Death sometimes can be a relief if the person is in a terminally ill situation after a major car crash or a stroke yet it is an unpopular opinion. People tend to have the need to keep people they love alive as animals do for their loved ones even when they are experiencing the worst illnesses. The truth is that it is unbearably difficult for someone to accept that they are not going to see the faces of the ones they care about anymore, and they are even shocked and startled when they hear of a loss of a friend or a family member they had never met in their lives. It is normal therefore for people to pass through a heavy psychological process, that of grief.

The article will cover the following:

• Untangling concepts
• Theories and Frameworks
• Neuroendocrine Changes of Grief
• Gratitude
• Grieving does not apply only to the loss due to death
• Acceptance

Untangling concepts

Grief follows loss closely, yet they are separated as concepts. Grief is the natural human response to separation, bereavement or loss of a loved one [1]. However, the terms of grief, mourning and bereavement are erroneously used interchangeably even though they have different meanings.

• Grief: individual’s personal response to loss, it has emotional, physical, behavioural, cognitive, social and spiritual dimensions
• Mourning: active and external expression of grief, grief is involved in the process of mourning
• Bereavement:

• the period after loss when grief and mourning occur
• a state of having experienced a loss
• it is a form of depression that evolves over time
• people experiencing it show signs of anxiety, insomnia, inertia, hyperactivity or a feeling of helplessness

People may pass through bereavement at different times after the loss of a loved one and may experience some or all of the aforementioned symptoms. This depends on the relationship one had with the person they lost, their personality or various triggers in the environment that may remind the deceased person. Stroebe et al (1993) defined bereavement as a state of loss, triggering a grief reaction that manifests in a set of behaviors known as mourning [1]

Theories and Frameworks

You may have often heard that there are some stages of grief that people pass through when mourning and yes, many theories describe common themes or stages of grief. One model, that of ‘’grief wheel’’ describes the process of grief as a static process. Other models however, describe grief as a dual process explaining that mourning happens using a two- ways coping process: that of grieving and the trials the person goes through to find ways to cope with the loss.

Even though there are many theorists analyzing grief, in this article I will mention the newest three, starting from Bowlby’s (1973) theory of attachment. It emphasizes how people’s bonds are significant and especially those developed in early life stages. Grief here is explained through the stages of:

• Shock
• Yearning and protest
• Despair
• Recovery

The theory mostly elaborates how important it is for people to feel attached with others and how desperate and distressed they feel when these bonds reach a point where they break. Attachment for Bowlby is a mutual relationship that occurs because of long term interactions that start early in life e.g. child - parents. Grief is so distressful in adult life because these attachments remain active during life.

Parkes’ (1988) theory of grieving reassembles a lot that of Bowlby’s. The stages of grief in his theory are the following:

• Shock or Numbness
• Yearning and Pining
• Disorganization and Despair
• Recovery

Grief for Parker is the transition between ‘’incomprehension and denial, then confrontation with reality and finally to some form of resolution’’ (Parkes, 1988) [1]. Again triggers play an important role in the terms of which phase will emerge sooner or later. This theory suggests that grief is not a state, it is rather a process that does not involve symptoms which begin after death and then fade away. It proposed instead a succession of phases that merge into and replace each other.

Worden (1991) described a completely different approach to loss [1]. He proposed some tasks that have to be explored and worked through if one wants to resolve their grief. The model Worden proposed moves from passive phases of grief to active tasks of mourning. There tasks include:

• Task 1: to accept the reality of loss
• Task 2: to work through and experience the pain of grief
• Task 3: to adjust to an environment without the deceased person

• Important here is for the mourning person to understand that he/ she has to adopt new roles and to embrace new dynamics that did not exist before

• Task 4: to withdraw emotionally from or relocate the deceased

• Relocation requires that the bereaved person creates a dynamic relationship with their memories of the deceased person in a way that they are able to continue their life

Neuroendocrine changes of grief

In their study Hopf et al. (2020), describe multiple neuroendocrine mechanisms of grief and bereavement. The results show that grief is not solely a psychological, emotional or cognitive process but that it also evokes bodily reactions. These are usually neuroendocrine changes such as increased cortisol levels (hormone known as stress-hormone), dysregulation of the HPA axis (hypothalamic-pituitary-adrenal axis in the brain regulates processes such as the stress response)

Of course as with all meta- analyses there are some drawbacks due to the methodology and the number of studies from which these results are extracted but nonetheless it can be concluded that cortisol levels of people that have lost a beloved one change and specifically are higher. This finding is somewhat important because it indicates that one should not hesitate to seek for physical support along with emotional or psychological support during bereavement.

Gratitude

A common sentiment that people feel together with grief is gratitude. Gratitude for their life as they are still alive, but also for the lives of other people they’ve loved. Ramstad Sheryl (2014) shares in her article her personal experience working as a nurse in a hospital during her studies where she observed how people were finding it easier to talk about their gratitude than about their grief even though they felt both quite strongly [3]. She herself had survived a serious accident and she was hospitalized for a long time and she started thinking about herself as well the same question. She indeed expressed gratitude to her family and hospital staff for example, but thinks it would be harder for her to express the grief related to he scars and marks she has on her body.

She concludes that grief takes time and that gratitude can come more spontaneously than grief, especially when one is struggling for survival. Gratitude creates a more positive emotional environment compared to grief that sometimes might feel endless. The point is that both grief and gratitude are part of a healing process that differs per individual. Sheryl mentions that through her experience working in the hospital, people seemed to gain a lot from having conversations about the tragic events that caused them to lose others and when exploring the relationship between gratitude and grief.

Grieving does not apply only to the loss due to death

Grief is not only present when people lose a beloved person due to death but it is also a phenomenon applicable to the living as well. Women that have suffered intimate partner violence (IPV) also experience grief [4]. Kubler and Ross had developed a grief model including five stages: denial and isolation, anger, bargaining, depression and acceptance. Messing et al., (2012) discovered that many victims of IVP passed through these stages of grief. Women felt denial mainly because of self -blame for what their partner did to them because they were afraid of them but also because they thought the abuse would stop. Other women were afraid to be alone and ended up going back as well. Bargaining creates false feelings of hope and similarly to when one experiences the death of a close person; abused women always believed that things will get better. After a while though, when feelings get triggered this idea collapses and a state of depression arises. Feelings that one cannot move forward also appear together with hopelessness.

Acceptance

In the end, there is acceptance. The white flag as if a war is over. It is then that people realize that they are strong enough to start a new life, accompanied by feelings of relief, hope and empowerment [4]. Mourning individuals like women who suffered abuse, take the necessary step to move forward to a world that is full of happier places and beautiful experiences. It is important that we are supportive, emotionally and verbally, towards people who have undergone the loss of a loved one. One should help boost the new image they have created for themselves and how they turned to be after these emotionally draining experiences.

Prigerson and Maciejewski (2008) examined grief and acceptance and concluded that a decline in grief-related distress appears to correspond with an increase in peaceful acceptance of loss [5]. Resolving grief then suggests that acceptance is facilitated and that both clinicians and family members could form potential intervention mechanisms to boost the process of this resolution. This may not sound like something new but it is useful to keep in mind to not push people that care for and love us far away but rather try to incorporate them into our healing processes.

Closing this article, we talked a lot about heavy concepts and that is why we should now take a step back and a deep breath to comprehend that life and death form one of the dualities that keep balance on the planet and in nature. People tend to be disconnected from their feelings but a healthy acceptance and a resolution process for  traumatic or distressing events are essential steps for a healthy mind and soul. Try to let out your feelings and share your experiences with the people you are close to as much as possible as it will help you heal.

Additional sources:

Movies dealing with the sentiments of grief and loss:

• Big Fish (2003)
• Up (2009), animated
• Dead poets society (1989)

[1] Buglass, Edith. "Grief and bereavement theories." Nursing Standard, vol. 24, no. 41, 16 June 2010, pp. 44+. Gale Academic OneFile, link.gale.com/apps/doc/A230415628/AONE?u=erasmus&sid=bookmark-AONE&xid=fc97a06f. Accessed 2 Sept. 2021.

[2] Hopf, D., Eckstein, M., Aguilar‐Raab, C., Warth, M., & Ditzen, B. (2020). Neuroendocrine mechanisms of grief and bereavement: A systematic review and implications for future interventions. Journal of Neuroendocrinology, 32(8). doi:10.1111/jne.12887

[3] Ramstad, Sheryl, MN,R.N., J.D. (2014). Grief and Gratitude. Creative Nursing, 20(3), 194-6. http://dx.doi.org.eur.idm.oclc.org/10.1891/1078-4535.20.3.194

[4] Messing, J. T., Mohr, R., & Durfee, A. (2012). Intimate partner violence and women’s experiences of grief. Child & Family Social Work, 20(1), 30–39. doi:10.1111/cfs.12051

[5] Prigerson, H. G., & Maciejewski, P. K. (2008). Grief and acceptance as opposite sides of the same coin: setting a research agenda to study peaceful acceptance of loss. British Journal of Psychiatry, 193(06), 435–437. doi:10.1192/bjp.bp.108.053157