Addressing the question of what's "normal" or "expected" in grief is part and parcel of working in the field of grief and bereavement. Nevertheless, I still cringe every time someone asks me this because my answer is that is that there is no "normal" and this feels less than helpful. I do think there's some comfort to be found in the knowledge that, although your grief reactions feel distressing and out of control, they are likely okay, safe, and acceptable, but when you just want things to be predictable and manageable, it's frustrating to receive answers that are ambiguous and vague. It's like having someone answer your question with a question (which is obviously the worst).
People can sometimes feel like they're flailing the absence of black-and-white answers, so in this article, I'd like to try and approach this topic as deliberately and systematically as possible.Today is just about providing a framework for conceptualizing difficult and distressing experiences. There will be nuances we cannot cover this particular time around, some of which we've addressed in the past.
There's one more reason why we think this is important. When we write about specific grief-related experiences (for example, experiences like rumination, anxiety, isolation, and avoidance) we often receive comments from people telling us to stop pathologizing their grief because in their specific experience this behavior is normal. So this post is partially a response to this common (and correct) sentiment.
The specific grief response:
It's not possible to split grief responses into two categories where one category is "normal" and the other is "abnormal". It doesn't work this way. Some behaviors are so far beyond the norm that they are considered atypical (for example, talking loudly to someone who others can't see), but most of the time in grief it's not the inherent nature of the behavior that qualifies it as problematic, rather it's how that particular grief response manifests in the individual's day-to-day life.
Take anxiety, for example. Anxiety is normal and everyone experiences it from time-to-time. However, some people experience anxiety to a degree that causes great distress and interferes with their day-to-day life. In this instance, a normal emotion is experienced in a dysfunctional way.
When we can't label an emotion or behavior as normal or abnormal, helpful or unhelpful, good or bad, we instead must look at in on a continuum where the response is normal except when experienced to a certain degree or dimension. If all you're hearing right now is "Wah, wah, wah, wah" don't worry, I'm going to break this down a little further. If you're worried about a particular grief response, ask yourself the following four questions.
1. Does the response make sense given the situation?
In order for an emotion or behavior to be considered abnormal, it needs to be out of context for the situation. Certain situations call for more extreme responses than others. For example, it's normal to panic when you're walking through the woods and see a bear, but it's not normal to panic when you're walking through your neighborhood and see a dog. It's normal to feel a lot of anxiety before giving an important presentation, but it's not normal to feel a lot of anxiety before leaving a voicemail for your dog sitter. You get the picture.
After a loved one dies, it's normal to feel many distressing emotions. Depression? Fear? Anxiety? Confusion? Insomnia? Yes...yes...yes...yes...and yes. For this reason, doctors and clinicians are cautioned against diagnosing patients with depression in the weeks following a loss, because these experiences make sense in the context of bereavement.
Typically, the intensity of these responses diminishes over time, as explained by grief researchers Shear et al (2011),
“Studies show that for most people grief intensity is fairly low by a period of about 6 months. This does not imply that grief is completed or resolved, but rather than it has become better integrated, and no longer stands in the way of ongoing life.”
Of course, it's normal to experience intense grief on certain days and in the presence of certain triggers even years later, but these instances should grow more infrequent and become increasingly more manageable.
Which brings us to our second question.
2. How long has this been going on?
A distressing grief response that would be considered normal in the weeks and months following a loss may signify a problem if it becomes prolonged and/or chronic. For example, after the death of a loved one, it may be protective for a person to withdraw a little until they feel strong enough to face the world. However, if this person doesn't leave the house for weeks or months, then a response that seemed adaptive in the first few weeks may now be considered maladaptive.
3. Is the response causing ongoing personal distress?
People tolerate and withstand experiences differently and many times a response becomes problematic simply because it's causing distress to the individual. There are several things to consider when thinking about personal distress.
The individual's baseline:
Certain grief experiences cause such a profound shift in a person's identity and day-to-day functioning that it causes them to feel distressed. For example, when we talk about loneliness and isolation readers often comment that isolation isn't a problem because they happen to love their alone time. To which I say, me too! However, many other people happen to have really enjoyed having lots of social interaction prior to the death or depended upon the person who died for social contact. So, for these people, having copious amounts of alone time may be a distressing shift.
The individual's comfort level with distressing thoughts and emotions:
I write a grief website so suffice it to say, I'm pretty comfortable with grief-related emotions. However, on the other end of the spectrum, there are many (many, many) people in this world who are really (really, really) not comfortable with certain distressing emotions. For these people, coping with grief may be especially disorienting.
Also, grief often brings on new and unfamiliar emotions, thoughts, and experiences - for example, thoughts and feelings related to losing control, being unsafe, or feelings of emptiness/nothingness. These experiences may be entirely new to the grieving person and they may struggle to effectively cope with them.
Suicidal thoughts include thoughts like "I have no reason to live" or "Things will never get better for me, so what's the use?". If a person is having suicidal thoughts, then you can assume they are experiencing intense personal distress that they are struggling to constructively cope with. No matter how serious the thoughts seem, it's important to take steps now to find support, identify outlets for coping, and to know what to do when in crisis.
If you or someone you know is having thoughts of harming yourself or anyone else, please call the suicide hotline at 1-800-273-TALK. You can also call 911 or go to the local emergency department. Although the support you find online can sometimes make a difference when you’re feeling distressed and emotional, the Internet should never be anyone’s last line of defense. This is especially true if you have been having thoughts of suicide. That said, the Suicide Prevention Lifeline's website, https://www.suicidepreventionlifeline.org, also provides other resources including:
- The option to chat with someone as opposed to calling them on the phone
- The ability to locate crisis centers in your area
- Specific resources for young adults and veterans
4. Is the response causing impairment?
Occasionally, a person may engage in behaviors that they believe (or want to believe) are normal, but aren't. This can happen when a person experiences a serious psychological disorder that causes them to lose touch with reality (for example, a person engaging in reckless behavior while manic). It can also happen when a person rationalizes a behavior or denies it is having a negative impact on their day-to-day life out of fear and/or avoidance (for example, substances use or other behaviors used to avoid unpleasant thoughts, experiences, and emotions). In these instances, the behavior may not outwardly cause distress, but it gets in the way of the person's day-to-day functioning and/or prevents them from living a life in accordance with their values.
Wrapping it all up
Some of you may be reading this because you're considering seeing a counselor, going to a support group, or pursuing another grief coping measure. Although I hope this article has helped you to assess your grief responses, I like to add that you don't have to have a "problem" to get help. People often think their experiences must hit a certain threshold of distress or severity before they can rationalize actively seeking support and solutions, but the truth is that it never hurts to have little extra help/support/advice/insight/guidance/whatever-you-need when you're grieving.
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What’s Your Grief? Lists to Help you Through Any Loss is for people experiencing any type of loss. This book discusses some of the most common grief experiences and breaks down psychological concepts to help you understand your thoughts and emotions. It also shares useful coping tools, and helps the reader reflect on their unique relationship with grief and loss.
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