Understanding Grief and Loss Following Death

Grief is a normal reaction to the death of a loved one and affects individuals differently. This publication lists feelings, physical symptoms and thought processes commonly associated with this grief and discusses how different genders and ages handle grief. It also discusses ways to help a grieving person.

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MARTHA IS HAVING DIFFICULTY SLEEPING LATELY

and no longer enjoys doing things with her friends. A month ago, Martha lost her husband of 26 years to cancer.

Wayne has trouble concentrating. He feels angry and on edge. Wayne’s 20-year-old son died in an auto accident nine months ago.

Both of these individuals are experiencing grief. Grief is a natural emotion in all types of losses or significant change. Grief uses both physical and emotional energy. In the loss of a loved one, an individual may grieve not only the physical loss of the loved one, but also the hopes, dreams, needs and expectations shared with that person. People grieve not only what is lost in the present but also what is lost for the future.

The grief reaction individuals experience is unique and personal. There is a broad range of feelings and behaviors commonly experienced after the death of a loved one. Individual reactions vary in intensity, duration and processing of grief symptoms, depending on whom or what was lost. An individual may experience one or many of the following reactions.

Emotional Reactions

Sadness. This is the most common, and it is not necessarily expressed by crying.

Anger. This is one of the most confusing feelings for a survivor as it often seems inconsistent with feeling sad. The person may feel anger at not being able to prevent the death, anger at the deceased for leaving, anger at a higher power. Anger can range from frustation to intense outbursts and may become problematic if misdirected to someone else in the person's life or to oneself.

Anxiety. This can range from slight insecurity to panic attacks. For example, an individual may fear that he or she won’t be able to care for themself, or the individual might experience a heightened awareness of his/her own mortality.

Numbness. Especially when the loss is recent, feelings can be so overwhelming that an individual functions on “auto-pilot” to perform the expected daily tasks.

Shock. When death is sudden, shock is normal. But even when death occurs after a long illness, the caregiver may experience shock when death occurs.

Physical Reactions

Fatigue. There is an overall sense of feeling tired. Experiencing loss is physically draining and the surviving        loved one can have a feeling of weariness and low-energy.

Cardiovascular and gastrointestinal problems. Studies find that after a loss of a loved one, problems may occur.

Crying. This is a common reaction to grief. Crying may occur suddenly and at unexpected times.

Illness. Grief can suppress the body’s immune system, or aggravate existing medical conditions.

Sleeping Patterns. Sleep can be disrupted either by insomnia or over-sleeping.

Perception. Individuals may experience distorted perception of time.

Cognitive Reactions

Guilt and self-reproach. Guilt feelings may contain issues of believing that the survivor was not kind enough or caring enough of the person who died, or that the person should have seen the doctor sooner. Most often the guilt is irrational.

Helplessness. For the husband whose wife cooked for 30 years, learning how to use the microwave can be overwhelming. For the wife whose husband was the handyman, figuring out how to fix a leaking faucet is

intimidating. For the child who lost a parent, a range of insecurities may surface with the loss. He or she may be fearful of doing daily activities, fearful that something bad might happen to him/her.

Loneliness. Throughout the day, there are reminders that the partner, family member or friend is no longer

present. For example, meals are no longer prepared the same way, phone calls to share a special moment don’t happen, and even simple chores during the day are a reminder that the individual is no longer there.

Relief. There is a broad range of reasons why an individual may feel relief after someone close dies. It may be a relief for the symptoms an individual experienced if some one had a painful disease. For the caregiver who is exhausted, it may be relief that their responsibility is completed.

All of these emotions, thoughts and physical reactions are normal to experience and may last for a period of time.

Stages of Grief

Elisabeth Kübler-Ross’s five "stages of grief" have been widely used for the past 40 years. According to Kübler- Ross, when individuals grieve they go through a process of stages in the following order:

• Denial – the individual can’t believe the death is happening.
• Anger – the denial changes to anger over the death and how the situation is unfair.
• Bargaining – this stage involves the individual bargaining generally with a higher power to try and change the situation.
• Depression – is the fourth stage where the individual recognizes the death but becomes so sad that he/she does not see the reason to continue to go on.
• Acceptance – the final stage is when the individual accepts what has happened and begins to move on with life.

Although Kubler-Ross’s stages are used in understanding the process of grief, it is important to know that grief may continue for a considerable amount of time. It may take years to resolve a meaningful and loving relationship. Many people describe the grief experience as a roller coaster of ups and downs that is intense initially and gradually lessens as time passes. A wide range of intense feelings may be experienced in the first year, and then gradually diminish. It is not unusual for a bereaved person to experience episodes of intense feelings from time to time, especially at holidays, birthdays, anniversaries, and other important dates that were in the relationship.

Behavior Changes as the Result of Grief

The impact of the death may cause a change in behavior. Whether the death is sudden or expected, it forces an adjustment to live without that relationship.

The behavioral expressions of grief that are often experienced may include:

• Sleep disturbance – this can include either trouble sleeping or a desire to sleep all the time.
• Appetite change – either an increase or decrease.
• Absent-minded behavior – forgetting small things such as finding the car keys.
• Social withdrawal – turning down opportunities to be with friends or family.
• Anxieties – fearful of being in a crowded situation or fearful of being alone.
• Dreaming of the person who died – the dreams may relate to good times with the deceased or a reliving or imagining of the death.
• Searching – trying to find “the reason” the person died.
• Restless over-activity – attempting to fill the void through constant activity.
• Crying – this is a normal part of the grieving process. However, if one cannot control emotions after a period of time, seeking help from a therapist is important.

These behavior changes are common during the initial grieving period but can also emerge at times when the grief resurfaces on the special occasions previously mentioned. When this occurs, try to remember that grief is a process and be patient.

Complicated Grief

Sometimes grief can become so overwhelming that a person has a hard time getting through the day after a typical grief period. The person seems to be “stuck” and unable to move forward with life. Often this type of grief occurs when there has been a sudden unexpected or violent death. This is called complicated grief. If this occurs, an individual would be wise to seek professional help. Trained therapists can help the person process the grief and move beyond intense emotions.

Gender Differences in the Grieving Process

Men and women often experience the grieving process differently, as we are socialized differently in our society. Although this is changing, the idea that “men don’t cry,” still exists. Men have a tendency to want to solve the problem and become more active in work and leisure activities when grieving. They are less likely to reach out and talk to others and express their grief openly. They are more likely to share their sorrows and fears with their wives and not friends. They are more likely to take action than express grief. For example, men are more likely than women to return to work after the loss of a spouse, and then remarry. They are also more likely to turn to destructive or avoidance behaviors, such as alcohol abuse.

Women are more likely to be expressive in their grief and accept the support of others. In addition to their spouse, women tend to have more outlets and support as they go through grief. They are more likely to reach out to others. Women are more likely to attend grief support groups than men. Women often have fewer health consequences after losing a spouse than do men.

Knowing that there are some differences in how men and women grieve may assist a family as the members work through the grieving process. Perhaps men and women can learn from each other that expressing emotion, seeking support from others, and taking action to return to routines are all helpful in the grieving process.

Children and Grief

Society today tends to shield children from death. The process of caregiving ends in the home or hospital, then a funeral home or morgue takes over. During this time, children need age-appropriate explanations, and to be given the opportunity to grieve.

Children express their grief differently than adults due to children’s limited cognitive development. Young children do not understand what causes death or that it cannot be reversed. Children begin to understand the idea of death between ages three and four, but it is not until they reach age nine or 10 that they understand the permanency of death and that death is inevitable for all living things.

Children are often confused about grief. They may not understand why they feel sad, have no appetite, or cannot sleep. The result is that they often misbehave because of their confusion. Parents and other adults can help children better understand the grief process with the following ideas.

• Prepare children for the reality of death by discussing deaths on television, in movies or books.
• Use the death of animals or pets as opportunities to introduce the concept of death.
• Avoid using vague terms such as “she went away” or “Grandpa is sleeping now.”
• Understand that the disruptions caused by grief will confuse children.
• Be patient if a child regresses to an earlier behavior during grief such as thumb sucking, wetting the bed, or sleep-walking.
• Understand that children may ask the same questions over and over.
• Reassure children that the loss is not their fault – children may feel guilty believing that something they did caused the death.
• Be aware that young children cannot understand that the grief will become easier because they do not  understand the future.
• Be clear and honest about death in answering children’s questions.
• Talk to children at a level that is appropriate for their development – a very young child will not be able to understand death in the same way a teenager will.
• Allow children to attend funerals if they wish.
• Prepare children about what will happen and what they will see at the funeral.
• Model appropriate grieving by allowing the child to see you cry and express your sadness.
• Preserve the memory of the deceased by sharing stories about him/her.

Grief will be experienced by every family member, regardless of his or her age. It is important for adults to understand that children grieve and that they look to adults for guidance. How a parent or other adult handles grief impacts how children are able to cope.

Helping Others Experiencing Grief

Individuals often have a difficult time when a friend, loved one, or coworker is experiencing grief – how can they help? Understanding that grief is expressed through a variety of behaviors is useful. Reach out to others in their grief; however, understand that there will be various reactions. Some may not want to accept help and will not share their grief. Others will want to talk about their thoughts and feelings or reminisce. Be patient and let the grieving person know that others care and are there to support him or her. If the individual becomes despondent to a point where there is concern for his or her safety or the safety of others, contact a mental health professional, medical doctor or emergency personnel immediately.

Conclusion

Grief is a normal reaction to a death and affects individuals differently. Both young and old experience grief when they have a loss through death. Be understanding of others as they work through their grief. If you are experiencing grief, be gentle and patient with yourself. Do not try to rush the process; there is no specific timeline for grief. Feelings of loss may never totally disappear; however, over time it becomes manageable. It can be helpful to talk through your grief with a professional counselor. Counseling is a place where you can talk to someone about what you are feeling and thinking with no judgment. If grief becomes overwhelming and you cannot continue with normal activities, you should seek counseling immediately.

References

Harvard Medical School Family Health Guide: Complicated Grief. http://www.health.harvard.edu/fhg/updates/ Complicated-grief.shtml

Kübler-Ross, E. 1969. On Death and Dying. New York: Macmillian

Mayo Clinic: Complicated Grief. http://www.mayoclinic.com/health/complicated-grief/DS01023

Mayo Clinic: Grief. http://www.mayoclinic.com/health/grief/MH00036

Late Life Depression Evaluation and Treatment Center. University of Pittsburgh Medical Center. http://www. wpic.pitt.edu/research/depr/grief.htm

PubMed Health: Grief. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002497/

Acknowledgements

We would like to thank the following individuals for reviewing this Montguide:

• Denise Seilstad, Fergus County Extension Agent
• Laurie Lautt, Big Horn County Extension Agent