Monday, April 6, 2020

Complicated Grief: "Maybe I Am Nuts"

[Reviewed and updated December 14, 2021]

Complicated Grief is a form of grief that takes hold of a person's mind and won't let go.
  ~ M. Katherine Shear, MD

A reader writes: "Complicated Grief," "Prolonged Grief Disorder" and now "Persistent Complex Bereavement Disorder." In reading about all of these "disorders" with an open mind, I clearly am suffering from all three. And suffering is the appropriate word. It's been over four years since my beloved died and I still don't know my place in this world. Still feel my life is mostly meaningless without her. I've kept her clothes and most of her things just where they always were. I feel like if I got rid of that stuff,  my life would feel even more empty  than it already does. Her things being where they always were gives me a small sense of comfort.

I know my wife is not coming back in this world.  But, reading these articles makes me feel as though I haven't fully accepted her death because I've kept her things. I just can't bear any more emptiness. Removing her things just feels like another loss of what I had. I need something, anything, that eases my pain.

Categorizing those with prolonged grief as mentally ill seems harsh. We've lost not just the love of our life but the life we loved.

The article mentions that people who were caregivers and who have limited social and family support are more prone to prolonged grief. I fit that description to a "T". I know I need to find a way to push myself forward and to try to find some happiness for myself. To try to find meaning and my place in this world without my beloved spouse. But how?

Maybe there is some truth to a thought that has been playing on my mind. It seems like I still feel a bit guilty when I do find those brief moments of comfort. Maybe somehow I can't push forward because I feel guilty that I might be enjoyng myself but my deceased wife can't? Or that I'm enjoying something without her being in this world. Does that make sense?

Maybe I am nuts. 

I think the fact that I'm even thinking about all of this is progress. I'm just not willing or ready to accept that this is all my life will be. I need to push myself and see where it takes me. Of course that's way easier said than done. It's still baby steps for me even four years after.

My response: My friend, I would be remiss if I didn't point out that there are good people in our field who DO care and are working hard to find ways to better understand and support the bereaved, especially when there are those who are still suffering and looking for relief. 

There is a lot of room for research here, and I am grateful for those who choose to study the mysteries and complexities and variations in grief, discovering as they try various therapeutic approaches what helps and what does not. 

As a result, we've learned so much more about grief than we knew just ten or twenty years ago ~ and these studies have helped enormously to inform the practice of those who work in the fields of grief counseling and grief therapy. Katherine Shear, MD, founder of the Center for Complicated Grief at Columbia University School of Social Work, for example, has done important work in this regard, including having developed specific, short-term treatment modalities that have been proven truly effective in helping grieving people. 

We don't need to equate complicated grief with a form of "mental illness" in order to study, find and use effective ways to help people who are miserable and looking for help. Labels don't mean much to those of us who work in this field, and as you've undoubtedly known me to say so many times in my own writings, grief is as individual as a person's finger print. In that sense, everyone's grief is complicated, by dozens of different and individual factors, so no one label and no one set of rules applies.

In the natural course of grief, over time (in many cases, over years) most of us find ways to carry our pain and adapt to life without the physical presence of our loved one who has died. How long that takes is like asking how high is up. It takes as long as it takes, and for some it can take a lifetime ~ but it does change, and we change right along with it. We never really "get over" it. We just find ways to live with it. But as Dr. Shear points out, "Complicated Grief is a form of grief that takes hold of a person's mind and won't let go." She goes on to say that:
It is natural to experience intense grief after someone close dies, but complicated grief is different. Troubling thoughts, dysfunctional behaviors or problems regulating emotions get a foothold and stall adaptation. Complicated grief is the condition that occurs when this happens. People with complicated grief don't know what’s wrong. They assume that their lives have been irreparably damaged by their loss and cannot imagine how they can ever feel better. Grief dominates their thoughts and feelings with no respite in sight. Relationships with family and friends flounder. Life can seem purposeless, like nothing seems to matter without their loved one. Others begin to feel frustrated, helpless and discouraged. Even professionals may be uncertain about how to help.  People often think this is depression but complicated grief and depression are not the same thing.
Grief is a person’s response to loss, entailing emotions, thoughts and behaviors as well as physiological changes. Grief is permanent after we lose someone close though it’s manifestations are variable both within and between people. Still, there are some commonalities that can help you recognize complicated grief.
Acute grief occurs in the initial period after a loss. It almost always includes strong feelings of yearning, longing and sadness along with anxiety, bitterness, anger, remorse, guilt and/or shame. Thoughts are mostly focused on the person who died and it can be difficult to concentrate on anything else. Acute grief dominates a person’s life.
Integrated grief is the result of adaptation to the loss. When a person adapts to a loss grief is not over. Instead, thoughts, feelings and behaviors related to their loss are integrated in ways that allow them to remember and honor the person who died. Grief finds a place in their life.
Complicated grief occurs when something interferes with adaptation. When this happens acute grief can persist for very long periods of time. A person with complicated grief feels intense emotional pain. They can’t stop feeling like their loved one might somehow reappear and they don’t see a pathway forward.  A future without their loved one seems forever dismal and unappealing.
Complications get in the way of adapting to the loss
There are three key processes entailed in adapting to a loss: 1) accepting the reality, including the finality and consequences of the loss, 2) reconfiguring the internalized relationship with the deceased person to incorporate this reality, and 3) envisioning ways to move forward with a sense of purpose and meaning and possibilities for happiness.  Most people move forward naturally in this way and grief finds a place in their lives as they do. Sometimes there are thoughts, feelings or behaviors that interfere with adaptation. Complicated Grief Therapy (CGT) helps people identify and resolve these interfering issues.
Troubling thoughts: After a loved one dies, almost everyone has some unsettling thoughts about how things could have been different. People with complicated grief get caught up in these kinds of thoughts.
Avoidance of reminders: People with complicated grief often think the only way they can manage pain is to stop the emotions from being triggered. To do this they try to avoid reminders of the loss.
Difficulty managing painful emotions: Emotions are almost always strong and uncontrollable during acute grief and managing them is different than at other times in our lives. Most people find a way to balance the pain with respite by doing other things, being with other people or distracting themselves. People with complicated grief are often unable to do this.  [Source: CG Overview]
If this description of complications fits what you (or anyone reading this) may be thinking, feeling and doing, you might consider finding a therapist whose practice is informed by the work of Katherine Shear. Her website lists therapists with training and experience in treating complicated grief. See Find a Therapist.

You say "I think the fact that I'm even thinking about all of this is progress," and I agree. I don't think you are suffering from any sort of "disorder." I think instead that you are finding yourself in what some refer to as "the neutral zone" ~ and that, too, is normal. See Transition After Loss: Tips for Navigating The Neutral Zone  

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