Complicated Grief

I’ve been working on my book about grief, which is why you haven’t seen me here much. I’m spending most of my words on the book; most of my time, too, so I haven’t had anything much to talk about.

Until today.

In my research for the book, I keep stumbling upon a particularly odious phrase, “complicated grief.” We all know grief is complicated, straining, as it does, all our physical, mental, emotional, even spiritual resources beyond their limits. Complicating grief even more is its illogicalness, our inability to rationalize death, the unexpected and sudden triggers and upsurges of sorrow, having to find meaning and rebuild our lives after the death of person fundamental to our life, and a dozen other such complications.

But this is not what the professionals call “complicated grief.” To them, complicated grief is a medical condition that needs treatment. According to the Mayo clinic, signs and symptoms include:

  • Intense sorrow, pain and rumination over the loss of your loved one
  • Focus on little else but your loved one’s death
  • Extreme focus on reminders of the loved one or excessive avoidance of reminders
  • Intense and persistent longing or pining for the deceased
  • Problems accepting the death
  • Numbness or detachment
  • Bitterness about your loss
  • Feeling that life holds no meaning or purpose
  • Inability to enjoy life or think back on positive experiences with your loved one

Um, folks. This is called grief. Pure and simple.

The professionals say everyone grieves differently, but if your grief differs too much from other people’s grief, then you might have complicated grief disorder. I’ve been reading enough scholarly papers to know how they decide what is “normal.” They interview people. And if you’re one of the 7-15% whose grief falls outside the “norm,” then you have complicated grief disorder, no matter who died or how they died. (Apparently, in their studies, an aged parent who died quietly in bed should be grieved the same as a child who was murdered, and if it’s not, then the murdered child’s parent might have complicated grief disorder.)

They say grief takes as long as it takes, but if your grief takes longer than other people’s, then you might have CG. (Cute name, huh?)

According to one research paper I read, reactions such as having difficulty accepting the death, searching for and preoccupation with thoughts of the deceased, or being stunned by the death may well indicate complicated grief if they are present beyond the first few months after the loss. Thus, complicated grief involves the presentation of certain grief-related symptoms at a time beyond that which is considered adaptive. We hypothesize that the presence of these symptoms after approximately 6 months puts the bereaved individual at heightened risk for enduring social, psychological, and medical impairment.

Six months? Huh???? It takes at least a year just to get over the shock of it all!!!

The same study says: Complicated grief is the failure to return to preloss levels of performance or states of emotional wellbeing. Again, huh? Don’t they realize that once you have lost your life mate/soul mate, you can never return to preloss levels of anything. Everything changes, including us. Grief is a matter of becoming. Becoming the person who can survive the loss. Becoming the person who can live comfortably in a suddenly alien and hostile world. Becoming the person we need to be in order to find a new state of emotional wellbeing.

The professionals say if you have strong feelings of yearning for your deceased loved one, you might have complicated grief disorder, but studies have shown that yearning is the primary emotion of grief after the death of someone intrinsic to our lives.

They say that everyone’s loss is different, but they treat all losses as if they were the same. The Center for Complicated Grief at Columbia University says: Mental health training does not usually include learning about the syndrome of complicated grief. However, trainees often are taught that grief is complicated if there was an ambivalent relationship to the person who died. This is a misconception. Adapting to a loss is more difficult if a person can imagine how things could have been different. People might do this because the relationship was conflictual. However, this is uncommon. Most people with complicated grief have had an especially strong and rewarding relationship to the person who died.

So, let me get this straight. If we have had an especially strong and rewarding relationship with the person who died, as we do with a life mate/soul mate, the resulting profound grief is . . . wrong?

How the heck to do these people think? Don’t they read what they write? Do they truly have no idea that the loss of a distant cousin, for example, no matter how well loved, might . . . just might . . . be different from the loss of the person we intimately shared a life with?

Or maybe they are saying that the strong relationship is bad? Oh, right they do say that. They call it co-dependency. Cripes. What a world.

Apparently, they don’t understand that love is an interdependent relationship. They don’t understand how important love is and that the loss can be so devastating that you cannot get over it in a few months, and that such grief is not a disorder but an absolutely normal order. They don’t understand about the constant triggers that remind us that we’re alone. When you lose your one true love to death, all of a sudden you are supposed to be able to slough off your loss as if love didn’t matter, and go on with your life. Everyone else is celebrating their love, but you are supposed to accept that yours is over and you are supposed to have a good attitude so you inconvenience others as little as possible.

Because oh, yes, not only do we have our grief to contend with, we have the whole sociological horror to deal with: friends and family — and even mere acquaintances — who don’t understand what we’re going through trying to control our grief, sometimes with gentle (and not so gentle) reminders that we have to move on. People who are uncomfortable in our presence or who find our grief and inconvenient reminder of the fragility of life shunting us off to the side.  And of course, amateur and professional psychologists who try to define our grief as a disorder or a syndrome.

The grief — the normal grief — for a life mate can take years. We’re not necessarily actively mourning all that time; we often have long patches of peace. (According to the American Cancer Society, mourning is the outward expression of loss and is part of the grieving process. Grieving is the process of coming to terms with the loss. Researchers often get this backward, which complicates even further their already complicated papers on complicated grief.)

It takes a very long time to process death, to come to terms with our shattered couplehood, and to find a new way of living that can encompass the loss. In fact, I have found a distinct pattern to grief after the loss of life mate to whom we had a particularly strong attachment, and if the professionals had been reading this blog all these years, they’d see it too.

I do understand that some people get stuck in unhealthy thoughts and actions and so need help to get unstuck, but for most of us who have lost our life mate/soul mate, if we let grief do its work — no matter how hard it is or how long it takes, and no matter how abnormal it might appear to outsiders — we will get to where we need to be.

Maybe I should write a book about grief and tell the truth.

Oh . . . right. I am. Perhaps the professionals will even read it and learn something.

***

Pat Bertram is the author of the suspense novels UnfinishedMadame ZeeZee’s Nightmare, Light BringerMore Deaths Than OneA Spark of Heavenly Fireand Daughter Am IBertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Connect with Pat on Google+. Like Pat on Facebook.

24 Responses to “Complicated Grief”

  1. rami ungar the writer Says:

    If you include scientific studies, it’ll help the professionals to listen to them. One thing I remember from my last science class in college was that anecdotes, which your grief book might count as, are taken far less seriously as evidence than numbers. A few statistics or studies will definitely work in your favor.

  2. Lovey Says:

    Pat – once again – you nailed it…. what you said…
    “They don’t understand about the constant triggers that remind us that we’re alone. When you lose your one true love to death, all of a sudden you are supposed to be able to slough off your loss as if love didn’t matter, and go on with your life. Everyone else is celebrating their love, but you are supposed to accept that yours is over and you are supposed to have a good attitude so you inconvenience others as little as possible.”

    That hit home with me & more. Oh – how I long for the love between my husband & me. Every day I would savor it, and be thankful for it, because we both knew time was rapidly approaching when our time as a couple would run out, because of his ongoing illnesses. I just didn’t expect it would come as quickly as it did. This is another Sadder Day for me, recounting that awful Saturday, July 16, 2016, when came the unraveling, and I rushed him to the Emergency dept. The weather was bright, warm & sunny – much like today, however, days like this only remind me of that horrible trip to the hospital, as I unknowingly sped him away for the last time, from our home, our 4 dogs, his beloved rec room, big screen TV, riding lawn mower, his “Ponderosa” as he liked to call it, and all the rest of the treasures of a man’s castle. Most of all – away from our marriage, and me, his Queen, because that’s how he saw me, and treated me. He was a happy & grateful man, grateful to God for the life He gave back to him, after his early days of substance abuse, and living literally on the streets. Happy, because of me, and our love, and that we finally found each other after early years of misery with the wrong people. 34 years together, almost made it to our 30th wedding anniversary. Then, POOF – he’s gone, in a matter of hours.

    How am I supposed to go on like he was never there, or reconcile my life to this ‘new normal’ that I HATE? I don’t know what the “professionals” would say about my grief – how they would classify it? Probably something like complicated, & long running? Maybe even obsessive, as days & nights, every conscious thought revolves around him & his loss. What does it matter anyway? It’s still a struggle to go on, even after just passing the 2 year mark. It seems like it happened last month, And then, sometimes like many years ago. I am still often listless, walking around in a fog, unmotivated, and find life difficult to comprehend. Many days to fill, stretching out to the lonely horizon without him. These long summer nights – so long – knowing couples all around are making their plans to either go out for date night, or stay home & watch that movie, complete with popcorn. Or make love, satisfied in each other’s arms, blissfully unaware of anything else. Thinking of those many love songs, “Nights in White Satin”, “In Your Wildest Dreams” by our favorite group ‘The Moody Blues”. That’s the only way I can visit with him now, in my dreams, I’m grateful for the upcoming fall & winter, when I can sort of hibernate, cuddle up with my memories of my love and his silly crooked, loving smile. All I have to do is think of him, and know that I could never love anyone else like I do him. Often lacking energy, I am physically worn out, have to push myself to keep the house in order, doing only the basics. Hating myself being like this, because I used to love having a clean, orderly house. Now – I would still like that – only I am just too tired, tired not only physically, but also mentally, and drained emotionally. I do go out with my women friends, and church and Bible studies as well. But – I find my faith has been crushed, and my path back to the Lord has been strewn with WHYs, WHYs that don’t get answered. I know the Lord is my only hope of ever seeing my husband again, BUT – the emotion of loving Him the way He deserves to be loved, has also been quenched, much as I pray against it. I know God is there, but the hurt of Him not preventing my husband’s death is so overpowering, and I don’t have the will to pursue at this stage. And yet – I ask His forgiveness. I thank Him that He understands all this, and sees my heart. Some things are just not ours to know this side of Heaven, I guess.

    And yes, as you said – the constant triggers. From driving alone everywhere, wanting to get out of the house – but to where? His absence is everywhere, his presence is somewhere, just not where I am. Upcoming holidays, the changes of seasons, the joy of these things is extinguished, or at the very most, fleetingly felt. Knowing that no one is waiting at home for you, unless in my case – my 4 precious canine children. You become so intertwined with your soul mate, that trying to extricate yourself from the memories and built in responses of the two becoming one is literally impossible. Your surroundings shout to you that you are alone, but worse than that – without your love, your soul mate, the half that completed your half. You see couples everywhere, of all ages. You are alone, and feel diminished, stripped of the most important thing next to breathing. Yet – you have to go on.

    Pat – I am just so tired, and so very lost without him. Thanks for understanding.

    • Pat Bertram Says:

      At two years, you’re still in the middle of the process. And oh, my — long after my grief started waning, I was so darn tired of having to try to live without him. When you’re with your loved one, you simply live. When they’re gone, you no longer simply live. You live without. And that is hard. Grief strains most people’s faith. I have a hunch that as you get further into this new life, you’ll once again find comfort in your faith. Wishing you peace.

  3. Jo Green Says:

    Pat

    You are so right on with this article. Makes me wonder how many of this experts have lost
    The love of their lives.

    You keep right on writing and hopefully the experts will read your books and finally get some true understanding from someone who has experienced the grief they all write about

    Thanks for writing and how are you doing I know you still have a grieving heart from your recent lose

    Thanks for the words.
    Jo

    • Pat Bertram Says:

      Jo, I honestly do not think they have experienced such a loss. They can’t have. The things they say so often have little to do with the grief we feel. I read in one place where grief is supposed to be transitory, just a brief time of sorrow. That is simply not possible.

      Thank you for your kind words.

  4. Terry Jean Allard Says:

    BRAVO PAT!!! This really needs to be said loud and clear. Can these professionals be this stupid? Are they inventing these criteria and resulting diagnosis so insurance will pay for therapy?

    • Pat Bertram Says:

      I don’t think they’re stupid, they’re just ignorant and repeat what they learned. But none of them seem to have ever experienced grief. It’s amazing how many discussions of loss include everything — loss of a job, loss of a pet, loss of a co-worker. What do any of those things have to do with the death of a spouse or soul mate? Sheesh. But yes, they mustwant people on drugs and in therapy, otherwise why would they care if people who lost a life mate grief a long time?

  5. Terry Jean Allard Says:

    It occurs to me that some counselors may not agree with or be ignorant about this complicated grief diagnosis being bogus. Good counselors may see the need for long term counseling because of the nature of grief simply taking a long time.They are unable to deliver it because insurance companies will not pay unless there is a complicated grief diagnosis. Drug companies seem more than willing to replace therapy and healthy support systems for grievers with a pill. Drugs may be the only alternative for a griever who does not have access to APPROPRIATE long term counseling or family/friend support.
    I again see the importance of your work to get the word out to both the bereaved and those close to them as to the true nature of grief so help given does not create another problem (drugs) or re-victimize the bearved through inapproprite labels and advice.

    • Pat Bertram Says:

      Some people do need help. but their definition of who those people are is what I am questioning. Just because a person’s grief lasts longer than the prescribed time does not mean it is a medical issue or a psychological problem. My issue is that they seem to have no clue what normal grief is for a person who was deeply connected to the deceased. Often grievers go to therapists because they think there is something wrong with them when all that is wrong is that their life mate died. When people are given a sense that their grief is normal for their loss, then they no longer feel crazy. Often people want reassurance and validation, not a diagnosis or a drug.

      But your point is well made. I need to rethink this for the book.

  6. Terry Jean Allard Says:

    I can relate to this from another angle. I am a retired pre-school special education teacher. I witnessed young children being diagnosed with varying learning and/or social emotional disabilities because they were not able to fit into an increasingly fast and demanding curriculum. The “problem” was not the child but a curriculum that was not allowing for the spectrum we see in child/human development. BALANCE is required. Jumping in to soon can be as damaging as jumping in to late.

    • Pat Bertram Says:

      My objection is that this is a totally unnecessary classification. By taking the bereavement exclusion out of the diagnostic manual, it allows grief to be treated and to be paid for by insurance companies. The designation does nothing but make people who don’t get over their grief in six months feel as if something is wrong with them. Therapists only need to help them with whatever problems their clients have without labeling other than grief or depression. It makes grief seem as if it is wrong, and it isn’t. My problem with those who bandy about the term is that they have no understanding of the particular problems of people who have lost their life mates. Not their spouses. Their life mates. Two different things. Not all spouses even like each other or care about each other. My problem is that they make someone with an especially deep connection out to be abnormal in a bad way. My problem is that they expect people to slough off their loss in six months and the process itself takes a minimum of three and a half years. The problem is that they say a deep yearning is a sign of maladaption, without ever realizing that deep yearning is the defining emotion of grief. My problem is that these people are trying to categorize something they do not understand. In studies about grief, they often include all losses, not just the loss of a life mate, but also the loss of job or a pet or a distant cousin. They don’t ever seem to get to the heart of the issue is that people who had an especially profound connection to others will undergo an equally profound period of grief. Sorry for the rant.

  7. Terry Jean Allard Says:

    No no don’t be sorry!! It is not a rant…a rant says the samething over and over. You are building a case point by point with passion and compassion for those of us who have lost a life-mate. It is infuriating that someone who does not know what this is like assumes they do because they have studied psychology. The last sentence is very insightful
    “They don’t ever seem to get to the heart of the issue is that people who had an especially profound connection to others will undergo an equally profound period of grief.”

    My point was not to defend a diagnosis of “complicated grief”. My point was if it is the only way the surviving lifemate can get appropriate support over the long term (possibly years) then maybe it is the lesser of two evils. I define appropriate as validation of deep grief and not being made to feel crazy,weak or mentally ill for it. You have made me see using the words “complicated grief” with all that criteria is the wrong direction even if it gave a person more couseling than a diagnosis of depression or grief. It makes what is natural and needed a disease to be fixed. The end would not justify the means.

    • Pat Bertram Says:

      You make a good point, that such a diagnosis might be the only way for people who want help to get help. I just wish people who were in the business of counseling grievers knew more. I was lucky — I knew from the beginning there was nothing wrong with me, that I was perfectly sane and mentally stable, so anything that happened to me was, by definition, also sane no matter how crazy it felt. I was also lucky in that I trusted the grief process. I still do. It’s weird, though. Even people who should know better don’t know what grief is. A preacher friend asked me today if I’d moved on. I said yes, but the truth is, I went nowhere. Grief moved on.

      Thank you for a very insightful discussion.

  8. Alina Petroni Says:

    I lost my husband to suicide and was diagnosed with complicated grieving about 6 months after his death. I think it summed up what I was going through, the traumatic nature of his death delayed the grieving process because I had to accept his actions first and that delayed any sort of recovery or path forward. My 1st year was spent on traumas his death and my 2nd year was more like most people’s first year. I found it a helpful description of how I felt- it will be 3 years this November

  9. saraolivialeo Says:

    I am coming to this blog a little late but rest assured science is not always the end measure of emotional experience. Kubler-Ross made good points but no two people grieve the same… just listen to them and you will quickly figure this out.

  10. smilingtoad Says:

    Excellent post and your words resonate fully with me. I’ve been grieving for the past ten years- and yes, it changes you- and for me, it is a matter of adapting to that change, not returning to the person I used to be- that, to me, is impossible and ludicrous and even unwanted. Wonderful post and looking forward to your book.

    Regards,

    autumn jade

    • Pat Bertram Says:

      There truly is no way to return to the person we were. And you’re right, it’s about adapting to the change. One of the theories about grief that I object to is that resilient people don’t grief. In my experience, people who grieve are very resilient. We have to be to adapt to the changes in our lives.

  11. mswwrites Says:

    Sounds like an interesting book! I heard the term complicated grief a few years ago. It just means a more serious grief like depression or acute depressive episode. One who cannot function for a year, who disengages for a year and I mean becomes non-functioning or a recluse=that is cause for concern. Their grief is beyond what one is usually exposed to. It does not mean they stop grieving-so do not get me wrong or misinterpret; it means they need some assistance to progress enough in their grief that they can function again. The grief remains until the person themselves is ready to let go of some of it.

  12. Bianca Unwin Says:

    I relate to your words so much, grief is incredibly difficult and the most minor of things can trigger us into a sense of loneliness and entrapment. I am currently still grieving and this sums up the process wonderfully xx


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