In this article grief pain will be considered from a holistic perspective and will encompass the physical, emotional, spiritual and social. It is common for people to experience physical pain such as lack of energy, loss of sleep, loss of appetite, stomach aches, etc. as they move through the process we call grief. However, considering that the underlying source or cause of grief pain seems to be the separation from a loved one, it stands to reason that attention to grief pain demands special attention to the emotional and spiritual aspects of grief pain.
Processing Grief Pain: Pat and Chris
In William Worden’s book Grief Counselling and Grief Therapy, he describes the processing of grief pain as of the second of the four Tasks of Mourning. An important aspect of processing the pain of grief is acknowledging feelings such as anger, regret, sadness, anxiety, guilt, depression, and loneliness. If these feelings are denied or avoided they don’t get resolved, but lie hidden and contribute to unresolved grief or compounded grief. One example of the avoidance of grief pain is the experience of Pat*, whose spouse, Chris*, died after a year living with a terminal illness. The grieving person, Pat, left home and moved to another country, working there for several years before returning home. Pat thought the grief pain would go away with time. It didn’t go away, but was merely kept at bay and festered until Pat was ready to acknowledge the need to give it the attention it deserved.
The pain was that of separation and was alleviated by sharing the story of their common life. The acknowledgement of the grief pain and the various emotions experienced through the sharing of the stories of their life together, helped Pat to view life as it now was, from a different perspective. In essence, the exploration and review of their life as a couple helped Pat to realize that life with Chris had continued to be real, at least in an existential way.
Grief pain for Pat was obviously more than physical, more than loss of sleep or appetite, more than headaches and chest pain, and impacted Pat emotionally and spiritually. Pat moved away, heart-broken and unable to cope with the new reality. Consequently, the grief pain caused by the separation of Pat and Chris may also be referred to as pain of the human spirit, which Michael Kearney described in his book, Mortally Wounded, as soul pain. Kearney states, “Soul pain”, says Kearney, “is the experience of an individual who has become disconnected and alienated from the deepest and most fundamental aspects of himself or herself”. Pat and Chris’ separation caused by the death meant Pat was disconnected from Pat’s former purpose in life, part of which had been to care for Chris during the last year of Chris’ life. Pat was unable to bear the grief pain and unable to face the deepest hurt they had ever experienced. Pat decided to move in order to get away from the deep hurt caused by the grief pain. In time Pat realized that the grief pain didn’t just go away even after several years.
Healing through Mercy: Self-Care
A perspective developed by Stephen Levine in his book, Unattended Sorrow, is that “healing becomes not the absence of pain but the increased ability to meet it with mercy instead of loathing.” The ability to care for oneself with mercy may provide hope and encouragement to the grieving person because it is based on loving kindness and compassion rather than personal abuse and neglect. There is in fact the potential for healing of the human spirit, as well as the emotions and the physical and social condition, which results from the experience of processing grief pain.
There are various therapeutic approaches that may be used to address grief pain such as a narrative approach. One example of a narrative, therapeutic approach developed by Robert Neimeyer is “Meaning Reconstruction.” This approach consists of “sense-making, benefit-finding, identify-change, and purpose in life,” by working with the grieving person’s story and memories of their loved one. In the case of Pat and Chris, Pat was able to address their fear, and through exploring their memories of life with Chris, realized that there continued to be a purpose in life that made life worth living again.
Grief and the Life Cycle
In order to address the potential severity of grief pain it may be helpful to reframe the loss by making a connection between grief pain and the pain of child birth. All nature represents the cycle of life: Birth, death and rebirth. Picture the seasonal cycle of deciduous trees: the buds appear in the spring signaling new life; the fully formed leaves show life, the dying leaves of autumn signal death, and the following year’s newly-formed buds show new life, yet again. Similarly, animals in nature are born, live, die, decompose, and then nourish new plant life. These metaphors are an invitation to the grieving person to recognize the inevitability of death and then to look for the potential for new life, new beginnings and new purpose in life as dimensions of the healing process.
The example of Pat who moved away in order to cope with the grief pain is common and often results in the delay of the grief process. This contributes to the experience of complicated grief or complicated mourning. William Worden describes it as a paradigm using four headings:
1. Chronic grief reactions;
2. Delayed grief reactions;
3. Exaggerated grief reactions; and
4. Masked grief reactions.
Pat’s grief process was complicated by delayed grief reaction.
Relationships in the Therapeutic Process
Services to address complicated grief may be provided by a health care professional or a life-coach, such as a grief or bereavement coach, psychologist, psycho-spiritual therapist, social worker, psychotherapist, etc. Regardless of the therapeutic modality, the care provider must bring a “healing presence” to the relationship. One specific model to assist or help with grieving people, especially those experiencing complicated grief, is Stroeb and Schut’s “Dual Process Model”. This is explained as a rhythm or oscillation between two poles, loss orientation and restoration orientation. The grieving person is helped to acknowledge the need for time to feel sad while reminiscing and remembering their loved one as one pole, and to acknowledge the need for time to invest in new experiences and new relationships as the other pole. The rhythm in effect gives attention to the loss and to the transitioning to a new life, creating a new balance in the grieving person’s life.
It is important to pay attention to the significance of relationships in any therapeutic process and it is especially so in the treatment of grief pain. The therapeutic relationship may be one-on-one, or a group experience. In fact it is known that the great majority of grieving people are helped first and foremost by their family and friends. The therapeutic value of funerals and memorials for instance is to surround the grieving people with a caring community. It is the community who often brings stories of the deceased person as well as food and a healing presence to provide support and comfort for the healing of grief pain.
Trauma and Complicated Grief
Reference has been made to complicated grief being the impairment or delay of the grief process, and consequently prolongs the grief pain. There are indicators that represent factors that predispose a grieving person to the risk of experiencing complicated grief such as: the way their loved one dies, the multiple deaths of significant persons experienced in a given period of time, mental health concerns, and the importance of the deceased person or persons, and attachment to the grieving person.
Another consideration regarding complicated grief is the risk of trauma to the grieving person. Depending on the severity of the trauma caused by the death or deaths, the grieving person may require special trauma treatment in conjunction with the treatment of the complicated grief. The therapeutic approach must at least include “trauma informed care,” but may also require referral to specialized trauma services. In The Trauma-informed: The Trauma Toolkit we learn that “Trauma-informed services recognize that the core of any service is genuine, authentic, and compassionate relationships.” The acknowledgment of trauma in relation to the grief and the treatment of both by the same therapist may be a catalyst for deepening the therapeutic relationship and a means to restore trust in life for the grieving person. It might be said that Pat was mildly traumatized by the shock of Chris’ death. Pat was helped through the establishment of a supportive and in-depth therapeutic relationship with the grief counselor. Consequently, Pat was able to accept Chris’ death in an emotional or heart-felt way, as well as knowing it to be real.
Growth and Positive Change
It’s helpful to also look at the potential for growth and positive change through the grief process. Peter Bray explores the idea of transformation of grief pain for spiritual growth in his article “Bereavement and Transformation: A Psychospiritural and Post traumatic Growth Perspective.” “By broadly examining religious and spiritual experiences in the context of bereavement and post-traumatic growth,” says Bray, “it is proposed that the loss of a loved one, for example, can activate the human psyche in ways that allow transpersonal processes to influence psychological growth.”
In Pat’s experience, life would never be the same again, as Pat would always feel close to Chris, even though Chris had been dead for several years. Pat’s life was transformed in ways that Pat would not have expected: Feeling Chris’ presence and love on occasion and embracing Chris’ daughter and their grandchild. In addition, Pat experienced relief from depression and a more positive and hopeful attitude in general.
Everyone is Different
There are many aspects to the care of grief pain in order to facilitate the healing of the grieving person. For some people, this is a lengthy process requiring a community’s resources, especially the resources of the grieving person’s family and friends. Addressing the many layers of grief pain sometimes requires the attention of grief counsellors and trauma specialists in order to facilitate healing of the whole grieving person. The reality is that the grieving person can never be the same person they were before the death of their loved one or loved ones; consequently the goal of healing grief pain is more than restoration. It must embrace the potential and reality of new life for the grieving person after the death.
The healing of grief pain is a transformative experience in which the person engages change for the purpose of healing their body, mind and spirit.
*names changed to protect the privacy of individuals