Grief and Mental Health

Grief is defined as a "deep and poignant distress caused by or as if by bereavement" or "an emotion of great sadness associated with loss or bereavement at which causes of such suffering". There are many forms of grief that can come and go across the entirety of the human lifespan, such as loss of a loved one, abandonment from a close friend or family member, and relationship terminations. The main theme is that grief is related to the loss of an important person or attachment in one's life. There are also three main types of grief that typically manifest as the following: anticipatory grief, normal grief, and complicated grief.

Anticipatory grief refers to the process of anticipating real losses that are associated with diagnoses, acute and chronic illnesses, and terminal illness of either oneself or significant others. Similar to the main forms of grief, these losses may include health, independence, a major role, functionality, dignity, body parts, or life. Normal grief is what the majority of individuals experience when they typically experience grief, such as the "normal" feelings, reactions, and behaviors that are expected after a loss. As with all forms of grief, these experiences can be physical, psychological, spiritual, cognitive, and behavioral. Lastly, complicated grief encompasses chronic grief, delayed grief, exaggerated grief, or masked grief. Chronic grief consists of similar "normal" grief reactions, but these reactions do not subside or minimize and continue for much longer periods of time that are typically expected. Delayed grief, on the other hand, refers to emotional responses to loss that happen after a lot of time has passed since the initial loss, where the individual has usually either consciously or unconsciously avoided the pain in the first place. The next type of chronic grief is exaggerated grief when the individual engages in self-destructive behaviors, such as impulsivity, self-harming, or suicide. Masked grief is when the individual is clearly experiencing difficulties in daily function, but the individual is not cognizant of the fact these challenges are due to a recent loss. Although all forms of grief are important to understand in order to help any individual going through the grieving process, complicated grief posses the greatest challenge in the mental health field as it is typically associated with significant loss and trauma.

The study of grief, specifically the symptomatically and the management of acute grief dates back to the beginning of the field of psychosomatic medicine. Erich Lindemann is one of the most notable psychologists that was known for his research on grief, especially following his major study in 1944 that focused on the grieving family members of the 492 people killed in the Boston nightclub, Coconut Grove Fire. Lindemann focused on the systematic descriptions of medical and psychological responses to the death of a loved one and investigated medical outcomes following loss, the psychological predictors associated to the loss, as well as the biopsychosocial mechanisms. In addition to Lindemann's contributions to the field of grief studies, there are a handful of other prominent theories surrounding the idea of grief.

Sigmund Freud's famous paper on "Mourning & Melancholia: clinical focus on grief" provides a great example of a unique approach to understanding grief. He primarily discusses the concept of mourning as an inherently typical reaction to the loss of a loved person and proclaiming that the psychological purpose of grief is to withdraw emotional energy from the deceased and to become detached from the loved one regardless of how painful it may be. Freud called this "grief work" and believe that some people experience grief differently and more intensely and this heavy burden could lead to melancholia. Another significant theorist was John Bowlby, who is mostly known for his models of attachment. Bowlby believed grief endured a specific phase model, emphasizing its relationship to the functions of attachment and accentuating the idea that grieving is a process of yearning or searching for the person lost. Even further, Bowlby described the normative process of grief in children responding to prolonged separation or loss is similar to the experiences adult endure in traumatic grief. He eventually complied these grieving behaviors into four stages of grief, shock and numbness, yearning and searching, despair and depression, recovery and restitution.

In her 1969 book *On Death and Dying,* Dr. Elisabeth Kübler-Ross discusses her work with terminally ill individuals and their journey of acceptance regarding their impending death. Through this work, the Swiss-American psychiatrist developed what is now known as the Five Stages of Grief, or the Kübler-Ross model. Although the model was later adapted by grief expert, David Kessler, to apply to tragedy and grief as well, her original model consists of five stages that do not necessarily occur in any particular order. According to Kübler-Ross, these stages include denial, anger, bargaining, depression, and acceptance. Due to all of this research on the importance of grief and the way it impacts the majority of humans, there have been many studies conducted looking at the way people grieve and the impacts when they endure persistent levels of complicated grief and trauma.

There have been recent developments in the field of psychology including the DSM inclusion of 'complicated grief' (CG) as an official diagnosis as well as the proposal of 'persistent complex bereavement disorder' as an official psychiatric disorder. Additionally, there has been more research on the best approaches to working with individuals who have experienced either of these disorders or aspects of grief and most notably, the most efficacious forms of treatment include cognitive behavioral therapy, dialectical behavioral therapy, and exposure therapy. Furthermore, Rollo May states that “to grasp what it means to exist, one needs to grasp the fact that he might not exist...”, which highlights the inevitability of death and loss and therefore, demonstrates the important necessity of the ongoing study of grief as it pertains to the well-being of all humans.

1. ↑ Merriam-Webster. (n.d.). Grief. In *Merriam-Webster.com dictionary*. Retrieved May 5, 2022, from https://www.merriam-webster.com/dictionary/grief
2. ↑ 2.0 2.1 2.2 Petruzzi, Jimmy. (2019). The Different Forms and Reactions of Grief and Bereavement.
3. ↑ Berry, M. (2022). *The 5 Types of Grief: What They Are and What They Feel Like, According to Experts*. Health. Retrieved 6 May 2022, from https://www.health.com/mind-body/types-of-grief.
4. ↑ O’Connor, M. (2019). Grief: A Brief History of Research on How Body, Mind, and Brain Adapt. *Psychosomatic Medicine*, *81*(8), 731-738. https://doi.org/10.1097/psy.0000000000000717
5. ↑ 5.0 5.1 *The Story of the Cocoanut Grove Fire - Boston Fire Historical Society*. Boston Fire Historical Society. (2022). Retrieved 6 May 2022, from https://bostonfirehistory.org/the-story-of-the-cocoanut-grove-fire/.
6. ↑ Freud S. (1917). Mourning and Melancholia. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works, p. 2 37-58
7. ↑ Klass, D. (1988). John Bowlby'S Model of Grief and the Problem of Identification. *OMEGA - Journal Of Death And Dying*, *18*(1), 13-32. https://doi.org/10.2190/63pm-gef7-3p13-473d
8. ↑ Kubler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief

through the five stages of loss. New York ; Toronto: Scribner
9. ↑ 9.0 9.1 9.2 Corr, C. (2020). Elisabeth Kübler-Ross and the Five Stages Model In Selected Social Work Textbooks. *Illness, Crisis &Amp; Loss*, *30*(2), 320-332. https://doi.org/10.1177/1054137320932302
10. ↑ Nakajima, S. (2018). Complicated grief: recent developments in diagnostic criteria and treatment. *Philosophical Transactions Of The Royal Society B: Biological Sciences*, *373*(1754), 20170273. https://doi.org/10.1098/rstb.2017.0273
11. ↑ Machado, S. (2012). Existential Dimensions of Surviving HIV. *Journal Of Humanistic Psychology*, *52*(1), 6-29. https://doi.org/10.1177/0022167810389049