Loving Strongly, Suffering Greatly: The Physical and Psychological Effects of Grief and/or Trauma

{for my dear friend, A.H.F., who loves so strongly}

pere lachaise cemeterey

“Grief is replaced with a useful sadness. […] The timbre begins to fade. The edge dulls. The hurt lessens. Every love is carved from loss. Mine was. Yours is. Your great-great-great-grandchildren’s will be. But we learn to live in that love.”―Jonathan Safran Foer; Everything Is Illuminated

It is natural for us to feel deep sorrow when we lose someone dear to us—but it is also natural for our minds to attempt to shield us from intense pain through the numbing of our emotions. Such internalized suppression can remain deeply buried in our psyche for a long time, perhaps dormant but harmful and occupying on an abstract, unknown level. We may not even realize the reason we’re feeling depressed is connected with a past loss. Grief is a deeply complex host of feelings that affect us both physically and psychologically, and the more we understand just how we can be harmed by grave sorrow—even (or perhaps especially) if on a subconscious level—the more likely we are to begin to truly heal.

Elisabeth Kübler-Ross, the psychiatrist who introduced the notion of The Five Stages of Grief in 1969, has been widely credited with advancing the standard trajectory of of grief; however, it is important for survivors to know that it is not essential to go through each stage in order to heal, as everyone grieves differently. Remember, though: There is no concrete timetable for how long it takes to heal, or the manner in which one “should,” so resist the temptation to apply such baneful standards to yourself. You are already going through enough, and should only be concentrating on how to best reach your recoveryAccording to most psychiatrists, the typical stages of grief are as follows:

  1. Denial: “This can’t be happening to me.”
  2. Anger: “Why is this happening to me?” / “This shouldn’t have happened to me!”
  3. Bargaining: “Make this not happen, and in return I will […].”
  4. Depression: ““I am too depressed/hopeless/miserable to do anything.”
  5. Acceptance: “This happened.” (Remember: acceptance DOES NOT MEAN you have to like it!)

Still, there have been very different and apt  pictures presented on just how intense traumatic grief can be. Take, for example, acclaimed writer Joan Didion’s paradigm-changing non-fiction work, The Year Of Magical Thinking, which she wrote after her husband John died of a massive heart attack, explains the remarkably convoluted and non-linear path to such healing in a manner that is nothing short of brilliant. Didion writes:

In the version of grief we imagine, the model will be “healing.” A certain forward movement will prevail. The worst days will be the earliest days. We imagine that the moment to most severely test us will be the funeral, after which this hypothetical healing will take place. When we anticipate the funeral we wonder about failing to “get through it,” rise to the occasion, exhibit the “strength” that invariably gets mentioned as the correct response to death. We anticipate needing to steel ourselves the for the moment: will I be able to greet people, will I be able to leave the scene, will I be able even to get dressed that day? We have no way of knowing that this will not be the issue. We have no way of knowing that the funeral itself will be anodyne, a kind of narcotic regression in which we are wrapped in the care of others and the gravity and meaning of the occasion. Nor can we know ahead of the fact (and here lies the heart of the difference between grief was we imagine it and grief as it is) the unending absence that follows, the void, the very opposite of meaning, the relentless succession of moments during which we will confront the experience of meaninglessness itself.

The following are the most common physical and psychological symptoms of traumatic grief, often felt in striking waves of extreme physical and psychological differences for 30 to 60 minutes at a time. Experiencing deeply acute emotions (even if they are “normally” out of character) is a perfectly natural and frequent reaction to traumatic grief. We all need to mourn. Our feelings are not yet processed (or often even realized), and sometimes misplaced or misdirected. In the first weeks and even months after experiencing a traumatic event such as loss of a loved one, it is completely natural to have depressive symptoms ranging from anger to numbness. If these symptoms persist, or a general feeling of depression or marked uneasiness continues for more than six months, what is considered the “normal” grieving process begins to tip toward acute traumatic grief or pathological grief. In this case, if one has not already, it is imperative to seek out professional assistance from a mental health worker to assist in determining the best course of action to reach a state of radical acceptance.

Common Physical Symptoms of Traumatic Grief: 

  • Shortness of breath
  • Tightness in stomach
  • Tightness in throat
  • Fatigue
  • Feeling faint
  • Insomnia or nightmares
  • Anger and agitation
  • Being “on edge” or easily startled
  • Bodily aches and pains not attributed to physical injury

Common Psychological Symptoms of Traumatic Grief:

  • Intense sadness or hopelessness
  • Shock and denial
  • Anger, irritability, mood swings
  • Feeling disconnected or numb
  • Anxiety and fear
  • Guilt, shame, self-blame
  • Feelings of powerlessness
  • Lack of motivation, ability to concentrate, and confusion
  • Loss of interest in previously enjoyable activities
  • Social withdrawal

Signs of Acute Traumatic Grief:

  • Intense, “unprovoked” agitation
  •  Intense longing and yearning for the deceased
  • Self-accusation/self-hatred
  • Intrusive thoughts or images of your loved one
  • Engaging in high-risk behaviors
  • Suicidal thoughts or ideation
  • Extreme outbursts of anger (not directly triggered)
  • Feelings of lack of control/rage
  • Prolonged masking of emotions/numbness
  • Continual social isolation
  • Lack of ability to continue health relationships
  • Obsessive thinking about the traumatic event
  • Ongoing flashbacks and/or nightmares
  • Amnesia/repressed memories
  • Chronic insomnia
  • Development of Major Depressive traits or Major Depressive disorder
  • Development of PTSD
  • Specifically regarding death: Imagining that your loved one is alive; denial of the death or sense of sincere disbelief; searching for the person in familiar places; strict avoidance of activities or places that remind you of your loved one; and feeling that life is permanently empty or meaningless.

How Can I Tell If It’s Grief Or Depression?

Depression, which mandates engaging a psychiatrist and psychologist in order to receive true care, will likely include the following symptoms:

  • Intense, pervasive, and disruptive sense of guilty
  • Feelings of hopelessness or worthlessness
  • Slow speech and/or body movements
  • Inability to continuing function in school, work, social environment
  • Thoughts of suicide or a preoccupation with death and dying
  • Aural and/or visual hallucinations (in extreme cases)

Yes: There ARE Ways To Process Your Pain & Return To Full Health!

American Psychiatric Association's "Inventory of Traumatic Grief" table

American Psychiatric Association’s “Inventory of Traumatic Grief” table

In order to seek the return to health you deserve, it is essential to determine, honestly, how severe your grief is. While a visit to the psychologist is likely in order if a significant amount of time has passed and the pain or problems from the pain have persisted, anyone would benefit from talking to a medical professional to aid in deciding how to best proceed. Taking a look at the American Psychiatric Association’s Inventory of Traumatic Grief table (just click on the above photo to see a large version!) may assist you in first measuring the severity of your depression and help you better communicate your complex feelings.

 In addition to seeking the aid of a counselor, here are a few ideas for how to begin processing the loss (be it death, divorce, or a painful break-up) while retaining beautiful, positive memories.

10 Useful and Progressive Ways To Handle Grief : Life WILL Go On

  1. Realize that you are not alone/there is nothing wrong with you: When we are dealing with a loss, the feeling can be so intense—or so completely lacking that we are sure there much be something “wrong” with us. Well, stop being so critical of yourself! There is no “proper” way to handle a loss, and even though you may anticipate that you’d react in a certain way, the fact is, your reaction may be surprising, or even seemingly out of character. That’s okay! Just make sure you understand why so you can begin to heal, and resist engaging in self-blaming or -shaming. You’ve already been through enough, and this will never, ever help.
  2. Know that it’s not going to be easy, but it IS going to be all right: Very often, the road to recovery is long with twists and turns that we can only react to once we see them approaching—or are already there. Don’t put yourself on an unrealistic timeline, or compare yourself to others. You will only react as YOU can, and with proper support and forward motion, you WILL be okay again.
  3. Feel your emotions! Don’t judge yourself for crying, for feeling numb, or for being angry. It isn’t necessarily a “bad thing” when you feel a strong emotion, as they serve a purpose. For example, crying can provide a vital release. Responses to traumatic events are very individual, so even during this hard time, it is significant that you be yourself. No “appropriate” timeline or “proper” emotion nonsense! Just be you!
  4. Keep a mood journal/diary: This is something everyone can benefit from, as writing, especially in a way that’s meant to be private, to process what we are truly feeling and, in that way, come to understand it. While grief and loss aren’t things we “get over” but rather things we learn to live with, one needn’t feel guilty writing about still loving a grandparent who has passed or an ex we still have romantic feelings for, as this is nothing more than literally spelling out the truth. Even the act of radical honesty can be cathartic, as it brings on a release, even if it is painful to think about (particularly at first, or when we are less numb to our sadness).
  5. Learn to let go…enough. This is NOT meant to diminish the importance of positive memories, but we sometimes hold onto things, be they physical or emotional reminders of someone we’ve lost, just a bit too long or for the wrong reasons—and we know it’s the wrong reasons when it serves to hurt us more than help us, or prevents us from being able to progress in a healthy way. When you let go, you allow some of your grief to dissipate; you are choosing this. So be it shoes (as Joan Didion illustrated), or figurines, or even our attachment to places or objects that reinforce the connection—try to recognize when it’s not healthy and move on.
  6. Have a support system. Having a strong support network in place is of great aid in recovery. Your friends and family will want to be there for you because they love you. It is important to remember that during times of grief and trauma, one may want/need to be alone at certain times and with others when feeling more social. Try to communicate this to your loved ones so they can understand why you may reach out at certain times, and need solitude during others.
  7. Make time for exercise. Exercise is truly is a full-body workout, from your abs to your mind. Regular exercise boosts serotonin levels and causes endorphins to be released while it is simultaneously boosting one’s self-esteem and enhancing the chances for a regular sleep pattern. A mere 30 to 60 minutes of exercise if really all you need to begin to improve your mood, so even if you aren’t feeling great (understandable!), try to fit exercise into your day.
  8. The Yoga Sun Salutation Pose or Surya Namaskar

    Sun Salutation Poses or Surya Namaskar are a series of yoga poses for beginners (or anyone!) that enhance your breathing and ability to stretch. The PERFECT way to begin your day!

    Try to integrate relaxation techniques into your daily routine. In fact, some exercises are relaxation techniques too! For example, yoga may be just the thing someone who is grieving needs. Yoga provides a wealth of physical exercise, but also can help bring clarity, largely through deep, steady breathing. (You can and should also practice deep breathing on its own, as this is a highly effective means of calming oneself.). Whatever works for you, be it yoga, meditation, or prayer, engaging relaxation is a significant step toward recovery.

  9. Join a support group. It seems many people have negative images of support groups, or a general fear of talking about their private and personal problems/lives in front of other people. Try to resist this assumption if you’ve not given group support a try! You may find that solidarity from those who you don’t already know to be incredibly healing and even transformative. Not only will you meet people who will organically understand, but also others who will aid you in realizing you’re not alone/there’s nothing wrong with you. This can be hugely comforting…more so than you might assume.
  10. If you need to, seek out a therapist. THERE IS NOTHING WRONG WITH TALKING WITH A THERAPIST. That is simply an offshoot of the tremendous societal stigmatization against behavioral health, which, thankfully, is slowly waning in toto. A trained medical professional will be able to better assist you in understand precisely how your grief and trauma are playing out, and respectively, how to best approach recovery. There are three types of therapy in particular, in addition to psychotherapy (a.k.a. talk therapy) that have proven to be very beneficial in this case. Robinson, Melinda Smith, MA, and Jeanne Segal, PhD, these therapies include:
    • Somatic experiencing takes advantage of the body’s unique ability to heal itself. The focus of therapy is on bodily sensations, rather than thoughts and memories about the traumatic event. By concentrating on what’s happening in your body, you gradually get in touch with trauma-related energy and tension. From there, your natural survival instincts take over, safely releasing this pent-up energy through shaking, crying, and other forms of physical release. 
    • EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation. These back-and-forth eye movements are thought to work by “unfreezing” traumatic memories, allowing you to resolve them.
    • Cognitive-behavioral therapy helps you process and evaluate your thoughts and feelings about a trauma. While cognitive-behavioral therapy doesn’t treat the physiological effects of trauma, it can be helpful when used in addition to a body-based therapy such as somatic experiencing or EMDR.
You are going to be okay.

Even though dealing with grief and trauma are difficult, and sometimes have life long effects, you will get through the pain and live your life again. And you will learn to love it!