An Overview of Grief
Today I want to talk about a very important topic: grief. Now this is a heavy topic that may be uncomfortable or distressing for some readers, so please take breaks or take space if you need to. Talking about these topics has traditionally been considered taboo for a long time in our society, and in many ways it still is, but I want to challenge that today by having an open and curious conversation about what grief is, debunk some common myths and misconceptions, and share some thoughts on how to support people who are grieving. Because, frankly, we haven’t done a very good job of it so far as a society.
What is Grief?
When I say the word grief, many of you will think of death. Of someone you know or care about dying or that has died. Grief is absolutely connected to death and dying, but it is not only connection to the death of a person. Grief is the embodied reaction of loss. There are many different ways someone can experience loss, such as loss of income, home, job, pet, relationship, community, safety or security, identity, purpose. Grief can be about you or about someone or something else, or a mix of both.
There is ambiguous grief, which is the sadness or feeling of loss unrelated to another individual's death, typically emotional loss or connection. There’s traumatic grief, which is a combination of experiencing both a trauma and grief after an event that is sudden, violent or unexpected. Anticipatory grief is when a person is expecting a death, such as when a loved one or person is diagnosed with Alzheimer’s or enters palliative or hospice care. This experience can come with anxiety, feelings of hopelessness, anger and frustration, sadness, and at times the conflicting emotions of hope and gratitude at the time still remaining to the person. There’s also delayed grief, which describes the experience of a significant amount of time passing after the loss occurs before a person experiences grief.
Grief as a response to each of these losses is just as real, complex, unique, and valid as grief related to death and dying. There is no one way to grieve. Grief in all its forms can involve physical symptoms (such as insomnia, fatigue, loss of appetite & weight loss), mental and emotional symptoms (such as depression, anxiety, nightmares and flashbacks, intrusive thoughts, and difficulty concentrating), spiritual symptoms (such as challenges with or to religious beliefs or faith, difficulty engaging in spiritual practices), and behavioural symptoms (such as isolation, avoidance, and lack of previously-enjoyed activities/hobbies [again, clinically referred to as anhedonia], and difficulty with tasks and acts of daily life). It is important to note that just because a person is experiencing or struggling with these symptoms, it doesn’t mean that they are experiencing what we call Complicated Grief requiring specialized support, such as grief counselling. As Dr. Susan Cadell points out, all grief is complex, but not all grief is Complicated Grief in the clinical sense, meaning that we need to be careful of pathologizing natural and expected effects of a difficult experience.
The “5 Stages of Grief”
Yet that’s not really how we talk about grief, is it? Instead, we often hear grief discussed in terms of stages. Specifically, the 5 stages of grief. The 5 Stages of Grief was a model originally put forward by Elisabeth Kübler-Ross in her seminal book On Death and Dying. These stages are denial, anger, bargaining, depression, and acceptance. Denial can look like someone denying the diagnosis, attributing it to a failure of the medical system or a person, or simply avoiding the idea altogether. Anger can manifest as either directed towards someone or a general worsened temper. Bargaining often manifests as the search for regaining control, and these “deals” often involve the medical system, others, or religion; so, for example, a Christian might agree to pray more frequently and live by the Ten Commandments in order for their God to grant them improved symptoms or a longer life. Depression is as it sounds and includes low mood, lack of energy or motivation, and a loss of enjoyment in previously-enjoyed activities (otherwise known clinically as anhedonia). Acceptance is when a person recognizes the reality of their situation, and can often be seen in people who focus on making the most out of their remaining time and making the necessary end-of-life and after-death arrangements.
These stages are often discussed in linear terms, or sequentially, as though you work through each stage in order or one at a time in order to reach the next stage. The goal in this model that we often hear talked about is acceptance, the final stage. Many of us have heard of some of these stages or this model, have maybe used it ourselves as a way to understand ourselves or someone else. But… we’ve been using it wrong all along. Because Kubler-Ross actually intended the 5 Stages of Grief model for the experiences of people who have learned that they themselves are dying. Not someone who is grieving someone else. It certainly wasn’t intended for grief for loss unrelated to death or dying. This model is also a little bit problematic because it can be isolating for people if it does not explain your experience. It also does not reflect the complex nature of grief. In my opinion, it kind of individualizes grief, when the truth is that everyone experiencing grief and loss benefit from a supportive community. And what I mean by that is that the stages model suggests that the person grieving has to work through specific processes on their own in order to heal. It doesn’t leave much room to explore external factors, both that can support healing and that can worsen grief. There is power in a society that is supportive and grief literate, or better understanding of grief.
Contrary to how many people discuss grief, particularly with the incorrect use of the stages model, grief is not linear. There is not a “correct” amount of time to grief and no “correct” way to grieve. There are no steps you work through in chronological order until you achieve “acceptance” and “move on” for good. And if you could see me, there were a lot of air quotes in that. There is no formula for grief. We tend to pathologize mental health and how a person copes with something challenging, and we see this all-too-often with grief specifically. We also often tend to perpetuate a hierarchy for grief, listing some losses as worse than others, which then leads to judgements on how long and intensely a person is grieving based on where their loss sits in the hierarchy. I argue that there is no hierarchy to grief. Your grief is valid no matter what kind of loss it is. End of story.
But how can we be more sensitive and supportive to people who are grieving?
Continuing Bonds
One model of grief that may be more helpful to think about is the Continuing Bonds Model as put forward by Klass, Silverman, and Nickman in 1996, which is really about the idea that rather than having to “move on” without the person who has died, which is how we have traditionally thought of grief and bereavement, grief can be a process of learning how to navigate a new connection and relationship with the person after death. And I know I’ve talked about other forms of loss, so this model is more death-centric, but I think there’s still things that can be taken from it and put into other loss areas. Continuing Bonds has four key pillars, which are that it:
Acknowledges that grief is ongoing. Right, so like I said, it’s not linear. There isn’t a step-by-step to an end point, but you can really flow between emotions and experiences and challenges.
It's normal to stay connected with the person who has died
Continuing Bonds may describe many of your grief-related behaviors (holding items that are sentimental and significant, daily habits, private rituals)
Not only are these behaviors normal, but they may help you cope with grief
Otherwise, one of the most practical tips you can do as a person or professional to be supportive to someone grieving is to ask. Ask the person how they are doing, what they need, how you can support them. Provide a space to share stories about the person who has died or the loss they have experienced, about their grief, without judgement for how they are grieving. Many people feel uncomfortable and intentionally don’t ask someone about their loss, as they do not want to upset, trigger, or anger the person grieving. Yet people who are grieving are often waiting to be asked, to be given permission. So ask: if they don’t want to discuss it, they can decline the offer, but you have verbal confirmation that this is a safe space to share their story and that in itself is important.
Grief is often lifelong, so don’t be afraid to check in months and years later. We often receive a flood of support in the days and weeks that follow a loss, but the casseroles and inquiries quickly disappear as time goes by. Yet the grief is still real, still valid, and still impacting the person. That’s also why it’s so important for us to always be mindful. We don’t always know when someone is grieving or what a person is going through. We need to do better as a society, particularly in workplaces, of being compassionate, empathetic, and patient with people. Just because your job gives you three days off for “bereavement days” does not mean you are magically recovered in those three days. Honestly, I could go on for ages about why 3 days is difficult and a problem and nowhere near sufficient.
STUG Reactions
One example of lifelong grief is a phenomenon called STUG, which is short for a Sudden Temporary Upsurge of Grief. S-T-U-G. STUG reactions in grief are “an intense and unexpected wave of grief that arises in a person who has experienced the death of a loved one and who is grieving that loss.” Although the theory was again created to describe grief for death-related loss, it’s easily transferable to other forms of loss, too, in my opinion. STUG reactions can arise from environmental triggers, such as hearing a phrase commonly used by the person who died or entering the neighbourhood where you used to live, or other external factors, such as an anniversary of an important date or someone’s birthday. These can, and often do, occur years after a loss and can take people by surprise.
I’ll give you a personal example: recently I visited my family in England. As soon as I entered my aunt’s house, it evoked a memory of a prior visit when I was a child to attend the funeral of my other aunt, actually her sister. It wasn’t something I had thought of in years or really would say I’ve experienced grief in a very long time. But now the grief now brought tears to my eyes and it really threw me for a minute. And then I remembered learning about STUG in my grief and palliave care course in my Master’s and it really helped having a name for that kind of experience. So I hope that learning about it today can help others gain some comfort from understanding their experiences are valid. And also, if we know that these reactions are valid and common, it can maybe help us be more mindful to be offering that support and being mindful of the ways that grief might impact someone months or years later when we don’t realize it.
Supporting Grief
Another way that you can support someone (or yourself) who is grieving is by providing resources. Our healthcare system, particularly our mental health system, is difficult to navigate and you may not know who and what is out there to support people experiencing loss, grief, and bereavement. And that’s okay. Because of the taboo in our society, I think people also don’t know who is comfortable talking about death or loss, or who might be safe to turn to. After listening to this podcast, I hope that you’ll be added to that safe list, but it’s important not to forget that sometimes people do need more specialized support or formal support with their grief. That is normal, valid, and okay, too.
So, who can people turn to? Many people who are looking for more support with grief have found Grief Counselling with a social worker, psychotherapist, psychiatrist, or psychologist to be a helpful tool in understanding their experience and healing. A great resource for finding the right practitioner for you from this list is on Psychology Today. There are also counsellors and coaches who may be helpful, too, as well as death doulas, which assist in the dying process, much like a midwife or doula does with the birthing process. [clears throat] Peer support groups, both in person and online, can help connect you to others who have similar experiences. Finally, there are many online resources, such as Virtual Hospice and personal blogs or vlogs, that share stories and important information that can help you make sense of your experience.
Grief and Growth
Now, we’ve been spent a lot of time talking about a really difficult subject. If you’re still here, I’m glad you have sat with this discomfort to learn more about grief and what you can do to become more grief literate and supportive. I want to end this podcast today, though, by raising an idea that you might think sounds a little odd or insensitive when you first hear it, but I hope that you’ll stick with me on this one. While there are undeniably challenges and negative experiences that come with grief and loss, grief and loss can also have positive impacts and implications, too. Grief can remind us that time is short, and prompt us to evaluate ourselves, our lives, our goals and behaviours. Many people have expressed gratitude at receiving a diagnosis of a lifelong or terminal illness, describing the ways that this has enabled them to life their life to the fullest or connect deeper to their loved ones. Collective grief can also bring people together, and promote activism and positive change. I have definitely experienced this myself. Growing up with a father with a progressive, terminal illness really changes your perspective on life. At least, it did for me. I try not to take the future for granted and to say "yes" to as much as possible, even when my doubts or anxiety are like "girl, really?!" And the relationship with my dad (and in fact, the way I approach all of my relationships now) is stronger than ever, because we are both very intentional and appreciative about our time together, given how limited it might be. I also regularly get involved in advocacy for changes to our healthcare, economic, and employment systems based on our experiences.
I hope today’s blog showed you that it’s okay to talk about grief and provided you with some better ways to do so. Grief is understandably uncomfortable to talk about, because it makes us consider difficult experiences, our fears, even our own mortality and that of people we care about. But ignoring it won’t make it go away or prevent it. Grief is something that will touch literally everyone’s lives at some point, and I hope that we can strive for being more supportive to ourselves and to each other. We need to work on de-stigmatizing grief and moving away from the idea of it being “taboo” or “too morbid” to openly discuss. Share your stories, take up space, connect with others. I promise you it is better than suffering in silence.
