Module 13 : Loss and Grief

• Losses are encountered daily by each of us.
• The experience of loss must be defined broadly and with a clear understanding of the personal pain and disruption that can accompany it.
• Losses can be minor or major. The designation of “minor” or “major” depends upon the perception of the loss by the person experiencing the loss.

The impact of loss depends upon the value the person placed on what was lost.

• Death.
• Loss of a body part.
• Changes in physical health.

Intangible (perceived or psychological) losses are less obvious:

• May be tied to personal perceptions such as one’s prestige, power, dreams, plans, security, etc.
• Because these losses are less likely to be acknowledged, admitting to the accompanying feelings of loss can be difficult or embarrassing.
• Consequently, emotional support may be inadequate.

• Loss leads to mourning – the period of time during which the grief is expressed, and resolution and integration of the loss occurs.
• Bereavement is the period of grief following the death of a loved one.

Grief is a natural process, an intense fundamental emotion, a universal experience which makes us human. It is a process that entails extremely hard work over a period of many painful months or years. People grieve because they are deprived of a loved one; the sense of loss is profound. The loss of a spouse, child or parent affects our very identities–the way we define ourselves as a husband, wife, parent or offspring. Moreover, grief can arise from the survivor`s sudden change in circumstances after a death and the fear of not knowing what lies ahead.

The death of someone close can be a life-changing experience. If you are the primary caregiver of someone you love, this experience can affect every aspect of your life for some time. It is natural to grieve the death of a loved one before, during and after the actual time of their passing. The process of accepting the unacceptable is what grieving is all about.

Everyone experiences grief as an individual and the impact of grief depends upon the individual`s past experiences with loss, their culture, their coping skills, belief system, faith and life experiences.

Experts try to list “the stages of grief,” or “the tasks of mourning,” so we can better understand the process. But there is no real order to the grieving process. Like clusters of reactions or fluid phases that overlap one another, grief does not proceed in an orderly fashion any more than life itself does.

Immediate response following the death is probably shock, numbness, and a sense of disbelief. Many may feel like they`re wrapped in a cocoon or blanket. From the outside, we may look to others as if we`re holding up well. In fact, the reality of the death has not yet penetrated our awareness, giving the appearance that we are quite accepting of our loss.

In the months after the funeral, however, this numbness turns to intense feelings of separation, pain, and yearning. Psychiatrist Beverly Raphael describes the phase in this way:

“The absence of the dead person is everywhere palpable. The home and familiar environs seem full of painful reminders. Grief breaks over the bereaved in waves of distress. There is intense yearning, pining, and longing for the one who has died. The bereaved feels empty inside, as though torn apart or as if the dead person had been torn out of her body.”

We may have dreams in which our loved one is still alive. We may think we see her on the street or hear his footsteps in the hall.

When the realization that they will not return hits, despair may set in. Many feel extremely depressed, have trouble concentrating, and act very disorganized and forgetful. Strong feelings of guilt may plague your every waking hour. You may find it impossible not to act irritable, anxious, or restless.

Raphael notes:
“All of these feelings, as they swing dramatically from one pole to the other, can make you feel like two, even three or four, different people. At one moment you may want to avoid all reminders of the spouse who died; at the next moment, you may want to sit down with a family album and spend the whole day with your memories.”
But this is as it should be. We are learning to live with the reality of our loss.

Grief process theories

Experts try to list “the stages of grief,” or “the tasks of mourning,” so we can better understand the process. But there is no real order to the grieving process. Like clusters of reactions or fluid phases that overlap one another, grief does not proceed in an orderly fashion any more than life itself does.

Immediate response following the death is probably shock, numbness, and a sense of disbelief. Many may feel like they`re wrapped in a cocoon or blanket. From the outside, we may look to others as if we`re holding up well. In fact, the reality of the death has not yet penetrated our awareness, giving the appearance that we are quite accepting of our loss.

In the months after the funeral, however, this numbness turns to intense feelings of separation, pain, and yearning. Psychiatrist Beverly Raphael describes the phase in this way:

“The absence of the dead person is everywhere palpable. The home and familiar environs seem full of painful reminders. Grief breaks over the bereaved in waves of distress. There is intense yearning, pining, and longing for the one who has died. The bereaved feels empty inside, as though torn apart or as if the dead person had been torn out of her body.”

We may have dreams in which our loved one is still alive. We may think we see her on the street or hear his footsteps in the hall.

When the realization that they will not return hits, despair may set in. Many feel extremely depressed, have trouble concentrating, and act very disorganized and forgetful. Strong feelings of guilt may plague your every waking hour. You may find it impossible not to act irritable, anxious, or restless.

Raphael notes:
“All of these feelings, as they swing dramatically from one pole to the other, can make you feel like two, even three or four, different people. At one moment you may want to avoid all reminders of the spouse who died; at the next moment, you may want to sit down with a family album and spend the whole day with your memories.”
But this is as it should be. We are learning to live with the reality of our loss.

Personal Adjustments
For weeks after a death, most caring families and friends do all that they can to comfort us, making life as comfortable as possible. Many times, we are still in shock, accepting this support in a daze. Gradually, those around us return to their normal lives, but we do not. The reality of the situation may lead you to think “I am alone,” but you are not. Others who have felt what you are feeling now stand ready to help. Many people find it helpful to join a support group.

Anticipating the loss that it is coming and feeling helpless to do anything to change the inevitable can be just as painful as the post-death grieving period. Anticipatory grief can provoke a wide range of intense and often conflicting feelings. It is not unusual for those who are close to the afflicted person to experience guilt or shame for wishing it were finally over, or feeling as though their loved one is already a memory instead of a still-living presence. They may agonize over what they should or shouldn`t do regarding medical interventions, such as those that maintain life through artificial means, and wish for a quick and final resolution that will relieve them of the painful burden of such important decision making.

Other commonly experienced reactions include hopefulness quickly countered by hopelessness, rage, denial, extreme anxiety, and deep depression. It is important to recognize that these are all normal and quite understandable reactions and that ultimately all feelings associated with anticipatory grief are the result of attempting to emotionally prepare for the inevitable.

In fact, the process of accepting the inevitable is what grieving is all about. The impending death of someone close can be a life-changing experiencing that impacts all aspects of your being. Throughout the time of anticipatory grief, it is crucial to seek and accept as much caring support as possible. For many, help from a professional therapist during this difficult period can prove tremendously beneficial in preparing emotionally for the loved one`s death and using the interim time to contemplate and clear unresolved issues.

These include:

• The person cannot speak of the deceased without experiencing intense and fresh grief.  Different from bursts of grief,  if an individual experiences renewal of fresh grief each time he discusses the deceased this can indicate complicated grief.
• Sometimes a relatively minor event triggers an intense grief reaction. An example of this can be seen when one may overreact to passing a car accident.
• The person who has sustained the loss is unwilling to move material possessions belonging to the deceased.
• The person who has sustained the loss develops the symptoms like those the deceased experienced before death. Several years ago I had to counsel a young man who had lost his mother to leukemia.  He was convinced he had the disease even after test were negative.
• The person withdrawals from friends and family or makes a radical change in their lifestyle.
• The person has a compulsion to imitate the dead person, particularly if he or she had no conscious desire nor competence for the same behavior.
• The individual behaves in reckless or self-destructive ways.  Substance abuse, driving too fast, drinking too much, etc.
• The person develops a phobia about illness or death.
• The individual who avoids any reminder of the deceased.

Complicated grief may come as a result of the inability to express grief or unresolved grief from an earlier death of a loved one.

Loss is an inescapable part of the human experience. None of us will get through life without having multiple losses. Many will be minor and some will be profound. The impact of each will vary according to how significant it is to us, but all will carry a degree of grief.

Remember that coming to terms with loss is a very personal and private journey, but it is not one that should be traveled alone. Just as we need strength from inside, we need support from outside.

For further information on helping your self or others cope with loss and grief, see:

• Ways To Help Yourself Heal From Loss.When someone we love dies, it is natural to feel shattered; that what remains of our lives is empty and in pieces. People do recover from the pain of loss, however, and again the joy of living. Here are 18 simple suggestions for helping yourself heal from loss.

1.Recognize what is happening.“Recognize that your inner world is a `construction zone` and slow down in the work zone,” writes Rev. Richard Gilbert in his book Finding Your Way After Your Parent Dies. “Recognize when you need to reach out to others and take that risk. Recognize that you may have to reach beyond yourself and the familiar surroundings of your story to get the help you need. Therapy, counseling, medical care, spiritual direction: these are gifts that can move you along on your journey to freedom from the scars that control you.”

2.Expect highs and lows.The path through grief is never a straight line. It is more like a zigzag. Inevitably, grievers take two steps forward and one step backward. Be patient with yourself when you are in the setback mode. It is a temporary condition.

3.Pamper yourself. From time to time, inject something pleasant into your life. This need not be expensive. A woman shares this experience: “One day while my life felt completely miserable, I was in the grocery store picking up some items when I saw a new shipment of freshly arranged flowers on sale. Impulsively, I purchased one of the smaller bouquets. For less than ten dollars, I had a beautiful arrangement of colorful flowers gently gracing my kitchen. They lasted nearly two weeks and every time I went through that room, my spirits were refreshed and I was reminded that there was still ample beauty in this world.” Follow that women`s lead. Be good to yourself from time to time. Buy the new book you have wanted to read, soak in the tub for an hour, or go for a leisurely stroll through the woods.

4.Have a beginner`s mind. Be open to new lessons that you can glean from your painful experience. Every event in our lives has the seed of something new and good in it if we are open to receiving it. The converse view is to decide that there is nothing in the experience but a negative. That attitude is limiting and crippling. Remain open.

5.Keep a journal.Writing out thoughts and feelings is an effective way of observing what is happening. Methodically writing out insights about the issue and reflecting on them can empower you to gain insights, recognize fresh opportunities and move in new directions.

6.Practice the virtue of endurance.Do not hide, shirk or flee from the pain. Allow yourself to experience all aspects of it, but practice the virtue of endurance. Endure what cannot be changed. Live by the reality that you will grow stronger and be better because of the experience.

7.Establish goals for yourself.A major loss can leave you with the feeling that your life is completely out of control. This, of course, is not true, but it is important to counteract that feeling by establishing goals for yourself. Consider volunteering your time, learning a new skill, enrolling in a course, or joining a civic or religious organization.

8.Find those persons with whom you are comfortable.“Find those persons in whose presence you feel more energetic, more creative and more able to pursue your life goals,” writes Dennis F. Augustine in his book Invisible Means of Support. “Stay away from persons who make you feel apprehensive, or who influence you to doubt yourself. Especially, stay away from those persons who drain you, so that your energy is all used up in trying to maintain the relationship.”

9.Take action.Fabiola Scholnick of McHenry, Illinois, recently discovered that action can help overcome some of the feelings of loss. In October 1999, her two sons died in an automobile accident. Jeremy was 17 and his brother, Jonathan, was 14. Throughout her grieving, Mrs. Scholnick derived some comfort from the memories of her sons` habit of helping the homeless.

After two years of grieving. Mrs. Scholnick decided to spend the month of October helping the people her sons once helped. Working with 22 volunteers, including 14 teens, she raised $1,400 and collected more than 40 boxes of food and toiletries, all of which went to an agency serving McHenry County`s estimated 1,000 homeless. At the time, unemployment was increasing, demand for services was rising, and donations were at an all-time low. “We were just about empty when those bags and boxes came in,” recalls an agency worker. “It was a miracle.” For her efforts, Mrs. Scholnick discovered that in helping others she also helped herself. “I never thought I could smile on this day,” she says, referring to the October date when her sons died.

10. Look after your body.Dealing with the pain of loss is emotionally demanding and exhausting. “We want to sleep, but insomnia takes over. We cook big meals, but have no appetite. We tell ourselves that we really want to get to that yard work, mending, or spring cleaning, but we cannot find the energy or desire to get started,” observes Richard Gilbert. He offers these suggestions for taking care of your body during a time of loss:

– Watch what you eat. Be sure to eat.
– Drink plenty of fluids (but not the addictive kind).
– Get some exercise.
– Do something fun.
– Remember your spiritual connections.
– Take “time outs” from all of this.
– Watch your physical health. Respect symptoms.
– Seek help when you need it.
– If sleep is a problem (too much or too little), talk to someone about it.
– Overall, make it a priority to do what you need to do to stay healthy.

11.Share with others what helps and what does not.Most people want to be helpful, but many do not know how to do it. Because the people around you might not understand what you need, you might have to guide them. If you need to talk about your loss, say so. On the other hand, if you need more time alone, be honest. Remember that people cannot read your mind.

12.Get Physical.Get regular exercise four or five times per week for at least 30 minutes at a time. Find an activity you enjoy that will cause you to flex your muscles, stretch your body, and expand your lungs. You will improve both physically and emotionally.

13.Tap into healing resources. We are fortunate to live in a culture in which healing from pain is valued and promoted in many ways. Look around and identify healing resources you can use. Healing can come to you via books, cassettes, videos, groups, friends, counselors, doctors, clergy, medications, churches, synagogues, temples and surprise helpers.

14.Create meaning and purpose out of the loss.Those who recover most heartily from losses are those who work hardest to create meaning and purpose out of the loss. Consider the example of one woman whose son died in a vehicular accident. “The death of my son was the catalyst that sent me back to school,” she says. Within a five-year period, she completed an undergraduate degree and will soon finish a master`s program in counseling. “My son`s death will not have been in vain. Because of the hardships endured, the pain, suffering, loss and everything else wrapped up in the package of death, I have made it my mission to go out into the world and help those who are going through what I have been through,” she explains.

15.Engage your soul.Most people feel that life`s losses have a spiritual component and opportunity in them. Some do this through prayer, others through meditation and yet others spend time alone with nature. Find your own unique way to engage your soul. Engage your soul as you grow out of your suffering.

16.Never give up.Consider the experience and wisdom of 86-year-old Jerzy Kuszakiewicz. Although in his eighties, he continues to run marathons at record-breaking paces. He recently annihilated the record for his age group by 21 minutes at a marathon race in Austin, Texas, by completing the 26-mile course in four hours and 40 minutes.

“As a runner, one of the most important lessons I`ve learned is the power of perseverance and positive thinking,” he says. “I`ve learned firsthand the importance of not giving up no matter what. Every challenge brings an opportunity for self-improvement, regardless of age.”

17.Expect good to come out of the bad.Those who have suffered inevitably testify to the fact that much good came from their time of travail. “A deep distress has humanized my soul,” observed poet William Wordsworth. “No one truly knows happiness who has not suffered,” noted writer Henri Frederic Amiel.

Victor M. Parachin, Tulsa, OK, is an NFDA grief educator and author of the new book, Healing Grief.

• Tips for helping others cope with loss and grief.
  

  “The true test of intelligence is not how much we know how to do, but how we behave when we don`t know what to do.”

  Offer practical day-to-day help, such as helping with chores or errands. Rather than just asking if there is anything you can do, offer to do things you know need to be done. This eliminates the tendency to avoid asking for help for fear of imposing.

• Offer specific ways that you can assist your friend. Say “I am going to the drug store. Can I pick something up for you?” Look around her home and see where help may be needed. Does the shower need scrubbed? The leaves raked? The carpet shampooed. Offer to take care of these things.
• Volunteer to pick up some groceries rather than do the cooking. Many times people with illnesses have restrictive diets, so they may prefer some fresh fruits and vegetables than a casserole. Ask what meals he is eating and then freeze some of these for him to have on hand.
• Accompany him/her to places where he/she may need some assistance. Get your haircut at the same time, or have the oil changed in his/her car while you are eating lunch.

7 Simple Soothers to Lift Your Spirits.Some days we just need a little help. (…some days we need a lot!) Coping with the stress and sadness of loss, or divorce, relocation, down-sizing, long-term illness or any number of other all-too-human experiences, can challenge the bright spirit of even the most self-aware among us.Whoever you are…and wherever you sit, reading this article, perhaps something here will bring you comfort, or even remind you of what you already know, but have forgotten.

Try these “Simple Soothers” to find the ones that feel just right for you!Stuck in a Rut? Shift Gears!Take a brisk walk, varying your route and find 6 things that make you laugh along the way. Try Tai Chi, Reflexology, Reiki, or prepare an exotic new recipe. Get a free makeover in a department store. Rent a movie you`d NEVER pick. Buy a pet. Plan a trip. Tense day? Shake it up! Pop in some oldies and sing–really loud!Overwhelmed? Start Small…Make a “To Do” list of no more than 5 tasks. Keep goals small and manageable. House a mess? Piles to file?1) Ask for help.

2) Organize just ONE drawer.

3) Work 30 minutes on/30 off.

4) Pay 3 bills at a time. (Or pay weekly — avoid that “monthly mountain.”)

5) List your day`s successes…enjoy a healthy reward for your efforts!

Overworked? Re-Balance Your Day

• Take a lunch break every single day. Go for a walk. Feed the ducks. (Ducks need lunch too!)
• Organize your desk. (..okay, file just one pile.) External clutter can really increase internal stress.
• Take a mini-break every hour–No excuses.
• Keep water handy. Dehydration stresses the whole system.
• Write in your journal for 10 minutes.(OK. 4.)
• End your day with a steaming shower and one quiet “No-TV” evening.

Looking for the Secret to Happiness? (Hint: It`s in the Little Things)

• Pick out 3 cards. Send to 3 people for no particular occasion.
• Tell someone they`ve done a GREAT job!
• Smile at strangers. (Keep trying. SOMEbody`ll smile back.)
• Make up with someone you`re angry at. If forgiveness is in order, find some. Life is too short to waste much of it feeling angry…

Spirits Need a Lift? Make a “Thrills” List!

Get yourself a beautiful journal, a special pen and start a “Thrills” List– from shooting stars to simple pleasures. List every thrill you`ve EVER had (…or hope to!) The clearer we are about our desires and intentions for this life, the sooner we can take small steps that might just bring them closer. Update weekly and create a couple of new thrills!

Not Having Enough Fun? Take Time for “Recreation”

At the end of the day, most find, “Attend to personal well-being” somewhere at the bottom of the list. Set aside times each week to “re-create.” Do something utterly engaging that makes you feel real and alive and whole (and NOT “professional.”) Take Tai Chi, Yoga or dance classes. Play bridge, listen to music…make some! Stumped? Ask friends what THEY do for fun.

Okay..I Know This One Sounds Goofy..but Try it!

1) Stand.

2) Look up at the ceiling.

3) Extend both arms behind you, inhale, lift and

open your chest, arching your back (Gently!) as you keep looking up.

4) Breathe normally now. Did your mood lift? (This is the exact opposite of the typical round-shouldered slouch of sadness. Just a little oddity, but I have seen it work hundreds of times!

(Now if we could just stay that way…)

101 Reasons To Be Glad You’re Alive.

1.The birth of a child.

2.The warmth of the sun.

3.Seeing a rainbow in the sky.

4.Your wedding day.

5.Talking with your best friend.

6.Graduation day.

7.Being hired for your first job.

8.Getting your first paycheck.

9.Driving for the first time.

10.Flowers appearing in the spring.

11.A warm spring rain.

12.Baby’s first steps.

13.Baby’s first words.

14.Holding hands with someone you love.

15.Sharing.

16.Caring for someone who is sick.

17.Being able to lend a helping hand.

18.Seeing your daughter’s first dance recital.

19.Cheering for your sons at their baseball games.

20.Holding your grandchild.

21.A smile.

22.A kind word.

23.A cool breeze through your hair on a warm summer day.

24.Giving a present for no special reason.

25.Saying I love you.

26.A hug.

27.A good movie.

28.The stars on a clear night.

29.A favorite pet.

30.The wonderment in a child’s eyes.

31.The laughter of friends.

32.The sound of an old friend’s voice over the phone.

33.A winter snowfall.

34.The beauty of trees in the fall.

35.Children and parents spending time together.

36.Watching our children open gifts Christmas morning.

37.The sound of birds chirping in the morning.

38.The beauty of a butterfly.

39.The sight of a bright, full moon.

40.A good book.

41.A clear blue sky.

42.A good night’s sleep.

43.A good cup of coffee in the morning.

44.Dancing.

45.Hearing a favorite old song on the radio.

46.A high school reunion.

47.A Thank You.

48.Just being.

49.Communing with God.

50.Learning something new.

51.Watching your child grow into an adult.

52.The smell of freshly cut grass.

53.A family outing.

54.A hike in the woods.

55.Feeding the ducks on the pond.

56.Taking a day just to do nothing.

57.A sunset.

58.Looking through old photo albums.

59.A walk on the beach.

60.Summer vacation.

61.A hot bath.

62.A waterfall.

63.A canoe trip across the lake.

64.An amusement park.

65.Dinner by candlelight.

66.Valentine’s Day.

67.Coming home after a long, hard day.

68.A walk in the park with someone you love.

69.The work of an artist.

70.A tour of a museum.

71.A child’s finger painting.

72.A letter from a friend.

73.Hot cocoa and a warm blanket on a cold winter night.

74.Rocking an infant to sleep.

75.Pushing a child on a swing in the park.

76.Feeding the pigeons.

77.Relaxing.

78.Sun bathing.

79.Helping someone in need.

80.A bird in flight.

81.The smell of freshly baked bread.

82.Tears of happiness.

83.People working together.

84.Charting new territory.

85.Caring for extended families.

86.Poetry.

87.A vase full of roses.

88.The waves of the ocean.

89.A child’s conversation with an imaginary friend.

90.The stillness of the night.

91.The view of snow capped mountain peaks.

92.The end of an old year, and the beginning of a new year.

93.Shopping for someone you love.

94.Balloons.

95.Gazing at the shapes that clouds form as they move across the sky.

96.Riding a bike.

97.A field of daisies.

98.A parade.

99.A shooting star.

100.A Christmas tree.

101.Ice cream.

• These are just a few of the many wonderful reasons for living. I’m sure you can think of many more that have a personal meaning for you. Keep them in mind and you’ll have a better day everyday.
• Reproduced from:  http://pages.ivillage.com/celia721/thewriteway
• Things to say.When someone we care about is suffering, our first response is often  to try to stop their pain… Although this isn`t possible, words of comfort can be very helpful.Knowing what to say isn`t always easy. Below are a few suggestions:
• “I care.”
• “I`m here for you.”
• “I love you (if you mean it).”
• “I can`t imagine what it`s like for you.
  I just can`t imagine how hard this must be.”
• “I can`t really fully understand what you are feeling, but I can offer my support.”
• “You are important to me.”
• Be honest. Say “I wish I knew the right thing to say, but I care and I am here if you need me.”
• Ask him/her if she’d like you to pray for her and ask what she wants you to pray about. Respect her request. Don’t pray for healing if she wants prayer for new medications.
• Don’t assume that he/she copes with things the same way you do. Let him/ her cope in his/her own way and don’t tell her he/ she is coping in the “wrong” way.
• Let him/ her know you are thinking about him/ her . A card or a phone call can make the difference.
• Say Nothing – Sometimes just listening is the best thing to do!
• “God has a plan for everything.”
• “It was for the best.”
• “God needed him/her more.”
• “So what have you been doing now that you have the house to yourself?”
• “Go back to work (take up a hobby), it will distract you.”
• “At least he/she had no pain.”
• “You seem to be taking this well.”
• “At least your children are all grown.”
• “I know what you`re going through.”
• “Get over it.”
• “It must be such a relief.”
• “Now you can make a fresh start.”
• “I know exactly how you feel.”
• “Did she make her peace with God before she died?”
• “It could be worse, at least _____ …”
• “You`ll feel better soon.”
• “You can`t just mope around…. Cheer up.”
• “You just need to get out more.”
• “When are you going to get rid of that cane?” or “Did you know illness is caused by stress?”
• “A little walk might do you some good”
• “God will heal you (him, her).”
• “All things work together…”Things not to say.

• Words of care and support when a person is grieving can be comforting and appreciated. However we often unintentionally say things that are more hurtful than helpful when attempting to console those who are grieving.
• Below are examples of things well intentioned people say which can be unkind:
• Remembering/honoring the lost.From photo collages at a memorial service to planting a tree, there are many ways we can say, “I remember and loved this person.”As you consider how you might want to remember a loved one, here are some ideas to start with. Consider:
  • Lighting a candle in his/her memory.
  • Creating a memory book of photos of your loved one.
  • Donating a gift of money or time to those less fortunate.
  • Wearing a photo pin of your loved one.
  • Starting a memorial scholarship fund in his/her name.
  • Writing a poem or story about him/her.
  • Visiting a place you both liked to visit.
  • Hanging a special ornament on the tree in his/her memory.
  • Playing his/her favorite music.
  • Making a quilt from his favorite clothes.
  • Sharing memories of his/her with friends and family.
  • Providing memorial flowers for his/her at your church or synagogue.
  • Creating a memory box of items that were special.
  • Honoring his/her favorite tradition.
  • Creating a new tradition in your memory.
  • Hanging a stocking filled with loving memories of him/her.
  • Gathering your family and friends together in celebration of him/her.
  • Reading aloud your favorite story.

• Erich Lindemann published Mourning and Melancholia in 1944, a pioneering research describing grief.
• He described acute grief as a syndrome of psychological and somatic responses that he believed were normal after a distressing event.
• He proposed that appropriate interventions for ‘grief work’ could assist in resolving the grief.
• His work is the single most influential work on the topic of grief symptoms.

George Engel

• Dr. George Engel presented a model of grief in 1964.
• He compared the mental trauma of grief to the physical trauma sustained with injuries.
• He proposed that bereavement could be tracked to a successful resolution through a series of stages just as physical healing follows a series of stages.

Elisabeth Kubler-Ross

• Dr. Elisabeth Kubler-Ross became internationally known in 1969 for her book Death and Dying.
• From interviewing dying clients she outlined five phases of the person facing death:
• Denial– The person thinks “This isn`t really happening” or “No, this can`t be.” In this stage, the person will think thoughts that will help them deny the experience. They will lie about the situation and tell themselves that this is just temporary and everything will be back to normal soon. It is often used as an attempt to cushion the impact of the source of grief.
• Anger – The person thinks “Why me” or “How dare this happen to me.” The person feels generalized rage at the world for allowing something like this to happen. They will feel isolated and furious that this is happening to them. They will think it`s unfair and may feel betrayed. Outbursts of anger in unrelated situations can occur.
• Bargaining – The person thinks “If I do this, I can make it better, I can fix things.” One may feel guilt and feel it is their responsibility to fix the problems. They make an attempt to strike bargains with God, spouses, or parents.
• Depression – The person thinks “My heart feels broken” or “This loss is really going to happen and it`s really sad.” At this stage, the person is absorbed in the intense pain they feel from having their world come apart. They can be overwhelmed with feelings of helplessness and sadness.
• Acceptance – The person thinks “This did occur, but I have great memories” or “It is sad but I have so much to live for and so many to love.” The loss is accepted and we work on alternatives to coping with the loss and to minimize the loss.

• Suggesting physical exam
• Encouraging discussion about deceased. This can include their relationship with bereaved, their feelings about the death, etc.
• Suggest bereavement counseling.

For grief to be resolved an individual must:

• Accept the death of the deceased.
• Accept and express their own feelings-These can include anger, feelings of abandonment, becoming emotionally child-like and feeling confused over own emotions.
• Re-establish relationships with others – It helps to remind the bereaved that the relationship with the deceased cannot be substituted but other relationships may help fill the void.  Pets can be something that helps to re-establish relationships.
• Develop a health image of oneself and the world.  This can be assisted by actively engage in living and accepting its ups and downs.

About understanding the causes of maladaptive grief:

Sometimes it is complicated to understand individuals who fail to express grief.  It is important to realize that some individuals grieve in their own time or in private.  However there are factors in an individual`s life that can restrict their grieving and lead to complicate mourning.  These include:

• Relationship factors -” The most frequent  type of relationship that hinders people from adequately grieving is the highly ambivalent one.”   (William Worden, 1986) If the bereaved had a uneasy relationship with a parent or a sibling, they may be very confused about their emotions.  If the bereaved was highly dependent on the deceased they may also have difficulty expressing grief.
• Circumstance factors – If the loss was uncertain as in a missing person or a result of a multiple loss such in an accident or force of nature, the bereaved may have a difficult time sorting out their grief.  Also the care of a survivor may also hinder the grief of the bereaved.
• Historical factors – If the bereaved had maladaptive or complicated grief reactions in the past they may be more prone to difficulty expressing grief.  William Worden states the early parent loss can result in difficulty for the child in later years in grief.
• Personality factors – Individuals who do not tolerate dependency well will have problems grieving.  Individuals who see themselves as the strong one in the family often have this difficulty.
• Social factors – If the loss is socially unspeakable (suicide), or if the loss is negated (often seen in some individuals reaction to miscarriage) or if their is a lack of social support, the bereaved will have difficulty grieving completely.