Complicated grief: How to find joy again

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.”

What is complicated grief?

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:

• A persistent, intense feeling of yearning or sadness for the person who died
• A preoccupation with that person, “to the extent that it interferes with relationships or the ability to enjoy life or work,” says Shear. This may involve excessively daydreaming about being with the person who died, smelling their old clothes, or listening to old voice messages.
• Excessively avoiding reminders of the person who died
  

Who is at risk?

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.

When should you seek help?

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:

• Talk about the death of your loved one
• Honor the relationship and memories you’ve made with your loved one
• Find a way to see a future with purpose and potential happiness 

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.”

Learning to live with loss.

Grief is a natural process that takes time and may require support. Here are some words of wisdom from those who have been there:

• If grief is unending, seek professional help from someone who understands complicated grief. “Whenever I hear Johnny’s two favorite songs, ‘Desperado’ and ‘We are the Champions,’ I instantly cry,” says Deborah. “But I now know that’s OK. After 30 years, I found a therapist who gets my grief.”
• Find a bereavement group. For five years after the death of her father, Christine Burke, 42, of Bethlehem, Pennsylvania, was “consumed” by pain and rage. She finally joined a support group at her church. “The priest asked me to tell him what happened. No one had ever asked me that, and it was incredibly helpful. I needed a push to get to a place where I could cope.”
• Write about your loss and grief or keep a grief diary. Christine, for example, began a blog. “It allowed me to carve out time and gave me a voice for my grief.”
• Lean on family and friends for support. “Don’t go it alone,” says Jackie. “I can’t imagine how I would be without them.”
• Take the time you need to grieve. “People will ask, ‘Are you better yet?’ But in some sense,” Jackie says, “you are working on this forever.”
• Take care of yourself. “Some days, it’s about reminding myself that I need to be kind to myself,” Christine says. That could mean anything from taking a run, talking about her grief, or “simply letting the tears fall when they come.” 
  
  

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.”