Prolonged Grief Disorder
Grief is something that all of us will experience at some stage during our life. There are so many different types of loss we can experience as we are moving through this life: the loss of a loved one – a parent, a son or daughter, a sibling, a good friend, an appreciated colleague – really any person with whom we had a close relationship, a miscarriage, the loss of a breast after a mastectomy.
Grief is an umbrella term for a wide range of emotions: Anxiety, panic attacks, insomnia, distress, anger; a cauldron ofemotion and experience. When we experience a profound loss, everything changes. The way we view our friends. The way we find meaning in life. We will never be the same.
At a base level, 100% of us who are grieving need community support from family, from friends, acknowledgment of our loss, our rituals. For 60% of us this will be enough to help us manage our grief: we will integrate our grief over time. Approximately 40% of us will need further assistance, a support group, generally one specific to our loss, holistic therapies, or counselling and therapy. Approximately 10% of us will need more help; we will suffer from what we call prolonged grief disorder. That is where over time, and it depends on each individual case, the grief remains debilitating.
Everybody’s grief is debilitating in the early days, weeks, months, but many people begin to be able to do other things – socialise, go back to work, enjoy a day out, find new ways of filling their life with activities, they begin to live again. For people with prolonged grief disorder (PGD), they still can’t sleep at three o’clock in the morning several years after the loss. They’re still ruminating about “if only”. There’s no acceptance of the reality of this loss.
All grief endures. What we mean by prolonged grief is that the intense suffering, yearning, the debilitating effects of grief, endure and keep us from engaging with life. Some people can engage with life more fully again sooner, others later, but eventually we should be able to engage with normal life again. If we can’t, that’s when we talk about Prolonged Grief Disorder.
When it comes to grief, in terms of timelines, or months, or years, are really arbitrary. But when it comes to prolonged grief, there will simply be no progression or moments of subsidence from the more acute feelings of grief at all. In the early days, my clients and participants of the Living With Loss program come looking for support. They might say things like, “I don’t know if I can survive this.” But a little while later I start to hear, “I had a good day on Thursday.” “Actually, I was really worried about that anniversary, but it went OK.” “I went out with friends on Saturday, that helped.” People begin to realise what helps, and to begin to talk about their loss in a way that shows they are, gradually, beginning to accept it. With PGD, the volume of grief does not come down. People suffering with PGD don’t integrate their grief. They’re not really processing it; they are still in that acute, really fresh grief stage, where they’re shook, they can’t eat, they can’t sleep, they are in disbelief, they’re not accepting what has happened.
It is vital to differentiate between the moments of profound grief that will hit a person who is grieving normally, and the unrelenting level of grief being experienced by someone with PGD. For example: If your loved one was bereaved two years ago and you drop into them and they’re sitting down bawling crying saying “I miss them so much”, that could be completely normal. They’re having a bad day. Their grief is up. They’re expressing it. They just need your arm around them, they don’t need your PGD diagnosis. But if they’re like that all day every day, there could be a chance that they are really, really struggling with their grief, and they might need extra support. An inability to re-engage with life on an ongoing, long-term basis, would be a sign of prolonged grief.
The problem with grieving during a pandemic, and the attendant lockdown circumstances in which we lived, is that we were cut off from the kinds of supports that would have usually ensured the majority of us did not suffer from PGD. The people who would have been able to go out there and meet their family, friends or even a support group, to go back to work and network with colleagues, to maybe even find a new social activity, were unable to do that and spent way too much time on their own without the social interactions that are so important. They didn’t have that corner of the street conversation with their neighbours, the people dropping in with dinner. That level one support is really crucial in helping us to integrate our grief though and, since we didn’t have it for a long time, there are a lot more cases of PGD in Ireland and all over the world today than there were pre-pandemic.
I qualified as holistic therapist more than 20 years ago. And I specialised in grief and bereavement support during the first year of the pandemic. As part of this I created the Living With Loss program, a 6-months support program for people who are experiencing grief and bereavement following a loss. I couldn’t have known it then how important it was going to be one day to have this longterm support program in place for people, but it is exactly the right program for people suffering with PGD. The Reiki healings will help to relax, to release what is no longer needed, and to gently move forward into a place of acceptance. The Aroma Touch Massages and essential oil treatments will help to reignite the wish to find meaning in this life after loss, to heal the heart, to gently move forward. The Mindfulness Meditation classes and gratitude training will help people to experience the present moment fully and to develop a sense of gratitude and appreciation for what IS. The weekly support calls will be a gentle support and an opportunity to work with powerful tools as a support on the journey to a life where the loss is integrated, still there, still present, but no longer determining the person’s life.