Grief, bereavement, mourning: How to cope with the death of a loved one
The cycle of life includes events that greatly shape the people we are. Sadly, those events can include losing something that is important to us. By understanding the grieving process we may better cope with our loss.
On this page:
> Stages of grief
> Symptoms of grief
> When is grief not normal?
> Studies on the effects of grief
> What can I do? Tips and resources for positively adopting after loss of a loved one
> When to seek help
Grief is a normal emotional reaction to events that result in significant loss. The loss of work or employment, end of a relationship, loss of a position of status or role, loss of a goal or dream, loss of vitality or health, or even death of a pet can bring about grief.
However, most of us equate grief with the death of someone significant to us.
In reality, no one is isolated from the events of death of a loved one, whether it is the death of a spouse/partner, a parent, a sibling, a child, a relative, or a friend. It can be very painful to lose someone we deeply love and greatly care about. The state of grief from a death of a significant someone is called “bereavement”.
Bereavement normally involves feelings of pain and sadness. This may be accompanied by inability to sleep/insomnia and poor appetite that often leads to weight loss.
How long a bereaved person “normally” grieves is influenced greatly by social and cultural factors, and the duration of grief is different for each individual. The circumstances surrounding the death, the individual’s personality, a person’s faith and practices, and other factors shape how long a person goes into “mourning”, the outward expression of loss and grief.
To understand further how the grieving process works, we need to know the different stages of grief.
Stages of grief
In the past, different psychologists created different models to explain the grief reaction.
As described above, each person goes through the grieving process differently. It does not follow that everyone will go through the stages in the exact same order, as in the case of Dr Mardi Horowitz’ model:
The stages of loss/adaptation
- The Outcry is associated with the initial emotions of realising that you’ve lost a loved one. It may be an outward burst of crying or shouting and may often end in fainting. Others may try to repress emotions to themselves. Often, people who hide their feelings reach their limits and ‘explode’. Because of the intensity and energy of the emotions involved, this stage ends briefly.
- The bereaved may go into either one of two ends of a continuum. In Denial, people numb themselves of emotions by being involved in activities and thoughts that distracts them from dealing with death. On the other end, in Intrusion they may find themselves feeling the loss with a similar intensity of emotions as the outcry. It is important to note that cycling between denial and intrusion is normal.
- When the cycling between the denial and intrusion becomes less frequent and pronounced, the bereaved goes into Working Through his/her life without the relationship of the deceased. Here, the bereaved thinks about goals and plans that helps him/her move on with life -e.g. dating, moving to another house or place, pursuing a new hobby, meeting new friends, etc.
- As time passes, the intensity of emotions associated with grief process ablates and the bereaved comes into Completion. The “last attempt of denial” could be the persistence of longing of the deceased during anniversaries, birthdays or holidays. Goleman describes this yearning “gradually yields to an emotional acceptance of death.”
Another, perhaps more familiar model of the grieving process is Dr. Elisabeth Kübler-Ross’ (1969):
Five stages of grief
- Denial: The bereaved person is in shock and numbness, confusion, avoidance, and fear. A person tells him/herself: “Is it true? Did it really happen? Are they really gone?”. In Dr. Ross’ book On Grief and Grieving, she describes denial as an adaptive way for us “help pace our feelings of grief”. As denial fades, the bereaved asks how and why.
- Anger: It may be associated to the circumstances surrounding the death of a loved one – the doctor who gave the diagnosis, or directed to the loved one who should have taken better care of him-/herself, or directed at yourself: for not doing anything or enough to take care of them. Dr Ross describes there is pain and guilt underneath the anger. The pain and guilt is creates an emotional bridge we cling on to, better than the feeling nothing – better than the emptiness at the loss of a loved. It is important to not hinder yourself from this emotion. It “affirms that you can feel, that you did love, and that you have lost”.
- Bargaining: After the death of a loved one, bargaining would sound like “…if only…” and “what if…”. Bargaining runs closely with guilt. We bargain because we feel guilty, frustrated, even limited that we could have done something to change the situation.
- Depression: Finding that we are powerless to change the events leading to a death of a loved one, the bereaved enters a state of depression. The pain of losing someone, the loneliness and sadness really sinks in, sometimes keeping you from enjoying activities you normally love. This is not a mental illness. Depression like the other stages of the cycle is just one of the steps to process grief. However, long-lasting grief may need medical attention.
- Acceptance: In time, we learn to accept the reality of a loved one’s death. We learn and cope with the different roles and needs left to us. We begin to slowly adopt to the situation, developing new and existing connections that give meaning to our lives. By going through the grief process, we begin to be at peace with the loss of a loved one.
Symptoms of normal grief felt through the grieving process
- depressed mood
- searching for the deceased
- sense of the deceased being present
- sense of continuous communication with the deceased
- crying spells
- lack of energy or fatigue
- trouble sleeping/Insomnia
When is grief not normal? Persistent Complex Bereavement Disorder
If you have a persistent yearning/longing for the deceased associated with intense sorrow and frequent crying or preoccupation (e.g. the manner of death) for more days than not, plus the following symptoms for at least 12 months (six months in children) since the death of a loved one, then you may have Persistent Complex Bereavement Disorder (PCBD):
- marked difficulty accepting that the individual has died (e.g. preparing meals for them)
- disbelief that the individual is dead
- distressing memories of the deceased
- anger over the loss
- faulty judgement about oneself in relation to the deceased or the death , and
- excessive avoidance of reminders of the loss.
This may be accompanied with a desire to die to be with the deceased, feeling isolated, being distrustful of others, and believing that life has no meaning or purpose without the deceased.
A person with PCBD may experience a diminished sense of identity in which they feel a part of themselves has died or been lost, or have difficulty engaging in activities, pursuing relationships, or planning for the future”.
There must be a clinically significant distress or impairment in psychosocial functioning to consider a diagnosis of PCBD.
Studies on the effects of grief
A study on teenagers 6-9 years after the loss of a parent to cancer found out that about 50% reported no or little grief resolution. The youth studied had associated fatigue, sleeping problems and depressive symptoms.
Schorr and colleagues made a study to see whether the death of a child is related to parental death, risk of getting cancer, and cancer survival. Bereaved parents (mothers more than fathers) were found to have slight increased risk cardiovascular disease but no significant risk in cancer survival or acquiring cancer. This study noted that the longer the grieving period after the immediate loss of a child is, the lesser risk of death for the bereaved parents, a link they associate with the effects of psychological stress.
A study showed that older female spouses, characterised with more anxiety and depression, were less successful in adapting to bereavement than younger widows.
What can I do? Tips and resources for positively adopting after loss of a loved one
Dealing with the loss of a loved one can be overwhelming. When sadness and grief overtakes our lives, here are a few tips and resources to help deal with the loss and help ease the pain through the grieving process:
You should not feel alone. Talk to a family member, a close friend, or a spiritual adviser. A family counselor, a therapist, or a palliative care specialist can also help you process and deal with the emotions and stages of grief. Finding and joining a local support group can also help.
Dedicated grief helplines/call lines are also available. Find out more about grief support services.
This helps you to reflect upon your emotions and the events surrounding the loss of a loved one. Have a good cry and try not bottle up emotions, causing them to spill uncontrollably over later on.
Writing helps you process your thoughts by seeing a physical translation of your emotions (how you felt) after losing a loved one. You can even record the old happy memories shared with the deceased. Writing can help you see your progress through time, both good and bad days. When the longing overwhelms you, flip through the pages of your diary or journal and it can help reassure you.
It may be difficult at first but try to get back into your daily routine: meal, bed, and waking times. Eat a balanced diet and avoid using alcohol, smoking, prohibited drugs, and other medications (e.g. sleeping pills) to cover yourself and “escape” the grief.
Avoid too much coffee, tea or drinks (like cola or energy drinks) containing caffeine. It may alter your regular sleeping patterns and can make anxiety worse.
Get regular exercise and get yourself outdoors. Simple gardening or a short stroll or bushwalk (preferably with company) can change your mood, improve your health and refreshes your mind. Find ways to relax (like meditation, music, etc.) in the middle of the day and before sleep. If you have not had a medical check-up in a while, then book one with your GP.
Seek immediate help when:
- You are unable to perform the daily normal activities
- You have persistent grief
Losing a loved one can change a person’s life. Grief, when experienced fully with the proper understanding, good handling and availing of resources when needed, will become bearable with time.