A fact sheet on grief in adults was prepared for the Canadian Psychological Association by Dr. Lorne Sexton, Psychology Program Site Manager at St. Boniface General Hospital, Winnipeg Regional Health Authority, and Associate Professor, Department of Clinical Health Psychology, University of Manitoba. Some highlights are included below.
Bereavement is the loss by death of a loved one such as a parent, child, spouse, or close friend. Bereavement can occur at any stage of life, but a common occurrence for older adults and the rate of bereavement accelerates with age. Grief refers to the psychological reaction to the bereavement. Bereavement and grief take various forms:
- Anticipatory grief: When a spouse is experiencing a debilitating illness like Alzheimer’s or is admitted to a personal care home, grief may occur prior to the physical death. At the same time that one is experiencing “caregiver stress” for taking care of a debilitated spouse, one is also grieving the loss of the marital companionship and affection.
- Cumulative bereavement: This refers to the reality that older adults will experience a number of bereavements for siblings and friends, often very close together. As we age, our social network can grow smaller and smaller as friends die, and we need to be able to re-build it, sometimes over and over again. Maintaining and rebuilding social networks is one of the essential tasks required for successful aging.
Various theories of grief stages have been put forward, ranging from three to five stages. Some people experience an initial stage of shock or numbness, followed by a period of depressed mood and yearning for the loved one. Generally, as acceptance of the death increases, this denial, yearning, depression, and anger gradually diminishes. The last stage is always some form of resolution of the grief. The intensity and duration of grief may depend on many factors, such as the personality of the individual, the relationship to the deceased, and the circumstances of the death. Unexpected, sudden, or accidental death can be extremely shocking. Death of one’s child at any age is difficult to accept.
Normal grief may last for months or even several years. Death of a close life partner may lead to sensing the presence of the dead spouse, such as briefly hearing his or her voice; this is common and can last for over a year. Many people find hearing the voice of a spouse or dreaming of the spouse re-assuring if they are aware that it is normal. Increasingly grief experts suggest that a sense of a “continuing bond” and relationship with the deceased is quite normal and healthy. The resolution of grief does not mean forgetting the deceased person, or lessening affection for them.
However, many people (about 50%) do not experience an intense emotional shock and numbness, and are able to quickly accept the loss of a loved one and resume activities. Typically, these people do not experience either a stage of shock or a stage of depression.
Grief can be considered a problem if it is either too intense or too long. The normal grief response can be very intense, and may include waves of sadness, sleeplessness, fatigue, poor concentration, and loss of appetite. About 30% of people may experience this level of intensity following the death of a spouse or child. After a very close and lengthy relationship, experiencing being alone can be a shock and feel alarming and threatening.
An intense grief experience may thus closely resemble the symptoms of a depression. Indeed, grief can be more intense than a depression. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, suggests that grief can be differentiated from depression in that grief comes in waves of emotion, whereas depressive mood is more constantly negative. In grief, the individual usually maintains a positive self-esteem, whereas in depression there are often “corrosive feelings of worthlessness and self-loathing.” The focus of the grief experience is specific to the loss of a loved one, whereas depression includes a much broader negative view of the self and the world.
People can sometimes “get stuck” in grief, which is what is meant by terms such as “complicated grief.” Grief may be complicated by the circumstances of the death, such as being unexpected, accidental, by suicide, or after a difficult and painful illness. Life factors may contribute to the development of a complicated grief, such as a lack of support from family and friends. The personality style of the grieving person can also lead to complicated grief. For example, if the individual has been overly dependent on the now-deceased spouse or parent, the grief process may be more difficult or prolonged. In a prolonged complicated grief, the individual stops making progress in recovering from the death and remains overly focused on past memories for many months and years.
Grief is a normal response. Grief is not an illness and usually does not require medication or psychological treatment. However, an individual can consult with a physician or registered psychologist to determine if treatment might be of help to deal with prolonged complicated grief.