Grief and the mind,
grief and the body
Grief is a process that changes our relation from "presence" to "memory," according to grief counselor Judy Koeppl. The grief of bereavement, she says, is indescribably painful. It is fraught with loneliness, confusion, aching, yearning -- even anger, all coming in varieties that can be frighteningly intense. Koeppl says that grief typically has three stages, but cautions that they may happen in sequence, or they may overlap.

Denial: a feeling of shock and numbness masks the full intensity of the pain.

Suffering and disorganization: the heart of the grief, or what Koeppl calls "the working stage of grief." Here, she says, "you begin to feel the truth, that this is forever, and there's tremendous psychic, spiritual, emotional and physical pain." The symptoms can include lethargy, memory loss and anger.

Reorganization and integration: when the mourner starts to reorder his or her life and sense of self -- with the deceased as a memory instead of a presence.

Good grief
To Webster University's Dennis Klass, who has dealt with death and dying since he was a graduate student under death-studies pioneer Elisabeth Kubler-Ross in the late 1960s, a death forces survivors to answer some basic questions: "Who Am I? Who was this person in my life? Who am I now without this person?"

Ideally, grief will be healthy -- "an experience that opens us to each other and makes us care," he says. Healthy grief "lines us up with reality." Death is the one universal of life, "and if mental health is knowing what is true, this is mental health."

Bad grief
Grief is not just a personal matter. It can be socially destructive, instilling an enduring hatred that can ignite vendettas and ethnic wars. Skeptical? Then look at Bosnia these days, or Northern Ireland, or Beirut 10 years ago.

Grief can be destructive, as Yale University psychiatrist Holly Prigerson found while looking at what she calls "traumatic grief," an extreme version of the normal life passage that has many of the same symptoms as post-traumatic stress disorder. This affliction of some soldiers produces intense sensitivity to stimulus and extreme agitation, survivor guilt, intrusive (uncontrolled and unwanted) thoughts and agitation.

In addition, traumatic grief may be marked by avoidance of reminders of the deceased or a "yearning, searching, pining" for the deceased, Prigerson says, and "a feeling that part of yourself has died. 'I died with him.' We hear this over and over."

Traumatic grief is not rooted in inadequate coping after the death, but in the original relationship with the deceased, who was typically a close, important relative, like a spouse, parent or child. "They had an extremely supportive, symbiotic, secure relationship to the deceased; the person was a Band-Aid" for their problems, Prigerson says. When death severs this critical relationship, she points out, the mourner is "blown away, and at the time of greatest crisis, the person is not there."

Death leads to more death
An aching heart is bad enough. But Prigerson found that these symptoms seem to lead to physical illnesses like heart trouble, a newly diagnosed cancer, headache and flu. "We showed [the symptoms] are related to pathology, even over and above the effects of depression and anxiety." (The Why Files covered the interaction of emotions and health.)

Traumatic grief also impairs social and job relationships, she found. But death can be good news for the cancer merchants -- since Prigerson found that the most common by-product of traumatic grief was a change -- usually an increase -- in smoking, followed by a change in diet. (The Why Files covered nicotine addiction).

Traumatic grief does not depend on mourning style after death, so much as on the dynamics between the survivor and the deceased before death, says Prigerson. It mainly afflicts "compulsive caregivers, or those who are excessively dependent. "Most are normal, high-functioning people who possibly had a parent or spouse die earlier, then had a wonderful relation with a spouse who corrected for that loss."

Prigerson found that the symptoms of traumatic grief were common at first among her 150 subjects. Indeed, 57 percent of the subjects showed high levels of traumatic grief two months into the study (usually within a few weeks of the death).

Eventually most people recover their sense of self, and go on with their lives. But 6 percent of the subjects showed high levels of traumatic grief 13 months into the study. Then the healing seemed to stop. About 7 percent of the subjects showed high levels one year later. Prigerson concludes that the symptoms of traumatic grief "are unlikely to resolve much beyond the level of the second half of the first year of widowhood."

But you don't have to wait that long to intervene, she adds. "People who are totally blown away two months later are the same people who, years later, are still blown away."

That means it might be possible quite early to identify the people who could really use professional help or peer support.