Grief

Grief occurs not just when someone dies, but whenever a person experiences significant loss. Losses can range from loss of business, home, pet, possessions, security, trust, safety, or family member. Grief is a normal process that follows any significant loss. It affects the person physically, emotionally, socially, and spiritually. See Symptoms of Grief. Life is irrevocably altered, and the process of grief includes stages of coming to accept that reality.

The disclosure of a child's sexual abuse initiates a pervasive sense of loss in mothers. They grieve the loss of their child's innocence. They grieve the loss of childhood and adolescence without the damaging effects of sexual abuse. In the case of incest, they grieve the loss of family as it has been experienced in the past and family members whose role and place in the family change. If the perpetrator is a partner, the mother experiences loss of an intimate relationship and loss of trust. This loss compares to the loss of a spouse due to death or divorce. The loss may come without warning and initiate a traumatic experience similar to hearing a spouse has been killed in an automobile accident. Mothers may experience significant loss of self-esteem.

Elizabeth Kubler-Ross (1969) identified stages of grief, and these stages coincide with the experience of mothers following the sexual abuse of a child. The stages of grief include:

Denial or emotional numbness - This is a natural defense to protect the person from reality. Otherwise, the grief may overwhelm the person, and normal function would be impossible. Over a period of time, however, she can face the reality and recognize that nothing can undo the loss. Denial lessens with use of healthy coping and external support.
Anger - Anger can be directed at everyone involved in a situation. Grief is an emotional state, and a person is vulnerable to illogical thought processes and a lack of objectivity and clarity of thought. Anyone can become the focus of the anger. Mothers may be angry at perpetrators, themselves, victims, social workers, doctors, lawyers, courts, and anyone else involved in the process.
Guilt - Guilt is inevitable with any grief. In this case, mothers are vulnerable to intense and long-term guilt as they blame themselves for not protecting their children. They rethink situations, events, or lifetimes, looking for clues to how they may have known or should have known. Guilt can change to depression and even despair unless processed through.
Depression - Depression is a normal grief reaction and may feel like a heavy cloud hanging over your life. Depression is paralyzing and can sap energy, motivation, and hope. Left untreated, depression can affect jobs and other responsibilities and destroy relationships. When depressed, mothers may seek unhealthy solutions, such as alcohol or drugs, or isolate from the support desperately needed at this time. If mothers are depressed following the disclosure of a child's abuse, it is important to get professional help.
Acceptance - Eventually acceptance of the loss occurs. However, this does not mean that life goes back to what it was before. True acceptance is accepting life on life's terms, which means life as it is, in reality, incorporating positives and negatives.

A recent study by Maciejewski, Zhang, Block, and Prigerson (2007) showed that, although the five stages of grief were present, each peaked during the grief process. Results of the study show that:

Disbelief peaks at one month.
Yearning peaks at four months. Yearning is the missing of the way things were. In the case of losing a loved one, it is missing that person.
Anger peaks at five months.
Depression peaks at six months.
Acceptance is the strongest response to loss. It is present at the first and grows stronger with time.

The researchers concluded that sadness is not the predominant emotion in the grieving process. Yearning or what they characterized as pining increases steadily until the fourth month after a loss. The study showed that the first four stages gradually reduce in intensity after peaking; however, acceptance continues growing after a two-year period.

Parkes (1998) in his study of the grief process reports that about a third of people who lose a child or spouse will experience negative effects to both physical and mental health. Heart disease and other medical and psychological disorders increase following loss. The normal course of grief is outlined as:

Numbness - The initial response of disbelief and inability to comprehend and process the loss. May last for hours or days. Usually includes impaired judgment and difficulty concentrating.
Pining - Intense longing for the person accompanied by anxiety. Separation distress. Inability to accept the reality of the loss and yearning and searching for what was. Includes restlessness, anger, and guilt. Sometimes includes withdrawal from social activity.
Disorganization and despair - Going over the events leading up to the loss and trying to find out what went wrong and make it right. Includes depression and lack of familiarity with present life; however, acceptance of reality has increased.
Reorganization - Normal life functions, such as eating, sleeping, and short term memory, return to normal. Includes increased energy, decision-making, and self-confidence. Recovery often occurs in the second year after loss.

The tasks of the grief process include:

Using healthy coping skills and accessing support in order to process past the denial and accept the loss.
Experiencing the pain and the feelings associated with the losses. Allowing the process of "feeling the pain" to occur, rather than avoiding it.
Adjusting to life in the here and now and to new roles, new ways of being, and a new sense of self and the world.

Mothers who experience the sexual abuse of a child process through grief and experience stages and tasks as in other types of losses. These are unique to the individual and situation and not predictable. As mothers process through the grief stages and symptoms, they must also perform critical roles in supporting the victim and remaining engaged and functional with the rest of the family. Because of this, the grief process can be aborted. If mothers do not experience the grief process, they are more likely to demonstrate physical or emotional consequences at a later time. See Complicated Grief.

Grief is a lifelong process. The intensity reduces but continues to be present. Like the aftershock of an earthquake, small tremors may occur for a long time. Loss creates a wound, and wounds take time to heal. However, time alone does not heal grief. The process and outcome of grief is dependent on the use of healthy coping skills. Unprocessed grief can cause suffering for the rest of the person's life.