Getting Over Grief
Understanding Stages and Healing from Grief
HOW TO GET OVER GRIEF
Grief is a feeling of sadness as a result of any major loss. It is often associated with suffering and is also considered a necessary part of healing. When an event causes a crisis in the life of an individual, a radical change is made in the situation established until then. Grief also has the meaning of ‘definitive loss’ of an object that an individual can hold. Counseling can help deal with grief.
DEFINING GRIEF
Grief is a human and personal response to loss. Most of the literature dealing with grief refers it as a result of the loss in human life. However, a grief response can also occur in the face of other types of losses such as health, career, status, role, divorce, financial loss, and more. The reaction includes different expressions of sadness, anger and other emotional, cognitive and behavioral components, which may vary from person to person and from case to case.
Prolonged grief can also lead to depression, which is a common mental illness affecting 18% (40 million adults) of the US population every year.1 In the event of any definitive loss, the intensity of the grief and its duration is affected by the degree of emotional closeness to the deceased person. There are also customs that represents external, social or interpersonal characteristics of mourning. These customs are culturally dependent and include the existence of social rituals that vary from culture to culture, and from one religion to another.
STAGES OF GRIEF
Denial
The stage can be expressed in statements such as ‘I feel okay’, ‘It does not happen to me’, ‘It cannot be’. At this stage, the person affected does not believe in the knowledge of the loss and the approaching end, and is convinced that this is a mistake. Kubler-Ross refers to this response as a temporary defense mechanism that the person needs when receiving difficult information because of the great difficulty in accepting this reality. Denial allows a person a sort of time out to organize and mobilize forces, and gradually switch to more adaptive defense mechanisms.
Anger
This stage can be expressed in statements such as:
- Why me?
- It’s not fair!
- How can this happen to me?
For example, most people cannot deny long-term death or the death of a close person, and instead of denial usually express harsh feelings of anger, envy, and hatred. This is a difficult stage for dealing with people in a person’s environment as anger is often directed outwards at the environment, and sometimes in a seemingly arbitrary and indiscriminate manner. Apparently, understanding and accepting anger from those around can help a person to cope more adaptively while an opposite reaction from the environment may create feelings of loneliness.
Bargaining
The stage can be expressed in statements such as:
- I’ll do anything, just give me a few more years to live.
This stage characterizes terminally ill patients, who deal with the imminent gospel of death and the acceptance of a gradual but rare loss in the process of mourning for a loss that has already occurred. The patient expresses his desire to postpone the end in bargaining in an attempt to prevent the inevitable. The bargaining usually involves a commitment to any ‘payment’ from the patient in return for the postponement of the sentence or the fulfillment of last wishes.
Depression
The stage can be expressed in statements such as:
- It’s all pointless now, why bother?’
- He’s dead/I’m going to die, what’s the point of doing anything?
This stage is characterized by a strong sense of loss, sad thoughts about the future, guilt, shame, failure, and missed opportunity. Kubler-Ross claimed that at this stage, it is difficult to encourage and calm the griever and that the feeling of depression is important emotional processing of the situation, which can finally move towards acceptance of the situation. She recommends supporting the griever at this stage by listening and understanding.
Acceptance
This stage can be expressed in statements such as:
- I will be fine.
- I cannot fight it, but at least prepare for it.
This step appears if the person has passed the previous steps with the support of the environment. At this point, there is a concession of the struggle against fate and the cessation of negotiations and accounts with the past and with the environment.
At this stage, the person is able to express a variety of feelings from the previous stages to accept the finality of life and to part from the relatives who have lost or are about to lose. The person may gradually become withdrawn, relieved of the feelings of pain and the heat of the struggle against the situation so he or she may feel exhausted and need a great rest. Moreover, acceptance of the situation allows a process of separation.
According to Kübler-Ross, most of the grievers reach this stage, but there are few who continue the fight against their loss or denial. It is also important to distinguish between despair, surrender, and acceptance.
COMMON CAUSES OF GRIEF
Loss of a Loved One
Spouse’s death is usually considered as one of the most powerful loss. People who have lost their spouse majorly describe their conditions as they have lost half of their own self. Crying bouts, loneliness, emotional instability, and hopelessness are some of the most common feelings of widows and widowers. Likewise, the loss of a parent also brings about a significant psychological loss to an individual.
Illness
People suffering from terminal illnesses are mainly categorized here. Suffering from a painful medical condition and constantly living with a fact that ‘I am going to die soon’ is painful beyond our imagination. This usually brings about the constant feeling of hopelessness, peevishness, hatred, and disbelief in an individual.
Trauma
Traumatic events can be natural disasters, wars, kidnappings, rape, or accidents that threaten serious injury. This also includes war experiences, terrorist attacks, torture, camp imprisonment, political imprisonment, or other violent attacks. These events can cause extreme stress in a person and create feelings of helplessness or horror. The anxiety and stress that this causes in the human being can subside on its own in the majority of those affected, whereby the behavior of these people also changes resulting into long-term or short term grief.
Miscarriage
The miscarriage is the early termination of pregnancy, whether spontaneous or caused by a cause that is either pathological or traumatic. Miscarriage, neonatal death, SIDS or stillbirth of an infant easily takes a form of significant loss in a person’s life. In this case, the parents usually find grief to be the most distressing.
Divorce
Grief may also occur when someone loses a romantic relationship i.e. breakup or divorce. The long-term association with someone makes the griever to constantly think about the time they spent together.
Birth of a Child with Special Needs
Having a child with a special need can be a shock for some parents. It’s common for parents to mourn the life they expected for their child in order to accept the life their child has been given. Moreover, seeing their child suffers from health issues and painful conditions wrench one’s heart. Parents of a child with special needs usually express the feelings of helplessness, hopelessness, and constant stress.
RISK FACTORS FOR PROLONGED GRIEF
Environmental
The risk of developing stress disorder is higher when there is a dependency relationship (emotional or otherwise) between the grieving person and the deceased. In children, disorders associated with continuity in childcare increase the risk of developing the disorder.
Genetic & Physiological
Long-term Grief may also result in prolonged grieve disorder, mental illnesses and stress disorder in cases of severe loss. Women are at greater risk of developing the disorder than men.
Suicidal Risk
People with a complex but stable diagnosis often report an increase in suicidal thinking.
TYPES OF GRIEF
Normal Grief
Contrary to its name, normal grief has no defined guidelines in term of severity and timeline. It is referred to any potential response that you think would resemble grief. People experiencing normal grief feel a gradual decline in emotional intensity and move with their routine life quickly.
Chronic Grief
This involves feelings of hopelessness, disbelief, and situation avoidance for more than a period of 6 months. People with chronic grief often experience intrusive thoughts, and if left unaddressed, it can be converted into serious mental illnesses and disorders such as clinical depression, self-harming or suicidal thoughts, and substance abuse.
Anticipatory Grief
Grieving normally begins when your loved one gets diagnosed with something significant and his health starts to decline. Feelings concerning this loss start before the person actually passes away as one starts assuming about how life would be after him or her. This type of grief is usually difficult as the person is still alive but you start to experience the feelings of confusion and guilt.
Exaggerated Grief
This type of grief is felt through the escalation of normal grief reactions. This intensification tends to worsen with the passage of time. It may also result in suicidal thoughts, self-harming behavior, phobias, abnormal fears, nightmares, and occurrence of basic psychiatric disorders.
Delayed Grief
It is when the response is delayed towards a loss for a certain time. Reactions, in this case, could be excessive and the person may not realize initially that this delayed grief is the actual cause for his condition.
Traumatic Grief
It can be a result of emotional or physical trauma or injury. One may experience severe traumatic grief, which may result in a persistent and deep feeling of guilt, self-destructive or self-hatred behavior, suicidal thoughts, low self-esteem, violent outbursts, and radical lifestyle change.
Absent Grief
When someone does not acknowledge grief and shows no related signs. This happens when the griever is in a complete state of denial or shock. If someone experiences absent grief for an extended time period, it is seriously concerning.
Other forms of Grief:
There are various other types of grief including disfranchised grief, cumulative grief, masked grief, distorted grief, inhibited grief, secondary losses, abbreviated grief, and collective grief.
PHYSICAL SYMPTOMS OF GRIEF
Digestive Problems
Grief often results in appetite and digestive issues. A griever commonly complains about having disruptive changes in routine eating habits and digestive problems such as diarrhea, constipation, stomach pain, feeling of hollowness in the stomach, nausea, and queasiness.
Energy Loss
Tolerating a loss or grief is hard work and takes a strong toll on our bodies. For several unknown reasons, a griever may experience disrupted sleep and eating patterns, fatigue, weakness and overall low levels of energy in the entire body to perform any task.
Impaired Motor Skills
Everyday jobs like driving require the best of your motor skills. However, an individual grappling with a loss could experience impairment of motor skills. This includes loss of concentration or focus, the unexpected response of emotions such as sobbing or tears, etc.
Weakened Immune System
A definitive loss like losing your loved one also impacts your immune system, leaving it weak and suppressed while making you more vulnerable to illnesses and infections like flu, cold, and viral fever. People with a chronic health condition may experience severe symptoms.
Pain
Grief may also induce the unpretentious feeling of discomfort or pain, such as migraine or headaches, heaviness or inflation in limbs, aches in the head, neck, back or skeletal joint, and muscular pains.
Too Much or Too Little Sleep
A griever may experience insomnia when he/she finds it difficult to sleep. This results in affecting the griever’s physical and mental coordination, cognitive/brain response, and functionality. On the contrary, a griever may sleep too much as it helps him escape the grief. In this condition, it may leave the person lethargic and weak.
Weight Gain/Loss
Some people put on some extra pounds during mourning as they usually become distracted from their physical well-being and give up workouts. Likewise, another griever may experience loss in appetite and does not eat as much as he or she normally eats. This may result in the loss of some pounds.
MENTAL SYMPTOMS OF GRIEF
Anxiety
An individual grappling with grief may experience an anxiety attack and anxiety disorder in the long-term. An individual dealing with a definitive loss may become over-anxious about the situation, which is normal. However, if a person constantly feels difficulty in coping with his daily routine, he or she may be suffering from an anxiety disorder.
Irritability
Loss of appetite, decreased energy level, disruptive sleep, inflammation, and pains; all these symptoms collective result in increased irritability within the griever.
Depression & Loneliness
People coping with a loss or grief for too long may experience episodes of depression. However, depression could be short-term as well, and a person may come out of the situation as soon as the intensification of the grief reduces. The feeling of persisting loneliness and hopelessness is also a common emotional symptom experienced by the grievers.
EXPRESSIONS OF GRIEF
Avoidance
A griever may find escaping the situation easier than reacting to it. Avoidance is one way that a person actually responds to loss or grief. Some people find it more comfortable to avoid the entire situation that is going on around them and choose to continue with their routine to escape grief and pain.
Binge Drinking
Binge drinking, substance abuse, and alcoholism are common after a loss. People find it comforting to be drunk as it also helps them escape the situation.
Crying
After sadness, crying is the most common expression of grief. A griever outbursts in tears when overwhelmed by the emotions and his suffering from the loss. Some people experience episodic crying when they just can’t handle pain and emotional suffering.
Difficulty Moving On
Moving on is never easy after a huge loss. People may struggle with their emotional and physical situation to move on in life. Some people are expressive enough to share their feelings to others expressing that they are finding it really difficult to move on in life.
Guilt
Guilt is a unique expression of grief, when a griever may constantly blame himself, destiny, fate or someone else for the loss that occurs. This makes him feel guilty all the time, thinking that he might have prevented the loss from occurring if did this or that.
Isolation
People isolate themselves if they avoid the situation for too long. Constant feelings of loneliness and lack of finding stable emotional support may result in isolation.
Insomnia
Total inability to sleep or disruptive sleeping patterns are some other expressions of grief. Some people may express opposite symptoms and behavior.
Overworking
Another expression that people may often choose is to indulge themselves in work. People have been witnessed working extra hours in workplaces to keep themselves busy, especially during the days when they are coping up a loss.
Suicidal Ideation
Suicidal tendencies arise within a griever if they undergo depression for too long after suffering the loss. People may even think of ending their life just to escape their sufferings and loss.
Apathy
A griever expresses a lack of enthusiasm, concern, and interest in routine work, as well as, in relationships too.
Binge Eating
Many people express their grief by indulging in binge eating. People have complained about craving too much of a particular food during mourning. For instance, one may feel like eating McDonalds three times a day for a whole week.
Confusion
A griever may stay confused for short and long-term due to his ongoing sufferings. Confusion may be caused due to lack of concentration and focus, and other physical symptoms that affect the mental well-being of the individual.
Depression
Feeling of stretched stress, anxiety, loneliness, and hopelessness result in depression. A griever usually expresses symptoms and conditions of depression throughout the period of mourning and even after that.
Distracting One’s Self
Like avoidance, one may choose to distract himself from grief, the auxiliary topics, and things that go around to keep himself distracted.
Increased Negative Emotions
After facing a definitive loss, having negative thoughts becomes more common about one’s self, other family members, employment, life, children, religious belief, and almost about anything. This is simply a way to express their fear and anxiety while having grief at the back wheel of their mind.
Mistrust in Life or People
People usually express their grief by showing mistrust in other people or life. This is another way of expressing the heavy loss that they are bearing with.
Overcompensation
It is an expression of grief that one may use to cover his pain, frustrations, weaknesses, loneliness, and feeling of sadness to cope up the loss.
Sadness
Sadness is probably the most common expression of grief that one may go through. A griever may constantly express his suffering through sadness, which may turn into tear outburst or emotional breakdown when intensified.
GRIEF AND ADDICTION
Self-Medicating and Unhealthy Coping Skills
People usually get into negative or unhealthy coping to make a quick fix to avoid grief situations or pain. Unhealthy coping involves practices like isolation, procrastination, over-eating, alcoholism, substance abuse, over-sleeping, smoking, etc. Apart from that, people may misuse over-the-counter medicine to get rid of the pain, inflammation, and other physical symptoms that remind them of grief. Unhealthy coping and self-medication usually end up with worsening the symptoms when people have complained about having ‘numb emotions’ or ‘total situation avoidance’. Likewise, self-medication may also result in triggering some other physical issues and deteriorating well-being.
HOW TO COPE WITH GRIEF
Journaling
Journaling is considered as one of the healthiest coping technique that helps a person self-manage his grief. It encourages to keep a diary or journal to write out the thoughts and feelings or about the events that are surrounding your life. It helps people coping up very effectively as all of their emotional burdens comes out on a paper.
Routine
Sticking ones-self to a certain routine may also help. The psychiatrist treating a patient with grief disorders prefer providing them with a busy schedule to which they should stick sternly. This actually takes away all the time that a griever may spend unproductively thinking about his loss, and replaces it with productive activities that provide happiness and comfort.
Eat Healthy
Eating healthy always provides happiness as it boosts your metabolism and provides you with all the nutrition that keeps your energy level and moods elevated.
Counseling
A counselor or psychiatrist can always help coming up with the best coping strategies that suit your specific condition and type of grief that you experience.
Resources
World Health Organization. (2017). Depression and other common mental disorders: global health estimates (No. WHO/MSD/MER/2017.2). World Health Organization.
Boelen, P. A., & Prigerson, H. G. (2007). The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults. European archives of psychiatry and clinical neuroscience, 257(8), 444-452. Retrieved on May 18, 2019
Maciejewski, P. K., Maercker, A., Boelen, P. A., & Prigerson, H. G. (2016). “Prolonged grief disorder” and “persistent complex bereavement disorder”, but not “complicated grief”, are one and the same diagnostic entity: an analysis of data from the Yale Bereavement Study. World Psychiatry, 15(3), 266-275.Retrieved on May 18, 2019
Jacobs, S. (2016). Traumatic grief: Diagnosis, treatment, and prevention. Routledge. Retrieved on May 18, 2019
Jordan, A. H., & Litz, B. T. (2014). Prolonged grief disorder: Diagnostic, assessment, and treatment considerations. Professional Psychology: Research and Practice, 45(3), 180. Retrieved on May 18, 2019
Boelen, P. A., van de Schoot, R., van den Hout, M. A., de Keijser, J., & van den Bout, J. (2010). Prolonged grief disorder, depression, and posttraumatic stress disorder are distinguishable syndromes. Journal of affective disorders, 125(1-3), 374-378. Retrieved on May 18, 2019
Tsai, W. I., Kuo, S. C., Wen, F. H., Prigerson, H. G., & Tang, S. T. (2018). Prolonged grief disorder and depression are distinct for caregivers across their first bereavement year. Psycho‐oncology, 27(3), 1027-1034. Retrieved on May 18, 2019
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., … & Bonanno, G. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS medicine, 6(8), e1000121. Retrieved on May 18, 2019
Lichtenthal, W. G., Maciejewski, P. K., Demirjian, C. C., Roberts, K. E., First, M. B., Kissane, D. W., … & Napolitano, S. (2018). Evidence of the clinical utility of a prolonged grief disorder diagnosis. World Psychiatry, 17(3), 364. Retrieved on May 18, 2019
Goldstein, R. D., Petty, C. R., Morris, S. E., Human, M., Odendaal, H., Elliott, A., … & Prigerson, H. G. (2018). Pre-loss personal factors and prolonged grief disorder in bereaved mothers. Psychological medicine, 1-9. Retrieved on May 18, 2019
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