Chapter 14

Understanding Loss and Bereavement

Many times we can be living with bereavement and not even know it. Bereavement is like a marinade in that we are so permeated by it that we no longer notice how it affects us. All of us will die and all of us try to find ways to ignore that difficult fact. Instead when we lose things, people, parts of our lives or ourselves we try to continue as if nothing has happened. Not that we need to shroud ourselves in black and mourn every passed day…more that when we do encounter a significant event we need to honour it and ourselves. To ignore grief is fatal, its effects will only find a different way to flavour our lives.

Grief can be better understood in terms of phases or stages; not that these phases are distinct or follow in some kind of order, its more that they co-exist or overlap at any or all points. It’s this overlapping of emotions that can create feelings of being mad or out of control when dealing with bereavement.

Bereavement can flow from any and all of these. What I do believe is that the best way is to work through all of the feelings arising from loss, that the worst kind of grief is yours and yours alone and dealing effectively with your feelings  is best not done alone. Working with your feelings and allowing yourself to grieve effectively can be hard and draining work, which is why I suggest that you try to work with others, though this does take courage.

Recovery from bereavement is about overcoming the grief from death of a loved one or an end of a relationship and beginning the process of adapting to life after this. To understand bereavement is not about getting over loss, rather it is about adjusting to life after it and starting to restore balance. There is no getting over for a loss will always mean a change in our lives thereafter.

Typical phases;

Numbness; this often follows death or divorce, it is the feelings of being paralysed, distant and the loss of feeling other than that of an all consuming grief.

Denial and Isolation: this can be complete denial of the death or be seen in forgetful thinking or behaving as though the death has not happened and that the person will turn up shortly e.g. their place may still be set at table or favourite meals cooked. Recognising loss means accepting the reality of Death or the end of a relationship, this emotional recognition and acceptance of loss is difficult to achieve and can only happen when full recognition that the person or relationship has died and will not return.

Anger; Why me? Why him/her? Anger at the world and too with the dead person for leaving, this can lead to guilt if not understood as a natural part of bereavement.  Belief in religion or God can be questioned and bargaining for the return of the dead person may also happen. Releasing the emotions around the Death of a person or a relationship creates intense emotions; Anger, sadness, fear, despair, guilt, shame, jealousy and loneliness. To help the bereaved all of these emotions need to be fully expressed and understood. We may find it easier to understand if they want or need to weep but may find it harder if they wish to be angry at being left behind. These intense feelings will, over time, become less intense. At first though they can dominate their lives and can interrupt any and all necessary daily activities creating out of control feelings and possible panic at being thought mad for not being in control. This too is normal, we know too though that these feelings will ease over time becoming less frequent or intense except for possible trigger events like anniversaries, holidays and favoured places, films, theatre or music. After the initial impact of loss has passed, emotions will still be deeply felt and the bereaved begin to deal with changes that death brings. This can challenge their belief system about how things ought to be.  This creates immersion into their feelings and is highly internally focused. Here too, those bereaved may begin to deconstruct their values, beliefs and question why their loved one was taken from them. The processes here are of dealing reality, development of insight, the reconstruction of personal values and beliefs and the beginning acceptance and of letting go.

Depression; sadness and depression may begin to occur as the bereaved begin to acknowledge that their life will not be the same again. Depression can be seen as the flip side of anger and may represent that not all angry feelings have been worked through. This emotional energy needs to be focussed into the present by encouraging and supporting the bereaved to work through their emotions.

Acceptance; is coming to terms with loss, the beginning of moving on to explore the possibilities of life in the future. Here the extremes of emotion felt initially begin to abate, not that they are emotionally over their feelings, but that they no longer allow their emotions or thoughts stop them from dealing with their day to day lives. Acceptance can be the time to develop new skills; becoming independent again, making newer friends, networks, taking on new ways of being world or family. This is about building into our lives the experience of death or loss of relationship and is about our personal growth and development; how we as people learn about ourselves and take that learning forward. Acclimation and adjustment refers to the initial emotional shocks and disorientation brought by death: adjusting to changes brought about by loss, keeping going and appropriately in daily life, keeping emotions and behaviours in check and accepting support offered.
Here most issues about death have been resolved and the bereaved begins to reclaim and move on with their lives. This can be regarded as recovery from grief, however the death of a loved one does leave a permanent impression because life will not be restored to the way it was before their death. What we can do, is to begin rebuilding or creating a new life by engaging again with other people; living in the present rather than the past, re-establishing themselves in the world and planning for the future. development of social relations, decisions about changes in life style and a renewal of self-awareness.

 These phases indicate the processes that the bereaved can go through, however each of us will do these differently. There are no deadlines, specifics or right and wrongs.

The Stages of Grief

The goal of grief work is not to find ways to avoid or bypass the emotional turmoil and upsets brought by loss. Instead, its goals involve working through the tasks and emotions of each stage of grief.

Stage 1: “Acclimation and Adjustment”
In this first stage, the tasks largely involve dealing with the initial emotional shock and disorientation often brought by death:

	adjusting to changes brought by the loss
	functioning appropriately in daily life
	keeping emotions and behaviors in check
	accepting support

Stage 2: “Emotional Immersion and Deconstruction”
Although the initial impact of the death has passed, emotions are often deeply felt during this stage. The bereaved face and have to deal with the changes that the death has brought, and often challenges to their beliefs about the way things should be. This stage incorporates the most active aspects of grief work. It’s not that this stage is any more intense than the first stage — in fact, it’s difficult to imagine that anything could be more intense than the period immediately following a loss. But during this stage, people are likely to become deeply immersed in their feelings, and very internally-focused. It’s also quite common for the bereaved to undergo a “deconstruction” of their values and beliefs, as they question why their loved one was taken from them. The tasks associated with Stage 2 include:

	contending with reality
	development of insight
	reconstructing personal values and beliefs
	acceptance and letting go

Stage 3: “Reclamation and Reconciliation”
In this final stage many issues about the death have been resolved, and the bereaved more fully begin to reclaim and move on with their lives. This stage is generally thought to be one marked by “recovery” from grief. But the loss of someone close leaves a permanent mark on people’s lives in the sense that things can’t be restored to the way they were before the death. However, people can begin to rebuild, creating a new life for themselves and re-engaging with the world around them. As this stage ends, the bereaved become reconciled to the death itself, and the changes it’s brought to their lives. Perhaps most important, they begin to live in the present, rather than the past, re-establish who they are in the world, and plan a future. The primary tasks of this stage are:

	development of social relations
	decisions about changes in life style
	renewal of self-awareness
	Acceptance of responsibility

Respecting Loss and Bereavement

Talking about “recovering” from grief is almost disrespectful, as life is never restored to the way it was before the loss of someone close. When people talk of recovery, they really refer to overcoming grief and adapting to life after the death. This is an important distinction to draw, because the purpose of grief work is not to “get over” loss, but to adjust to its consequences, and restore balance.

1-Numbness:

This reaction often follows the death of a loved one and may last for seven to ten days. A sense of being paralyzed, distant, and removed from one’s feelings of grief is present. Some have referred to numbing as the body’s mechanism for protecting itself from being overwhelmed by the shock of the loss.

2-Denial and Isolation:

Here the bereaved individual has significant difficulty accepting the reality of their loss. This may be expressed in more severe forms as a complete denial of the death or in less severe forms in lapses of thinking and behaving as if the person had really died. While complete acceptance is part of the work of the entire grief process, the initial more acute difficulties with acceptance are included in this phase.

3-Anger:

In this phase the bereaved person feels anger with the world, fate, God, or people in their lives. A sense of “Why me?” and/or “Why not someone else?” give a flavor of this phase. Bargaining with God for the return of the dead person may be part of this phase

4-Depression:

As acknowledgement and acceptance of the loss and the reality of life after the loss grow, sadness and depression become more present.

5-Acceptance:

The bereaved person comes to terms with the loss, and is able to move on to re-invest in the new life that lies ahead. An absence of the extremes of emotion previously experienced is present.

More recently, mental health professionals, with the help of the bereaved, have come to understand that there are tasks involved in grief work that may occur in varied sequence and often simultaneously as the work of one task will move along the work in other tasks. Drawing on the work of Worden, Leick and Davidsen-Nielson (1991) describe four basic tasks that the bereaved individual needs to achieve in order to integrate their experience of loss into their life and move toward investing in a new life without the lost loved one. These four basic tasks are as follows:

Recognizing the Loss:

Accepting the reality of the loss is the difficult work here. Initially the loss may be denied or minimized. Then it may be intellectually processed. The emotional recognition and acceptance of the loss is the most difficult to achieve, and involves a full recognition that the lost person will not return.

Releasing the Emotions of Grief:

The pain experienced at the loss of a loved one is composed of many intense emotions including sadness, despair, anger, guilt, fear, loneliness, shame, jealousy. When a person who is integral to one’s life dies there are other losses which also follow. Being able to weep over the losses and to express anger and other uncomfortable feelings is part of the healing process. Initially, these painful feelings may be omnipresent. Eventually they become more periodic, surfacing at unexpected and expected times during the day. Their unpredictable nature can create as sense of being out of control and often the leave the sufferer with the experience of being on an “emotional roller coaster.” Eventually they become less frequent and may become intense mostly during anniversaries, holidays, and special events.

Developing New Skills:

This work involves the need to take on new roles and make new kinds of contacts in the world. Making a new set of friends, finding a support network, relating to others in a new way, taking on new roles in the family, and becoming more independent may all be part of this process. Underlying this work is the work of incorporating the experience of the loss into one’s identity. The opportunity for personal growth and development is perhaps most clearly seen in this part of the grief work.

Reinvesting Emotional Energy in the Present:

As the other types of grief work are achieved more energy is available to be released into the new life that the bereaved person has created. This may result in new relationships, closer relationships, investment in work, or even in investment in an activity that is in honor of the dead person, or stems from the experience of loss. Leick and Davidsen-Nielsen describe the work of this phase as being able to say a final farewell to the dead person. They stress that this does not mean a giving up of memories, but rather a release from a central attachment to the dead person so that there is more room and energy for engaging in life in the present.

For some this will mean integrating their experience of loss into a larger acceptance of human mortality. Individuals at this point in their grief work will sometimes report feeling increased energy and better ability to enjoy their present lives without guilt and fear.

These phases and tasks are indications of the kind of process that the bereaved individual will go through, but not of the unique and specific process of the individual. There are in reality no rights and wrongs and no deadlines. While individual paths share in the types of processes described above, each person’s path will still be uniquely influenced by the bereaved person’s personality and history, their relationship to the dead person, the manner in which the person died, and other factors as well. However, there are some universal aspects to grief work which Bob Deits (Deits, B., Life After Loss, p.61) nicely summarizes as:

1) The way out of grief is through it.

2) The very worst kind of grief is yours.

3) Grief is hard work.

4) Effective grief work is not done alone.

For the bereaved, the models of grief work can serve both as compasses which show the direction of your path at a particular time, and as topographical maps revealing the landscape of grief’s highs and lows. For the counsellor, therapist, and friend they can provide useful insights into the process of bereavement.

Understanding Loss and Bereavement (B)

Step 1: Recognise the bad environment.

This may not be easy, your stimulus avoidance responses may not be obvious, indeed, there may not be any external event, only fleeting thoughts or uncomfortable feelings.

To recognise a bad environment, recollect a difficult event, one that didn’t work out or one you felt could have gone better.

Difficult events.

• describe it: your body, work, event, record your feelings,
• identify the chain or links to the behaviour, the background  to it or history,
• talk to yourself, have a dialogue with the event, record this,
• read the dialogue back to yourself, record your feelings,
• have several daily dialogues, gain insight and learn how you build behaviours you no longer want.

Step 2: Avoid situations that lead to unwanted actions.

Break the chain early, either avoid an environment or change parts of it so that it is less likely to produce unwanted behaviour.

Thoughts and fantasies are triggers for actions. Thoughts can be stopped or changed to be more constructive. It is also helpful to recognise that many unwanted behaviours are the outcome of a recognised chain of behaviours. Each step along the chain of events serves as the stimulus for the next step.

Step 3: Provide cues or environments that prompt desired behaviour.

Put yourself in the right place at the right time.  Structure your environment by using a schedule, a to-do list or make a self-contract.

Step 4: Mentally prepare to increase the effect of environmental cues to prompt any desired behaviour. Create behavioural goals,

Goals are more helpful if they:

• Are very specific; time, place and exact behaviour,
• Are in the near future, not distant,
• Involve learning desired behaviours rather than evaluating of how well you are doing,
• Lead to positive outcomes instead of reducing negative behaviours. Once committed to your intentions, this helps turn them into actions. This approach uses self-instruction to strengthen connections between the environment and your desired or intended behaviours. Create instructions that create specific responses like “as soon as I hear X I will start to…” This emphasises the positive behaviours while avoiding bad habits, distractions and any unwanted behaviours.
•  

Not all desired behaviours can be pre-planned, however your emphasis of self-control is shifted from your conscious mind to automatic reactions. 

If you get distracted from your intentions it may be more helpful to work on ignoring the distraction rather than to try to work harder.

Step 5: Practice responding to stimuli you have created in your environment by paying attention to your plans, warning signs, prompting cues, schedules, and any stimulus situations. Keep records and reward your success.

Neil Benbow

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