LIVING & COPING WITH GRIEF COMPLICATIONS

SUPPORTING GRIEF 


In the short-term there may be any number of issues pertaining to the immediate death that require due attention. These might include any or all of the following:


-Funeral Arrangements


-Inquest / Post-Mortem Arrangements


-Legal Issues


-Financial Issues


-Family Relations 


-Living Accommodation


-Work Arrangements 


-Welfare Benefits      


-Childcare


-Health and Wellbeing


-Societal/Cultural Expectations 


Some of these issues are reconcilable in the short-term, however, others can become medium- to longer-term problems. 


Dealing with the 'real' rather than the 'ideal' is a practical way of helping to come to terms with loss. 


In the beginning this can help with focus on immediate issues such as leave from work/study, dealing with the funeral and the estate, adjusting certain living arrangements etc. Eventually it will have more relevance for coping with the reality of change and what this change means to you and others around you. 

LEARNING TO LIVE WITH GRIEF COMPLICATIONS - PART 1

Complicated Grief/Persistent Complex Bereavement Disorder/Prolonged Grief Disorder (CG/PCBD/PGD) ARE manageable conditions. 


A major aspect of reckoning with and dealing with grief complications is understanding the nature of the death, recognising the type of loss and identifying the range of complications that might be affecting you, either directly or indirectly. This helps to build-up a 'rich picture' of your grief, in other words an informed introspective regarding, first and foremost, what your grief means to you. 


Although many people might not recognise that they have it, the correlation with other manifest behaviours (comorbidity) can help to identify death/bereavement/loss as a principle catalyst for the emergence and development of problem behaviours over time. In such cases incidents of death, bereavement and loss can become corollaries for other complications to emerge and persist.


The following are all means by which a person experiencing bereavement and loss can engage with the emotions and feelings as well as some of the practical issues that it raises:


Emotional Pain


Sorrow is related to the strength and depth of feelings that those suffering loss have for their loved ones. Such relationships are unique and special in many different ways. Going through cycles of emotional pain is part of coming to terms with the death and the subsequent feelings and emotions associated with bereavement and loss. However, in cases of grief complications it's important to identify the ways in which focussing on the loss is painful and distressing (Craig White 2013 pp.37-44). 


This may involve taking the following steps:


-Outlining the sequence of events 


-Adding details 


-Creating a summary 


-Facing-up to avoidance issues 


Forgetting / Avoidance 


Rather than actively or passively remember and recall some people suffering with long-term grief symptoms forget or overlook events surrounding the death and the effects of their bereavement and loss. Emotional pain is such that the forgetting of aspects such events can actually have a beneficial effect i.e. protecting the person suffering from the reality of an overwhelming loss and the grief symptoms from experiencing additional feelings associated with trauma (Craig White 2013 p.6). 


Confronting grief can be an exhausting process for any bereaved person, mentally, emotionally and perhaps even socially (Craig White 2003 p.6). In light of this it's understandable that people affected by grief might develop avoidant coping mechanisms in order to help them deal with their loss. 


However, in terms of 'Avoidant Coping' and 'Engagement Coping', the latter is a more effective long-term response to grief. Longer-term the person dealing with the bereavement and the subsequent feelings of loss will need to actively engage with the issue rather than constantly relegate it (Craig White 2013 pp.50-51, 59-62).


Especially in cases where grief symptoms persist the source of the emotional pain needs to be identified, explored and worked through. This can be a gradual process that takes time and requires a certain amount of intervention.  


Meanings 


Trying to find meaning when the source and inspiration for your meaning has gone is a massive challenge, which for some people is understandably overwhelming. A central focus of your life is forever displaced, your feelings and emotions, your daily activities, your sense of sharing, your semblance of identity through relations and belonging, your hopes and dreams for an imaginary future are all impacted upon in multi-various ways. 


In experiencing grief, feelings of aloneness and loneliness often come to the fore, the belief that nobody understands, that nobody can relate, that one is 'stuck with the grief' and has nowhere to go with it. Meaning is to be found both within yourself and in others. Finding what those meanings are, exploring them and trying to understand them can be integral to ways and means of coping. 


Re-configuring and re-confirming these meanings can help to focus attention on short-term and long-term issues e.g. planning, prioritising and negotiating as well as comprehending events related to the actual death itself and learning to live your life without the physical presence of your loved one. 


Memories 


Although the mind and body of a dead person cease to physically be, representations in the form of thoughts, feelings and memories substitute the physical presence for those that actually experience the bereavement (as well as life beyond it). Whether you are engaged in remembering (short-term) and/or recollecting (long-term), memories are important links to the past; to people, places and events. It's often the case that these are conjoined in memory and consequently difficult, sometimes impossible, to separate from each other i.e. every memory has a context, a certain time and space associated with it. 


Memories and experiences form networks (Craig White 2013 pp.64-65). They are not only situated according to time and space they are relational. When memory of the bereaved is shared by one or more persons the inter-subjectivity of these memories can have an amplified resonance. They pertain not only to the person who has died but to those who had shared experiences with them. In this respect memories 'multiply' according to the number of people that share them. 


Examples of things that can be used as memory prompts or memory cues might include any or all of the following:


-Photographs 


-Letters 


-Postcards


-Stories


-Poems


-Music 


-Artwork


-Recipes


-Receipts 


-Certificates 


-Newspaper/Magazine articles and cut-outs 


-Audio/Video sources 


-Other Artefacts (jewellery, keepsakes, mementos)


-Places 


-Activities  


There are issues here with respect to the 'physical' and the 'virtual' and with public/private domains:


-If you decide to share material of a personal nature on the Internet then consider what's actually appropriate for you to share with others, many of whom you may not know


-Respect the fact that people have died and that others have been bereaved


-Be responsible. Do whatever you can to promote healing and minimise potential harm 


-Issues such as security, storage, access and permissions should all be properly identified and considered

  

Creating a Memorial 


The following are all examples of memorials that can be used for commemorative purposes:

 

-Compile a tribute with pictures/video/music


-Create a 'Memory Box' 


-Commission a piece of art


-Set-up a charitable trust 


-Sponsor children and/or animals


-Plant a tree/shrub


-Name a star/constellation 


-Create a dedicated site on the Internet 


-Create a Book of Remembrance 


There are issues here with respect to the 'physical' and the 'virtual' and with public/private domains:


-If you decide to share material of a personal nature on the Internet then consider what's actually appropriate for you to share with others, many of whom you may not know


-Respect the fact that people have died and that others have been bereaved


-Be responsible. Do whatever you can to promote healing and minimise potential harm 


-Issues such as security, storage, access and permissions should all be properly identified and considered  


Time-lines 


Death, bereavement and senses of loss are all inextricably related. In dealing grief we can move forwards as well as move 'backwards' and 'sideways' whenever necessary. It's very important to learn to balance time spent doing these things with time spent living our own lives. Being in the present and looking forward to the future with genuine hope and aspiration involves having a relationship with the past and with past events that both promotes and enables this to happen.


Although it's important not to live in the past there are ways we can remain connected with it that are both healthy and affirmative e.g. commemorating the death and subsequent anniversaries/special occasions, engaging with possessions and other artefacts, keeping memories alive through looking at photos, listening to audio recordings, watching video recordings, talking, recounting, remembering and recollecting and creating lasting memorials in honour of loved ones. 


The cliché time is a great healer is antithetical to CG/PCBD/PGD. Time alone does not heal the effects of traumatic death. Informal support networks can be valuable and important over time, however, this is not always enough. In order to promote genuine, long-term healing therapeutic intervention is often required. This can be a long-term process that requires a significant amount of time and energy in order to progress with. 


Reconciling vs. Resolving 


All human beings are unique and irreplaceable. To 'resolve' a death would mean to bring a person back to life after death, which is not possible. In terms of grief the death of a loved one cannot be resolved as much as it can be reconciled


Reconciliation is essentially about enabling those affected to gradually come to terms and ultimately accept the reality of the death of a loved one. One can reconcile oneself with the death of a loved one by finding ways that:


-Encourage learning about and grief and the feelings associated with it 


-Foster an ability to live with memories and recollections (which may be based on a wide variety of life experiences)


-Promote healing and minimise potential harm


-Help to plan moving ahead by learning to adjust, re-balance and refocus whatever priorities in life are important at a given time and in a particular place 

LEARNING TO LIVE WITH GRIEF COMPLICATIONS - PART 2

In terms of managing bereavement and loss an objective is to create new experiences and memories that don't necessarily involve the deceased person(s). It's also about learning to control and accept 'cues' and 'triggers' that may be difficult and painful, often unexpected. 


In this respect the following areas can be identified and explored (adapted from Teresa Jackson 2017):


Communications 


-Communicating with others using whatever ways and means you are comfortable with is vital. Maintaining contact with family, friends, colleagues and other support networks using whatever forms are appropriate e.g. writing, speaking, visiting can be really constructive and make a genuine difference to how you cope.


-Deleting phone numbers, non-essential e-mails and other documents pertaining to the deceased and the events surrounding the death e.g. copies of the will, copies of the death certificate, 'dealt with' correspondence. 


External Relationships


-Desensitising painful cues and triggers can also be achieved through recognising and talking. This can help to reduce intrusive/negative thoughts and feelings and enable you to share worries and concerns, doubts and fears. 


-Going out, meeting lots of people and having lots of conversations. This opens-up the possibility of different social encounters and enables forms of connection with others in wider social circles. Bereavement support groups may be particularly helpful in this respect.


-Developing new (as well as old) interests with other people and exploring different ways of being with others e.g. work, voluntary work, educational/training courses, recreational activities, societies and clubs etc.


Shared Life Experiences 


-Visiting places that have relevant memories 


-Going to the same places and engaging in the same activities 


-Listening to the same music (as a background for other activities)


-Doing the things that the other person didn't like to do but you do (developing individual interests)


Re-storying Techniques 


-Visiting gravesides and verbalising feelings


-Acknowledging the lost person by not suppressing memories 


-Attending to dream material in waking life by writing down, retaining key points and afterwards recounting/sharing with others 


Writing Tasks 


-Using healing letters written to the person 


-Writing stories/accounts about the person and reflecting upon them, retaining key points, afterwards recounting/sharing with others


Moving On 


-Identifying advantages/disadvantages of new situations (both good/bad features) and understanding the various ways that changes have brought them about


-Moving house, upsizing/downsizing, fulfilling a dream to live in another place 


-Looking forward positively, constructively and with hope for the future   

IDENTIFYING & NEGOTIATING PROBLEM ISSUES

Identity & Self-Image


Often our sense of identity and image is connected to the relationship that we had with our loved ones and learning to adjust to this can be particularly challenging. The feeling that a part of you died when the person that you loved died is a recognisable and understandable feature of grief, however. In recognising this it's possible to begin working with it, taking small measured steps to develop a sense of self that we had perhaps forgotten, overlooked or never realised we had. Where there are challenges there are also opportunities. 

 

Self-Esteem


Long-term grief can seriously effect self-esteem, creating and nurturing feelings of doubt and low self-worth. This can have compound effects over time. You can help to counteract this by accessing, using and maintaining whatever helping and social networks are available to you, developing 'circles of trust' in order to raise your confidence and that of others and engaging in a variety of activities that are constructive. Exploring new interests can lead to opportunities for self-development, transformation and actualisation, all of which are important in achieving your potential and boosting your self-esteem. 


Guilt & Blame 


Many people experience strong feelings associated with guilt and blame over aspects of their relationship with the person who has died including past actions and/or non-actions (both verbally and physically), the events leading up to their death and the situation and circumstances of their death. Learning to understand and explore these feelings and emotions as well as the situations and circumstances surrounding them may help to ameliorate them. Living with guilt and blame is difficult, however, it's often understandable and it's never insurmountable. 


Fear


Being scared or frightened about death and having trepidation regarding various aspects of bereavement and loss is very understandable. Sometimes fear relates to the unknown as much as what is already known, in some cases to a greater or lesser degree. Find and develop support networks that will help you to negotiate these feelings, also weigh these feelings constructively in relation to the actual object(s) of your fear. Often by putting issues in perspective and by challenging them head-on they end up having less of a hold than they otherwise might. 


Life  


Life after death is sometimes more difficult to adjust to than dealing with the death itself. The aftermath of death and the subsequent feelings of bereavement and loss often seem insurmountable and overwhelming. However, accommodating and assimilating beliefs about life and death is a significant part of the process of bereavement and coming to terms with loss. We live for ourselves and we live for others, in recognising this we can maintain a focus on a range of life activities that enhance and improve our lived experiences of bereavement and loss. Following the death of a loved one life essentially becomes about living with that loss and trying to find ways forward. This is rarely an exact science and is usually a case of exploring pathways that you feel are relevant to you and learning from the experiences that you gain.

 

Others 


Although there are similarities with respect to incidences of death and people's experiences of them they are all unique and idiosyncratic. One person's experience of death, bereavement and loss may be very different to that of another person. Some people may have more experiences of death incidents and associated feelings of bereavement and loss, whereas some may have no experience of these things at all. Respecting and supporting these differences is critically important. Everyone is an individual and deserves to be treated accordingly. Whatever has happened to you and whatever the nature of your bereavement and loss, you are not a lone-survivor. Others who have experienced similar deaths, bereavements and losses are capable of being empathic towards those who have experienced their own personal issues. Family, friends, colleagues, neighbours, support groups and therapy contacts can all be useful sources of support. 


World View(s)


Death can change people's perspectives, sometimes radically so. It may lead us to question our beliefs and our motives and also challenge aspects of our behaviour that we once took for-granted. In some cases these are reactionary and tend to be operative in the short-term, in other cases they become measured responses that develop over extended periods of time. Assimilating the death that you've experienced with your particular world view(s) often involves challenging and negotiating beliefs and values that may be long held. This can involve both affirmation and rejection as well as a longer-term re-valuation of what these things mean to you and to others close to you.


The Future 


Learning to live after the death of a loved one is an important and invaluable life resource, one that can be applied and re-applied throughout life. Believing in yourself and in the strength and resilience that you possess can be integral to the ways in which you learn to manage bereavement(s) and loss(es) and eventually move forward. Management of grief entails learning to live with loss, of 'coming to terms' in your own special and unique way. 

MOVING FORWARD

Mourning is a natural human behaviour, a mechanism that enables us all as human beings to cope with death, bereavement and loss. In this respect grief is a functional part of life and should be recognised and appreciated as such. 


However, in many contexts grief remains a stigmatic 'taboo' subject for many and this needs to be addressed, both politically and economically in terms of targeting and funding research. It also needs to be addressed socio-culturally in terms of raising awareness and increasing understanding regarding our relationship with various types of grief and how these are capable of affecting us both individually and in the various contexts of partnerships, families, communities and in society. 


Communication and its importance to people suffering with CG/PCBD/PGD cannot be overstated. Talking with family members, friends, colleagues, neighbours, medical personnel and fellow sufferers can all be beneficial in dealing with a range of symptoms. Emotional transparency enables others to recognise the feelings of sufferers and can promote greater understanding regarding the conditions, their causes and their range of effects. 


Processed/Integrated Grief 


Learning to live with the grief being there but being processed in such a way as it becomes manageable and acceptable is a major aspect of reconciling the death of those we love with our own lives. 


When we are able to integrate the death of a loved one with our own lived experiences then we are better able to move forward, adjust to the loss(es) that we have experienced and adapt to these changes as a matter of course. This involves learning to live with death and it's after effects and developing means that enable us to move-on constructively. 


For people that experience and live with CG/PCBD/PGD this may be a long-term process that requires a significant degree of patience, diligence and in-depth understanding. There may not be any such thing as 'straight-forward' grief, only relative degrees of it, together with various difficulties and challenges that present themselves in different ways over time.


For references to Further Reading Material please see the following LINK:

DISCLAIMER

 Please note that the information presented on these web-pages is not a substitute for medical advice or for seeking professional help through therapy and/or other forms of treatment.  

REFERENCES

Jackson, Teresa (2017), Loss Of A Parent: Adult Grief When Parents Die

Amazon Books 


White, Craig (2013), Living with Complicated Grief 

London: Sheldon Press 


  

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