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悲嘆(グリーフ)とは
What is loss?

Losing somebody one cares about is a painful event and is said to be the biggest test in their life. It is often only after a loss that they realize how painful and sad bereavement can be.

 

After death claims someone important to them, they are tormented by all sorts of unthinkable emotions such as anger, guilt, and depression. It also causes various physical symptoms, such as insomnia and extreme fatigue. These symptoms are called grief reactions, and they can be sometimes so strong that they seem to last forever, and can overwhelm a person’s life and living itself.

 

Though grief reactions are unique individually, some are common to many people. It is said that knowing this beforehand can help the bereaved to cope with grief.

 

It is also said that if supporters understand what the bereaved will experience, they should be able to unravel the bereaved family’s situation, needs and problems early and respond appropriately.

What is grief response?

The important thing to understand about grief is that it manifests itself in different ways in different people. Typical grief responses are as follows, but they vary from person to person.

 

[Emotions most likely to occur]

1.Shock, numbness and paralysis

Feeling that what happened is not real, they become stunned, feeling numb. Sometimes the bereaved might look calm and seem not be as sad as surrounding people.

 

2.Denial

They don’t want to admit or accept the facts.

 

3.A sense of hopelessness and helplessness

They can’t find meaning in life nor hope. They feel they don’t have the strength to do anything, and sometimes they even feel like ending their own life.

 

4.Fear and anxiety

The fear of not being in control, the fear of being alone,the fear that the same thing might happen again, the fear that this world is full of danger that no place is safe, etc.

*Some sounds, smells, and textures can cause fear, sadness, and panic.

 

5.Sorrow

A feeling of sadness that the person will never come back, that they will never see that person again, and that life with that person will never return.

 

6.Longing

A strong desire to meet and resume life with the deceased.

 

7.Anger

Feeling angry at death (anger at God and fate) and at those involved in the scene, the circumstances and cause of death. Feeling angry at those who don’t understand how the bereaved feel, feeling angry at the injustice of it happening to their family…. Or feeling angry at themselves for not being able to help their own family, etc.

 

8.Regret and self-blame

“If only I had done this (if only I hadn’t done this) at that time…” or “It’s my fault…”. Or “I could have protected you better…”, or “how I could be the only one who survived.

*Particularly after the loss of a loved one, this is called survivor’s guilt. It has been known to produce a strong sense of self-blame.

 

9.Hope for a miracle

The desire to hold on to the hope that “they might be alive somewhere,” “they will come back.”

 

10.Shame

Sometimes, the bereaved feel ashamed, feeling they are useless, being unable to act like they used to, or crying easily.  They feel ashamed of themselves when they imagine how others perceive their bereavement.

 

[Common thoughts, behaviors, physical symptoms, etc.]

1.Repeatedly thinking about death or the deceased

he deceased and their death repeatedly come to mind, and they constantly think about the deceased. They keep wondering how it happened, why it happened to them, how it could have been prevented … Nightmares about death, dreaming of the deceased, etc.

 

2.Lack of concentration

They feel they can’t concentrate on what they are doing, feeling that their ability to think and make decisions is impaired, etc.

 

3.Behavioral changes

Crying more than before, being in a daze throughout the day, avoiding remembering the event or the deceased, engaging in behaviors that they experienced (e.g., being overly busy, withdrawing, increasing their intake of alcohol and drugs). Clinging to belongings of the deceased, etc.

 

4.Physical symptoms that are likely to occur

Loss of appetite, sleeplessness, extreme fatigue (tiredness), pain in the chest, head or abdomen, dizziness, feeling thirsty, throat congestion, breathlessness, feeling body weakness, increased blood pressure and heart rate, sensitivity to sounds and smells, etc.

 

5.Effects on relationships with family members and friends

Feeling lonely even when family and friends are around, yet at the same time feeling anxious unless someone else is present.

 

*Source: Disaster leaflet for bereaved families “Coping with Trauma and Loss, Cruse Bereavement Care.

Grief process

The grief process after bereavement is not linear but a process which moves back and forth.

 

 

[Often perceived phenomena]

The various reactions that occur during the grief process are unique for each individuals, but there are some common phenomena as noted below:

 

1.Grief wave

In the grief process, instead of feeling sad all the time, emotional waves with large amplitudes are repeated, with emotions spurting out at one moment and calming down at other moments.

*At first glance, they may look fine when the waves are settled. But sorrow usually lasts much longer than one thinks.

 

2.Anniversary reaction

On the anniversary (or the monthly anniversary) of an important event, on the birthday of the deceased, or on a day with memories such as Christmas, the bereaved often feel sad and painful, even after many years have passed.

*It might be a good idea to prepare yourself in advance, for example spending time with someone you trust.

 

3.Loss of role

Losing an important family member means that you lose the role you held in that relationship. For example, it could be the role of wife (or husband), the role of a parent, etc. Such changes in environment can be significant, and some people may feel like they lost their meaning and value in life.

*It takes time to get used to a new environment. Find your role in the new environment gradually, at your own pace, without comparing that pace to others.

 

[Grief process]

The grief process can be described occurring in phases.

The chart below lists the four phases identified by Parkes (1972). The phases do not always proceed in order, but may go back and forth, or two phases may overlap.

 

The four phases

1.The shock and numbness phase

They are shocked and do not believe the facts.

2.The yearning and sorrow phase

They search for the deceased. They feel that the deceased might yet be living.

3.The disorganization and despair phase

They react to the inability to bring back the past. They are distracted and bewildered in the face of new demands.

4.The reorganization phase

They start to develop a new mode of living without the deceased.

Four tasks in mourning

A word very similar to grief is the word “mourning.” Generally, the response to loss is called “grief,” and the psychological process that changes over time after loss is called “mourning”. In detail “mourning” is used to describe the sorrow expressed externally, while internal sorrow is translated as “grief”.

 

Worden (2008) stated that the bereaved have four tasks while mourning. Mourning is considered not to be a passive process that heals naturally over time, but rather an active process that the bereaved deal with the following tasks: To work with the pain of grief itself has meaning and is considered necessary.

 

[Worden’s four tasks of mourning]

First task: To accept the reality of the loss

  • To face the reality that the person has died and will not return.
  • Traditional rituals, such as funerals, can help many bereaved accept death.

 

Second task: To work through the pain of grief

  • Avoiding the pain of grief can prolong sorrow.

 

Third task: To adjust to an environment in which the deceased is missing

  • Adjusting to a new environment has different meanings which depend on the relationship with the deceased and the role played by the deceased.
  • The bereaved is asked to reconsider one’s view of the world, and to discover the meaning of the loss.

 

Fourth task: To relocate the deceased emotionally and move on with a new life

  • To replace the deceased appropriately in the bereaved heart (watching gently by one’s side, always living together in one’s heart, etc.).
  • Mourning can be considered complete when the bereaved can remember the deceased without pain.

 

Source: Worden JW (2008): Grief Counseling and Grief therapy: A handbook for the Mental Health Practitioner. 4th edition. Springer Pub Co.

Coping with grief

In the process of mourning, some factors seem to cause the bereaved to repeatedly sink deeper into sorrow, even though they appear to be moving forward. But that does not mean they retreat to a new bereaved state. They do understand the new reality, recognize the new life without the deceased, and manage their new life, roles and relationships, while they recall memories of the deceased.

 

The grief process described by Stroebe (1999) involves a balanced oscillation between two complementary sets of coping processes; one is “loss oriented” or concerned primarily in coping with loss, and the other is “restoration oriented” or concerned primarily in coping with attending to life changes.

 

The “loss oriented” processes involves one’s mourning work while feeling pain and sorrow. On the other hand, the “restoration oriented” processes include developing a new way of life, distracting oneself from grief, and living productively with their new roles.

 

The time required for completion of the coping process depends heavily on one’s talents and past experiences. It is important for each bereaved person to maintain their own pace for recovery, without comparing it to others.

 

*Mourning work refers to the activities which help the bereaved feel comfortable in grief process, such as crying, talking with others, or sitting in front of a home alter.

 

*Stroebe, M. and Schut, H. (1999) The Dual Process Model of Coping with Bereavement. Death Studies 23:197-224.

Factors that prolong grieving

Grief is a normal reaction that can occur in anyone following a bereavement, but

the bereaved families of a catastrophic loss after a disaster may suffer from so called “prolonged grief” which could require specialized treatment.

 

Below is a list of factors which might contribute to developing prolonged grief. If the bereaved are experiencing more than one of these factors, and grieving for a while, they should not keep it to themselves, but they should try to seek as much support as possible from people around them or support organizations. If you are a supporter, please monitor them carefully.

 

  • When the deceased is considered an irreplaceable person
  • When many bereavements or losses occur simultaneously or consecutively
  • If the bereaved believe that they were directly or indirectly involved in the cause of death
  • If the bereaved cannot find the body of the deceased
  • When the bereaved witnessed a shocking situation, such as severe damage to the body of the deceased
  • If the bereaved had a conflict or love-hate relationship with the deceased
  • If the bereaved had any previous unresolved loss experiences
  • If the bereaved have suffered any current of past mental illness
  • The bereaved had a tendency to feel uneasy even before the disaster
  • When the bereaved has been isolated, having no one to share sad feelings with
  • When a child or an adolescent loses an important person
  • When the bereaved face financial difficulties due to the bereavement
  • If any lawsuit or legal action is involved

 

Source: Noriko Setou, Soichiro Maruyama (2010): Fukuzatsusei Hitan no Rikai to Soki Enjyo. (Understanding Complicated Grief and Early Aid), Kanwa Kea (Palliative Care) 20 (4): pp. 338-342

Complicated grief and depression

It’s natural to feel sad and bitter after the loss of a loved one, but sometimes it can last for a long, intense period of time and interfere with daily life. If the grief after bereavement remains the same for months, and instead of decreasing, the pain is increasing, or you are unable to focus on new living conditions and life, you could be experiencing a serious problem such as “complicated grief” or “depression.”

 

“Complicated grief” refers to the continued intense grief over the loss of a loved one. You may not be able to accept the death of a loved one, or you may not be able to stop thinking about him/her, your daily life may get more complicated, your relationships are hindered, and it seems that life without that person doesn’t have meaning. The symptoms of complicated grief are closely related to the pain of bereavement and the feelings and love for the deceased.

 

“Depression”, on the other hand, may involve a depressed mood, low motivation, sleep disturbances (such as early morning awakening), a loss of appetite, difficulty concentrating and suicidal thoughts. While “depression” often causes a persistent sense of depression and a pessimistic outlook on life in general, “complicated grief” is associated with intense pain and grief related to the deceased.

 

Medications can’t cure grief itself, but they can improve symptoms of depression and insomnia. Complicated grief is said to lead to depression and post-traumatic stress disorder (PTSD). If you are experiencing symptoms, such as sleeplessness, persistent depression, distressed feelings that interfere with life and feeling like you want to die, please contact a mental health professional (psychiatrist, psychotherapist or psychologist). Medication and counseling may help with your symptoms.

Ambiguous Loss

“Ambiguous loss” is a concept developed by Prof. Pauline Boss of the University of Minnesota. Bereavement clearly refers to the loss of a person, but there are losses which are not clear.

 

For example, when a person is missing and the body is not found, there is no certainty if the person is deceased, leading the family unable to sort out their feelings toward that person. Then ambiguity of the loss short circuits their mourning and the grieving, often prolonging these responses, affecting their family relationships.

 

Therefore Prof. Boss stresses that it is necessary to differentiate between “ambiguous loss” from loss by death, and to provide a separate type of support. It is not recommended to call family members experiencing ambiguous loss as “the bereaved.”

 

Prof. Boss’s “ambiguous loss” theory describes a state of loss and not see it as a disease to be treated. We name the situation as “ambiguous loss” and assume that the cause of not being able to find closure lies not in the person, but in the ambiguity of the situation.

 

Additionally, in ambiguous loss, family relationships may develop problems. Prof. Boss emphasizes the need to increase family resilience based on a family therapy perspective.

 

 

For more information on ambiguous loss theory and interventions, please refer to the sister version of this website, the JDGS Project, Ambiguous Loss-Information Website.

 

Ambiguous Loss-Information Website http://al.jdgs.jp/e_top

Trauma and loss

Being involved in a disaster can be a traumatic, strongly fearful experience. Also, losing an important person due to a disaster is a great loss experience. When an important person dies in a disaster, they face both a traumatic experience and loss experience at the same time, which can cause confusion and strong pain in survivors.

 

These reactions manifest themselves in different ways after a disaster. Some survivors find their memories and emotions so intimidating that they wonder if they have lost control and gone crazy. Some other survivors seem to feel that their experience not real and do not show any emotion.

 

While scenes related to traumatic death are thoughts that the bereaved wish to forget or eliminate from their memories, those people who have died are irreplaceable to them. It is a difficult process to live with those contradictions and sort out their feelings. It takes time for them to feel less intensity when remembering the deceased.

 

However, over time, many of them gradually feel that they have “stayed connected” to the deceased, while feeling less pain. Immediately after bereavement, it can feel like they may suffer forever, but everyone has the power to heal their grief. In many cases, people will be able to start a new life again, though they initially felt like it was beyond their control.

 

Until that day comes, it is important for the bereaved to be gentle in terms of their own feelings, without blaming themselves. For those who are around the bereaved, it is also important to respect the pace of the bereaved’ recovery and to accompany that process.

Children’s grief

The loss of family and friends is a profound experience in a child’s life. Bereavement is said to have a significant effect on the child’s environment, human relationships, mental health, and subsequent developments such as character development. On the other hand, children have been found to be more resilient to bereavement than adults, provided they have sufficient support from others.

 

1.Grief reactions of children

It is said that a child’s expression is different from that of adults. Adults usually have very strong grief reactions months after bereavement and have it settle down over time. On the other hand, in the case of children, sadness is always present in the growth process and is expressed in different forms. For example, on birthdays, on special days with memories such as entrance to school, graduation, employment or marriage, they realize the fact that person is no longer there, causing feelings of sadness or loneliness. As a result, it is said to take years for a child to accept the death of an important person.

 

 

2.Various grief expressions

The grief response that appears in children varies, and some children show strong anxieties and sadness, while others play innocently or behave as if nothing had happened. Grief may also manifest itself physically (ex. falling asleep, anorexia, headaches, abdominal pain, etc.). Some children may behave more childish than their age, such as crying at night or sucking their fingers, while others may behave more mature than their age. Some school age children show poorer academic performance.

 

These “visible” behaviors are easy for adults to notice. But it is important to be mindful of the “invisible” feelings and potential emotions that may not be noticed so easily. Children six years of age or older may blame themselves for not preventing the death, which can lower their self-esteem.

 

Some adults do not relate the facts of a death to children or do not allow them to attend the funeral because they are worried about the children feeling sad. However, it is important that adults explain what happened using age appropriate language that the children can understand.

 

Children learn how to deal with sadness through adults. It is important for adults not to leave children out of the loop, but to be supportive toward children working through their sadness.