chapter four: loss and grief

overview of the chapter

During the podcast episode, I spoke with Dr. I-Ching Hung about loss and grief. This chapter contains various sections that build on the information from the podcast episode. In the first section, I explain the complex nature of grief associated with losing a loved one. The second section describes how grief impacts college students and how grieving college students are more common than we think. The third section explains the type of current interventions that exist and provides information and resources to help students. In the final section, I present the significant limitations of the research and gaps in the literature that remain researched and explored regarding grief.

Understanding the Complex Nature of Grief

Grief functions at different levels. It can affect us at an individual level, at the group level, such as familial grief, and at a larger societal level. Grief at each of these levels is usually not independent; the loss and grief felt at each level and build off each other and interact to create an even more profound sense of grief and desperation.

At an individual level, a person experiencing grief may feel intense feelings of yearning and sorrow for those they lost (The Center for Complicated Grief, 2020). For individuals, grieving the loss of a family member or a friend can be one of the most impactful, stressful, and life-changing experiences that an individual can experience (Cox et al., 2016). The grieving process tends to last six to twelve months and will usually resolve itself naturally without the need for clinical intervention (Cox, Dean, & Kowalski, 2015). However, when grief does not subside, it can become a condition called complicated grief (CG). CG is characterized by intense grief, feelings of inability to accept the loss, and difficulty imagining a future without the deceased person, and it is associated with problems like sleep depravity, suicidal ideation, and substance abuse (Shear, 2015). It affects around 2-3% of the global population (Shear, 2015). CG can also lead to long-term anxiety, depression, and cardiovascular problems (Cox, Dean, & Kowalski, 2015). However, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) does not acknowledge CG as a diagnosable disorder (Shear et al., 2011), although it includes a similar disorder called Persistent Complex Bereavement Disorder (PCBD) and classified as “severe and persistent grief and mourning reaction” (The Center for Complicated Grief, 2020).

At a familial level, differences in grieving styles can create conflict among families, but communication throughout the grieving process with your family helps individuals overcome their grief and strengthens familial relationships (Liew & Servaty-Seib, 2018).

At a societal level, there is communal grief, which occurs when a community, society, or nation experience significant losses, such as that experienced due to the grave losses during the covid-19 pandemic, natural disasters, or war (Rehman, 2020). Moreover, due to the extreme collective losses of the covid-19 pandemic, CG has been on the rise, and the prevalence of people with CG is estimated to be 10% – 20% (Gesi et al., 2020). Additionally, the absence of traditional grieving rituals is correlated with CG (Eisma et al., 2020). Due to mandatory government lockdowns and social distancing guidelines, many individuals have not been able to mourn their loved ones traditionally, potentially leading to increases in CG (Eisma et al., 2020).

Loss and Grief Among Undergraduate Students

Studies indicate that between 22% to 30% of students grieve the death of a close friend or family member (Balk, 2008; Cox et al., 2016), and mourning the loss of a family member or friend can be especially challenging for college students. Such a major life event can have significant negative consequences for students, such as negatively influencing their academic work and affecting their graduation rates (Cox et al., 2016). Research shows that a student’s GPA significantly decreases in the semester of loss (Servaty-Seib & Hamilton, 2006). Other adverse effects of grief on students can be depression, self-harm, substance abuse, and eating disorders (Roberts, 2016). Combined with academic life stressors, like homework, assignments, classes, and other deadlines, grief can be overwhelming for many students and can impair their social relationships (Roberts, 2016).

Moreover, during the pandemic, students face many things to grieve: the loss of normalcy, the loss of connections from their school social circles, and the fear of the economic toll, to name a few factors. These factors can all contribute to a sense of grief among students.

Useful Resources for Undergraduate Students

There exist various interventions and resources to help college students cope with grief. The first resource mentioned in the podcast episode is a Harvard Business Review article by Scott Berinato, The Discomfort You’re Feeling is Grief. This article features Dr. Kessler, a leading expert in grief, about how we can manage grief during the pandemic (Berinato, 2020). Dr. Kessler explains that we can recognize the five stages of grief (listed below) and these stages are very fluid and do not follow a linear trajectory (Holland, 2018). Each individual may experience them differently (Holland, 2018).

Denial

Anger

Bargaining

Sadness

Acceptance

Another resource mentioned in the podcast episode is the youth website Hope Again. Students can read others’ stories about loss on this website and share their own (Hope Again, 2020). This sharing can help students understand that they are not alone in their grieving process and help them process their grief.

Moreover, as Dr. I-Ching Hung mentioned during the episode, various Buddhist lessons and beliefs can help individuals cope. Firstly, acknowledging that there is accepting the impermanence of living things and letting go of the things we cannot control (Domyo, 2020).

At a more social level, students and educators can advocate for grief leave policies during college to help students cope (Servaty-Seib, & Liew, 2019).

Limitations and Current Gaps in the Research

Currently, there is not enough data assessing the risk factors that can lead to CG (Shear, 2015) and whether those factors interact with one another to increase or decrease the risk of developing CG. Moreover, a limitation of grief research is that diagnostic criteria are not consistent, as evident from the differing definitions in the DSM-V and the International Classification of Diseases 11 (ICD11) by the World Health Association.

Furthermore, the rigorous research on collective grief is sparse, mostly centered on different wars. Yet, the covid-19 pandemic poses a unique event for more research to be conducted on this topic. Research on multicultural effects of grief is also not as well studied. Therefore, researchers could conduct studies and explore questions on the specific impact of the covid-19 pandemic on culturally distinct regions.

references

Balk, D. E. (2008). Grieving: 22 to 30 percent of all college students. New Directions for Student Services, 121, 5‑14.doi:10.1002/ss.262

Berinato, S. (2020, March 23). That Discomfort You’re Feeling Is Grief. Retrieved March 19, 2021, from https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

Cox, B. E., Dean, J. G., & Kowalski, R. (2015). Hidden trauma, quiet drama: The prominence and consequence of complicated grief among college students. Journal of College Student Development, 56(3), 280-285.

Cox, B. E., Reason, R. D., Nix, S., & Gillman, M. (2016). Life happens (outside of college): Non-college life-events and students’ likelihood of graduation. Research in Higher Education, 57(7), 823-844.

Domyo. (2020, May 20). 135 – Grief in Buddhism 1: Buddhist Teachings on Grief and the Danger of Spiritual Bypassing. Retrieved March 19, 2021, from https://zenstudiespodcast.com/grief-in-buddhism-1/

Eisma, M. C., Boelen, P. A., & Lenferink, L. (2020). Prolonged grief disorder following the Coronavirus (COVID-19) pandemic. Psychiatry research, 288, 113031. https://doi.org/10.1016/j.psychres.2020.113031

Gesi, C., Carmassi, C., Cerveri, G., Carpita, B., Cremone, I. M., & Dell’Osso, L. (2020). Complicated grief: what to expect after the coronavirus pandemic. Frontiers in psychiatry, 11, 489.

Holland, K. (2018, September 25). Stages of Grief: General Patterns for Breakups, Divorce, Loss, More. Retrieved March 19, 2021, from https://www.healthline.com/health/stages-of-grief

Hope Again. (2020). Hope Again. Retrieved March 19, 2021, from https://www.hopeagain.org.uk/

Hyder, S. (2020). Covid-19 and collective grief. Child & Youth Services, 41(3).

Liew, C. H., & Servaty-Seib, H. L. (2018). College student grief, grief differences, family communication, and family satisfaction. Death studies, 42(4), 228-238.

Roberts, K. E. (2016). Grief and bereavement among college students.

Servaty-Seib, H.L. & Hamilton, L. (2006). Educational performance and persistence of bereaved college students. Journal of College Student Development, 42, 225-234.

Servaty-Seib, H. L., & Liew, C. H. (2019). Advocating for bereavement leave policies for college students. Journal of College Student Development, 60(2), 240-244.

Shear, M. K. (2015). Complicated grief. The New England Journal of Medicine, 372(2), 153–160. https://doi.org/10.1056/NEJMcp1315618

Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., Lebowitz, B., Sung, S., Ghesquiere, A., Gorscak, B., Clayton, P., Ito, M., Nakajima, S., Konishi, T., Melhem, N., Meert, K., Schiff, M., O’Connor, M. F., First, M., … Keshaviah, A. (2011). Complicated grief and related bereavement issues for DSM-5. Depression and anxiety, 28(2), 103–117. https://doi.org/10.1002/da.20780

The Center for Complicated Grief. (2020, August 25). Diagnosis: Center for Complicated Grief. Retrieved March 19, 2021, from https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/diagnosis/#:~:text=DSM 5