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By Peter A. Purpura, Ph.D.

Dr. Purpura has been in private practice since 1972. He was on the faculty of Washington Square Institute for twelve years where he taught psychotherapy technique. For five years he was the regional coordinator for Compassionate Friends, a self-help bereavement group for parents who have lost children. Dr. Purpura is a graduate of Fordham University with a Ph.D. in Clinical Psychology. He is also a graduate of The New York Freudian Society with a certificate in psychoanalysis, and a certified EMDR therapist.

Dr. Purpura answers the following questions:

• What is grief?
• What does grief accomplish?
• How long does grief take?
• Can we avoid grief?
• Are there stages of grief?
• How do we cope with the loss of a bad relationship?
• Does how the person died effect the nature of grieving?
• Does your relationship to the person shape the grief reaction?
• What kinds of issues can complicate the grief reaction?
• What might I say to someone who is grieving?

Grief is the process that the mind uses to adjust to and accept unwanted changes in one's reality. The process we use to adapt to losing our youth is the same as the one used to adapt to the loss of a loved one.

Grieving enables us to change our emotional expectations for the world around us. Over time and with much painful work, we come to accept that we have lost someone we wanted in our lives and adjust our expectations for a world in which they do not exist, except in our memories. In the beginning, holidays, anniversaries, birthdays, indeed all special events are made painful by the absence of the loved one and the need to adjust to their permanent loss. In time, we are able to adjust to the loss so that new events will not be overshadowed by it. We can even remember the good things we had with that person.

Longer than anyone wants! Grieving is work. Work is defined as effort over time, and the grieving process requires both effort and time. We need to take the time to be sad and confront our loss. Funerals, memorials, emptying out the person's belongings, and telling the story of the loss all help to foster the work of mourning. Usually major losses, like the loss of a spouse or parent, take about a year. Emotionally complicated relationships can take longer. The more central the relationship to your daily life, the longer the grief period. The loss of a child, and especially a young child, can take at least three years. Enormous effort is exerted by a person in grief and with that comes the usual symptoms of stress. Fatigue and physical illness are often an outcome of the stress of grief.

Yes! But, at a great price. By avoiding the situations that remind us of the loss, we can delay and often stop the grieving process. The usual result is a chronic depression instead of the more intense pain of grief. However, grief has an end. This depression can only be resolved by doing the grief work. In addition to depression, there is a loss of the person's grasp on reality, so they may have poor judgment and seem a bit spacey. This is because any accurate holding of reality will remind them of their loss. Throwing one's self into work or other distractions is another way to avoid the grieving process, however, as soon as the person slows down, they are confronted with the grief work they must do.

Yes. Different writers speak of stages of grief, but shock or denial is the usual initial reaction to loss. To protect ourselves from the full impact of the loss, we detach and then slowly let the reality of the change in our lives sink in. At a wake, for example, the bereaved repeat the story of the loss over and over as people come to pay their respects. This repetition helps us to slowly absorb and adjust to the new painful reality with which we must live. Most traditional funeral rites include viewing the body of the lost loved one. While this may seem morbid, it helps to avoid the denial of the death: "It is harder to deny what I have seen with my own eyes." Mourning where there is no body or the person is missing and presumed dead is especially difficult because the uncertainty fosters denial. We all have experienced situations where we knew something was true but our wishes and hopes for the situation would not let us accept the reality we must face. This phenomenon is especially strong where there are doubts about loss, and an absence of concrete evidence.

As the shock wears off, the person usually enters into a period of deep mourning. This frequently involves a loss of interest in the person's usual involvements and activities. In one sense, the world of mourning is so intense that it leaves little energy for usual activities. During this time, the bereaved may keep up the activities of work and other routines, but seldom is there energy for new or creative pursuits. Anger can often be a part of this picture, and it can be directed anywhere. It is best to not take the angry statements of a grieving person seriously; they usually regret their outbursts when the pain of grief has passed.

Often the next stage of grief involves a return of energy and a sense of well-being, however often an incident or memory can plunge us back into a hole. This stage is often like a roller coaster, with sharp ups and downs.

The resolution of grief often includes what I call a consolation prize. This can take many forms, such as taking into ourselves part of the special feeling or talent we shared with the lost loved one. One woman I worked with, who had felt especially supported and protected by her late husband, found herself becoming more assertive and confrontational. In effect, she had taken on the role her husband had played in her life, that of protector. Others take on a cause as a way to memorialize their lost loved one. Organizations like Mothers Against Drunk Driving (MADD) and even this very website are ways people have eased grief to change and impact their world.

When we have done the work of grieving, we can remember the lost person without pain, and even recall and enjoy the memory of the good things that made them so special to us.

This is an especially difficult grief situation, because we must grieve lost opportunities and failed attempts at a more positive relationship. I know it sounds odd, but a bad relationship is harder to grieve than a good one. There is more anger to cope with and fewer good memories and situations to draw upon. It is essential to realize that this is a difficult situation and you must try to be kind to yourself while dealing with this type of loss. Cut yourself some slack!

Definitely! If a person dies suddenly from an accident or heart attack, then the shock and denial period are more exaggerated as there has been no time to prepare. On the other hand, the slow lingering death of a loved one gives us plenty of time to repair. But a slow death can lead to guilt and confusion when relief and even pleasure are felt after the person dies. Joy that the loved one's suffering is over overshadows, for a time, the reality of his or her loss. Both these situations modify the initial stages of grief, but over time the subsequent stages emerge.

In the case of someone who dies of Alzheimer's or another illness involving dementia, where the person slowly fades, the finally reaction to the death may be nondescript. This is because the loss of the person has been grieved in small increments over time as different qualities of that person's personality disappeared.

People who mourn a sudden death can often feel guilt at their cold reaction to the news. They mistake the detachment of shock denial for not caring and begin to question their feelings for the loved one. People who avoid the grief reaction often suffer a similar confusion, as they don't realize how hard they are working to avoid the grief reaction.

Yes! Who the person was in your life and the depth of your relationship both effect the grief reaction.

A Parent

The death of a parent is often the loss of our support network. Now there is no one to fall back on, give advice, or be there and care. Many people are reminded of their own mortality at the death of a parent. "There is no one before me now." Parental relationships are often ambivalent and this can complicate grief leaving us confused and distraught.

A Mate

The loss of a significant other is one of the most difficult losses possible. This person was intimately connected to every aspect of our daily life, all our dreams and hopes for the future. When this loss is in the prime of life, further complications of how to cope with the responsibilities of children and finances all come crashing down on someone not emotionally prepared to cope with these problems. These particular circumstances make this form of loss very stressful.

A Child

It has been said that when you lose a parent you lose your past, when you lose your mate you lose your present, and when you lose your child you lose your future. The loss of a child often damages the person's sense of order in the universe, leading to a terrible rethinking of all the person has held close. Marriage, religion, philosophy of life, purpose and meaning can all get thrown into question. All of the hopes, dreams, and expectations for the child add to the burden of the loss. This type of loss often can lead to a grief reaction lasting three years or more.

A Friend

This loss will be specific to the nature of the friendship. The loss of a soul mate is like losing a piece of yourself, while the loss of an acquaintance can trigger simple sadness over the hardships of life.

Circumstances of the death, such as not knowing the cause of death, can result in a person becoming distracted with why the other person died. This can lead to the avoidance of the reality that they are dead and gone.

A sense of injustice around the death can become another distraction from the grief process. Thoughts such as "My son's suffering was unfair or unjust, things like this shouldn't happen, etc.," can become distractions from the loss and delay the grieving process indefinitely. While, "I refuse to accept this injustice" is a very understandable reaction, it serves to prolong the pain of the loss and prevent acceptance and reconciliation.

What a person in grief needs is as simple as it is difficult to do. Essentially, someone in grief needs someone to listen and share his or her sense of loss. The profound feeling of helplessness and vulnerability that the grieving person is experiencing-and the way that they engender these feelings in us-makes responding sensitively difficult. This helplessness is very real! We are all helpless in the face of death. This makes us all uncomfortable and often causes us to say things to the bereaved that they find hurtful, such as "you will get over it � time will heal � I don't know how you are handling this, I know I couldn't." These comments often leave the bereaved feeling dismissed and misunderstood.

The best rule is to say as little as possible and just share the person's pain. Grief is like a poison, so if you take this little bit from me, I will have just that much less to deal with alone. Remember, grief takes longer than any of us would like it to. We must be patient, understanding, and tolerant of those among us who are grieving.