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Dr. D. Writes: Understanding and Coping with Grief

Grieving is the internal processing of the loss of a loved one (especially the range of emotions that we experience) whereas mourning is the externalizing of the loss (expressed through the rituals and ceremonies after the loss).

We all have to deal with the death of a loved one at some point in our lives. There is the dreaded potential first instance of losing somebody near and dear to us as we hear about others losing their loved ones.

The cascade begins as we get older and, suddenly, people we know start dying all around us: grandparents, uncles, aunties, parents, family friends, neighbors, colleagues and classmates.

There are those who also have to deal with the unfortunate event of burying a child. Losing a loved one can be overwhelming. It is even more difficult when we lose multiple people in a short period of time. Sometimes, the loss of a prominent figure with whom we have no personal relationship can be just as painful as we feel attached to them from a distance.

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In grappling with the loss of a loved one, we have to resolve the deep emotions that we experience while we seek the strength to engage in the customary activities to give them a good send-off. Grieving is the internal processing of the loss (especially the range of emotions that we experience) whereas mourning is the externalizing of the loss (expressed through the rituals and ceremonies after the loss).

Although grieving and mourning vary by culture, death is a universal phenomenon that elicits similar reactions and experiences regardless of one’s ethnicity or geographical location. Elisabeth Kübler-Ross, M.D., a Swiss-American psychiatrist, introduced us to the five different stages of grief that we experience after a loss. Her final work on grief with David Kessler (Kübler-Ross & Kessler, 2014), further elaborated on her decades-long research on that topic.

The Five Stages

Denial: Common reactions in the first stage include denial, shock and horror. Typical comments include, “I can’t believe this… This is surreal… How is this possible?” This shock reaction, which could involve physiological reactions such as numbness and bodily weakness, is actually a protective mechanism that helps us survive the loss. Imagine trying to take in the harsh reality of the situation all at once.

Anger: We internalize or externalize our anger in this stage with the anger directed at ourselves, others, the world, the circumstances and even God. We could be angry at ourselves for not doing more to help our loved one; blame others for their culpability in the loss; or be angry with God that He did not intervene when we asked Him to. Some people give up on their faith and walk away from God. We experience a range of feelings such as blame, guilt, shame, pain, hurt, and disappointment at the outcome of the situation. Other feelings include feeling betrayed, abandoned, or rejected. We could also experience symptoms of anxiety or panic, which sets the foundation for clinical syndromes such as depression, anxiety disorders, and Posttraumatic Stress Disorder.

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Bargaining: We seek resolution for the anticipated loss or just-experienced loss at any price in this stage. We may beg God for healing in exchange for more commitment to Him. We may seek an alternate reality or end to the loss we have just experienced. There is also an element of guilt, blame and unforgiveness of self, other, and/or God if the ending is not as we hoped it would be.


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Depression: The fourth stage of depression is especially difficult as we accept the reality of the situation and despair sets in. We experience a sense of helplessness and hopelessness, which, together with other feelings such as blame, guilt, shame, anxiety, sadness, and hurt results in feeling depressed. Some of us find ourselves withdrawn from others and may feel lonely. We may struggle with keeping up with self-care and everyday tasks. Some of us flirt with suicidal ideation and make comments such as, “I just want to die.” This is not the same as clinical depression, however.

Acceptance: We come to terms with the loss in the fifth stage. We are able to find a way to power our way through the difficult situations and even find the silver lining. In other words, we strive to find the meaning in the loss. We may accept that death is a part of life or believe that our loved one has found rest and is no longer suffering. We start to resume our normal routines and start to feel better. Some people struggle with survivor’s guilt; the guilt of being alive and moving on from grieving or mourning. However, healing from the pain of the loss we have experienced actually draws us closer to our loved one as we can memorialize them in a positive way without all the negative emotions.

It is important to understand that we do not go through the stages in a linear, step-by-step fashion. We typically experience denial and shock as the initial reaction. However, we could jump straight to being depressed without experiencing any anger. We could also think that we have accepted the situation but somehow find ourselves feeling angry or bargaining for a different resolution to the issue.

Physiological and Mental Health Symptoms

It is important to seek ways to resolve our grief as failure to do so could result in physiological reactions or symptoms such as lethargy, headaches, poor appetite, stomachaches, gastrointestinal problems, ulcers, insomnia, panic attacks, and high blood pressure. Unresolved grief or trauma could also result in mental health problems such as clinical depression (diagnosed 6 months after unresolved grief), withdrawal from others, suicidal ideation, anxiety disorders, substance abuse, eating disorders, decompensation (E.g., mental confusion), and failure to thrive.  

Coping with Loss

Understand that we all grieve differently: Everybody’s pain is unique to them. We should not dictate to people about how they should grieve or experience their pain. Rather, we should seek to understand how we can make others (or ourselves) feel better. We should never assume that our words are providing any comfort. For example, well-intentioned people rush to say words such as, “Be strong… Be strengthened” or “It is well.” Those words may be encouraging to one person but meaningless to another who feels completely lost or angry about the loss. When visiting or consoling the bereaved, gauge their personality, presentation and reactions as well as that of others before you speak. Saying, “Please accept my condolences” could suffice in some instances.

Express your emotions: Repressing one’s emotions is unhealthy. We have to allow ourselves to process our feelings and not be afraid of what we feel. Tears do not represent weakness and unshed tears are likely to affect us in different ways. People who do not know how to express their emotions are at higher risk of developing symptoms such as headaches, insomnia and anxiety.

It is important to remember that emotions are raw soon after a loss but that we heal over time. Also, be empathetic, understanding, nonjudgmental, kind, and accommodating to others and yourself. Seek to process the loss with others, if possible. There is healing in encouraging and supporting others as well as sharing our pain and experiences with them. Humor is a great way to cope; whether through sharing funny memories of the deceased or watching funny movies. Savoring the good memories of our loved one by recounting good stories about them is a good way to boost positive emotions.

Understand the stages of grief, emotions and symptoms you are dealing with: Understanding what you are dealing with is half the work done. Knowing what stage of grief you are in, what emotions you are experiencing and what physical symptoms you are struggling with helps with seeking out good coping strategies.

Anger and sadness affirm that you have loved, despite your loss. Anger, especially externalized anger, carries pain but gives strength. This typically could result in advocacy projects in our loved one’s name or memory. However, sadness does not typically give strength. Regret also causes deep sorrow but does not carry enough positive memories to facilitate healing. Also, the deeper our love or attachment to the deceased, the deeper our grief will be. However, positive memories about our loved one help to resolve our grief faster and better.

Understand your limits and triggers: We have to understand what we can handle and what triggers our negative emotions. For example, would it be helpful to take a leave of absence from work? Should we still be the chief organizer in the women’s ministry? We have to be careful not to engage in excessive activities at the expense of acknowledging and processing our grief. If you find yourself feeling overwhelmed and struggling to cope with everyday things that you previously had no trouble with or find yourself being hyperreactive (having extreme reactions) to seemingly simple things, it is time to stop and deal with your grief.

Engage in healthy coping strategies: It is important to develop healthy coping strategies such as proper self-care (E.g., eating well, exercising, and getting enough sleep) as opposed to destructive coping strategies (E.g., substance abuse, overeating, overindulging in unhealthy foods, and not sleeping). Find activities that you enjoy that relax and calm you. Consider picking up a new hobby. We have to utilize behavioral activation (identifying and engaging in goal-directed activities) if we are feeling unmotivated. It would be helpful to have somebody who could check on us and encourage us to be functional.

Although some people prefer to be alone, we have to be careful not to be isolated, which could prove to be detrimental in the long run. People who complete suicides, for example, become increasingly isolated towards the end of their lives. We also have to examine what we consider to be the source(s) of our strength and how deep our roots are. For example, do we rely on family, church, reading the Bible, prayer, etc., as our source(s) of support? If so, we need to consistently utilize those resources to help us heal.

Positive Reframing: We have to find ways to put our loss in a positive light and find the silver lining in the loss. Most people comfort themselves with the thought that God knows best, that their loved one is in a better place, that he or she is not suffering anymore or that they will see them again someday. Additionally, we could adopt the paradigm that death makes life more valuable.

We could seek changes in our lives based on the loss. We could focus on fostering better relationships with others and God, be better versions of ourselves, and find ways to make the world a better place. For example, it may be time to get a will, update the security system in the house, volunteer to make a difference in the world or others’ lives, or be more serious about medical checkups (if your loved died from a medical condition such as unmanaged high blood pressure, for example).

Resolve unresolved issues/emotions: We have to make peace with our regrets about our relationship with our loved one. We have to forgive ourselves if we are blaming ourselves somehow for contributing to the death of our loved one. Deal with resentments that you feel and seek forgiveness from them if you think that you wronged them. For example, if you are angry that their lack of self-care led to their death or that they abandoned you, you could resolve that by praying to God about it, speaking to them as if they were present, or writing them a letter or poem to address these issues. It is important to have closure about their death.

Recognize and address re-traumatization: A current loss can trigger memories of past losses or trauma. Some people consequently experience clinical syndromes such as depression, anxiety, panic disorder, and Posttraumatic Stress Disorder or complex trauma, which can be debilitating. It is thus important to recognize and properly address grief.

Acknowledge the reality of death: As difficult as it is to accept, death is a part of life. Everybody experiences it. We thus have to prepare ourselves that we will certainly experience it and will make our own exit at some point in time. We could thus focus on how to accept this unfortunate certainty in life and focus on the legacy that we hope to leave behind.

Give people their flowers while they are still alive: We have to learn to love, appreciate, and celebrate people while they are still alive as opposed to waiting until they are dead to eulogize them.

Memorialize your loved one: One good way to resolve grief is to move our energy from dwelling on the loss to engaging in activities that would memorialize our loved one’s name or memory. This could include advocacy projects such as donations in their name, adopting a project in their name, painting a picture of them, forming a charitable foundation or writing a book.

Give yourself time to heal: There is no time limit as to how long we should grieve a loved one. However, if we find ourselves struggling months or years later with the same depth and rawness of emotions that we felt at the beginning, we need to seriously address our grief. Unresolved grief that cripples our ability to function on a daily basis becomes clinical depression after 6 months. It is unrealistic to think that every negative emotion and pain will magically disappear. However, we have to strive to get better over time.

Seek psychotherapy if needed: It is expedient to find a good psychotherapist to help address our challenges if we cannot cope on our own. The difference between a counselor and a psychotherapist is that the former may be able to offer words of advice and wisdom whereas the latter is professionally trained to address clinical difficulties such as depression, anger, and complex grief or trauma.

A psychotherapist would be able to help you assess your thoughts, emotions, and behaviors and their outcomes/consequences, move you from being negative and irrational to being positive and rational. They would be able to help you to master techniques such as mindfulness, thought challenging, art or music therapy or utilizing imagery to find healing from your loss. A psychotherapist who shares your spiritual beliefs, if that matters to you, could be the best thing that happens to you. Bible-centered therapy (juxtaposing psychological principles and scriptures), for example, is very beneficial to many people.

References

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders (5th Ed.).

Kübler-Ross, E., & Kessler, D., 2014. On Grief & Grieving. Scribner.

 

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