Dr Alistair McBeath is an experienced Chartered Psychologist and accredited Counsellor and Psychotherapist. He works as an Associate of the Craigie Partnership, an Edinburgh-based team of Psychologists and Coaches.
Grief is a natural and multi-layered response to the loss of someone of real importance in our lives. For most of us it is an unwelcome and deeply uncomfortable process that can affect our psychological and physical well being. Of course, grief also uneasily awakens our own sense of mortality. From a psychological perspective quite a lot has been written about grief and it is the purpose of this article to try and capture some of the important insights that have enhanced our understanding about grief and how it can affect us.
One of the key points about grief is the fact that it is an almost unavoidable response to the loss of someone of real importance in our lives. This point was firmly made by the British psychiatrist John Bowlby who emphasised that when a strong attachment to someone is broken there will be an almost inevitable strong reaction. So, a key point about grief is that, in many ways, it is an understandable and proportionate reaction to a deeply important loss. The most commonly used system to diagnose psychiatric conditions (DSM V) reinforces this point in recognising that although grief reactions can be deeply disturbing and intense they are essentially ‘normal’. So, there is nothing essentially dysfunctional or pathological about the painful experience of grief.
The experience of grief and how it affects us has been likened to a form of psychological journey and one where there are recognisable stages or phases to our pain and feelings. This notion has been advanced by a number of theories, which, although differing in detail, have the common theme that grief has vital and differing stages of experience. Recognising that grief has various stages of experience has some very important implications. Perhaps most important is the fact that healthy grief is a progressive psychological experience where certain grief reactions have to be successfully negotiated before one can move on to the next and an eventual readjustment to the loss of a loved one.
One of the most intuitively recognised theories of grief comes from the combined work of two British psychiatrists, John Bowlby and Colin Murray Parkes who proposed a four-stage model of grief. The stages were identified as (1) shock and numbness (2) searching and yearning (3) disorganisation and despair and (4) reorganisation and recovery.
Shock and Numbness – this is the initial reaction to the loss of a loved one where the reality of the loss is unable to be accepted. This stage was actually conceived as a self-protective coping state where individuals shut down many cognitive processes and, instead, rely on what appears to be a psychological autopilot.
Searching and Yearning – this stage is really one of confusion where emotions such as anger, guilt and despair can swirl around with no apparent logic. Individuals frequently socially withdraw at this stage.
Disorganisation and Despair – this stage is where the reality of the loss starts to become apparent; that the world can never be the same. Individuals are prone to depressed mood at this stage and may show signs of lack of self-care and heighted social withdrawal.
Reorganisation and Recovery – at this stage there are the beginnings of an acceptance of the loss. Energy levels and decision-making increase as the individual begins to ‘manage’ their loss.
It is important to recognise that whilst grief may involve several discernable stage or phases they are not necessarily experienced in a linear fashion. They may overlap and also may vary significantly in depth and duration depending on an individual’s personal history or, indeed, their pervious experience of loss. But what is clear is that a focus on the stages of grief serves to highlight the varying psychological experiences that grief can involve and also the breadth and depth of the journey that is necessary to achieve a healthy adjustment to loss.
In seeking to progress through the journey of grief it is important to recognise that an active purposeful response is far more likely to be successful than a passive response. Sigmund Freud coined the term ‘grief work’ to identify discrete areas of psychological processing that were thought to promote an eventual adjustment to the loss of a loved one. Freud identified four areas of grief work; these are,
Perhaps most important within Freud’s grief work is the importance of giving expression to grief, to feel the pain and not to try and supress inevitable painful feelings. Grief is a painful and disturbing experience but one where a stoical attitude or just ‘getting over it’ will delay the natural process of recognition and adjustment to a painful loss.
Another important contributor to the concept of grief work was the Austrian psychiatrist Erich Lindemann who identified three key areas of grief work. These involved (1) recognising that the strength of attachment to a deceased person has to be readjusted (2) adjusting to a world in which a deceased person is not present and (3) forming new relationships. Again, the value of these ideas is in highlighting that healthy grief requires an active psychological response. It’s important to emphasise that Lindemann wasn’t talking of trying to forget a loss; on the contrary he emphasised the need to incorporate the loss within an adjusted future focussed view of the world.
It’s worth noting that Lindemann made an important contribution to our thinking about grief by emphasising that our reactions would inevitably involve physical as well as psychological responses. He identified 5 specific physical sensations that may be familiar to those who have experienced a painful loss; these were
Grief is painful journey but one which should be regarded as a normal response to a painful loss. Grief can deliver very challenging psychological challenges and also discrete physical symptoms. The process of a healthy grief response is really a journey from shock and disbelief to a position of meaningful adjustment to a changed world. The healthy reaction to grief is a proactive rather than a passive response to the loss of a loved one.
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