While grieving the death of a loved one, most people go from a period of acute grief through to a more accepting stage. But what can be done for people who can’t get past that raw first stage?
THE MAN, a psychologist, had visited his wife every day for years. She suffered from dementia and could not talk, but he spent his time with her and organised his life around her nonetheless.
He had prepared himself for her death, but when it came the disruption it brought to his own life “really threw him”, according to Dr Katherine Shear, professor of psychiatry at Columbia University School of Social Work.
Shear works with people suffering from what she calls “complicated grief”. She shared her knowledge with counsellors, psychologists and social workers at a recent two-day workshop organised by the Irish Hospice Foundation and St Vincent’s University Hospital.
The bereaved husband was referred to her service for treatment. It took three months to get him to finally come to her clinic, because the journey there involved passing places he and his wife used to visit together, and the prospect was unbearable at first. The story shows just how hard grief hits, even when death is expected.
In an interview following the workshop, Shear charted the interruption that can take place due to grief in about 10 per cent of cases of normal death and 20 per cent of violent deaths.
The first stage is acute grief. Here, the pain is raw and “very dominant in your life. In other words, it’s hard to think about anything else. It’s pretty pervasive”.
After a period of time – she estimates about six months, though it varies from person to person – acute grief gives way to what she calls integrated grief.
During this stage, “we pretty much accept the finality of someone’s death, and we’ve more or less come to think of our lives as going on without that person.
“That is not to say that once we move ahead into integrated grief that it’s all gone. We don’t forget the person we lost. We don’t stop caring about them. We don’t stop missing them. We all miss the people who are gone, and that’s really what grief is about.”
But integrated grief is “more subdued” than acute grief, and while experiencing it we can set about rebuilding our lives and begin to experience joy again.
Sometimes, however, this doesn’t happen, and the grief remains as fresh as ever. This is complicated grief.
“With complicated grief the acute grief just persists and persists, so we don’t make the transition to integrated grief. Something has complicated and essentially derailed the natural, instinctive mourning process.”
On average, people come to her clinic for help with complicated grief about two years after the death of their loved one.
But some may have suffered acute grief for decades, and “when they start to talk about the death it is as though the person died yesterday”.
People can get caught in complicated grief because of a feeling of guilt at the idea of moving on without the person who has died. Perhaps they feel they or somebody else could have done more to prevent the death. Perhaps they spend their time ruminating on these matters.
The approaches used by Shear’s clinic to help people move on from complicated grief include techniques adapted from the treatment of soldiers and others with post-traumatic stress syndrome.
For instance, the grieving person is encouraged to revisit in imagination the time they learned of the person’s death.
The aim is to help them to reflect on the experience, what it means to them, and to work out if there is a way of thinking about the death that helps them to “make some peace” with it.
An imaginary conversation with the dead person can also help greatly. In the imaginary conversation they can talk to the dead person about, for instance, things they might feel guilty about.
They may feel guilty, for example, about the desire to find somebody else to share their lives.
In the imaginary conversation the dead person can give permission to the living person to go ahead and meet someone else.
Talking to the dead person in imagination “often gives you a deep sense of connectedness to that person”. This, in turn, reassures the living person that they will never lose the connection with the one who died even as they go on to make new relationships in their lives.
People generally come to her clinic “because they are suffering a fair amount. They are feeling very estranged from other people around them.”
Usually “they have tried lots of other things by the time we see them”.
Very often, she points out, society puts unreasonable demands on people to get over a death too quickly.
But when the suggestion that it might be time to move on comes from good friends or family members, then it is worth considering whether one is suffering from complicated grief and needs help in overcoming it.
YOU'RE NOT ALONE: WHERE TO GO FOR HELP
Dr Susan Delaney, bereavement services manager at the Irish Hospice Foundation, says that about 3,000 out of the 300,000 people bereaved in Ireland every year are at risk of developing a more complicated grief.
The foundation has established a national education and resource centre from which it provides a comprehensive range of education and training programmes, as well as resources on bereavement.
A series of leaflets on bereavement can be downloaded from its website at hospice-foundation.ie
