Posted by Aurora on Wed, 05/09/2012 - 1:35 PM
GRIEF AND LOSS
We often think of the loss of a loved one as the only reason for grief when in fact we mourn many losses in our lives, i.e. a lost job, a lost pet, a lost relationship, a change in community. The significance of the loss determines the intensity and duration of our mourning, and multiple losses may compound our grief. Each loss must be mourned—recognizing the significance it played in our lives, commemorating or paying tribute, recognizing that the contributions can never be lost because they are a part of you, coming to terms with the reality of the loss, and learning to accommodate and reinvest in life.
Grief is considered a normal response to the death of a loved one and usually lasts six to twelve months. Symptoms of grief include a yearning to be with the deceased, deep sadness and crying; sometimes irritability, anger, remorse, and guilt; recollection of memories without warning; sensory triggers of memories; somatic symptoms such as appetite and sleep disturbances and fatigue; disbelief, even to the point of forgetting occasionally that the loved one is gone; withdrawal, disengaging, apathy; and raw grief with significant holidays, anniversaries, birthdays, and activities resumed for the first time without the lost loved one.(1)
Grieving is harder if there was conflict or dependence in the relationship; if there were unresolved issues with the deceased that cause guilt, anger, resentment, or lack of closure; if there are multiple deaths; if there is pre-existing mental illness and/or childhood trauma; if the death was traumatic, untimely, or unexpected; if a caregiver's life was structured around the deceased; and if the person's support system is inadequate, i.e., for persons who outlive their spouses.(2)
Despite Elisabeth Kübler-Ross's identification of five linear stages of grief (denial, anger, bargaining, depression, and acceptance), others have proposed alternative, non-sequential responses. Dr. Colin Murray Parkes writes that people in grief experience "several prolonged and overlapping phases" (numb disbelief, yearning for the deceased, disorganization and despair, and then reorganization)(3). Dr. J. William Worden suggests three tasks of the grief process: "to accept the loss, to experience the resulting pain, and to put the loss in some perspective and adjust to a changed world."(4)
Early in grief, according to Dr. Margaret Stroebe and Dr. Henk Schut, people focus "on the person who died, the circumstances of the death, and painful feelings like yearning and despair." Later people turn to focusing on "managing practical issues that arise, such as loneliness or challenging new circumstances." People may take breaks during the grief process.
According to Dr. Barbara Okun and Dr. Joseph Nowinski, authors of Saying Goodbye: How Families Can Find Renewal, when loved ones are lost to prolonged illness, grief begins with the diagnosis. Unity is required as their care is organized and managed. Upheaval occurs when the crisis passes and caregivers stop and realize the impact on their own lives. Resolution that the inevitable loss will occur follows, along with decisions related to hospice and end-of-life matters. This is the time for "resolving old issues, healing wounds, and addressing resentments and jealousies."(5) The final state is Renewal which begins with the funeral and progresses through loss and changed roles.(6)
Complicated grief or traumatic grief occurs when grief is not resolved as expected and symptoms of depression and/or post-traumatic stress disorder (PTSD) occur. If a death is untimely, unexpected, or traumatic, complicated grief may occur. Persons with a history of depression, anxiety disorders, or a personality disorder may suffer complicated grief, as well as PTSD if the loss was traumatic. If a person experiences increased alcohol, tobacco, or drug abuse; weight or appetite change; insomnia or hypersomnia; uncontrollable anxiety; and failing to feel better after a year, professional help may be essential.(7)
Suggestions for managing grief include: healthy diet, sleep, and exercise; delaying important decisions; avoiding risky behavior; self-care; talking with others; expressing feelings and needs; accepting mixed feelings; clarifying your needs to others; support groups and support systems; avoiding isolation; recognizing that everyone grieves differently. One common fear is that a loved one will be forgotten. Commemorating your loved one may help assure you that your loved one will be remembered and may include: creative projects such as scrapbooking; journaling; developing a slide show; putting together a memory box or a photo wall; contributing to a charity in your loved one's name; donating a park bench; planting a tree; having a memorial service; offering a prayer; and creating an "echo" (doing something your loved one did that was a happy memory).(8)
It has been my experience that even though it may seem that you will never be able to stop crying or that you can never be happy again, eventually the traumatic, tragic, or disease-death-funeral-cemetery images are gradually replaced with memories of treasured times with your loved one. When you are lonely or missing them, it may help to go through the photo album or call someone who knew them and loved them almost as much as you did. Death cannot take away the impact they had on your life nor diminish the things you learned from them.
- Elizabeth S. York, M.Ed., LPC, LMFT