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Grief
Macmillan Encyclopedia of Death and Dying, (2003) by ROBERT KASTENBAUM, KENNETH J. DOKA, JOAN BEDER, REIKO SCHWAB, KENNETH J. DOKA, REIKO SCHWAB, KENNETH J. DOKA, NORMAN L. FARBEROW, MARGARET STROEBE, WOLFGANG STROEBE, HENK SCHUT, LILLIAN M. RANGE
There can be cognitive manifestations of grief, including a sense of depersonalization in which nothing seems real, a sense of disbelief and confusion, or an inability to concentrate or focus. Bereaved individuals can be preoccupied with images or memories of the loss. These cognitive manifestations of acute grief can affect functioning at work, school, or home. Many persons also report experiences where they dream of the deceased or sense the person's presence.
Grief has spiritual manifestations as well. Individuals may struggle to find meaning and to reestablish a sense of identity and order in their world. They may be angry at God or struggle with their faith.
Behavioral manifestations of grief can also vary. These behavioral manifestations can include crying, withdrawal, avoiding or seeking reminders of the loss, searching, hyperactivity, and changes in relationships with others.
The reactions of persons to loss are highly individual and influenced by several factors, including the unique meaning of the loss, the strength and nature of the attachment, the circumstances surrounding the loss (such as the presence of other crises), reactions and experiences of earlier loss, the temperament and adaptive abilities of the individual, the presence and support of family and other informal and formal support systems, cultural and spiritual beliefs and practices, and general health and lifestyle practices of the grieving individuals.
The Course of Acute Grief
There have been a number of approaches to understanding the process or course of acute grief. Earlier approaches tended to see grief as proceeding in stages or phases. Researcher and theorist Colin Murray Parkes, for example, described four stages of grief: shock, angry pining, depression and despair, and detachment. Recent approaches have emphasized that grief does not follow a predictable and linear course, stressing instead that it often proceeds like a roller coaster, full of ups and downs. Some of these more intense periods are predictable, such as holidays, anniversaries, or other significant days; other times may have no recognizable trigger.
Approaches during the 1990s have emphasized that acute grief involves a series of tasks or processes. Psychologist William Worden describes four tasks pertaining to grief: recognizing the reality of the loss, dealing with expressed and latent feelings, living in a world without the deceased, and relocating the deceased in one's life. Psychologist Therese A. Rando suggests that grieving individuals need to complete six "R" processes: recognize the loss, react to the separation, recollect and re-experience the deceased and the relationship, relinquish the old attachments to the deceased and the old world, readjust to the new world without forgetting the old, and reinvest. (While the language of both Worden and Rando is specific to death-related loss, their models can be adapted to other losses as well.) These and other similar models reaffirm the very individual nature of grief, acknowledging that these tasks or processes are not necessarily linear and that any given individual may have difficulty with one or more of the processes or tasks.
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