By Toni L. Eaton, RN, BSN, MS, President & CEO of Old Colony Hospice & Palliative Care

Most people think of grief as a singular emotion. Working in the hospice field, though, we see many kinds and layers of grief. Loss takes on all shades, and what we feel as we grieve can be complex, overlapping, and confusing.

You’ve probably heard the phrase that everyone grieves in their own way. And that is true. But every grief we experience also has its own makeup. Understanding that can help us understand what is happening, how to support each other, and find a way to move forward.

One of the most recognizable forms of grief is called normal grief. It’s probably what you think of when the word grief comes up, and it’s often accompanied by sadness and loneliness. The American Psychology Association defines normal grief as lasting months to two years following a significant loss. In the case of the death of a loved one, for instance, we mourn the person we have lost, and we expect society to recognize that.

But Maria Campbell, Spiritual Care Coordinator at Old Colony Hospice & Palliative Care, said there is also often secondary grief that goes unnamed or is overlooked, although it too is important to understand. For instance, a member in one of her grief support groups recently lost his wife. They had enjoyed traveling together and had made many happy memories. He was sad and lonely that she was no longer with him, but it wasn’t only her being with him now that he missed.

“He talked about the loss of future memory-making and dreams,” said Maria C. “He said that part of his grief and his pain came from the realization that she would no longer join him in future travel. She would no longer be part of his future memories.”
Secondary losses come as a result of the primary loss and can come in a variety of forms, such as changes in relationships, family finances, and shifts in identity and circumstances.

One woman suffered from a loss of security after her husband died. When her husband had been alive, she was never afraid; he made sure the stove was off, locked the doors, and attended to the windows. She had always felt safe.
“Now, she was afraid in her own home, and this was not the person she had been,” said Maria C.

These kinds of associated losses create their own grief. Another woman lost her sense of self when her partner died. She had been his caregiver for many years because he had been chronically ill leading up to his death. She had dear friends, children, and others in her world, but she struggled.

“She said, ‘I don’t know what my purpose is. I no longer have a purpose to my life.”

It’s important to recognize that these secondary losses are also important to people.

There are many forms of grief beyond normal grief. Some include anticipatory grief, complicated grief, and disenfranchised grief.
Anticipatory grief occurs in anticipation of a significant loss, such as when a loved one is diagnosed with a terminal illness, the end of a marriage, separation from a job or moving to another community.

“Even our patients experience anticipatory loss,” Maria C. said. “Often, they are fearful and sad about how their death will cause their loved ones pain.”

Complicated grief brings in conflicting feelings about the loss, such as for an abusive partner. A person’s sadness may mix with other emotions, such as anger or relief.

Another form of grief is cumulative grief, which involves a number of losses in a relatively short amount of time. During the pandemic, many people felt this cumulative grief and exhaustion in the face of multiple deaths around them.

There are many more kinds of grief, such as disenfranchised grief, when people feel they cannot, or society doesn’t, acknowledge their grief, such as with a hidden or little-known relationship or the loss of a deeply loved pet.

“There really are as many kinds of grief as you can possibly think of,” Maria C. said.

While most people will work through their grief, it can be helpful to seek help from friends, a counselor, or a healthcare provider, especially if it becomes overwhelming or debilitating. Consider a support group. Most hospices, such as Old Colony Hospice & Palliative Care, offer a variety of grief support groups that are open to the public. If you have questions or would like more information, call (781) 341-4145.

Toni L. Eaton, RN, BSN, MS, is the President & CEO of Old Colony Hospice & Palliative Care of West Bridgewater, a dynamic non-profit hospice serving more than 55 communities south of Boston. OCH also runs the Dr. Ruth McLain Hospice Home in Braintree. A native and resident of the South Shore, Toni brings her compassion and experience as a nurse, veteran, and community leader to her insightful columns for South Shore Senior News. She is also the founder of Sunny Paws Dog Rescue. Several groups have honored her leadership, including the South Shore Women’s Business Network. She currently sits on the board of the Hospice & Palliative Care Federation of Massachusetts. For more information, call (781) 341-4145 or visit Old Colony Hospice & Palliative Care at