My dear mum, Ethel, did not manage well at all after my dad, Bob, died when my brother and I were aged 8 and 5. Although we were all absolutely grief-stricken, mum's grief was especially intense, prolonged and tragic. In the immediate days following, mum was incapable of caring for us and allowed neighbours to do so. Perhaps this is understandable - she may have thought it best to protect us from her grief.
In the weeks following, she suffered facial palsy, where one side of her face became paralysed. In the following years, she suffered a type of emotional palsy where she found it hard to express any affection to her sons. Perhaps if she had allowed herself to feel even positive emotions the pain would have been unbearable.
You can put your tissues away now. Things did eventually improve, but it took some years. But this story prompts the question, ‘How do you know when grief is going wrong?' There are a number of ways you can do so.
The first is to notice that someone is not moving through their grief. Here I want to clarify that there are some losses you simply never ‘get over'. But there is often a sense by people with problematic grief, that they are ‘stuck'.
Professor James Worden suggests that there are four stages people need to go through in coming to terms with their grief. The first is to accept the reality of their loss. Secondly, people have to find a way of expressing their pain that is appropriate for them. Some do so by crying and talking with their support people. Others express their pain through rituals such as visiting the cemetery or talking to their loved one who had died. Some do so through physical activity - perhaps working harder or through exercise.
The third stage according to Worden is to overcome the barriers to moving forward with their life. In the case of loss associated with injury, it could be managing their pain or changing what they do for a living. Fourthly, people need to find an emotional place for the loss that allows them to continue to live their life well. They still feel sadness at different times, but they are still able to live, love and laugh.
Although people grieve in different ways, often at a different pace, and to different intensities, if people become stuck at one of the early stages, this is a sign that the grief may well have become complicated.
Another sign of problematic grief is a delayed grief reaction. Perhaps people were not able to grieve properly at the time of their loss, due to having to hold it together for the sake of others or the extent of their losses not being fully appreciated until later. However, a more recent event triggers a strong grief response from the earlier loss. In my counselling practice, I often saw people coming to terms with losses associated with their childhood abuse when they have young children themselves.
People can also have exaggerated grief reactions, where the pain of their loss is expressed through depression, anxiety or problematic alcohol or drug use. When such conditions are present after someone has suffered a major loss, chances are the real problem is the grief, not so much how it is coming out. But if a clinical condition, such as depression is present, this needs to be addressed as well.
Some people even have what is called masked grief reactions, where they experience similar symptoms to a person who has died or imitate the deceased in other ways. One widow I know of developed similar heart problems to her husband who had died even though there was no diagnosable condition.
There are also special types of loss, such as the death of a child, a family member's suicide, the murder of a loved one that increases the likelihood of problematic grief. For example, the police investigation, the absence of a body, other people's lack of support, or ongoing court actions can make what is an unimaginable loss much, much harder to deal with.
