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Grief & Bereavement Issues

Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Complicated Grief

Allan N. Schwartz, LCSW, Ph.D. Updated: Dec 18th 2006

Why write about grief during just prior to the holidays? This is an excellent question! The reason is that the holidays can be difficult for those who have lost loved ones. The holidays tend to bring on nostalgic feelings for those who have died. Even worse, if the death has been recent, the holiday season can bring about feelings of grief, loss and sadness. This is one reason for discussing grief at this point. There are other reasons:

Have you noticed that no one ever wants to talk about death, loss and grief? OK, so it’s not the happiest topic in the world. However, death has this habit of happening and of touching the lives of every person on earth. There seems to be some superstitious fear that if we talk about death we might increase the risk of it happening. As Americans, we also seem to share the belief that if we do not discuss or think about death, it will not happen. A brilliant book about this was written many years ago by Ernest Becker called The Denial of Death. Becker wrote the book while he was dying of a terminal disease. He points out that we try to convince ourselves that death does not happen.

Non existence is too overwhelming a thought and, so, we move through our lives denying the fact that it comes to all of us. Even more, we Americans react to death as though it was someone's fault and could have been avoided. When a tragedy occurs we look for someone to blame.

We have also made death alien or foreign. During most American funerals family and friends follow the hearse to the cemetary where more words or prayers are said. Everyone then leaves and the burial crew lowers the coffin into the ground and fill the grave. I was recently talking to someone from Eastern Europe who described how, at the funeral of a friend, how the family buried the coffin themselves. Grave diggers may build the grave but family does the rest of the work themselves.

Becker points out that we are so focused on ourselves that we believe that death will come to other people and not to ourselves. We cling to the notion that other soldiers will die in war and not ourselves. We mistakenly think that others will be caught in terrorist attacks and not ourselves. We hear about and read about tragedies through the faulty notion that these things can only happen to others and will never touch our homes. Behind all of this is the totally narcissistic idea that we are immortal. The problem is that death does come, it does visit and it does interrupt our lives. Then, we are confronted with grief.

When a loved one dies the reaction is grief. No only do people tend to fear death but they tend to fear those who are grieving. It is as though the grief of another person brings about the uncomfortable reminder that death is always close and intimate fact of life.

Grief is a normal reaction to the loss of a loved one.

The experience of grief includes:

1. Crying.

2. Vivid dreams of the lost person as though they are still alive.

3. Thinking and believing that the dead person is still alive.

4. Self blaming for the death.

5. Anger that the dead person is gone.

6. Ruminating about the dead person.

7. Depression.

These experiences or "symptoms" of grief are considered normal and do not require psychotherapy.

However, if the symptoms persist and become crippling of the individual’s ability to function then treatment is called for. It is difficult to define a "normal" amount of time for the grieving process. Many religions define the mourning period for a period of one year with the most intense mourning taking place anywhere from the first week to the first month. During that first year after the loss of the loved one grief reactions tend to slowly diminish in intensity.

Joan Didion wrote a brilliant autobiographical book about her experiences after the death of her husband. This sensitive book, which is not depressing but is written with great insight and sensitivity, is well worth reading and is entitled The Year of Magical Thinking. During the year after the death of her husband she reminisced about the events of the previous year as each day went by. Sometimes she thought about what she might have done differently in order to have prevented his death. Other times, her memory went back deeper into the past, when their daughter was a child and they lived near the ocean in Massachusetts. At times she felt angry with him for having died, at other times she imagined he was alive and at yet other times she recalled some of his criticisms of her and whether or not she could continue on without him.

For those who experience complicated grief there is no diminishment of the mourning process and the individual cannot seem to move beyond the loved one's death. The people stuck in complicated grief seem to desperately yearn for the dead person. They never seem to stop crying, begin to wish for their own death and become symptomatic of someone who is suffering from Major
Depression sometimes with psychotic symptoms of hallucinations. In these cases there can be a real risk of suicide and mental health treatment is necessary.

What Causes Complicated Grief?

There are many explanations for complicated grief and there are many reasons for why it occurs:

1. People who tend to be depressed have a greater vulnerability to complicated grief.

2. An unexpected and violent death can cause complicated grief. Relatives lost in auto accidents, war, were the victims of violent crimes are among those who are defined as unexpected and traumatizing deaths.

3. Parental loss of a child is always deeply traumatizing, leaving the family in a state of shock and in which parents are vulnerable to depression.

4. The more complicated the relationship to the dead person was, the more difficult the mourning process. In other words, parents who were abusive, angry, intrusive and difficult can result in the surviving children having a hard time working out their feelings of loss.

5. When death is violent and unexpected the surviving relatives may experience Post Traumatic Stress Disorder.

These are just a few of the reasons why a death may be experienced as traumatic or extremely depressing beyond normal grief. Under these circumstances psychotherapy is definitely called for and people should not hesitate to seek help and work through their feelings. In some of these cases anti depressant medication may be necessary.

Reprise:

So, why discuss death and grief just prior to the holidays? Why not? Death exists. It even happens to people during the holiday season. The idea is not to "deny death" but to make the most of our lives while we are alive.

What are your thoughts and feelings about this topic?

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    Affect by childhood death - Jullian - Apr 13th 2010

    I was 3 yrs old in bed with my parents when my younger sister 1 1/2 passed away in her crib in the same room. I still wake up hearing the screaming and being alone.  I think I soaked up all my mothers depression and aggravation.  I grew up feeling terrible guilt, fear of sleeping,death,people, and an over all mysteriousness about her. I'm 32 yrs old now, and am crippled with intense emotions, depression and isolation after having my own baby. All these emotions are at their strongest. 

    going thru hell - cindy - Apr 27th 2009

    I didn't know what the name was but it fits me to a T.My mom died 12 years ago and I think I just tried to keep on going.She was not well emotionally or pysicalyy.  She dropped dead of a double anuresym in her brain and I was not notified until 2 days after her death.She also disowned my sister and me, because we were trying to forge a decent relationship with my father.  They were going thru a nasty divorce.I am currently in psychodynamic psychotherapy and EMDR for both her death and the abuse that went on in my childhood.It is also coming close to the anniversay of her death and I can barely see straight and am wrought with grief. I have cancelled jobs because I am either so apathetic or emotionsally distraught, I know I just can't take anymore of anything.I am healing, but slowly. I don't feel that I would take my own life; but when it gets this bad, I wish I were dead.Life for me, right now is neither joyful or fulfiling, but I a trying to hang on and wait for the healing that will make it not hurt so bad.Thanks for reading. cindy

    I hear you loud & clear - JJ - Oct 30th 2008

    Hello, I lost my mom 10 yrs. ago. I have since not fully grieved properly. I live with sadness, pain, & confusion too. The holidays are the worst time for me. I'm in therapy now. My nightmares have been crazy... I just can't cry or show emotion... Good luck to you.  JJ

    Grief over dead parents years later - Steve - Dec 24th 2006
    This brief synopsis of grief is pretty good and helped me balance my eddying thoughts regarding a renewed grief at Christmas time. My mother and father died many years ago (1977&1982 respectively) and I was 19 when Mum died. Even though it is a long time ago, because of 'complicated grief' I have felt an acute sense of unhappiness this year and attribute it to loss of my parents. I have four brothers and four sisters, so there are a lot of relationship ties going on. Add to that we are all quite a bit older now and I have married and have two children. Events in recent months have transpired a certain present atmosphere and created in me a mind set that has been vulnerable and I thus did become morose and withdrawn in the lead up to Christmas 2006. I became depressed, although, I was unaware of the true feeling (feeling the 'christmas stress blues') until a pre organised get together at my wife's parents place precipitated my upset and I sent her and the kids off and left the christmas to myself. I have been weeping and reflective, sad and unaccountably lost when trying to focus on the 'Christmas spirit'. My wife is full of seasonal joy and gift buying and child like happiness and merrily going off to enjoy a christmas together with her parents and brothers with new babies to welcome into the extended family. That is all fine, except I have unrequieted memories of our parents and family together from a time that is somehow obsolete, defunct, and of a bygone time. And, there are somewhat tense sibling ties, now, that can be much of a trial, as we are all in the same boat of grief puntuated with a question mark. I am not suicidal, or deeply depressed ('Major Depression'). I am just stuck, in the present, and doing nothing much, yet waiting for something important enough to come along and draw my attention out of staring into a blank and vacuous shaft that all the light has now left. I am comforted by the fact I feel okay about Mum & Dad. Just one wish though.....to see them again.

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