Grief is necessary and serves as an adaptive function to a completely new reality for the bereaved, allowing them to face and adjust to their environment (Guillem, Romero & Oliete, n.d.). It is a normal emotional response to the loss of a loved one, but it also occurs when one loses a job, moves houses, or ends a relationship (Ruiz, n.d.). Therefore, one goes through a grieving process with any change or loss experienced throughout life (Ruiz, n.d.). The term "normal grief" or "uncomplicated grief" refers to the set of feelings and behaviors that are normal after a loss, and these will manifest throughout the phases of grief (Guillem, Romero & Oliete, n.d.). However, according to Guillem, Romero & Oliete (n.d.), the manifestations of grief are not obligatory, meaning they may occur in one or several areas of life, or there may be no changes in one of the spheres.
Physiological Alterations
Grief is characterized by being a crisis phase, which produces a state of shock throughout the body and can lead to psychiatric complications and physical disturbances (Guillem, Romero & Oliete, n.d.). The degree of physical impact that grief can have is surprising (Hairston, 2019). In some situations, somatic changes may arise during grief, revealing or exacerbating conditions that the person was unaware of (Guillem, Romero & Oliete, n.d.). It involves a decompensation of a pre-existing chronic illness during the course of grief (Guillem, Romero & Oliete, n.d.). According to Defaz (2016), these sensations mainly occur in the acute phase and, despite being often overlooked, play a very relevant role in the grieving process. Therefore, each of them should be addressed based on the individual needs of each case: a feeling of emptiness in the stomach, hypersensitivity to noise, perception of depersonalization, difficulty breathing, increased morbidity and mortality, among others.
Behavioral Alterations
It is about changes in behavior compared to the previous pattern, which are important because they influence both the individual's proper development in their immediate environment and their relationship with others (Guillem, Romero & Oliete, n.d.). According to Defaz (2016), these alterations are the most frequent and are overcome throughout the grieving process.
Sleep Disorders
It is common for people in the early stages of grief to experience sleep disorders (Guillem, Romero & Oliete, n.d.). These can involve difficulty sleeping or waking up early in the morning. In normal grieving, they usually resolve on their own, but in some cases, medical intervention may be needed. Sometimes, according to Guillem, Romero & Oliete (n.d.), these disorders may reflect some of the fears that the grieving person has, such as the fear of dreaming, the fear of being alone in bed, or the fear of not waking up.
Eating Disorders
This alteration can be expressed through overeating or undereating, although a decrease in intake is a behavior reported more frequently (Guillem, Romero & Oliete, n.d.). For example, in clinical practice, according to Casali (2020), the onset of anorexia and bulimia is often related to the difficulty of processing grief over the loss of a person, that is, a bond that is important to the individual.
Distracted Behavior
In correspondence with Guillem, Romero & Oliete (n.d.), individuals who have recently experienced a loss may find themselves acting distractedly and doing things that ultimately cause discomfort or harm.
Social Isolation
In correspondence with Guillem, Romero & Oliete (n.d.), it is common for people going through the grieving process to reduce their social contacts to strictly necessary ones and avoid relationships with individuals they used to interact with.
Dreaming of the Deceased
It is quite common to have dreams related to the person who passed away, including normal dreams, nightmares, or distressing dreams (Guillem, Romero & Oliete, n.d.). On some occasions, according to Guillem, Romero & Oliete (n.d.), these dreams serve as a diagnostic clue regarding the person's situation during their grief.
Avoiding Memories of the Deceased / Visiting Places the Deceased Frequented
Some individuals will avoid places or things that cause them painful feelings (Guillem, Romero & Oliete, n.d.). For example, they may avoid the location of the person's death, the cemetery, or items that remind them of the lost loved one. Rapidly getting rid of all things related to the deceased, making them disappear in any way, can lead to complicated grief. In correspondence with Guillem, Romero & Oliete (n.d.), visiting places the deceased frequented is the opposite of avoiding memories of the person who passed away, and often, highlighting this behavior reflects the fear of forgetting the deceased.
Crying and/or Sighing
Crying is a natural way to express the pain and sadness felt, so it is important to allow its free expression (Guillem, Romero & Oliete, n.d.). Frequent crying usually diminishes as the days pass and the grieving tasks are consciously performed. According to Guillem, Romero & Oliete (n.d.), sighing is also a behavior often observed among grieving individuals, correlating with the physical sensation of breathlessness.
Searching and Calling Out Loud
If not done verbally, it can be done subvocally (Guillem, Romero & Oliete, n.d.). In correspondence with Guillem, Romero & Oliete (n.d.), this type of search often occurs because the person does not fully accept the fact of death and its irreversibility from a physical standpoint. Measures aimed at achieving acceptance of what happened prevent inappropriate behaviors.
Carrying and Treasuring Objects
To perpetuate the presence of the deceased loved one in their surroundings, individuals redirect their attention to objects associated with that person and keep them close permanently (Guillem, Romero & Oliete, n.d.). According to Guillem, Romero & Oliete (n.d.), some gradually accept the reality of their loved one's death using these objects to partially mitigate their absence. However, if these experiences persist over an extended period in the grieving process, they may indicate complicated grief.
Hyper or Hypoactivity
In correspondence with Guillem, Romero & Oliete (n.d.), some individuals, as a manifestation of their anxiety, maintain constant restless behavior and a heightened state of attention to everything and everyone, leading to severe exhaustion in a short period of time.
Affective Disturbances
Emotional disturbances are fundamental in the grieving process, as they are related to the emotions and feelings that emerge during grief (Defaz, 2016). In short, according to Guillem, Romero & Oliete (n.d.), it is associated with feelings, that is, with the emotional aspect, the area where the grieving person is most often found at this moment.
Sadness
Sadness is the most frequent and persistent feeling throughout the grieving process and is the first to reappear when the event is remembered (Guillem, Romero & Oliete, n.d.). However, some individuals try to disguise these feelings throughout the day by engaging in activities (Maya, 2014). Consequently, it is important to emphasize that avoiding sadness can lead to complicated grieving. This feeling does not necessarily manifest through crying behavior, although it often does (Maya, 2014). Crying is a signal that elicits a response of understanding and protection from others and establishes a social situation where normal laws of competitive behavior are suspended (Guillem, Romero & Oliete, n.d.). According to Guillem, Romero & Oliete (n.d.), sadness is often accompanied by feelings of loneliness, fatigue, and helplessness.
Anger
After a loss, anger and aggression are frequently experienced, directed towards the departed for leaving them alone and even towards life for taking away what they love (Maya, 2014). The anger and aggression experienced by the bereaved are indiscriminate and directed outward, inward, and towards the deceased (Guillem, Romero & Oliete, n.d.). According to Guillem, Romero & Oliete (n.d.), these attitudes can lead to conflicts with others, foster suicide attempts, and intense feelings of guilt when aware that loved ones or other innocent people are the target of their anger. Similarly, when losing someone important, there is a tendency towards regression, feeling helpless and unable to exist without that person, which also causes much anger and frustration (Guillem, Romero & Oliete, n.d.). Feelings of rage and the resulting behavior, aggression, can arise from anxiety about danger and frustration from unmet needs for connection with the deceased. According to Guillem, Romero & Oliete (n.d.), other subsequent feelings, such as guilt, decreased self-esteem, thoughts of death, or suicide attempts, will emerge in later mental processing, that is, in the person's attempt to understand what is happening.
After an initial moment, difficult to pinpoint, maintaining hostile feelings would require a constant effort not to let go of the loved one (Guillem, Romero & Oliete, n.d.). As long as there is anger towards someone, there is always hope of being able to do something, or the magical possibility that what has happened can change. Therefore, according to Guillem, Romero & Oliete (n.d.), the persistence of anger is incompatible with the acceptance of death.
Guilt
Guilt in the face of death arises as part of the denial of reality, where the grieving person judges themselves and accuses themselves of not having done something to keep their loved one alive, even if it is not directly related to the fact (García, García & Portillo, 2020). Faced with guilt, the grieving person needs to feel the forgiveness of others; however, due to its absence, the situation becomes more complex. Guilt usually manifests in relation to something that happened or was neglected at the time of death (Guillem, Romero & Oliete, n.d.). However, most of the time, according to Maya (2014), guilt is irrational and is relieved by facing reality.
Anxiety
Anxiety can range from a mild feeling of insecurity to severe panic attacks, and the more intense and persistent it is, the more it suggests a pathological grief reaction (Guillem, Romero & Oliete, n.d.). Anxiety stems from two sources: the fear of not being able to take care of oneself or other family members and the more intense awareness of personal death, accentuated by the death of a loved one (Maya, 2014; Guillem, Romero & Oliete, n.d.). Similarly, anxiety can manifest as a result of fears that are now arising, not only about one's own health and well-being but also about that of other loved ones (Guillem, Romero & Oliete, n.d.). Fear exists because the duality of events is seen: the desire to keep living, but the thought that the same thing could happen as to the person who has just died. In that duality, according to Guillem, Romero & Oliete (n.d.), the foundation of fear is found.
Attachment
On one hand, attachment to a person causes a significant part of the subsequent pain upon their loss (Guillem, Romero & Oliete, n.d.). On the other hand, detachment is the essential effort to minimize pain in all types of relationships and is achieved by enjoying the present and taking action. In grief, according to Guillem, Romero & Oliete (n.d.), attachment to the absent loved one can shift towards their objects, their "traces," and the pain caused by their memory, which makes the deceased feel alive and close. Similarly, according to Guillem, Romero & Oliete (n.d.), it is common to want to remain sad, reject pleasure, and have a victim-like and suffering expression and attitude, to keep the loved one "present" and receive secondary benefits in the environment.
Finally, the pain and suffering of loss can be, in some individuals, of an addictive nature, and due to the intensity of the symptoms, these individuals become so dependent that they cannot let go (Guillem, Romero & Oliete, n.d.). This dependence on the deceased facilitates the bereaved in creating new bonds with other people or with their own pain. According to Guillem, Romero & Oliete (n.d.), this can lead to persistent or pathological grief.
Absence of Feelings
Emotional anesthesia or sensory dullness is experienced right after learning about the death of a loved one (Guillem, Romero & Oliete, n.d.). This feeling lasts from a few moments to a few days and feels like an oddity for not being able to experience natural grief. The person remains confused, distracted, and bored without noticing what is happening. Sometimes, they feel guilt for not apparently feeling severe pain, or for those close to them who see them as strange and distant, disconnected from the present and acting automatically. According to Guillem, Romero & Oliete (n.d.), this probably happens because there are too many emotions to face, and it would be overwhelming to let them all become conscious; thus, the person experiences insensitivity as protection from the flow of emotions.
Cognitive Alterations
In correspondence with Guillem, Romero & Oliete (n.d.), this refers to changes at the level of beliefs and concepts, meaning that lucidity and mental clarity are compromised, leading to discomfort due to the lack of a clear understanding of what is happening.
Memory, Attention, and Concentration Disorders
Attention disorders are experienced because one is immersed in an incessant flow of thoughts and feelings that cannot be controlled (Guillem, Romero & Oliete, n.d.). This hinders concentration. Additionally, according to Guillem, Romero & Oliete (n.d.), there may be small "gaps" in memory as a defense mechanism against painful events; often, the ability to memorize present actions with low impact decreases.
Disbelief and Confusion
Disbelief is the first thought when learning about a death, especially if it occurs suddenly (Sacón, 2020). Trust in what used to inspire it is lost; therefore, all influential theories undergo a rigorous credibility test (Guillem, Romero & Oliete, n.d.). This, coupled with mental and physical fatigue, often generates confusion with a loss of clarity prior to grief (Guillem, Romero & Oliete, n.d.). According to Sacón (2020), people seem unable to organize their thoughts, have difficulty concentrating, and forget things.
Worry and Repetitive Thoughts
There is an obsession with thoughts about the deceased (Sacón, 2020). Sometimes, these include obsessive thoughts about how to bring back the lost person (Guillem, Romero & Oliete, n.d.). Worry can take the form of intrusive thoughts or images of the suffering or death of the deceased (Sacón, 2020). Sometimes, in correspondence with Guillem, Romero & Oliete (n.d.), people spend hours and days ruminating on the same idea, especially a "what if" scenario that does not let them rest.
Sense of Presence
This is the cognitive equivalent of the longing experience that grieving people undergo (Sacón, 2020). They may believe that the deceased somehow continues to exist in the spatial and temporal dimension of the living (Sacón, 2020). This belief may arise in the moments following death (Guillem, Romero & Oliete, n.d.). However, as the days go by, in accordance with Guillem, Romero & Oliete (n.d.), the sensation of the presence of the loved one decreases.
Hallucinations
Among the normal behaviors of grieving individuals, visual and auditory hallucinations are included, as they are considered a normal experience (Sacón, 2020). These hallucinations are usually brief illusory experiences that occur in the weeks following the loss and generally do not indicate a more difficult or complicated grieving experience (Guillem, Romero & Oliete, n.d.). Although they may surprise some, many others find them helpful. Guillem, Romero & Oliete (n.d.) suggest that, with the recent interest in mysticism and spirituality, it is interesting to speculate whether these are truly hallucinations or perhaps some other type of metaphysical phenomenon.
References
Casali, C. (2020). EL DUELO Y LOS TRASTORNOS DE LA ALIMENTACIÓN. TRIA Centro de Tratamiento e Investigación de Anorexia, Bulimia y Obesidad. Recuperado 11 September 2021, a partir de https://www.triacentro.com/el-duelo-y-los-trastornos-de-alimentacion/
García, S., García, J., & Portillo, S. (2020). DIAGNÓSTICO Y CREACIÓN DE UN PROGRAMA DE INTERVENCIÓN PSICOLÓGICA DE LOS PROCESOS DE AFRONTAMIENTO ANTE LA PÉRDIDA DE VIDAS HUMANAS QUE SE MANIFIESTAN EN LAS PERSONAS TRABAJADORAS DE INSTITUCIONES QUE BRINDAN ATENCIÓN EN EMERGENCIAS DE LA REGIÓN METROPOLITANA DE SAN SALVADOR. Ri.ues.edu.sv. Recuperado 7 September 2021, a partir de http://ri.ues.edu.sv/id/eprint/21349/1/14103788.pdf
Guillem, V., Romero, R., & Oliete, E. MANIFESTACIONES DEL DUELO. Seom.org. Recuperado 7 September 2021, a partir de https://seom.org/seomcms/images/stories/recursos/sociosyprofs/documentacion/manuales/duelo/duelo08.pdf
Hairston, S. (2019). How Grief Shows Up In Your Body. WebMD. Recuperado 11 September 2021, a partir de https://www.webmd.com/special-reports/grief-stages/20190711/how-grief-affects-your-body-and-mind
Maya, C. (2014). La vejez y la Tanatología: Homenaje a la vida. Tanatologia-amtac.com. Recuperado 7 September 2021, a partir de http://www.tanatologia-amtac.com/descargas/tesinas/254%20La%20vejez.pdf
Ruiz, M. Duelo emocional: ¿cómo superarlo?. MariangelRuiz. Recuperado 7 September 2021, a partir de https://mariangelruiz.com/duelo-emocional-como-superarlo/
Sacón, S. (2020). DUELO Y SU INFLUENCIA EN LAS ALTERACIONES COGNITIVAS EN ADOLESCENTE DE 14 AÑOS. Dspace.utb.edu.ec. Recuperado 11 September 2021, a partir de http://dspace.utb.edu.ec/bitstream/handle/49000/9017/E-UTB-FCJSE-PSCLIN-000399.pdf?sequence=1&isAllowed=y
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