A woman sits on the end of a bed with her head in her hands
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Health

We Want Grief To Follow a Timeline. It Doesn’t

Cultural stories about grief promise it gets better with time. This is largely true, but grief can also set its own messy course—feeling delayed, surging unexpectedly, or lasting too long.

There is a Hindu tale about the first mortals to live on Earth, a twin brother and sister named Yama and Yami. In their world, it was always daytime and the sun shone uninterruptedly alongside perfect, spring-like weather. 

One day, Yami found her brother lying down, as if sleeping, yet he was cold to the touch. He was dead. Her grief was overpowering and destructive, and the gods worried it would destroy the Earth. When they tried to comfort her, she would respond, "But Yama just died today!"

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The gods created nighttime so that Yami was no longer trapped in the same endless sunny day. With the creation of night, Yama began to experience the passage of time. When she awoke after the first night, her brother's death was in the past—yesterday, instead of today. As the days and nights went on, her grief abated. 

This story serves both as an explanation for the origin of night, as well as a parable about processing grief—the lesson being that time is the best salve for healing from a loss. 

The dominant fable in the Western world concerning grief is the “five stages”—denial, anger, bargaining, depression, acceptance. They were developed in 1969 after Elizabeth Kübler-Ross observed how patients with terminal illnesses came to terms with dying. Though Kübler-Ross asserted throughout her career they should not be taken too literally, the stages have become a cultural landmark, and like the story of Yama and Yami, foretell that grief is a process that over time, gets better. 

This is largely true. But in some cases, time doesn't interact with grief in the ways we expect it to. When one of my best friends died by suicide in May, the crushing grief that Yami felt did not come for me. It wasn't until very recently, months later, that I've had any moments of wild bereavement or intrusive thoughts about how he died. Though I know better than to expect emotions to progress in any sort of orderly fashion, I was still confused. My experience felt somehow delayed, as if I felt nothing at first and was starting the grieving process late. 

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"Delayed grief" is not an official diagnosis or condition, but a phrase I've seen others use to describe this experience of feeling intense grief weeks, months, or years later after a loss, rather than immediately. But what we feel as a “delay” is not really a delay at all. Instead, it is part of a complex grieving process that takes longer to unfold than we grant it the time to, or than the world around us allows for. 

For some people who are grieving, time betrays them. About one in 10 people have Prolonged Grief Disorder, when they still feel extreme symptoms of grief six months or more after a loss, causing significant disruptions to their day-to-day functioning. Prolonged Grief Disorder is more likely after the death of a romantic partner, after parents lose a child, or when a death is sudden or violent. Prolonged grief, in some people, can emerge after a period of numbness, which can feel like a "delay."

We do not live in a mythic world without the passage of time; I go to sleep and wake up each day with my friend's death further in the past. But we do live in the midst of a pandemic, and experiencing a loss right now can leave little room for processing grief. With so many sudden and upsetting losses, we may find ourselves among  people who are grieving in messier ways than in the fables, enduring grief that veers off-track, bubbles up in disarming ways, and seems delayed or drawn out. In this context, it's more important than ever to talk about grief, and all the ways it can present itself. 

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In the days following his wife's death from cancer in March, Nick Wright, a 29-year-old from Ohio, said he was unresponsive and emotionally numb. He had trouble sleeping, didn’t want to eat, and felt exhausted. “Going through this in the midst of the COVID-19 pandemic has made everything exponentially worse,” Wright said. The couple had used in-home hospice and so Wright had to quarantine alone at home “in the same home that we shared together, sleeping in the same bed that she died in.”

For people experiencing the death of someone close to them, it’s unusual for grief to be truly “delayed," said Kathy Shear, a professor of psychiatry at the School of Social Work at Columbia University and the Director of the Center for Complicated Grief. 

What people may actually be experiencing is a later presentation of the symptoms we most associate with grief, like sadness, crying, depression. Instead, “people can feel kind of numb,” Shear said, like Wright did. Though we may know intellectually that denial and shock is a part of grieving, actually living it is another thing.

"It's a combination of numbness and an inability to wrap your mind around the loss of someone very close," Shear said. "Because in a way, it's unthinkable to all of us to lose someone close. Our minds don't fully comprehend what's happened.”

Holly Prigerson, a professor at Weill Cornell Medical College and an expert in grief, said that this shock can feel like everything is going in slow motion, or as if it's unreal. Like C.S. Lewis described in A Grief Observed: “There is a sort of invisible blanket between the world and me.” 

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Kaitlyn Garcia’s aunt died at the beginning of the summer. The 30-year-old said that she too only felt shock and disbelief. “Then, just an overwhelming sense of numbness." She doesn't think she's started to tap into her other emotions yet. “Being so far away and not close in those first few days has detached my grieving process," she said. "I think because it was so sudden, plus the lack of connection and the [funeral] service has pushed this out." 

Prigerson felt this sense of detachment herself recently. Her mother was having heart surgery, and as she drove to the hospital, she thought to herself, “'I'm feeling like a zombie. I'm kind of upset. But I don't even know what I'm feeling.’ It's almost hard to name it,” she said. “It's not good.”

If a person is overwhelmed, an all-too common state right now, Prigerson wouldn't be surprised if this numbness is more prevalent. People have lost their jobs, are reckoning with the looming election and violently divisive national politics, have children constantly at home, are dealing with the trauma of structural racism, or have other family members that need caring for. “There are a lot of things that would make it very difficult to focus on feelings about the loss of a person," Shear said.

David Kessler, an author and expert on grief, said smaller losses are populating our lives now too, not just death: Cancelled weddings and graduations, lost jobs, distance from friends and families. In an interview with the Harvard Business Review, Kessler said that many of the uncomfortable, paralyzed sensations we’re having trouble identifying could be grief. 

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“My hypothesis is that just too much shit has hit the fan,” Prigerson said. “The constant need to be figuring out how to just get through the day is exhausting.”

British psychiatrist John Bowlby and his colleague Colin Parkes first proposed grief stages in the 1960s—four of them, instead of five: numbness and shock, yearning and searching, despair and disorganization, and then re-organization and recovery. Kübler-Ross’s stages were developed almost a decade later, after her observations and interviews with dying patients. There are other theories of grief too, like that of the Dutch researchers Margaret Stroebe and Henk Schut, called “dual process model,” which posits that grieving people switch back and forth between feeling loss, or being loss-oriented, and focusing on building their life back, or being “restoration-focused.”

We like projections and definitions of grief because “we are pattern-seeking, storytelling primates trying to make sense of an often chaotic and unpredictable world,” wrote science writer Michael Shermer in Scientific American.

"When people are hurting, they want to know, 'How long is this going to last? What will happen to me?’” George Bonanno, professor of clinical psychology at Columbia University, told the BBC in July. “They want something to hold on to. And the stages model gives them that."

Kessler, who collaborated with Kübler-Ross, said that on the first page of the book they co-wrote, On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss, it states plainly that the stages of grief are not linear. 

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“What I always say is they don't prescribe, they describe,” Kessler said. In life, patterns of grieving are unique to the individual. We could feel some of the proposed stages, all of them, or none of them, or ones that didn't make the cut. In order, out of order, or repeating the same one over again. The stages "were never meant to help tuck messy emotions into neat packages," Kessler and Kübler-Ross wrote.

For some people, grief that doesn’t appear after a loss isn’t lying in wait or embalmed in shock. Bonanno has found in his research that many people bounce back faster than they expect. As Derek Thompson wrote in The Atlantic after the death of his mother, “for some, grief is a dull and unrelenting ache that fades—or doesn’t. But for many of us, grief is something else. Grief is resilience.”

Kessler said that feeling a grief “delay” isn't always a bad thing—it can be a positive coping mechanism. “You could not handle all the pain of a loved one dying in one day, you would be on the floor and you would never get up,” he said. “Our mind paces out the grief and the pain over time so that it's sort of dosing us and giving us a little bit of the time.”

That made sense to Wright. “In many cases your loss will be so overwhelming that you can only process in bits and pieces; and that is okay,” he said. 

Yet, according to a study from 2010, when young adults lost someone to a violent or sudden cause, it led to greater feelings of disbelief in the first few months, and then a resurgence of depression around the second anniversary of their loved one’s death. Sudden or shocking deaths are more likely to lead to Prolonged Grief Disorder, recently added to International Classification of Diseases's 11th Revision, which can profoundly interfere with everyday life.

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A case in the NEJM reported that a 68-year-old was sleeping on her couch four years after her husband died, “because she cannot bear to sleep in the bed she shared with him.” She has also stopped eating regular meals, was angry at the medical staff who cared for her husband, avoided activities they used to do together, and “often wishes she could die to be with him.” Prigerson is on the committee to get Prolonged Grief Disorder added as a diagnosis to The Diagnostic and Statistical Manual of Mental Disorders (DSM). (Currently in the DSM, Persistent Complex Bereavement Disorder is listed as a "condition for further study." Prolonged Grief Disorder would be a modification of this disorder, and an official diagnosis if added.) 

While coming up with the definition for prolonged grief, a discussion about delayed grief arose, she said. The proposed entry says that to qualify for prolonged grief, a person should be feeling intense grief  constantly for 12 months after a loss. Prigerson said this ignores data on the subgroup of people that are so overwhelmed at first, that they don’t feel grief symptoms right away. “About 6 percent of our sample community-based sample had this delayed response,” Prigerson said. “And this delayed response was related to a whole host of problems, both at a year and at 24 months post loss,"—problems like the 68-year-old woman had: avoiding daily activities you used to like, having trouble sleeping, not eating or sleeping normally. 

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Prigerson wants to ensure that a DSM addition will include whose intense, disrupting grief makes its entrance a bit later. “Just because there was a delay doesn't mean you should hesitate to seek out help,” she said. 

Prigerson said that she hopes that just having a label for these feelings, like prolonged grief disorder, will help. “People are feeling these symptoms of yearn, like 'I don't know what I'm going to do without this person,'” Prigerson said. “'How do I go on? I can't make my way.' That's different from depression. This is more like, 'Where do I fit in anymore without this person?'”

Beyond this is a larger question: Grief is a normal response—should it be in our code books of diseases and disorders at all? Is six or 12 months, really, “prolonged” when it comes to mourning the death of a loved one? It’s not, the thinking goes, but to have extreme impairment in your life—an inability to do much of anything for six months—is a hint that you may need more support, not that your grief itself is a pathology. 

Kessler said that people put too many time constraints on grief that isn't completely uprooting our lives; we expect it to dissipate too quickly. “The general population has this myth that in the first months or the first year, you grieve and then you're done,” he said. “That isn't how grief actually works. Early grief for me, and what I teach, is the first two years.” Why did I think of my grief as delayed, when in truth, I lost my friend so recently?

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Siri Chilukuri said she only started to really understand her grief around her father's death a year ago in counseling—nine years after he died. When she was 12, her father died of ALS. She didn’t want to talk to anyone about it. 

Right after he died, the emotions were all encompassing and chaotic. “They didn't seem rational to me and I didn't understand how to deal with them,” she said. “And even though I had resources to deal with them, I just didn't want to, and so I didn’t.”

She finished the 8th grade, and went to high school. “I went about my days going to school, hanging out with friends, and taking care of my little sister,” she said, now 22 and living in Chicago.  

Varun Choudhary, a psychiatrist who oversees behavioral health for Magellan Health, an HMO, said that we can often be told to just “keep going.” The reason it can be alarming or disorienting if emotions that have "delayed" suddenly emerge is we're fixated on the ideas of progress, and moving on. 

“Because of the roles and the pressures we put on ourselves, we oftentimes don't allow ourselves to feel the emotions we need,” Choudhary said. “We should really give ourselves a break, allow ourselves to feel what we need to feel.”

When my friend's mother told me over the phone that he had died, I got straight into bed, shaking and freezing cold, wrapping myself up in blankets. The next day I was back to work, by my own choice. I was devastated, but felt detached and a surreal sense of disbelief. Work was a welcome distraction. 

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Then recently, in an angry response to an article I had written, a person emailed me: “You deserve a bullet between your dumb ass eyes.” 

That was how my friend had died—a bullet between the eyes—and ever since I read those words that a stranger sent me, I've been ripped out of the numbness I had been mired in. Something clicked, and I was finally conceptually understanding the violence through which my friend was extinguished from my world. 

I'm lucky to work in a flexible setting where I could take some time off for a death that happened months ago that I was now feeling freshly traumatized by. But many people don't have that. While lived experience and researchers agree grief is not steady forward movement, that's not the way that our safety nets are set up. Business Insider reported in March that the average HR policy only allows for between one and five days of bereavement right after a loss. 

Outside of work, right after a loss, a bouquet of support can bloom up around you. People reach out, they share memories of your loved one, they offer help, they are understanding of your tears, your rage, your rants, or your need for silence. After a while this erodes. It’s a common feeling, Kessler said, for people to feel like it’s too “late” or too much time has gone by to be feeling the extreme emotions of sadness and grief. “You feel like old news,” he said. 

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A pandemic can heighten these feelings—when more than 180,000 people have died, your loss from several months ago might feel irrelevant.

Chilukuri still feels grief come up, sometimes unexpectedly. “I could be sad because of something that’s directly connected to my dad, like he was a baseball fan and I saw an ad for the team that we used to go see,” she said. “Or, I could just be doing an assignment and I miss him. I think that’s hard for people to understand.” 

Jenny Mandel, a 36-year-old from Illinois, lost her father in March. She said that because of the pandemic, her grief feels stunted, and has been materializing in small waves. “I can be sitting anywhere and in one second start crying,” she said. 

She said that it’s not confusing why it’s happening, it's more about when. “I can explain it,” Mandel said. “My dad passed away and I am crushed. I think the part that is confusing is the logistics of it all. Why do some things trigger it, why do some things that don’t matter at all suddenly cause it to happen?”

Shear told me it’s very common. “We don't 100 percent come to terms with the loss of anyone, probably none of us do,” Shear said. “If it's a permanent loss, you're going to grieve it permanently.” That can be an uncomfortable notion—that we'll carry grief, with all its unwieldiness, for the rest of our lives. 

Our dedication to the stages of grief in the U.S., or what they symbolically stand for, in spite of Kübler-Ross and Kessler's efforts, reveal much more about our desires and projections than grief itself. Stages are clean and iterative, a checklist that implies progress, completion. 

That matches better with a world that seeks to have us be the most productive and efficient as possible. “I think that we live in a country that has a very backward view of grief and what mourning looks like,” Wright said. 

As the American author and activist bell hooks wrote in her book All About Love, “sustained grief is particularly disturbing in a culture that offers a quick fix for any pain. Sometimes it amazes me to know intuitively that the grieving is all around us yet we do not see any overt signs about grief that lingers. Like a stain on our clothes, it marks us as flawed, imperfect. To cling to grief, to desire its expression, is to be out of sync with modern life, where the hip does not get bogged down in mourning.” 

With a potential wave of new grief on the horizon, it would be worth it to expand our ideas about grief, and recognize it in those around us. Chilukuri thinks that people who are grieving should talk to one another, and recognize it as a lifelong journey that waxes and wanes. “I don't think there's ever going to be a point in my life when I'm not at least a little bit impacted by grief,” she said. 

Follow Shayla Love on Twitter.