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    April  01,  2016



Grief and Loss

Normal grieving includes a variety of feeling, moods and behavior that follow a significant loss of someone or something that was meaningful to the person e.g. the death of any love one. Following are the two types of grief.

Anticipatory grief: It is a multidimensional process that includes intellectual and emotional response and behaviors an individual experiences before a perceived potential loss or grieving before and actual loss occurs.

Dysfunctional grief: It is a process that includes maladaptive intellectual and excessive or prolonged emotional response and behaviors that one intensified to the degree that an individual is unable to progress through the process of normal grieving after experiencing a significant loss.

Losing a close family member or any potential losses are unpleasant reality. Certain life events or illness may cause extreme or abrupt change in people’s life. These disabling conditions tend increasingly compromise a person’s ability to function independently. Grief is an aspect of the human situation that touches every individual, but how an individual or a family system respond to losses and how grief is expressed varies widely. The more significant the loss, is the more intense the grief. Grieving is a personal and highly individual experience. How you grieve depends on many factors including your personality and coping style, your life experience, your faith and the nature of the loss. Healing happens gradually; it can’t be forced or hurried. It’s important to be patient with your self and allow the process to naturally unfold.

Complicated grief also referred to as prolonged grief disorder. (Prigerson, vanderwerker and maciejewski, 2008). The inability to accept the fact that a loss has occurred can lead to prolong, excessive denial as well as prolonged depression. Inability to trust other, feeling that life is meaningless and suicidal ideation.

In 1969, psychiatrist Elisabeth Kubler Ross introduced “Five stages of Grief”.

Denial: “This can’t be happening to me.”

Anger: “Why is this happening?” “Who is to blame?”

Bargaining:”May this not happen, and in turn I will…….”

Depression: “I am too sad to do anything.”

Acceptance: “I am peace with what happen.”

Grief and grieving process

It is complex phenomenon which deals with multiple dimensions of grief but there is lack of explanation in context of why and how grief response occurs.

Bowl by’s proposed an attachment theory which deals with reasoning behind grief in response to death and major losses. According to this theory, attachments develop from needs for security and safety which are acquired through life. Bowl by’s proposed that grief responses are biologically general responses to separation and major losses and these behavioral response are making up the grieving processes.

Dimensions of grief The process of grief is multifaceted with bereaved individual, experiencing major physical, emotional and cognitive changes.

Physical Response It includes physical sign and symptoms such as tight feelings in throat and chest, over sensitivity to notice, breathlessness, and muscular weakness and of energy (Barton and Irwin 1992).These sensation are considered to be normal component of grief, but intermittently physical health may be seriously impaired.

Emotional response Grief is a fundamental emotional response to loss, which includes sadness, fatigue, depression, shock, anger guilt and anxiety. Although grief and depression do share a number of similar aspects including sleep and appetite disturbance, intense sadness but these aspects evident for a shorter period of time. However, the intense feeling of loneliness and isolation, following the death of loved one can make bereaved person withdraw from social contact (Worden, 1991) In most of the cases if anger will not addressed complication may occur.

Cognitive response Most of the time new thought pattern occurs in early stage mourning but disappear after short period. However, persistent maladaptive behaviors may lead to depression or anxiety. Disbelief is often initial cognitive reaction, although this response is usually transitory but it can persist and can become denial. Other cognitive response includes feeling of confusion, and difficulty in organizing thoughts. Braved may report to a sense of presence of deceased presence of auditory and visual hallucination, these feelings may be comforting and can be coping with loss. Number of behavior associated with grief generally subsides by the time.

Saima Bhimani
Registered Nurse
Bone Marrow Transplant Unit
Aga Khan University Stadium Road Karachi Pakistan



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