Mental Health Matters: Processing Grief

M. Regina Asaro, MS, RN, CT

As discussed in previous columns, losses which follow an air disaster may involve not only grief but also posttraumatic stress reactions; these may combine to make it particularly difficult to mourn.

Indeed, grief might feel like it just goes on and on; hopefully though, if you stand back and look at where you’ve been, you should see a change or difference in how you’re doing now, compared to how you felt when your loss was new. This column will go back and look more closely at the process of grief itself.

Probably the best known grief theory is that of Elizabeth Kubler-Ross; she observed five emotional stages in those who were dying: denial, anger, depression, bargaining and acceptance. Almost thirty years later, it is pretty much accepted that mourners do not go through “stages,” as such; rather, many of the reactions people experience (described in an earlier column) may come all at once.

So is there something called “the grief process?” If so, what is it? Dr. Therese Rando (1993) described six “R” processes, which are usually encountered in the course of grieving. She noted that these processes should not be considered as grief “tasks” or as a checklist but that they are useful in figuring out where one is in the overall process, and where one may need help to either move forward or get “unstuck.” Although some of these processes build upon others, they may occur at the same time so they are not necessarily linear. A brief description of these processes follows:

Recognizing the loss–here the family member must first know that the death has occurred and understand how and why it happened. Knowing about the death is not just the event of getting the death notification. While we may know in our heads that our loved one has died, it may take quite a while for us to accept the death and believe it. In air disasters, this process may be compromised by the fact that proof of the death–a loved one’s body–may not be recovered.

When the bereaved know the death has occurred, they begin to react to the separation from the deceased and the accompanying pain. As the knowledge of the death sinks in, it triggers reactions to the loss; other losses and changes become evident and the mourner must begin to deal with them as well.

The next process is that of recollecting and reexperiencing the lost loved one–“warts and all” as they say–to remember the person realistically and not put them on a pedestal. For example, the loved one may have had a bad temper on occasion. It may be useful to tell ourselves that we will miss our loved one but not that particular quality.

The fourth process has to do with relinquishing the old attachments to the deceased. Here, we begin to let go of the way we were connected to our lost loved one and the way the world was with him or her in it. This must happen in order to make room for a new way of being in the world without the deceased. We must also let go of the assumptions we used on a daily basis that included our lost loved ones. An example of an assumption might be that Mom would always be there when the kids got home from school and dinner would always be on the table in the evening.

The fifth process is to readjust to the new world without forgetting the old world. Here, we change our relationship with the deceased from one where they are physically there to one where they exist only in our memories. This does not mean we forget them; we understand that the bonds we have with those who have died, though changed, continue and remain a part of us. And why would we want it any other way? After a loss, people often find they must deal with a new identity that has been thrust upon them–some version of bereaved person: widow, widower, and bereaved parent, child or friend. This “identity” may involve many changes to life style, though not all aspects should be perceived of as negative. Oftentimes, an individual develops or explores interests that they either didn’t have time for or did not elect to pursue when the deceased was still alive.

The last process is that of reinvesting. Once the emotional energy is no longer devoted exclusively to keeping the relationship with the deceased the same, it can be put into new relationships or pursuits. These may be with other people or involve taking on a volunteer job or a worthy cause. These new endeavors are not meant to take the place of the deceased, just to take us in a different direction with new purposes and/or interests and provide a measure of personal satisfaction.


The grief process is definitely that–a process; a road on which we travel. We do not leave behind our loved ones when they die; however, we eventually learn to continue our lives with their memories such that we begin to open a space for new experiences and relationships. The grief process demands that we are able to feel the feelings and go through the pain in order to get through it.

You may feel that your grief is “taking too long;” if so, remember that time is a relative thing and that traumatic losses often take longer to grieve than losses perceived to be more “normal.” On the other hand, you or a family member may be feeling “stuck” somewhere in the process, with no forward movement. Good support (including professional assistance) can be very helpful in coping with grief, especially after a traumatic loss such as occurs in an air disaster. I hope these thoughts have been useful to you. Having information about all these aspects of trauma and grief can be helpful in sorting out the emotional aftermath of loss and allow a sense of how successfully one is coping with the overall process. The next column will look at some of the issues which might block one’s efforts at grieving.

Rando, T. A. (1993). Treatment of complicated mourning. Champaign, IL: Research Press (p. 45).

M. Regina Asaro, MS, RN, CT of Newport News, VA, a consultant on traumatic loss issues, may be contacted at

© Copyright 2004, M. Regina Asaro, MS, RN, CT. The above may be copied in part or in its entirety with acknowledgement of the author and its source.