COVID-19 Losses – Complicated Grief, Part II

In Part I we described ways the Pandemic has created massive amounts of loss and how it can manifest itself in physical symptoms we don’t always ascribe to grieving. OUR COMMENTS ARE IN RED

Based on the seminal work by Elisabeth Kubler Ross, the most well-known stages of grieving are: denial, anger, bargaining, depression and acceptance.  We now know they do not happen in a neat linear timeline but are tools to help us identify what we may be feeling. Grief is often messy and each of us experiences it uniquely.
The universal expression of grief is described as a year.  Marking the end of a year after losing a loved one many cultures and religions hold ceremonies.  However, anyone who has ever lost a love one, grief doesn’t end, anymore than our memories end.  Our grief simply takes on different complexities, expressions, intensities over a life-time.
There are many labels for the duration experienced:  “normal vs pathological”, acute vs chronic, situational vs compounded, simple vs complex.  Basically each describes a variation of what we experience.

Here are excerpts from a WEBMD article on Normal vs. Pathological Grief
“Depression is not a normal part of grief, but a complication of it. Depression raises the risk of grief-related health complications and often requires treatment to resolve, so it’s important to know how to recognize its symptoms. Sidney Zisook, MD, a grief researcher and professor of psychiatry at the University of California, San Diego, says people can distinguish normal grief from depression by looking for specific emotional patterns.”

“In normal grief, the sad thoughts and feelings typically occur in waves or bursts followed by periods of respite, as opposed to the more persistent low mood and agony of major depressive disorder,” Zisook says.”

“He says people usually retain “self-esteem, a sense of humor, and the capacity to be consoled or distracted from the pain” in normal grief, while people who are depressed struggle with feelings of guilt and worthlessness and a limited ability “to experience or anticipate any pleasure or joy.”

“Complicated grief differs from both depression and normal grief. M. Katherine Shear, MD, a professor of psychiatry at Columbia University’s School of Social Work and director of its Center for Complicated Grief, defines complicated grief as “a form of persistent, pervasive grief” that does not get better naturally. It happens when “some of the natural thoughts, feelings, or behaviors that occur during acute grief gain a foothold and interfere with the ability to accept the reality of the loss.”‘

Symptoms of complicated grief include:

  • Persistent efforts to ignore the grief and deny or “rewrite” what happened.

  • Complicated grief increases the risk of physical and mental health problems like depression, anxiety, sleep issues, suicidal thoughts and behaviors, and physical illness.

How Does Avoidance Harm Your Health?
“Margaret Stroebe, PhD, a bereavement researcher and professor of clinical psychology at Utrecht University, says that recent research has shed light on many of “the cognitive and emotional processes underlying complications in grieving, particularly rumination.”‘

“Research shows that rumination, or repetitive, negative, self-focused thought, is actually a way to avoid problems. People who ruminate shift attention away from painful truths by focusing on negative material that is less threatening than the truths they want to avoid. This pattern of thinking is strongly associated with depression.”

(NOTE:  Rumination has also been show to be our cognitive brain and our emotional brain locked in a feedback loop which is set to protect us from further harm.  Negative, ruminations are not because of personality or intelligence but a function of brain processes. We can break into this process by forcing our thinking into neutral or positive thoughts but it takes effort to do so and over-ride the brain’s natural stress response.)

“Rumination and other forms of avoidance demand energy and block the natural abilities of the body and mind to integrate new realities and heal. Research by Stroebe, and others shows that avoidance behavior makes depression, complicated grief, and the physical health problems that go with them more likely. Efforts to avoid the reality of loss can cause fatigue, weaken your immune system, increase inflammation, and prolong other ailments.”

But the researchers all indicate professional help is needed to heal from complicated grief and unremitting depression.

Click here to see part one


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