The Inability To Mourn
Martha Vanschaick
Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. Most people experiencing normal grief and bereavement have a period of sorrow, numbness, and even guilt and anger. Gradually these feelings ease, and it's possible to accept loss and move forward.
For some people, feelings of loss are debilitating and don't improve even after time passes. This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble recovering from the loss and resuming your own life.
These differences are normal. But if you're unable to move through these stages more than a year after the death of a loved one, you may have complicated grief. If so, seek treatment. It can help you come to terms with your loss and reclaim a sense of acceptance and peace.
During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually start to fade over time, those of complicated grief linger or get worse. Complicated grief is like being in an ongoing, heightened state of mourning that keeps you from healing.
At times, people with complicated grief may consider suicide. If you're thinking about suicide, talk to someone you trust. If you think you may act on suicidal feelings, call 911 or your local emergency services number right away. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
It's not clear how to prevent complicated grief. Getting counseling soon after a loss may help, especially for people at increased risk of developing complicated grief. In addition, caregivers providing end-of-life care for a loved one may benefit from counseling and support to help prepare for death and its emotional aftermath.
Yet, in Melancholy Acts: Defeat and Cultural Critique in the Arab World, Nouri Gana weaves a different articulation of melancholy. To Gana's mind, melancholy blossoms into forms of resistance, emerging at the crossroads of sorrow and defiance. It does not yearn to sever ties with the entity of loss, nor does it endeavor to immortalize loss itself. Rather, it transforms grief into a claim or a grievance, becoming an integral thread in the psycho-affective fabric of resistance. It echoes in the calming voice of Al-Dahdouh, microphone in hand, tears streaming; in the resonant ululations of a mother as she bids farewell to her son; in the defiant spirit of the warrior who, amidst mourning his impending martyrdom and the loss of comrades, kin, and beloved, summons a strong heart, an unyielding prowess to move his body at the nexus between human and machine, at the gallow of a tank.
Beginning the work of mourning necessitates acknowledging the colonial condition, and therefore also the distinct performances and possibilities of mourning, melancholy, and grief. It is at this juncture that Judith Butler's argument falters; she depoliticizes mourning, failing to account for the inherent structural power involved, even though she points towards these contextual elements. This leads her to hold Palestinians equally accountable to the structure that produces subjective violence. That is, she holds both the state of Israel and the Palestinian resistance groups accountable, equally.
Moreover, the Palestinian inability and unwillingness to begin the process of mourning is paradoxically entwined with an Israeli sense of invincibility, wherein not only is mourning permitted, but it is also weaponized and projected as political anger and aggression. This colonial form of mourning transforms Palestinians into modern-day equivalents of the Amalekites, fueling a yearning for power, autonomy, and unchecked militarism. It engenders a racialized discourse that redirects the grief and anger of the Holocaust onto a people who simply existed where the state of Israel was to be established. We reside in this place, whether by accident, coincidence, or sheer fate, as lambs sacrificed at the altar of Jewish memory of vulnerability, which is politicized every time we dare to resist.
For Palestinians to begin the work of mourning is for the war in Gaza, and the slow unbridled horizon of living within a horizon of revulsion and erasure, to end. Until there is a real ceasefire, one that allows us to commence the work of mourning, our resistance will fight for our right to mourn.
Objectives:
- Differentiate between the normal grief process and prolonged grief disorder, recognizing the key distinctions and criteria for each.Screen for risk factors that may predispose patients to prolonged grief.Apply evidence-based treatments and therapeutic approaches in managing prolonged grief disorder, tailoring them to the individual patient's needs.Improve care coordination among interprofessional team members when planning therapy to optimize patient outcomes.
Grief is a natural and universal response to the loss of a loved one. The grief experience is not a state but a process. Most individuals recover adequately within a year after the loss; however, some individuals experience an extension of the grieving process. This condition, identified as prolonged grief disorder, results from failure to transition from acute to integrated grief.[1] Symptoms of acute grief include sadness, tearfulness, and possibly insomnia, and typically require no treatment. Prolonged grief disorder involves intense, painful emotions associated with a lack of adapting to the loss of a loved one that persists for more than 1 year in adults and more than 6 months in adolescents or children. This condition is estimated to affect as many as 7% of bereaved individuals.[2][3]
Intense grief can have physical consequences and may trigger the acute onset of myocardial infarction, particularly in people with higher baseline cardiovascular risk.[5] There is a correlation between complicated grief and acute coronary syndrome. Takotsubo cardiomyopathy, also called broken heart syndrome or stress cardiomyopathy, is another cardiovascular syndrome triggered by intense grief. This condition is a weakening of the left ventricle leading to apical ballooning caused by severe emotional or physical stress, such as losing a loved one, sudden illness, a severe accident, or a natural disaster (eg, earthquake). Takotsubo cardiomyopathy occurs in women 90% of the time, most commonly in postmenopausal women, and often resolves within a month.[6]
Traumatic circumstances such as the death of a spouse or a child, the death of a parent in early childhood or adolescence, sudden, unexpected, and untimely deaths (particularly if associated with horrific circumstances), multiple deaths (particularly disasters), and deaths by murder or manslaughter can prolong grief.
Vulnerable people such as those with low self-esteem, low trust in others, previous psychiatric disorders, previous suicidal threats or attempts, young age of the deceased, lower perceived social supports, an ambivalent attachment to deceased people, dependent or interdependent attachment to the deceased person, and insecure attachment to parents in childhood (mainly learned fear or learned helplessness).[7][8]
Results from studies evaluating gender differences in prolonged grief show mixed results, with some showing little difference.[9] Other study results showed that men tended to exude higher levels of acute distress that decreased over time, while women tended to have increasing symptoms over time.[10] Other results have reported female gender and low social support as risk factors for prolonged grief.[11] There are likely significant personal and cultural variances affecting these outcomes.
Grief can manifest differently in patients of varying ages. Children and adolescents will grieve differently according to their developmental stages. Identifying prolonged grief in children can be challenging, depending on the child's ability to communicate their emotions and needs. Increased grief and distress can be anticipated if the loss was of a primary attachment or caregiver. Grieving children may display delays in meeting developmental milestones or anger and frustration at their needs not being met. Children rely heavily on adults and social support to help them cope and navigate the grieving process. Some specific types of distress seen in children after loss include separation distress and existential or identity distress.
If the death occurred in a traumatic fashion, it may bring up recurrent images of the trauma or complicated emotions ranging from self-blame to fear or desires for vengeance. Well-intentioned adults may limit the information given to children about death to protect them. However, they could also limit their ability to process death due to a lack of clarity of information.[12] A child's ability to conceptualize loss and death is influenced by their developmental stage, for example, an ability to comprehend abstract concepts. It is advised to seek the consultation of a professional trained in developmental stages and their influence on the grieving process to support a child's grief.
Physiologic stress resulting from intense grief can have a wide range of consequences. Increased cardiovascular and cerebrovascular events have been associated with intense grief, in some cases leading to myocardial infarctions or cardiomyopathy. Various mechanisms have been theorized to explain this association. Emotional triggers are linked to increases in stress hormones, catecholamine release, and increased sympathetic nervous system stimulation. This stress can result in hemodynamic changes, including the following:
Creating a safe space for patients to discuss their grief is essential during an evaluation, as they may be reluctant to bring it up and may need an invitation or direct question to begin talking about their grief. Patients may also not be fully aware of how their grief is manifesting and may not be aware that it could lead to many common physical complaints.
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