What is bereavement?
Grief is a psychological state resulting from the loss of an important person who has been part of the individual’s existence. The loss of a loved one or a subtraction (homeland, freedom, an ideal), in some individuals unable to accept its ineluctability, acquires pathological characteristics. The experience of loss is experienced differently from individual to individual. It is therefore incorrect, from a clinical point of view, to judge the psychological reactions of a subject as pathological in the early stages of grief.
How is grief processed?
According to Kübler Ross’s five-step theory, grief includes:
- A phase of denial or rejection of reality;
- A phase of anger, characterized by the feeling of loneliness and the need to address the pain externally or internally;
- A phase of negotiation or compromise, which consists of the revaluation of one’s own resources and reality;
- A phase of depression, constituted by the awareness that death is inevitable;
- The last phase of acceptance of grief, where one becomes aware of the different conditions of life.
How do people react to grief?
According to Onofri and La Rosa, reactions to grief are divided as follows:
- Feelings: sadness, expressed through tears, is the most common feeling among those who have suffered a loss. Anger is caused by the fact that the person could not avoid the loss. Guilt is an irrational feeling, which refers to something that could have happened but did not happen in the moments prior to the bereavement. Anxiety comes from the feeling of not being able to protect oneself, especially from death. Other emotions caused by bereavement can be loneliness, shock (in case of sudden bereavement), longing, relief (if the deceased person has had to face a long and difficult path) and numbness (not feeling emotions).
- Physical sensations: after a bereavement it is easy to experience tightness in the chest, feeling of gastric emptiness, difficulty breathing, hypersensitivity to noise, weakness and lack of energy, feeling of depersonalization, dry mouth.
- Cognitions: disbelief, confusion, worry, sense of presence (thinking that the deceased is in the current spatio-temporal area) and auditory and visual hallucinations (typical of survivors).
- Behaviors: bereavement may cause sleep disturbances, appetite disturbances, distractibility and social isolation. It is not uncommon for the person to dream of the deceased, call him/her, or visit places that remind him/her of the deceased. Others, however, try to avoid memories and are hyperactive. Crying and sighing are two other frequent behaviors.
When does a bereavement become pathological?
We usually reach the acceptance phase of grief 18 months after the event. The person manages to return to a situation comparable to the pre-bereavement phase, with an improvement in mood and the abandonment of psychosocial problems. However, some subjects cannot accept the inevitability of the loss and continue to show symptoms.
How to overcome pathological grief?
A psychotherapist can help to overcome grief through cognitive-behavioral therapies (CBT), EMDR (eye movement desensitization and reprocessing) or sensorimotor therapies. In addition, group therapy often yields better results than individual therapy.