When Can Grief Begin?

by Kambria Kennedy-Dominguez

I've learned through my last few years as a counselor that grief is not what I once thought it was. I used to think that it only began after a loss had occurred, and generally that loss had to be severe, like the death of a loved one or the ending of a marriage. 

But then I started working in hospice, and visiting family members of those who were dying from terminal illnesses. Sometimes these family members had been caring for their loved ones in declining health for up to 10 yeas...or longer. And I realized then that the grief process starts much earlier than I'd imagined. The loss is not always a dramatic final ending, rather sometimes it's the small losses along the way that are the more critical experiences to mental health.

 In this article, I will focus on losses that occur gradually, and the experience of grief as a cumulative process. However, of course, there are times when losses occur suddenly and unexpectedly. Such as losing a loved one in an accident or to an acute health condition. My goal is not to minimize or dismiss those very real and devastating sudden experiences of grief. Rather my goal is to help us bring light to how grief operates in other, less understood, ways. Here are a few examples. None of these stories represent one person I have seen. Rather they are bits and pieces of stories that illustrate how grief can operate in unexpected ways.

I was working once with a wife who had been caring for her husband with Alzheimer's for about 9 years, when he finally stopped remembering the vintage cars that had been one of the joys of his life. This particular escalation of his memory loss was one of the hardest parts of the journey for her. The cars had meant the world to him. He had spent countless hours looking at them, naming them, talking to friends about them, and sharing his passion for them. She asked herself, "Who was he if he didn't remember the cars? Was he still her husband, and why was it harder to relate to him now, to see him the same way?"

​Another time, I was working with a husband whose wife had a form of dementia that in some ways mimics schizophrenia with visual hallucinations and delusions. He struggled most at times that surprised me. It wasn't when his wife saw things that weren't there or rambled on about ideas that didn't make sense to him. The difficulty came when his wife, who had always been diligent in decorating their home in meticulous detail, no longer recognized important objects from their family history. This change represented a tremendous loss for him because her remembrance of care for family heirlooms was fundamental to how he defined her. 

Another time, a young woman came to counseling to work on issues in her marriage that were resulting in her drinking alcohol to excess at times. Over the course of our sessions she also shared that she had learned that her mother had been diagnosed with an illness that was degenerative and incurable. She was seeing a decline in her mom's ability to use words, to navigate around her house safely without falling, and to learn and retain new information. We discovered that her drinking problem had arisen just at the time that her mom was diagnosed with this illness. For her, the knowledge  of the incurable diagnosis was the most difficult loss. She hadn't realized that she was coping with the loss by using alcohol, and that in turn was seriously impacting her marriage.

Discovering losses and recognizing grief are common aspects of work done in counseling sessions. Normalizing and educating ourselves about grief can have a tremendous impact on healing. The five stages of grief are denial, anger, bargaining, depression, and acceptance. They do not always occur in this order, and do not represent finite periods of time or intensity. And they do not always begin after a death has occurred. In the case of illnesses and changes in loved ones that are more gradual, the grief process begins early. And knowing that grief starts early can help us better name our emotional experience and help us be more compassionate with ourselves through moments of suffering.