Complicated Bereavement

Overview of Complicated Bereavement
Why Complicated Bereavement?
What does Complicated Bereavement look like?

Complicated Bereavement

It can be useful to think of bereavement as a series of mental and emotional challenges that form the path back to living-- though with a different destination from life before the loss. Unfortunately, the somewhat common belief that those who experience a death sooner or later return to "normal" at some point, is typically not the case. Many who survive a painful loss emerge rather, at the end of a constructive bereavement process with a new definition of "normal." For experts, what this new orientation to the world suggests is that the bereaved has found a way to live that's consistent with the profound internal and external realities brought on by the death - ultimately permitting a return to life. This is the essence of a successful bereavement process. Unfortunately, in some cases, experts also see bereavement processes that present challenges that burden the bereaved and leave them feeling, "stuck" and unable to constructively live again. The barriers that create these problems are usually painful or complex aspects of the loss too difficult for the bereaved to find his/her way past. Common challenges are a particularly strong or complicated relationship between the loved-one and the bereaved; a difficult history of earlier losses (through death or other means); experience of a traumatic and/or unexpected death; and/or some other hurdle that proves too overwhelming to manage. The signs and symptoms produced by such challenges are referred to by experts in the term, "complicated bereavement."

Why Complicated Bereavement?

Among the factors listed above, the most generally recognizable as challenging is likely the means of the death confronted by the bereaved. A sudden and/or violent manner of death, for example, such as unexpected illness, suicide, or car accident  creates more profound grief than an expected death, such as that of an older loved-one from a known illness. The effect of unexpected and traumatic deaths typically come with such grave surprise that, even after the initial shock, loved-ones may continue to experience the world around them as chaotic and frightening. A sudden and overwhelming experience of life's potential for terrible harshness may leave the bereaved with a view of life as treacherous, and as little more than a minefield of painful possibilities. Overwhelming grief and a complicated bereavement path commonly emerges from this experience with the choice to avoid potential pain by simply avoiding participation in life.

Another barrier commonly found after a loss comes in difficulty finding sufficient sympathy from others. It may initially sound surprising that friends or family members could be unmoved in the face of another's grief, but stigmatized losses such as those to suicide, or to abortion or stillbirth, for example, frequently leave friends and family at a greater distance and less available to assist with the challenges of loss. The need for others' help in surviving a loss grows painfully clear when the absence of comfort, support, practical assistance, and an available ear lead the challenges of bereavement to inflate to what feel like unmanageable heights. As the weight on the bereaved's shoulders grows, she or he may lose the ability to confront new realities and stall in their recovery. In some cases, the bereavement process fails to even begin, as the bereaved is convinced by others that the loss sustained is not "real" (particularly in cases of stillbirth and abortion) and feelings of grief are inappropriate. This may lead to great effort spent by the bereaved to convince themselves the loss is, "not a big deal." Unsurprisingly, in these very difficult cases, adaptation to a changed life cannot begin in the absence of an understanding that life has changed at all.

Another means for understanding the challenge of grief and bereavement is found in the nature of the personal relationship between the deceased and the bereaved. The loss of a parent or spouse from whom one experienced abuse, for example, can lead to a very complicated collection of feelings to make sense of following a death. Also commonly troublesome is the loss of a loved one, often a spouse, who provided invaluable personal or real-world support for the bereaved. One may find, for example, that his or her self esteem or, more plainly, but no less meaningful, his or her finances, depended, to a great extent on the now lost relationship with the deceased. The challenge of suddenly needing to get through one's days without such basic tools, previously taken for granted, often complicates the healing process.

Related to this, though in some ways in a class by itself, is the loss of a child by a parent or the loss of a parent by a young child. The centrality of children to most parents' sense of meaning and purpose in life, and of parents to children's identity, security, and even physical existence, lead these types of losses to require careful and extensive hard work to press through. Both types of losses can leave the bereaved with the challenge of moving forward in life with a grave sense of unpredictability and emptiness. For parents, the weight of recreating a sense of purposefulness in life slows the bereavement process. For children the great challenge is in working through the challenges of growing up feeling abandoned and without the example, love, and protection of one or both of their parents.

What does complicated bereavement look like?

Recognizing complicated bereavement is often not straightforward. Its' signs may be similar to those of a less challenging grief/bereavement process as well as of other types of personal problems. When signs are of complicated bereavement though, they are usually  similar to the symptoms of what professionals refer to as "clinical" depression-- a depression that goes beyond the temporary dark or sad mood many people think of as depression to something much more significant and enduring. It is important to note though, that complicated bereavement may also result in alcohol or drug use, problematic anger, pronounced anxiety, and any of an number of behaviors associated with a barrier on the path back to living.

With respect to depression, the mourner or those around him or her might specifically notice pronounced lethargy, sadness, tearfulness, feelings of hopelessness, insomnia or excessive sleep, poor concentration, significant changes in appetite, and preoccupation with death or even suicidal thoughts--but how do you tell these apart from the grief anyone might feel after the loss of a close loved-one? The answer is usually found in how long these signs last (more than three months following the death) but may also show up in the timing and circumstances under which unmanageable problems arise and/or the type of sadness the bereaved feels. As for timing and circumstances, a common clue is the emergence of problems following another less serious loss (e.g., a romantic separation or the death of an acquaintance). Five, ten, or even twenty years after the loss of a parent, for example, one might attend a funeral for an acquaintance and feel overwhelmed by strangely powerful feelings or unexpected behaviors. In fact, any experience that stirs up earlier memories can be  a trigger for complicated grief in the present. As for the sadness of depression associated with grief versus complicated bereavement, those experiencing grief often find in their sadness the feeling that the world is empty and impoverished without the loved-one. In complicated bereavement, in contrast, the bereaved him- or herself often feels empty and impoverished without the loved-one's presence.

For some bereaved, the signs may not arise so much in feelings as behavior. Those who have lost a husband or wife, for example, may resist accepting the loss in a refusal to do tasks once managed by the absent spouse (bill payment, cooking, etc.) and/or, over the long term, refuse  to form new, close relationships. Some even try to keep the deceased spouse present by maintaining physical symptoms experienced by the spouse prior to death. Others similarly work to deny the death by preserving his/her possessions exactly as they were at the time of death (a child's bedroom, for example) for a particularly long time.

These examples demonstrate complicated bereavement as the outcome of an attempt to live with a distorted view of oneself and the world, created after crookedly stitching a life back together without painful emotions, memories and thoughts connected with the deceased. It is important to note though that this kind of escape from reality is not necessarily a problem that needs fixing. To the extent that the challenges that follow a death add to the basic, daily demands of work, children, etc., it may be impossible to simultaneously cope with painful grief, evaluate the meaning of enormous changes, and create a new way of living. Telling oneself, "white lies" about the pain and scope of these problems can be a way to cope while properly handling responsibilities that won't go away. The problems of complicated bereavement do arise though, when recognition of painful realities is put off for too long or the separation from reality is too great to manage daily life. Sooner or later, most find that the suspension of these concerns and the attempt to live in an unreal world can't be easily sustained. Hopefully, at these times, when this strategy begins to fray, and  quality of life suffers too much, the bereaved considers the time may have come to slowly approach a new, more accurate, and more practical reality-- that is, to continue the bereavement process. Many though, feel lost at this point and grow hopeless regarding the existence of a way out. Though it's difficult and painful to set back on the path to life, there is good news in the existence of individuals who have thought carefully and at length about the problems of bereavement who are available to help.


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