When you hear the word grief, what do you think of? Death of a loved one might be the most common experience we associate with grief; while this is an event that elicits high levels of compassion from others, there are an array of grief experiences that may not even be considered as such because of the perceptions we have formed about the word. Put simply, grief is defined as the reaction to significant loss. Additional types of loss can include non-death loss, such as that of a job, an important relationship (familial, platonic, or romantic), a valued possession, and physical/cognitive functional abilities. A prominent reason why grief experiences can be so disorienting and difficult to cope with is, it involves the process of change. 

Generally, change is an experience that we are not fond of. In fact, our brains automatically reject any sort of change when initially presented, even if the change is positive (or at least has the long-term potential to be). This may seem counterintuitive, but if we really consider what change means, we will find uncertainty at its core. If change means uncertainty, and uncertainty means we can’t predict or control the outcomes for events, our automatic response is resistance (a giant red danger sign might as well be flashing in our brain!) However, this is just our body’s way of trying to protect us, and not always necessary. 

While positive change may be easier to adapt to, the change associated with loss can feel more threatening to our stability; we can’t plan how long it will take to work through, how we will feel from day to day, or how we will cope with the absence of whatever it is that we have lost. For individuals with OCD, intolerance of uncertainty can be a driving force behind obsessional thinking, often leading to an intense need to maintain a sense of control through compulsions. Adding grief and loss into the mix, this can make an already arduous disorder even more overwhelming. 

The change associated with grief can lead to a disturbance in identity, especially if what we’ve lost was foundational to our core being. Similarly, with OCD, the sudden onset of obsessions that are ego-dystonic to one’s known identity often creates excessive self-doubt, which may lead to a sense of loss towards the aspects of oneself that were thought to be fully integrated. With both grief and OCD management, one may learn that trying to rigidly control our internal and external world rarely works. Alternatively, acceptance is a term that you might hear if you are in OCD treatment, or reading up on the five stages of grief. In both contexts, there seems to be a large misunderstanding about what this actually means for healing. 

Acceptance is often equated to liking or approving of something. With grief, some may fear that getting to the point of acceptance means that the object of loss no longer holds the same importance in their life as it once did. For others who hear the word acceptance, this may translate to, ‘just get over it’ even if this is not the intention. It is no wonder that there is a rejection of the concept of acceptance for grief and OCD sufferers, when these interpretations fail to recognize the lived experience of undergoing painful change and uncertainty that can make navigating daily life feel paralyzing. Practicing acceptance doesn’t mean we always hold positive regard for our current reality, only that we acknowledge it as it is.

In Dialectical Behavior Therapy, there is a distress tolerance skill referred to as, riding the wave (also known as urge surfing). To understand this skill, I’d like you to imagine that you are stuck in a storm in the middle of the ocean. When you try to swim against the current, it pulls you in further, making it more difficult to escape. Instead, you decide to stop pushing against the current, and let go enough to where you are flowing with it; eventually you find that the storm slows down, and you’re able to find your way back to shore. Our emotions are similar to the wave that we try to fight against. In DBT, it is suggested that the more we try to suppress unwanted emotions or end them prematurely, the more suffering we invite in. In this analogy, allowing ourselves to flow with the wave is where acceptance comes from. Riding the wave means noticing our emotions, giving them permission to be present, and then letting them dissipate naturally. Building acceptance towards uncertainty also means being willing to observe one’s feelings without judgement, rather than evaluating emotions that come up as good/bad, or right/wrong. 

Fighting against the ocean current might look or sound like… 

Grief: 

→“I should be past this by now, I don’t want to feel this way anymore.” 

→“I avoid things that remind me of my loss–if I don’t, it’ll dredge up hard feelings” →“I just have to stay positive, and focus on moving on. Being sad isn’t productive!” 

OCD: 

→”I wouldn’t be able to handle it if my fears were to come true. The feeling would be unbearable.” 

→”Maybe my OCD is right, and it is better to avoid being around others. It is the only way to make sure that nothing bad happens.” 

VS 

Riding the wave… 

→Letting yourself cry when you feel tears come up, instead of pushing them down even if the loss is no longer new, or you feel that you’ve gotten to a more healed state. →Exposing yourself to situations that OCD says are unsafe, and choosing to remain present with uncomfortable feelings that arise. 

→Allowing yourself to feel angry when reminded of past job or relationship mistreatment, even if you’ve found healthier friends, partners, and work environments. 

→Feeling anxious about the unknown challenges you may encounter as you undergo a significant life change, and still participating in the activities that are important to you while the feelings remain. 

In the next part of this series, we will talk about how to manage obsessions and compulsions that arise in the context of experiencing grief/loss.

References: 

https://sps.columbia.edu/news/brain-power-revealed-neuroscience-human-behavior https://dictionary.apa.org/grief