When Grief Never Ends: Complicated Grief

Complicated Grief, Also Known as Prolonged Grief Disorder.

“There is no pain so great as the memory of joy in present grief.”


Aeschylus was an ancient Greek author known for his tragic plays and poems.

I lost my wife to pancreatic cancer eight years ago after 50 years of marriage. Many well-meaning people told me I have wonderful memories of our marriage. However, Aeschylus said it best in his quote above. Yes, I have sweet memories of my wife and our marriage. But those memories bring pain because they remind me of what I lost. That is one symptom of Complicated Grief.

Grief and mourning are terms often used interchangeably but have distinct meanings and processes.

Grief refers to the emotional response and reaction to a loss. The internal experience of sadness, pain, and other emotions occurs when someone or something significant is lost. Grief can be triggered by various types of losses, such as the death of a loved one, the end of a relationship, losing a job, or the diagnosis of a serious illness. It is a natural and normal response to loss. It can manifest in different ways, including sadness, anger, guilt, confusion, and even physical symptoms like fatigue or changes in appetite.

Mourning is the outward expression of grief. It is adapting to the loss and coping with it. Mourning involves rituals, customs, and culturally influenced behaviors that vary from person to person. These may include funeral ceremonies, memorial services, wearing black clothing, creating memorials, or engaging in religious or spiritual practices. Mourning provides a structured and socially acceptable way to express grief and seek support from others.

In summary, grief is the internal emotional response to loss. Mourning is the external expression of adapting to that loss. Grief is a personal and individual experience, while cultural and social norms influence mourning. Both grief and mourning are important aspects of the healing process after a loss.

Part of this blog article is taken from the Mayo Clinic.

Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. Most people experiencing normal grief and bereavement have a period of sorrow, numbness, guilt, and anger. Gradually, these feelings ease, and it’s possible to accept loss and move forward. However, when the grief is prolonged, it interferes with daily life.

For some people, feelings of loss are debilitating and don’t improve even after time passes. It is known as complicated grief, sometimes called Prolonged Grief Disorder. In complicated grief, painful emotions are so long-lasting and severe that you have trouble recovering from the loss and resuming your own life.

These differences are normal. But if you cannot move through these stages more than a year after the death of a loved one, you may have complicated grief. If so, seek treatment. It can help you accept your loss and reclaim a sense of acceptance and peace.

During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually fade, those of complicated grief linger or worsen. Complicated grief is like an ongoing, heightened state of mourning that keeps you from healing.

Signs and symptoms of complicated grief may include:

  • Intense sorrow, pain, and rumination over the loss of your loved one
  • Focus on little else but your loved one’s death
  • Extreme focus on reminders of the loved one or excessive avoidance of reminders
  • Intense and persistent longing or pining for the deceased
  • Bitterness about your loss
  • Feeling that life holds no meaning or purpose
  • Inability to enjoy life or think back on positive experiences with your loved one

 It is also be indicated if you continue to:

  • Have trouble carrying out normal routines
  • Isolate from others and withdraw from social activities
  • Experience depression, deep sadness, guilt, or self-blame
  • Believe that you did something wrong or could have prevented the death
  • Feel life isn’t worth living without your loved one
  • Wish you had died along with your loved one

Complicated grief can affect you physically, mentally, and socially. Without treatment, complications may include:

  • Depression
  • Suicidal thoughts or behaviors
  • Anxiety, including PTSD
  • Significant sleep disturbances
  • Increased risk of physical illness, such as heart disease, cancer, or high blood pressure
  • Long-term difficulty with daily living, relationships, or work activities
  • Alcohol, nicotine use, or substance misuse

Potentially, there are also physical consequences from this type of prolonged grief. The stress and emotional turmoil associated with the loss can manifest in physical symptoms such as fatigue, insomnia, headaches, and changes in appetite. These physical symptoms further contribute to the individual’s overall distress. They can make it even more challenging for them to cope with their grief.

Elizabeth Kubler-Ross and her Five Stages of Grief:

The five stages of grief, also known as the Kübler-Ross model, were first introduced by psychiatrist Elisabeth Kübler-Ross in her book “On Death and Dying” in 1969. These stages are not experienced linearly or sequentially; individuals may move back and forth between or experience them in different orders. The stages are:

1. Denial: The first stage of grief is often characterized by disbelief and denial. It is a defense mechanism that helps individuals cope with the overwhelming emotions and shock of the loss. During this stage, individuals may find it difficult to accept the reality of the situation. They may cling to the hope that the loss is not permanent. Denial can provide a temporary respite from the pain, but it is not a sustainable coping mechanism.

2. Anger: As the reality of the loss sinks in, individuals may experience intense anger and resentment. This anger can be directed towards various targets, including the deceased, oneself, or others who may seem unaffected by the loss. It is important to note that anger is a normal and natural response to grief, and it is essential to find healthy outlets for expressing and processing these emotions.

3. Bargaining: In this stage, individuals may attempt to negotiate or bargain with a higher power or the universe to reverse or postpone the loss. They may make promises or seek ways to regain control over the situation. This stage is often characterized by “what if” or “if only” statements as individuals desperately search for ways to change the outcome. Bargaining can provide a temporary sense of hope and control. Still, ultimately, it is a futile attempt to avoid the pain of grief.

4. Depression: As the reality of the loss becomes more accepted, individuals may enter a stage of deep sadness and depression. This stage is marked by emptiness, hopelessness, and a loss of interest in previously enjoyed activities. It is important to distinguish between normal grief-related sadness and clinical depression, as the latter may require professional intervention. Depression is a natural response to loss, and it is important to allow oneself to grieve and seek support during this stage.

5. Acceptance: The final stage of grief is acceptance, where individuals come to terms with the reality of the loss and move forward. Acceptance does not mean forgetting or getting over the loss but integrating it into one’s life and adjusting to a new normal. It is important to note that acceptance does not mean that all the pain and sadness disappear but that individuals have reached a point where they can live with the loss and find meaning and purpose in their lives again.


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