How does grief and the grieving process affect your mental health? In this article, we begin to unpack the complex relationship between grief and mental health.
Grief and loss
Grief is a slippery concept. So let’s start to get to grips with grief by understanding just what it is we might grieve about. Here’s a definition.
Grief is an emotional state of intense sorrow experienced as result of personal loss.
This loss can be:
- loss of a person;
- loss of a previous self (through injury or illness);
- loss of place or an object;
- loss of identity (Brexit anyone?).
The loss doesn’t have to have happened recently. Grief can be for something long past as well as in the recent present.
There is also future or anticipatory grief: grieving for a loss that is yet to happen.
Consider, for example living, or caring for someone, with a terminal, prolonged or degenerative illness. Dementia, stroke, Motor Neurone Disease (MND); spinal cord injury (SCI); loss of sight; or simply old age. There can be present grief for a loss of identity, future grief for the eventual loss of a life, or past grief for the person they used to be.
We all have different vulnerabilities as we get older. And for a partner, it is not just the loss of the person they can grieve for, but also for the loss of intimacy and communication.
There is also the paradox of grief for a partner who has passed away. Some people cope with their loss by imagining that their loved one is still there:
“I have survived five years without her because I have not been without her.”
Feelings of grief can be exacerbated due to a lack of societal norms of how we should behave when grieving and for how long. Given their unique personal nature, and a lack of clear behavioural expectations, grief and loss can be difficult to experience and comprehend.
However, some people have tried to make sense of their experience of grief using language and literature.
Grief in language and literature
Language is important for our understanding and expression of grief.
In terms of understanding, there are subtle nuances that come from using the verb form rather than the noun. Consider the difference between:
“Grief”
“Grieving”
The noun ‘grief’ implies a reactive emotional state. The present progressive tense verb ‘grieving’ implies an active ongoing process. A process that can be both necessary and normal, or seen as troublesome and abnormal if it continues for too long.
Everyone’s experience of grief is unique. Take, for example, these two quotes from Julian Barnes’ 2014 book Levels of Life that Barnes used to describe the nature of grief when writing about the death of his wife Pat Kavanagh:
“Every love story is a potential grief story.”
“[Y]ou don’t come out of [grief] like a train coming out of a tunnel, bursting through the downs into sunshine and that swift, rattling descent to the Channel; you come out of it as a gull comes out of an oil-slick. You are tarred and feathered for life.”
Grief is clearly not neatly packaged and linear like the DENIAL-ANGER-DEPRESSION-BARGAINING-ACCEPTANCE stages of Kübler Ross and Kessler’s grief cycle might suggest.
For Barnes and others, grief is personal and messy and full of intertwining emotional and physical reactions. For Keanu Reeves,
“Grief changes shape but it never ends”
A model like the grief cycle can’t possibly capture this individual complexity – to be fair, it doesn’t intend to – but personal accounts of grief like Barnes’ and Reeves’ can.
Grief, pathological grief and mental health
So when does grieving and grief become a mental health problem?
Because there can be severe maladaptive reactions to intense sorrow in terms of behaviour, self care, and mental and physiological states, medical professionals like to draw lines between ‘normal’ and ‘abnormal’ grief. This delineation of pathological grief, or grief as a psychiatric disorder, has been the preserve of the DSM (Diagnostic and Statistical Manual of Mental Disorders) in the USA and the International Classification of Diseases (ICD) for the rest of the world.
The DSM defines, for psychiatrists at least, how long someone is ‘allowed’ to be grieving, and for what reason, before they might be classified as mentally ill. This normative definition of grieving has been subject to a number of revisions over the years. For example, DSM-V removed the bereavement exclusion from its definition of Major Depressive Disorder (MDD). Prior to that, in DSM-IV, someone who experienced depressive symptoms for less than 2 months following the death of a loved one could not be diagnosed with depression. In DSM-V this was no longer the case. This revision was not made without controversy (Kavan and Barone, 2014).
If grief is part of the human condition, should it be even medicalised at all? Is the concept that grief for a certain amount of time is OK valid? And should this period of time be 2 months, 12 months or longer? Richard Bryant is a leading critic of the DSM’s medicalisation of grief.
Grief and resilience
Grief and depression do overlap, but there is little evidence that psychiatric medication helps grief. If medication doesn’t help those who are grieving, then what does? How can we assist those with prolonged grief who want to be assisted?
Recognition of what someone is going through is an important first step. Sometimes that it is all that is required. Beyond that there are ideas of resilience which are themselves not without their own controversies.
On the side of resilience as a positive force in coping with grief are the likes of, former Facebook Chief Operating Officer, Sheryl Sandberg. In her book, Option B: Facing Adversity, Building Resilience and Finding Joy, Sandberg advocates you ‘kick the shit out of Option B’ when Option A is no longer available. Option A in this case is her dead husband. Sandberg and co-author organisation psychologist Adam Grant see resilience as the right path to bouncing back to normal as quickly as possible.
Others, like Candyce Ossefort-Russell, see notions of resilience as potentially dangerous. She wants people to find their own paths through their loss and to embrace grief as a necessary of the emotional healing process. It should not be something we want to bounce back from as quickly as possible she argues.
Sandberg’s and Ossefort-Russell’s standpoints on grief and resilience don’t have to be in opposition to each other. Especially if we consider grieving to be an active process as Cole suggested in today’s talk. We should instead follow his language lead and reconfigure resilience to be a verb rather than a noun. As a verb, resilience then becomes an active process – something we do in order to cope with loss – and as such grieving can be seen as a legitimate part of this survival process.
Learn more
This article was inspired by a talk give by Professor Jonathan Cole, at the University of York on 25 Feb 2020 entitled ‘Grief and Neurological Impairment’. This was the inaugural event for an AHRC funded project based at the University of York on the nature of grief. A neurophysiologist at Poole Hospital NHS Foundation Trust, Cole is also author of a number of books including Losing Touch: A Man Without His Body and Pride and a Daily Marathon.
Delphis has written extensively on resilience in business, and even offer a half-day workshop for managers. We’ll be exploring the links between grief, mental health and resilience in future articles.
If there’s anything specific you’d like us to cover then please comment or drop us a line. We’d love to hear from you.
Thanks for reading.
