Veronica Semenova, Ph. D. is a private practicing psychologist working with a variety of psychological conditions, including depression, anxiety, grief, bereavement, coping with chronic and critical illness, fear of death, caregiver issues, aging issues, interpersonal and relationship issues. She is a member of the American Psychological Association, Psi Chi International Honor Society in Psychology, and the Association for Psychological Therapies.

Dr. Semenova is the author of «Learn How to Cope with Death, Loss, Grief, and Bereavement – Helpful Tips from the Cognitive-Behavioral Therapy».

Visit Dr. Semenova’s website at www.vsemenova.com for more information.

Book Description

Many books are written about grief: what it is and how to deal with it – but no loss is the same. The intensity of grief depends on many different factors. Grief varies between young and old and between cultures and religions, and depends on levels of existing dysfunction and on the nature of death (if the death was expected or sudden). It depends on previous experiences with death and attachment styles, and, of course, interpersonal factors play a very important role, as well. Grief also depends on the personality of the bereaved and the type of relationship the bereaved had with the deceased. Unprocessed emotions in that relationship, conflicts, repressed feelings, and unspoken words all come out in grief and weigh heavily upon a grieving person, often complicating recovery.

In Faces of Grief, I share many stories of grief from my psychotherapy practice and explain how grief can be anticipatory, disenfranchised, or complicated. I also discuss the common myths about grief. All stories reveal the extensive work that the bereaved has to go through to enable them to come to terms with guilt, self-reproach, and the pain of grief.

I also provide practical information on how to help yourself or your grieving loved one, how to talk to children about death and grief, and what not to say to a person who is grieving. This book will be useful for anyone going through bereavement and grief, and for those supporting them.

Chapter one. Losses in our Life

«The deep pain that is felt at the death of every friendly soul arises from the feeling that there is in every individual something which is inexpressible, peculiar to him alone, and is, therefore, absolutely and irretrievably lost.»

Arthur Schopenhauer (1788—1860)

There comes a time in everyone’s life when the death of a loved one – a spouse, parent, child, sibling, or a friend – enters the room. Some people experience it as kids when one of their elder relatives dies, while others do not experience loss until later on in life. In some tragic cases, early loss occurs when the parent of a young child passes away. Death is one sure thing, like birth, that happens to all living beings.

Many of us remember the first time the word death was spoken: when we found a dead insect, when a family pet died, or when an elderly relative passed away. These events generate acute curiosity. Children may observe people crying, parents mourning, or funeral arrangements being made. Parents often rush to comfort the child and offer a consoling explanation (“Don’t worry: Granddad is just in a deep sleep, and his soul is traveling to heaven.”). Different stories of eternal life, meeting again in heaven, being re-born or resurrected, and so on are shared with children. I imagine you’ve heard some of these explanations, too.

Later on, children find out that death has nothing to do with “deep sleep”. By then, anxiety and fear have conquered their minds. In fact, some children are afraid to sleep as a result of “death explanations”, and their parents may wonder why. If you were told that dying is like going to sleep, then it would be hard to sleep without worrying about dying.

I can’t repeat this enough to parents who need to explain a death in the family to their young child: Please do not hide the truth. Children are able to cope with the knowledge of death. At different ages, this understanding is different, but the truth is better than any of the stories commonly used as explanations.

In fact, there is often a relationship between sleep and death. Sleep and the loss of consciousness that takes place when we sleep is thought by many to be a “death rehearsal” that happens to us every night. (By the way, in Greek mythology, Thanatos (death) and Hypnos (sleep) are twin brothers.)

One way or another, the myths of dying are one day dismissed. That usually happens around adolescence, as young individuals realize their own and their loved ones’ mortality. The end of belief in fairy tales brings about the first existential crisis: the end of childhood and the beginning of adolescence, with the accompanying strong animosities that teenagers often display. The first loss leaves a very deep scar; and even if it happened very early on in life, the consequences of reactions to that loss (words that were exchanged by grown-ups at the time, or rituals observed) all define the ways in which future losses will be experienced and handled.

In the chapter “Grief in Children”, I will describe how children see and understand death at different developmental ages and why it is important to be honest and present information about death and loss in a way that is understandable to a child, which does not foster myths, fears, or anxiety.

No matter when the next loss happens and how close the relationship was with the person who passed away, grief is a natural reaction to loss. Nobody is ever prepared for grief. You can’t learn to deal with grief until the feeling overwhelms you, bringing with it sadness, anger at destiny, despair, and acute loneliness. Anger resolves over time – we learn to live with our loss, and there comes a time when it doesn’t hurt as much as it did – but why doesn’t the sadness go away? Why do we still hurt every time we come close to the next anniversary of our loved one’s birth or death, and why does flipping through pictures or letters bring so much heartache? If grief is a natural reaction to loss, then how long is it normal for that reaction to last?

I will answer these and many more questions in this book. In fact, there are so many myths surrounding grief – what’s normal and what’s not, how the bereaved should be “handled”, and what to say to a grieving person – that it would require a set of books just to go over all the myths and resolve many misconceptions. Whether the grieving person is you yourself or if you are reading this to find some helpful advice for someone close to you who is dealing with the loss of a loved one, I am sure this book will provide the necessary tools and support to help you through this difficult time.

Sadly, our society tends to impose rules on what is acceptable in grief and what’s not. How often do you hear that mourning a loss should not exceed one year? So, according to this logic, after precisely 365 days, a grieving person is expected to magically stop crying and feeling sad? It does not happen that way. Grief, even one year after a loss, may feel overwhelming and cause depression, loneliness, anxiety, and the feeling that the deceased is still present and continues to communicate.

Not many people are able to come to terms with their loss at the end of the first year, and some people may require as much as three to four years to achieve emotional stability. With some losses, the pain is still sharp even decades later. Replacing the deceased in one’s life does not end grief. For example: a new marriage does not stop a bereaved spouse from grieving, while having another child does not stop parents from grieving for their deceased child.

Many books are written about grief, what it is, and how to deal with it, but many people still struggle to come to terms with the loss of their loved ones. Indeed, no loss is the same. You cannot just come up with a soothing formula that fits everyone.

I find, in my work, that the intensity of grief depends on many different factors. Grief varies between young and old and between cultures and religions, and depends on the levels of existing dysfunction and on the nature of death (if the death was expected or sudden). It depends on previous experiences with death and attachment styles, and, of course, interpersonal factors play a very important role, as well. Grief also depends on the personality of the bereaved and the type of relationship the bereaved had with the deceased. Unprocessed emotions in that relationship, conflicts, repressed feelings, and unspoken words all come out in grief and weigh heavily upon the grieving person, often complicating recovery. It takes a long time and a lot of work to go through these feelings and identify those that cause pain.

In the chapter “Types of Losses”, I will talk about differences between the loss of a spouse, a parent, a child, a sibling, or a loss through suicide. I hope that some of the examples I present in this book will show you what type of emotional pain needs to be dealt with in the process of coping with grief.

Grief may be experienced not just after the death of a loved one, but can follow any form of catastrophic personal loss. This can include the loss of a job or income, the breakup of a major relationship or divorce, imprisonment, a diagnosis of infertility, chronic or terminal illness, the loss of a home from fire, a natural disaster and/or many other tragic events in life.

The stages of grief we go through to accept the loss and to reconstruct our lives are common to any catastrophic loss: denial, anger, bargaining, depression, and finally, acceptance. We will discuss each stage in the chapter “Stages of Grief”.

It is also important to note that grief can be anticipatory. In family members of terminally ill patients, this is a major factor leading to complicated grief in bereavement. Anticipatory grief can be defined as a reaction to an imminent and upcoming loss. It may manifest itself when the physical condition of the patient deteriorates and family members are faced with the necessity of final decisions and saying good-byes. I will discuss anticipatory grief in the chapter “Types of Grief”.

We will also look at disenfranchised grief (grief that cannot be publicly acknowledged and loss that cannot be publicly mourned). It can be as varied as the loss of a secret lover, losses of partners in gay relationships, or losing a family member convicted of a grave crime.

And, of course, there are situations where grief stops being a normal reaction and begins interfering with the life of the bereaved or starts haunting the grieving person. This is called complicated or pathological grief. It is very difficult to distinguish between normal and pathological grief, and the majority of bereaved people will manage to come to terms with their grief over time. However, there are some people who will experience an extreme overall reaction, persistent symptoms, or an over-intensive manifestation of one of the symptoms of grief. Why does that happen? Often it is because not all stages of grief have been processed, and because each of us is different and we all react to situations and events in different ways. In the chapter “Types of Grief”, I will explain how to know when grief has turned into a complication and when to seek professional help.

Grief is a response to the dissolution of an important bond. The deeper the attachment between the deceased and the bereaved, the stronger the grief reaction can be. Evolutionary scientists often explain grief as the need to maintain important bonds in families, social groups, and communities that we as humans form over the duration of our lives. We will look at some other explanations of the grief experience which have been formed by science in the last few decades. I find that it helps my clients to understand some theories behind grieving, to see how some of the emotions and feelings they are going through can be explained through the lens of scientific knowledge. In the chapter “Types of Grief”, I will briefly present some of the major theories that explain grief which I find helpful in my work.

In this book, I share many stories of grief, some of them real written with the permission of my clients and some of them fictional, inspired by the real life stories I witness around me.

I am very grateful to the clients who have shared their stories with me. They must remain anonymous, but I acknowledge that this book could not have appeared without them. All the names (and most details of their stories) have been disguised to preserve confidentiality. The emotions, though, remain intact and all stories reveal the extensive work that the bereaved had to go through to enable them to come to terms with guilt, self-reproach, and the pain of grief.

Chapter two. Myths and Truths About Grief

«While grief is fresh, every attempt to divert only irritates. You must wait till it be digested, and then amusement will dissipate the remains of it.»

Samuel Johnson (1709—1784)

The death of a loved one always brings sadness and overwhelming feelings of loss, loneliness, and despair. Before we proceed, I would like to explain a few terms used in this book, which are often confusing. Bereavement refers to the loss of a loved one. Grief is a reaction to bereavement: a severe and prolonged distress in response to the loss of an emotionally significant figure which may manifest itself in psychological and physical symptoms. Grief is what you feel inside. Mourning is what you show outside, it is the external display of grief. Mourning is crying in public, wearing black clothes (common for widows and other close relatives, in many cultures), and avoiding events.

But if someone does not mourn their loss publicly, doesn’t cry, or doesn’t want to talk, this does not mean that the person doesn’t experience grief. What you show and what you feel can be two different things. Grief will usually present itself through psychological and physical symptoms. I emphasize, again, that many feelings of grief may be hidden, and a grieving person may only share a part of what they feel inside.

Symptoms of grief can be divided into affective, behavioral, cognitive, and physiological (or somatic) manifestations.

Affective symptoms may include depression, despair, anxiety, guilt, anger, disbelief, numbness, shock, panic, sadness, anhedonia (loss of ability to enjoy pleasurable activities), and feelings of isolation and loneliness.

Behavioral symptoms may include agitation, fatigue, crying, change in social activities, absent-mindedness, social withdrawal, or seeking solitude.

Cognitive symptoms may include preoccupation with thoughts of the deceased, lowered self-esteem, self-reproach, helplessness and hopelessness, inability to believe in the loss, and problems with memory and concentration.

Physiological symptoms may include loss of appetite, sleep disturbances (feeling lethargic or not being able to sleep through the night), loss of energy and exhaustion, physical complaints similar to those the deceased had endured when alive, drug abuse, and susceptibility to illness and disease.

Grief may also lead to spiritual emptiness and pessimism.

Grief symptoms can be overwhelming and distressing. However, it is important to accept them and not avoid them. It is helpful to keep in mind that all of your symptoms and reactions are common and natural, and that you are not alone.

Grief as a reaction to an immediate loss can present itself in two forms. The first one is protest, defined as a preoccupation with loss, the feeling of pain, agitation, and tension, and accepting the possibility that the deceased may reappear. The second is despair, defined as the opposite of protest and characterized by depression, persistent sadness, and a withdrawal of attention from real life. Protest and despair may come and go in phases. Often protest sets in first and then despair takes over. In both the protest and despair states, feelings of guilt, anger, and anxiety are present and are experienced by grieving individuals.

Grief symptoms may be different, depending on the type of loss. For example, the loss of a spouse awakens feelings of loneliness and abandonment, while the loss of a child evokes feelings of having failed to protect the child, and self-blame. We will look at the differences in grief, depending on the type of loss, in further chapters.

Grief has been described as an emotion; however, it is currently being regarded more and more as a disease. As this trend continues, grief will accrue more and more definitions particular to disease and will lose the definition of being an emotion.

Earlier research provides solid evidence of biological links between grief and an increased risk of illness and mortality. Bereaved individuals are at higher risk for depression, anxiety, and other psychiatric conditions, and are highly susceptible to infections and a variety of other physical illness due to a considerable weakening of the immune system. Bereaved individuals have higher consultation rates with doctors, use more medication, and are more often hospitalized. An increased risk of mortality and suicide is associated with medical conditions in bereavement.

Needless to say, people in grief will neglect their own health by not maintaining a well-balanced diet, forgetting to take necessary medications, not getting enough sleep, and not exercising. Some may abuse alcohol, smoke excessively, use drugs, or engage in other self-destructive behaviors.

Social support is very important in grief. However, a grieving person should be advised to designate their own comfortable boundaries of support (for example, by telling people what exactly they can do to help them, when, and for how long they would like to be together, or sharing that they may not want to do certain activities now, but would consider doing them later).

Finally, the grief process may be different for every individual. It is important for the bereaved to do as they feel, especially during the mourning phase: to be left alone if they so wish, or allowed to cry or to have a chance to talk to someone when they feel the need. It may be helpful to engage in activities that help commemorate their loved one: for example, through attending religious services, visiting the gravesite, praying, creating a memory book with photos and stories, or assembling a memory box with the belongings of the deceased, or by giving to a good cause such as medical research, a scholarship fund, or charity.

Grief is often compared to Post Traumatic Stress Disorder (PTSD), particularly in the acute phase of traumatic grief, which holds similar symptoms such as re-experiencing, avoidance-numbing, increased arousal, guilt, shame, changes in value systems and beliefs, and a search for meaning. Often, in traumatic grief, the relatives of the deceased are preoccupied with issues surrounding the trauma such as the pain of dying, the cause of death, and self-blame for not being able to protect/save or for having survived. Traumatic images flood the consciousness of survivors.

In grief, it is important to resolve feelings of guilt, anger, anxiety, and depression. Sadness occurs both in depression and grief. The difference is that in grief, sadness is focused on missing the person who died, while in depression, sadness is focused on hopelessness and helplessness about self, the world, and the future. Sadness is normal in grief; however, depression in a time of grief can make it very difficult to come to terms with loss and reconstruct a life going forward.

There are a lot of examples of unhelpful thinking that can block the normal bereavement process and cause emotional distress. Negative thinking can lead to the symptoms of complicated grief and depression. For example, self-blame or self-reproach can heavily impact the emotional condition of the bereaved.

In overcoming the pain of grief, it is critical to consider what is causing self-blame and other negative thinking about self, the world, life, the future, and what causes anxious and depressive avoidance behavior. Often patients with complicated grief continue to perceive their loss as “unreal” or remain preoccupied with thoughts and recollections of the deceased or the death event. Working through grief in therapy helps patients change the perception of loss into something more “real”, helps them to acknowledge their loss, and ensures the loss is recognized as permanent and not reversible. Unless this is done, thoughts of the deceased will constantly bring fresh emotional distress and sorrow.

Let’s look at some myths and negative thoughts that may be obstacles to recovery, and consider how to handle them.