Typical and Atypical Grief

A recent study of the grief response, published in JAMA (Journal of the American Medical Association), supported the experience that I have had in working with people with grief over the years. The research made three very interesting points.

First, there is a common and rather consistent pattern of five stages of grief that occur over approximately six months –
1) disbelief
2) yearning
3) anger
4) depression
5) acceptance.

There isn’t a sharp demarcation between stages - rather they evolve gradually from one to the other where the next stage begins to predominate over the preceding one.

The second finding – much stronger here than in the literature when I did research for my dissertation on grief in 1980 – is the importance of “anticipatory grief” in shortening and easing the work of grief. In cases where death followed a prolonged illness, especially where the loved one suffered for an extended period of time, death was easier to accept. When death comes suddenly, such as an accident or an acute illness, grief is more difficult to accept and frequently is more painful and takes longer.

The third significant finding is that while about 85% of people have a general sense of acceptance after about six months, nearly 15% take longer, sometimes much longer. The two researchers speculate as to the reasons for this – from the particular nature of the relationship with the deceased person to individual characteristics of the survivor.

From 25 years of clinical experience, it is clear that when grief is extended, there are many individual reasons that grief can be difficult to resolve. And when those reasons are explored and articulated in treatment, my patients and I have found that the grief process can begin to move forward. It is important to note that “normal” grief doesn’t mean that the survivor no longer has feelings about the lost loved one after six months – only that they become both less frequent and less powerful.