Even when individual differences in grieving are taken into account, there are some general patterns which are similar for everyone. Psychologists who work with the bereaved have identified four clusters of emotions which their clients seem to experience:
- Resentment (also called "Anger and Guilt"
or "Searching and Yearning")
- Despair (also called "Disorientation")
- Resolution (also called "Reorganization")
Mourners do not necessarily progress in an orderly fashion from Denial to Resolution. Some may bounce from Despair to Resentment and back again several times before moving on. For others the sequence is more of a spiral than a straight line. They cycle repeatedly through different sets of feelings while their pain gradually decreases in intensity, and acceptance of their loss gradually increases.
No matter how bizarre and confusing our emotions and impulses may seem, no matter how crushing our pain, each step we take on the path of grief is a step toward healing. It may help to think for a moment about how the body responds to a physical injury. Initially, a severely injured person experiences traumatic shock. Bodily sensations are blocked and the person may be semi-conscious and unable to move, which is just as well if bones are broken or internal organs bruised. As full sensation returns, the body brings pain to the injured person's consciousness, assuring that the parts of the body which have been damaged will remain motionless and less likely to undergo further harm. If there are open wounds, the body mobilizes its immune system, which may bring swelling and additional pain. Finally, the body is ready to complete the healing process by generating new tissue to repair the damage. The various steps taken by the body to preserve life and repair injury may not represent its "normal" mode of operation, but they are the expression of natural, built-in mechanisms available to every body. Grief works the same way on the psychological level. A body that has healed itself is not necessarily "as good as new". There will always be a scar on the skin, a weak place in the bone, a twinge of pain that returns on cold winter days. Grief, too, leaves behind its scars.
Our first reaction as parents after the death of a baby is often disbelief - "This can't be happening", "There must be some mistake", "Are you sure the machine is plugged in?" This response usually goes along with a kind of numbness - a sense of unreality, of "being in a dream" or of watching someone else go through the motions without the parent really being emotionally involved. These reactions are instinctive and help to soften the initial impact of the death. It is easy for outsiders unaccustomed with the grieving process to be deceived by our behavior while we are in denial. They may incorrectly assume that we are holding up well or are insensitive or incapable of expressing emotion. What is actually happening during this period, which may last for hours, days or weeks, is that our mind is blocking out pain, just as the body does during traumatic shock. When we are better able to face the death, emotion will come flooding back, often accompanied by crying or some other form of release.
Once our child's death becomes a reality to us, we begin to experience feelings of frightening intensity. Anger is very common as the full impact of what has happened becomes clear. "Why did it have to be us?" "It's not fair!" Our anger may be directed at the physician and hospital staff, who should have done more sooner to save the baby; at other expectant parents, who seem to flaunt their naive joy and pride; at the spouse, who must have done something wrong to cause the baby's death; at God (in the case of a religious family) for allowing such a thing to happen; even at the child, for abandoning the prospective parents. Directed inward, anger may turn to guilt. "If only I had stayed in bed that day." "If only I had eaten better." "If only I hadn't smoked those cigarettes." "If only I had supported my partner better during her pregnancy."
Anger and guilt aren't good or bad - they just are. It is important for us to give these and the other intense emotions experienced during grief full expression rather than reserving them for a "correct time". Holding back only prolongs grief and slows our progress toward acceptance and resolution. Suppressed anger may surface at an even more inappropriate time in an even more inappropriate manner. There are many different ways to release anger safely. The mode of expression we choose - screaming in private, hitting a pillow, engaging in strenuous exercise, writing a journal - is not important as long as our anger is acknowledged in some way and not denied.
This is in many ways the most difficult aspect of grief, especially since it typically lasts long enough after the initial loss that friends and family, as well as we ourselves, expect mourning to be over. It is the dull, nagging pain eating away at the base of our heart. It's the jagged hole in the fabric of our life, the gray emptiness which greets us every morning as we emerge from our gray, empty dreams. Life loses whatever meaning it had, and even the simplest tasks seem impossible. Pain associated with past losses - divorces, layoffs, previous deaths of relatives and friends - is often reawakened. We may feel worthless, may feel we are complete failures as human beings. We may contemplate ending our own lives either to escape from the seemingly unending pain of grief or to be with our dead child. It is common for us to be preoccupied with our lost child, to hear it crying in the night, to feel our arms literally ache to hold a baby. It is even within the range of what is "normal" at this stage to pick up a cat, a doll, a pillow -- anything to put a child-sized weight on our arms. We may speak of our child as if it were still alive or have vivid dreams in which we are allowed to visit the child.
Fear is also a common emotion during this phase. We may experience an overwhelming sense of foreboding, a feeling that another horrible thing is about to happen. We may be obsessed with fantasies involving the death of another family member, including that of our spouse or partner. We may become overly protective of any surviving children and at the same time doubtful of our ability to continue protecting their welfare when we have already proven ourselves incapable of preserving the life of the child we have lost. Many of us find that it is hard to concentrate for any length of time. Our minds wander and it is impossible to read, write, or even to make trivial decisions.
There is no clear-cut boundary separating those who have healed their loss from those who are still in the process of healing. In a sense, no one is ever completely "healed", for grief is a journey of transformation, and we are different now from the people we were before our encounter with death. We will never forget the child we have lost or the pain we have endured, but we find that as time passes, our burden lightens slowly - very, very slowly - but surely. The "good days" begin to outnumber the "bad days". We find that we have more energy to put into the other parts of our lives, that we are able once again to deal with everyday chores and aggravations. We still get choked up when we talk about our child, but we do not break down. Holidays, due dates, and the anniversary of our baby's death still trigger tears and waves of sadness, of course, but in general we are no longer incapacitated by grief. We are coping.
Unfortunately, there is no way to know ahead of time how long it will take any of us to reach this approximation of normalcy. A lot depends on the intensity of our feelings and on how we express (or fail to express) them. We can only know that eventually, in its own time, healing will come. The entire process generally takes at least six months to a year and many parents find they need two years or more before they are ready to let go of their grief.
Grief is not only a mental and emotional process. Our bodies, too, participate in our anguish. Sleep is often disrupted, and when it does come it may do little to relieve a persistent feeling of exhaustion. This, along with prolonged psychological stress, takes its inevitable toll on a body whose immune system may not be functioning up to par, making it more susceptible than normal to flus, colds, and other diseases. During the stage of despair, our body's dietary and hygienic needs may be neglected. Physical symptoms centering around the heart or in the stomach or muscles are fairly common. A medical examination can prevent a minor health problem from becoming a serious one. Sleeping pills, anti-depressants, and other medications should be used only on the advice of a physician, and even then it is wise to use such drugs sparingly, since they can interfere with healthy expression of emotion and may even make depression worse. Regular exercise is also a good idea, since it helps to maintain our body's tone while reducing stress and releasing pent-up energy.
The Importance of Expressing Feelings
The powerful emotions kindled by grief can be overwhelming and terrifying, especially for people who have always prided themselves on their self-control. Many of us feel that we are literally "going crazy", that once we let ourselves start to cry we may never be able to stop. Grief therapists, however, stress the importance of allowing full expression of these emotions at the time they are first experienced. Such expression can take many forms, as long as it is safe and feels comfortable for us. Many parents have found keeping a journal to be valuable both as a creative outlet and as a record of their progress over time. Others turn to poetry or find non-verbal modes of expression - sculpture, painting, music, crafts - equally eloquent of their inner experiences. Sharing feelings with friends, family, clergy, physicians, therapists, anyone who can listen without passing judgment or withdrawing from the reality of death, is also a powerful tool for healing. Attending support groups composed of parents who have undergone similar losses and are themselves dealing with grief is a good way to find listeners with these abilities, people who are telling the truth when they say they "know how you feel".