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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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Bereavement. "I just lost a loved one, how will I get over this?"
This was the message I received from a member on DS with a suggestion to write this blog. How do you carry on after the death of a loved one? I know there are people on DS who have suffered more personal grief than I and are more qualified to bring you the perspective of someone who has suffered. I bring to this discussion the perspective of walking the suffering family members though the anticipation of grief and the aftermath. This is a process I have done hundreds of times and it is always painful, my hope is that some of you will find comfort knowing that you too will get through this.
Between 5 and 9 percent of the population sustains the loss of a close family member each year. The vast majority of bereaved individuals (80 to 90 percent) cope with their losses without requiring professional intervention. However, bereavement can have serious and long-term adverse health effects, and you may have to consult your physician for help in managing the distress associated with bereavement. What is "normal" and what is "not normal" in the grieving process and what interventions can be used to help those experiencing dysfunctional reactions to loss.
What is NORMAL BEREAVEMENT? Death is the most powerful stressor in everyday life, and the effects may be intense and long lasting.
We use three terms to talk about the loss of a close relationship:
- Bereavement is the reaction to the loss of a close relationship.
- Grief is the emotional response caused by a loss including pain, distress, and physical and emotional suffering.
- Mourning refers to the psychological process through which the bereaved person undoes his or her bonds to the deceased.
Why am I feeling so numb right now? Immediately following death, whether or not it has been anticipated, survivors often experience feelings of numbness, shock, and disbelief. They will "go through the motions," taking care of funeral arrangements, greeting relatives and friends, and tending to financial matters. Shock and numbness, intense feelings of sadness, yearning for the deceased, anxiety for the future, disorganization, and emptiness commonly arise in the weeks after the death.
What should I expect in the first couple weeks after the death? I am often asked from survivors what it means when they see or hear their loved ones in vivid dreams in the weeks after the death. These are "searching behaviors" and include visual and auditory hallucinations of the deceased person. Despair and sadness are common as it becomes clear that the deceased will not return. Sleeplessness, appetite disturbances, agitation, chest tightness, sighing, and exhaustion are also common. The survivor often replays and remembers the relationship with the deceased, particularly the events of the terminal illness and death, and commonly ruminates over regrets and missed opportunities. Anger may occur at the person for dying, at God, and at professional caregivers.
How can your physician, friends and family care for you right after your loss? Your physician should serve to answer any immediate questions, and offer the option of viewing the body. Encourage your friends and family members who are grieving to maintain regular patterns of activity, sleep, exercise, and nutrition as much as possible, as these activities can help you adapt during bereavement.
Most grieving persons do not want or need professional help in the grieving process; instead they turn to family, friends, and religious institutions. Sleep disruption is a common symptom of grief and a short-term prescription of a sleep aide can help. Also, if you are experiencing high levels of anxiety and panic attacks, a short term prescription of an anxiety medication can be useful as a crisis measure. These medications generally should not be prescribed for long periods since their use has the potential to slow down and inhibit the grieving process.Support groups are a valuable resource for many bereaved individuals and have been shown to facilitate grief resolution. Local hospice organizations usually can identify community resources for bereavement support and Chaplains, social workers, and grief counselors are a great resource.
I think I'm fine, and then Ill burst in to tears in the grocery store: Grief comes in waves that are often brought on by reminders of the deceased. You may feel fine one moment and be overcome with sadness and grief the next moment. You are not alone if feelings of pleasure (laughing and having fun) are experienced as a betrayal of the relationship with the person who has died.
When will these feelings get better? Feelings gradually diminish in intensity for most bereaved persons, usually over months. You will slowly come to accept the reality of the loss and this means reestablishing mental and physical balance. Resolution of grief, to some degree, occurs in stages. The signs and symptoms described above and their intensity subside slowly over time for patients experiencing normal grief. Usually, these impairments are beginning to resolve by six months.
What if I'm not feeling any better, when is it not normal? Normalizing really means reorganizing your life and reinvesting in living. You may slowly become able to remember the deceased without being overwhelmed by grief; you can work productively and carry on with pleasure and enjoyment. We all know, grief will never go away entirely and anniversaries and important events will continue to evoke waves of sadness. The hope is these waves diminish over time.
Who will have the hardest time getting over the grieving process? Common sense will tell us the variables that may have an impact on how long you grieve.
1) Age of deceased: The death of an elderly person after a full life will have a different impact than the death of a child or a young adult. The death of a child is more than I can imagine and I hope those on DS who have experienced can help guide us on this. Do you ever come up for air again?
2) Pregnancy and newborns: Miscarriage or death of a newborn can precipitate prolonged grief.
3) Suicide: Bereavement due to suicide or other socially disapproved deaths (overdose, etc) may lead to more isolation and to increased vulnerability to suicide among some survivors.
When is grieving complicated or going on too long? Complicated or prolonged grief is defined as the persistence, for at least six months, of a constellation of disruptive emotional reactions including yearning and four of the following eight symptoms:
1) Difficulty moving on
2) Numbness/detachment
3) Bitterness
4) Feelings that life is empty without the deceased
5) Trouble accepting the death
6) A sense that the future holds no meaning without the deceased
7) Being on edge or agitated
8) Difficulty trusting others since the loss
Symptoms of complicated/prolonged grief at six months post-loss are highly predictive of impairment and complications at 13 and 24 months post-loss.
When should I get help for bereavement related depression? While many people with complicated/prolonged grief also meet diagnostic criteria for major depression and/or generalized anxiety disorder, only a small minority (<20 percent) of patients with bereavement-related depression are treated with antidepressants. The diagnosis of major depression in a grieving person is a challenge because these feelings are an understandable part of the grieving process. There may be benefit, however, in psychiatric evaluation for those with complicated grief. How will it help? Focusing on mastering concrete tasks (managing finances, learning how to cook) that were carried out by the deceased can lead to a new sense of competence and independence. Complicated grief treatment (CGT) is a psychotherapeutic approach that includes cognitive behavioral methods similar to those used for post-traumatic stress disorder (confronting the loss through exposure). A therapeutic trial of antidepressants and psychotherapy may be helpful in some though it is no surprise that treatment with antidepressants is associated with improvement in symptoms of depression, but appears to be ineffective in ameliorating the symptoms of grief.
Does grieving worsen my health? It can. Bereavement is associated with higher rates of mortality (especially among older men), consumption of alcohol, tobacco, and sedatives. Increased substance abuse may contribute to the rise in disease-related mortality and suicide among the bereaved. Patients with continued symptoms of complicated grief six months after a loss may be at increased risk of cancer; hypertension; heart disease; changes in eating, smoking, and drinking habits; hospitalization; disability; and reduced quality of life over the ensuing one to two years. Depression, suicide, and anxiety are the most common adverse psychological effects of loss. Rates of depression during the first year after the loss of a spouse, 15 to 35 percent, are four to nine times higher than the rate in the general population. Suicide rates after loss of a spouse are elevated, particularly in older men and in the first year.
Please jump in with your thoughts. My life was forever changed in ninth grade with the death of my cousin in a drowning at Trancas Canyon in Malibu, followed closely by my young friend dying after accidentally running through a sliding glass door. As a blessing, these experiences solidified my drive to pursue medicine.
Dr O.
On the death of a friend, we should consider that the fates through confidence have devolved on us the task of a double living, that we have henceforth to fulfill the promise of our friend's life also, in our own, to the world.
~Henry David Thoreau
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Displaying comments 62-43 of 62
Got a Question?
Yours Sildenafil
Lately, all I've been thinking about is what I'd do if I ever lost my parents or siblings. I honestly don't know how I'd get through it. If I can get this depressed over a guy I barely knew (it takes time to really get to know a person), imagine how I'd react if it were my mother, or brother or sister. Sometimes I just want to be dead. That way I would never have go through all of life's pains. I know that sounds really pathetic & cowardly, but honestly, that's how I've been feeling lately. I must say though, I do have my good days. I stumbled across his myspace page (didnt know he had one) a few days ago. So that has sparked these emotions all over again.
Also, I am not a particularly religious person, but if you believe, I suggest you pray for help and for Him to take some of the pain. It worked for me. But always, keep reaching out to anyone you can. And thank them for being there to listen to you. Life is good, focus on the good memories and push the bad ones to the back of the line...
My mom died of lung cancer, and she did smoke. I hated it when people would ask, "Did she smoke"? It seems like people often say this, when people have cancer. It almost implies, well, they deserved it. My mom was a lot of things, besides, a person who smoked. She had integrity, honesty, compassion, plus many very admiral qualities - some of which - were absent in many non-smoker's, I've known.
I myself have only been hanging on by a thread,and information like this helps me to realize just how much I need to be a member here..how I found it ,I do not know.
the things a person puts themselves thru" when left to their own devices never ceases to amaze me.Very good read doctor. here is a secret from my own primary care doctor,I had asked him after his routine was done.,"so tell me ,how do I stay young forever" ? he told me to fall in love.
Stephen
Thank God my sons were here or I wouldn't be. And my husband Gary was my backbone. I didn't know what to do, so I ate gained 100 lbs, and shopped about $30.000 worth. I hated to be home, so I started working at the school that my sons attended. I was to all types of doctor s and then my fibo set in so more doctors., I went to grief counseling , psys, interenest, church groups etc.
I didn't know how to celebrate anything any more. Tina died Dec 12 and I had 2 little ones waiting for santa. Target donated the most beautiful Angel tree to our family. they walked in and set it up. Should I hang Tinas stocking up? what do you say to the boys when there is nothing in it. Yes, I hung it up and wrote a check to St Judes Hospital (they determined what type of Cancer it was). I told the boys that this will help little kids with cancer and they accepted it.
Birthdays? cupcake and balloons. We went to the cemetary and sang Happy Birthday and set off balloons for our angel to see and we left a cupcake. again a donation was made to a cancer foundation.
You must just say to yourself<"Its just another day" dont look at it like its their birthday, or christmas. Your love ones live in your heart.
Try to be with people who have lost someone so the day is not as hard. Sometimes when you are with family it brings on tears. You may have to stop the family dinner for the holidays and stay with friends. The first couple of years is the worst. It does get better and easier.
Hope this helps someone
Have a great Day,
Doreen