A normal grief reaction may be abbreviated or anticipatory.
A normal grief reaction may be abbreviated or anticipatory. Abbreviated grief is grief but genuinely felt. This can occur when the lost object is not significantly important to the grieving person or may have been replaced immediately by another, equally esteemed object. Anticipatory grief is experienced in advance of the event such as the wife who grieves before her ailing husband dies. A young girl may grieve in advance of an operation that will leave a scar on her body. Because many of the normal symptoms of grief will have already been experienced in anticipation, the reaction when the loss actually occurs is sometimes quite abbreviated.
Disenfranchised grief occurs when a person is unable to acknowledge the loss to other persons. Situations in which this may occur often relate to socially unacceptable loss that cannot be spoken about, such as suicide, abortion, or giving a child up for adoption. Other examples include losses of relationships that are socially unsanctioned and may not be known to other people (such as homosexuality or extramarital relationships).
Unhealthy grief - that is, pathologic or complicated grief - exists when the strategies to cope with the loss are maladaptive. Many factors can contribute to complicated grief, including a prior traumatic loss, family or cultural barriers to the emotional expression of grief, sudden death, strained relationships between survivor and deceased, and lack of adequate support for the survivor.
Complicated grief may take several different forms. Unresolved or chronic grief is extended in length and severity. The same signs are expressed as with normal grief, but the bereaved may also have difficulty expressing the grief, may deny the loss, or may grieve beyond the expected time. With inhibited grief effects, including somatic, are experienced instead. Delayed grief occurs when feelings are purposely or subconsciously suppressed until a much later time. A survivor who appears to be using dangerous activities as a method to lessen the pain of grieving may be experiencing exaggerated grief.
Complicated grief after a death may be inferred from the following data or observations:
1. The client fails to grieve; for example, a husband does not cry at, or absents himself from, his wife's funeral.
2. The client avoids visiting the grave and refuses to participate in memorial services, even though these practices are a part of the client's culture.
3. The client becomes recurrently symptomatic on the anniversary of a loss or during holidays.
4. The client develops persistent guilt and lowered self-esteem.
5. Even after a prolonged period, the client continues to search for the lost person. Some may consider suicide to effect reunion.
6. A relatively minor event triggers symptoms of grief.
7. Even after a period of time, the client is unable to discuss the deceased with composure; for example, the client's voice cracks and quivers, and eyes become moist.
8. After the normal period of grief, the client experiences physical symptoms similar to those of the person who died.
9. The client's relationships with friends and relatives worsen following the death.
Many factors contribute to unresolved grief after a death:
1. Ambivalence (intense feelings, both positive and negative) toward the lost person.
2. A perceived need to be brave and in control; fear of losing control in front of others.
3. Endurance of multiple losses, such as the loss of an entire family, which the bereaved finds too overwhelming to contemplate.
4. Extremely high emotional value invested in the dead person; failure to grieve in this instance helps the bereaved avoid the reality of the loss.
5. Uncertainly about the loss - for example, when a loved one is "missing in action".
6. Lack of support systems.