To understand what grief is from a psychological standpoint, it is necessary to understand the terms "cathexis" and "decathexis". A cathexis is a concentration of emotional energy towards a person, thing, or idea. When a sibling dies, survivor siblings must go through the process of decathexis, or the gradual weakening and separating of this emotional tie. It is a painful process, that we call the grief process.
In my experience, both as a clinician and researcher, I have found that, in siblings, the grief process does not always result in a complete separation. For this reason, the grief of siblings does not fit well into some of the existing theories of grief stages.
Grief is either "uncomplicated" bereavement (normal grief) or "complicated" bereavement. Complicated bereavement takes many forms, such as the absence of grieving, conflicted grief, pathological grief, and chronic mourning. First, we'll look at normal grief.
Professionals in the field of psychology use a book called the "Diagnostic and Statistical Manual of Mental Disorders, fourth edition" (or DSM-IV for short) to diagnose their patients and clients. Here's what the DSM-IV says about bereavement.
(Also called "normal grief")
This category can be used when the focus of clinical attention is a reaction to the death of a loved one. As part of their reaction to the loss, some grieving individuals present with symptoms characteristic of a Major Depressive Episode (e.g. feelings of sadness and associated symptoms such as insomnia, poor appetite, and weight loss). The bereaved individual typically regards the depressed mood as "normal," although the person may seek professional help for relief of associated symptoms such as insomnia or anorexia.
The duration and expression of "normal" bereavement vary considerably among different cultural groups. The diagnosis of Major Depressive Disorder is generally not given unless the symptoms are still present 2 months after the loss.
However, the presence of certain symptoms that are not characteristic of a "normal" grief reaction may be helpful in differentiating bereavement from a Major Depressive Episode. These include
- guilt about things other than actions taken or not taken by the survivor at the time of the death;
- thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person;
- morbid preoccupation with worthlessness;
- marked psychomotor retardation;
- prolonged and marked functional impairment, and
- hallucinatory experiences other than thinking that he or she hears the voice of or transiently sees the image of, the deceased person.
Source: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorder. Fourth Edition. Washington DC, American Psychiatric Association, 1994, page 684-685.
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Now, let's look at some of the forms of complicated bereavement.
Anticipatory Grief and Unanticipated Grief
Anticipatory grief occurs when you know in advance that your loved one is going to die. You start getting ready psychologically, and you begin the grieving process. For someone who has been visiting the hospital or hospice daily, the death may be the last stage of grief.
The strange thing about this anticipatory grief is that it can result from an imagined death. Everyone has heard about the famous "Dear John" letters that soldiers get during wartime, when their wife or girlfriend finds a new love. This is not surprising, when you consider anticipatory grief as a factor. As soon as she finds out her husband is going to war, the wife imagines the worst and prepares herself--without realizing it, she begins to grieve and to go through the process called decathexis, or emotionally separating herself from her lost love. After a period of time, her grief process ends, and she is ready to love again.
Unanticipated grief, on the other hand, follows a sudden death that was not expected, such as deaths that occur in car accidents, aircraft crashes, and murder. Our human minds need time to grasp events, and without that time buffer, serious complications can occur. The pattern of recovery is extremely uncertain, but includes withdrawal from relationships, and a lifelong fear of loss, and fear of associations to the cause of death.
Conflicted grief occurs when your relationship with the deceased was ambivalent (you had both love and hate for the person). Initially, the bereaved person does not show a lot of pain, but later feels a great deal of sadness and guilt about the hate part of the relationship.
Chronic grief occurs when the survivor was totally dependent on the deceased person. These survivors are insecure and anxious and need the deceased person's presence to soothe them--something they never learned to do for themselves. Hanging on to the grief is the closest they can come to hanging on to the deceased.
Distorted grief is more unusual than the other forms of complicated grief. Often associated with great anger or guilt, this grief takes unexpected forms, such as the development of a symptom that the deceased had prior to death. Other signs of distorted grief are overactivity without a sense of loss, a conspicuous change in behavior, hostility towards a specific person, and the taking of actions that are self-destructive.
Absent, Delayed, and Inhibited Grief
These are fairly self-explanatory. Absent grief is difficult to determine, because there is always the possibility that the survivor will eventually realize the loss and start to grieve. Delayed grief is fairly common, because there are many reasons grief might be delayed. People will delay their grief for purposes of survival. Mothers will often put their grief process on hold in order to protect their children. Inhibited grief occurs when some part or feelings associated with the loss are not expressed.
This is simply a term which applies to all of the forms of complicated bereavement. How do you know when grief is resolved? Some say it is resolved when the bereaved can love again. Possibly, the resolution continues at ever-increasing depth, for years, even a life-time, until the part of the self that was lost at the time of death is available again to the whole self. This is often experienced by the bereaved as a re-birth.