1. Recovering from Loss & Grief
Dr Timothy Dunne
Consultant Clinical Psychologist
Public Lecture delivered on behalf of Kilkenny Bereavement Support Group
Wednesday 10th September 2014 ©
(c) Dr Tim Dunne

2. Outline Introduction Definition of terms Models of Grief
Grief & Complex Grief
Grief & Loss
Mourning
Myths about Grief
Suicidal Ideation
Healing & Recovery
(c) Dr Tim Dunne

3. Terms Grief = Emotion – the natural reaction to Loss Loss = Experience
Mourning = Process of adaptation to the Loss
Bereavement = Social & Cultural Processes
Complex Grief = Any Loss which is accompanied by obstacles to psychological healing
(c) Dr Tim Dunne

4. Loss
Loss without death (eg) job, health, marriage, relationships, home, youth, being childless, emigration, financial,
Rarely a single Loss – with every loss there are Secondary Losses and all of these Secondary Losses have to be mourned (eg) spouse/partner
“In every loss there is a trauma and in every trauma there is a loss” (Rando , 1990)
Loss can also provide opportunities for growth over time
(c) Dr Tim Dunne

5. Shakespeare
“Give sorrow words, the grief that does not speak Whispers the o’er fraught heart, and bids it break”
(c) Dr Tim Dunne

6. Grief
Process with psychological, behavioural, social & physical aspects
Concerned with pain, sadness & suffering
Grief is the necessary first part of Mourning (ie) recognizing the Loss
Without Grief there can be no Mourning but Mourning is much more than Grief
(c) Dr Tim Dunne

7. Mourning Process of adaptation to the Loss
Iterative Process – old Losses can get recycled on top of the new Loss
The person has to build a new identity not return to the old identity – the “old identity” is destroyed by the Loss
Life is divided into “before the Loss” and “after the Loss”
As in Trauma, assumptions about Life, God and the world are violated
Mourning is not a state but a process
(c) Dr Tim Dunne

8. Successful Mourning
Reaffirmation of the Loved One in a new way – a new relationship with the deceased
Reconstruction of the inner world – which means a new self
Renewal of turning outward – a new relationship with the world & re-engagement
(c) Dr Tim Dunne

9. Simple / Complex Grief
No clear cut boundary between normal/simple and Complex Grief
Death of a Child – any age & any stage of life (eg) stillborn, miscarriage, infant, school-age, Adult Child
Natural causes V Man made (murder/suicide)
Natural disaster V Man made (train/plane crash)
Sudden death V Gradual decline
If the death is perceived as preventable
Ambivalent Loss – where there are no Remains to bury
(c) Dr Tim Dunne

10. Losses Permanent physical injury or disability
Any change in health status (eg) diagnosis of long term condition such as diabetes, cancer
Any major Life Event, even positive ones such as house move, new job, marriage & divorce, emigration
Ageing & retirement
Financial losses & reduced standard of living
(c) Dr Tim Dunne

11. Models of Grief Kubler – Ross (1969) Warden (2000)
Dual Process model (2010)
(c) Dr Tim Dunne

12. Kubler-Ross’ Model Shock/Denial Anger Bargaining Depression Acceptance
(c) Dr Tim Dunne

13. Some Difficulties
The model was first used to describe stages in acceptance in the dying not in the bereaved
Not everyone goes through every stage
The stages are iterative rather than progressive
“Is” can become “ought”
Too prescriptive, rigid and passive
(c) Dr Tim Dunne

14. Warden’s Tasks of Mourning model
To accept the reality of the loss
To experience and process the pain of grief
To adjust to life without the loved one
To relocate the dead person emotionally and find an enduring connection with him/her & embark on a new life
(c) Dr Tim Dunne

15. Some difficulties Perhaps too prescriptive also
Can appear to minimize the individual experience of grief
Fails to recognize that the powerful nature of grief which may only be handled in manageable chunks
People can get “stuck” on a particular task or stage
(c) Dr Tim Dunne

16. Dual Process model (DPM) of Grief (Stroebe & Shear, 2010)
Based on concept of “Oscillation” whereby the bereaved person confronts the loss at times and at other times avoids it
The person “swings” between facing the loss and restoration or rebuilding their life
“Time out” is an essential feature of this model as continuously facing grief is “arduous & exhausting” – “defensive exclusion” is vital at times
This model takes account of other stressors in the person’s life such as bringing up children or financial pressures
(c) Dr Tim Dunne

17. Three Phases of Mourning
“Shock, numbness and a sense of disbelief” – “This can’t be happening! No, It cannot be!”
Sometimes people might weep and wail or be completely still and silent;
Perhaps waves of grief will alternate between times of stunned incomprehension
(c) Dr Tim Dunne

18. Three Phases of Mourning
(2) Phase of intense psychic pain Period of lamentation & weeping Emotional swings and physical complaints Lethargy, hyperactivity, regression, anxiety, helplessness, hopelessness & despair Guilty feelings over what was said/wasn’t said; done/not done “I should have been more understanding”; “I Should have visited /called more often when s/he was alive” etc And now its too late!
(c) Dr Tim Dunne

19. Three Phases of Mourning
(2) We feel guilt about our failures towards the person and also about any negative feelings we might have had or still have towards them Three processes here : Idealization – “S/he was a saint” Canonizing Mummification – Queen Victoria
(c) Dr Tim Dunne

20. Three Phases of Mourning
(2) We are aware that death has taken place but there is an intense yearning for the loved one which may be accompanied by a disbelief that it has occurred leading to an urge for searching for the loved one – This may express itself in restless, random activity We hear their step in the hallway, their key in the door, see a stranger in the street & follow them for a while until we see the stranger’s face….
(c) Dr Tim Dunne

21. Three Phases of Mourning
(2) In this acute phase some will mourn quietly, some will be very vocal but we will all pass through the terror, tears, anger and guilt, anxiety and despair Iterative process Not linear Spiral staircase metaphor (CS Lewis) of sorrow doubling back on itself
(c) Dr Tim Dunne

22. Three Phases of Mourning
(3) Completion of Mourning – some degree of recovery, acceptance and adaptation to life without the Loved One Its not about making the best of a bad situation but in a very real sense, creative change Internalization – by making the dead person part of our inner world we can at last let them go but never lose them Letting go is not about forgetting the Loved One
(c) Dr Tim Dunne

23. Cultural Assumptions
Our Western culture (and helping professions) have arrived at a “common wisdom” that it is generally healthy to focus on pain of grief and distress and to express it openly
Suppression of same is thought to be unhealthy & not to be encouraged (“stiff upper lip”)
However, research (White, 2013) does not support this “common wisdom”
(c) Dr Tim Dunne

24. Cultural Assumptions
In addition to the need to face grief & pain there is also a natural tendency to avoid the reality of death
This should be factored in to any intervention process
Avoidance can have a valuable protective effect for someone struggling to make sense of an overwhelming loss
This is now standard procedure in Trauma treatment (ie) a “titration” approach
(c) Dr Tim Dunne

25. Cultural Processes Irish Wake/ Month’s Mind
Used to have outward signs/symbols such as wearing black for a certain period or diamond on a jacket sleeve
Jewish Shivah (7 days); Shloshim (30 days) and Shneim asar Chodesh (12 months)
Most people underestimate how long it takes to fully get over the death of a loved one
(c) Dr Tim Dunne

26. “The Deal”
In complex or traumatic grief the person may often, unconsciously, make a deal with the loved one which goes like this:
“I will continue to suffer pain and loss in order to prove my love for you because if I don’t feel this pain, it means I don’t love you or if I let go of my grief it means I have forgotten you”
The same can occur with self-blame especially if the survivor believes that they somehow are responsible for the death of the loved one
(c) Dr Tim Dunne

27. Complex Grief Long lasting
Intrusive images or thoughts of the loved one
Pre-occupation with the deceased
Social withdrawal & detachment
Pining or yearning for the deceased
Have trouble accepting the death
Inability to trust others
Excessive bitterness
Prolonged feeling that life is empty & meaningless
“This will not be healed by the passage of time. I will never get over it”
Coping magnificently and carrying on as if nothing has happened and “taking it very well” when in fact, we can’t take it
We fear that once we start weeping, we will never stop or fear a breakdown and go insane or that our grief, if we really showed it, would overwhelm those around us
We may be tense & short-tempered; formal or wooden; forcibly cheerful; withdrawn; physical symptoms or insomnia
(c) Dr Tim Dunne

28. Complex Grief
“Its all a rotten hoax, this life of ours.. Why attach yourself only to have your beloved ripped from you? Better not to give yourself to anything”
“Some days I gave at her picture and the image revives me. Other days, I gaze at her and I am blinded with tears…utterly bereft”
“Bit by bit I re-enter the world…a new phase, a new body…its like a slow recovery from a sickness this recovery of one’s self”
(c) Dr Tim Dunne

29. Myths of Mourning Grief declines steadily over time
All deaths and losses produce the same type of grief reaction
The intensity of emotions experienced and the length of time spent grieving is testimony to how much love there was for the deceased
Grief & Loss are only about death
Time heals all wounds
(c) Dr Tim Dunne

30. Myths of Mourning
If you are not sad 24 hours a day, this proves that you didn’t love him/her
If you still cry about it after many years, it means you did not process it properly
To be healthy after a death of a loved one you have to put that person out of your head
Letting go means forgetting about the person
(c) Dr Tim Dunne

31. Myths of Mourning
You should only cry over the death of a loved one not other losses – “Nobody died”
If you still cry after many years it means you are crazy and you will be locked up in a psychiatric hospital
Stiff Upper Lip is best – “Just get on with it”
All you need is to express your feelings and you will feel better
(c) Dr Tim Dunne

32. Suicidal Ideation
Suicidal ideation or wanting to die occurs in up to 65% of those bereaved
Complex grief produces 5 times as many suicidal thoughts
Some people see suicide as a way of gaining control over the pain
Sometimes people put themselves at risk or neglect themselves or act with less concern for themselves or in a way which increases the likelihood of accidents or death
(c) Dr Tim Dunne

33. Thoughts & Beliefs I didn’t do enough for her
He died without knowing how much I loved him
I cant stand not knowing if he suffered pain
It was unfair how she died
I don’t know if he is at peace
Its not right for me to enjoy life without her
(c) Dr Tim Dunne

34. Healing & Letting go Not everyone needs Bereavement Counselling!
Social support is important – find one person who you can talk to without embarrassment and who is a good listener
Compassion for yourself is also important
Anniversaries, birthdays, weddings, Christmas are all occasions which can trigger strong emotions of sadness & loss
(c) Dr Tim Dunne

35. Healing & Letting go How has life changed since your loss?
What never happens now as a result of the loss?
What do you miss most about your life since the loss?
What do others comment on since your loss?
What has surprised you most about your thoughts & feelings?
How has this impacted on your view of yourself, others, relationships, life or the world in general?
(c) Dr Tim Dunne

36. Healing & Letting go 5 Ps Presence – I’ll be there for you
Permission – Its OK
Patience – I can take the time you need
Predictability – You can count on me
Perseverance – I’ll stay as long as you need me
(c) Dr Tim Dunne

37. Healing & Letting go
If you feel that it is taking you a long time to recover, then consider seeking professional help
Use your memories and memorabilia of the loved one to support yourself
Create a lasting memorial to the loved one such as planting a tree, make a donation or start your own charity/fundraising
Choose a significant picture/image and have it commissioned by a professional artist
(c) Dr Tim Dunne

38. Final Thoughts
“ And so perhaps the only choice we have is to choose what to do with our dead: To die when they die. To live crippled. Or to forge, out of pain and memory, new adaptations…..through mourning we let the dead go and take them in. Through mourning we come to accept the difficult changes that loss brings – and then we begin to come to the end of mourning” – Viorst (2002)
(c) Dr Tim Dunne

39. References Kushner, H (2010) When bad things happen to good people
Warden, P (2000) Tasks of Mourning
White, C (2013) Living with Complicated Grief
Viorst, J (2002) Necessary Losses
(c) Dr Tim Dunne