THE CHAOS OF DYING AND GRIEF

“Learn to get in touch with the silence within yourself and know that everything in life has a purpose." Dr Elisabeth Kubler-Ross

When someone you love dies, it is often experienced as both a physical and emotional wound so large, it feels it will never be filled. Apart from the actual physical loss of the person, there is a death as well of the relationship that was shared.

A bereaved person may have many other relationships, friendships, family members and loved ones in their life, but that relationship, that human transaction is unique. The challenge therefore, for the living, is to somehow continue on in the relationship, even in the face of the physical absence of the other. The real frontier to navigate when someone you love dies is to continue to live fully so their absence can, in memory and in action, maintain a sense of meaning.

Swiss psychiatrist Dr Elisabeth Kubler-Ross researched and wrote insightfully for decades about death and dying and opened up a narrative that, without her, would still be largely avoided and undiscussed.

Dr Kubler-Ross’s five-stage model was created by her for people who were terminally ill. The five stages (which are progressive, according to Kubler-Ross) are denial, anger, bargaining, depression and acceptance.

At some point, the model came to be accepted as a ‘grief model’ as well. This was not Kubler-Ross’ original intention as she worked exclusively with the terminally ill and not those experiencing bereavement. However, the discourse of the five-stage model quickly became entrenched within the ‘grief’ literature as well as ‘death and dying’ literature.

Recently, a group of Dutch doctors have identified a type of bereavement, known as ‘complicated grief’. It occurs when an individual suffers intense and persistent yearning for the loved one and experiences difficulties “moving on" with life after a period of time. Other markers include a sense that life and the future are meaningless and lack purpose in the absence of the person who has died. People with complicated grief are stuck in a state of chronic grieving.

"Although some of these symptoms also occur in people with normal (as opposed to complicated) grief, in people with complicated grief these symptoms are very intense and persist for at least six months to the point of functional impairment," Dr Paul Boelen, a psychologist and psychotherapist from Utrecht University in The Netherlands said.

Who is most at risk for complicated grief? General bereavement research has indicated that people confronted with deaths that are violent (due to suicide, homicide, accidents) and that are untimely (loss of child) have greater risks of getting stuck in the process of mourning than people confronted with other losses, according to Dr Boelen.

"Moreover, personality styles such as insecure attachment and high neuroticism have been found to be risk factors," he said. Negative thinking and particular types of avoidance behaviors (i.e., suppressing thoughts and emotions about the loss, and failing to adapt ones every day life) also put people at risk for ‘complicated grief’.

In our society there is a strong avoidance of death – of dealing with it, talking about it and accepting it. This is paradoxical as it is the only event in life that we can’t avoid. Allowing our selves to experience deeply and fully, and not avoid, the vast range and depth of emotions that can overwhelm is possibly the most valuable way to deal with grief and move through the acute suffering.


References
Boelen, P. (2006). Clinical Psychology: Science and Practice, Summer.
Kubler-Ross E (1969). On Death And Dying. Touchstone Publications, US.

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