20 Loss

Bereavement is the period of grief and mourning after a death. When you grieve, it’s part of the normal process of reacting to a loss. You may experience grief as a mental, physical, social or emotional reaction. Mental reactions can include anger, guilt, anxiety, sadness, and despair. Physical reactions can include sleeping problems, changes in appetite, physical problems, or illness.

How long bereavement lasts can depend on how close you were to the person who died, if the person’s death was expected and other factors. Friends, family, and faith may be sources of support. Grief counseling or grief therapy is also helpful to some people.

Grief

What is grief?

Grief is the normal response of sorrow, emotion, and confusion that comes from losing 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.

How does grief feel?

Just after 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. Almost everyone in grief also experiences guilt. Guilt is often expressed as “I could have, I should have, and I wish I would have” statements.

People in grief may have strange dreams or nightmares, be absent-minded, withdraw socially, or lack the desire to return to work. While these feelings and behaviors are normal during grief, they will pass.

How long does grief last?

Grief lasts as long as it takes you to accept and learn to live with your loss. For some people, grief lasts a few months. For others, grieving 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, 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?

Every person who experiences a death or other loss must complete a four-step grieving process:

1. Accept the loss.
2. Work through and feel the physical and emotional pain of grief.
3. Adjust to living in a world without the person or item lost.
4. Move on with life. The grieving process is over only when a person completes the four steps.

People cope with the loss of a loved one in different ways. Most people who experience grief will cope well. Others will have severe grief and may need treatment. There are many things that can affect the grief process of someone who has lost a loved one. They include:

• The personality of the person who is grieving.
• The relationship with the person who died.
• The loved one’s cancer experience and the way the disease progressed.
• The grieving person’s coping skills and mental health history.
• The amount of support the grieving person has.
• The grieving person’s cultural and religious background.
• The grieving person’s social and financial position.

This summary defines grief and bereavement and describes the different types of grief reactions, treatments for grief, important issues for grieving children, and cultural responses to grief and loss.

Bereavement is the period of sadness after losing a loved one through death.

Grief and mourning occur during the period of bereavement. Grief and mourning are closely related. Mourning is the way we show grief in public. The way people mourn is affected by beliefs, religious practices, and cultural customs. People who are grieving are sometimes described as bereaved.

Grief is the normal process of reacting to the loss.

Grief is the emotional response to the loss of a loved one. Common grief reactions include the following:

• Feeling emotionally numb.
• Feeling unable to believe the loss occurred.
• Feeling anxiety from the distress of being separated from the loved one.
• Mourning along with depression.
• A feeling of acceptance.

Normal Grief

Normal or common grief begins soon after a loss and symptoms go away over time.

During normal grief, the bereaved person moves toward accepting the loss and is able to continue normal day-to-day life even though it is hard to do. Common grief reactions include:

• Anxiety over being separated from the loved one. The bereaved may wish to bring the person back and become lost in thoughts of the deceased. Images of death may occur often in the person’s everyday thoughts.
• Distress that leads to crying; sighing; having dreams, illusions, and hallucinations of the deceased; and looking for places or things that were shared with the deceased.
• Anger.
• Periods of sadness, loss of sleep, loss of appetite, extreme tiredness, guilt, and loss of interest in life. Day-to-day living may be affected.

In normal grief, symptoms will occur less often and will feel less severe as time passes. Recovery does not happen in a set period of time. For most bereaved people having normal grief, symptoms lessen between 6 months and 2 years after the loss. Many bereaved people will have grief bursts or pangs. Grief bursts or pangs are short periods (20–30 minutes) of very intense distress. Sometimes these bursts are caused by reminders of the deceased person. At other times they seem to happen for no reason. Grief is sometimes described as a process that has stages.

There are several theories about how the normal grief process works. Experts have described different types and numbers of stages that people go through as they cope with loss. At this time, there is not enough information to prove that one of these theories is more correct than the others. Although many bereaved people have similar responses as they cope with their losses, there is no typical grief response. The grief process is personal.

Complicated Grief

There is no right or wrong way to grieve, but studies have shown that there are patterns of grief that are different from the most common. This has been called complicated grief.
Complicated grief reactions that have been seen in studies include:

• Minimal grief reaction: A grief pattern in which the person has no, or only a few, signs of distress or problems that occur with other types of grief.
• Chronic grief: A grief pattern in which the symptoms of common grief last for a much longer time than usual. These symptoms are a lot like ones that occur with major depression, anxiety, or post-traumatic stress.

Cultures have different ways of coping with death

Grief felt for the loss of loved ones occurs in people of all ages and cultures. Different cultures, however, have different myths and mysteries about death that affect the attitudes, beliefs, and practices of the bereaved.
Individual, personal experiences of grief are similar in different cultures.

The ways in which people of all cultures feel grief personally are similar. This has been found to be true even though different cultures have different mourning ceremonies and traditions to express grief.

Cultural issues that affect people who are dealing with the loss of a loved one include rituals, beliefs, and roles.

Helping family members cope with the death of a loved one includes showing respect for the family’s culture and the ways they honor the death. The following questions may help caregivers learn what is needed by the person’s culture:

• What are the cultural rituals for coping with dying, the deceased person’s body, and honoring the death?
• What are the family’s beliefs about what happens after death?
• What does the family feel is a normal expression of grief and the acceptance of the loss?
• What does the family consider to be the roles of each family member in handling the death?
• Are certain types of death less acceptable (for example, suicide), or are certain types of death especially hard for that culture (for example, the death of a child)?

Death, grief, and mourning are normal life events. All cultures have practices that best meet their needs for dealing with death. Caregivers who understand the ways different cultures respond to death can help patients of these cultures work through their own normal grieving process.