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Thursday, September 16, 2010

T3 - Types of Grief, Part 1

There are two terms psychologists throw around to help conceptualize grief. The first is cathexis. A cathexis is the focusing of emotional energy and connection toward a person, thing, or idea. When there is death, disappointment, hurt, or anger, a person must go through decathexis, which is a gradual ebbing and eventual severing of that emotional connection.  It's a painful process, of course, and we colloquially call it "grief."

I'm starting this series on grief because in so many ways, a vast majority of people (and fictional characters) suffer from some form of this ailment. There are two types of grief: uncomplicated grief, which is considered "normal bereavement," and complicated grief, which has many subtypes.

Uncomplicated grief is what we find in the Diagnostic and Statistical Manual under Bereavement. It can manifest like Major Depression, including extreme sadness and crying, insomnia, poor appetite, and weight loss. Major Depression would not diagnosed, though, unless the symptoms are still present after 2 months following the loss. The reason for this is that the death of a loved one would result in a grief response that is considered "expected and culturally sanctioned response to a particular event," so therefore grief in and of itself is not a mental disorder.

There are a few symptoms that, if present, would alert a therapist that the person had slipped into a Major Depressive episode. Those symptoms would be:
  1. Guilt about things other than something the survivor did or did not do at the time of the loved one's death
  2. Thoughts of death other than the survivor wishing they could have died with the deceased person
  3. A morbid preoccupation with worthlessnes
  4. Marked physical slowness (psychomotor retardation)
  5. Impairment of functioning for longer than one would expect
  6. Hallucinations other than the survivor thinking that (s)he hears the voice of or sees the image of the deceased person.
While therapists really only differentiate between bereavement and major depression for diagnostic purposes, bereavement can be uncomplicated in the technical sense, or fall more into one of the subtypes of complicated grief.

One aspect of complicated grief that makes a big difference is time.

I've been asked a few times from writers how long is long enough for a character to wait after a spouse has died before diving back into a romantic relationship. The answer to that question depends largely on which type of grief the survivor has gone through below.

Anticipatory grief is what people go through when they know in advance their loved one is going to die. They start the grieving process as soon as they learn of the terminal diagnosis, and for many, the actual death of the person is at the end of their grieving cycle.

Once they learn about the impending death time line, they automatically begin to think about life without that person, how they will grieve the person's passing on, how they need to prepare for the death, etc. Spouses/girlfriends of men serving overseas can sometimes begin grieving the loss of the presence of their partner, begin to envision their life without them should something happen to their husband overseas, and as they move through the grief process, actually begin that decathexis and move on with their lives....thus so many "Dear John" letters.

A blessing of anticipatory grief is the possibility of resolution of unresolved feelings between the person dying and those that will be left behind. Saying "I love you" to an estranged father, accepting forgiveness, and time to pass on previously unspoken blessings all aid in the grieving process.

A widow experiencing this type of grief is more likely to move on sooner after the actual passing of her husband. If she's been taking care of her spouse for 6 months to a year or more, the passing might be a relief of sorts because she no longer has to see a person she loves suffering and no longer has to bear the brunt of the burden/weight to take care of them.

Unanticipated grief is what hits after a very sudden, unexpected death. Car accidents, natural disasters, and murder all precede a grief process that extremely difficult, as the human mind can't grasp what has happened immediately. This type of grief overwhelms coping strategies and defense mechanisms and often leaves the person unable to function with day-to-day activities.

The full impact of the death might not be felt for years to come. It's simply a product of time and slowly going through several "firsts" until eventually they run out. for example, the survivor will be have to pay bills during the first week without their loved one. They'll have to survive the first anniversary or child's birthday without them present.

A widow going through this type of grief will likely not be psychologically ready to move one for at least two years. 2 years is a good rule of thumb, as anything less could be considered "tacky."The only exception to this might be older men. They seem to be more needy later on in life and will often remarry quickly, as they can't sustain life by themselves as they had grown codependent on their spouse.

Next week, we'll look at two more types of complicated grief and how you might utilize this information in your writing.

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Claire King said...

This is such a useful and interesting post. I'm very pleased to have found you!

Christine said...

Thank you for this post. I am getting ready to write another book/series and one of the characters is grieving a loss of a spouse--anticipatory grief works in this case.

Miss Sharp said...

Hi Jeannie - what about a person who seems (at least outwardly) to not go through grieving at all, or only a very little?

Shannon said...

As always, insightful and thought-provoking.

Jeannie Campbell, LMFT said...

miss sharp - will be covering that type of grief in a later post. :)

claire - thanks so much for stopping by! hope to see more of you.

shannon, christine....thanks for the kind words!

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Both comments and questions are welcome. I hope you enjoyed your time on the couch today.