What is grief?
Grief is the normal response of sorrow, emotion, and confused emotions that come from the loss of someone or something important to you. It is a natural part of life. Grief is a typical reaction to death, divorce, job loss, a move away from family and friends, or loss of good health due to illness.
What does grief feel like?
Following a death or loss, you may feel empty and numb, as if you are in shock. You may notice physical changes such as trembling, nausea, trouble breathing, muscle weakness, dry mouth, or trouble sleeping and eating. You may become angry - at a situation, a particular person, or just angry in general. Guilt is a common response which may be easier to accept and overcome by looking at the experience in terms of "regret". When we think "I regret I was not in the room when he died" or "I regret I was not able to speak more openly about dying" it is less critical than "I feel guilty about my behavior".
People in grief may have strange or disturbing dreams, be absent-minded, withdraw socially, or lack the desire to participate in activities that used to be enjoyable. While these feelings and behaviors are normal during grief, they will pass.
How long does grief typically last?
Grief lasts as long as it takes you to accept and learn to live with your loss. For some people, this is a few months. For others, it may take years. The length of time spent grieving is different for each person. There are many reasons for the differences, including personality, health, coping style, culture, family background, other stressors and life experiences. The time spent grieving also depends on your relationship with the person lost and how prepared you were for the loss.
How will I know when I'm done grieving?
After a significant loss, you may be consumed and overwhelmed by the grief reactions you are experiencing. In time, as the reality of the loss sinks in, and all the changes as a result of the loss have been experienced, you will learn to adjust to living without the physical presence of the person who died. Eventually, even after significant loss, you will realize you are grieving less as you discover renewed energy in living. You will become less consumed by the impact of the loss and begin to draw comfort rather than pain from the memories. In a sense, you are never "done grieving." With a significant loss, there will always be moments when you will remember the loss, and perhaps you experience some of the feelings of grief. Fortunately, the time period between these surges will lengthen considerably as you learn how to cope with your loss.
How should I handle a major death or loss?
There is no right or wrong way to grieve after a significant loss. Most discover how to eventually move on with life, even though the grief experience is a difficult and trying time. Coping styles depend on one's personality and their relationship with the person who has died. This experience can also be affected by one's cultural and religious background, coping skills, mental history, and their support system. Taking care of yourself, accessing the support of friends and family can help a person get through difficult times.
What is bereavement?
Bereavement is the period after a loss during which grief is experienced. 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.
Some view the process of bereavement as having 4 phases:
Shock and numbness: Usually occurring soon after a death, this is evident when the person finds it difficult to believe the death has occurred; is feeling stunned and numb.
Yearning and searching: As shock and numbness recede, there remains the tendency to "forget" the person has died. Perhaps one catches a glimpse of somebody who reminds them of the deceased, or you expect them to be there when you first arrive home.
Disorganization and despair: As the reality of the absence of the person who died settles in, it is common to feel depressed and find it difficult to think about the future. You may be easily distracted, or have difficulty concentrating and focusing on any one task.
Reorganization: As one slowly makes the adjustment to all the ways in his or her life that have changed as a result of the loss, a sense of reorganization and renewal begins to evolve. Life is forever changed after a significant loss, but you slowly learn how the different aspects of your life become reprioritized as you "pick up the pieces" and begin to move on. It is not that you forget about the person who died, but you have begun to learn how to live with this knowledge.
How can I cope with grief?
Each one of us has an individual style of coping with painful times. The lists and information on this web site may help you generate ideas about how to manage your feelings of grief. You may want to experiment with these ideas or create a list of your own, as - again - there is no "set way" to cope with grief. Talking to friends who have dealt with loss in the past can help you generate new ways of coping. But ultimately, only you know what coping skills will fit best with your personality and lifestyle.
One way to examine your own style of coping is to recall the ways you've dealt with painful times in the past. It's important to note that some ways of coping with grief are helpful, like talking to others, writing in a journal, and so forth. Others may be hurtful or destructive to the healing process, like substance abuse or isolation. Healthy coping skills are important in resolving a loss. They cannot take away your feelings of loss. They can, however, help you move forward in the healing process.
Does my culture play a role in the grieving process?
Grief experienced from the loss of a person, a treasured possession, or an important life change occurs across all ages and cultures. The role that cultural heritage plays in an individual's experience of grief is not well understood, but, attitudes, beliefs, and practices regarding death must be understood within the context of the myths and mysteries surrounding death within different cultures.
Individual, personal experiences of grief are similar in different cultures, yet they have different mourning ceremonies, traditions, and behaviors to express grief. These vary greatly from one culture to another. Helping families cope with the death of a loved one must include respect for the family's cultural heritage. One should encourage them to decide how to honor the death, from their own rich tradition of practices and rituals.
Death and grief spare no one and are normal life events. All cultures have developed expectations and norms about coping with death. Interfering with these practices may complicate the grief process. For this reason, it is important to understand someone else's loss from the perspective of the cultural and family traditions unique to that individual.
Important questions to ask those who are dealing with a significant loss - and even yourself - include:
- What are your cultural rituals for coping with dying, the deceased person's body, the final arrangements for the body, and honoring the death?
- What are the family's beliefs about what happens after death?
- What does your family believe is a normal expression of grief and the acceptance of the loss?
- What does your family consider to be the roles of each family member in coping with a death?
- Are certain types of death that are less acceptable (for example, suicide), or are certain types of death especially hard to handle for your culture (for example, the death of a child)?
- Are some deaths more 'expected' than others?" "If so, are expressions of grief and mourning after those types of deaths less acceptable?"
Your cultural background can affect how you understand and approach the grief process. Some cultures anticipate a "time to grieve" and have developed rituals to help people through the grief process. Support from others can be a reminder that grief is a universal experience and that you are not alone. After a significant loss, some cultures have mourning rituals to mark the passage of time and help individuals reconnect with their ordinary lives.
A mourning ritual can occur during a meaningful time, like an anniversary, wake, or holiday, or at a distinct location, like a church, synagogue, or home. In North American cultures, for example, there are the Catholic anniversary mass, the reciting of Kaddish, and El Día de los Muertos. Many ceremonies have spontaneously grown up around the Vietnam War Memorial, and a special mourning project, the AIDS Quilt, traveled throughout the nation to enable mourners to participate in this expression of grief. Grief rituals and ceremonies acknowledge the pain of loss while also offering social support and a reaffirmation of life.
You may not be conscious of how your own cultural background affects your grief process. Talking with family, friends or clergy is one way to strengthen your awareness of possible cultural influences in your life. Friends and family may be able to help you generate ideas to create your own rituals. Some have found solace in creating their own unconventional ceremonies, such as a funeral or ceremony with personal friends in a private setting.
Is "anticipatory grief" as difficult to deal with as a sudden loss?
When a patient or family is expecting a death, it is normal to begin to anticipate how one will react and cope when that person eventually dies. Many family members will try to envision their life without that person and mentally play out possible scenarios which may include grief reactions and ways they will mourn and adjust after the death.
Anticipatory grief reactions may include feelings of depression, extreme concern for the dying person, and preparing for the death. Anticipatory grief is a natural process that enables the family more time to slowly get used to the reality of the loss. People are able to complete unfinished business with the dying person (for example, saying "good-bye," "I love you," or "I forgive you"). Anticipatory grieving may or may not occur and feelings following the death may be much different from what was anticipated before the death.
What about sudden loss?
The grief experienced after a sudden, unexpected death is different from anticipatory grief. Sudden, unexpected loss may overwhelm the coping abilities of a person which may result in the sense of feeling overwhelmed and/or unable to function "normally." A person may not be able to realize the total impact of their loss. Even though one may be able to acknowledge the loss has occurred, the full impact of this loss may take much longer to fully comprehend than in the case of an expected loss.
When is "normal" grief different from "complicated" grief?
Complicated grief reactions are different from the grief reactions described above. Depressed or anxious mood, disturbed emotions and behavior, major depression, substance abuse, and even posttraumatic stress disorder are some of the ways in which grieving can become complicated. Grief becomes complicated when it is masked by significant physical or behavioral symptoms, or when it is exaggerated. If an individual has personality, developmental, or emotional issues, grief therapy may be needed.
If a person suspects they are clinically depressed in addition to their grief, they should seek professional assistance. One who avoids any reminders of the person who died, who constantly thinks or dreams about the person who died, and who gets scared and panics easily at any reminders of the person who died may be suffering from posttraumatic stress disorder. In cases such as these, professional assistance is likely needed.
How do different people cope with grief differently?
It is essential to allow oneself to feel all the emotions that arise, as painful as they may be, and to treat oneself with patience and kindness.
Grieving people have two choices: they can avoid the pain and emotions associated with their loss and continue on, hoping to forget. This is a risky choice, since experience shows that grief, when ignored, continues to cause pain.
The other choice is to recognize grieving and seek healing and growth. Getting over a loss is slow, hard work. Give into the pain, even over other emotions and activities, because grief is a pain that will get in the way later if it is ignored. Realize that grief has no timetable; emotions may come and go for weeks, months, or even years. While a show of strength is admirable, it does not serve the need to express sadness, even when it comes out at unexpected times and places.
So what helps with the grieving process?
- " Talk about your loss Talk the time to seek comfort from friends who will listen. Let them know you need to talk about your loss. People will understand, although they may not know how to respond. If they change the subject, explain that you need to share your memories and express your sadness.
- Forgive yourself For all of the things you believe you should have said or done. Also forgive yourself for the emotions such as anger, guilt or embarrassment you may have felt while grieving.
- Eat well and exercise Grief is exhausting. To sustain your energy, be sure to maintain a balanced diet. Exercise is also important in sustaining your energy, find a routine that suits you - clear your mind and refresh your body.
- Indulge yourself Take naps, read a good book, listen to your favorite music, go to a ball game, rent a movie. Do something that is fun, distracting and that you personally find comforting.
- Prepare for holidays and anniversaries Many people feel especially "blue" during these periods, and the anniversary date of the death can be especially painful. Even if you think you've progressed, these dates may bring back some painful emotions. Make arrangements to be with friends and family members with whom you are comfortable. Plan activities that give you an opportunity to mark the anniversary.
- Learning about the grief process will help support a grieving loved one. Formal and informal supportive services may be helpful to a person who is grieving. These support services can be guides through some of the challenges of grieving as the person adjust to their loss. Grief counseling can be provided by professionals. Consult a hospice in your local community, as all hospice bereavement programs provide grief support to the community, regardless of whether their loved one was cared for by hospice or not. Through learning about the grief process, you can help support a grieving loved one as well.
What sort of grief supports are out there?
Counseling and support services may be helpful to a person with normal grief reactions. They can be a guide through some of the challenges of grieving as they adjust to their loss. Grief counseling can be provided by professionals. Self-help groups are often available and are there for participants to support one another. Consult a hospice in your local community, as all hospice bereavement programs provide grief support to the community, regardless of whether their loved one was cared for by hospice or not. In Herkimer County and nearby, the following known support groups are offered:
Adult Parental Loss, for adults who have experienced the death of a parent, 735-6484.
Bereaved Parent/Grandparent Support Group - "Those So Young": 866-4590, 866-1349.
Bereaved Parents (Sister Rose Troy): 724-2221 or 724-6105.
Bereavement Support Group, to cope with the losses of aging: 732-8011 or 337-7954.
Bereavement Support Groups with Sister Rose Troy: 724-2221 or 724-6105.
GOAL Bereavement Support Group: 866-4292 or 866-4596.
Grief Resource Center at Erwin Library: 942-4834.
GriefShare, recovery seminar and support group: 724-2943.
Herkimer County Walkers, a walking group for Herkimer County residents who have experienced a death: 735-6484.
Herkimer County Passages: 735-6484. For any adult has experienced a death.
Hospice Bereavement, groups for all ages including children: 735-6484.
Hospice Walkers, walking group for bereaved adults: 735-6484.
Journey Together, a social group for bereaved: 735-6484.
Kuyahoora Bereavement Support Group, 845-8532, 845-8202.
Passages, for newly bereaved: 735-6484.
Pathways Group, for anyone dealing with a loss of a loved one: 732-2164 or 724-0218.
Pregnancy Loss and Infant Death Support Group, for anyone whose life has been impacted by the loss of a pregnancy or an infant death: 363-5490.
Share Group (Hospice), for those who have had a child die through miscarriage, stillbirth, SIDS: 735-6484.
Suicide Survivors, for those who have experienced the death of a loved one by suicide: 724-2221 or 724-6105.
Teens Grieve Too: 735-6484 or 697-5040.
Widowed Persons Service: 866-9288.
Widows/Widowers Support Group: 735-6210.
Widows/Widowers I (more than 65 years old): 724-2221 or 724-6105.
Widows/Widowers II (age 20 to 64): 724-2221 or 724-6105.
What About Me?, for children 5 to 12 who have experienced the death of a loved one: 735-6484.
What goes on in grief support groups?
The goals of grief counseling may include:
- Understand the natural process of grief " Accept and adjust to the reality of the death " Receive affirmation for the "normalcy" of feelings " Provide information about the grief process and common grief responses " Understand common obstacles and how to deal with them " Help the bereaved identify and utilize effective coping strategies
Bereavement groups can help you recognize your feelings and put them in perspective. They can also help alleviate the feeling that you are alone. The experience of sharing with others who are in a similar situation can be comforting and reassuring. Sometimes, new friendships grow through these groups - even a whole new social network that you did not have before. There are specialized groups for widowed persons, for parents who have lost a child, for teenagers, for victims of drunk drivers, etc. There are also groups that do not specialize. Check with your local hospice or other bereavement support groups for more information, or just use the information above. If you find that you are in great distress or in long-term depression, individual or group therapy from a counselor who specializes in grief may be advisable. You can ask your doctor for a referral.
What goes on in grief counseling?
Grief therapy is sometimes indicated when individuals have more complicated grief reactions. The goal of grief therapy is to identify and resolve the conflicts of separation that interfere with the ability to mourn the loss. It is indicated when any of the previously described complicated grief symptoms are evident. Complications in grief may also occur if grief from previous losses resurfaces. Grief therapy addresses what is interfering with the grief process, identifies unfinished business with the deceased and other losses that result from the death.
Many people discover that there is hope after death. Death takes away, but grief can give back. It is possible to recover from grief with new strengths and a new direction. By acting on our grief, we may eventually find peace and purpose. A clinician helps with that healing process in a way to return the grieving individual to former functionality.
How can I help friends or family who are grieving?
When people are grieving, know that all emotions are often heightened. Acknowledge all feelings. Their grief reactions are natural and necessary. Do not pass judgment on how "well" they are or are not coping. Understand and accept cultural and religious perspectives about illness and death that may be different from your own. For example, if a family has decided to remove a loved one from life support, do not second guess this decision; try to be supportive.
Be specific in your willingness to help. Offer assistance with chores such as childcare or meals. For example, suggest "I'll bring dinner on Thursday, how many people will be there?" Identify friends who might be willing to help with specific tasks on a regular basis, such as picking up the kids from school or refilling prescriptions. Acknowledge that life won't "feel the same" and the person may not be "back to normal." Help the person to renew interest in past activities and hobbies, when they are ready, or discover new areas of interest. Offer suggestions may help, such as, "Let's go to the museum on Saturday to see the new exhibit," but be accepting if your offer is declined.
Know and accept that how your friend or family member copes with their loss may be very different from how you would cope, even in the same situation. There is no right way to grieve and mourn. Be very careful not to impose your expectations on someone else, no matter how much you think it might "help."
How can I help someone in grief who's also a caregiver?
To support a caregiver who is grieving, ask how you can best help, and listen for what they seem to need. Express your concern for how the illness is affecting them personally. Even if you have been a caregiver yourself, don't say you know what they are going through. Empathize, by saying, "I am so very sorry," but don't say you understand.
When caregiving ends, it is normal to feel both grieved and relieved, but caregivers often feel guilty about any feelings of relief they may experience. Remind them that these feelings are normal and common. Caring for a loved can be exhausting work, but when caregiving ends, time often seems endless. Offer to help grieving caregivers fill their day with meaningful activities. Help them get back into life at a pace that is acceptable to them. Caregivers and former caregivers often haven't had enough sleep, nor have they eaten well, so encourage a grieving caregiver to obtain adequate rest and nutrition.
How about helping a grieving employee?
If someone in your workplace has experienced a loss, it will have an effect on all who come into contact with that co-worker. If you are one of those people, you may feel uncomfortable, or perhaps uncertain. "What should I say?" is a common question. Some coworkers experience feelings of helplessness. You are not alone. What matters most is not what you say, but the fact that you care.
Consider alternative workplace solutions such as co-workers donating leave or offering shared leave for someone with a very ill family member. Understand that your co-worker or employee is likely to be distracted or preoccupied and may need to make more personal calls or take longer breaks. Be flexible and give employees "permission" to take care of themselves. "I know you are going through a difficult time. If you need to leave the office for a while today or you want to work from home, let me know so that I can make the necessary arrangements." Ask if your co-worker wants to discuss the subject. If not, be sympathetic while also allowing the person to concentrate on the job. Ask human resources managers for information or referrals to counselors or other resources. If your company offers Employee Assistance Programs, let your co-worker or employee know that this service is available.
For further information specific to the grief process, or to child and family therapy in general, please contact Ward V. Halverson, LCSW, M.Ed. at (315) 868-1000.