COPING WITH GRIEF AND LOSS



What Is Grief?

When someone experiences a loss, they go through a normal process called grieving. Grieving is a natural and expected process which, over time, can allow a person to accept and understand their loss. Grieving involves feeling many different emotions over a period of time, all of which eventually help the person to come to terms with the loss of a loved one.

Bereavement and mourning are two other words that are commonly used to describe the grieving process. Bereavement is what a person experiences when someone close to them dies. It is the state of having suffered a loss. Mourning is the expression of one's loss and grief. Mourning includes behaviors and rituals that are specific to each person's culture and religion.


Phases of Grief

Many people think of grief as a single instance or very short period of pain or sadness in reaction to a loss -- for example, the tears shed at a loved one's funeral. However, the term grieving refers to the entire emotional process of coping with a loss. Normal grieving allows us eventually to let a loved one go and continue with our lives in a healthy way. Though grieving is painful, it is important that those who have suffered a loss be allowed to express their grief, and that they be supported throughout the process. Each person's way of grieving for a loved one will be different. The length and intensity of the emotions people experience will also vary from person to person.

It is normal for people to feel better for a period of time, only to become sad again soon afterward. Sometimes, people wonder how long the grieving process will last for them, and when they can expect to experience some relief. Although there is no one answer to this question, it may help to know some of the factors that can contribute to the intensity and length of grieving. The kind of relationship you had with the person who died, the circumstances of their death, and your own life experiences will all play a part in determining your individual grieving process.

Researchers have studied grief to better understand the ways that people work through a loss and eventually accept it. They have identified several phases, or emotional states, that people can experience while grieving. The first phase involves a period of shock or numbness. This phase is often followed by a period of emotional upheaval, which can involve feelings of anger, loneliness, disbelief, or denial. The final phase of grief is the one in which people find some way to come to terms with the loss.

The First Phase of Grief

Often, people's initial reaction to a loss is one of shock, disbelief, and numbness, which can last anywhere from a few hours to days or weeks. During this time, the bereaved may feel emotionally "shut off" from the world. However, their numbness may be disturbed by waves of distress from time to time. During these periods of distress, which are often triggered by reminders of the deceased, they may feel agitated or weak, cry, engage in aimless activities, or become preoccupied with thoughts or images of the deceased.

The rituals of mourning -- receiving friends, preparing for the funeral, and burial -- often structure this time for people. They are seldom left alone. Sometimes the sense of numbness persists, leaving the person feeling as though they are mechanically going through the rituals.

The Second Phase of Grief

At some point the reality of the loss becomes painfully apparent, and the numbness wears off. This phase of grief, sometimes called confrontation, is when the feelings of loss are most intense and painful. It is during this phase that one must confront the loss and cope with the changes it has brought about in their lives.

People have many different ways of confronting loss, so this time can involve many different, equally intense emotions. This time of grief, with its characteristic waves of distress and difficulty concentrating and functioning, can last for weeks to months. The length of time can vary greatly. You or your loved ones may see some or all of the following in a person who is grieving:
    • Withdraws socially
    • Has difficulty concentrating
    • Becomes restless and anxious at times
    • Has little appetite
    • Carries a sad appearance
    • Has a depressed mood
    • Dreams of the deceased (may even have hallucinations of hearing or seeing the deceased)
    • Loses weight
    • Has difficulty sleeping
    • Experiences fatigue or weakness
    • Becomes preoccupied with death or events surrounding death
    • Searches for reasons for the loss (sometimes with irrational results)
    • Dwells on mistakes, real or imagined, that he or she made with the deceased
    • Feels somehow guilty for the loss
    • Feels distant from others
    • Expresses anger or envy at seeing others united with loved ones

It is often during this time that a grieving person needs the most emotional support. Finding sources of support, whether they are family members, friends, support groups, or community organizations, can be the key to a person's eventual recovery and acceptance of the loss.

The Third Phase of Grief

The first two phases of grief are designed to help people come to terms with the loss in some way. Usually, one comes to accept a loss gradually over the months that follow it. Like the first and second phases, acceptance does not happen overnight. It is not uncommon for it to take as long as a year or more for someone to resolve the emotional and life changes that result from the death of a loved one. Although the intensity of the loss may lessen, it is common for people to continue to feel emotionally involved with the deceased for many years after their death.


Loss After Long-Term Illness

Grief is experienced somewhat differently when the loss occurs after a long-term illness rather than suddenly. When someone is terminally ill, their loved ones often grieve in anticipation of the loss. This anticipatory grief is a normal response, and it helps to prepare them for the actual loss. Usually, the period just before the person's death is one of physical and emotional preparation for those close to them. During this time, the urge to withdraw oneself emotionally from the person who is ill is normal. For most people, the actual death brings about the beginning of the normal grieving process. Many people believe they will feel prepared for the loss when it is expected. However, when the death actually occurs, it can still be a shock and bring about unexpected feelings of sadness and loss.


Major Depression and Complicated Grief

It is common for people to experience sadness, pain, anger, bouts of crying, and a depressed mood after the death of a loved one. It is important to learn to distinguish these normal grief responses from clinical depression, as grief can lead to clinical depression. About 20% of bereaved people will develop major depression, a condition requiring medical intervention. People at particular risk for developing clinical depression include those who have a history of depression or alcohol abuse, an inadequate support system, or those who have other significant life stresses. Symptoms of major depression not explained by the normal bereavement process may include:
    • Continual thoughts of worthlessness or hopelessness
    • Continual thoughts of death or thoughts of suicide
    • Persistent inability to perform day-to-day activities successfully
    • Delusions (beliefs that are not true)
    • Excessive or uncontrolled crying
    • Slowed physical responses and reactions
    • Extreme weight loss

In some people, the grieving process can go on for a long period of time. This is most often caused by attempts to deny or get away from the pain or to avoid letting go. If normal mourning does not occur, or if the mourning continues for a long period of time without any progress toward resolution, it is called unresolved or complicated grief. Symptoms of this may include:
    • Continued disbelief in the death of the loved one
    • Inability to accept the death
    • Persistent flashbacks, nightmares, intrusive memories
    • Magnified and prolonged grief symptoms
    • Maintenance of a fantasy relationship with the deceased with feelings that he/she is always present and watching
    • Continuous yearning and searching for the deceased
    • Breaking off all ties to social contact
If any of the above symptoms of major depression or complicated grief occur, they should be discussed with a qualified health or mental health professional.


Coping with a Loss

Ideally, the bereaved person will work through the process of grieving. With time and support, they will acknowledge and understand the loss, experience the pain of separation, and adapt to a new life and identity.

If you or someone you know has lost a loved one, the following suggestions may help in coping with the loss:
    • Give yourself permission to feel the pain and loss.
    • Be patient with the process and don't pressure yourself with certain expectations.
    • Accept yourself as you experience your pain, your emotions, your own way of healing, and your own timetable.
    • Express your feelings. Let yourself cry. Both are necessary for healing.
    • Get support. Talk about your loss, your memories, and your experience of the life and death of your loved one. Do not protect your family and friends by not expressing your sadness. Ask others for what you need. Find others who have lost a loved one to talk to.
    • Try to maintain your basic lifestyle. Avoid making major life changes (for example, moving, changing jobs, altering important relationships) within the first year of bereavement. This will allow you to maintain roots and a sense of security.
    • Take care of yourself: eat well and exercise. Physical activity is a good way to release tension. Allow yourself small physical pleasures that may help you replenish yourself like hot baths, naps, and favorite foods.
    • Avoid overindulgence in alcohol. Since alcohol is a depressant, it will only make you feel worse in the long run.
    • Forgive yourself for all the things you said or didn't say or do. Compassion and forgiveness for yourself and others is important in healing.
    • Give yourself a break from grief. Although it is necessary to work through grief, you do not need to constantly focus on it. It is healthy to find appropriate distractions like going to a movie, dinner, or a ball game, reading a good book, listening to music, getting a massage or manicure.
    • Prepare for holidays and anniversaries. Decide if you want to continue certain traditions or create new ones. Plan in advance how you want to spend your time and with whom. Do something symbolic in memory of your loved one.
    • Join a bereavement support group. Others can give encouragement, information, guidance, comfort, practical suggestions, and can help you feel less isolated.


Family Changes

The death of a loved one affects all family members. Each family develops its own ways of coping with death. A family's attitudes and reactions are influenced by cultural and spiritual values as well as by the relationships among family members. It will take time for a bereaved family to regain its balance.

The ability of each member to grieve with one another is important in helping the family cope. Each person will experience the loss differently and have different needs. As hard as it may be, it is important for family members to remain open and honest in their communication. This is not the time for family members to hide their grief to protect one another.

The loss of one person in a family means that roles in the family will change. Family members will need to discuss the affect of this change and the shift in responsibilities. This period of reorganization is stressful for everyone. This is a time to be particularly gentle and patient with each other.


Helping Someone Who Is Bereaved

It is common to feel awkward when trying to comfort someone who is grieving. Many people do not know what to say or do. The following are suggestions to use as a guide.

What to Say
    • Acknowledge the situation. Example: "I heard that your_____ died." Use the word "died" rather than a euphemism. That will show that you are more open to talk about how the person really feels.
    • Express your concern. Example: "I'm sorry to hear that this happened to you."
    • Be genuine in your communication and don't hide your feelings. Example: "I'm not sure what to say, but I want you to know I care."
    • Offer your support. Example: "Tell me what I can do for you."
    • Ask how he or she feels, and don't assume you know how the bereaved person feels on any given day.

What to Do
    • Be there. Even if you do not know what to say, just having someone near can be very comforting.
    • Be there to listen and give support. However, you should not force someone to talk if they are not ready to talk.
    • Be a good listener. Accept whatever feelings are expressed rather than advising the person about how to cope with the loss.
    • Provide reassurance without minimizing the loss. Try to empathize with the person without assuming you know exactly how they feel.
    • Offer to help with errands, shopping, housework, cooking, transportation, or lawn care. Sometimes people want help and sometimes they don't. Although they may reject your offer, remember they are not rejecting you or your friendship.
    • Avoid telling the person "You're so strong." This puts pressure on the person to withhold feelings.
    • Continue to offer support even after the initial shock wears off. Recovery takes a long time.

If the grieving person begins to abuse alcohol or drugs, neglects hygiene, develops physical problems or talks about suicide, you or someone close to the person should suggest professional help.


Grief During Childhood

It is a very common adult misconception that children cannot understand the meaning of death. How old a child is at the time of the death is important because a child's understanding of death changes with age. Preschool children usually think death is temporary and reversible. Between the ages of 5 and 9, they understand that the person is gone, but see it more as a separation. After about ages 9 or 10, they begin to understand the finality of death.

Children grieve. They just don't have the coping mechanisms that adults do. They experience feelings like sadness, anger, guilt, insecurity, and anxiety. Children sometimes show anger towards surviving family members. They may develop behavior or discipline problems. They may think the death is their fault, especially if they had once "wished" the person dead. Or, they may start having nightmares or acting younger than their age. Sometimes they may seem unaffected by the loss, while other times they express grief at unexpected moments.


Talking to Children About Death

It is difficult for parents to comfort others when they are experiencing their own grief. Parents may not want to discuss death with their children because they don't want to upset them or worsen their own pain. However, talking with children about death will help them deal with their fears.

Children's responses to death are often very different from adults'. Sometimes a child's feelings or questions about death may seem inappropriate or be upsetting; however, it is important to recognize that they, too, are working to understand and accept what has happened. You can help them by listening to what they have to say and answering whatever questions they may have as sensitively and honestly as you can.

Use the following suggestions as a guide when talking to a child about death:
    • Explain what happened in a way they can understand. Children know when you are hiding something, so be open and honest.
    • Encourage communication. Listen and accept their feelings no matter how difficult it may be.
    • Answer their questions in brief and simple terms. Telling them they are too young to understand only avoids dealing with the problem. It is okay to not have all the answers.
    • Reassure them that they will still be loved and taken care of.
    • Show affection, support, and consistency. Let them know that you will be there to help as much as possible.
    • Share your feelings in terms they will understand, and in a way that won't be overwhelming. For example, it is okay to let them know that you hurt too. If you try to hide your feelings, they may think they shouldn't share theirs.

Parents want to protect their children, but children should be offered an opportunity to share in the grieving process. Attending the funeral may help them accept the reality of the death, but they should be prepared for what they will see and hear at the funeral. They should know that they may see people cry, and that it is okay. If children do not want to go to the funeral, they should not be forced.


Losing a Child

Facing the death of a child is probably the most difficult event in a parent's life. People who have lost a child have stronger grief reactions with more anger, guilt, physical symptoms, greater depression, and a loss of meaning and purpose in life. A loss is tragic at any age, but the sense of unfairness of a life unfulfilled magnifies the anger and rage felt by parents. A longer and slower bereavement and recovery period should be expected when someone loses a child. The grief may intensify with time. Bereaved parents may especially benefit from a grief support group, which may be available in the local community.


Additional Resources

National Organizations and Web Sites

*Inclusion in this list of resources does not imply endorsement by the American Cancer Society.

Candlelighters Childhood Cancer Foundation
Telephone: (800) 366-2223
Internet Address: www.candlelighters.org

National Hospice Organization
Telephone: Hospice Helpline: (800) 658-8898
Internet Address: www.nho.org or www.hospicenet.org

Parents Without Partners International, Inc.
Telephone: (312) 644-6610
Internet Address: www.parentswithoutpartners.org

The Compassionate Friends
Telephone: (630) 990-0010
Internet Address: www.compassionatefriends.org

Contact your local hospice or hospital for bereavement support groups in your area.

Additional Reading*

*Inclusion in this list of resources does not imply endorsement by the American Cancer Society.

A Grief Observed. Lewis, C.S. New York: Bantam Books, 1983.

Beyond Grief: A Guide for Recovering from the Death of a Loved One. Staudacher, C. Oakland, CA: New Harbinger Publications, 1987.

How to Go on Living When Someone You Love Dies. Rando, T.A. New York: Bantam, 1991.

Living with Death and Dying. Kubler-Ross, E. New York: MacMillan, 1997.

Motherless Daughters: The Legacy of Loss. Edelman, H. Reading, Mass: Addison-Wesley Publishing, 1994.

On Death and Dying. Kubler-Ross, E. New York: Collier Books, 1997.

Books for Parents

After the Death of a Child: Living With Loss Through the Years. Finkbeiner, A.K. Baltimore: Johns Hopkins University Press, 1998.

Bereaved Children and Teens: A Support Guide for Parents and Professionals. Grollman, E.A. (Ed.). Boston: Beacon Press, 1996.

The Bereaved Parent. Schiff, H.S. New York: Viking Press, 1978.

How to Go On Living When Someone You Love Dies. Rando, T. A. New York: Bantam, 1991.

On Children and Death: How Children and Their Parents Can and Do Cope With Death. Kubler-Ross, E. New York: Collier, 1997.

When the Bough Breaks: Forever After the Death of a Son or Daughter. Bernstein, J. Lenexa, Kansas: Andrews McMeel Publishing, 1998.

Books for Children

Daddy's Promise. Cohen, C.K., Heiney, J.T., & Gordon, M.J. Promise Publications, 1997. (Ages: 4-8)

Don't Despair on Thursdays! The Children's Grief Management Book. Moser, A. Ontonagon, Michigan: Landmark Editions, 1998. (Ages: 9-12)

Dusty Was My Friend: Coming to Terms With Loss. Clardy, A.F. New York: Human Sciences Press, 1985. (Ages: 7-11)

The Dying and Bereaved Teenager. Morgan, J.D. (Ed.). Philadelphia: The Charles Press, 1998. (Ages: 12 and up)

Everett Anderson's Goodbye. Clifton, L. New York: Henry Holt & Co., 1988. (Ages 4-8)

The Fall of Freddie the Leaf. Buscaglia, L. New York: Holt Rinehart & Winston, 1983. (All Ages)

How it Feels When a Parent Dies. Krementz, J. New York: Knopf, 1988. (Ages: 7 and up)

Lifetimes: The Beautiful Way to Explain Death to Children. Melonie, B. & Ingpen, R. New York: Bantam, 1987. (Ages 6-11)

A Quilt for Elizabeth. Tiffault, B.W. Omaha: Centering Corporation, 1992. (Ages: 6-11)

The Tenth Good Thing About Barney. Viorst, J. New York: MacMillan, 1987. (Ages: 4-8)


References

Chochinov Harvey, Holland Jimmie C. Bereavement: A Special Issue in Oncology. Handbook of Psycho Oncology. Holland & Rowland (eds). NY: Oxford University Press. 1990;50:612-627.

Lev L Elise, Robinson Linda, McCorkle Ruth. Loss and Bereavement. Cancer Nursing: A Comprehensive Textbook (2nd ed.). McCorkle, Grant, Frank-Stromborg, and Baird (Eds). Philadelphia, PA: W.B. Saunders Company. 1996;10:110-117.

Revised: 07/23/2001 12:00:00 AM

 
 
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