When Marla died of kidney cancer at age 45, her sister, Jackie J., wasn’t just sad — she was engulfed by grief. The sisters were the best of friends, and the fact that Marla would never get to watch her two young children grow up was too much for Jackie to bear.
So for the next two years, the New York mom of two “disconnected from the world.” She struggled to laugh or find joy in her life. She “robotically” raised her children. And she suffered from crippling panic attacks that at times prevented her from breathing and exhausted every ounce of her strength. It was a year before she could even look at photographs of Marla. “It was horrific. I couldn’t shake it,” says Jackie, 50, of her sister’s absence. “I was in a constant state of tears. I couldn’t function anymore.”
She first heard the phrase “complicated grief” when she joined a bereavement group. At that point, “I realized my grief was something deeper,” she says. “It was the intensity of my grief more than the duration.” So Jackie asked her doctor to refer her to a therapist, who has helped her start to move on. Now, she says, “I have a nice picture of Marla in my house, and I laugh now at things she would have liked. I can smile.”
Feeling sad, depressed, or anxious after the death of a loved one is “normal,” according to psychiatrist Katherine Shear, MD, director of the Center for Complicated Grief at Columbia University. But for people who experience complicated grief, the initial intensity of these feelings doesn’t fade over time and ultimately robs them of the ability to engage in and enjoy life.
Some classic signs of complicated grief include:
Complicated grief affects around 7 percent of people who have lost a loved one, or more than 10 million people in the U.S. alone, according to estimates from the Center for Complicated Grief. Though it can affect anyone, people with a history of anxiety or depression or who have lost someone in a sudden, violent way may be more prone. Additionally, losing a partner doubles your risk of complicated grief; when a child dies, it’s even higher.
Experts say there is no timetable for grieving, but when you are still unable to function or experience any joy six months to a year after the death of a loved one, it might be time to seek help.
Thoughts of suicide, which are elevated among those suffering from complicated grief, are another red flag. “In grief, there can be passive suicide ideation, like, ‘It might be better if I were no longer here or, ‘If I don’t wake up, it would be OK,’” says Elisabeth Zaragoza, a behavioral case manager in Aetna’s San Antonio, Texas, office. “That’s a sign you need help.” Last Thanksgiving, for example, she made a routine call to an elderly man who was in a near catatonic state over the death of his wife and having suicidal thoughts. She made arrangements to hospitalize the man and find a therapist who would be a better fit. He later told her she saved his life.
“From everything we know, it’s very difficult to deal with complicated grief on your own,” says Shear. Treatment typically includes targeted psychotherapy with a complicated grief therapist, which studies have shown to be highly effective. The therapist may encourage you to:
Some therapists may also encourage you to have an imaginary conversation with your loved one, which Shear says can be “very powerful.”
Experts say those who seek help are more likely to regain a sense of normalcy. Deborah Kusick, 65, of Sebastopol, California, for example, struggled with complicated grief for decades after the death of her younger brother. She sought the help of a therapist who, she says, “helped me change my perception of reality.”
Grief is a natural process that takes time and may require support. Here are some words of wisdom from those who have been there:
Losing a loved one is devastating, but as survivors and experts point out, you can get through it. As Shear explains, “Grief emerges naturally after a loss and seeks a place in our lives where it can enrich us, even if it saddens us.”
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Susan Donaldson James is a reporter whose health stories have appeared on ABC News, NBC News and WebMD. She now lives in bucolic Vermont, where she tries to keep up a healthy lifestyle hiking, skiing and doting on four grandchildren under the age of 3.
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