Is This Grief or Something More?
The loss of a loved one is a difficult, emotionally-charged time and can be associated with a wide range of feelings and experiences that can feel like a roller coaster ride. Much of what you experience is the normal and expected response to loss, and allowing yourself to experience these emotions, which may not always be pleasant, can help you progress through the grieving process.
Grief is a normal response to loss. Grief following a death is called bereavement. It begins when a person learns that a loved one has a terminal illness. Grief experienced prior to death, either by the patient themselves or by their loved ones, is termed "anticipatory grief" and involves the mourning of things lost to the limited future. Family and friends are faced with the task of accepting and envisioning a future without their loved one. It is common for this experience to feel overwhelming at times, and it is common for those going through it to wonder if what they are feeling is normal or excessive. Normal grief is a process, the length of which is quite variable and partly dependent upon an individual's acceptance of their feelings and the need to work through the experience. Resistance to dealing with loss and its impact can prolong the grieving process.
Normal grief is commonly felt in waves, the intensity of which tends to diminish over time. These waves of grief can arrive without warning, or they can be triggered by things that remind you of your loved one. Objects, places, songs, smells, anniversaries, holidays, or anything that triggers a memory can lead to a sudden wave of emotion. One can expect "good days" and "bad days," with the proportion of good days increasing over time. Grief can be associated with transient sadness, physical and emotional fatigue, loneliness, longing for your loved one, crying, anxiety, loss of appetite, and sleep disturbances.
Complicated grief, which is also referred to as prolonged or pathologic grief, occurs in 10-20% of survivors and is defined by its persistent and debilitating nature. There is no strict time cutoff separating normal from prolonged grief, but six months after the loss, survivors should be able to accept the death as reality, be able to imagine a future without their loved one, and be exhibiting evidence of adapting to their new reality by engaging again in meaningful relationships and productive endeavors.
There are factors that increase one's risk for complicated grief. An excessively dependent relationship or obsessive caregiving behaviors increase the risk for complicated grief. Other factors include the loss of a child (even if the "child" is now an adult), an unexpected or traumatic death, and the death of a family matriarch or patriarch (even at a very old age). Loved ones who have been resistant to the possibility or reality that a terminal condition exists are also at risk for complicated grief. They may have lost the opportunity to begin accepting and processing the loss while their sick loved one was still alive and able to discuss issues of life and death to obtain some meaningful closure.
Common aspects of complicated grief include difficulty accepting the death, excessive anger or bitterness about the death, persistent intense yearning or longing for the deceased, overwhelming guilt, inability to be emotionally close to others since the death, and continued difficulty moving forward with normal life. In sum, complicated grief lasts longer and is more intense than normal grief, interfering more with the resumption of normal life.
Major depression is not an expected part of the normal grieving process. Loss of hope, inability to experience pleasure (anhedonia), lack of self-worth, or suicidal thoughts are flags for the development of depression, representing reasons to meet with your physician to determine if you are experiencing more than normal grief. If so, your doctor may offer tips for coping, refer you to a support group or a counselor, or discuss the initiation of medication to help you through this difficult time.
Other signs of depression can overlap with normal or complicated grief and include fatigue, lack of energy, difficulty concentrating, loss of weight or appetite, and difficulty sleeping or sleeping too much. Again, the frequency, intensity, and duration of these symptoms are generally what distinguish a normal grief response from more serious issues that warrant further discussion with a medical professional, spiritual leader or counselor.
—Dr. Glenn Golaszewski, Chief Medical Officer of Mountain Valley Hospice
Mountain Valley Hospice & Palliative Care offers free grief support to the community at large. For more info, contact us today at 336-789-2922 (toll-free 1-888-789-2922).
Tags: Grief Support