Understanding Grief and Adaptation
Grief is a natural response to loss. It’s the emotional suffering you endure when someone you cherish or love dies, or whenever close ties are irrevocably broken. Grief comes from many varied losses. These might include divorce, loss of a job you enjoyed, loss of financial stability, or even the death of a loved pet. Even subtle losses in life can spark a sense of grief. For example, the company for which you work might require you moving to a different city or state. Relationships with friends and coworkers may end or change because of the geographical changes. You might have to leave the house you built, in which you raised your family, that gave you a powerful sense of “home.” These are all things that can spark grief in your life.
The context and source for grief differs from those types of things just mentioned. Lifestyle changes forced by chronic pain, may cause loss of function or mobility, losses resulting in significant lifestyle changes for you and your family, or those close to you. Grief is a personal and fundamental experience of life, carrying many meanings, revealed by emotional, cognitive, behavioral and bodily manifestations and expressions. We must consider also, that grief requires adaptation in order to move through striving to thriving.
The emotional and physical pain you feel from loss can overwhelm you. You may experience a cadre of difficult and unexpected emotions. These may include shock, anger, disbelief and guilt accompanied by a profound sense of sorrow. Grief can disrupt your physical health making it impossible to sleep, function or even think straight. These are normal reactions to loss—and the more significant the loss, the more intense your experience will be.
As with most aspects of chronic pain, grieving is a highly individual experience. If someone tells you there is a specific or right way to grieve, or there is one model or process you should follow in order to grieve and move on, kindly smile, say thank you and walk away. They will be of no help to you.
So, What Does Grief Look Like?
In 1969, Swiss-American psychiatrist Elisabeth Kübler-Ross introduced a model for grief in her book “On Death and Dying.” Her ground-breaking model describes the often repeated “5 Stages of Grief” as denial, anger, bargaining, depression and acceptance. It is important to realize her model for grief addressed those plagued with terminal illness such as cancer. This model could apply to both the person with cancer and their survivors. However, the applicability of this model is a point of contention, and rightly so, when universally applied to situations outside of terminal illnesses, especially in chronic pain management. Ross’ model has a somewhat sequential or linear series of experiences through which one must work before arriving at the last stage called “acceptance.”
Others interpret or view Ross’ model of the five stages to that of a roller coaster ride, starting with denial. The “ride” cycles through anger, bargaining and depression multiple times and in no particular order before the rides ends at acceptance.
Kübler-Ross makes the clarification in her book, stating, “The stages have evolved since their introduction, and they’ve been very misunderstood over the last few decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but they are not a typical response to loss as there is no typical loss. Our grief is as individual as our lives… They are not stops on some linear timeline in grief. Not everyone goes through all of them or goes in a prescribed order.
While there are similarities between grief from chronic pain and that of death, there remain significant differences. There seems to be little recognition of the differences between the grief experienced from losing a loved one from terminal cancer vs. that of a person living in chronic pain. This might be due in part to unreported intervention in cases related to chronic pain. One major difference in the two is the grief from a loss by death is primarily emotional or psychological with some social considerations. Chronic pain is a complex multidimensional biopsychosocial and subjective phenomenon.
All biopsychosocial domains (physical, psychological and social) come into play when one experiences grief. Also, with death, there is finality, not so with chronic pain, as grief is perpetual. Some consider the grieving process from loss of a loved one as a pseudo-linear healing process. The process describes how one moves from shock and denial, moving through the stages, eventually arriving at acceptance. With chronic pain however, losses experienced are not singular nor finite, but repeated throughout one’s life.
Take, for example, the person who played golf with their friends regularly in a course in their neighborhood but can no longer do so because of a back injury. Each time they drive by their favorite course, the potential for experiencing that loss manifests itself again and again. Losses experienced because of chronic pain, unlike death, is everlasting. One limits their potential for reliving those losses only by one’s life journey, their choices, and ultimately their passing. So how does one move from grief through adaptation to living life unburdened with grief?
The Chronic Pain Version of Kübler-Ross
Relearning the World
Birth and death, grief and loss are all fundamental human experiences. While these phenomena are typical of human life, each conveys life experiences differently and uniquely. The painful movement through grief requires continual readjustment and hope for future life situations. We view this process as circling through two major concepts, “relearning the world” and “adaptation.” This understanding is crucial for both those who experience loss caused by death of a loved one and loss produced by chronic pain, where the grieving person might need support in this process.
Relearning the world and adaptation comprise a steady movement through four spectrums, continua or sub-themes. These are “despair to hope”, “lack of understanding to insight”, “meaning disruption to creating meaning”, and “bodily discomfort to reintegrated body.” Grief may require repeated movements along each of these continua and between “relearning the world” and “adaptation.” Here the continuous movements include a sequence of experiences of similar type in which the unique experiences vary in strength and endurance. Movement in this model is both circular and vertical. To see a graphic representation of this model, go to strivingtothriving.com in the “articles” section. It will help you conceptualize what I’m presenting here.
Grief may stem from moving away from home, graduating from college, or other things not associated with death, but are by nature temporal. As discussed, grief and loss stemming from chronic pain is quite different. Reject the notion it’s somehow inappropriate to grieve for certain things. If the person, relationship, or situation was significant to you and chronic pain somehow changed or ended that relationship, it is normal to grieve the loss you’ve experienced. It’s expected. Whatever your loss, it’s personal to you. As such, don’t feel embarrassed or ashamed about how you feel, think or believe. In fact, embracing the experience is part of the process to re-establishing your “normal”, whatever that might be, and establishing meaning in new life experiences.
Regardless of the cause of your grief, there are healthy ways to cope with the pain. Given time and support, the pain eventually lessens and sadness eases. For many, the support received enabled them to grieve their loss, find new meaning, and eventually move ahead in life. The same holds true for you. If you find yourself mired down by grief or some significant loss and need some supportive coaching to help you re-create your new normal, call me. I can coach you as you continue your journey. Together, you’ll find your way from striving in loss, grief or despair to a new refreshing thriving existence.
Until next time, be well and take care of each other.