Motrin, Advil, Pepcid AC.

They all claim to work quickly to relieve the physical symptoms of pain and we expect to feel better within minutes. Living as we do in a culture having no tolerance for pain of any kind — especially the physical, psychological, social, and spiritual agony of grief — it’s no wonder that people who are grieving feel abnormal when they can’t stop their pain.

“No! This can’t be happening!” is our initial reaction when confronted with devastating news, as we resist facing the awful truth. This phase of protest may be present for months (in extreme, complicated cases, for years), particularly if the death was sudden, and especially if the bereaved did not see the person’s body after they died. People in protest may try to avoid any evidence that contributes to acknowledging the painful reality of this loss.

Among those whose mourning rituals permit viewing of the deceased, such viewing is an important component of the work of grief, as it confirms the fact that the person has, in fact, died. And yet, more and more families are opting for direct cremation with no viewing. If the bereaved were not present when the person died and then refuse or decline to see the deceased prior to cremation or burial, complicated or protracted bereavement may result. Many will report fantasies that their loved ones are not really dead; that it was a big mistake. “Maybe they exist on an island somewhere” (these authors have coined that delusion the “Gilligan’s Island Syndrome”), or, “Perhaps they have amnesia and are wandering around aimlessly searching for their identity.”

Once the psyche acknowledges the sad reality that a loved one has died, profound despair may follow, along with symptoms that constitute a major or “clinical” depression. While the symptoms may appear identical, these authors assert that treatment of depressive symptoms from bereavement may need to be quite different from treating depressive symptoms from other causes.

While medications may help to allay some symptoms of anxiety and depression, we hear over and over from those taking tranquilizers and antidepressants that their symptoms persist or, in some cases, are worse. As noted bereavement therapist, Peter Lynch, MSW, said at an annual Holiday Service of Remembrance, referring to the many feelings associated with grief, “The only way through it is through it.” Medication doesn’t make the pain of grief go away. Clients need to understand this important point.

Most people expect to feel better after the first year following a loss and they become frightened when they instead feel worse as they approach the second year. For anyone grieving a significant loss, and especially for someone who has lost a spouse or life partner, the first year is a time of learning to adjust and physically survive. Consider noted psychologist Abraham Maslow’s “hierarchy of needs” (1998).

As Maslow observes, the basics of food, clothing and shelter must be established as a foundation to allow individuals to proceed on a path toward self-actualization. Whether real or imagined, the majority of our clients who have lost their life partner spend much of the first year worrying about their basic survival needs. Once these issues have been resolved, the emotional impact of the loss may dominate the subsequent year. This is when profound feelings of sadness may arise, which may be especially frightening if they are not expected or perceived as “abnormal” or “pathological.” In this emergence of feeling, the meaning and significance of the loss emerges more clearly. The press of business has subsided and the bereaved person is left with what the “now what do I do with the rest of my life” questions and fears.

J. William Worden, professor of psychology at Harvard Medical School, developed a model that he calls the “Tasks of Mourning” (1991). His premise is that grief is work. It requires commitment and active participation on the part of the person who is grieving, and, these authors would add, on the part of those who wish to help them. The tasks are:

  1. to accept the reality of the loss;
  2. to work through to the pain of grief;
  3. to adjust to an environment in which the deceased is missing; and
  4. to emotionally relocate the deceased and move on with life.

Worden’s task-focused model offers a motivational framework for grief work. Time, in and of itself, does not heal all wounds. There is no magic in the one- or two-year anniversary date following a loss. Moreover, this model acknowledges that death does not end a relationship. Emotionally relocating the deceased is a dynamic process that will continue throughout the life cycle. Personalized, meaningful commemoration and ritual may facilitate this process.

Love endures death. The loss of a significant loved one is something that is not gotten “over.” Words like “closure” may evoke anger and hostility on the part of the bereaved. Things (doors, lids, bank accounts) are closed. How, then, does closure apply to a relationship that was, is, and always will be significant? The work of grief involves learning to live with and adjust to the loss. According to Worden, there may be a sense that you are never finished with grief, but realistic goals of grief work include regaining an interest in life and feeling hopeful again.

Redefining and recreating a purposeful, meaningful life poses enormous physical, social, psychological, and spiritual challenges to our bereaved clients. Educating, supporting and coaching them through the tasks of mourning may help to rekindle their desire to live and to thrive.