The background contours of bereavement

I have found that the best way to make use of these more recent theories, whilst still respecting each individual’s grief journey, is to see them as background contours (borrowing from Neimeyer’s belief that general contours of mourning exist as backdrops to individual contexts and experiences, that there are both individual and relationship contours and that ‘typical’ grief responses should be seen as general, not universal).

Reference: Neimeyer R (1999) Lessons in Loss: a Guide to Coping McGraw Hill, New York

The contours of feelings, thoughts, behaviour and physical reactions

Some feelings commonly felt by those who are grieving include numbness, sadness, anguish, anger, guilt, panic, helplessness, shock, loneliness and depression. Some members of a Bereavement Support Group that I facilitated in the past described themselves as feeling shaky, unsteady and afraid or having a hurt that is too deep for tears.

Some common thinking includes disbelief, confusion, being unable to concentrate, focusing on the loss, and disorientation. This was articulated by some members of the Bereavement Support Group as I felt there was no hope. I was confused and did not know where I was going and  I only see dark shadows and have lost sight of the light beyond.

Some common behaviour can be social withdrawal, sighing, searching and calling out, crying, restlessness and absent mindedness. Other members of the Bereavement Support Group said I have to go away to grieve – away from all the people and I've fallen off the track – my heart feels like it is outside my body.

Common physical reactions can be sleep and appetite disturbance, lack of energy, weakness and lightness in muscles, breathlessness, over-sensitivity to noise and having a dry mouth. This was described by some members of the Group as feeling like I've been through an explosion and am looking into the big black hole of space and I'm so alone – no-one is out there for me and the wheels have fallen off my cart.

The contours of common patterns of avoidance, assimilation and accommodation

Neimeyer says that these three common patterns exist in those who are mourning.

In avoidance the reality of the loss is impossible to comprehend, there is shock, panic and confusion, there is avoidance of the full awareness of too painful a reality, the mourner may act as if the person is still alive and may be unable to do normal routines, they may be disorganised and distracted, they may experience vivid emotional reactions as reality sinks in, and the sharp awareness of pain may be punctuated by the apparent denial of the reality of the death.

Neimeyer says: We accommodate loss in degrees, glancing at it, then away until it becomes undeniably real and its implications for our own future begin to be understood on an emotional level. (See reference quoted as the beginning of this post)

Assimilation is about: Learning the hard lessons of a loved one’s absence in a thousand contexts of daily living. (Neimeyer)

It is about loneliness and sorrow, longing and grief (but may also be about relief or guilt), deepening despair, withdrawal from social worlds to give more attention to ‘grief work’, there may be intrusive images and dreams, unpredictable crying spells, depressive symptoms and physical reactions and pain that comes in waves, and there may be more proneness to disease.

Accommodation is: The uneasy balancing act between remembering the past and reinvesting in the future and this continues for the rest of our lives, requiring on-going adjustments. (Neimeyer)

Accommodation includes the resigned acceptance of reality, the possible persistence of yearning and loneliness, a sense of emotional control, an improvement in concentration and functioning, reorganisation punctuated with the painful awareness of loss, possible pangs of guilt and sadness, taking two steps forward and one step back, and rebuilding a shattered social world.

Longer term contours

The grief journey can be a long climb towards reorganisation and renewal, but on a rocky path that evolves over years, not months. Deterioration may be expected on significant occasions and “grief spikes” may occur years or even decades later.

Other contours

These include loss orientation vs. restoration orientation, meaning making/ re-learning the world, continuing bonds and Neimeyer’s five tasks of mourning, and I will elaborate on these in the next post. There is so much to take on board in relation to working with grief!