Bereavement

How can we define grief?

In literature, the definition of grief has sought to refer to an inclusive vision, capable of recognizing and analyzing many affective states. According to the classical framework, we can understand grief as a reaction primarily characterized by intense anguish, therefore a mainly emotional (affective) response to the loss of a loved one through death.

Grief encompasses different manifestations:

• psychological (cognitive, socio-behavioral)
• physical (physiological and somatic)

Clinically, and closely related to a traumatic loss, it is the specification of a constellation of specific symptoms, cognitive and affective, linked to grief: depressed mood, desire to reunite with the lost person, loneliness, and seeking even esoteric ways to contact and communicate with the deceased person.

In more general but comprehensive terms, grief can be defined as the most disruptive emotional reaction caused by the unexpected loss of someone or something deeply important. More specifically, grief is the complex processing of a loss that impacts multiple levels beyond what we may think: emotional, cognitive, behavioral, familial, relational, social, community, cultural, and political.

What are the reaction patterns to a traumatic loss?

Recently, there has been an effort to redefine reaction patterns to traumatic loss, whether it is death, the end of a relationship, loss of home or job, destruction caused by natural disasters, etc. This cultural and scientific shift, combined with the awareness that grief is a genuine threat to physical and mental healthWhat is meant by mental health? According to the World Healt... More, not only allows for strengthening the network of knowledge and resources that can be activated within the individual and the family and social context to favor specialized support in reducing the risk of developing persistent grief, but also helps to understand:

1. trajectories and processing methods culturally determined,
2. the influence of personality traits and attachment styles,
3. the influence of experiences of past stressful life events,
4. the influence of individual copingCoping is the ability to face and manage stress, challenges,... More strategies,
5. the influence of stigmaStigma towards mental health can be defined as prejudice and... More surrounding grief, especially if related to the death of a loved one.

Indeed, from a purely theoretical perspective, we can state that there has been a shift from the strictly private experience of grief to the need to live grief openly in one’s social context.

Why is it important to raise awareness about grief

Awareness about grief, the processing of a traumatic loss, and death should be increased: according to the classical taxonomy of grief reactions, in the first year about 15% develop contained and non-maladaptive reactions in psychopathological terms, not at risk for persistent grief. Indeed, 85% of those who develop moderate reactive symptoms (dysphoria, disorganized thinking, health problems, difficulties in social and work contexts), if supported at the family, relational, social, and cultural level – experiencing positive interactions in terms of understanding, listening, formal and informal support, non-judgment, etc. – are at risk of developing pathological persistent grief (with post-traumatic, severe depressive, or reactive anxietyAnxiety is an emotional response characterized by feelings o... More symptoms) in only 15% of cases.

Thus, we can well say that the nature of the concept of grief and loss is strictly relational and social. It changes a relationship (depriving us of the other), modifies the emotional response and internal working models through which we understand the world and interpret our own and others’ behaviors, and alters the image others have of us, imposing a redefinition of our role in society. Grief should be recognized as a state of loss that could lead to a depletion of our social role quality (for example, due to disconnection and social withdrawal, perceived stigma, and feeling different and misunderstood). However, facing social deprivations without abandoning work, connections, and passions can promote adaptation to the loss.

What can be done to support those experiencing grief or a traumatic loss, beyond the necessary specialized psychological support?

Archer (2008) identified the basic elements to consider to increase knowledge and awareness regarding reactions to loss, namely:

1. understanding the evolutionary origins of grief, in terms of similar processes in other species, and its adaptive significance;
2. analyzing the differences in grief related to the mode of loss (death, traumatic death, separation, etc.) and how it can be predicted in terms of pathological outcomes using the individual’s evolutionary principles;
3. observing the mechanism that triggers the grief process, using both psychodynamic and cognitive theoretical frameworks;
4. monitoring how reference theoretical frameworks can help understand variations in reaction during the grief processing depending on the context of the loss;
5. observing the developmental trajectory, both individual and social, of grief.

Grief and traumatic loss, additionally, have a potentially devastating impact not only individually but also socially, economically, and politically.

In conclusion, it can be stated that there is a need to strengthen awareness about grief, loss, and death through concrete and educationally targeted actions, attentive to information, training, and enhancement of individual coping abilities in response to events that may generate deep fear and disorientation. This type of educational topic should be integrated into curricula, not only during the study path of helping professionals but also in schools – from early childhood – and in parenting training. Implementing individual and social processes of understanding and accepting every part of life’s trajectory could increase empathetic openness and reduce problems (individual and beyond) arising from forced silence on these topics and, consequently, the deep suffering associated.