The Grieving Process

 
 
 
 
Although grief is "not a linear process with concrete boundaries but, rather, a composite of overlapping, fluid phases that vary from person to person," meant only to be guidelines, normal grief does tend in general to follow Kubler-Ross's (1969) conceptualization of death and dying (Shuchter & Zisook 23). Kubler-Ross identified three partly overlapping phases:

(1) initial "shock, disbelief, and denial,"

(3) restitution (Shuchter & Zisook 23-24).

The shock phase lasts a variable amount of time, anywhere from a few hours to several weeks, and the griever experiences it by going through "varying degrees of disbelief and denial" (Shuchter & Zisook 24). The mourning phase begins at the moment that the griever acknowledges the loss both on a cognitive and an emotional level, and the griever experiences it as "periodic waves of intense emotional and often somatic discomfort," sometimes precipitating social withdrawal and "a painful preoccupation with the deceased" (Shuchter & Zisook 24). This acute phase of mourning may endure for a matter of months before it is gradually replaced by the return of feelings of well-being and a willingness and capacity to go on living (Shuchter & Zisook 24).

As R. Scott Sullender points out, loss occurs because of an attachment; "attachment and loss go hand in hand," and "grief is a reflection not just of the loss, but also of the character of the attachment." Putting it


     
 
 
 
    

 

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. Events at the time of death, such as the particular type of death, funeral, coffin, grave, and patient's visit to the grave . Change in the patient's life situation, such as environmental and psychic changes . Initial responses to the death-splitting of the ego, dissociative reaction . Occurrences of pathological grief symptoms, such as the absence of normal grief symptoms, chronicity of normal grief symptoms, delayed grief reactions . Factors in past histories, such as sensitization toward separations, sibling differences . Attempts at and defense against reunion with the lost one, such as repeating dreams, symbolic references to "reincarnation" with anxiety, symbolizing objects, slip of the tongue, internalization processes . Aggression (Volkan 232-245). Volkan (232) found, for example, that if the type of death were sudden, the subject's grief was more likely to become pathological; in fact, of the 23 subjects he studied that had undergone pathological grief, all 23 had experienced a sudden loss. An environmental change such as the need to move to a smaller home after the death of the father can also precipitate pathological grief (Volka

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