Guest post by Sean Szutka

This series of articles has attempted to normalize the end-of-life process by exploring the full spectrum of changes that you and your loved one may go through during their final days. It has considered “The Existential Slap” that comes when your loved one fully acknowledges their coming death, as well as the duality of existence that comes from being “Here” but preparing for “There.”

It also presented the process of Active Dying in clear and unambiguous terms; intending to reduce the fear and discomfort of those supporting the dying person as they pass their final days.

In this last installment, understanding grief and grieving will be the focus. Where do you find the strength to let your loved one go? At the same time, how can you carry them with you as you move on without them? What happens after the death of your loved one? It aims to help you find new ways to honour your loved one, find peace in their passing, and asks “Is it possible that your loved one is now ‘Everywhere’?”

What Is Grief?

Simply stated, grief is the experience of coping with loss. It can be a Loss by Non-Death, like a divorce, a child moving out of the family home, or immigrating from one country to another, or it can be a Loss by Death. This article will focus on Loss by Death.

In this context especially, grief is a fundamental part of human life and a very natural consequence of forming emotional bonds. The results of grief can be a disconnection from our sense of self or profound changes in our worldview. It is the process by which we struggle with the fact that our loved one was “Here,” but now they are “There.” Through our grief, we can create a new reality, so that our loved one can be both “Here” and “There.” We can create a singular reality … because, really, they are “Everywhere.”

Types of Grief

When we mourn our dead loved one, that initial grief that surfaces is known as Primary Grief. These are the feelings of sadness and remembrance directly related to the person. These emotions can be very difficult to process, but there are many other types of grief that can complicate our experience of mourning.

For instance, we often don’t consider Secondary or Accompanying Grief. The loss of our loved one also includes the loss of their companionship, their help, maybe their social network. We are also losing the future self we envisioned ourselves to be while they were alive. This could be the self that was going to grow old with them, raise children with them, or maintain a business with them … or all of the above! Our grief can become complicated by the loss of potential or the loss of financial security that accompanies the death of our loved one. It’s possible that this death is complicated by a growing loss of faith. Acknowledging these layers to our grief is an important part of the healing process. We do not just lose the person we loved; we may also be losing a version of ourselves that can no longer be.

When the death of our loved one is sudden, unexpected, or traumatic, the grief we feel becomes heightened. These types of losses are those related to events outside our usual scope of control like accidents, natural disasters, or suicide. Just like a trauma response, these losses, especially, can get stuck in our body, and it is important to remember that our grief is not an external process or only societal. It can show itself in physical symptoms like fatigue, pains, headaches, digestive issues, and more.

Another often-disregarded form of grief is when it shows itself before the actual loss has occurred. Anticipatory Grief comes when there is forewarning or time to prepare for the death of our loved one. Early diagnosis of dementia, long battles with cancer, and slowly deteriorating physical health conditions like Multiple Sclerosis are some examples of when Anticipatory Grief can touch our lives.

Chronic disease and loss of ability can also present Non-Finite Grief. When we lose a loved one to death, our grief is offered the benefit of time to soften the pain. When long-term and degenerative diseases like Parkinson’s Disease, Multiple Sclerosis, Arthritis or Fibromyalgia affect us or our loved one, time acts as a constant reminder of the loss. This type of grief can also present itself when we are forced from our homelands as refugees or migrants due to climate-related disasters.

Ambiguous Grief is an insidious form of grieving because we are often not even aware of its presence. This type of grief occurs when there is no clear evidence of the finality of the loss. Things like addiction, missing persons, kidnappings, and incarceration erode our confidence that there is even something to mourn. Will the person return? Will they return as the same person they were when they left? Ambiguous grief can also show itself when the loss is filled with conflicting emotions like a divorce, changing jobs, or the death of an abusive or neglectful parent. Finding some compassion for ourselves and others in these situations can make the difference between processing the emotional content of the loss or getting stuck.

Finally, there is one type of grief that, unfortunately, often complicates a person’s grieving process. Disenfranchised Grief comes to us when our loss is socially unacceptable to our larger community, which could be losses such as elective abortions, the loss of an extramarital lover, the loss of a same-sex partner, or when a father divorces and starts a new family. The accepted societal norms around grief and grieving can also disenfranchise a person from their grief. There are many unspoken expectations about grieving too long or too much or grieving only in the right context – for example, not grieving during open war. On a personal level, too, siblings may inadvertently disenfranchise each other’s grief by placing their expectations about their own grief on their siblings; saying things like “This is not your loss but mine” or “He was my dad, too, and I’m fine, so you should stop grieving.”

Grief Science

In the late 50s and early 60s, John Bowlby was conducting research on what would become his attachment theory: four styles of attachment that are rooted in the relationship between a child and their primary caregiver. During his experiments, he recognized that grief was a normal, adaptive response to loss and that attachment style contributed to whether an individual exhibits a healthy or problematic pattern of grief following a loss. Through this process of connecting attachment style to grief, Bowlby identified four stages of mourning: Numbing, Yearning & Searching, Disorganization, and Reorganization.

Independent of Bowlby’s work, Swiss psychiatrist Elisabeth Kübler-Ross was working with terminally ill patients and formulated her own stages of grief. These five stages have become embedded in western culture. Her stages – Denial, Anger, Bargaining, Depression, and Acceptance – have been nearly universally misunderstood as also being a linear series of stages, whereby a person graduates from one step to the next until their feelings of loss and pain have been successfully processed. Because of the ubiquitous knowledge of her work, much of western society believes that grief is meant to be hard, will inevitably cause conflict, and that there is a “right” and a “wrong” way to grieve.

In the early 1980s, J. William Worden brought the force of his work to the discussion around grief and childhood bereavement. His major contribution was to shift the paradigm of grieving away from listing and prescribing stages of feelings that the mourner should go through and towards identifying tasks that the mourner needs to achieve. While this frees the person to feel whatever emotions may come up while mourning, there is still an inherent “staging” to the process. Worden’s four Tasks: To accept the reality of the loss, to process the pain of the grief, to adjust to a world without the deceased, and to find enduring connections with the deceased.

Expanding on Worden’s idea that grieving is a collection of tasks that can be attended to in a non-linear way, Therese Rando presented her work on the “Six ‘R’” mourning process in her 1991 book “How to Go on Living When Someone You Love Dies.” It outlines three emotional phases, with a total of six processes, that a person goes through when healing from the loss of a loved one. These processes are: Recognizing the loss, Reacting to the separation, Recollecting and Re-experiencing the deceased, Relinquishing old attachments, Re-adjusting to the new world without forgetting the old world, and Re-investing in relationships. These tasks can be experienced in any order and/or concurrently and emphasize the new paradigm of the uniqueness of every grieving process.

Conclusion

In contradiction to the general understanding of grief, there is no single “right” way to grieve. In fact, the ubiquitous societal acceptance (and misunderstanding) of Elisabeth Kübler-Ross’ Five Stages of Grief – Denial, Anger, Bargaining, Depression, and Acceptance – may have made grieving all the harder for those experiencing a loss. Recognizing that grief has no timelines and is not linear can free a person from the expectations they may put on themselves or others regarding their grieving process.

At the same time, we can still feel stuck in our grief. By building a reliable set of tools, a person can allow for grief to be a process; a long-term practice as they work towards letting their loved one go, while concurrently sustaining their memory. Ultimately, through our grief we can come to recognize that our dead loved one is, in fact, “Everywhere” around us and is accessible to us at any time.

Guest post by Sean Szutka

Sources

Patient Pathways provides one-on-one support in helping patients access BC healthcare services and determine Advance Healthcare Directives. See our Services and Fees.

Here, There & Everywhere: Everywhere (Part 3)