Grief and Mourning: Responding to Loss

By 
Dr. Sara Glazer

Grief and Loss

At nineteen, I formed a close friendship with another student while at a pre-college program. We bonded over music, family, and deep discussion. I was having a difficult time adjusting and there was comfort and ease in our developing friendship that allowed me to connect authentically. She died during that year suddenly from a staph infection. Immediately after, I remember not feeling much of anything. It took time for the numbness to subside and the emotion to surface, and these feelings have continued to emerge at different moments throughout my life.

 

Grief is an internal reaction to loss and can generate varied responses, challenging us to come in contact with emotions that can be painful, complex and, at times, confusing. The American poet Stephen Levine notes that, “Grief can have a quality of profound healing because we are forced to a depth of feeling that is usually below the threshold of awareness.


Dr. Susan Delaney, Clinical Psychologist and head of the Complicated Grief program at the Irish Hospice Foundation references the concept that nothing endures but change, stating that impermanence is inevitable.

Although we often associate grief with the death of a family member or friend, it refers to any form of loss, including the loss of pets, relationships, mental health, jobs and dreams.

Delaney describes the loss of the assumptive world, noting that we grieve not only for what we have lost, but also for what we had hoped to have and experience. We grieve because we attach. We attach to people, situations, roles and ideas. Attachments are necessary for our survival, and yet also make us vulnerable to pain.


During the pandemic, loss is astoundingly present. Countless individuals have lost family members and friends due to COVID-19 and other illnesses, and they have been unable to mourn in a typical and nonrestricted manner. Loss of normalcy, in-person connection, time, and finances are pervasive. David Kessler, co-author of On Grief and Grieving, notes that we are also feeling anticipatory grief during this period. Anticipatory grief is linked to an uncertain future and is usually concentrated on death. Kessler cites a dire diagnosis or the acknowledgement that a parent will someday die as two examples of anticipatory grief. We understand that something negative exists, and yet there is uncertainty about how and when that will manifest, leading us to experience a general loss of safety and control. 

Our Understanding of Grief

Our understanding of grief and ways to approach and support those who are grieving have shifted over time.  We are now aware that grief does not follow a linear, universal process that results in an ultimate “recovery.”

Additionally, we no longer believe that grieving appropriately requires releasing the person or the source of the loss. Rather, there can be benefits to maintaining bonds. 

Sigmund Freud contributed to initial theories on grief intervention in his paper “Mourning and Melancholia” (1917/1951). Freud focused on disconnecting from the deceased and posited that to accomplish separation one must express feelings about the loss, such as guilt and anger. He believed this separation should occur quickly or the grief might become complicated and problematic. Interestingly, in his personal life, Freud relays maintaining a strong connection with his daughter three decades after she died. 


Many subsequent theories center on stages of grief, such as the famous conceptualization posed by Elizabeth Kubler-Ross in her book On Death and Dying. Based on clinical work with patients who were terminally ill, Kubler-Ross, a Swiss psychiatrist, identified five stages of grief: denial, anger, bargaining, depression and acceptance. 


Stage theories have been critiqued for their simplicity and rigidity. Movement toward more dynamic understandings of the grief process has ensued. One such model created by Margaret Stroebe and Hank Schut is the Dual Process Model. It involves oscillation between confronting and avoiding the loss. When one is engaged in the loss-oriented mode, the griever connects with a range of emotions associated with the loss, such as crying, yearning and anger and when in the restoration oriented mode, the griever focuses on the practical demands that follow the loss. Within this model, grief is fluid and involves both attention and diversion that might vary from moment to moment and across individuals. 

Strategies to Help Cope with Loss

Given the pervasive nature of loss, what responses are healing? Delaney underlines the significance of accepting the unwelcome nature of the situation. It is important to allow oneself to experience feelings in any manner that they show up and refrain from self judgement, as often loss of any kind carries with it ambivalence and can include intense emotions such as anger and relief. 


In order to soothe our fight-or-flight system that is often activated when we experience loss, Delaney suggests engaging in gentle self-talk, the way that we might interact with a small child. She encourages self-compassion exercises, as well as self-soothing techniques, such as mindful breathing, yoga, meditation and grounding exercises that involve the five senses. As referenced in the oscillation model, it can also be beneficial to allow for breaks from one’s grief if that feels natural and needed. 


 Dr. Alan Wolfelt, the director for the Center for Loss and Life Transition, created a “companioning” model of grief, underlining the unique wisdom of the individual who is grieving. This model encourages presence with pain and moves away from efforts to fix the griever and modify the distress associated with grief.  Wolfelt distinguishes between grief and mourning, noting that mourning is the active process of openly expressing one’s thoughts and feelings about the loss. This can be accomplished through verbal expression, art, crying, journaling, praying and engaging in rituals. 


Wolfelt notes that we exist in a “mourning avoidant” culture and receive messages to “keep our chin up.” Often we cope with the difficult feelings of grief by attempting to maintain control.

This might manifest in active attempts to suppress our feelings or ruminating about ways we might have behaved differently preceding a loss.  And, this makes sense. Loss involves a significant loss of control and felt safety. As noted, our threat systems are activated. Yet, Wolfelt states it is when we give ourselves permission to feel, even in small doses, that we have the opportunity to heal. 

Dr. Sara Glazer is a Clinical Psychologist at NY Health Hypnosis & Integrative Therapy. To learn more about how mindfulness and hypnotherapy can help you or to make an appointment, please contact us here.

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