Primary Care Physician
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?"
Posted in Accidents by Dr. Sharon Orrange on Apr 19, 2009
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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71
Thats really impressive and very differ than others because you want to show the reality and you will.so I really appreciate with you because when a person lose his first love then he get more tears and pain so heart will be break.naturally health problem will also come in to their body but the main solution i have for that Time.they spend their time and they improve day by day so i think time is the better solution because death is natural no one can stop it.
By neurovision  Jun 24, 2014
70
my mom recently passed away(dec 2011) Its march now and i still have "crying days" I chose to write away my feelings. We alll knew it was going to happen soon as she was very ill and had been living in a nursing home. She had 4 auto immune diseases and asthma copd and congestive heart failure... sometimes I hear her and feel her... i sorta want to hold on to that. Is this normal? I wear her watch everyday... i just want to hold on to her memory... she was my stregnth and inspiration, she was a fighter. She has taught me to appreciate the little things in life and to not worry over small things. Even though we all knew this would happen its still painful... i just want her to be with me...
By pkukid  Mar 26, 2012
69
The thing is, I love him sooooooo much! I would've gotten passed it all...I would've in time...I regret now not seeing him, not giving him the hug and kiss...the next time I saw him he was in his casquett...dead. I am devastated and lost...desperate to tell him I love him and anguished with the question if he knew how much I love him! I don't know how to do this! In my mind he was my husband even if I didnt have the ceremony or papers to solidify it...he was my everything, my best friend! Now what?!?!?
By niseber  Apr 01, 2010
68
I recall that the last time I saw him was when he told me about the hooker and I was so hurt that when he tried to kiss me and hug me to say he was sorry I told him not to touch me, that I was disgusted by him at that time and I walked out telling him he wouldn't see me or our dog again unless he got help, and that even then I would need time to heal from all the chaos and could not garantee we'd survive this one...it was getting to be too much pain!
By niseber  Apr 01, 2010
67
I had been trying to play the tough love card and I separated from him telling him that either he got some professional help or it just wouldn't work. The last time he relapsed prior to his death was the hardest for me...he was found in a motel room with a hooker all drugged up and out of his skull. I was devastated in so many ways!
By niseber  Apr 01, 2010
66
I just lost my boyfriend of 10 years on March 18 2010. He died of an overdose which I am sure was accidental. I am devastated and I don't know how to do this! how do I go on?
By niseber  Apr 01, 2010
65
I know in my head it will get easier, I will never get over the suicide of my ex-husband, but I will learn to live with it, or so everyone says. I am seeing a therapist and I recommend this to anyone who just needs someone to talk to, someone who has no vested interest in anything except you. It is okay to be a little selfish when reaching for help. The guilt you feel with a suicide is overwhelming and you need to have guidance on how to navigate this strong emotion, where to put it when it comes. club penguin cheats
By dontcry  Jan 12, 2010
64
I lost my 31 year old son on August 13, 2009. Will I be able to carry on my life as it was before. I don't think I will be able to ever do that. I feel like something is missing and I am trying to find it. I cry at the drop of a pin and everything and nearly everyone around me agitates me. My patience is so thin. Will these feelings eventually subside?
By JanMarie7  Dec 09, 2009
63
It is hard to lose a mother who is not just a mother but your best friend... I can not accept she is gone no maatter what I do it does not help.There is this emptiness that feels as though I have slipped in this bottomless pit, there is no way to free myself..everyone says it wil get better, she's in a better place if I hear that bullshit one more time she is in a better place I am going to scream. I do not want to get that close to anyone ever again, they are here than they drift away your left hold on to what was, never will be again. I only hope my mom knows that I loved her for the person she was, things held in the heart are a treasure that never fades or departs..
By konacutter  Dec 08, 2009
62
my son shot himself just over a week ago,i miss him and dont know how to go on...i have 4 other kids thst i must go on for, but it is so hard.....
By lostin  Nov 04, 2009
61
It is very hard to you, try to talk with your parter.
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By mar4ela  Sep 30, 2009
60
My father, age 93 died almost 3 years ago. I am still dealing with it. I still have good days and bad days. I mean I cry when I think of him still. I was very lucky to be with him when he passed away in a hospital. I was holding his hand and was going to spend the night in a chair in his room, because I knew he was close to dying. My Mom went home to eat a quick dinner and 2 mins. before she came back into the room, he passed. I'm 55 and all I can say is it will take a lot of time to get over anyone, if you ever do. That person has been with you through good times and bad times. Why get over them is what I always ask? There is no reason to get over them. You loved them! Just cry when you want and never forget about them. debi
By Dee1212  Aug 18, 2009
59
My daddy lost 2 brothers and both parents. My father's daddy died (in side the house) from a heart attack when my father was just 14. His mother (or my grandmother) just passed in January 2009. His younger brother was killed by his brother-in-law back in 1992, I believe. And his oldest brother died from heart failure back in July 2005... I didn't recall my daddy being all that sad when his mother or brother died. He did appear a little cold & aloof the day of his brother's funeral. But he appeared to be his normal self the day after. A few weeks ago I asked my daddy how come he didn't seem sad when his mother or brother passed. His response was, "what's to be sad about?" I replied, "because you'll never ever see that person again." He said he wasn't sad when either one of his brothers died because he hardly saw them, anyway. And he wasn't really sad when his daddy died either. I think he was lying, though. I we all have different ways of dealing w/ death and stress, but I don't believe him. I hope it's that easy for me. But I doubt that it will be...
By mimi1988  Aug 05, 2009
58
Wow! Reading some of these comments have made me even more depressed. I lost a friend of mine 2 months ago. He was a guy that I was REALLY crazy about. We weren't even what you would call a 'couple', though. We were only in the beginning stage of a relationship. And yet it (still) feels like I've lost someone I've known my entire life. I think about him EVERYDAY. Sometimes I'll think of him for hours at a time, bcus I still can't believe he's actually gone. I can only imagine what his family is going through. I just don't understand why it hurts so much. It would've made a little more sense had we actually been in a REAL relationship. But we weren't! I guess I'm more sad & angry bcus I REALLY REALLY wanted us to be together, and now I'll never get that oppurtunity. I'll NEVER know what we could've been. I know some ppl may think I'm crazy for feeling this way. But when I like a person I get EXTREMELY attached to them, to the point where I'm not even interested in meeting other guys.

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.
By mimi1988  Aug 05, 2009
57
I know in my head it will get easier, I will never get over the suicide of my ex-husband, but I will learn to live with it, or so everyone says. I am seeing a therapist and I recommend this to anyone who just needs someone to talk to, someone who has no vested interest in anything except you. It is okay to be a little selfish when reaching for help. The guilt you feel with a suicide is overwhelming and you need to have guidance on how to navigate this strong emotion, where to put it when it comes.
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...
By CIndyJoyce  Jul 21, 2009
56
I thought that your article was very well done. I am glad that you put in the part about child loss. Having "survived" the loss of my 17-year old son in 2005, I can honestly say that 6 months of healing time is way out of the ballpark. It has been 3 and a half years now, and though I have started allowing myself to laugh or share memories of him, the loss is deep and the pain has only slightly diminished. I have 2 young daughters to raise as well. I live with the fear every day that something could happen to them. I deal with THEIR grief as well as my own. Watching your other children struggle and grieve over the loss of their sibling, compounds my own grief 10-fold. Admittedly,This profound loss has strengthened our family bond, but there is always a missing part. Whenever one of my girls gets an award or performs in a school show, the first thing they think about is that they wish their brother was here to see it. Besides that, we live in a small community where everyone knows you and what has happened. People are scared to approach you, so they avoid you altogether. The loss goes deep and wide: Loss of family, friends, future, community, and the lack of sympathy from a world that continues to revolve without your child, and the fact that you can't seem to revolve as quickly.I do agree also with your comment about medications slowing down the natural grieving process... I feel that I would not have made it this far if I didn't allow myself to feel the deepest, darkest depths of that pain very early on, because after that, I knew it could never again get as bad as those moments I allowed myself to have, and that's when the uphill climb began. I am still climbing, but I am climbing away from that grief prison I locked myself in. I am now able to enjoy watching my daughters succeed and overcome hopefully the worst tragedy they will ever have to live through. Thank you so much for writing this article. It helped me remember where I was, where I am now, and where I go from here.
By Jons Mom  Jun 20, 2009
55
My son died Dec,12,2008 and I still find myself bursting into tears and longing for him to be here. He was 23 and had sudden heart failure which is perplexing due to his being athletic and a happy young man. My feelings are so strong that I long to escape them to no avail. I don't know what to do.
By spermwhale  May 30, 2009
54
My brother is dying from ALS. We are very close and I am one of his main caregivers. As time gets closer to his death. I almost find myself feeling empty. When I would cry often and hurt deep inside. I have grievedd so much while he has been alive. I wonder if I am just getting numb to it. He has suffered so much.
By 080663  May 26, 2009
53
One thing that helped me, was reading "that we only get to BORROW the people in our lives". We don't have any guarantees, that our loved one(s) will be with us, for the amount of time we WANT.
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.
By page  May 25, 2009
52
it will take time but i know it hurts because i have loss many loved ones to .
By cewidder  May 17, 2009

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Military Families
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Motherless Children
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