Grief and loss: how to cope and when psychological help is needed

Losses, throughout a lifetime, are multiple and varied, as well as inevitable. Failure to deal with a major bereavement predisposes to difficulties with other bereavements. A mourning or a set of poorly elaborated mourning can become chronic in any mental illness. In these situations, a psychologist can be consulted to find out how to deal with it.

On the other hand, if the systems of containment of pain and emotional suffering are flexible and receptive, they lead to an elaborated mourning that can lead to an increase in the creativity of the individual and in his or her internal and external relational capacities. The importance of the mourning processes for the structuring of the personality and for mental health must be kept in mind.

There are different types of losses that we (all people) may go through during our lives:

  1. Loss of people: by death, divorce, emigration, children becoming independent.
  2. Loss of objects: due to theft, catastrophes or economic difficulties.
  3. Loss of physical capacities, due to physical problems or aging.
  4. Loss of status, due to change of job.
  5. Loss of pets

What is bereavement?

Mourning is the normal process of the elaboration of a loss, which aims to reorganize sentimentally, cognitively and socially, to accept the loss and to follow a new path.

To elaborate the mourning means to get in touch with the emotions that this loss provokes and to understand them, assuming and finally accepting the new internal and external reality of the person.

We understand grief and mourning processes as the set of emotions, mental representations and behaviors related to loss, frustration or pain.

The duration of mourning in time depends on each individual but, in general, we can think of what was done in the past, when people were in mourning. The first year they wore rigorous black and the second, gray and purple. Today we do not mourn, but internally the first year is black and the second year is gray and purple. In principle, mourning should not last more than two and a half years.

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What are our normal reactions to a loss?

When human beings suffer a loss, they react in different ways that are considered normal. The most common are:

  1. Feelings: sadness, anger, guilt, recriminations, feelings of emptiness, anxiety, loneliness, fear of having the same disease as the person we have lost, relief, helplessness, etc.
  2. Physical symptoms: tightness in the chest, choking, muscle contractions, headaches, insomnia, etc.
  3. Behavior: crying, unwillingness to let go of objects belonging to the lost person, hyperactivity, etc.

The appearance of what has been described is common; what may be of concern is the degree of intensity and its maintenance over time.

Does the patient go through certain phases to overcome grief?

In general, the bereaved person goes through five phases, but it does not mean that all people have to go through all five stages, and they do not always appear in the same order.

  1. Denial: This is a defense mechanism to postpone the pain that this reality produces in us. This means that we know that it has happened rationally but we do not connect emotionally, as we do not believe it at all. It is a mechanism that gives us time to be more prepared to face the emotional impact. We have not yet had time to adjust to the news.
  2. Anger: Anger and resentment are felt due to the frustration that the loss is a reality and that nothing can be done to change it. It is common for anger to be directed towards people who are not to blame, or even animals and objects. It is anger with life that is projected onto the environment.
  3. Negotiation: Ideas of negotiating reality appear, it is a defensive behavior that tries to avoid the unacceptable. The idea of reversing the process is fantasized and strategies are sought. For example, it is common to try supernatural connections or connections with divine entities.
  4. Depression: The reality of the loss is fully connected with the reality of the loss and a feeling of emptiness appears. A deep sadness floods. There is a tendency to isolation with the idea that “I will never be able to get out of this state”. The support of loved ones is absolutely necessary.
  5. Acceptance: It is characterized by lack of intense feelings and fatigue. At this stage one arrives weak, which is due to the effort that has been made in the previous stages. It is common to make an evaluation of one’s own life.
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When is grief considered pathological?

When grief is poorly resolved or becomes complicated it is considered pathological. Also when the grieving process is interrupted. Sometimes it cannot begin because it is too painful or it gets stuck in some stage, without being able to move on to another. It can also happen that the process goes on but returns to a previous stage.

In these cases, thoughts of death, depressed mood, apathy, physical changes such as weight loss or gaining weight in a short time, insomnia, anxiety symptoms, lack of concentration and avoidance behaviors such as alcohol and drug use may appear. Unrestrained hyperactivity may also appear.

The person can become trapped in the defense mechanism with all the suffering it can entail for not being able to move forward with his life, harming himself and those around him.

The most appropriate treatment to overcome grief

Since what the bereaved person needs most is to be able to understand in order to be able to accept, the most suitable treatment is psychodynamic psychotherapy, since it is a technique that helps to know oneself, establishing bridges with the experiences lived with the significant people at an affective level.

In the treatment it will be essential that the person can express his feelings and does not feel judged but on the contrary, that he finds an interlocutor who gives him back understanding to what he manifests and that facilitates him to dare to go ahead, since it provides energy.

The loss suffered will not be forgotten, it was part of our life and must remain in our memory. If it was a beloved person, it is necessary that what we lived with him/her is carried inside us and his/her memory can be present, we will never lose it. If it was a person with whom we had a conflict, it will be even more necessary to review, analyze and understand what happened. In these cases, grief is more difficult to elaborate. If it was not a person, if it is the loss of an object, a job, etc., it will be necessary to learn from the experience, so that it can be elaborated.

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What type of patients usually come to grief therapy to overcome grief?

When a person is interested in therapy with a psychologist, it is because he/she is suffering. They want and need to live differently. When a grief cannot be elaborated, it causes great suffering to the person and to those who live with him/her.

One can enter into a state of desperation, for not being able to bear the suffering that the loss entails. They also worry about feeling laziness and passivity, feeling that they are not living life. And if they are fathers or mothers, there is the added feeling of guilt for not taking care of their children as they feel they should.

In general, we can say that patients who suffer a complication of grief come to us:

  1. Chronic grief: excessive duration and never reaches a satisfactory conclusion. Resistance to accept the loss, need to clarify and deal with confusing and ambivalent feelings. For those who had a very dependent relationship with the deceased, help to adapt to the absence and develop one’s skills.
  2. Delayed grief: The person may have had an emotional reaction at the time of the loss, but it was not sufficient. Delayed reactions can be triggered not only with a loss, but also in other situations that relive the loss. It can even be at the movies or in the theater.
  3. Exaggerated grief: The person feels overwhelmed and resorts to maladaptive behavior. They are aware that their symptoms are related to the loss.
  4. Masked grief: They experience symptoms and behaviors that cause them difficulties, but do not realize that they are related to the loss.