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:
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
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.
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