Grief processing: the loss of a loved one

It is possible to define grief as the physiological process that follows the loss of a loved one . Although each bereavement is a different experience, it is now known how recurrent reactions are detectable. These concern the succession of different mental states, which can alternate or mix.

As described by Onofri and La Rosa (2015), many authors have dealt with describing the characteristics of mourning, often focusing on different aspects of it.

In 1944 Lindemann, following an observation made on over 100 people who had lost their loved ones in a fire, found and described the recurring characteristics of physiological mourning . These included:

  • somatic disorders
  • concerns and feelings of guiltabout the deceased or the circumstances of his or her death
  • hostile reactions
  • loss of functional capabilities prior to the event
  • tendency to assume behavioral aspects typical of the lost person.

Stages of mourning

Lindemann also identified and described three different stages of mourning . The first, of shock , includes the inability to accept the loss, to the point of denying it. The second, of acute grief , includes the awareness of loss. It is associated with manifestations such as disinterest in daily activities, crying, a sense of loneliness, insomnia and loss of appetite. The last stage, of resolution , instead implies a gradual resumption of daily activities and was associated with a lower frequency of thoughts about the deceased.

In 1980, however, Bowlby described four different stages of grieving .

In the first, of daze / disbelief , there is no understanding for what happened and there may be states of intense pain and anger.

This phase is followed by that of research and yearning for the deceased. Here the awareness of loss, albeit discontinuous, leads to states of pain and alarm. These are associated with physical changes typical of stress which include elevated levels of arousal, alertness and agitation. Attention can be focused on parts of the environment where the lost person may be, who is actively sought after.

The third phase described by Bowlby is instead that of disorganization and despair , which derives from the awareness that efforts to get the lost person back are useless. This phase includes depressed mood , hopelessness and generalized sadness.

Finally, in the fourth phase, of more or less successful reorganization , the acceptance of the definitiveness of the loss and the need to reorganize one’s life in the awareness of the non-return of the deceased is noted. In order to reach this final stage of processing, the bereaved person must have been able to contact and manage the painful and intense emotions that the loss entails.

Factors that hinder bereavement

As pointed out by Onofri and La Rosa (2015), several authors have focused on other aspects that can influence the grieving process . Thus, as with any stressful event, the coping processes put in place by those who suffer the loss will have an impact on the way they elaborate and restructure their reality.

In the context of trauma theory, Horowitz (1986) has focused on the symptoms of intrusion and avoidance as apparently opposite reactions typically present simultaneously in trauma. While Janoff-Bulman and Berg (1998) have shown that when the loss of a loved one occurs as a result of traumatic circumstances (such as, for example, in cases of suicide , murder or accident), or when death violates the natural order of things (as in the case of the death of a child for a parent), the person’s ability to adapt is further stressed.

Thus, in line with what is described in the literature review presented by Onofri and La Rosa (2015), normal reactions to loss can be divided into four main categories:

  1. Feelings: sadnessanger , guilt and self-reproach, anxiety , loneliness, asthenia, helplessness, shock, yearning, emancipation, relief, lightheadedness.
  2. Physical sensations:feeling of gastric vacuum, chest tightness, laryngeal constriction, hypersensitivity to noise, sense of depersonalization , feeling of apnea, muscle weakness, lack of energy, dry mouth.
  3. Cognitions:disbelief, confusion, worry with constant thoughts about the deceased, sense of presence of the deceased, hallucinations .
  4. Behaviors: sleepand appetite disturbances , sighing, hyperactivity, crying, distracting behaviors, social isolation, avoidance of circumstances relating to the deceased, search and recall behaviors of the deceased, visiting places or carrying objects that remember the lost loved one.

The normal grieving process

In general, the human being has the ability to cope with the loss of a loved one. The mourning process spontaneously tends towards resolution and is therefore not to be considered a pathological condition. However, for resolution to be reached, two conditions appear to be necessary: ​​the first concerns the acceptance of the loss as definitive .

In line with Bowlby (1980) this does not imply the cancellation or the end of the link with the deceased, but an internal reorganization with transformation of the same. A sort of new way of being in relationship for which an internal bond replaces the bond that requires physical presence to exist.

The second condition necessary for resolution concerns the ability to manage the pain that normally accompanies the loss and the grieving process. In line with this, Onofri and La Rosa (2015) describe resolution as the phase in which the active search for causes, explanations or culprits gives way to the recognition and acceptance of loss and its inevitability. As well as to the recognition and appreciation of the good that the relationship with the deceased has entailed, to the point of finding one’s own personal way of finding closeness with those who are no longer there and transforming their way of life, taking into account their absence.

Complicated mourning

In general, resolution can be achieved in a period of approximately 18 months . We speak, however, of complicated grief when the process following the loss stops at an earlier stage. Thus, the normal and intense reactions expected in the physiological process of bereavement remain. They do not diminish over time and imply repercussions on the general functioning of the person, which persists in adopting dysfunctional cognitive, behavioral and emotional strategies.

In line with what has been described, it is not considered necessary in itself a psychotherapeutic care of people who experience a bereavement. However, psychotherapy may prove useful in order to prevent possible complications, or to assess the risk that they may occur. The charge psychotherapeutic socket is rather important in situations where the mourning becomes complicated and pathological or is associated with psychopathology.

 

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