Although loss is a nearly universal experience, there is considerable variety in how people grieve. Bereavement is always a painful experience, but some people return to their normal life rapidly, experiencing uncomplicated bereavement, while others never do. All that defines uncomplicated bereavement and separates it from complicated bereavement is not yet known. However, some critical facts have been identified.
Uncomplicated Bereavement
Loss is a powerful stressor in life; even those going through uncomplicated bereavement are likely to experience many symptoms of anxiety and depression and to undergo physiological changes which reduce the body's ability to fight off disease. While popular notions suggest a steady and orderly progression of bereavement ill stages, people grieve in highly individualized ways.
Depending on prior losses and on the particulars of file current loss, symptoms of anxiety may be most prominent or may mix with or be overshadowed by symptoms of depression. There is often a sense of unreality associated with first becoming aware of the loss. The griever may refuse to believe it has happened and can feel out of contact with those around him or her. Many people feel guilt because riley do not initially feel any pain about the loss. They worry that they are abnormal or secretly unloving. This experience of numbness does not imply a poor relationship. The numbness and sense of unreality may be replaced later with a sense of profound anxiety or sadness. This stage may be marked by repeatedly seeking the person who has died, possibly even feeling they briefly hear or see the deceased.
As the loss becomes 'real,' grievers often experience overwhelming waves of sadness (and sometimes anger) that come suddenly with reminders of tile loss. Interspersed among the low and painful periods can be brief bursts of almost ecstatic and enthusiastic feelings, which may again cause the individual to feel guilt. Wide swings in mood are, however, a normal part of bereavement. Most individuals feeling the ordinary pain of bereavement do not need counseling or medication to adjust. They may, however, benefit from participation in groups for those who have had recent losses.
Complicated Bereavement: Warning Signs
While there is no standard for what is healthy and unhealthy in bereavement, there are some warning signs of poor adjustment. Extensive avoidance of painful feelings and of reminders of the person who has died is not healthy. Coping by avoidance may appear to be working because it minimizes early distress but it appears to place the griever at greater risk later. Those who find that they cannot bring themselves to go to the funeral or who isolate themselves from their grief experience with distracting activities, (even those of planning the funeral) may be at increased risk for psychological and physical difficulties.
While a death usually disrupts the ability of tile mourner to carry on daily activities, a crippling loss in ability to function indicates tile need for therapy. Those who function most poorly one month after a loss often fail to regain normal function even one to two years later. Thus even very early after a loss it may be valuable for some individuals to seek counseling or antidepressant medication. Ironically, starting or increasing the use of tranquilizing medication with a loss may interfere with the natural process of grief.
Some of those who adjust poorly to a loss will express that difficulty in physical ailments. Those who see a physician with complaints that are not easily diagnosed or treated medically may be experiencing unresolved bereavement. Medical pursuit of diagnosis and treatment of such complaints can result in greater damage because of risks from diagnostic procedures mid from unnecessary medical interventions for problems that will not respond to treatment (such as dizziness, fatigue, irritability, vague pains etc.).
Guided mourning, using imagery and behavioral assignments, is a powerful tool for provoking and safely reviewing thoughts and painful memories. Although complicated bereavement is a disruptive experience, such treatment can be successful. Better than treatment, however, is prevention.
Prevention Issues
Families sometimes try to protect the griever by removing the reminders of the loss. This strategy promotes avoidance by communicating that the pain of dealing with the loss would be overwhelming; it also hampers normal bereavement by removing important reminders that trigger painful but necessary memories. Family and friends can help any griever adjust by encouraging talk about feelings and thoughts about the loss.
Similarly, children do not benefit from being protected from file rituals around bereavement. Such 'protection' may be costly; those old enough to understand death (age 5 or older) often need tile painful reminders and rituals just as adults do. It is important that children be allowed to participate in mourning at their own developmental level.
Depending on their ages, children will deal with the loss in a very different way than adults. Younger children may need to hold 'play funerals' for dolls or stuffed animals and may need to ask questions that may provoke pain in the grieving adults. Older children may become withdrawn or may begin to act out. For children of all ages, modeling ways to think and talk about painful feelings can be beneficial.
Bereavement is an experience that must be treated with great respect.
First, family members need to recognize and respect individuals' rights to grieve in their own way.
Second, respect needs to come from health care professionals. While distress is inevitable with loss, unresolved grief means that distress can continue without relief unless effective treatment is begun.
Most people need no formal intervention for bereavement. However, behavior therapists and other qualified mental health professionals can help guide those dealing with complicated bereavement through a process of resolution. Such a process can start even years after a loss; the sooner the process begins, however, the sooner the griever can return to normal functioning.
Aggressive: In oncology, quickly growing, tending to spread rapidly. As, for example, an aggressive tumor.
Anemia: The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Anger: An emotional state that may range in intensity from mild irritation to intense fury and rage. Anger has physical effects including raising the heart rate and blood pressure and the levels of adrenaline and noradrenaline.
Angry: Pertaining to anger, an emotional state that may range in intensity from mild irritation to intense fury and rage. Anger has physical effects; it raises the heart rate and blood pressure and the levels of adrenaline and noradrenaline, and so on.
Anxiety: A feeling of apprehension and fear characterized by physical symptoms such as palpitations , sweating, and feelings of stress . Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.
Bereavement: The period after a loss during which grief is experienced and mourning occurs. The time spent in a period of bereavement depends on how attached the person was to the person who died, and how much time was spent anticipating the loss.
Breathing: The process of respiration, during which air is inhaled into the lungs through the mouth or nose due to muscle contraction, and then exhaled due to muscle relaxation.
Cancer: An abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread).
Cancer care: Taking care of cancer. When cancer is suspected, a biopsy is usually performed and the tissue is sent to a pathologist for evaluation. If a cancer diagnosis is made, an oncologist will evaluate the patient to determine the stage of the cancer. Staging usually involves a precise evaluation of the tumor, lymph nodes, and any metastasis (spread) of the disease.
Cardiac: Having to do with the heart.
Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time.
Complicated grief: Grief that is complicated by adjustment disorders (especially depressed and anxious mood or disturbed emotions and behavior), major depression , substance abuse, and post-traumatic stress disorder are Complicated grief is identified by the extended length of time of the symptoms, the interference in normal function caused by the symptoms, or by the intensity of the symptoms (for example, intense suicidal thoughts or acts).
Condition: The term 'condition' has a number of biomedical meanings including the following:
- An unhealthy state, such as in 'this is a progressive condition.'
- A state of fitness, such as 'getting into condition.'
- Something that is essential to the occurrence of something else; essentially a 'precondition.'
- As a verb: to cause a change in something so that a response that was previously associated with a certain stimulus becomes associated with another stimulus; to condition a person, as in behavioral conditioning.
Cure:
1. To heal, to make well, to restore to good health. Cures are easy to claim and, all too often, difficult to confirm.
2. A time without recurrence of a disease so that the risk of recurrence is small, as in the 5-year cure rate for malignant melanoma .
3. Particularly in the past, a course of treatment. For example, take a cure at a spa.
Depression : An illness that involves the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely 'pull themselves together' and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus . Diabetes mellitus and diabetes insipidus share the name 'diabetes' because they are both conditions characterized by excessive urination (polyuria).
Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV.
Donor: The giver of a tissue or organ, for example, of blood or a kidney.
Durable power of attorney: This is a type of advance medical directive in which legal documents provide the power of attorney to another person in the case of an incapacitating medical condition.
Empirical: Based on experience and observation, rather than systematic logic. Experienced physicians often use empirical reasoning to make diagnoses, based on having seen many cases over the years. Less-experienced physicians are more likely to use diagnostic guides and manuals. In practice, both approaches (if properly applied) will usually come up with the same diagnosis .
Euthanasia:The word 'euthanasia' comes straight out of the Greek -- 'eu', goodly or well + 'thanatos', death = the good death -- and for 18th-century writers in England that was what euthanasia meant, a 'good' death, a welcome way to depart quietly and well from life.
Event: A set of outcomes. Cardiovascular events might include a heart attack and gastrointestinal events a GI bleed. The use of the term 'event' in medicine comes from probability theory.
Familial: A condition that is tends to occur more often in family members than expected by chance alone. A familial disease may be genetic (such as cystic fibrosis ) or environmental (such as tuberculosis ).
Grief: The normal process of reacting to a loss. The loss may be physical (such as a death), social (such as divorce), or occupational (such as a job). Emotional reactions of grief can include anger, guilt, anxiety , sadness, and despair. Physical reactions of grief can include sleeping problems, changes in appetite, physical problems, or illness.
Heart: The muscle that pumps blood received from veins into arteries throughout the body. It is positioned in the chest behind the sternum (breastbone; in front of the trachea, esophagus, and aorta; and above the diaphragm muscle that separates the chest and abdominal cavities. The normal heart is about the size of a closed fist, and weighs about 10.5 ounces. It is cone-shaped, with the point of the cone pointing down to the left. Two-thirds of the heart lies in the left side of the chest with the balance in the right chest.
Heart attack: The death of heart muscle due to the loss of blood supply. The loss of blood supply is usually caused by a complete blockage of a coronary artery, one of the arteries that supplies blood to the heart muscle. Death of the heart muscle, in turn, causes chest pain and electrical instability of the heart muscle tissue.
Heart rate: The number of heart beats per unit time, usually per minute. The heart rate is based on the number of contractions of the ventricles (the lower chambers of the heart). The heart rate may be too fast ( tachycardia ) or too slow ( bradycardia ). The pulse is bulge of an artery from the wave of blood coursing through the blood vessel as a result of the heart beat. The pulse is often taken at the wrist to estimate the heart rate.
Homicide: 1. The killing of a person. 2. Strictly speaking, the killing of a man. femicide. From the Latin meaning murderer, from homo, man + caedere, to kill.
Hospice: A program or facility that provides special care for people who are near the end of life and for their families. Hospice care can be provided at home, in a hospice or another freestanding facility, or within a hospital. See also: Hospice care.
Hospice care: Care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure. The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. Aggressive methods of pain control may be used. Hospice programs generally are home-based, but they sometimes provide services away from home -- in freestanding facilities, in nursing homes, or within hospitals. The philosophy of hospice is to provide support for the patient's emotional, social, and spiritual needs as well as medical symptoms as part of treating the whole person.
Hospital: It may seem unnecessary to define a 'hospital' since everyone knows the nature of a hospital. A hospital began as a charitable institution for the needy, aged, infirm, or young.
Infant: A child up to 2 years (24 months) of age.
Infarction: The formation of an infarct, an area of tissue death due to a local lack of oxygen.
Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a 'germ') growing within him, drawing its nourishment from the person.
Informed consent: A process in which a person learns key facts about a clinical trial, including potential risks and benefits, before deciding whether or not to participate in a study. Informed consent continues throughout the trial.
Intervention: The act of intervening, interfering or interceding with the intent of modifying the outcome. In medicine, an intervention is usually undertaken to help treat or cure a condition. For example, early intervention may help children with autism to speak. 'Acupuncture as a therapeutic intervention is widely practiced in the United States ,' according to the National Institutes of Health. From the Latin intervenire, to come between.
Life support: 1. A therapy or device designed to preserve someone's life when an essential bodily system is not doing so. Life support may, for example, involve enteric feeding (by a tube), total parenteral nutrition, mechanical ventilation, a pacemaker, defibrillator, heart/lung machine, or dialysis.
2. Something that sustains life, as in 'The earth is the ultimate life support system.'
3. A product, program or company being propped up, as in 'Medicare is on life support.'
Living will: A living will is one form of advance medical directive. Advance medical directives pertain to treatment preferences and the designation of a surrogate decision-maker in the event that a person should become unable to make medical decisions on their own behalf.
Major depression: A disease with certain characteristic signs and symptoms that interferes with the ability to work, sleep , eat, and enjoy once pleasurable activities.
Mourning: The process by which people adapt to a loss as, for example, the death of someone near and dear. Mourning is influenced by cultural customs, rituals, and society's rules for coping with loss.
Myocardial infarction: A heart attack . Abbreviated MI.
Nursing: 1) Profession concerned with the provision of services essential to the maintenance and restoration of health by attending the needs of sick persons. 2) Feeding a infant at the breast.
Organ: A relatively independent part of the body that carries out one or more special functions. The organs of the human body include the eye, ear, heart, lungs, and liver.
Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia . Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors.
Palliative care: 1) Medical or comfort care that reduces the severity of a disease or slows its progress rather than providing a cure. For incurable diseases, in cases where the cure is not recommended due to other health concerns, and when the patient does not wish to pursue a cure, palliative care becomes the focus of treatment. For example, if surgery cannot be performed to remove a tumor, radiation treatment might be tried to reduce its rate of growth, and pain management could help the patient manage physical symptoms. 2) In a negative sense, provision only of perfunctory health care when a cure is possible.
Pregnancy : The state of carrying a developing embryo or fetus within the female body. This condition can be indicated by positive results on an over-the-counter urine test, and confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about nine months, measured from the date of the woman's last menstrual period (LMP). It is conventionally divided into three trimesters, each roughly three months long.
Prevalence: The proportion of individuals in a population having a disease. Prevalence is a statistical concept referring to the number of cases of a disease that are present in a particular population at a given time.
Psychiatric: Pertaining to or within the purview of psychiatry , the medical specialty concerned with the prevention, diagnosis , and treatment of mental illness.
Psychiatry: The medical specialty concerned with the prevention, diagnosis , and treatment of mental illness.
Psychology: The study of the mind and mental processes, especially in relation to behavior. There are a number of fields of psychology. Clinical psychology is concerned with diagnosing and treating disorders of the brain, emotional disturbances, and behavior problems. Child psychology is the study of the mental and emotional development of children and is part of developmental psychology, the study of changes in behavior that occur through the life span. Cognitive psychology deals with how the human mind receives and interprets impressions and ideas. Social psychology looks at how the actions of others influence the behavior of an individual.
Psychotherapy: The treatment of a behavior disorder, mental illness, or any other condition by psychological means. Psychotherapy may utilize insight, persuasion, suggestion, reassurance, and instruction so that patients may see themselves and their problems more realistically and have the desire to cope effectively with them.
PTSD: Post-traumatic stress disorder. (The abbreviation PTSD has rapidly gained in popularity because saying 'post-traumatic stress disorder' can be enough of a mouthful as to be stressful in itself.)
Qualitative: Having to do with quality. In contrast to quantitative (which pertains to quantity, the amount).
Regress: To return or go back, particularly to return to a pattern of behavior or level of skill characteristic of a younger age. For example, if a three-year-old child begins to regress by losing the ability to control his bowels or speak, that is a cause for medical concern. In reference to a disease, to 'regress,' means tending to worsen.
Resolution: In genetics , resolution refers to the degree of molecular detail on a physical map of DNA , ranging from low to high.
Respiration: 1. The act of inhaling and exhaling air in order to exchange oxygen for carbon dioxide. Synonymous with breathing and ventilation. 2. The cellular metabolic process by which oxygen is taken in, substances are oxidized, energy is released, and carbon dioxide and oxidized products are given off.
Rest: 1. Repose. Relaxation. 2. A fragment of embryonic tissue that has been retained after the period of embryonic development. Also called an embryonic rest.
SAD: Seasonal affective disorder , a form of depression that tends to occur as the days grow shorter in the fall and winter. It is believed that affected persons react adversely to the decreasing amount of light and the colder temperature as autumn and winter progress.
Sense: In biology and medicine, the faculty of sensory reception . The ability to convey specific types of external or internal stimuli to the brain and perceive them. Sensory reception occurs through a process known as transduction in which stimuli are converted into nerve impulses which are relayed to the brain.
Shock: In medicine, shock is a critical condition brought on by a sudden drop in blood flow through the body. There is failure of the circulatory system to maintain adequate blood flow. This sharply curtails the delivery of oxygen and nutrients to vital organs. It also compromises the kidney and so curtails the removal of wastes from the body. Shock can be due to a number of different mechanisms including not enough blood volume (hypovolemic shock) and not enough output of blood by the heart (cardiogenic shock). The signs and symptoms of shock include low blood pressure (hypotension), overbreathing (hyperventilation), a weak rapid pulse, cold clammy grayish-bluish (cyanotic) skin, decreased urine flow (oliguria), and mental changes (a sense of great anxiety and foreboding, confusion and, sometimes, combativeness).
Sleep : The body's rest cycle.
Stage: As regards cancer , the extent of a cancer, especially whether the disease has spread from the original site to other parts of the body. See also: Staging .
Stress: Forces from the outside world impinging on the individual. Stress is a normal part of life that can help us learn and grow. Conversely, stress can cause us significant problems.
Suicide prevention: Diminishing the risk of suicide. It may not be possible to eliminate entirely the risk of suicide but it is possible to reduce this risk. For example, the suicide rate among US Air Force personnel fell precipitously after the service launched a community-based suicide prevention program. Suicide should not be viewed solely as a medical or mental health problem, since protective factors such as social support and connectedness appear to play significant roles in the prevention of suicide.
Syndrome: A set of signs and symptoms that tend to occur together and which reflect the presence of a particular disease or an increased chance of developing a particular disease.
Therapy: The treatment of disease .
Trauma: Any injury , whether physically or emotionally inflicted. 'Trauma' has both a medical and a psychiatric definition. Medically, 'trauma' refers to a serious or critical bodily injury, wound, or shock . This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. In psychiatry , 'trauma' has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects.
Further Reading
Living When a Loved One Has Died
by Earl A. Grollman - Beacon Press (June 1995) Available in Hardcover and Paperback
This book takes you through the acknowledgement of the loss of a loved one, and helps you start back on the road to living your life again.
On Death and Dying
by Elisabeth Kubler-Ross - Scribner, 286 pages (Reprinted 1997)
This is the landmark book that first talked about the stages of grief and how to cope with loss. Several other related topics have also been published by this author.
Questions and Answers on Death and Dying
by Elisabeth Kubler-Ross - Touchstone Books, Paperback: 192 pages (June 1997)
This book consists of answrs to the most frequently asked questions about death, dying and dealing with a terminally ill friend, relative, or partner. It is an expansion on her previous book, in response to the many questions she has been asked at speaking engagements.
The Hospice Handbook: A Complete Guide
by Larry Beresford, with Foreword by Elisabeth Kubler-Ross
Paperback: 165 pages - Little Brown & Company (March 1993)
When Bad Things Happen to Good People: Twentieth Anniversary Ed ition, with a New Preface by the Author by Harold S. Kushner
Hardcover: 202 pages Schocken Books (September 4, 2001)
This is another excellent book on bereavement which has been recommended by professionals assisting people in dealing with a personal loss.
The Courage to Grieve by Judy Tatelbaum
Paperback: 177 pages, HarperCollins (paper), (October 1984)
This book is a few years old, but still available and still relevant. It provides excellent advice for those dealing with a personal loss.
External Links
· www.bereavementontarionetwork.ca/about.htm