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The Nature of Grief: What is Normal? When Does it Become Complicated?

“Each substance of a grief has twenty shadows.” — William Shakespeare
The pain and sorrow that accompany loss are deep and cast many shadows.  There is “normal” mourning and complicated mourning.  There are STUG reactions, or sudden and temporary upsurges of grief, that can occur throughout one’s life. There are thought to be stages of grief.
Feeling impacted by a death or other loss is a part of the human condition.  We can feel, we can love, and we can connect.  When someone with whom we’ve connected dies, it’s logical and expected for us to mourn that loss.  (This makes sense, as one emotion can’t exist without the context of its opposite.  We only know happiness because we know sadness, and vice versa.)
What does this normal grief feel like?  It involves varying degrees of sadness, loneliness, guilt (Why didn’t I do more when she was alive? Why him and not me?), trouble sleeping, anxiety or numbness (often both), fatigue, and even physical pain.  Those are some of the most common feelings, but there are others, too, and each person experiences grief in a unique way.  Each person mourns differently, too.  Two people dealing with loss might feel many of the same emotions (known as grieving), but one might express them (or mourn) through frequent crying, while the other withdraws.  And yet another might become irritable.  As long as no one is harmed, there isn’t a “wrong” way to grieve and mourn.
It’s widely accepted, although admittedly disputed by some, that the above feelings of grief are experienced in five stages.  Researched, categorized, and described by Dr. Elisabeth Kubler-Ross, they include denial, anger, bargaining, depression, and acceptance.  It’s important to know that this is not a linear progression, nor do they all have to be experienced for equal length and with equal intensity.  It’s very common for someone in mourning to “bounce” back and forth, to move from one phase to another and then back again before moving on.  This is part of Shakespeare’s twenty shadows.  The shadows hide things.  Someone may be feeling anger (at the world, at himself, even at the person who died), but lurking in its shadow is both denial and bargaining.  Denial might come back to light and keep the others in its shadow.
A brief note regarding depression:  Grief isn’t a mental illness.  The symptoms discussed above are considered normal, and a person experiencing them after a loss would not be diagnosed with major depressive disorder.  Even the “depression” in the Kubler-Ross model doesn’t mean clinical depression.  It refers to the expected sadness, emptiness, and lack of energy that accompanies loss.  Major depressive disorder is only diagnosed when the required criteria are met.
Can grief ever escalate beyond what is considered healthy?  Yes, it can.  It can become what is called complicated mourning or complicated grief, and it can happen for a number of reasons.  A death that is unexpected or traumatic can lead to complicated mourning as can the death of someone with whom one has had a complicated relationship.  If there is an event, such as a car accident, in which someone survives but others die, survivor guilt can escalate into complicated mourning.
I wanted to show what this is like, so I incorporated it into the novel Leave of Absence.  In the story, Oliver Graham has experienced the traumatic loss of his wife and young son.  He’s admitted to a behavioral health center after an unsuccessful suicide attempt, and at one point in the story he laments to his doctor, “I don’t want to live my life! I have nothing to live for.  Why can’t everyone just accept that and let me go?”  This sentiment is a very common part of complicated mourning.  A person so rooted in grief often wants nothing other than to die.  This feeling can be part of “normal” grieving, too, but it’s fleeting and doesn’t turn into an obsession or a mission like it does with complicated mourning.

Complicated mourning can make it feel impossible to move forward.

Complicated mourning can make it feel impossible to move forward.

With complicated mourning, the symptoms simply don’t fade, and often they intensify over time.  The person becomes completely stuck in his grief, unable to move on.  The longing for the deceased loved one is so intense that the deceased becomes the sole focus of the grieving person’s thoughts.  The person loses all ability to enjoy life (hence Oliver’s lament that he has nothing to live for), and as a result he or she becomes not only numb and detached but completely withdrawn.  In Leave of Absence, Oliver barely uttered a word for several months (this of course occurred before the opening of the story or it would make for a pretty boring novel).  Clinical depression often sets in, making it extremely difficult to carry out daily tasks.  Oliver had such difficulty concentrating on what he needed to do that he quit his job and walked away from his life.
Frustrated, at one point Oliver expresses his feelings this way:  “She’s gone and I’m here and it’s my fault and I don’t deserve help and I miss them so much and I don’t want to betray them by getting better.”
With complicated mourning, it is absolutely essential to get help.  And even with less intense mourning, mourning of the expected variety, help can be useful.  Treating grief is possible and important.
 

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