Complicated Grief

Rabbi Azriel Hauptman

Death is part of life, and therefore grief and bereavement are also parts of life. Our existence in the set number of years allotted to us by Hashem tends to be full of emotional ups and downs. This is normal. Indeed, even some extreme symptoms of grief are normal for a period of time and can include emotions such as sorrow, numbness, guilt, and anger. But when a person gets stuck in their sorrow and the acute symptoms of grief persist, then we might be dealing with a disorder that is often called complicated grief. Or in other words, the individual is unable to achieve Nechama.

When one is faced with the unfortunate loss of a loved one, especially when the death was unexpected or untimely, there are certain milestones in one’s bereavement process that are helpful in achieving Nechama, such as facing the reality of the loss, allowing oneself to embrace and experience the pain of the loss, and adjusting and modifying one’s life incorporating the reality that the deceased is no longer in the picture. This process is not quick, but after several months, the acuteness of the grief should start to subside, and the sense of loss and emptiness starts becoming easier to handle.

After six months to a year, if the symptoms of grief linger or become worse the person is probably experiencing complicated grief. The symptoms include focusing on little else other than the loss, excessive focus or avoidance of reminders of the deceased, numbness, bitterness, seeing no purpose in life, inability to enjoy life, not being able to reflect on the positive experiences that one had with the deceased, wishing one had died with the deceased, and social isolation. This can lead to additional problems, such as insomnia, increased risk of physical illness such as cancer and heart disease, suicidal ideation, and dependence on substances such as prescription drugs.

One of the most important factors in preventing the onset of complicated grief is talking about the grief and allowing oneself to cry and feel the pain. Although, initially the pain can be overwhelming, it is still very therapeutic. When one avoids the pain and suppresses the painful emotions, the grief just becomes stuck inside one’s psyche and starts wreaking havoc with one’s emotional health.

Another factor in the prevention of complicated grief is connecting with one’s family, friends, and community. Humans are social creatures, and our relationships and friendships are anchors that help keep us grounded in difficult times. Support groups with other people who share similar experiences can be very helpful as well. 

The wisdom of the Torah that mandates a week of Nichum Aveilim now becomes abundantly clear. The week of Shiva is a time when the mourners process their pain by talking about the deceased and connecting with their community who rallies around them to help them through this difficult time.

If months or even years have passed and someone is unfortunately suffering from complicated grief, “just getting over it” is not an option. He or she is suffering from a real mental health disorder and intervention is necessary. Therapy and/or medication is often a necessity in such a case. As grief and bereavement is a unique process and is not the same thing as typical depression, it is preferable to seek the services of a therapist that has training and experience in treating complicated grief.

It was once said, “The art of living lies in a fine mingling of letting go and holding on.” The goal of the bereavement process as well is not to forget the deceased, because something so special can never be forgotten. Rather, the goal is to have space in our heart for the full range of emotions from profound sadness to genuine joy. When we can reach this goal, we will have mastered the balancing act that is our lives.

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