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
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
- 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
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
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
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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