Grief & Loss

Grief is a natural response that occurs after the death of a loved one, friend, or pet. It can also occur as a response to having been diagnosed with a terminal illness and as a response to any significant loss in a person’s life. Some organizations use an extended definition of grief, defining it as “conflicting feelings caused by the end of or change in a familiar pattern of behavior.”

Grief is an experience that is both universal and extremely personal. People across all cultures grieve, and each person has a different emotional response and manner of processing a bereavement. While grief is considered a normal, healthy response, many people need support as they go through the grieving process.

Examples of Loss That May Trigger Grief

Since grief is a highly personal experience, some people may enter a state of grief as a response to losses or experiences that may not cause grief in another person. Experts have identified more than 40 life experiences that may result in the development of grief. These experiences were identified by psychiatrists Richard Rahe and Thomas Holmes. Together, they created what became known as the Homes-Rahe Stress Scale. It identifies 43 events that may provoke a stress or grief response. The experiences are categorized according to the severity of the stress they are likely to cause, and both negative and seemingly positive experiences are included.

Examples of some of these negative experiences include divorce, the death of close family member or friend, and personal illness or injury. Grief may also develop due to a change in the health status of a family member, including getting a diagnosis of cancer or experiencing a medical emergency. Interestingly, seemingly positive events that can provoke a stress or grief response in certain individuals include marriage, the birth of a child, retirement, vacations, and holidays. Patients may also experience depression, stress, or grief after the loss of a job, an experience of financial difficulties, a move to a new school or residence, and arguments with family or friends.

In addition to events that they have personally experienced, some individuals may enter the grieving process as a result of events in which they were not directly involved. For example, psychiatrists treat numerous patients who are struggling to cope after violence or a natural disaster occurs in their community or state, and some patients feel a sense of deep, personal loss after tragic events occur in distant countries.

Symptoms of Grief

The grieving process can produce a variety of physical and emotional symptoms that may have dramatic and disruptive impacts. Physical symptoms of grief are typically the most unexpected. For some individuals, the physical manifestation of grief can include fatigue and exhaustion, and there may also be sleep difficulties or a fear of going to sleep. Others may find that they feel restless and are unable to sit still. Some patients may engage in comfort eating or overeating while others have no appetite. Patients can experience breathing difficulties, sometimes as a result of panic or anxiety attacks. Many individuals report vague aches and pains, including headaches, back pain, chest pain, and pain in the neck and ribs. It is common for many people who are grieving to have difficulty concentrating and making decisions, and some may also experience memory problems and forgetfulness. Patients may experience dizziness that is accompanied by heart palpitations or an increased heart rate; this can occasionally be accompanied by feelings of nausea.

The emotional symptoms experienced during the grieving process may include a feeling of shock or numbness, even in cases where a death or loss was expected. Patients may also feel anger and guilt, perhaps feeling that they could have done something differently or feeling angry at their deceased relative or friend for leaving them on their own. People often feel an extreme sadness that some have described as physical pain, and they may also experience an intense longing or dream about those that they have lost. Some people may feel a sense of relief, and this may also be accompanied by guilt. Certain individuals who have experienced the death of a loved one from cancer or another illness may become extremely anxious that they also have the disease themselves.

When to See a Doctor

While it is normal for the grieving process to take months or years, individuals who are going through this process should be vigilant for signs and symptoms indicating that they need extra support. Left untreated or prolonged, the grieving process can result in depression or disorders known as complicated or prolonged grief disorders.

Patients who have experienced a loss and notice that they have thoughts of suicide should seek urgent professional help from a licensed therapist. If they feel that they may be in danger of acting on these thoughts, patients should go to the nearest emergency room. Other symptoms that indicate a need for professional help include ongoing guilt and a persistent feeling of worthlessness, a symptom that is strongly associated with depression and is not considered a healthy part of the grieving process. Patients should also make an appointment with their physician or a licensed therapist if they have persistent difficulty functioning in terms of daily tasks or if they consistently feel either physically or mentally sluggish. While occasional hallucinations, including thinking that one hears or sees the deceased person, are considered normal after a loss, patients should get in touch with their doctor if they have hallucinations of other things on a more-than-occasional basis.

Other symptoms that indicate the possibility of a grieving disorder that merits professional attention include a constant, painful yearning for a deceased loved one, an inability to accept the death as real, a sense of being detached from others, and frequent nightmares. Psychiatric help should be sought if an individual experiences a persistent and desperate sense of loneliness, helplessness, bitterness, or anger. In particular, patients who have intrusive and upsetting memories and thoughts of the deceased individual often need professional help to overcome these.

Diagnosis of Grieving Disorders and Major Depression

While grieving disorders and major depression are related, there are some distinctions that doctors use to reach a correct diagnosis and begin the most effective treatment. To receive a proper diagnosis, patients typically visit their primary care doctor first to undergo a complete medical examination. This exam provides valuable information about the physical symptoms that a person may be experiencing during the grieving process. Since grieving can adversely affect the heart and occasionally result in “broken heart syndrome,” doctors pay particular attention to cardiac function during the medical exam. The doctor will check the patient’s blood pressure and listen to the heart with a stethoscope to identify any murmurs, palpitations, or other abnormalities. Patients will have their weight checked, and they will be asked about their eating and sleeping habits. At the conclusion of the medical exam, the doctor may recommend follow-up tests or appointments, or the patient may be referred for psychological counseling. Patients may be started on medications for depression, anxiety, and other symptoms.

Pharmacological Therapies for Grieving and Clinical Depression

Patients who are struggling with the grieving process, including those who have been diagnosed with a grieving disorder or with clinical depression, may be prescribed medication to help with symptom management. Some of the most commonly prescribed medications are selective serotonin reuptake inhibitors or SSRIs. These are a newer type of antidepressant medication, and they include drugs such as paroxetine, fluoxetine, citalopram, sertraline, and escitalopram. These drugs are commonly known as Paxil, Prozac, Celexa, Zoloft, Lexapro. These medications work by increasing the levels of serotonin in the brain.

The majority of patients who take SSRIs tolerate them well and report few side effects. Potential side effects that may occur include dry mouth, nausea, insomnia, agitation, dizziness, headaches, and blurry vision. Some patients may also experience diarrhea. Patients taking SSRIs should report any side effects to their health care providers, and they should be followed closely by their medical team. If bothersome side effects occur, patients can often be switched to another type of SSRI or another form of antidepressant.

Psychological Therapies for Grieving and Depression

Psychological therapies are often used either alone or in combination with medication for the treatment of grieving and depression. A specific type of psychotherapy known as complicated grief therapy is particularly effective for those who have experienced a bereavement. This therapeutic technique is a combination of traditional counseling techniques that are used for the treatment of post-traumatic stress disorder and clinical depression. Patients can have this form of counseling in individual sessions, and it is also practiced in group therapy sessions and community bereavement support groups.

During therapy sessions, patients explore their experiences with bereavement, learning to process their thoughts and emotions. Therapists help the patient redefine his or her life goals and adjust to a loss. During a therapy session, the therapist may encourage the patient to have an imaginary conversation with their deceased loved one. In retelling the circumstances surrounding the deceased’s death, this activity helps the patient reduce the distress he or she may feel from looking at pictures of or thinking about the deceased individual.

Therapy teaches the patient to use healthy coping mechanisms in response to anxiety or other stressors that may have been triggered by bereavement. One of the major aims of the therapy process is to enable the patient to reduce his or her feelings of guilt and blame about the loss.

Helping a Grieving Friend or Loved One

Support from family and friends is very beneficial in helping a person through the grieving process. Yet, it can be very difficult for family and friends to know what to say or do after a loss in the life of someone close to them. Experts say that the most important thing a friend or family member can do for someone who is grieving is to be present. This can be in person, on the phone, or by text, email, or video chat. If you live far away or cannot attend the funeral, send a heartfelt sympathy card. Some people like to include a spiritual or self-help book with the card, perhaps one that has helped the sender through his or her own grieving. In particular, sharing your memories of the deceased can be meaningful for your friend or loved one, especially if you have any memories of the person that may be new for your friend.

Sharing your stories of similar bereavements can be a comfort to a grieving person as well. These stories can help a person realize that the grieving process doesn’t continue indefinitely and that he or she will survive it and experience joy again. If you have any photographs of the deceased individual, save these to give to your grieving friend at a later date after the funeral. Since people are often inundated with flowers and food immediately after a loss, consider sending your loved one flowers or bringing a meal several months after the funeral; this gesture will help them know that they are still remembered and supported. Make a note of important anniversaries, including the deceased’s birthday and date of death, and reach out to your friend in a special way on these dates.

Bereaved friends and loved ones often appreciate help with the practical details of a death, too. For example, you could offer to go with a person to sign the death certificate and offer to help in any way possible with the funeral, including driving your friend to and from the service, reading a poem at the service, or bringing food for the gathering after the funeral. Sometimes, it may also be helpful to offer to assist with the preparation of the obituary.

In supporting your friend, take note of any signs that indicate he or she may need professional help to get through the grieving process. You might offer to attend a bereavement support group with your friend or attend appointments with a mental health professional.

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