Death & Dying

Grief

Kathryn Patricelli, MA

As alluded to above, grief is another natural part of life that tends to make people uncomfortable. Understanding more about the typical stages of grief can help you cope with the challenging emotions and thoughts that accompany this experience. Grief is the process, emotions, and thoughts that people experience when important relationships, roles, or important possessions are interrupted, ended, or destroyed; either through death, divorce, relocation, theft, destruction, or other similar processes.

There are two types of losses that people grieve. The first is the actual loss of the person or thing in someone's life. The second is the symbolic loss of the events that will no longer occur in the future. For example, when a loved one dies, mourners may grieve the actual loss of the loved one as well as grieving for the loss of future events (birthdays, holidays, etc.) that they might have shared with the loved one.

Grief is a normal and natural process that takes time, effort and energy to work through. The consequences of grief can be physically, psychologically, and spiritually demanding. In addition, people tend to grieve in very different ways. Some grieve openly, while others conceal their feelings of distress. Some people grieve quickly, while others take a long time to "finish." There is no "right way" to grieve. Individual grieving patterns are shaped by our personalities, coping styles, and the particular loss we have sustained.

Even though everyone grieves in slightly different ways, there are some regular patterns or stages of grieving that people usually experience. The following models describe the emotions and mental processes that are often experienced at different stages of the grief process.

Horowitz's Model of Loss/Adaptation

Psychiatrist Mardi Horowitz divides the process of normal grief into "stages of loss." These stages are typical, but they don't occur for everyone or always in this exact order.

  • Outcry. People often get extremely upset when they first realize that they have lost someone important. They may publicly scream and yell; cry and collapse. Alternatively, they may hold their distress inside and not share it with others. Outcry feelings may be suppressed in order to decrease the intensity of the feelings, or they may spill out uncontrollably. In either case, initial outcry feelings take lots of energy to sustain and tend to last for only a short period of time.
  • Denial and Intrusion. As people move past the initial outcry stage, they will often enter a period characterized by movement between 'denial' and 'intrusion'. On one end of the continuum, people distract themselves so thoroughly with other activities and thoughts that they don't think about the loss (denial). At the opposite end of the continuum, the loss is felt very strongly, almost as intensely as during the initial outcry stage (intrusion). It is normal for people to bounce between these opposites of denial and intrusion. People may also feel guilty when they experience the denial portion of the continuum (out of fear that they may be betraying their lost loved one by not remaining faithful to them). It is important to keep in mind that the presence of some medium amount of denial is not so much a betrayal as it is a sign that healing of the emotional wound created by the loss has begun. Denial serves to decrease the intensity of feelings so they are more manageable and less overwhelming.
  • Working Through. As time goes by (days, weeks, months), the movement between denial and intrusion slows down and becomes less pronounced, with people spending more time not thinking about or feeling the loss, and less time being overwhelmed by it. During the working through stage, people start to figure out new ways to exist without the lost relationship. Plans and goals during this stage might include making preparations to date again (or just starting to think about it - assuming the loved one was a spouse), developing new friendships and strengthening existing ones, finding new hobbies, engaging in new projects, etc.
  • Completion. At some point (months, years), the process of grieving is completed or rather, "completed enough", so that life has started to feel normal again. While memories remain of what has been lost, the feeling attached to the loss is less painful and no longer regularly interferes with the person's life. Temporary reactivation of grief feelings may occur on important anniversaries (marriage dates, birthdays, holidays, etc.), but such upwelling of hurt feelings tend to be temporary in nature.

Kubler-Ross's Stages

As mentioned previously, the stages described by Dr. Kubler-Ross also apply to the grieving process. To read about those stages again, click here. Again, not everyone will experience all of these stages, or, if all are experienced, they won't necessarily occur in this particular order.

Therese Rando's Six R's

Researcher and Clinical Psychologist Therese Rando has also developed a stage model of the grief process that people experience while adjusting to significant loss. She called her model the "Six R's":

  • Recognize the loss: First, people must experience their loss and understand that it has happened.
  • React: People react emotionally to their loss.
  • Recollect and Re-Experience: People may review memories of their lost relationship (events that occurred, places visited together, or day to day moments that were experienced together).
  • Relinquish: People begin to put their loss behind them, realizing and accepting that the world has truly changed and that there is no turning back.
  • Readjust: People begin the process of returning to daily life and the loss starts to feel less acute and sharp.
  • Reinvest: Ultimately, people re-enter the world, forming new relationships and commitments. They accept the changes that have occurred and move past them.

Though different in approach and ordering of stages, each of these models suggest that grief begins with an intensely painful emotional adjustment which necessarily takes time and cannot be hurried along.

 




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