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Grief and Loss

Processes of Grief
Each person will go through the following processes at his/her own pace, in his/her own order, and in his/her own time. The order of the processes or the length of time spent with each process can vary depending on the amount of unfinished business left over from previous losses and/or the type of loss experienced (e.g., natural death vs. suicide or murder, loss of a job through a lay off vs. retirement). Each process is normal, healthy, and natural!

  • Recognizing the loss 
    This process involves accepting the reality of death as well as understanding the facts and circumstances surrounding the death.
    • Acknowledge the death
    • Understand the facts and circumstances surrounding the death
  • React to the Separation 
    Mourners are faced with the reality of the loss in the many ways that one is emotionally affected. This includes reacting to losses not immediately apparent such as role changes, hopes and dreams that will not be fulfilled, and parts of self that died with the loss.
    • Experience the pain of separation
    • Feel, accept, and give some form of expression to the psychological reactions to the loss
    • Identify and mourn secondary losses, e.g., the unfulfilled needs, wishes, dreams, expectations
  • Recollect and reexperience the deceased and the relationship 
    Part of grieving is finding a new way of relating to the deceased, the outside world, and even oneself. This includes changing one's attachment to the deceased and identifying and achieving closure on any unfinished business.
    • Review and remember the departed realistically, all the positives, negatives, and neutrals
    • Revive and reexperience feelings associated with relationship with the loved one
  • Relinquish old attachments to deceased and old assumptions about the world 
    With loss of a loved one, one is faced with the challenge of reorganizing one's expectations for the deceased being in one's life. The meaning of one's life has now changed in many important aspects.
  • Readjust to move adaptively into the new world without forgetting the old 
    Mourners establish a new relationship with the deceased and form a new sense of identity incorporating their loss. Rather than cut all ties with their loved one, mourners come to maintain emotional and symbolic links to the one they lost while maintaining growth in the present.
    • Revise assumptions about the world
    • Develop a new relationship with the deceased
    • Adopt new ways of being in the world
    • Form a new identity
  • Reinvest 
    New attachments are developed that provide renewed sources of emotional gratification.

Rando, T.A. (1993). Treatment of complicated mourning. Champaign, Illinois: Research Press. 

Manifestations of Health Grieving
Many people who are first encountering a significant loss are surprised at the range of emotions thoughts, behaviors, and sensations they experience. Often grieving people wonder if what they are experiencing is typical. the following is a listing of the most frequently reported symptoms that grieving persons report. these are all quite normative, although they can be disruptive at times. It is often reassuring to persons grieving a loss to know that their experiences are very normal. 

  • FEELINGS
    • Sadness

    • Anger

      • from sense of frustration

      • from feeling helpless

      • anger can easily be turned inward

    • Guilt and self-reproach

    • Anxiety

      • from dependency

      • from heightened sense of own mortality

    • Loneliness

    • Fatigue

    • Helplessness

    • Shock

    • Yearning

    • Emancipation and/or relief if, for example, the deceased had been painfully ill for some time

    • Relief

    • Numbness

  • PHYSICAL SENSATIONS

    • Hollowness in the stomach

    • Tightness in the chest

    • Tightness in the throat

    • Oversensitivity to noise

    • A sense of depersonalization - numbness

    • Breathlessness, feeling short of breath

    • Weakness in muscles

    • Lack of energy

    • Dry mouth

  • COMMON THOUGHT PATTERNS

    • Disbelief

    • Confusion - disorganization

    • Preoccupation

    • Sense of presence (of the deceased)

  • COMMON BEHAVIORS

    • Sleep disturbances

    • Appetite disturbances

    • Absent-minded behavior

    • Social withdrawal

    • Dreams of the deceased

Factors that Inhibit Grieving
There are various factors that can inhibit (or hinder) grieving. All of the following examples may be inhibiting factors in the grieving process, but they do not preclude that the person will not grieve at some time. Hopefully, these inhibitions or blocks will be overcome and grieving will proceed unimpeded. Some of these include the following:

  • STOICISM - For example, people often tell others (or tell themselves) to "be strong," "don't cry," "be brave," or "put on the strong front for everyone else." Frequently, people who do this miss the opportunity to deal with their own grief.
  • DENIAL - Sometimes a person avoids participating in or attending funeral rituals or visiting the grave. This can be a sign that the death has not been accepted. An individual may go on for weeks, months, and sometimes years speaking of the deceased as though s/he has just died, thus shutting out the pain and process of grieving.
  • ABUSING SUBSTANCES - Shock and depression weigh heavily on bereaved persons, which can and does at times lead to abuse of alcohol or other drugs. This can shut out the pain temporarily, but eventually it must be faced.
  • OTHER LOSSES - Unfinished or unresolved grief from an earlier loss (not necessarily a loss through death) can awaken so much pain that the individual is reluctant to add to the painful experience by grieving the more current loss.
  • FEAR OF LOSING CONTROL - Individuals who fear losing control (e.g., "If I start crying, I'll never stop") can actually prolong their grieving process. They often close themselves off from their support systems by shutting out relatives and friends who would create an atmosphere that may induce tears or sadness.
  • LOSS OF EXTENSION OF SELF - An individual may have been very dependent upon the deceased (or the relationship was very important), which may lead him/her to avoid grieving in order to avoid the reality of the loss (e.g., "We were so much a part of each other. I am not complete without her/him, so s/he can't be dead."). This dependence or closeness is usually found in a relationships of many, many years.
  • RUNNING RAGGED SYNDROME - Some individuals attempt to put grief aside and not deal with it at all by keeping very busy (e.g., "Oh, I keep busy," "There is so much to do, I just don't have time to grieve," "I keep going 'til I'm so tired I just drop"). Although it is important to stay active, this "running ragged syndrome" usually leads to physical illness or an emotional breakdown because the grief has not been dealt with appropriately.

Understanding and Coping with the Grieving Process
There are no easy answers for how to cope with grief and loss. However, the following is a list of suggestions from those who have lived through and beyond the loss(es) they have experienced. Here are some of their thoughts:

  • Know you can survive. You may not think so, but you can.
  • Struggle with "why" it happened until you no longer need to know "why" or until you are satisfied with partial answers.
  • Know you may feel overwhelmed by the intensity of your feelings but all of your feelings are normal.
  • Anger, guilt, confusion, and forgetfulness are common responses. You are not crazy; you are in mourning.
  • It's okay to be angry. Be aware that you may feel anger at the person, at the world, at family members or friends, at God, at yourself. Don't push down the anger. Let it out! Hit a pillow, swim, exercise, hit a bunching bag, scream.
  • You may feel guilty for what you think you did or did not do. Remember that very often there was nothing you could have done to control what happened. Guilt is simply a natural part of the grieving process.
  • Don't be afraid to cry. Tears are healing.
  • Don't be afraid to talk to the person who has died. This a healthy way to work through "unfinished business."
  • Keep a journal. Write a letter(s) a letter to the person who has died. This another good way to work through "unfinished business."
  • Don't be surprised by fear. After a loss, you have many new behaviors you need to learn and many new situations you need to cope with.
  • Remember, it's okay to feel depressed. Sadness is a powerless feeling, but it's a VERY important part of the grieving process.
  • When individuals are depressed, it's not uncommon to have suicidal thoughts. However, it is very important you not act on those thoughts. If you have more than passing suicidal thoughts, please consult a professional counselor!
  • Wear out your questions, anger, guilt, or other feelings until you can let them go. Letting go doesn't mean forgetting.
  • Find a good listener with whom to share. Call someone if you need to talk.
  • Accept help and support when it's offered.
  • Don't be afraid to ask for help; our family and friends can't read our minds. It's okay to need comforting.
  • Steer clear of people who want to tell you what or how to feel.
  • Be aware of the pain of your family or friends if they were also impacted by the loss.
  • Doing something for someone else can give you some relief from the pain; call a friend and listen, talk to the lonely, do some volunteer work.
  • The willingness to laugh with others and at yourself is healing.
  • If you are grieving the loss of someone who committed suicide, remember, the choice was not yours. No one is the sole influence in another's life.
  • If your loss involved the suicide of a family member or friend, know that there are support groups that can be helpful, such as Compassionate Friends or Survivors of Suicide groups. If not, ask a profession to start one.
  • Give yourself permission to get professional help.
  • Call on your personal faith to help you through.
  • Remember to take one moment or one day at a time.
  • Give yourself time to heal. Be patient with yourself.
  • Expect setbacks. If emotions run like a tidal wave, you may only be experiencing a remnant of grief, an unfinished piece. Grief comes and goes.
  • Try to put off major decisions.
  • Set your own limits and learn to say no.
  • It is common to experience physical reactions to your grief, e.g., headaches, loss of appetite, inability to sleep.
  • REST, AND REST SOME MORE! Go to bed earlier. Try to eat balanced meals because good nutrition is important to the healing process. Be gentle with yourself; your body needs energy to repair.
  • Exercise is important. It provides a physical outlet for emotions.
  • Read. There are many helpful books available on the grieving process. Understanding grief makes it a little easier to handle.
  • When you are ready, plan things to look forward to (e.g., a trip, lunch with a special friend).
  • Holidays can be especially difficult. Schedule activities that you find particularly comforting during these time, and be careful not to overdo.
  • Knowing that you will never be the same again, but you can survive and even go beyond just surviving.
  • Remember you will get better; hold onto hope. Some days you just hang on, but the better days will be back. You will gradually develop a renewed sense of purpose.

Grieving:  What you can "DO"

  • Feel the feelings. Emotions are normal and healthy; everyone experiences them when grieving!
  • Get angry! Direct your anger in healthy ways. Yell, pound a pillow, run, play a sport. Don't let the anger build.
  • Cry. It's okay to cry. It is even better to have someone to hold you while you cry.
  • Listen to yourself. You will often know what you need. If you are uncertain, then listen to a trusted family member or friends (someone who has your best interest as their first priority) who will help you keep reality in focus.
  • Set limits. Don't be afraid to say "no" to yourself or to others. Be gentle with yourself, and don't expect too much of yourself right now.
  • Stay active. Continue to be active; part of taking care of yourself is going on.
  • Write a letter. Write a letter to the loved one or yourself. In it, write down your feelings and say good-bye.
  • Laugh. Life still goes on and there are things to be happy about.
  • Reflect. Take some time to reflect on yourself and your loved one and the good times you had together.
  • Your faith. If important to you, find comfort in your religion or spirituality. Talk with a minister, rabbi, clergy person.
  • Read about grief. So you will know that you are normal!
  • Ask for support. Remember that it feels good to be able to give to someone you care about. Give someone a gift by letting them be there for you.

BE GOOD TO YOURSELF!

How to Survive those "Special Days"
In our lives, there are many holidays or "special days" (e.g., wedding anniversaries, birthdays, holidays, graduations, the anniversary of someone's death). These can all be difficult days for someone who is grieving the loss of someone they cared about; however, there may be one or two "special days" that for you means "togetherness." It is during these times when you may be acutely aware of the void in your life. For many, the wish is to avoid these "special days." However, if it is a holiday shared by many in your society (e.g., Christmas, Hanukkah, New Years), you may be unable to escape the seasonal greetings or wishes. You may also see the perfect gift for your dead partner, child, relative, or friend, and you may suddenly realize that s/he will not be with you this year. Listed below are some ideas and suggestions that others have found helpful in coping with "special days." Choose those ideas that appeal to you.

  • Sit down with your family and decide what you want to do for the holiday season and what each family member can handle comfortably.
  • There is no right or wrong way to handle the day. Some may wish to follow traditions, while others may choose to make changes and do things differently.
  • Once you have made the decision on the role you and your family will play during the holiday, let friends and relatives know.
  • Don't take on too many responsibilities. Make it through each day a little at a time.
  • Do something for someone else (e.g., volunteer at a homeless shelter, visit a convalescent hospital, spend time with someone who is house-bound). Ask someone who is alone to share the day with your family. Provide help for a needy family.
  • Don't set your expectations too high. If you want things to be the same as they were before the death of someone you cared about, you will be disappointed.
  • Realize that it isn't going to be easy. Just do the best you can.
  • If you feel like crying, go ahead. It will not ruin the day for others, and it may provide them with the freedom to do the same.
  • Set limitations. Do the things that are very special and important to you.
  • "Special days" are emotionally, physically, and psychologically draining. You need your strength. Try to get enough rest.
  • Donate money or a gift in your loved one's name.
  • Projects such as cleaning the house can get out of proportion. If the chores are enjoyable, go ahead; but not to the point that it is tiring.

Grief and Loss References 
*Becker, M. R. (1992). Last touch: Preparing for a parent's death. Oakland, CA: New Harbinger Publications, Inc.

*Bridges, W. (1980). Transitions: Making sense of life's changes. Reading, MA: Addison-Wesley Publishing Co.

*Buscalia, L. (1982). The fall of Freddie the leaf. New York: Charles B. Slack, Inc. (for children)

Colgrove, M., Bloomfield, H. H., & McWilliams, P. (1976). How to survive the loss of a love. New York: Bantam Books.

*Dunn, E. J., McIntosh, J. L., & Dunne-Maxim, J. (Eds.). (1987). Suicide and it's aftermath. New York: W. W. Norton & Co.

Faire Donnelly, K. (1988). Recovering from the loss of a sibling. New York. Dodd, Mead & Co., Inc.

Kubler-Ross, E. (1975). Death: The final stage of growth. Englewood Cliff, NJ: Prentice-Hall, Inc.

Kubler-Ross, E. (1985). On children and death. New York: MacMillian.

Kubler-Ross, E. (1969). On death and dying. New York: Macmillian.

Kubler-Ross, E. (1974). Question and answers on death and dying. New York: Macmillian Publishing Co.

Neal, R. E. (1973). The art of dying. New York: Harper & Row.

Rofes, E. E. (1985). The kids book about death and dying. Boston, MA: Little Brown and Co. (for children)

*Staudacher, C. (1987). Beyond grief: A guide for recovering from the death of a loved one. Oakland, CA: New Harbinger Publications.

Staudacher, C. (1991). Men and grief: A guide for men surviving the death of a loved one. Oakland, CA: New Harbinger Publications.

*Particularly recommended

We gratefully acknowledge the assistance of Anne Reith, Ph.D., and Mary Rudy-Chapman, M.A. in the creation of this handout.