The Four Phases and Types of Grief and Mourning

Introduction

According to Hockenberry & Wilson (Hockenberry & Wilson, 2007, p. 139), there are four phases of grief and mourning. The first phase of grief is disbelief or denial. There is a feeling of dullness or having an “out of body” experience. At this time, one goes into the second phase. The second phase is overwhelming need to be with the deceased. These phases can last minutes or days. The third phase is a feeling of hopelessness and scattered thought processes.

The person in this phase is usually despondent and may retreat to a void within oneself. Sometimes they feel in this phase that life has no meaning without the deceased at their side. The last phase is “reorganization, when the person begins to again find meaning in life, integrating the loss of the loved one into a renewed sense of normalcy” (Wacker-Guido, 2010, p. 139). There are four kinds of grief. The first type of grief is disenfranchised grief; this is the result of a loss for which they do not have a socially recognized right, role or capacity to grieve.

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These socially ambiguous losses cannot be openly mourned, or socially supported. Essentially, this is grief that is restricted by "grieving rules" ascribed by the culture and society. The bereaved may not publicly grieve because, somehow, some element or elements of the loss prevent a public recognition. Disenfranchised grief occurs in three primary ways. The first way is the relationship is not socially recognized. The relationship is not based on recognizable kin ties (the death of a friend), or socially sanctioned, (a partner in a gay or lesbian relationship), the relationship exists primarily in the past (ex-spouse).

The second way is that the loss is not socially recognized or is hidden from others. Not socially recognized losses include perinatal losses. Hidden losses include abortion, the loss of pet, and losses that result from causes other than death. The third way that disenfranchised grief may occur is where circumstances of the death or deaths that contribute to stigma and negative judgment by others. Forms of death that would fall into this category include suicide, abortion, death as a result of AIDS, and fatal drug overdose are all examples of this type of disenfranchisement.

The second kind of grief is anticipatory grief. Anticipatory grief can be described as the normal mourning that occurs when a patient or family is expecting a death. Anticipatory grief has many of the same symptoms as those experienced after a death has occurred. It includes all of the thinking, feeling, cultural, and social reactions to an expected death that are felt by the patient and family. Anticipatory grief includes depression, extreme concern for the dying person, preparing for the death, and adjusting to changes caused by the death.

Anticipatory grief gives the family and friends more time to slowly get used to the reality of the loss. People are able to complete unfinished business with the dying person for example, saying "good-bye," "I love you," or "I forgive you". Anticipatory grief may not always occur. Anticipatory grief does not mean that before the death, a person feels the same kind of grief as the grief felt after a death. There is not a set amount of grief that a person will feel. The grief experienced before a death does not make the grief after the death last a shorter amount of time. Some people believe that anticipatory grief is rare.

To accept a loved one's death while he or she is still alive may leave the mourner feeling that the dying patient has been abandoned. Expecting the loss often makes the attachment to the dying person stronger. The third kind of grief is complicated grief. “Complicated grief is an intense and long-lasting form of grief that takes over a person’s life. It is natural to experience acute grief after someone close dies, but complicated grief is different. Complicated grief is a form of grief that takes hold of a person’s mind and won’t let go. People with complicated grief often say that they feel “stuck. ” ("Complicated Grief").

Linda's case

The term complicated sometimes is referred to a factor that grief interferes with the natural healing process. There are many people that get stuck in this type of grief. The last type of grief includes the normal type of grief. In this normal type, the four phases of the grief process will occur. Whenever someone in your life passes away no one knows how you will respond or what kind of grief you will go through. This is how it happened with my friend Linda. When you get that phone call and someone at the end of the phone gives you news that you wish that you never had to hear is the most devastating event that can occur in one’s lifetime.

My friend Linda received this phone call fifteen years ago. The caller let her know that her son was involved in a single shooting accident and that he was found dead with a note next to him. After talking with Linda, I cannot imagine the pain that she had to go through. Knowing you lost someone in your family is one thing but losing a child that you brought into the world is another thing. Linda went through all stages of grief. She stated that when she went through the third stage she stayed in the third phase a long time. She stated that she cooked and cleaned and was in a “fog”.

She said she cooked for days and threw food away. She did not know what to do with her time. Being a nurse, I knew she needed to be able to talk and vent. She stated she could not talk to anyone because in her religion it was known to be a sin to have committed suicide and therefore she dealt with this guilt on her own. After reviewing what disenfranchised grief is, I recognized my friend Linda. I also recognized that because of the stigma of suicide this was a barrier in the normal process of grieving. There may be different reasons for a barrier to occur.

My dad went through a different kind of grieving process. My mom passed away after being on hospice for many months. The hospice nurse explained to all of us the stages of death and the stages of the grieving process. This led us through a positive grieving process. He went through the anticipatory grieving process. He planned the funeral; he said his goodbyes before she passed. He grieved for months. After my mom did pass away he grieved all over again. I grieved before my mom passed away and when she finally did pass, it took me seven months for the grieving to start again after she actually passed away.

I felt guilty when I did not grieve when she died. I went into automation mode. I made the plans, I made sure the family was ok and I did not even shed a tear. This was my barrier. I needed to be the nurse and make sure everyone else was cared for. Seven months later, I had waterfalls of tears, and I went into a deep depression. This was a negative coping mechanism. The depression had to be treated clinically and therefore showed negative coping. It is strange how different people grieve. It is also strange knowing the right way to grieve and the wrong way to grieve.

This scenario goes to show that no matter what your knowledge base is, it is how you react when it happens to you, or how you respond as a nurse to someone else.

References

1. Doka, K. (2012). Disenfranchised Grief. Retrieved from www. researchpress. com/sites/default/files/books/addContent/5160.
2. Wilson, D. (2007). Wong’s Nursing Care of Infants and Childrens, St Louis: Mosby Elsevier
3. Wacker-Guido, G. (2010). Nursing Care at the End of Life. , 139, Boston, MA: Prentice Hall What is Complicated Grief, Retrieved from www. complicatedgrief. org/bereavement

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