Grief Articles

What Is Normal Bereavement?
By Susan B. Arlen, M.D.

A frequent question in the clinical practice of bereavement counseling is, "Are my feelings normal?" This is an understandable concern since we live in a society where the media often portray idealized norms that are unrealistic. Though my private practice includes mental-health professionals and clergy (people with experience and proficiency in comforting and counseling the bereaved), questioning as to normal feelings and behavior arises again and again.

Whether lay people or professionals, experience in dealing with other people's grief is often an inadequate preparation for coping with one's own situation. Readers of Bereavement magazine are experienced in bereavement and know the various manifestations of normal mourning. But sometimes we falsely assume that either everyone else also knows the basics or that experience, knowledge and understanding will automatically confer immunity. Naturally, these assumptions are not true.

Mary is an experienced psychologist who has provided hundreds of people with therapy and counseling during the course of her twenty years in practice. When Edwin, her husband of twenty-five years, was diagnosed with cancer, initially Mary was in a state of shock. After realizing that the diagnosis was not a mistake and that there would be no cure, Mary decided to mobilize all of her inner resources and make Edwin's remaining life a quality time for him and for the entire family.

Though her plan was successful, it was at great emotional expense to Mary. Day by day, week by week and month by month, she watched her husband’s slow deterioration. He slid from being a vital surgeon and community leader, to a bedridden and dependent person who was unable to follow any but the simplest conversation. Though this was devastating for Mary, she continued to function as wife, mother, family fulcrum and psychologist.

Several months after her husband's death, she came to see me. Since her emotions had been more painful during the time she was slowly losing him day by day and inch by inch, she was concerned that she was not properly mourning him. She missed him terribly, but she was not experiencing the painful bereavement she had expected and observed in her own grieving patients. In short, she thought that something was "wrong" with her emotionally.

After several sessions, Mary came to understand that she had indeed mourned her husband. During his illness, slowly and painfully she had come to the realization that he was not, and never again could be, the lifetime companion that she had hoped for. She sadly recognized that his illness had robbed them of the essence of his personality, the glue of their love. She came to see that any decisions regarding the two of them would have to be made by her alone. Her beloved husband's wise counsel and judgment (on which she had relied for so many years) had disappeared with the relentless progression of his disease.

During his illness, Mary had gradually learned to live without important facets of her relationship with her husband. By reliving during therapy what had actually occurred emotionally during her husband's illness, Mary came to understand that she had been functioning alone and independently for some time prior to Edwin's death. She had also recognized that there would be no future that could be shared by the two of them, that she would face future milestones of life alone, that she would see grandchildren born and mature without her beloved husband, and that she would grow old without him.

She also recognized that she had learned to live without the little everyday manifestations of togetherness that she had so cherished during their life together – the hugs, the secret looks of unspoken understanding, the code words that had meaning only for the two of them. Long ago she had stopped listening for the sound of his car in the driveway or for his footsteps in the hall. She had even been eating dinner alone. From the time of their marriage, this meal had been a symbol of togetherness for the two of them. In short, Mary had experienced most of the painful emotions of loss already, and now she was ready to face the uncertainty of a future alone.

Over the course of the next phase of our sessions together, Mary said her final goodbyes to her husband. She also explored possibilities for her own future, including both day-to-day functioning and long-term planning.

Mary was satisfied that she had done everything possible for her husband while he was alive. Prior to his illness they had had a close communicative relationship. They had shared many interests in common. During his illness she was there for him. She was able to make peace with the unfairness of her situation and had few regrets or feelings of guilt to fixate her.

Mary had also been able to keep other facets of her life relatively intact. Although she had not been able to see her friends or talk with them as often as she had before Edwin's illness, she did manage to maintain some contact with friends, and she kept seeing a few patients. She was able, therefore, to define herself in many ways. Along with the many interests she could pursue, she had a good support system among her friends.

Donna and Harvey had been married for thirty-five years when one night he suddenly died of a massive heart attack as he lay sleeping beside her. There had been no warning. Harvey had never been sick except for minor, occasional flu. He had been to his internist for a regular and thorough annual checkup the week before and was given a clean bill of health.

Donna and Harvey had been childhood sweethearts since their teen years. Never having been blessed with children, Donna had devoted herself to caring for Harvey and making a good home for him. She supported him emotionally as he climbed the corporate ladder of a large, hospitality corporation. His job had required that they move frequently to live in many parts of the world – a new city with each promotion. In their younger days, this had been very exciting to both of them, but recently they had both begun to long for the stability of a permanent home.

Their lifestyle had exacted other prices, too. Because of the constant moving, it was difficult to establish and maintain close and ongoing friendships or to set down roots and become part of a community. Though this is understandable given their circumstances, it is particularly ironic since Harvey's expertise was in the field of human relations! He was an expert at solving interpersonal problems in the workplace as well as improving company and worker morale.

Donna was a social worker who had been unable to maintain consistent employment because of the frequent moves required by Harvey's work. She had managed to do some part-time work over the years and had always done volunteer work wherever they had lived, but Harvey and his career had always come first.

Two months prior to Harvey's death, they had made what was to be their final move. Harvey had agreed to run a large convention facility with the help of several assistants. This would give him more free time than he had ever had before. There would finally be time for the two of them. The town was near where they had grown up.

Their hope was to reestablish themselves, set down roots and try to reconnect with relatives and childhood friends. Donna had already contacted a few people and had joined a church. She planned on having a series of lunches and dinners as soon as Harvey felt more comfortable in his new job.

Two months after her husband's death, Donna came to see me. She was still in a state of emotional shock and disbelief and felt completely adrift. A church member had read that the period of shock lasts for about two weeks to a month and suggested that Donna see me.

For Donna, Harvey had been the emotional anchor, the only external constant in a lifestyle consistent only in its constant change. She had longed for stability throughout her life but had happily sacrificed this desire to accommodate Harvey and his profession. Now, just as their dreams seemed to be really coming true, her world fell apart.

Through therapy, Donna came to see that shock protects us from the full impact of emotional trauma and can last as long as the mind needs its protection. Shock permits the impact of reality into consciousness bit by bit as the mind is capable of handling it.

Donna felt as if she had lost everything, including her husband and all predictability, and in effect, she had. She was in a new community, a new home, with new people and suddenly, she was without Harvey. At first she didn't know where to turn.

We started by gently reminding Donna of all the previous adjustments she had successfully made (essentially by herself) throughout their lives together. Harvey had always been busy working, so it was left to Donna to make a new home and new friends. Now, this ability, this flexibility, this creativity could be used again.

At first, Donna protested this declaring that her strength had actually come from her husband and that much of her activity had been to elicit his approval. She also felt that there was just too much change, too many different things for her to deal with now. In reality, her entire life had changed, and the dream for this, their final move, was shattered. There was a lot for her to cope with, and the entire picture looked so overwhelming, she was immobilized. Very slowly, bit by bit, we addressed this concern with constant reminders of previous creative solutions that she had used successfully throughout her life.

An important facet of Donna's treatment was the recognition, acknowledgment and resultant shame that she felt about her anger toward her husband. Objectively, she knew that Harvey did not want to die and abandon her; but inside, she felt abandoned and furious at him, the world and God. It was difficult for her to recognize this emotional conflict because she loved her husband. Besides, what kind of a selfish monster could possibly be angry at a beloved dead person? As her anger was acknowledged, it slowly began to dissipate.

Gradually, Donna began to be free to recognize that part of their success in adjusting to all of the moves was due to her own efforts. Eventually, she was able to recognize that Harvey was not her only source of strength and she identified the fact that much of it came from within herself.

Donna had a long and difficult road to travel. She had to build a support system, and she had a less distinct sense of personal worth and self identity than Mary did. For Donna, along with the challenge of coping with many changes at once – alone – there had been no preparation. Her shock, fear, immobilization, bewilderment, abandonment and anger were normal. It was also normal for each phase of bereavement to take longer than it did for Mary.

Each situation, relationship, resource and coping mechanism is unique to each individual. Mourning is painful and must be experienced without being rushed. Physical reactions, such as pain, should always be checked out by a doctor. Changes in sleeping habits or appetite can sometimes be a normal manifestation of bereavement, but if these changes persist they should be brought to the attention of a doctor.

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