Grief & Bereavement
Following the death of a loved one, most people experience bereavement, a feeling of desolation or loss, grief, and deep mental anguish. This is more than a purely emotional experience; however, extreme experiences of grief can become life-threatening. Although there are a number of widely reported reactions to the loss of a loved one among individuals and cultures alike, not everyone experiences the same stages or the same order. Eventually, most people come to a point of resolution and the willingness to go on with their lives without the other person. Working through the grieving process is neither a short-term activity nor one that can be rushed. However, if complicated grief is suspected, it is important that the individual receive professional help.
Keywords Bereavement; Complicated Grief; Culture; Dejection; Demographic Data; Depression; Grief; Mourning; Pangs of Grief; Panic; Resolution; Shock; Subject
Everyone experiences a period of bereavement a some point during their lives following the death of a friend or loved one. Bereavement may be marked by grief; a deep mental anguish whose symptoms may include physiological distress, separation anxiety, confusion, yearning, obsessive dwelling on the past, and apprehension about the future. Although grief may seem like a purely emotional or psychological response to bereavement, extreme experiences of grief can become life-threatening not only if the grieving person neglects him/herself or has suicidal ideation, but also because the immune system may become disrupted during the grieving process. Whether or not grief is expressed publicly, the bereaved person typically goes through a period of mourning during which s/he may experience feelings of apathy and dejection, loss of interest in the outside world, and decreased activity and initiative. Although these symptoms are similar to those of depression, mourning and clinical depression are not the same. Symptoms of mourning are of shorter duration than those of clinical depression, and are not considered pathological. Grief is considered to be a normal and natural reaction to the death of a close friend or loved one.
Five Stages of Death
Based on her work with terminal patients, Kübler-Ross has identified a general pattern of five reactions to impending death:
Frequently, people who have been given a terminal diagnosis first go through a stage of denial and isolation in which they question their prognosis and then attempt to avoid reminders of the situation. Many people also become angry and rail against their fate and may direct their rage toward the living including family, friends, and caregivers. Another common reaction to a terminal diagnosis is bargaining with God (or fate) and promising to mend their ways in exchange for a few more years. Many people may also become depressed, particularly as they realize that their death is inevitable and will come in the foreseeable future. In the end, however, many people are able to resolve the issues surrounding their death and come to terms with their mortality, accepting it with peace and dignity.
Kübler-Ross has noted that people who have lost a loved one similarly go through these stages. Because of the individuality of the grieving process and the fact that the reaction of each person is not necessarily the same, there is some disagreement in the literature as to where to draw the lines between the stages of the grieving process as well as what they should be called. The manner in which grief is experienced may depend on a number of factors including the personality of the bereaved and how that person typically deals with stressful situations, the relationship of the person to the one who has died, whether the loss was sudden or lingering, whether or not the death was painful, or whether or not the person had unresolved issues with the one who died.
Stages of Bereavement
Despite the individuality of the grieving process, most theorists do recognize a variety of reactions that are commonly experienced in bereavement. Initially, many people go through a state of denial in which they cannot seem to believe that the person is gone or shock in which they appear dazed, numb, or show little emotion. Emotional shock may last anywhere from a few minutes or hours to a few days. (However, if the period of shock lasts for weeks, it is best to seek professional help.) During this time, most people find it very difficult to accept the reality of their loss. For most people, however, emotional release eventually comes as the person realizes that the loved one is gone for good. The end of shock usually comes about the time of the funeral, which often can be a catalyst for the release of unexpressed tears and emotion. This may be accompanied by acute pangs of grief in which the person experiences an intense and anguished yearning for the person who has died. During this time, one may continue to feel as if the deceased is still alive, thinking that one hears the other person's voice, sees him/her out of the corner of one's eye, or have vivid dreams about the person. Such feelings are often accompanied by tears and other outward expressions of their distress. The grieving person may experience alternating episodes of agitated distress and silent despair during this time. Many people also feel apathetic, dejected, depressed, or lonely as they grieve, particularly if the loved one played a significant part in their lives. This is a time when the support of nonjudgmental friends and family can be particularly important. Some people may also experience psychosomatic symptoms of distress or episodes of panic in response to the death of a loved one and are unable to think of how they can go on with their lives without the other person. If there were unresolved issues between the deceased and the person in mourning, the latter may also experience feelings of guilt over things that were said and done or left unsaid or undone. As the person overcomes the natural depressive reaction to the death of the loved one, s/he may also experience anger or resentment, whether at the loved one for dying and leaving the person to go on without him/her or at God, fate, or someone else for having taken the loved one away.
Eventually, the grieving person will come to the realization (either on his/her own or with the help of a counselor or support group) that life must continue to be lived. During this phase of resolution, the person comes to an acceptance of the loss of a loved one and the recognition of the need to build a new life without that person. At first, however, many people are resistant to picking up their lives again. But gradually, hope typically breaks through and they struggle to move on and live without their loved one. Resolution occurs gradually, as the bereaved person slowly learns to accept that the other person is out of his/her life forever. The person may continue to experience pangs of grief during this period, but they become increasingly less frequent. Although for many people it takes approximately a year to reach the point of resolution, it is not uncommon for it to take two or three years. Mourning at a low level of intensity may even continue indefinitely (Coon, 2002). However, grief can also be complicated by adjustment disorders, major depressive disorder, substance abuse, or post-traumatic stress disorder. In this type of complicated grief, the symptoms of grieving last significantly longer, cause greater interference with normal functioning, or express themselves in more intense symptoms (e.g., suicidal ideation) than in normal grief. If complicated grief is suspected, it is important to seek professional help.
However, although reactions in grief appear to be universal, the five stages of grief are not so. Although the five stages are commonly observed reactions to death and dying, it is important to note that not every terminally ill person exhibits all these reactions nor do those who do necessarily go through them in the same order. Not everyone experiences all five stages of grief and some people experience one or more stages multiple times. There has been much misunderstanding over these stages, and Kübler-Ross is quick to point out that the grieving process is not the same for every individual just as the relationship between the grieving person and the deceased are different in each case. Although many people have these responses and may even have them in the order listed, not every does. Further, not everyone goes through all the stages. In addition, for some people, the grieving process may be cyclic, and the individual will experience one stage more than one time before resolution is finally reached.
Helping with the Grieving Process
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