Faces of Grief. Overcoming the Pain of Loss - Veronica Semenova 2 стр.

Symptoms of grief can be divided into affective, behavioral, cognitive, and physiological (or somatic) manifestations.

Affective symptoms may include depression, despair, anxiety, guilt, anger, disbelief, numbness, shock, panic, sadness, anhedonia (loss of ability to enjoy pleasurable activities), and feelings of isolation and loneliness.

Behavioral symptoms may include agitation, fatigue, crying, change in social activities, absent-mindedness, social withdrawal, or seeking solitude.

Cognitive symptoms may include preoccupation with thoughts of the deceased, lowered self-esteem, self-reproach, helplessness and hopelessness, inability to believe in the loss, and problems with memory and concentration.

Physiological symptoms may include loss of appetite, sleep disturbances (feeling lethargic or not being able to sleep through the night), loss of energy and exhaustion, physical complaints similar to those the deceased had endured when alive, drug abuse, and susceptibility to illness and disease.

Grief may also lead to spiritual emptiness and pessimism.

Grief symptoms can be overwhelming and distressing. However, it is important to accept them and not avoid them. It is helpful to keep in mind that all of your symptoms and reactions are common and natural, and that you are not alone.

Grief as a reaction to an immediate loss can present itself in two forms. The first one is protest, defined as a preoccupation with loss, the feeling of pain, agitation, and tension, and accepting the possibility that the deceased may reappear. The second is despair, defined as the opposite of protest and characterized by depression, persistent sadness, and a withdrawal of attention from real life. Protest and despair may come and go in phases. Often protest sets in first and then despair takes over. In both the protest and despair states, feelings of guilt, anger, and anxiety are present and are experienced by grieving individuals.

Grief symptoms may be different, depending on the type of loss. For example, the loss of a spouse awakens feelings of loneliness and abandonment, while the loss of a child evokes feelings of having failed to protect the child, and self-blame. We will look at the differences in grief, depending on the type of loss, in further chapters.

Grief has been described as an emotion; however, it is currently being regarded more and more as a disease. As this trend continues, grief will accrue more and more definitions particular to disease and will lose the definition of being an emotion.

Earlier research provides solid evidence of biological links between grief and an increased risk of illness and mortality. Bereaved individuals are at higher risk for depression, anxiety, and other psychiatric conditions, and are highly susceptible to infections and a variety of other physical illness due to a considerable weakening of the immune system. Bereaved individuals have higher consultation rates with doctors, use more medication, and are more often hospitalized. An increased risk of mortality and suicide is associated with medical conditions in bereavement.

Needless to say, people in grief will neglect their own health by not maintaining a well-balanced diet, forgetting to take necessary medications, not getting enough sleep, and not exercising. Some may abuse alcohol, smoke excessively, use drugs, or engage in other self-destructive behaviors.

Social support is very important in grief. However, a grieving person should be advised to designate their own comfortable boundaries of support (for example, by telling people what exactly they can do to help them, when, and for how long they would like to be together, or sharing that they may not want to do certain activities now, but would consider doing them later).

Finally, the grief process may be different for every individual. It is important for the bereaved to do as they feel, especially during the mourning phase: to be left alone if they so wish, or allowed to cry or to have a chance to talk to someone when they feel the need. It may be helpful to engage in activities that help commemorate their loved one: for example, through attending religious services, visiting the gravesite, praying, creating a memory book with photos and stories, or assembling a memory box with the belongings of the deceased, or by giving to a good cause such as medical research, a scholarship fund, or charity.

Grief is often compared to Post Traumatic Stress Disorder (PTSD), particularly in the acute phase of traumatic grief, which holds similar symptoms such as re-experiencing, avoidance-numbing, increased arousal, guilt, shame, changes in value systems and beliefs, and a search for meaning. Often, in traumatic grief, the relatives of the deceased are preoccupied with issues surrounding the trauma such as the pain of dying, the cause of death, and self-blame for not being able to protect/save or for having survived. Traumatic images flood the consciousness of survivors.

In grief, it is important to resolve feelings of guilt, anger, anxiety, and depression. Sadness occurs both in depression and grief. The difference is that in grief, sadness is focused on missing the person who died, while in depression, sadness is focused on hopelessness and helplessness about self, the world, and the future. Sadness is normal in grief; however, depression in a time of grief can make it very difficult to come to terms with loss and reconstruct a life going forward.

There are a lot of examples of unhelpful thinking that can block the normal bereavement process and cause emotional distress. Negative thinking can lead to the symptoms of complicated grief and depression. For example, self-blame or self-reproach can heavily impact the emotional condition of the bereaved.

In overcoming the pain of grief, it is critical to consider what is causing self-blame and other negative thinking about self, the world, life, the future, and what causes anxious and depressive avoidance behavior. Often patients with complicated grief continue to perceive their loss as unreal or remain preoccupied with thoughts and recollections of the deceased or the death event. Working through grief in therapy helps patients change the perception of loss into something more real, helps them to acknowledge their loss, and ensures the loss is recognized as permanent and not reversible. Unless this is done, thoughts of the deceased will constantly bring fresh emotional distress and sorrow.

Lets look at some myths and negative thoughts that may be obstacles to recovery, and consider how to handle them.

Myths about Grief

There are many beliefs in the culture and traditions of different people about how to deal with death and grief. Many traditions are passed on to us through generations and we follow them without questioning the reasons behind them. Indeed, it is not easy to change the long-held beliefs of our families or to insist on doing things differently. But holding on to archaic knowledge at a time when we have gained so much understanding about the subject from research and therapy would be wrong. It is in the best interest of each of us  our families, loved ones, and society as whole  to embrace this new knowledge and dispel the myths that still govern our societies and often cause harm to people.

Some of the common myths I often hear are:

All losses are the same

No loss is equal. There are many different factors that affect grief. Grief varies between young and old, between cultures and religions, and depends on the type of relationship the bereaved had with the deceased (parent, child, spouse, sibling, grandparent, friend, lover), the levels of existing dysfunction, and upon the nature of death (if the death was expected or sudden). It depends on previous experiences with death and on the attachment style, and of course, interpersonal factors play a very important role. It depends on the personality of the bereaved, as well. Unprocessed emotions in that relationship, conflicts, repressed feelings, unspoken words: all these all come out in grief and weigh heavily on the grieving person, thus complicating recovery.

Mourning should last for a year

There can be no exact time frame for grief or mourning. As every loss is different, it will take every person a different amount of time to come to terms with their loss. Different cultures also may have their own rules on mourning (i.e. widows required to wear black for several months, a year, or a lifetime, or are prohibited to re-marry, and so on). Irrespective of all rules, every person will ache differently, will go through their memories of the deceased on their own terms, will arrive at forgiveness for him/herself and the deceased, and will find their own meaning in continuing to live.

Once you get over your grief, it never comes back

Stages of grief known as denial, anger, bargaining, depression, and acceptance may come and go in sequence and interchangeably. The duration and intensity of each stage may vary greatly. The stages can overlap or occur together, and a grieving individual can miss one or more stages altogether. It is also not rare for someone to go back and forth between the stages, as important pieces of information about the nature and causes of death come to light. New cycles of grief can be launched at milestone birthdays or anniversaries of the deceased or the bereaved person, and during major family events (the birth of children, the death of other family members, a family relocation, or the sale of the house where the deceased lived, for example).

It is better to avoid anything that reminds you of the deceased

Avoidance is the worst coping strategy in grief outside of denial. Even the most painful reality is better dealt with head on and with full realization of what has happened. Avoiding reminders of the deceased and denying a loved ones death will only extend the time needed to come to terms with the loss and achieve acceptance. Denial and avoidance may come naturally as the first reaction to the shocking news; however, it should not last too long, as a healthy coping pattern requires that the grieving person should work through their pain and loss to restructure their perceptions to help themselves emerge from grief. Grief also comes in cycles, so it is normal to try and avoid reminders of the deceased loved one during these periods of intense longing. However, it is more helpful to dedicate a space and time in your life to purposefully embrace what seems to cause pain (photographs, personal belongings, letters) and celebrate the presence of the lost loved one in your life.

Feeling angry while grieving is not right

Anger is one of the healthy and normal feelings of grief. In fact, anger constitutes one of the five stages of grieving (denial, anger, bargaining, depression, acceptance). Anger is the first realization that the loss is real. Anger comes when the bereaved starts looking for something or someone to blame for the loss. It can revolve around the feeling of guilt for not protecting a loved one or not being there when they died. It is helpful to understand that anger in grief is not similar to anger in ordinary daily life. The cause of this anger cant be undone: no one can make it right. Anger in grief is not directed at anyone in particular; therefore, it can involve anyone around the grieving person and even the grieving person him/herself.

Children need to be protected from death, funerals, and grief: they cant understand it, anyway

Children at different developmental stages understand death, dying, and loss differently. However, as they mature, they often question the information previously received. Honest and clear explanations appropriate for the age of the child will help a child deal with loss and help them form a trusting relationship with the surviving significant adult. The child learns how to grieve by looking at parents, other family members, or significant adults in life. The way the child grieves the first loss and the coping mechanism and skills they learn while living through this loss will remain with them for life. If a child is shielded from any contact with pain, loss, and grief or is told fairy tales about what happened, he/she will form mental misrepresentations and misperceptions of reality that will block healthy and reasonable thinking and may become a foundation for future fears and phobias.

You cant continue a relationship or communicate with your loved one after they die

Death ends a life, but does not end a relationship. Everyone who goes through the loss of a loved one will realize this. Relationships with a loved one carry on and continue for as long as they are remembered. The heritage of a person is formed through memories, photographs, and recalling the sayings, deeds, and impact your loved one had on your life. Many bereaved people report mentally talking to the deceased. When a very close person is lost, you would know how he/she would react to events happening in your life after the loss, what they would say, and what advice they could have given you. An ongoing mental connection with the deceased proves the strength of the bond that existed and allows the bereaved to feel the connection and existence of the deceased in their life.

The intensity of your mourning and grieving proves how deeply you loved the deceased

The intensity of grief and the intensity of mourning are not the same things. Grief is your internal reaction to the loss and mourning is the external display of grief. Very often, these two do not coincide. As we know, people often differ in how they express their emotions, depending on whether they are extroverts or introverts, on how close, understood, and accepted they feel in their social circle, and on many other factors. So if someone is not mourning their loss publicly, doesnt cry, and doesnt want to talk, it does not mean that the person doesnt experience grief. What you show and what you feel can vary a lot. This is particularly true for children and adolescents who often have difficulty expressing their feelings in public, fearing judgment or feeling uncertain about how to do so simply because they have still not reached their emotional maturity.

People who have physical problems in grief must have been sick before

Grief causes many different symptoms affecting the psychological, behavioral, and physiological health of the bereaved. Physiological symptoms may include loss of appetite, sleep disturbances (feeling lethargic or not being able to sleep through the night), loss of energy and exhaustion, physical complaints similar to those the deceased had endured, drug abuse, and susceptibility to illness and disease. Previously healthy individuals may present with severely weakened health during and as a result of their bereavement. Through research in the last decades, we now know that grief is associated with an increased risk of illness, the most common being infections due to the weakening of the immune system as well as depression, anxiety, and other psychiatric conditions. Bereaved individuals are more likely to seek medical help as both outpatients and inpatients, and may use more medication. A grieving person will usually neglect his/her own health by not maintaining a well-balanced diet, forgetting to take necessary medications, not getting enough sleep, and not exercising. Some may abuse alcohol, smoke excessively, use drugs, or engage in other self-destructive behaviors.