Pomeroy, E., & Garcia, R. (2009). Expected grief experienced in adults. In The grief assessment and intervention workbook: A strengths perspective (pp. 49-55). Cengage Learning.
Overview of Expected Grief
As stated in the basic tenets of the strengths-based framework of grief in Chapter 1, grief in response to the death of a loved one is a natural, expectable, and health-producing process that aids the individual in adjusting to the absence of the loved one. We will use the term “expected” grief to describe the predictable grief experience that reflects the healthy process of separation from the deceased individual. Although it can take on a wide variety of forms, this type of grief is what we would “expect” to see with someone who has lost a loved one. Expected grief leads to health producing growth.
Although grief interjects a temporary yet major disruption in well-being and life functioning, it is a universal response to the loss of a loved one. Virtually every adult will experience some form of grief in his lifetime. Although grief clearly creates tumult in one’s life for a period of time, it is a process that propels mourners to alter his/her life and potentially grow in response to the loss. This health producing quality of grief encourages a person to struggle with the new reality—one without his/her loved one—and transition to a new way of living. For some, grief is solely an experience of endurance and survival. Grief can, however, result in positive life changes such as greater self-awareness and self-efficacy, improved personal relationships, and renewed appreciation for life. Regardless of the outcome, the process of grief is about being human and is a predictable reaction to loss.
The symptoms, emotions, and behaviors associated with expected grief reactions represent a process of healthy adaptation and are not inherently pathological. Although his grief reaction may be expected, it is not unusual for a client to express worries about “going crazy” or “losing my mind.” In fact, most clients experiencing symptoms of grief are highly distracted and dysfunctional for a period of time. Individuals with expected or “normal” grief reactions often feel relief upon learning that they are not abnormal because of their responses. Thus, an important role for you, as the practitioner, is to educate clients about the nature of expected grief and assist them to cope with the changes and the fluctuations in emotions that the loss introduces into their lives. Although focusing on ways to cope with grief is important, you should not attempt to dissipate the responses to grief. Rather, the counsellor provides the opportunity for the client to safely navigate through the unknown territory of loss with a trusted helper.
The Impact of Expected Grief
Expected grief can affect a person in a wide variety of ways. For some people, grief is an all-encompassing experience that impacts their entire life for a period of time. For others, grief may disrupt specific areas of individual functioning while not affecting other areas of functioning. Some areas of functioning that are commonly impacted by grief are cognitive, emotional, behavioral, physical, social/cultural, and spiritual.
Complex grief, on the other hand, can lead to a life-depleting experience as compared to expected grief due to the variety of psychosocial factors that impinge on the expected grief process or the inability of the mourner to marshal health-producing responses and coping strategies. Complex grief will be discussed in detail in Chapter 4.
Expected Grief and Cognitive Functioning
Grieving clients commonly report significant disruption in their cognitive functioning at the onset of grief. Cognitive disruptions may present as forgetfulness, disorientation, difficulty concentrating, distractibility, preoccupation, impaired judgment, and distortions in reality testing Stroebe, Hansson, Stroebe, Schut, 2001). Some clients state that they feel as if they are in a “fog” or “brain dead.” They also report problems with thinking clearly and making decisions. These symptoms often result in frustration because they impair the client’s ability to work, read and accomplish tasks. For example, one female client described great difficulty finding her counsellor’s office despite the fact that she was familiar with the location. Another client, whose daily routine included reading the newspaper, stated that it took great effort for him to finish reading just one article. These types of reactions are characteristic of the initial onset of grief and may serve to protect the individual as he adjusts to the reality of the loss. Some clients actually appear to be in a state of “shock” or on “auto pilot” and display difficulty expressing their thoughts. Frequently clients hesitantly report visual or auditory perceptions of the deceased. Dreams in which the person has communication with the deceased are also common. Although changes in cognition can be alarming to the client, with expected grief, they eventually abate over a period of time (Stroebe, Hansson, Stroebe, & Schut, 2001).
Expected Grief and Emotional Functioning
Society tends to focus primarily on the emotional impact of loss felt by grieving individuals. However, although adults expect to have emotional difficulties following the death of a loved one, they are often surprised by the depth and intensity of their feelings. These feelings may fluctuate throughout the day or week depending on the client’s prior emotional experiences, history with the deceased, circumstances surrounding the death, and current life situation. The very nature of grief suggests that the emotions of the mourner oscillate with varying degrees of strength and force (Stroebe & Schut, 1999. Although the continual and unpredictable change in emotional state may be unsettling for some, this fluctuation of grief-related feelings is one of the life-enhancing aspects of expected grief. It allows the mourner the opportunity to feel the loss while also adapting to it (Stroebe Schut, 2001).
Some of the feelings associated with expected grief include sadness, loneliness, anger, guilt, irritability, periods of numbness, depression, disbelief, relief, regret, anxiety, emptiness, and restlessness. It is not uncommon for someone with an expected grief reaction to feel as if the deceased is “in the room” with him or that he has “seen” the person who died. These hallucinatory experiences should not be misconstrued as evidence of mental illness but rather as manifestations of the emotional strength of expected grief. Because of the unbidden and ever-shifting emotional state of the mourner, individuals often report feeling out of control of their emotions. For example, a woman complained that she had to leave work early due to an irrepressible surge of tears that caught her off-guard and caused her fellow workers to be concerned for her. She explained that she not only felt embarrassed but worried that it would happen again and that she wouldn’t be able to control her feelings. Emotional upsurges are characteristic of expected grief reactions and need to be normalized for the mourning individual.
One thing that can be disconcerting to others is the fact that individuals may become angry, irritable, and overly sensitive during an expected grief reaction. They may push other people away and not want to engage in social activities or conversation. Often, persons in bereavement will explode in anger or crumble in despair over mild irritations. Their response is out of proportion to the actual circumstances. You should be aware that although these are common reactions of expected grief, they can elicit damaging social and occupational consequences.
Expected Grief and Behavioral Functioning
People in mourning engage in a wide variety of behaviors due to the loss of a loved one (Stroebe, Hansson, Stroebe, Schut, 2001; Worden, 1991). Some people behave quite differently than they did before the loss, whereas others exhibit an exacerbation of their usual behaviors. For example, a normally outgoing and active man might become withdrawn and reclusive after the death of his daughter. A husband who normally spent 8 hours a day at work before his wife died may spend 12 to 15 hours a day working after her death. With expected grief, these changes are temporary and eventually the individual’s behavior reverts to a more functional state.
Because feelings and behaviors are inextricably tied together, when a person’s feelings are in turmoil, this behavior can also be erratic and unstable. For example, when a person is experiencing overwhelming sadness and loneliness, he may have difficulty socializing with others, become isolated and withdrawn, and feel unable to accomplish daily tasks. With expected grief reactions, a person’s behavior will reflect his attempt to cope with the grief experience. As a reflection of his emotional state, an individual’s behaviors exist on a continuum from life-enhancing to life-depleting and can either help or hinder the adaptation process. You, as the practitioner, need to be able to distinguish between life-enhancing and life-depleting behaviors and encourage and support strengths-based coping mechanisms. In addition, you can assist the individual in modifying life-depleting behaviors (see A Strengths-Based Framework of Grief and Loss in Chapter 1).
Life-enhancing behaviors are those activities that nourish and promote healing within the mourner. These behaviors have health-promoting benefits and cause no harm to self or others. Life-depleting behaviors, on the other hand, may have damaging consequences to the mourner or others. These behaviors stifle the grief process by directing energy into unhealthy and unproductive activities.
The following table provides some examples of life-enhancing and life-depleting behaviors. At any given time during the process of grief some of these behaviors may be life-enhancing at one point and life-depleting at another time. For example, crying may be a healthy release of emotions for some individuals but endless and excessive crying may exhaust the person and prevent him from carrying out daily and necessary tasks. In this case, you may need to assist him in finding other tools for managing the sadness that comes with expected grief. This doesn’t mean that the practitioner is telling the client not to cry or that crying is inappropriate. The practitioner, rather, recognizes that excessive crying can drain him of needed energy for daily living and can deplete him of inner resources. Therefore, an understanding of the subtle complexities of grief and its expression is an important component of counselling bereaved individuals.
Expected Grief and Physical Functioning
Many mourners complain of physical changes or ailments during bereavement. It is as if we are “hardwired” to grieve with the repercussions of the loss manifesting in our physical being. Physical symptoms vary widely among individuals and different cultural groups. Some of the symptoms that are commonly associated with grief are fatigue, tightness in chest, headaches, stomach aches, insomnia or hypersomnia, increase or decrease in appetite, and a wide variety of aches and pains. In addition, medical conditions that were present prior to the loss may become more severe during the grieving process.
| Life-Enhancing Behaviors | Life-Depleting Behaviors |
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One study suggests that neuroendocrine functioning can be compromised during bereavement (Seeman, Singer, Rowe, Horwitz, & McEwen, 1997). Another study suggests that the competence of the immune system can be heavily impacted following the loss of a loved one (Hall & Irwin, 2001). Finally, sleep disturbance is a common physiological problem that accompanies a grief reaction. In fact, there is evidence that “the strong link between sleep and the immune system suggests that disrupted sleep following bereavement may affect health directly by suppressing the immune system” (Hall & Irwin, 2001, p. 4g4). Therefore, the added discomfort of physical or medical problems can affect a person’s cognitive, emotional, and social functioning as well as their ability to cope with the loss.
An individual who presents with physical complaints must be referred to a medical professional for a thorough assessment and treatment. Following a medical examination, practitioners can often help individuals with physical symptoms that appear to be stress-related, rather than medical in nature. Some individuals in mourning may focus on their physical pain in an attempt to circumvent their emotional distress. With consent of the client, the practitioner collaborates closely with the physician to provide a holistic intervention.
Expected Grief and Social Functioning
During a grief experience, an individual’s social support system, that is, friends, family, coworkers, and neighbors, can be very influential in how well a person is able to cope with the loss and the events that follow. There are a variety of ways in which an individual’s social support system may react to the grief event. From the mourner’s perspective, assistance from others may be welcome in some instances but may be avoided in other circumstances. Some members of a mourner’s support system may attempt to placate the mourner in ways that are insensitive and inappropriate. For example, mourners often report feeling angry and discounted upon hearing clichés about grief such as “He’s in a better place now,” or “You should be happy that she lived a long life.” Such statements and actions reflect little understanding of grief and are often felt as unsupportive by the mourner despite the good intentions with which they were offered. Because grief is highly stigmatized in this society, even close friends of the mourner may feel awkward and ill-equipped to provide support or assistance. Instead, they may avoid the person rationalizing that the friend “just needs some time” or “doesn’t need company right now” When a mourner perceives that his support system does not understand his grief, it is often experienced as a secondary loss, which heightens his feelings of loneliness, helplessness, and despair.
Many people who are grieving experience feelings of self-consciousness, discomfort, and awkwardness while interacting with the people in their lives. Some mourners report that after some perfunctory expressions of sympathy, friends and co-workers begin to avoid them and/or the subject of the death because they don’t know what to do or say. As one woman described, “It is as if I’m wearing a big sign that says ‘Contaminated! Use caution!’”
On the other hand, a strong and active social support system can greatly ameliorate the painful feelings associated with grief (Colon, 2004; Schaefer & Moos, 2001). A bereaved individual may gravitate toward his friends in an effort to bolster his emotions. Friends can ease a mourner’s transition from being attached to the deceased to re-orienting himself to his new and separate existence. Friends and neighbors can provide both tangible and intangible types of assistance. Any support that reduces the stress and strain associated with this major life transition can contribute significantly to the life-enhancing aspects of the grief process. For example, a neighbor might volunteer to mow the yard of a newly widowed neighbor. A close friend may give a grieving spouse a needed break by keeping her children for an evening. Organizations may coordinate the delivery of meals to a family who has lost a loved one. Mourners who are able to accept such offers of support are often able to stabilize their emotions more easily than individuals who feel they have to take a solitary journey through grief.
There are times when persons in grief don’t know how to utilize their friends and neighbors or are reluctant to request their assistance. As practitioners, we can help clients by encouraging them to accept offers of help and identify other untapped sources of support. You can also offer guidance through role-playing with the client. For example, friends often say to a grieving individual, “If there’s ever anything you need, just let me know.” You can work with the client on how to accept such an offer and follow up with a request for assistance. Sometimes, this means the mourner must assertively educate his support system about his particular needs, both practical and psychological.
Expected Grief and Spiritual Functioning
Many people find that there are changes in their spiritual life upon the death of a loved one. Spirituality takes on different forms and meanings for each individual person. Although there are many definitions of spirituality, Levinson (1998) defines spirituality as “activities which renew, lift up, comfort, heal and inspire both ourselves and those with whom we interact.” Another definition refers to spirituality as a personal inner experience that connects one with her essential nature (Sichel & Driscoll, 1999). An individual’s spirituality is distinct from her religious affiliation or theological beliefs, although for some people the two overlap. Due to the diversity of belief systems and spiritual practices, we will be speaking here about spirituality in the broadest sense of the word.
Witnessing or being closely tied to the dying process is for many people a profound and life-altering experience. For some people, this is a spiritual affirmation that validates and strengthens their beliefs. For others, it provokes a disruption in their entire faith system ushering in disillusionment. As a result, some mourners abandon their existing beliefs and find themselves in a spiritual crisis. For still others, this experience prompts a search for life’s meaning and an exploration of their unique spirituality (Becvar, 2001).
When death of a loved one occurs, some people find solace in their faith which acts as a source of comfort and hope. Their faith serves as an internal anchor, grounding their thoughts and emotions and providing some stability during a time when they feel out of control. Often, people use their faith to make sense of their loss. The issues of separation and abandonment can be buffered by a belief system that offers a coherent explanation of death and a paradigm for looking toward the future (Jacobs, 2004).
On the other hand, some people question their faith and have a difficult time adhering to their beliefs. They may feel disappointed and angry when their faith seems insufficient in alleviating their pain. For example, one client stated, “How could God let this happen?” Other individuals may feel that, if only they could believe more fervently in their faith, the pain from their loss would be tolerable. Another client felt alienated from his church due to the insensitive responses of church representatives. In all of these situations, the disconnection from one’s faith is often experienced by the mourner as a secondary loss.
When facing the loss of a loved one, some individuals will find themselves on a quest to ascertain the meaning of their experience and more generally the meaning of life. Existing paradigms, which helped the mourner understand his or her world prior to the loss, are rattled and a process of questioning previous assumptions ensues. New answers and explanations are sought as a way of mitigating the pain and regaining a sense of control.
Counsellors must be keenly aware of their own spiritual make-up and respect the unique belief system of each client. The spiritual questioning and quest for meaning is a common component of the expected grief reaction and clients must be allowed to express their thoughts without censure, judgment or persuasion on the part of the practitioner. Counsellors who have strong spiritual beliefs must be especially mindful of ways in which they may exert a covert bias in favor of their own belief system in their discussions about spirituality with clients. Other practitioners may feel inept at dealing with spiritual issues and should refer clients to spiritual resources and professionals in the community. Given the wide variation in spiritual and religious beliefs, we recommend that students explore specific literature related to this topic.
