Dealing with grief and bereavement

Grief will be with many of us this holiday season. If you’re over age 40, there’s a 1-in-3 chance that a close relative or friend of yours died in the last year. Or you may be among the 1 million Americans who lost a spouse. Still, in an era when the media seem to tout the wisdom of “closure” within days of any tragedy, it’s easy to feel abnormal when confronted with the long, painful, and messy process of adapting to a death.

Healthy grieving can be a slow, difficult process that lasts for months or years. And although you may gradually be able to refocus your life, you’ll probably never “get over it” or stop thinking about the person who died.

Initially, a person may feel shock and numbness as the reality of the death sinks in. Yet during that time, he or she may seem to be handling things well and may be quite competent in managing the funeral and legal matters. Later, feelings of sadness, distress, anger, and guilt may become more prominent.

To others, a grieving person may seem irritable, disorganized, or restless. Rather than “moving on,” the person often seems worse and less able to function several months after a death than he or she did during the first weeks. That’s one reason ongoing practical help and emotional support from friends is so important.

If a person feels stuck and months go by with no improvement, however slow or painful, it could be a sign of complicated grief. Complicated grief is not a mental illness; it’s the term mental health professionals use when grieving has proved to be particularly difficult and the bereaved person could benefit from professional attention.

Signs of complicated grief include an inability to accept that death has occurred; frequent nightmares and intrusive memories; withdrawal from social contact; and constant yearning for the deceased. Complicated grief is more common after a suicide or other traumatic death.

It’s important to distinguish feeling down or depressed from true clinical depression that requires treatment. A professional can help make this determination. He or she will assess whether someone is unable to cope with everyday activities and is showing symptoms not explained by grief. These include constant feelings of worthlessness and hopelessness, continual thoughts of death, suicidal thoughts, uncontrolled crying, delusions, and slowed thinking and physical responses.

In the year after a spouse’s death, 50% of widows develop depression. Treatment may involve medication, psychotherapy, or both. Medication does not take away grief, but rather helps a grieving person preserve the emotional energy needed to cope with feelings.

For many of the bereaved, recognizing and expressing the strong emotions associated with grief is an integral part of healing. To that end, they may want to write about their feelings, talk to friends or a spiritual adviser, see a therapist, or join a support group. Under Medicare hospice programs, bereavement counseling is available for up to a year after the death. Other things that can help:

• Group support. Relatives and friends often can’t understand what a grieving person is going through. People often find uniquely helpful support in discussing their loss with others in a similar situation.
  
  Bereavement support groups may be general or may focus on a particular disease or type of relationship. They’re not meant to be psychotherapy, although some are led by professionals. Some are ongoing; others are time-limited. A local hospice, hospital, or community organization may be able to guide you to a group that is capably led and seems like a good fit.
• Individual therapy. You may not be comfortable speaking in a group setting. Perhaps your relationship with the deceased was troubled, and you have difficulty talking about it. Or you wish to address unresolved issues from your past that a recent death has brought to the fore. In that case, working with a therapist one-on-one may be easier.
• No pressure to talk. At the same time, new research suggests that people who find it difficult to disclose their feelings shouldn’t be pressured to do so. In two European studies that followed widows and widowers for two years, neither talking nor writing about the loss reduced distress. (Journal of Consulting and Clinical Psychology, February 2002.)

Help for the holidays

Some people who are grieving find it reassuring to participate in holiday activities as usual. Others may find it too painful to do so. Here are a few ideas to help you through the holiday season, however you choose to observe it.

Build on tradition. For the holiday meal, place a lighted candle on the table in honor of the deceased; include one of his or her favorite foods. Create a memorial ornament or decoration. If the person who has died always played a special role in holiday festivities, formally ask another family member to carry on the tradition.

If tradition is too painful, change the way you celebrate. Instead of putting up a Christmas tree indoors, decorate an outdoor tree with lights and food items for the birds. Go out for dinner with friends or family instead of trying to have a crowd in for a holiday meal. Instead of staying at home, where memories may be strongest, take a holiday trip.

Do something for others. Volunteer to help others, through your place of worship or a charity. Invite someone who is alone during the holiday to join you and your family for a meal, a religious service, or an activity such as a concert. Make a donation to a favorite cause in memory of the deceased.

Help yourself adjust. Let others know that you might not participate in all the usual festivities. For example, you may feel like attending a religious service, but not the gathering that follows. Feel free to change plans at the last minute. Cry if you need to. Let others know if it’s OK for them to share their memories of the deceased with you.

The physical side of grief

Grief is physical as well as emotional. After a death, you may lose your appetite or have trouble sleeping. Other symptoms include abdominal or chest pain, headache, fatigue, heart palpitations, dizziness, and muscle tension.

Bereavement can also have subtler effects on health. Recently widowed women show reduced activity of natural killer cells (cells that attack viruses and tumors) and higher levels of the stress hormone cortisol compared with women whose husbands are still alive. Persistently elevated levels of stress hormones can reduce immunity, raise blood pressure and cholesterol, and induce abnormal heart rhythms.

In addition, some people are too upset to follow their usual diet, exercise, and medication regimens in the months following a death. All this can lead to a decline in health and an increased risk of death — particularly from heart disease — in the year or two following a loss.

If you think you’re experiencing grief-related physical symptoms, your clinician can help determine whether a medical workup is warranted and may be able to help you find emotional as well as medical support. She or he may prescribe medication for insomnia or anxiety and will monitor its use to prevent drug tolerance or dependency.

December 2003 Update

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