That’s Not Fatigue: Dealing with Unresolved Grief

by Frederick Jansohn

When grief goes unresolved, it will eventually deplete our resources until we can no longer function properly. The author shares steps toward renewal.

It was after dinner and my wife and I were sitting in our living room with a missionary couple who came seeking advice. For some time, the wife had been worried about her husband and was encouraging him to talk to someone about the behavioral changes she was observing. They had read some books on burnout and made some changes to reduce his stress, but she felt the problems were getting worse. He felt tired from all the ministry on his plate, and he needed a long break. “Not a bad idea,” I suggested, “maybe some R&R would be good for him.” The wife turned to her husband, saying, “But dear, when we do take a break you don’t rest.”

This raised a red flag for me. I increasingly find missionaries who think they are just stressed from work or overburdened with demands on their time, but a closer look reveals that more is going on beneath the surface. Such was the case with this man.

He didn’t realize that he was barely performing his work or that his moods were so dark so often that gloom had become his natural state.

When I asked him to name the last time he felt peace, joy, or contentment, he was shocked to realize that he couldn’t even remember. Yet he continued to blame overwork, stress, and the need for a longer vacation. So I probed a little further and as we began to talk, he admitted that he would sometimes sit for hours at a time and not be able to work, even though he had a long list of things to do.

He was consistently quick to anger to the extent that his family was learning to “test the water” when they were around him to see how to approach him. (He later discovered that his children called this period of his life his “angry time.”) In fact, he had lost hope and found it hard to care about the next day, let alone the future.

What was going on in his life? Did he need a change of ministry or scenery, a new understanding of his position in Christ, or a renewed passion to serve the Lord? What was the source of his hopelessness, fatigue, and frustration? As we worked together it became apparent that, like a number of other Christian workers with whom I have recently spoken, this once-vibrant missionary was suffering from unresolved grief.

Grief
Grief is what we experience when there is loss in our lives. It can be very painful—sometimes immobilizing. Grieving is healthy, however, and is the way we process and heal from loss. Unresolved grief occurs when we don’t grieve our losses or don’t grieve them properly or completely.
Different cultures grieve differently, but most have some type of ritual that aids the process of closure. This helps people to acknowledge their loss, come to terms with it, and continue with their lives. In her landmark book, On Death and Dying, Elizabeth Kübler-Ross suggests a process called “The Five Stages of Grief” (1976). These stages are familiar to many people:

• Denial: “This can’t be happening to me.”
• Anger: “Why me? This isn’t fair.” “God, how could you let this happen?”
• Bargaining: “Just get me through this and I’ll…” “I’ll do anything if…”
• Depression: “What’s the point in trying?” “Nothing will work, why go on?”
• Acceptance: “It will work out eventually.” “I need to continue on.”

What people may not be familiar with, however, are the difficulties that can arise when a person either avoids the process or stalls somewhere in the middle instead of working all the way through it. The pain of the loss continues and instead of allowing the healing process to occur, a person seeking to avoid the pain stalls in denial, anger, bargaining, or depression. Unfortunately, the “coping mechanisms” the person must develop to maintain these states cannot be sustained indefinitely and eventually cause greater problems than originally existed.

In order to avoid dealing with loss, a person can form a habit of avoiding grief to the point that he or she rarely deals with even the small losses. These losses build up, each one contributing its share of negative symptoms. The person is then caught in a vicious circle, expending more and more of his or her resources to overcome the mounting symptoms of loss until the resources are depleted.

When this happens, he or she is no longer able to live a normal life. There are not enough resources to cope with normal life and overcome the negative symptoms of the accumulating grief. In the case of the man mentioned above, several large losses had occurred and then a number of small losses began to pile up, leaving him unable to cope with the everyday stresses of life.

Hidden Loss
There are two elements of grief, and specifically unresolved grief, which make loss harder to see and deal with: accumulated grief and ambiguous grief.

Accumulated grief occurs when losses are not dealt with properly or completely. As described above, the losses add up until a person is no longer able to bear the burden. The problem is that most of the losses are so small that a person doesn’t register them as being something to grieve about until these have accumulated into an overwhelming mass. Sometimes, a person develops a “tough-it-out” mentality and attempts to ignore the losses.

Let me use an illustration: If you throw a frog into hot water, it will immediately jump out; but if you put it in cool water and turn up the heat slowly, it will stay in until it is too late. As the water heats slowly, the frog is able to tolerate the new temperature and considers it normal. This keeps happening until the frog succumbs to the heat. The problem for the frog, of course, is that it can only tolerate a finite amount of heat stress.

Ambiguous grief clouds the picture as much as (if not more than) accumulated grief and refers to the hidden losses in life. For example, missionaries move a lot, and each time they leave behind people and things that have become an important part of their lives. In the past, this has been considered a normal, though difficult part of missionary life. It was something that needed to be endured, not grieved over. Studies show, however, that this type of loss has profound effects on us and our children (Third Culture Kids, TCKs). It is only recently that this is being recognized in mainstream thinking as a type of loss.

Has anyone ever asked you, “How did you get that bruise?” Until he or she brought it up, you may not have even noticed the bruise—after all, we all bang our arms and legs and often ignore the little bumps. If you are too rough on your body, however, the aches and bruises add up until it can be difficult to exercise or even stand.

Missionary life, too, can bring a lot of bruises. As a matter of fact, if the missionary lifestyle were a sport, it would be an extreme sport. Sure, such a “rough-and-tumble” lifestyle can be exciting and rewarding, but there are a lot of bumps as a matter of course and we ignore their accumulation to our own peril. If we’re not careful, we can find ourselves depleted of the resources necessary to live a normal life, and it may come as a surprise that the effects of these small and sometimes unseen losses have become so large that they can’t be avoided any longer.

Missionaries are especially susceptible to this. The same deep commitment that most missionaries feel toward their calling can actually lead them to suppress feelings of loss and either avoid or shorten the grieving process as they press forward in serving the Lord with alacrity and fervor.

Prevalence
So just how prevalent is the problem of unresolved grief? Although statistics are not that easy to come by for missionaries, there is other research that can give us an idea of the scope of this problem.

An interesting way to approach this question is by first looking at how much loss a person can endure. In one study, Thomas Holmes and Richard Rahe examined the medical records of five thousand people to see if stressful events could cause illness (Holmes 1967). They found a close correlation and published their results as The Social Readjustment Ratings Scale or The Holmes and Rahe Stress Scale.  

Forty-three life events were placed on a scale and points were assigned depending on how much effect the event had on a person’s life. The highest was the death of a spouse at 100 points, and a minor violation of the law the lowest at 11 points. Patients were asked to list the events they had experienced and the score for each person was totaled. The authors discovered that a score of 150 indicated a slight risk of illness, 150-299 indicated a moderate risk, and 300+ indicated a definite risk.

Although the research was designed to study stress, a large percentage of the life events listed in the scale have at least a small component of loss and some largely so. The correlation between loss and stress is clearly seen. Loss causes stress and great loss causes great stress.

I have spoken to several colleagues over the past few years and the consensus is that while people in the States endure scores of 400, some missionaries often live at sustained levels of stress at around 600 on the scale. The thought is that we are able to live like this for periods of time because as Christians and trained missionaries our resource pool tends to be deeper than most and so we are more resilient. However, even missionaries are not able to live at this level indefinitely and will eventually develop the symptoms of accumulated loss and unresolved grief unless they are able to properly deal with the situation.

Looking at the question of prevalence from another angle, David Pollock and Ruth E. Van Reken discuss the difficulties that TCKs experience because of loss (2009). In fact, this can be one of the most prevalent issues with which adult TCKs deal. If children experiencing these losses need help in dealing with the resultant grief, then it follows that their parents and other adult missionaries who have lived under these same stresses for longer periods of time will also need to deal with their losses. If loss is considered to be prevalent, and if missionaries have a tendency to ignore loss, then unresolved grief will be prevalent as well.

Member care professionals and mission leaders do well to consider unresolved grief when evaluating personnel experiencing difficulties. It is also important to note that it is a spouse or co-worker who will often bring this to light as the missionary is often blinded to the seriousness of his or her condition.

Symptoms
The symptoms of unresolved grief are not necessarily clear cut. They can mimic those of other problems like marriage issues or overwork. Burnout, for example, is often a reality with missionaries who have carried heavy loads, and in the last twenty years much time has been devoted to understanding, diagnosing, and resolving burnout and its many causes. I am finding, however, that burnout is often a symptom of unresolved grief.

To confuse things further, sometimes the inappropriate coping mechanisms a person has developed can make his or her life look like he or she has actually processed and handled the loss well. Take the grieving workaholic, for example. Instead of dealing with his or her loss and grief, the person blocks the loss from his or her mind and throws him or herself into an unrealistic amount of work in order to forget or avoid the situation. The insidious thing is that the person can actually receive praise for how much he or she is accomplishing in his or her profession while he or she and the family languish until eventually it all comes crashing down around him or her.

If someone doesn’t see that the source of the problem is actually unresolved grief and the worker is merely treated for a symptom of the problem, then the real problem of unresolved grief will remain unresolved. In the end, vacation, instruction in time management, marriage seminars, and prioritizing will provide only temporary relief and the problem will continue. It is vitally important to continue working until the root problem is uncovered.

So, what are some of the main symptoms of unresolved grief?

• Burnout—no vision, no desire: “What difference is it going to make if I do this?” “I don’t even feel like going to work anymore.”
• Marriage issues—lack of communication, romance, intimacy: “I feel like we’re growing apart, but I don’t have the energy to do anything about it.”
• Parent/child relationships—lack of communication, nurturing, discipling: “I just can’t deal with them right now.” “I just need to be alone. They (spouse) can deal with it.”
• Unreasonable emotions: Sometimes a person can go for days and not get out of a chair. He or she may have a “quick fuse” that can trigger intense, unreasonable anger with little provocation.
• Lack of hope: It’s hard for the person to consider doing something in the future when he or she doesn’t have enough energy to deal with today.
• Lack of forgiveness: This person has typically either refused to forgive or to be forgiven.
• Blocking out the past: This person may refuse even good memories in order to avoid bad ones.

This last symptom is fairly common and often seems to characterize unresolved grief. Painful memories can range from a difficult childhood to a demanding job or the death of a loved one.  They may include being betrayed by a co-worker or someone we trusted, or experiencing a very difficult term on the field. It can seem easier to avoid thinking about a dear friend we’ve had to leave behind rather than remember the good times we had if it means we must experience the hurt of separation again. Unfortunately, this robs us of all the good that was there, as well as making the problem worse.

While this article is too short to encompass all the possibilities for diagnosis and solution design, there are some practical things a person can do to get started on a path of healing (see below).

Conclusion
Grief is a difficult, painful process and it may seem that avoiding it would be beneficial. Yet when grief goes unresolved, it will eventually deplete our resources until we can no longer function properly. The good news is that when the grieving process is completed, it brings renewed health and the ability to go on with greater strength. There is relief from the burden of pretending to handle things, and from striving to cover up with inadequate coping mechanisms.

We need to understand the path to healing and make sure that we do not skip or shortcut the journey. Remember that you don’t have to struggle with this on your own—there are others who can help you find your way through to joy. Most importantly, Jehovah Raphi is God, our Healer, and he can heal the pain of loss and bring you to new levels of peace and joy in your life. There is always hope in him.

References
Holmes, Thomas. 1967. “The Social Readjustment Rating Scale.” Journal of Psychosomatic Research 11(2): 213-218.
Kubler-Ross, Elizabeth. 1976. On Death and Dying (16th ed.). London; New York: Tavistock Publications.
Pollock, David and Ruth E. Van Reken. 2009. Third Culture Kids: Growing Up among Worlds. (rev. ed.). Boston: Nicholas Brealey Publishing.
 

Five First Steps to Begin the Healing of Unresolved Grief

1. Are you unsure how well you are functioning? Ask someone! Spouses and teammates can give extremely valuable feedback. Be sure you approach them with an open heart and listen without being defensive. Don’t be afraid of the truth. (Prov. 1:5, 12:15, 19:20)

2. Ask God to give you discernment to understand how you feel, what others are saying, and what he wants to teach you through this. (James 1:5)

3. If God begins to show you that unresolved grief is a problem in your life, humble yourself under his hand and be willing to investigate your patterns of living with a heart that is willing to change. (Ps. 139:23-24; 1 Pet. 5:6)

4. Don’t despair. You have already demonstrated your ability to bear pain as you have struggled with unresolved grief; now turn that strength to dealing with the actual problem and see it all the way through to joy. When you deal with loss and grief, instead of wearing you down it forges a stronger faith and a deeper relationship with God that leads to increased joy and new levels of love and service. (John 10:10, 15:11; Ps. 51:8)

5. Talk to someone who has experience in helping others with grief. This could be a pastor, a member care person, or a counselor. With training and experience he or she will be able to help you identify your losses, point out any coping mechanisms you have adopted, and help you build a strategy for healing. (Just as importantly, he or she will be able to tell if your symptoms are being caused by something other than unresolved grief.)

Frederick Jansohn is director of member care at Biblical Ministries Worldwide. His focus is on developing and leading a program of comprehensive, sustainable member care to uphold and nurture mission personnel from recruitment to retirement.

EMQ, Vol. 49, No. 1, pp. 72-79. Copyright  © 2013 Evangelism and Missions Information Service (EMIS).  All rights reserved. Not to be reproduced or copied in any form without written permission from EMIS.