When grieving gets complicated

Nowadays, grieving someone's death is often experienced as socially undesirable. Instead of seeing grief as something normal and healthy that takes time, people feel that they are expected to quickly get over their loss and move on with life. Family and friends are often very supportive initially. But many bereaved describe how a few months after the death, the support and interest begins to fade away, which is when they would need it the most.

Whereas in former times, grief was often shared within and held by the extended family, these close-knit family structures rarely exist today. Especially, when the bereaved is living and working far away from home and doesn't have a strong local support network, grief can become very isolating. And even friends who tried to be understanding at first can feel overwhelmed and helpless when faced with the deep and enduring pain of someone's loss and may decide to stop contact.

While social mobility and the lack of extended family structures are social factors that hinder the expression of grief, there can be specific circumstances that make grieving particularly difficult. Three of these specific forms of grief that are fairly common but not much talked about are disenfranchised, anticipatory and delayed grief (Worden, 2010).

Disenfranchised Grief
This term describes a bereavement that is linked to a relationship that is not socially sanctioned. It can include the death of someone with whom the bereaved had an affair or some form of alternative lifestyle that is not recognised by the dead person's family. In these situations, the bereaved may not be able to fully participate in funeral rituals and may not receive the necessary social support. Grief can also feel disenfranchised when it concerns losses that are negated by society such as miscarriages or abortions or when it relates to losses that carry some stigma such as deaths by suicide or AIDS.

Anticipatory Grief
We are talking of anticipatory grief when a person begins to experience the various grief reactions before the loss actually occurs. This often happens when there is some forewarning of the death, such as when caring for a relative or partner who is terminally ill. While there is some evidence to suggest that anticipatory grief helps people in their bereavement, it can bring its own problems. On the one hand, it can lead to increased anxiety with regards to having to survive without the loved one and facing one's own mortality. On the other hand, by beginning to cut one's emotional ties with the person who is dying, this can lead to resentment and a strong sense of guilt. Anticipatory grief can also be experienced by the person who is dying and then often leads to emotional withdrawal as a way of coping with the enormity of the situation. On the positive side, the time prior to the death can be used very effectively to deal with any unfinished business in the relationship with the loved one. Such a communication can be crucial for the bereaved person's ability to cope with the loss and will prevent regrets over things left unsaid.

Delayed Grief
Grief reactions are delayed when they are not sufficiently expressed at the time of the loss but then emerge at a future date where they seem disproportionate to the situation. This mainly relates to the task of working through the feelings associated with the loss that had previously been ignored and suppressed. At the time of the loss, these emotions might have felt overwhelming, for example when faced with a particularly traumatic death, or there might have been a lack of social support. A skilled therapist can help the client to connect the grief reaction to the earlier loss and help him or her to work through their feelings.

Whether it is due to social factors or specific circumstances that grieving is made difficult, bereavement counselling can help. It can support the bereaved in making sense of their situation and in working through the mourning process in a healthy way. Grief may include a range of feelings, thoughts, behaviours and physical symptoms, and a bereavement counsellor can explore, hold or normalise these with the client.

References:
Worden, J.W. (2010) Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner. (4th edition) London: Routledge.