Grief is a natural reaction to loss.  Grief is the price of love and as long as love survives, the bond will never be broken.  Even though one may never see the other, the bond remains.  How that bond exists is important.  If the bond remains and the person is again able to reintegrate into society, then it is a healthy bond, if however, the bond prevents one from living again, then the bond is existing at an unhealthy state.  Also bear in mind, whether the loss is death, or any type of loss, complications can occur where one does fully readjust and adapt to the new situation.  In all these cases, the grieving process, while natural, became unhealthy due to a variety of issues.  In Grief Counseling, we refer to unhealthy adjustment in loss as Complicated Grief.

Complicated Grief can be seen as an extreme grief reaction beyond what is defined as normal, or as an absent grief reaction all together.  It can also be seen by its manifestations upon the mental, emotional, physical and social aspects of the person, as well as its duration.  It can occur at any point within the grieving process and keep a person at a particular stage of his/her grief.

Some cases of grief are more susceptible to complications in grieving, albeit not guarantees of complications. Such losses that are extremely traumatic as found in war, natural disaster, rape, grotesque displays of death, and acts of terrorism can have more serious imprints upon the brain and cause PTSD and grief complications that prevent the evil from being processed.  In addition, extremely painful losses such as the loss of a child or parent,  or suicide can have a more impactful sting to a person’s recovery.  Finally, sudden losses can also shock the system.  If a loved one is murdered, dies in a car crash, or one is suddenly faced with a personal loss or injury, then grief responses can be become complicated

Grief Counselors have a special role in monitoring grief trajectories to ensure they remain steady and on normal pace.  While everyone grieves uniquely, there are general human responses to loss that involve stages of denial, anger, bargaining, emotional distress, restructuring and re-adjusting to the loss itself.  Within this, individuals may bounce back and forth between stages, or oscillate in extremity of emotion from day to day, but there is a general measurement that is not equated as pathological.   Grief Counselors who are not licensed counselors need to spot complications in grief and refer patients to licensed counselors when depression or complicated grief appears.  Licensed Counselors with expertise in grief can then help the person unblock the impasse that permits the person to continue the grieving journey.

It is important to note that grief is not a pathology and individuals suffer from loss and the imbalance it causes for the rest of their lives, but what is pathological is inability to readjust to living life.  It is also important to note that the degree of the loss and attachment play a key correlation with the time to normally recover from a loss.  Time and duration are difficult assessments with deep emotional pain when grading it with a loss.   The attachment and how the person is progressing sometimes needs to be evaluated to see if the person is stuck in complication or merely still progressing at a natural rate.

Key Signs of Complications

Acute grief is extremely painful.  Someone in acute grief cannot function at first.  They are emotionally unable to rationalize, they cannot interact with others, and have no meaning for the loss.  One cannot find complications in acute grief because the grief is raw and new.  In fact, the extreme pain in acute grief is natural and important in the grieving process itself.   When someone is experiencing acute grief symptoms months or years later, depending on the loss, then one can better access if complications have occurred.  If a person is still extremely emotional over the loss as if it just occurred and is unable to process it and feels depression to the point it is crippling to life, then this is a sure sign of a complication.  These emotional intense pains will creep into every aspect of the person’s life.  One’s physical health, stress levels, sleeping patterns and immune response can all take hard hits.  In addition, one’s mental health can decline as a constant state of depression emerges over the person.  Life will no longer have any meaning to the person.  Happiness will be unattainable in any activity.  One’s social life will become isolated.  One may resign from past activities that gave oneself joy and completely disassociate from family and friends.  This will negatively affect profession and career and academics.  Finally, one will maladaptively cope with the issue through possible drug use.  As pointed out, the absence of grief can also be a sign. Maladaptive coping that prevents the person from recognizing the loss can occur.  Individuals may deny the grieving process by keeping oneself busy.  One may avoid cleaning out a deceased’s closet after a year.  These are also signs of not adjusting to the loss in a healthy way.

Complications within the Trajectory

When someone denies a terrible reality or loss, they are naturally protecting themselves.  This is normal in grief reaction, however, if denial persists, then the processing of the loss can never take place.  If a grief counselor discovers constant denial, avoidance of the subject, the person’s possessions, or areas where the person died, then there are chances of a complication in the grieving process that have prevented the person from moving forward in the denial phase.  It is no longer healthy but has become a toxic maladaptive coping mechanism.

If someone experiencing extreme adverse emotions beyond the initial acute phase of grief, then there are also signs of complications within the grieving process.  Individuals may be extremely angry, sad, or guilty even over a death.  Complicated relationships with the deceased, how the deceased passed, a person’s role in the passing of the deceased, unresolved issues with the deceased, and not expressing emotion earlier in the loss can lead to a mass of untamed emotions.  One needs to discuss these emotions and why they are exhibiting themselves later in the grieving process.  Through grief counseling, one can better understand the source of the emotions and help individuals come to grips with how they felt about the person, the person’s death and their emotions in relationship to it.

Someone who is suffering over depression, or suffering from pro-longed grief have exceeded any normal time frame.  Again time frames and duration of grief can vary, but a good grief counselor can calculate if someone is experiencing excessive duration and depression.  When the person has lost meaning to life and is unable to find happiness over an extended period of time after the loss, then the person needs professional aid in fighting off the depression which may be chemically based as well.

Other individuals suffer from an inability to reorganize their lives and find meaning the loss.  They are unable to live with the loss but still live from day to day.  Individuals may not be able to make new connections or tie the loss of the past to the present and future.  They remain stuck in the past and unable to proceed into new venues.  They feel obligated to the past.  They may utilize maladaptive practices such as drugs to cover feelings or ignore new events.  They may not be able to visit a grave, or discuss the loss.  The deceased’s past is only of pain, with no remembrance of happiness or smiles.  Healthy grieving permits one to have both sad and happy memories.  It allows one to make new connections with people without feeling a betrayal to the deceased.  It permits one to find meaning in the deceased’s life and push forward with that meaning into other venues or social agendas.

Resiliency

Most individuals who grieve losses face difficult acute phases but grieve naturally.  They are able to process the loss and move forward in life despite the pain.  For the percentage who does not grieve normally, one should not consider weak.  Resiliency to loss has many factors.  The nature of the loss itself has a large impact to the adjustment to it.  Again, objective natures of loss can play a key role into how one recovers.  Traumatic, stigmatic, sudden, or severe loss can play key role in preventing processing of a memory or loss.  Others who face complications may have family history of depression and a natural serotonin imbalance, hence reducing resilient behavior.  Still others without emotional support can face a difficult uphill battle in adjusting to the loss.  Individuals with family and social support have an easier time healing from loss than those alone or with unsupportive friends and family.  Others have proper guidance to avoid maladaptive coping mechanisms such as drinking and find guidance in support groups that offer other venues to cope with loss.  Prayer, mediation, exercise and hobbies are ways they adjust to the pain and loss itself.  Finally, individuals whether religious or not that hold to some world view to anchor them have a better chance of adjusting to loss over time.

Conclusion

Hence when grief is not processed properly, complications can occur within any point within the trajectory.  Complications manifest in extreme emotions or lack of emotions well beyond the acute phase of grief and duration of these emotions exceed normal process ranges.  They prevent the person from moving forward and adjusting to the loss in a healthy way.  Grief Counselors play a key role in helping individuals remain on a healthy trajectory, with special care to the unique grieving situation.  Licensed counselors who are also grief counselors can play a key role in helping those who fall off the healthy trajectory and help them again find the care they need to find adjustment to the loss.

Again it is important to note that grief is normal.  It is  natural and healthy process.  Grief is not an imbalance that needs corrected.  There is no true recovery but more so a process that leads to acceptance of the loss and finds meaning in the loss.

To better help others through the grieving process, the American Academy of Grief Counseling and AIHCP offers a four year Grief Counseling Certification for qualified professionals.  The program is online and independent study and open to those interested in helping others navigate the murky waters of grief. Please review AIHCP’s Grief Counseling Program and see if it meets your academic and professional goals.

Additional Resources

“Complicated Grief”.  The Mayo Clinic.  Access here

“Complicated Grief.” The Cleveland Clinic.  Access here

Sutton, J. (2022). “How to Treat Complicated Grief in Therapy: 12 Examples”. Positive Psychology.  Access here

Shear, K. et, al. (2013). “Bereavement and Complicated Grief”. Psychiatry Rep. 2013 Nov; 15(11): 10.1007/s11920-013-0406-z. National Library of Medicine.  Access here

Talbbl, R. (2017). “Six Signs of Incomplete Grief”. Psychology Today.  Access here