grief

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The death of a loved one, even when expected, is always a shock and sometimes the pain of the grief is so powerful it seems too hard to bear. Losing someone you love can be devastating particularly when their passing is unexpected. Different people respond in different ways and at different times. Some people experience strong emotions quickly, while for others it takes time to for their feelings to surface.

Most of us have experienced grief in our lives. There are many aspects of grief. Apart from the obvious emotional ones, there are often behavioural, physical, cognitive, social and philosophical or spiritual facets. In 1974, The Handbook of Psychiatry defined grief as "...the normal response to the loss of a loved one by death". Bereavement is the term used for the state of loss while grief refers to to the response to loss. We all respond differently to loss and those responses are influenced by culture, family, personality, spiritual and religious beliefs.

Many people deal with their grief by themselves, accepting it as a normal part of life. For some, however, additional support may help the process of healing. This is especially so in certain situations, the loss of a child, for example, or when the loss has been unexpected and caused through violence.

Processes of Grief

In the 1960s Dr. Elisabeth Kübler-Ross proposed the Five Stages of Grief. These are:

Denial - "This can't be happening to me."

Anger - " It's not fair."

Bargaining - "I'll do anything, if only ... "

Depression - "What's the point?"

Acceptance - "I'll get through this", or "I may as well prepare for it".

Since Dr Kübler-Ross first proposed these stages, others have noted that they can be applied to many types of loss, not just to bereavement. People dealing with work redundancy, disability and injury, relationship break-up, financial despair and bankruptcy, etc. all go through similar stages. Even something like losing your purse or wallet can provoke these responses. (Just imagine misplacing something that you value or need and think about what you feel and say to yourself as you look for it - I am sure that you will notice many, if not all, of the above stages.)

Of course, there is tremendous variation and the stages are not necessarily experienced in sequential order. People may cycle through some or all of the stages or get stuck in one, especially depression. Other researchers, notably John Bowlby and Colin Parkes, have found the Five Stages to be too simplistic and have proposed other processes such as Shock and Numbness, Yearning and Searching, Disorganization and Despair, and Reorganization.

Grief experts have also identified other dimensions in grief, such as a yearning for the lost person or state of affairs, a need to think repeatedly about past events, a sense of guilt, or even thoughts of suicide. A distinction can also be made between the immediate response to loss and the grieving that may continue long afterward or which does not appear until some time has passed since the death or other loss.

Currently five aspects are receiving particular attention from grief experts.

First, the grief response has a strong stress effect on the physical body and many studies have found increased risks for stress-related illnesses among those who are grieving. Colin Parkes found that, in the first six months after the death of a loved one, family members visited the doctor more often with symptoms such as abdominal pain and breathing difficulties.

Secondly, perception and thought are also affected, leading to an increased possibility of making impulsive decisions and becoming more at risk for accidents.

Thirdly, there can be a questioning of spiritual beliefs and guiding values.

Fourth, the support or lack of support of family and friends is significant in how well a person copes with loss.

Fifth, cultural influences and support systems influence the way one expresses and copes with the stress of bereavement.

Complicated Grief

Usually people experiencing bereavement move through the period of mourning to accept their loss and move on but sometimes a person can develop Complicated, also called Prolonged, Grief. The signs and symptoms of normal grief and Complicated Grief are the same but in Complicated grief they do not fade over time. In fact, they may get worse.

According to the Mayo Clinic, the signs and symptoms of complicated grief can include:

Extreme focus on the loss and reminders of the loved one

Intense longing or pining for the deceased

Problems accepting the death

Numbness or detachment

Preoccupation with your sorrow

Bitterness about your loss

Inability to enjoy life

Depression or deep sadness

Difficulty moving on with life

Trouble carrying out normal routines

Withdrawing from social activities

Feeling that life holds no meaning or purpose

Irritability or agitation

Lack of trust in others

Complicated grief is relatively uncommon. Because there is little research on this, it is hard to know how many people are affected. Some estimates suggest that as few as 6 percent or as many as 20 percent of bereaved people develop complicated grief.

While it's not known specifically what causes complicated grief, risk factors may include:

An unexpected or violent death

Suicide of a loved one

Lack of a support system or friendships

Traumatic childhood experiences, such as abuse or neglect

Childhood separation anxiety

Close or dependent relationship to the deceased person

Being unprepared for the death

In the case of a child's death, the number of remaining children

Lack of resilience or adaptability to life changes

It is normal to experience grief after a significant loss and most people move on with their lives with support from family and friends. However if, after several months, the emotions remain so intense or debilitating that you have trouble going about your normal routine, then it may be time to seek help.

Specifically, you may benefit from professional help if you:

Can focus on little else but your loved one's death

Have persistent pining or longing for the deceased person

Have thoughts of guilt or self-blame

Believe that you did something wrong or could have prevented the death

Feel as if life isn't worth living

Have lost your sense of purpose in life

Wish you had died along with your loved one

Coping with Loss

Remember that grief is a natural response to death and is a normal part of the human experience. There are many things that you can do to help yourself recover from the death of a loved one including:

Allow yourself to feel sad and to cry - this can help you to heal.

Be gentle with yourself.

Remember to eat well - you need nutritious foods to help your body cope with the stress.

Exercise - walk or jog; do aerobics or gardening; even giving the house a good clean can help. It has been found that exercise helps to relieve stress - and the time out helps you to gather your thoughts.

Make sure you get plenty of rest.

Keep a personal journal - some people find that writing about their thoughts and feelings is a great help.

Often cultural or family rituals, such as memorial services or planting trees, can provide comfort.

For some, it is appropriate and helpful to find comfort in faith. Churches, synagogues, temples, mosques, and other places of worship provide a safe, supportive environment.

It may be appropriate to find a support group in your area. Many communities have secular and faith based support groups focused on spousal, parental, and child death.

Avoid making major decisions or changes in residence, jobs, or marital status. It may be best to wait for about a year after the death of a loved one before making such changes.