Understanding Grief: Types, Models, and Impacts

Anticipatory Grief

Happens before the actual loss occurs; common when a loved one has a terminal illness or is nearing death; the grieving process starts early, bringing emotions like sadness, anger, guilt, or even relief when the loss finally happens; can be helpful in allowing people to prepare emotionally, but it doesn't necessarily make the loss easier.

Ambiguous Grief

Happens when a loss is unclear or lacks closure; two types: physical absence but psychological presence (example: a missing person, a kidnapped child, or an estranged loved one) and physical presence but psychological absence (example: a loved one with dementia, addiction or severe mental illness); can be hard because there is no certainty, making it difficult to grieve fully.

Disenfranchised Grief

Happens when a loss isn't socially recognized or validated; society may not acknowledge the grief, making the person feel isolated; examples include losing a pet, grieving a miscarriage or infertility, and the death of an ex-partner or a secret relationship; the lack of recognition can make grieving more painful.

Complicated Grief

When grief is intense, long-lasting, and interferes with daily life; the person may feel stuck in grief, unable to move forward; can involve persistent yearning, intrusive thoughts, guilt, or an inability to accept the loss; often happens with sudden, traumatic, or deeply significant losses.

Primary Grief

The initial and direct grief related to the loss itself; example: the immediate sorrow after losing a loved one; this is the core emotional response to loss.

Secondary Grief

The ripple effects of loss that impact other areas of life; example: after a spouse dies, secondary grief may include financial struggles, loneliness, or a shift in identity; the secondary losses can sometimes feel just as painful as the primary loss.

Traumatic Grief

Grief combined with shock and trauma, often after a sudden, violent, or distressing loss; can involve PTSD-like symptoms, flashbacks, or extreme fear; examples include death by accident, suicide, homicide, witnessing a loved one's painful death, and loss due to war or natural disaster.

Ambivalent Grief

Happens when there are mixed or conflicting emotions about the loss; example: a child grieving an abusive parent - feeling both sadness and relief; mourning an estranged family member; the inner conflict can make the grieving process more confusing.

Chronic Grief

Excessive duration, individuals not making progress on getting back to life again.

Delayed Grief

At time of loss, grief is inhibited, suppressed, surfacing later only to appear excessive, usually in response to triggering event.

Exaggerated Grief

Reactions are excessive, disabling, irrational fears, physical or psychiatric symptoms, maladaptive behaviour.

Masked Grief

Complete absence of typical outward grief response, symptoms/difficulties are not attributed to their loss.

Kubler-Ross Model

Developed in 1969, and is one of the most well-known grief models; originally designed for terminally ill patients, it has been widely applied to all types of grief; stages include Denial, Anger, Bargaining, Depression, Acceptance; criticism: grief is not always linear - people don't necessarily go through all the stages in order nor experience them all.

Worden's Four Tasks of Mourning

1. Accept the reality of the loss

2. Process the pain of grief

3. Adjust to a world without the deceased

4. Find a way to maintain a connection while moving forward

Key difference of Worden's Model

Views grief as a process of active engagement rather than passive stages.

Strobe & Schut's Dual Process Model of Grief

Recognizes that grieving involves oscillation between two states.

Two stages of Strobe & Schut's Dual Process Model of Grief

Loss-Oriented Coping: Focuses on emotions, pain, and memories of the person who has died

Restoration-Oriented Coping - focuses on adjusting to life, practical changes, and personal growth

Key Insight of Dual Process Model

Grieving isn't just about expressing sadness - it also involves adapting to a new reality.

Bowlby & Parkes Phase Model

Describes 4 phases in mourning.

1. Shock and numbness

2. Yearning/searching

3. Disorganization/Despair

4. Reorganization

Sanders 6 Stage Model

Integrative model that ties together adaptive physiological response with psychosocial reactions to loss.

The truth about grief (Davis-Konigsberg, 2011)

Stages are pervasive, axiomatic and divorced from the context in which they were created.

Negative consequences of stage models

Lengthened the duration of grief for many. Mistakenly believe stages are like conveyer belt "depositing us at a psychological finish line"

Klass's Model of continuing bonds

'Death ends a life, but it does not end a relationship.' (Anderson)

Continuing bonds: internal representation of lost loved one.

Enriched remembrance: bonds maintained through prayers, shrines, memorials, pictures, storytelling, legacies.

Nora McInerny TED Talk: general theme of her talk

We don't "move on" from grief, we carry it with us and learn to move forward while still honoring the people we've lost

Impacts of suicide loss

Intense guilt and 'what if' questions: survivors often struggle with feelings of responsibility

Stigma and Isolation: suicide can carry societal judgment, making it harder for mourners to seek support

Complicated Grief: The sudden and often violent nature of suicide can lead to prolonged trauma and distress

Impacts of perinatal loss

Disenfranchised Grief: society often minimizes this loss, making parents feel they shouldnt grieve deeply

Loss of Future Dreams: Parents mourn not only the child but also the life they imaged for them

Physical Reminders: The mother may experience hormonal changes and physical recovery alongside grief

Impacts of children losing a parent

Developmental Impact: The child's age affect their understanding and coping mechanisms

Risk of Abandonment Fears: Younger children may worry about losing other caregivers

Long-Term Identity Formation: The absence of a parent can shape self-esteem and relationships into adulthood

Impact of loss of a sibling

"Invisible Mourners": Grief is often overshadowed by parental grief, making siblings feel overlooked

Identity Shifts: A sibling's loss may disrupt a person's sense of self, especially in close relationships

Survivors Guilt: If the death was due to illness or suicide, the surviving sibling may wonder why they lived

Impact of loss of an adult child

"Out-of-Order" Death: Parents are expecting to outlive their children, making this loss feel unnatural

Loss of Future Caregiving: Parents who expected their child to care for them in old age may feel especially vulnerable

Social Isolation: Others may not understand the depth of a parent's grief over an adult child

Impacts of older adults experience of loss

Multiple Losses: They often grieve spouses, siblings, friends, and even children in quick succession

Loneliness: As social circles shrink, older adults may lack support systems

Reflection on Mortality: Their own sense of time left may intensify feelings of loss and existential concerns

Negative Consequences of Overreliance on Stage Models

Rigid expectations can pressure people to 'move through stages' at a set pace, it ignores individual diffrences, can patholigize normal grief, lacks imperical support

Uncomplicated Grief

A natural response to loss that includes sadness, longing, and adjustment difficulties but gradually improves over time.

Complicated Grief (Prolonged Grief Disorder)

Persistent and intense grief that does not ease over time, often lasting beyond 12 months (6 months in children).

Types of complicated grief

chronic, delayed, exaggerated, masked

Chronic Grief

Grief symptoms persist for years without significant improvement.

Delayed Grief

Grief reactions are postponed, sometimes due to initial shock, responsibilities, or suppression.

Exaggerated Grief

Grief amplifies existing emotional struggles, leading to extreme reactions.

Masked Grief

Grief manifests in physical symptoms or maladaptive behaviors instead of recognizable emotions.

Risks of Developing PTSD from Trauma/Traumatic Death

nature of the death- violent

personal vulnerability-history and attachment

situational and social factors- lack of docial support, guilt

Bonanno's Resilience Paradox

Most people do NOT develop PTSD after trauma; resilience is the norm, not the expectation.

Key Aspects of Resilience in Trauma and Loss

Flexibility, positive emotions, and cognitive reframing help buffer against PTSD.

Toni Bisconti's Longitudinal Research on Spousal Bereavement Patterns

Studied daily emotional well-being of widows over three months, showing grief follows nonlinear patterns.

toni bisconti's spousal berevament pattern findings

emotional stabilitization overtime, however milestones (anniversaries) may increase distress

Daily Positive Emotions Study

A 98-day study of 34 recently bereaved widows tracked daily emotions and stress. Positive daily emotions were strongly linked to lower stress, depression, and anxiety.

Enriched Remembrance/Memorializing

Includes personal rituals, storytelling, community memorials.

Gudmundsdottir's Work on Embodied Grief Styles

Research focusing on the physical manifestations and impacts of grief.

Physical Manifestations of Grief

Bereaved parents often experience intense physical sensations, such as feelings of heaviness, emptiness, and physical pain, which they directly associate with their loss.

Altered Bodily Perception from grief

Some individuals report sensations of depersonalization and derealization, feeling disconnected from their bodies or perceiving the world as surreal following the death of their child.

Impact on Daily Functioning

Grieving parents may encounter disruption in sleep patterns, appetite, and overall energy levels, indicating the extensive toll grief takes on physical health.

Current Hospital Practices for Miscarriage and Stillbirth

dedicated bereavement rooms, memory making opportunities, comprehensive bereavemtn care, staff are trained for support

Bereavement Photography

Capturing images of deceased infant can be a vital part of the grieving process, offering families tangible memories to cherish.

Now I Lay Me Down to Sleep (NILMDTS)

This organization provides complimentary professional photography services to parents experiencing the loss of baby, delivering delicately retouched black-and-white photographs as enduring keepsakes.

Neonatal Immersion Photography (NIP)

NIP involves photographing the infant submerged in water, creating serene, womb-like images that some families may find comforting.

Durkheim's 4 Types of Suicide

A classification of suicide types based on social integration and regulation. Egoistic, altruistic, anomic, fatalistic

Egoistic Suicide

occurs when an individual has weak social ties, experiences isolation, or lacks a sense of belonging to a group.

Altruistic Suicide

Happens when someone is too connected to a group and dies for what they think helps the group.

Anomic Suicide

life suddenly changes and a person feels lost, confused, or like life has no rules or direction anymore.

Fatalistic Suicide

person feels trapped by too many rules or oppressive control, with no hope for change.Example: Prisoners with life sentences.

Psychological & Mental Health Factors of Suicide

Includes previous suicide attempts, mental disorders, substance use disorders, impulsivity, and poor problem-solving skills.

Social & Environmental Factors of suicide

Includes history of trauma or abuse, family history of suicide or mental illness, social isolation, major life stressors, access to lethal means, and bullying.

Situational & Cultural Factors of suicide

Includes chronic illness or disability, exposure to suicide, recent loss, work-related stress, and lack of access to mental healthcare.

Individual Protective Factors of suicide

Includes strong problem-solving skills, resilience, optimism, religious beliefs, and good physical health.

Social Protective Factors of suicide

Includes strong family and social support networks, positive relationships, and stable employment.

Healthcare & Access-Related Factors of suicide

Includes access to effective mental health treatment, reduced access to lethal means, early intervention, and crisis intervention services.

Cardinal Rules of Suicide Intervention

take every threat seriously, ask directly aboit suicide, do not leabe the person alone, listen with empathy not judgemnt, establish a safety plan, get professional help immediatly, follow up

Ageism, Self-Stereotyping & Canada's Healthcare Failures for Older Adults

Ageism in healthcare leads to undertreatment of mental health issues.

Death Rituals & Their Functions

Activities involving gestures, words, and objects, performed in a set sequence to acknowledge death.

Distrust in the Medical System & End-of-Life Decisions

Fuels doubt they will receive equal health care, or end-of-life wishes will be respected.

Religion & Coping

Provides meaning-making, social support, and afterlife beliefs. Can be both protective and distressing (e.g., fear of punishment in the afterlife)

Those who lack religious community were more prone to negative religious coping

Neimeyer & Attig's Work on Meaning Reconstruction

Reflects our natural desire to impose structure and coherence in response to loss.

2 Common Ways People Do Meaning Reconstruction

Developing a benign account of the significance of the loss and focusing on positive benefits for those left behind.

Neimeyer's and Attig's research on meaning reconstruction & and relearning the world process

Involves grieving individually and collectively, grappling with existential questions.

Attig (2000) on Narratives

Bereaved persons are challenged to move from "loving in presence" to "loving in separation"

Bereaved people face the challenge of learning how to "live meaningfully again after the loss

individual diffrences in meaning making

"Some people find the key dangling around their necks with instructions printed on it. Others are left to fend for themselves, and they do not fend as well."

Sense-making

The process of understanding and making sense of a loss, which is a stronger predictor of grief outcomes.

Benefit-finding

The process of identifying positive outcomes or personal growth that can arise from experiencing a loss.

Meaning-making

The process through which individuals find significance and understanding in their experiences of loss.

Duration of Meaning Making

The time frame in which individuals focus on comprehensibility first, and significance later in the meaning-making process.

First Few Weeks After Loss

The critical period during which bereaved individuals are more likely to find meaning in their loss.

Complicated Grief Therapy

A therapeutic approach that includes meaning-making exercises, such as retelling the story of the loss and setting new life goals.

Who needs meaning making the most?

Parents who lose children

Those who were dependent on the lost loved one

Those who lose a loved one in a sudden, unexpected or traumatic way

Bereaved spouses who has attachment issues in childhood & who found stability in their spouse

Pennebaker's Expressive Writing

Write about a highly stressful experience (deepest thoughts, feelings), 15-20 mins a day, 3-4 days

Pennebaker's Expressive Writing results

Concludes that expressive writing is associated with better physical and psychological well-being

Trauma writing outcomes

Found that people who wrote about traumas went to the doctor/hospital fewer times in the following years

Post Traumatic Growth

growth arises in 5 domains: Improved relationships, deeper spirituality, greater appreciation of life, increased personal strength, sense of new possibilities

According to Haidt, what is the difference between Adam 1 and Adam 2, and how can adversity shift our values?

Adam 1 values focus on success, achievement, and status.

Adam 2 values focus on character, relationships, and living a meaningful life.

After a tragedy, there is a brief window when people become more open to Adam 2 values like family, religion, and helping others.

Roepe & Seligman's Research

6 item measure of extent to which participants engage with new possibilities after loss

Advanced directives

Legal documents that outline a person's preferences for medical treatment in case they become unable to communicate

Legal aspects of advanced directives in Canada

Advance directives cannot currently request MAID in advance for future conditions (e.g., dementia)

Substitute decision-makers

Some provinces allow for 'substitute decision-makers' to make healthcare decisions, but not to request MAID

Organ donation and MAID

MAID patients can be organ donors, but strict protocols must be followed

Criteria for death in Canada

Neurological death (brain death): Irreversible loss of all brain function; Cardiorespiratory death: Irreversible cessation of heartbeat and breathing

MAID and death determination

Patients undergoing MAID typically experience cardiorespiratory death due to administration of medications