Complicated Grief; Frozen in Loss

This is the last in a series of articles over the past month exploring loss and grief.  It is our hope these posts have provided chaplains and caregivers better insight into issues concerning crisis and bereavement.

There is a degree of chaos which follows any loss, no matter how insignificant it might seem. We are pulled from our place of security all the way to the edge.  From losing credit cards to the death of a loved one, the question Why always comes around. 

Suddenly it becomes a matter of being judged, cosmic payback or karma. 

Why is it happening to me?

Why do I deserve my fate?

Why am I left behind to survive alone?

Why is God doing this?

Of course, asking questions surrounding the Whys is a normal part of grieving, but when it persists and becomes acutely internalized along with a lack of resilience, there exists a bereavement disorder called Complicated Grief.

Just what is Complicated Grief?

It is life turned outside in. It is chaos. Several years ago, the National Institute of Health began to recognize the phenomenon of persistent and all-consuming grief.  Studies show that 7% of those who suffer significant losses such as the death of a child are unable to make a transition to acceptance but rather, begin to present with symptoms of PTSD or clinical depression. CG (Complicated Grief) is particularly prevalent in older adults (about 9%) who have experienced many losses over the years (parents, siblings, friends, spouses) causing a cumulative reaction. It has also been reported that at least 20% of those with substance abuse disorders have unresolved grief or CG.

Complicated Grief Defined

Complicated Grief is a persistent form of intense grief in which maladaptive thoughts and dysfunctional behaviors are present along with continued yearning, longing and sadness and/or preoccupation with thoughts and memories of the person who died.  Grief continues to dominate life and the future seems bleak and empty.  Irrational thoughts that the deceased person might reappear are common and the bereaved person feels lost and alone." ~ Columbia University Center for Complicated Grief

Katy's Story: A Grief So Deep It Won’t Die

The reason I refer to Complicated Grief (CG) as chaos is because it cycles endlessly leaving life in disarray with a seeming inability to adapt to loss.  This kind of grief was not uncommon in the patients I treated for substance abuse disorders.  But a good example of a life dominated by the chaos of CG is the story of my patient named Katy.  She suffered deeply after the death of her young son.  Her husband, a physician, and daughters were devastated by the loss as well, but only Katy found it impossible to heal.  Ultimately she became dependent upon the benzodiazepines prescribed to relieve her emotional turmoil and depression. 

For over three years, Katy refused to leave the house except to buy groceries.  When alone, she spent hours preoccupied with thoughts of Joey.  Her last words to him were cross as he went over to a friends house for an afternoon of video games and sleepover.  And she failed to tell him she loved him in response to his "Love you Mom" as he left.  Joey was accidentally shot while playing with a handgun that belonged to his friends' father less than an hour later.  Her self blame and inability to function increased until she was finally forced into treatment by her family. Luckily, Katy came to a center familiar with CG and was able to treat her dual diagnosis effectively.  She told me that "When Joey died, I died too. I stopped doing everything." Katy was finally able to engage in treatment and her condition improved dramatically.  Of course, she continues to grieve Joey's death. She regularly visits and decorates his grave. Katy created a  FindAGrave virtual memorial site and a Memorialized FaceBook page to preserve his memory, but has resumed her normal activities and is rediscovering pleasures in life.  She no longer uses mood-altering substances to cope.

"CG is a form of grief that takes hold of a person’s mind and won’t let go." ~

Dr. Katherine Shear, MD

All grief is permanent and it is experienced differently by everybody. 

For most people who face losses, the intensity begins to ebb and soften over the months.  However, this is not the case for those who suffer from CG. The negative feelings become chronic and the condition becomes diagnosable. Though CG was not included as a mental illness in its' 2018 Diagnostic and Statistical Manual (DSM-V), the American Psychiatric Association did refer to it as a persistent complex bereavement-related disorder and gave it a "v" code which identifies conditions "other than a disease or injury and are also used to report significant factors that may influence present or future care."  So, like most chronic disorders, professional assistance is necessary for dealing with Complicated Grief. There can be a purpose-filled, abundant life and happiness after CG is treated.

Effective CG Tool

I am including a Grief Questionnaire pdf that is very useful in determining the presence of Complicated Grief for the use of those professionals and others who are trying to help people who are overwhelmed by long term suffering. 

My intention in offering it for your use is that it might help identify the possibility of Complicated Grief and direct you to someone who is familiar with its specific treatment.  Remember...this is not a disorder that will go away over time and requires expert intervention.  The Center for Complicated Grief provides a list of therapists who can be of service by using the following link

Download Grief Guides

The Center for Complicated Grief also offers these two pdf handouts for your perusal and use.