The facts about grief

·       How does grief happen
·       What is grief
·       Factors which determine the grief response
·       Stages of grief
·       Anticipatory grief
·       The tasks of grieving
·       How to recognise grief - common manifestations
·       Similarities between grief and depression
·       How to distinguish grief from depression
·       Getting a correct diagnosis
·       Dealing with your loss

How does grief happen

A bond forms when we become attached (or form close relationships) to objects (people, things or animals). However, this bond is broken when the object is lost, for example by death. The loss may produce an internal feeling of loss which may lead to the painful experience known as grief. Grief is not limited to death, but can be the result of two types of loss: actual and symbolic.

Actual losses are those which are tangible such as the loss of an existing relationship or job or the destruction of existing life patterns.
Symbolic losses may include, for example, the loss of a of a dream or future potential (Macnab, Dr. F. (2000). Traumas of Life & their Treatment: Spectrum Publications, Melbourne.)

What is grief

Grief is the feeling we experience that may follow loss and/or death ie the emotional pain. (Mourning is the process by which grief is resolved.)

Grief is a sign that it is difficult or distressing to adapt to the loss and any necessary changes the loss brings. However, a short period of grief is normal as we readjust, especially where the object has been significant.

Grief is an active process which goes through several stages (see below).

Chronic grief is that which endures over a longer period (eg many years) and does not relent.

Grief can be a form of debt we owe to the lost object.

Grief is a unique response to loss, depending on the individual.

Factors which determine the grief response

Many factors can determine the way one responds to a loss. For instance, the significance of the loss or the context can make a big difference. For example, the death of a very close family member caused by a tragic unexpected road accident, will usually have a more shocking effect than a peaceful, expected death, at the end of a long life. The latter may, however, still have an effect and these feelings should not be dismissed.

Other factors include:
History of loss,
Thoughts, expectations, beliefs, values and attitudes
Cultural norms
Lifestyle, eg isolation vs support
Personality traits, eg positive vs negative
Health eg. a history of depression.

Stages of Grief

Grief is a unique experience and therefore, there is no set pattern. However, various models of grief have been proposed. Grief has several stages or phases which do not necessarily follow a strict order and vary greatly from person to person. The stages can also be repetitive, that is, a person may fluctuate between feeling better and then feeling sad again. The following order is only a guide (Weber, Z.A. (2001) Good Grief. Double Bay: Margaret Gee).

The initial stage: experiencing the loss eg shock, numbness, disbelief.
This stage generally lasts for several weeks.

The intermediate stage: active grieving eg crying, despair, pain, sorrow, disorganisation, intense searching and yearning.
This stage often lasts for approximately two to twelve months' duration.

The final stage: re-establishment eg recovery, reorganisation, reinvestment in a new interest.
The duration of this stage is approximately one to three years.

Note: The duration of each stage is only an approximation since grief is unique. However, a much longer duration may indicate chronic grief which should be addressed.

Each stage of grief has a purpose.
Stage one prevents the person being overwhelmed by the pain/sorrow and allows time to develop coping mechanisms to deal with the loss.
Stage two is the expression of grief.
Stage three is the acceptance of the new reality.

Anticipatory grief

This is grief expressed in advance of a loss which is seen as inevitable, for instance, with an aged person or pet or when a terminal diagnosis has been made. When death occurs, much of the grief may have already been expended.

The tasks of grieving

There are four tasks of grief according to J. William Worden (1991) (cited in Weber, Z.A. (2001) Good Grief . Double Bay: Margaret Gee) which include:

Acceptance of the loss.

Working through the emotions of grief.

Adjusting to the new environment.

Reinvesting emotional energy in new relationships.

How to recognise grief - Common Manifestations:

Because it is unique, grief can be expressed in many different ways. There are four main categories: our feelings, thoughts, behaviour and physical well being. The following list of examples is by no means comprehensive and there may be many other responses. Everyone's response is different and should be respected.

1. Feelings
Common emotions may range from shock, numbness, horror, sadness, devastation, exhausted, worry, anxiety, depression, loneliness, hopelessness, feeling suicidal, shame, betrayal and even relief (this is often followed by guilt).

2. Thoughts
The range of thoughts or cognitions include disbelief, confusion, forgetfulness, self-blame, memory loss, hallucinations, obsessions, ideas of suicide, pre-occupation with lost object, dreams, nightmares & disillusionment with our view of the world.

3. Behaviour
This may include being agitated, angry, crying, social withdrawal, inappropriate joking, lethargy, sleep walking, hyper-activity, eating and drinking alcohol to excess, taking drugs, lack of personal care, taking risks.

4. Physical Signs & Symptoms
Perspiring, vomiting, dry mouth, shortness of breath, fainting, headache, shaking, insomnia, loss of appetite, fatigue and exhaustion.

Similarities between Grief and Depression

It is important to distinguish between grief and depression. The symptoms of grief may resemble those of depression (particularly sleep problems, fatigue, irritability, crying for no reason, lack of concentration, loss of appetite, or diminished interest in the world). Therefore, a person's insomnia may be due to grief rather than depression. However, there are distinct differences.

How to distinguish grief from depression

Depression :
Usually with depression, one's mood is "pervasive and unremitting". That is, one feels continually 'down' or depressed in most situations. If there are "mood fluctuations, they are relatively minor" (Kaplan, H.I. & Sadock, B.J. (1998). Synopsis of Psychiatry, Lippincott, Williams & Wilkins, U.S.A.).
There is a feeling of hopelessness and the person cannot imagine feeling better. Shame and guilt are common in depression as are feelings of self-hatred and worthlessness. Depressed people threaten suicide more often than bereaved persons, who (except for physically dependent and older persons) usually do not wish to die even if they feel life is unbearable. People who have a history of depression are at risk of further depression at times of major loss (Kaplan, H.I. & Sadock, B.J. (1998). Synopsis of Psychiatry, Lippincott, Williams & Wilkins, U.S.A.).

Grief:
By comparison, fluctuations in grief are common. Grief is often described as coming in "waves washing over them and then subsiding" (Kaplan, H.I. & Sadock, B.J.(1998) Synopsis of Psychiatry, Lippincott, Williams & Wilkins, U.S.A.). Even in intense grief, moments of light-heartedness and happy reminiscence are possible (eg laughing over what the cat used to do before its demise). Shame and guilt are usually related to not having done enough for the deceased, or surviving, rather than a fundamental belief of worth-lessness as in depression. (Kaplan, H.I. & Sadock, B.J.(1998) Synopsis of Psychiatry, Lippincott, Williams & Wilkins, U.S.A.).

Getting a correct diagnosis

Grief can lead to depression and can even co-exist with depression; but grief is sometimes overlooked as the root cause. Many types of loss can lead to grief - death is not the only reason for grief. Therefore you may have disregarded loss as the cause of your depression and what you may be experiencing is a combination of grief and depression.

Therefore, to get an accurate diagnosis, it is important to see your doctor and tell them of any events which may be contributing factors to your symptoms, even if they seem unrelated and may have been dismissed by you as unimportant, due to the passage of time. For instance, a recent or past loss or anniversary of a loss or traumatic event may be the trigger. This may not have been thoroughly resolved and even overlooked by you.

Dealing with your loss

It is important that grief is dealt with as soon as possible as further loss compounds the grief even more and can lead to severe depression. Speak to someone about your loss and feelings of grief – a psychologist or a well-qualified grief counsellor. It may be difficult and ineffective with a friend who perhaps does not understand how you feel, or a family member who is also grieving. Grief needs to be addressed, no matter what the cause. There is no shame in grief counselling; it really can alleviate the pain of loss. Look for a qualified professional.

The aims of counselling are: