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Features Behavioural Sciences
Complicated grief


December 12, 2019
By Peter Collins


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Grief is a natural occurrence in our life and everyone grieves in their own way. In the acute stage of grief, it is normal for a bereaved person to experience intense emotions and a preoccupation with thoughts and memories of the person who died. Some individuals may feel that they will never be happy or fulfilled again but eventually, over time, most adapt to their loss and that the future holds happiness, joy, connection and meaning, albeit in a world without the deceased. The reality of the loss is accepted and the loss is no longer preoccupying or disruptive. Ultimately, the majority of individuals who grieve do not require therapy.

Approximately seven to 10 per cent of those bereaved will experience a persistent, prolonged and impairing grief, a condition referred to as complicated grief. Other terms, for this condition, include “pathological grief,” or “unresolved grief,” or “prolonged grief disorder.” According to Igleicz et al (2019)1 a higher percentage of those who have lost a child or have lost a loved one from suicide, accident or murder, are at greater risk for complicated grief.

Who else is more at risk for complicated grief? According to Shera et al (2011)2, complicated grief is more common in females, in individuals who have a history of a mood disorder, and individuals who are pessimistic and were overly dependent on the deceased.

Without appropriate treatment, those who suffer from complicated grief are more at risk for developing a major depressive disorder and are susceptible to a general deterioration of their health, substance abuse, suicidal ideation and suicidal behaviour.

Complicated grief can also impair personal, family, social, educational and occupational areas of functioning. Roadblocks to adapting to the death — which can lead to complicated grief as such — include dysfunctional thinking, maladaptive behaviour and difficulties with the regulation of emotions — especially if alcohol and/or drugs are used to self-medicate.

Individuals who suffer from complicated grief may believe that nothing can assist them in getting on with life, but they should be encouraged to seek out treatment from a health professional.

What can we do, in the profession of law enforcement, to assist our colleagues who may be experiencing complicated grief? Here’s a starting point:

  • As mentioned above, the individual should be encouraged to seek out professional assistance. Typically, a health professional will provide psycho-education on what constitutes complicated grief to the patient and why people grieve;
  • Individuals should monitor their grief and take five to 10 minutes at the end of each day and think back over the day and identify the time(s) the grief was at its highest and rate it on a scale of one to 10, noting what was happening at that time. Monitoring the days that are the highest for the week and lowest for the week can be useful, especially when discussed with the counsellor/therapist;
  • Set positive, future-oriented personal goals;
  • Reconnect with others in addition to making plans for interesting or fulfilling goals. The bereaved person should seek out at least one person who can act as a confidant. The bereaved person should be encouraged, over time, to re-engage in different social activities as they feel ready to do so;
  • Sharing the story of the loved one’s death can be therapeutic and can help the person accept the reality of the death. Telling their story shouldn’t be limited to the time immediately after the death. Many people may feel that having the bereaved speak about the deceased, over time, is counterproductive and they become harsh in their insistence that the person refrain from doing so. As a result, a person experiencing complicated grief will avoid such discussions. When guided, in a professional therapeutic setting, the telling and revisiting of the story can assist the person with coping over time;
  • Many people living with complicated grief believe they should avoid events, thoughts, people, places and activities that remind them of their loss. These reminders should not be avoided. Although “bittersweet,” they hold benefits as well as pain. It is suggested that a ranked list of places and activities that have been avoided can be revisited, either alone or with a friend.

In summary, therapy for complicated grief addresses seven core themes: (1) understanding and accepting grief, (2) managing painful emotions, (3) planning for a meaningful future, (4) strengthening on-going relationships, (5) telling the story of the death, (6) learning to live with reminders, and (7) establishing an enduring connection with memories of the person who died.

This article is dedicated to the memory of my father, Sydney P. Collins z”l (1922-2019).

References

1. Iglewicz, J., Shera, M., Reynolds, C., Simon, N., Lebowitz, B. & Zisook, S. (2019) Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. Depression and Anxiety wileyonlinelibrary.com/journals/da. doi:10.1002/da22965
2. Shera et al (2011) “Complicated grief and related bereavement issues for DSM-5” . Depression and Anxiety. 28 (2): 103–17. doi:10.1002/da.20780

 

Dr. Peter Collins is the operational forensic psychiatrist with the Ontario Provincial Police’s Criminal Behaviour Analysis Unit. He is also a member of the crisis/hostage negotiation team of the Toronto Police Service Emergency Task Force. His clinical appointment is with the Centre for Addiction & Mental Health in Toronto, and he is an associate professor with the University of Toronto. Dr. Collins’ opinions are his own and may not reflect the opinion of the OPP, University of Toronto, CAMH or his mother. Contact him at peter.collins@utoronto.ca.


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