Grief can be painful.

Counseling can help.

Change in life is inevitable. Yet change is one of the most difficult things we do in this life. We have feelings when we change and even years or decades later, feelings can be very strong.

We might yearn for different choices or outcomes in life. We can even have feelings about our life choices in the past that are bittersweet, which many people call nostalgia.

Grief and sadness, which sometimes come in response to loses can be remarkably painful. Loss of a friend or person, loss of job or other situation can lead to great life change and great pain.

However, anything can cause sadness related to change. The pain that results form those changes can be overwhelming no matter what the reason, or the cause of the grief and sadness.

At times, grief can also be intertwined with shock from a bad situation or incident. Bad things happen to good people and sometimes people are in the wrong place at the wrong time and tragedy happens.

LOSS OF A PERSON

Losing someone you love or care about is always filled with pain and despair. It can come as a shock or sometimes we anticipate the loss of someone because they are ill. At times can be so bad that it seems like it will never get better. And the pain can last a long time.

A common theme can be observed when people go through grief and a Swiss Psychiatrist and researcher Elizabeth Kubler-Ross observed and defined stages of grief. These is not a guarantee or certainty that the stages are accurate for all people. Indeed that someone might not go through feelings that relate to all the stages, any stages, or go through them in sequence. Sometimes people experience different feelings from the stages or jump around in the stages. Sometimes people grieve in a unique way or in advance of someone’s actual passing.

STAGES OF GRIEF

Denial - When people hear of a loss for the first time, frequently they make statements that involve a denial that the loss has occurred. Their reaction is to say, ‘no” or “tell me you are lying” or “no that is not correct”. But unfortunately as the person thinks and feels in response to this news, shocking feelings are present. Often shock is the mental state the person presents with and at times

Anger - Sometimes when a person has suffered the acute shock of a personal loss, anger is the misplaced sadness that results. Anger at a doctor, or a hospital, or anger at something that the affected could have done differently are all things that are common. Often counselors identify this stage when they are first involved with a grief situation and see a person try to make sense of things with the, “I coulda, shoulda, woulda things.” Unfortunately that Monday morning quarterbacking does not make someone feel better; only more angry. When counselors say that sometimes men express sadness as anger, this is what they are talking about, however any gender can experience this.

Bargaining - The last painful attachment that someone has to accept the news of loss is when humans say things such as, “if you pull them though this then I will do this thing.” It is sometimes the state that humans are in, marked by despair, that makes them throw themselves at the mercy of a spiritual being, or fate.

Depression - When bad things happen and we lose something or someone valuable to us, we can become sad. When the creator of the stages of grief named the stages, perhaps what she meant was “acute sadness”. Grief often produces a sharp, painful sadness that is related to loss. However there are some differences between acute sadness and the formal diagnosis of Depression. Firstly, often Depression has no specific cause, rather multiple causes related to perceptions and erroneous thought processes. Usually with a diagnosis of depression, there is a concurrent lowering of self esteem and very negative self talk. Also, there are biochemical changes in the brain that happen when depression is the diagnosis. Acute sadness from loss is usually difficult and painful, but shorter in duration, and has none of these longer term depression related effects.

Acceptance - This is exactly as it is defined. With time, some talking and thinking, (which counselors often call processing) people begin to change how they look at a loss. They begin to think about it less frequently and for smaller durations of time until hours, days and weeks and months go by without thinking at all about the loss. This is at the stage at which often people start to feel better. At first just a little bit and then over time more and more. They also alter how they see the loss.

NORMAL GRIEF

While stages of grief are long known, science has changed how it thinks about grief. How someone processes grief may be mediated by factors involving cultural issues and personal issues. Grief can manifest itself in a variety of ways. How a person grieves depends on spiritual, cultural, emotional, and behavioral factors. 

There is no typical response to a loss. However, there are some common symptoms of grief that many people experience. You may experience some or all of these emotions.

• Disbelief or Shock – One of the first emotions that a person may experience after the loss of a loved one is disbelief. You may feel numb or have trouble believing that the event happened at all. You might expect the person to show up or believe that you see them on a crowded street somewhere. Denial and shock are normal during the initial period after a loss. Denial is the brain’s way of making sure that you don’t get too overwhelmed with emotions at once. It helps you get ready for the difficult road ahead and prepare to process the grief.

• Sadness – After the shock wears off, deep sadness will likely take its place. You might feel empty or lost. You might find yourself crying for no reason at all. The sadness can make it hard to perform normal daily tasks. These feelings are normal. Even though they are unpleasant, they are natural and should subside with time.

• Anger – Losing someone or something important can feel unfair. It can make you feel resentful or angry. You may feel the need to blame someone for this injustice – the doctor, God, or even the person who died for abandoning you — especially if the death was from suicide. The death of a loved one can shake your religious beliefs. You might feel angry with God for a period of time. Placing blame is a way to try to alleviate sorrow.  Eventually, you will work through the anger and learn to forgive.

• Guilt – Some people feel guilty after a loss. You may regret things that you said or didn’t say to the person. You might feel frustrated that you won’t have the chance to do things differently. There may be things you wish you would have done while they were alive.

• Fear – A loss can trigger feelings of fear or anxiety. It reminds you that you and others that you love are mortal.  You may fear for the safety of your remaining friends and family. You might even vividly imagine terrible things happening to yourself or your loved ones. These feelings of anxiety and fear are a normal part of the grieving process.

• Physical Symptoms – Grief can take a toll on your physical health, as well. Due to the intense levels of stress associated with grief, it can affect your physical health. Common physical symptoms associated with grief include stomach aches, nausea, pain, and fatigue. Weight loss is common with grief.

COMPLICATED GRIEF

So, how do you distinguish normal grief from complicated bereavement?

• Unshakable denial. As discussed above, disbelief is a normal emotion that most people experience after a loss — for a certain period of time. The key is acceptance. Eventually, you’ll accept the loss. However, some people fail to come to terms with reality. In these cases, denial is unhealthy. Taking a temporary break right after a loss is healthy, however, trying to completely avoid the fact that your loved one is a sign of complicated grief.

• Self-destructive behavior. Some people engage in self-destructive behavior, such as drug abuse, alcohol, self-harm, or unsafe sex to cope with the loss of a loved one. This behavior is a sign that something deeper is going on.

• Extreme anxiety. It is normal to experience some anxiety after the death of a loved one, however, if the anxiety is prolonged or significantly impacts your daily functioning, it could be a sign of complicated grief. An example would be an extreme fear of being sick that is not alleviated even after having numerous medical tests come out normal.

• Problems functioning in daily life. Right after a loss, you might have difficulty keeping up with housework, taking care of the kids or going to work. That is normal and usually alleviated with the help of a good support system. However, sometimes, these problems persist, which can indicate a bereavement disorder.

TIPS FOR COPING WITH GRIEF

If you are struggling with grief, there is good news. You do not have to live with debilitating, long term pain. There is a way to healthy grief. These tips can help.

TIP #1 – USE THE SERVICES THAT ARE AVAILABLE TO YOU

One of the most important factors in healing from loss or death is having sufficient social support. Support from friends, family, and others can make grief an easier burden to bear. When family and friends offer to help with funeral arrangements, prepare meals, care for your kids or clean your home, let them. It can be overwhelming to do these things right after a loss. Not having to worry about these responsibilities can free you to focus on coping with your grief.

TIP #2 – VERBALIZE HOW YOU FEEL AND STAY IN TOUCH WITH WHAT YOU ARE THINKING

Don’t hold your feelings in after a loss. Most people are more than willing to lend an ear to friends who need to talk about a loss. Share your feelings with family, friends or religious leaders. You can also try bereavement support groups, which provide an opportunity to share your sadness with others who are also going through a loss and can relate to your feelings.

TIP #3 – FOCUS ON YOUR FEELINGS AND MAKE SURE YOU ARE FEELING GOOD.

It is important to take good care of yourself when you are grieving — even though that can be especially hard. Here are some tips:

Focus on sleep. Make sure you are getting enough sleep. Try to stick to a sleep schedule. If you are having difficulty falling or staying asleep, talk to your doctor.

Stick to a healthy diet. When you’re grieving the death of a loved one or a divorce – you might have trouble making good decisions. Suddenly, what to eat becomes another hard decision. Your emotionally drained already and don’t want to think about it, so you opt out of eating altogether or you make the most comforting decision, which is to gulp down an unhealthy meal of donuts and French fries. High carb meals can sap your energy and lead to blood sugar ups and downs that lead you to feel even worse.

Stay active. Grief can cause you to want to do nothing more than lay on the couch with a spoon and a tub of Ben & Jerry’s Ice Cream. Exercise can help you stay healthy during this tough time in your life. Plus, going to the gym is a great way to meet friends and take your mind off your pain.

TIP #4 – KEEP GOOD THOUGHTS IN YOUR MIND

If you are feeling bad, chances are you are thinking bad. If you want to feel better, think happier, more gratifying thoughts on purpose. At times it may me difficult to muster positive thoughts. In fact, one of the symptoms of depression is anhedonia: the lack of pleasure in previously pleasurable things. And during this time if there are bad things in your life, or you are no longer finding pleasure in the things you used to, you may have to practice a little bit. You may have to conscientiously try hard to think positive thoughts. You may have to remind yourself to think them regularly. Go ahead - take stock. What do you have going for you right now? Even if it is just getting out of bed and making your bed and washing your body, that is a good start. Get some modest exercise and eat some good food - and then really pat yourself on the back for it! More good thoughts will come with practice.

TIP #5 – SEEK PROFESSIONAL GRIEF COUNSELING

Even if you are grieving normally and are not experiencing the pain of prolonged or complicated grief, getting counseling can help you cope. A therapist can promote a healthy healing process by assisting you with working through tough emotions. Also, do not let access be a problem for you….online counseling is a good thing if you do not have direct access. It is only a short walk through the google park that can yield several online groups that can help you feel like you are not alone. Grief can cause loneliness and the last thing you need right now is to be isolated. Take our advice: Find some people to talk with. Online groups are just an easy way to get started.

TREATMENT FOR COMPLICATED GRIEF AND LOSS

So, what kind of treatment is available for grief and loss?

• Psychotherapy. Complicated grief psychotherapy may be used to treat persistent complicated grief disorder. This therapy is similar to techniques used to treat other mental health issues like anxiety and depression. However, it is specifically for complicated grief. Complicated grief psychotherapy may be done in a group format or individually.

• Medications. There is little evidence to support the use of medications to treat grief. However, anti-depressants may be helpful to treat depression, which can sometimes occur with a bereavement disorder. Especially if things have gotten so bad they are having a deleterious effect on your health, family or career. Research shows medications combined with psychotherapy provided by a licensed clinician is the fastest way of helping.

• Do not neglect alternative methods to treat these negative feelings. Spending time with an animal. Taking a break from work. Taking some time off to vacation. Get a change of pace, a change of scenery or some new support systems and friend. Be kind to yourself and you will feel better.

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REFERENCES

1. Scientific American. (2018, May). Why We Need to Take Pet Loss Seriously. Retrieved April 10th, 2019, from https://www.scientificamerican.com/article/why-we-need-to-take-pet-loss-seriously/

2. Mayo Clinic. (2017, April). Complicated Grief. Retrieved April 10th, 2019, from https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374

3. Scientific American. (2018, November). Five Fallacies of Grief: Debunking Psychological Stages.  Retrieved April 10th, 2019, from https://www.scientificamerican.com/article/five-fallacies-of-grief/

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