People cope with the loss of a loved one in many ways. For some, the experience may lead to personal growth, even though it is a difficult and trying time. There is no right way of coping with death. The way a person grieves depends on the personality of that person and the relationship with the person who has died.
How a person copes with grief is affected by the person’s cultural and religious background, coping skills, mental history, support systems, and the person’s social and financial status.
The terms grief, bereavement, and mourning are often used in place of each other, but they have different meanings.
Grief is the normal process of reacting to the loss. Grief reactions may be felt in response to physical losses (for example, a death) or in response to symbolic or social losses (for example, divorce or loss of a job).
Each type of loss means the person has had something taken away.
As a family goes through a cancer illness, many losses are experienced, and each triggers its own grief reaction. Grief may be experienced 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.
Social reactions can include feelings about taking care of others in the family, seeing family or friends, or returning to work.
As with bereavement, grief processes depend on the relationship with the person who died, the situation surrounding the death, and the person’s attachment to the person who died.
Grief may be described as the presence of physical problems, constant thoughts of the person who died, guilt, hostility, and a change in the way one normally acts.
Bereavement is the period after a loss during which grief is experienced and mourning occurs. 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.
Mourning is the process by which people adapt to a loss. Mourning is also influenced by cultural customs, rituals, and society’s rules for coping with loss.
Grief work includes the processes that a mourner needs to complete before resuming daily life.
These processes include separating from the person who died, readjusting to a world without him or her, and forming new relationships.
To separate from the person who died, a person must find another way to redirect the emotional energy that was given to the loved one.
This does not mean the person was not loved or should be forgotten, but that the mourner needs to turn to others for emotional satisfaction. The mourner’s roles, identity, and skills may need to change to readjust to living in a world without the person who died.
The mourner must give other people or activities the emotional energy that was once given to the person who died in order to redirect emotional energy.
People who are grieving often feel extremely tired because the process of grieving usually requires physical and emotional energy.
The grief they are feeling is not just for the person who died, but also for the unfulfilled wishes and plans for the relationship with the person.
Death often reminds people of past losses or separations. Mourning may be described as having the following 3 phases:
- The urge to bring back the person who died.
- Disorganization and sadness.
Grief and the phases of a life-threatening illness
Understanding how other people cope with a life-threatening illness may help the patient and his or her family prepare to cope with their own illness. A life-threatening illness may be described as having the following 4 phases:
Phase before the diagnosis.
- The acute phase.
- The chronic phase.
Recovery or death.
The phase before the diagnosis: The phase before the diagnosis of a life-threatening illness is the period of time just before the diagnosis when a person realizes that he or she may develop an illness.
This phase is not usually a single moment, but extends throughout the period when the person has a physical examination, including various tests, and ends when the person is told of the diagnosis.
The acute phase: The acute phase occurs at the time of the diagnosis when a person is forced to understand the diagnosis and make decisions about his or her medical care.
The chronic phase: The chronic phase is the period of time between the diagnosis and the result of treatment. It is the period when a patient tries to cope with the demands of life while also undergoing treatment and coping with the side effects of treatment.
In the past, the period between a cancer diagnosis and death usually lasted only a few months, and this time was usually spent in the hospital. Today, people can live for years after being diagnosed with cancer.
The recovery or death phase: In the recovery phase people cope with the mental, social, physical, religious, and financial effects of cancer.
In the final (terminal) phase of a life-threatening illness occurs when death is likely. The focus changes from curing the illness or prolonging life, to providing comfort and relief from pain.
Religious concerns are often the focus during this time.
how the following factors affect the grief response:
Whether the death is expected or unexpected.
It may seem that any sudden, unexpected loss might lead to more difficult grief.
However, studies have found that bereaved people with high self-esteem and/or a feeling that they have control over life are likely to have a normal grief reaction even after an unexpected loss.
Bereaved people with low self-esteem and/or a sense that life cannot be controlled are more likely to have complicated grief after an unexpected loss.
This includes more depression and physical problems.
The personality of the bereaved.
Studies have found that people with certain personality traits are more likely to have long-lasting depression after a loss.
These include people who are very dependent on the loved one (such as a spouse), and people who deal with distress by thinking about it all the time.
The religious beliefs of the bereaved.
Some studies have shown that religion helps people cope better with grief. Other studies have shown it does not help or causes more distress.
Religion seems to help people who go to church often. The positive effect on grief may be because church-goers have more social support.
Whether the bereaved is male or female.
In general, men have more problems than women do after a spouse’s death. Men tend to have worse depression and more health problems than women do after the loss.
Some researchers think this may be because men have less social support after a loss.
The age of the bereaved.
In general, younger bereaved people have more problems after a loss than older bereaved people do. They have more severe health problems, grief symptoms, and other mental and physical symptoms.
Younger bereaved people, however, may recover more quickly than older bereaved people do, because they have more resources and social support.
The amount of social support the bereaved has.
Lack of social support increases the chance of having problems coping with a loss. Social support includes the person’s family, friends, neighbors, and community members who can give psychological, physical, and financial help.
After the death of a close family member, many people have a number of related losses. The death of a spouse, for example, may cause a loss of income and changes in lifestyle and day-to-day living. These are all related to social support.
Normal grief may not need to be treated.
Most bereaved people work through grief and recover within the first 6 months to 2 years. Researchers are studying whether bereaved people experiencing normal grief would be helped by formal treatment.
They are also studying whether treatment might prevent complicated grief in people who are likely to have it.
For people who have serious grief reactions or symptoms of distress, treatment may be helpful.
Complicated grief may be treated with different types of psychotherapy (talk therapy).
Researchers are studying the treatment of mental, emotional, social, and behavioral symptoms of grief. Treatment methods include discussion, listening, and counseling.
Complicated grief treatment (CGT) is a type of grief therapy that was helpful in a clinical trial.
Complicated grief treatment (CGT) has three phases:
- The first phase includes talking about the loss and setting goals toward recovery. The bereaved are taught to work on these two things.
- The second phase includes coping with the loss by retelling the story of the death. This helps bereaved people who try not to think about their loss.
- The last phase looks at progress that has been made toward recovery and helps the bereaved make future plans. The bereaved’s feelings about ending the sessions are also discussed.
In a clinical trial of patients with complicated grief, CGT was compared to interpersonal psychotherapy (IPT). IPT is a type of psychotherapy that focuses on the person’s relationships with others and is helpful in treating depression.
In patients with complicated grief, the CGT was more helpful than IPT.
Cognitive behavioral therapy (CBT) for complicated grief was helpful in a clinical trial.
Cognitive behavioral therapy (CBT) works with the way a person’s thoughts and behaviors are connected. CBT helps the patient learn skills that change attitudes and behaviors by replacing negative thoughts and changing the rewards of certain behaviors.
A clinical trial compared CBT to counseling for complicated grief.
Results showed that patients treated with CBT had more improvement in symptoms and general mental distress than those in the counseling group.
Depression related to grief is sometimes treated with drugs.
There is no standard drug therapy for depression that occurs with grief. Some health care professionals think depression is a normal part of grief and doesn’t need to be treated.
Whether to treat grief-related depression with drugs is up to the patient and the health care professional to decide.
Clinical trials of antidepressants for depression related to grief have found that the drugs can help relieve depression.
However, they give less relief and take longer to work than they do when used for depression that is not related to grief.
Phases of grief
The process of bereavement may be described as having 4 phases:
- Shock and numbness: Family members find it difficult to believe the death; they feel stunned and numb.
- Yearning and searching: Survivors experience separation anxiety and cannot accept the reality of the loss. They try to find and bring back the lost person and feel ongoing frustration and disappointment when this is not possible.
- Disorganization and despair: Family members feel depressed and find it difficult to plan for the future. They are easily distracted and have difficulty concentrating and focusing.
Treatment for grief
Most of the support that people receive after a loss comes from friends and family. Doctors and nurses may also be a source of support.
For people who experience difficulty in coping with their loss, grief counseling or grief therapy may be necessary.
Grief counseling helps mourners with normal grief reactions work through the tasks of grieving. Grief counseling can be provided by professionally trained people, or in self-help groups where bereaved people help other bereaved people. All of these services may be available in individual or group settings.
Complicated grief reactions require more complex therapies than uncomplicated grief reactions.
Adjustment disorders (especially depressed and anxious mood or disturbed emotions and behavior), major depression, substance abuse, and even post-traumatic stress disorder are some of the common problems of complicated bereavement.
Complicated grief is identified by the extended length of time of the symptoms, the interference caused by the symptoms, or by the intensity of the symptoms (for example, intense suicidal thoughts or acts).
Complicated or unresolved grief may appear as a complete absence of grief and mourning, an ongoing inability to experience normal grief reactions, delayed grief, conflicted grief, or chronic grief.
Factors that contribute to the chance that one may experience complicated grief include the suddenness of the death, the gender of the person in mourning, and the relationship to the deceased (for example, an intense, extremely close, or very contradictory relationship).
Grief reactions that turn into major depression should be treated with both drug and psychological therapy.
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 post-traumatic stress disorder.
Substance abuse may occur, frequently in an attempt to avoid painful feelings about the loss and symptoms (such as sleeplessness), and can also be treated with drugs and psychological therapy.
Culture and response to grief and mourning
Grief felt for the loss of a loved one, the loss of a treasured possession, or a loss associated with an important life change, occurs across all ages and cultures.
However, the role that cultural heritage plays in an individual’s experience of grief and mourning is not well understood.
Attitudes, beliefs, and practices regarding death must be described according to myths and mysteries surrounding death within different cultures.
Individual, personal experiences of grief are similar in different cultures. This is true even though different cultures have different mourning ceremonies, traditions, and behaviors to express grief.
Helping families cope with the death of a loved one includes showing respect for the family’s cultural heritage and encouraging them to decide how to honor the death.