavement

And then there is mourning, which is defined in Wikipedia in the simplest sense, as synonymous with grief over the death of someone.  The word is also used to describe a cultural complex of behaviors in which the bereaved participate or are expected to participate.  Customs vary between different cultures and evolve over time, though many core behaviors remain constant.  Wearing black clothes is one practice followed in many countries, though other forms of dress are also seen.  Those most affected by the loss of a loved one often observe a period of grieving, marked by withdrawal from social events and quiet, respectful behavior.  People may also follow certain religious traditions for such occasions.

What I also learned is that there is another stage of grief.  A state of being, if you will, that I was totally unaware of called complicated grief.  This is an intense and long-lasting form of grief that takes over a person’s life.  It is natural to experience acute grief after someone close dies, but complicated grief is different.  Complicated grief is a form of grief that takes hold of a person’s mind and won’t let go.  People with complicated grief often say that they feel “stuck.”

What is Complicated Grief?

The term “complicated” refers to factors that interfere with the natural healing process.   These factors include:

• Strong feelings of yearning or longing for the person who died
• Feeling intensely lonely, even when other people are around
• Strong feelings of anger or bitterness related to the death
• Feeling like life is empty or meaningless without the person who died
• Thinking so much about the person who died that it interferes with doing things or with relationships with other people (rumination)
• Strong feelings of disbelief about the death or finding it very difficult to accept the death
• Feeling shocked, stunned, dazed or emotionally numb
• Finding it hard to care about or to trust other people
• Feeling very emotionally or physically activated when confronted with reminders of the loss
• Avoiding people, places, or things that are reminders of the loss
• Strong urges to see, touch, hear, or smell things to feel close to the person who died

They have also learned that there are certain types of people who are probably at a heightened risk:

• women appear to be more susceptible than men
• people who are vulnerable to mood or anxiety disorders
• those who had a difficult relationship with their parents growing up
• losing a loved one in a sudden, violent way

Most people who have complicated grief have lost someone very important with whom they have had a positive, rewarding relationship.  Most commonly it’s a child or a romantic partner.

For parents, the death of a child may be the most difficult experience a person ever faces.  Parents begin to care for a child as early as conception as they imagine what the child will be like.  Taking good care of a child is often the most important thing in a parent’s life.   A child’s death triggers feelings of care-giving failure.  The loss of a child can sever a parent's feeling of connection to the future.  Losing a child can feel to parents like losing a part of themselves.

And grief can sometimes be further complicated when a loved one dies by suicide since survivors almost always blame themselves.

I walked out of that room that day and realized that I had not moved forward very far on that path I trod, that road of grief, at all.  I have let Tiffany's death define me for the last three years in many, many ways.  That's not to say that I haven't made any strides toward healing but that I get to a certain point past which I can't seem to progress.  Then I slide back to all those overwhelming feelings of grief and anguish and the process starts all over again.  So now I need to commit to moving past the roadblock in my mind and it is my hope that this blog will help me accomplish that task.

Yesterday, I read something that really hit home.  I've included the link below.  In this article, the author talks about agony and strength.  She puts into words what has been going through my mind but that I could never verbalize.  And that is that the agony and pain of Tiffany's death will never end -- it will be mine until the day I leave this earth.  And that as much as I think that I can't do this day in and day out, I have and I will.  I really have no choice.  But most significantly, when people tell me how strong I am, it is not from being strong at all.  As the author says, "there is no strong when it comes to the death of a child".  And she's right.  It's not about being strong; it has nothing to do with being strong.  It's all about perseverance and putting one foot in front of the other day after day, hour after hour, minute after minute.  And unfortunately, one would have to experience this type of loss, this kind of pain, to understand.

Suicide, Our Children and Grief