If we are suffering from loss, or if we are supporting others through loss, it is helpful to have some idea of  what we can expect as ‘normal’ and what is considered ‘abnormal’. Our last article explored various ways of thinking about grief and how research has conceptualised it as a process. While there are different ways  of grieving and different ideas of whether we go through stages or phases—and if we do what these stages  might be—what are common to all notions are the types of reactions we experience. This article covers  normal and abnormal reactions to loss, while the next focuses largely on depression in the grief process.

Broadly speaking, all human behaviour can be  pigeonholed into one of four categories:

  • our feelings and their expression— Emotional
  • our bodily processes and mechanisms— physiological or physical
  • our thinking and thought processes including memory—cognitive
  • the things that we do—behavioural

Together, these make up the richness of everyday life. We say together because rarely do they occur  independently of each other in the more complex behaviour that is characteristic of humans. When  we walk out our door and feel uplifted by the smell  of freesias on the breeze, we do so only because of the interaction of some or all of these components.  We breathe the scent in deeply, triggering the  receptors in our nose to communicate chemically  and electrically with our brains to help us smell (physical) and recognise the smell (cognitive). The  smell itself triggers memories (cognitive) involving  pleasure and happiness creating in us a positive and  happy mood (emotional). We smile and walk more briskly (behavioural) to our appointment. So are our responses to everyday events created.

Grief—A Unique Experience

When we look at grief, we see that this also brings  about a number of complex responses. Ours will be  unique to us, as not only is our cause of grief unique,  but we ourselves are unique too. Our backgrounds,  age, previous experiences, personality, genetics, and  whether we are male or female—all these factors  contribute. What we notice is that we experience  a cluster of responses which give us our unique  experience. At any one time therefore, we will  exhibit a range of grief responses, many of which are  predictable even though our responses change as the  course of our grief changes. Emotions so obvious in  the first few days or weeks can give way to different  emotional responses in the later months.

Think for a moment of how Scripture portrays  some of David’s grief: his mourning of Bathsheba’s  child (2 Sam 12:15-23), his deep grief at the death of  his closest friend Jonathan (2 Sam 1), and his later  quite different though just as strong response to the  slaying of Absalom (2 Sam 18:33-19:8). Different  again are the example of Ezekiel who loses the “desire  of his eyes” and the exceptional experience of Job.

Grief Responses

Listed below are the more common responses we  may make while grieving. The examples we have  referred to above will provide some basis for seeing  the outworking of some of these.

Emotional Responses: sadness, anger, rage  aggression, panic, feelings of hopelessness and  helplessness, loss of pleasure, irritability, guilt,  anxiety, relief, loneliness, feeling persecuted,  resentment, embarrassment, jealousy, blame,  self-doubt, lowered self-esteem, paranoia, fear,  inappropriate emotional expression (nervous smiles  and laughter), feeling out of control.

Physiological Responses: appetite changes,  weight gain or loss, crying, increase in aches  and pains, shaking or tremor, tightness in the  chest, restlessness, rashes, eczema, stomachache,  shingles, lowered immune response, palpitations,  hair loss, shortness of breath, exhaustion or fatigue,  dizziness, headaches, sleep disturbances.

Cognitive: denial, altered perception of time or reality,  hallucinations (of all senses), recurring or obsessive  thoughts (also sometimes called ruminating), inability  to concentrate, confusion, disconnected thoughts,  errors in judgment, irrationality, rationalising or  intellectualising1, thoughts or fantasies about suicide  (not accompanied by concrete plans or behaviours),  difficulty with memory.

Behavioural: social withdrawal, isolation, or  alternatively over-engaging socially, “searching”  for meaning (enrolling in courses, bargaining with  God, trying different spiritualities), substance use  or abuse, exercise, new projects, rejecting others,  changing appearance, changing house or job,  spending money, establishing rituals.

All these changes to our bodies, our thoughts,  our feelings and our behaviour are the way we react  to our trauma and it’s helpful for the grieving person  and their supports to be mindful of the breadth and  complexity of reactions.

As already mentioned, different people manifest  different clusters of these responses. When we combine this list of symptoms with one or more  of the frameworks outlined in the previous article, then we begin to develop as it were a roadmap of  grief. Because grief is so individual, any model of  grief remains just that, and it cannot represent us  completely. It might though help us to understand  how a normal process of grief might evolve so that we can also understand when normal grief becomes abnormal grief.

It is normal for people to experience the sudden trauma of loss, and then to feel better for a period,  only to then deteriorate and become sad again. In  terms of the process of grief, we usually call this  a shock or numbness period, followed by a period  of emotional upheaval, before we reach a time of  resolution and acceptance. Let’s look at these in turn.

Shock and Trauma

Lasting from a few hours to days or even weeks is this initial period in which we feel shut off from the world, as if suspended in timelessness while the world marches relentlessly on. We typically experience disbelief, shock and numbness, often with waves of distress. On many occasions we can feel aimless, easily upset and agitated. Appetite often changes as does sleep, and our thoughts can become muddled and illogical. Mourning rituals such as arranging for funerals can be a useful form of structure during this time, and other people tend to take some of this burden. Once the mechanical details have come and gone, say two weeks after a bereavement, the numbness can persist. Unfortunately it is usually at this time that social support drops off.

There is a real lesson here for those of us who watch a brother or sister mourn the loss of a loved one. We need to take notice of the fact that the need for care and encouragement is ongoing. Just as any one of us, if we stop to think, finds the support of the members of the ecclesia vital to our spiritual well being—and vice versa—so even more do we need to be sensitive to the new situation that our brother or sister continues to face. “Bear ye one another’s burdens, and so fulfil the law of Christ” (Gal 6:2). The word for “burden” suggests a weight that is too heavy for a person to bear alone. Our Lord has shown us by his perfect example that he is prepared to bear our griefs and carry our sorrows (Isa 53:4). So we may safely place all our burden upon him—“casting all our care upon him, for he careth for you” (1 Pet 5:7)

Reality

At some point the disbelief begins to falter, and the numbness wears off. Other things have continued as normal and now the reality of the loss becomes obvious and real. Some researchers call this time a period of confrontation, and it is during these weeks and months, when the feelings of loss are the most intense, that we are also the most alone while we endeavour to come to grips with the loss and the change it has wrought in our lives.

Here again, we can find solace in the fact that our Lord was, among men, the loneliest of all. “I am full of heaviness: and I looked for some to take pity, but there was none; and for comforters, but I found none” (Psa 69:20). Yet he knew he was not bereft entirely. His Father in heaven watched his grief and felt his sorrow. So he turned to Him and did not find his trust misplaced. Brothers and sisters, as servants of the Lord, must act God’s part in the very practical issues that face our mourning [1] brethren. There must be a standing alongside; a patient sharing of the burden. It is not a matter of merely supplying a temporary distraction, or of ‘telling’ our brother how he must do better, but of listening and accepting the grief which our brother is trying to work through, while taking time to read the word of life together, which we both are equally in need of.

As the day to day reality sinks in and the new situation we find ourselves in becomes starkly obvious, a general pattern emerges which might include one or more of the following: restlessness, lowered mood, fatigue, guilt for the loss or for surviving, anger at or envy of others united with loved ones, sad appearance, difficulty concentrating, social withdrawal, sleep and weight disturbances.

Resolution

When we enter this last period we’ve usually come  to terms with our loss in some way, and we can now  develop a more thorough and grounded acceptance.  This is a gradual process, up to a year or more in  many cases, where we find that the intensity of  our feelings lessens and we gradually adjust to our  new life. This is not to suggest that we might not  experience setbacks and many of the symptoms  of the previous period, but these too diminish in  intensity and frequency. Now, we accept the loss  and can, in modern parlance, “move on”. At this  point, modern theorists would suggest that we have  completed the grieving process. These modern  theoretical models of grief are helpful in giving  us an understanding of this process and what we  might expect to happen, but they fail—and many  readers saw the evidence for themselves in our last  article—in that they seek to capture grief through  the eyes of the world, and thus do not recognise that  in addition to these three stages is a fourth.

True Comfort

Grief, we must remember, is a part of the fabric  of every life and like every other experience, is  designed by God to draw us closer to Him. In Christ  we know that we have true comfort. The reality of  God and of the Kingdom to come enable us to reach  that period of resolution and acceptance. However, as we have stressed, every situation is unique and  so is every individual. It is not possible to demand  that a person immersed in great grief should be  able to “get over” their sorrow, simply because the facts concerning the future are so compelling.  Though the final calmer period depends on their  personal response, we as their brethren and sisters  must be patient and constant in gentle help and  awareness over time, so that we can assist them  to give glory to our Father. God alone knows their  need, but we are ministers on His behalf to turn their grief into positive acknowledgement of His continuing overshadowing care. Such well-known  words as found in 2 Corinthians 1:3–7 can help us  direct our brother’s thoughts into that higher plane  where true and lasting comfort can be found. The Psalmist reminds us that the word of God is our  source of solace (Psalm 119:49–50). These are not platitudes designed to assuage our grief by deluding  us, as popular theology would have us believe, in  heaven-going and other such fables. These are the  words of the living God, who has woven suffering into His plan of salvation for all mankind.

Hence the servant of God must be able to climb  out of his depth of despair and come to his heavenly  Father with renewed thankfulness and praise. He  must allow himself, as it were, to be drawn out of  the ‘grave’ where his thoughts have been centered  and rise to new thoughts of praise and thanks to  the living God, who has given us our life for that  very purpose. The new resolve, however feeble at  times, must be as the Psalmist’s: “The dead praise  not the Lord, neither any that go down into silence.  But we will bless Yahweh from this time forth and  for evermore. Praise Yahweh” (Psalm 115:18).  Unfortunately, while this is our goal in all things, at  times the process of grief can become stuck.

When Grief Lasts Too Long …Or Is Too  Intense

At 76 Mary is a healthy, active woman. Sadly though, she lost her husband to cancer 11 years ago. Every night however, she sets the table for two, cooks for two, and eats her dinner while waiting for her Doug to come home. He never does, and every evening she disposes of the uneaten dinner, reads for a bit in her chair and heads off to bed. She gets Doug’s pyjamas out, puts his slippers where he liked them and leaves a glass of water on the table by his side of the bed. How would you attempt to understand Mary’s actions? Has she adjusted to life without Doug? Is Mary, as we would like her to be, “over it”?

By contrast, Allan is a 45 year old lecturer in business studies. He is happily married with two sons. Four years ago, while reversing down his driveway, Allan drove over his three year old daughter. She died on the way to the hospital. Allan was with her in the ambulance as she died. From the outside looking in, Allan seems to have picked up well, returning to work and having no apparent mood problems. His family does not blame him for what happened, but as he says “they don’t have to live with it”. He still drives, but at work is unable to park in the staff carpark because to get there he must drive over four speed humps. Instead, he parks on the road and walks the rest. Is Allan, as we would like him to be, “over it”? Is what he is doing “normal”? Does the idea of normality have any currency here? How could we have helped?

Magnified and Prolonged Symptoms

Grief is typically viewed as a normal, though intense, form of sadness; some would say passionate sadness. However, grief can at times cause extreme or prolonged problems as the sadness evolves into serious disorders of anxiety and depression. Our last article called this form of grief complicated grief and it is here that depression and anxiety most commonly become severe and persistent. Along with the schizophrenia type disorders, anxiety and depression make up the bulk of referrals to psychiatrists and clinical psychologists. In mild cases of anxiety or depression, only low levels of professional help may be needed, as it is normal to experience some depression and anxiety. It is important to recognize when these are occurring, and when they can become severe and abnormal.2 In short, when these reactions significantly interfere with the everyday functioning of the particular person as we knew them before grief overwhelmed them, and has noticeably been continuing for six months or more after the loss, we could safely say this is unusually long for the reaction to persist. If this occurs, it is an indication that additional help or support is recommended. Usually many physicians will suggest medication or ‘talking therapies’ from as early as two to three months and sometimes earlier, if the level of disruption to one’s life is severe. The most salient characteristics to watch for are magnified and prolonged symptoms.

In the early days after a loss, our bodies respond with a barrage of stress hormones to assist us with the shock of the loss. All of our emotions seem somehow more intense and the pain can seem so breathtaking. Everybody understands that this is normal, and onlookers have no difficulty in understanding the keenness of the response. The majority of people continue to experience grief symptoms for up to two years, but the symptoms change over this time and become less and less intense as time moves on. When however, time has moved on, but the grief response seems as raw and visceral as it was in the first few days, then we could with confidence suggest that something is awry.

Extreme reactions may include:

  • feelings of overwhelming panic and/or Frenzy

  • feeling overwhelmed and incapacitated by fear and grief

  • emotional numbness that does not go away

  • persistent flashbacks, nightmares and intrusive Memories

  • going to extremes to avoid thinking about the loss, such as abusing drugs or alcohol, or becoming totally immersed in work, hobbies or exercise

  • severe and persistent symptoms of depression which may include: significantly depressed mood most of the time, sleep disturbances,  appetite change, loss of pleasure in usual  activities, thoughts of or attempts at suicide

  • maintenance of a fantasy relationship with the deceased, feeling that they are watching you

  • lack of basic personal self-care

  • magnified and prolonged symptoms

  • unusual and alarming behaviour patterns

  • breaking off all social contact

  • continued disbelief in the death or loss

  • inability to accept the loss

  • radical lifestyle changes

  • continuous yearning and searching for the Deceased

While most people generally grieve reasonably successfully, it is this smaller category of people who need special assistance. Fortunately there are some clues to help us think about complicated grief, and this requires us to step back from the process of grief, and to consider the people who grieve, for they too tend to gather in certain clusters. We know already that people experience grief to a greater or lesser degree and this, too, can indicate how ably [2] we cope over time. It is helpful then to place people on a simple continuum. At the left hand end of the continuum are those who display intense and severe reactions. At the other end are those who display little or sometimes nothing in the way of a grief response. All of us fall somewhere along the continuum.

The People Who Grieve

It was once thought that if we grieve intensely and severely early on, that this was condensing a longer period of grieving into a short time, and so we would be likely to be “over it” sooner; short and sharp versus long and gentle. Similarly, it was believed that those who display little in response are usually in denial, struggling to express their grief, need generous doses of therapy or medication or both, and are therefore abnormal. In reality, the reverse appears to be true. Intense reactions are, unfortunately, an indicator, at least in Western society, of things not going well.

Those who dwell on the loss, who constantly revisit it in their minds while experiencing intense and sometimes uncontrollable emotions are those most likely to develop complicated grief and its attendant problems. Usually we have tasks to distract us or other people around us who can take our mind off the concentrated problem. Friends also help us to regain a sense of control and a sense of being productive. If we are unable to feel these things, we are more likely to become significantly depressed and possibly anxious. What develops is the sense that in some way the loss has expanded and taken over the person, so that it’s as if they have lost their own life, rather than a loved one. They have so identified with the person’s death that they cannot wrench themselves free and relate realistically to the present. It is as if they have been swallowed up by death.

Loss involving sudden, violent events is also a strong indicator of the possibility of complicated grief, as is early depression. We have seen Scriptural examples of this above. Sudden and violent deaths, for example by car accidents, generate trauma symptoms such as thoughts that dominate the mind and become all-consuming and beyond control. They intrude and become more and more persistent to the point where we lose the ability to manage them and finally end up being controlled by them. People who are able to regulate themselves, by which we mean to have some control over when they might think about the loss, sometimes being able to put it from their minds, are those people who tend to be reasonably able to cope in the coming months of grief. This is the largest of the three groups and falls around the middle of the continuum.

In contrast is the last group, composed of people who tend not to show much in the way of grief symptoms at all. With these we would in fact, do more damage by intruding, for we are presuming that they are in complete denial and need of help. While not a large group, they are clearly identified by their seeming lack of response to grief. Running against conventional wisdom, (particularly that of the self-help section of your bookshop and most ‘pop’ psychology programmes), these people don’t need to “talk about it”, nor do they need to get in touch with their “inner child”, nor do they need to show their emotions. In the main, they have very good control, and can regulate their thoughts and feelings perfectly well, including in situations like this. This is not to say that they feel nothing, only that their response is low-level and managed well, independent of anything else. They may avail themselves of supports that are available but also know what is and what is not useful for them.

Our heavenly Father understood all these situations and the emotions that we would suffer. For our benefit He left on record countless scriptures that provide the key to a new way of thinking; not necessarily entirely new to us, but new as to the present circumstances that have overwhelmed us. There is coming a time when death itself will be swallowed up of victory and “God will wipe away tears from all faces… for Yahweh hath spoken it” (Isa 25:8). God has given His word. It is to that time we must turn our gaze, away from the dread reality of that emptiness that has overshadowed our once fruitful daily life. We are not to feel guilty for doing so, for we are not forgetting the one who has so absorbed our thoughts; we are not forgetting the pain and the anguish, but gently letting go in order that we may go forward, for to go back is our ruin. In this way we are learning from our grief to praise God all the more for the blessing of life that not one of us deserves. It is His will that we do so.

What about Therapy and Counsellors?

Often, friends and family are frustrated by their attempts to help, which seem not to be making any difference—the sufferer is not making any headway. The sufferer may find that friends and family are simply unable to provide the level or kinds of support needed in the grieving or mourning process. In many cases, they themselves may be overwhelmed by the circumstances, or they fall prey to popular myths about how grieving and mourning are supposed to occur.

There are specialist grief counsellors and trauma counsellors who can help you understand your own grieving process by providing information and support. You pay for this much as you would for any professional service. In some cases, they can be extremely valuable simply because they have worked with others who have been in a similar situation.

In many cases though, people’s first contact with professional services in this field is their GP. GPs are often inclined to prescribe antidepressants and thereafter possibly refer people for counselling. In some instances this can hasten the first appointment, as it is a professional-to-professional referral, from the GP to the counsellor. In more extreme cases, the GP may refer people to a psychiatrist, because the symptoms they are presented with are beyond their level of expertise, or require medication they are not competent or legally allowed to prescribe.

Always ask for full information and take along a brother or sister for support to help you understand what is happening.

Cautionary Note

With GPs and psychiatrists, you are assured that they have met the mark in terms of training and practical experience. Sadly this is not necessarily the case with counsellors and therapists. In many countries, there is no minimum requirement to be a counsellor except a room and a sign on the door. Many who have “been there” set themselves up as counsellors believing, rightly or wrongly, that because they have experienced the same thing they can therefore help others. Unfortunately, some people who seek counsellors have the same view. In short, this is not a requirement to be an effective counsellor. Similarly, we don’t expect our oncologist to have had cancer before he operates on us, or our neurosurgeon to have had neurosurgery so that having “been there” they can help us better. Having said this, it is true that a personal experience does endow us with a particular view. The problem comes when we presume to apply this view to all other people.

If you choose to visit with a counsellor, apply the same rigour to selecting them as you would to selecting a GP. You are entitled to ask for evidence of qualifications and experience, and to sight certificates and diplomas. You can ask about the style they use with their clients, because there are hundreds of different counselling approaches. They should be able to explain their approach to you without excessive jargon. Also, you are free to change counsellors if you find it unhelpful. For all counsellors, the purpose is to help you achieve whatever change you need or wish. To do this, they will generally attempt to understand your background and views, so that they can walk beside you to your goals. This means that they should in no way attempt to subvert you from your belief system unless it is patently nonsensical. In some cases, counsellors can highlight irrationalities in our thinking, but should only do so based on the information we give them, not conclusions of their own. Therefore, the irrationalities will become obvious to us too. They should not compare your thinking with their own and conclude that because they don’t understand it you are therefore wrong. Nor should they reinterpret events for you in a way that runs counter to your entire belief system. The first session or two therefore, needs to involve them understanding about what life in the Truth means, and how this affects us. They also need to understand that standard Christian counselling is inappropriate, and can’t assume that they know what being Christadelphian is about. If you’re unsure, get a second opinion.

By the same token, don’t be scared off counsellors. A good counsellor is easily able to do these things and can be extremely valuable, particularly if the Brotherhood lacks people like this or people who can understand about grief and what to do.

Our fifth article actually covers in depth things  that are helpful and unhelpful when supporting  others through grief, and many of these things  eliminate the need for professional assistance.  Our next article explores in detail the issue of  depression.