| The following two articles describe the
process of dealing with grief and loss.
Overview
Normal feelings to expect after the death of a
loved one
Each person's reaction to the loss of a loved
one is different, and each person must work through grief in his or
her own way
There is no "right" or "wrong" way to feel after
someone dies
Most people who are very upset over someone's
death take months to get beyond the most severe emotional stress.
Grief beyond a year is common but may require help
Start with your family doctor
Symptoms indicating the need for professional
help
Information to have ready when you call for help
What to say when you call
Allow yourself to experience the pain of grief
Select a person to share your grief with
Find what works for you in returning to normal
routines
Read books or poetry on the subject
Keep a diary or journal
Encourage others to talk about the deceased
Talk out loud to the person who has died
Find out about a bereavement support group
"People say I should be over this."
"People give me advice that I don't want to
take."
"Nobody wants to talk about Dad when they're
around me."
Checking on results
If your plan does not work
Topics with an arrow ( )
in front of them are actions you can take or symptoms you can look for.
 The
information in this home care plan fits most situations, but yours may
be different.
If a
doctor, nurse, or counselor tells you to do something other than what is
recommended here, consider all of the information and apply what is
meaningful to your own needs.
Top
People who lose a friend or family member to
cancer face the same issues as anyone who experiences the death of a
loved one, whether by accident or illness. Your feelings and emotions
after someone's death can profoundly affect how you relate to others and
get through your daily routine. Depending on your personality, you may
find it helpful to confide your feelings to another person - sometimes a
friend is best, sometimes a family member, and sometimes a professional
such as a nurse, a counselor, or a member of the clergy. You may find
consolation through sharing or listening at a group - sharing session
involving others who have had a recent loss; such groups usually are led
by a counseling professional. On the other hand, if you have never been
open about your feelings, it is unlikely that you will suddenly change
now. Well-meaning people may insist that you must talk it out, but they
may not understand you, your past, or your methods of dealing with
life's difficult moments.
Each person must work through grief in his or her
own way - and it is work (even if not always of the physical kind).
Despite the existence of widely published "stages" of grief, each
survivor deals with loss as an individual, and the ways in which people
handle their loss vary widely. When you are struggling to deal with your
own loss, it is useless to worry about whether you are following
somebody else's timetable.
The range of reactions to someone else's death is
broad. Some people are devastated when it occurs, and others feel very
little emotion. Sometimes, people feel their grief only later, and some
people never have strong feelings. Different people also may experience
different emotions. They may feel guilt, remorse, sadness, or resentment
toward others, such as doctors, nurses, hospice workers, or even God.
Some people who lose a family member or close friend feel anger and ask
questions such as "Why did this happen to him (the one who died)?" and
"Why did this happen to me?" Anger also may reach back to events that
occurred during diagnosis and care, and you may ask, "Why didn't the
doctors find the cancer soon enough?" or, "Why did mother suffer so?"
You may think that you hear the deceased person's
voice calling to you, or you may want to have a conversation with that
person. You may experience flashbacks, such as remembering the funeral
or even the moment of death itself, for no apparent reason. In addition,
you may feel as if you are making progress but then suddenly feel worse,
and without knowing what triggered it. Although upsetting, these are
normal experiences for people who grieve.
Even if the illness was prolonged and you
anticipated the death of your loved one, you still may encounter both
shock and numbness in the same way as if the death had occurred
unexpectedly. During this time, which may last from only a few up to 6
weeks, you may experience a sense of "just going through the motions,"
as if you were in shock.
When this feeling of numbness and shock begins to
subside, you may feel as if you might be overcoming it - thinking "I'm
getting back to normal." Just then, however, you unexpectedly may
encounter a deeper sense of grief or sadness as reality sets in. When
this occurs, you may experience symptoms of grief like those of acute
depression - being unable to sleep soundly, losing your appetite, not
wanting to get up in the morning, or not wanting to be around other
people.
Whatever happens, understand that there is no
"right" or "wrong" way to feel after someone's death. Most people's
feelings, even if they seem extreme at the time, fall within a range of
normal reactions.
Most people who lose someone close to them
take months to get over the most severe part of their emotional
stress, and for most, it will take at least a year to work
through the grieving process. Counselors often consider how a
person is doing at the 1-year anniversary of the death as an
indicator of how well he or she has adjusted to the loss. Grief
that lasts beyond a year is common but may require help.
Remember that life will never again be exactly
the way it was before your loved one died. If you are expecting things
to "get back to normal" after awhile, you may be disappointed or
frustrated to find that the new "normal" is not like the old "normal."
Your life will go on, but - precisely because the person was
important to you - it will not be the same without him or her.
Your goals
Know when to get professional help with grief.
Understand that people handle loss with a wide
range of emotions, none of which is "right" or "wrong."
Grieve for your loss in your own way rather than
feeling that you should be the same as other people you have known or
read about.
Understand that most people who grieve return to
their daily routines in 2 to 4 months, but healing often takes a year or
longer. Each person's reactions are unique, so be wary of timetables
that others may try to force on you.
Top
The first question you should ask is whether you
need help from other people. If you do, an excellent place to start is
with your family doctor. He or she may help you directly or aid you in
finding the right group session, counselor, or clinic. You should seek
help if any of the following is true:
Continued
difficulty in sleeping.
If you are losing sleep or feel tired all the
time, the first place to go for help is your family doctor. A physician
who knows you and your medical history can make an informed decision
whether to prescribe medication and, if so, what kind.
Substantial
weight gain or loss.
Any substantial change in eating, such as loss of
all appetite or a sudden increase in appetite, may be the result of
emotional distress. Again, consult your family doctor first, because he
or she already knows you and can make an informed judgment about
treatment.
Prolonged
emotional distress.
If, after 6 months, you do not see a marked
improvement of your ability to function in daily life, you should
consider seeking help. It is natural to want to withdraw from others
after losing a loved one, but if you still cannot enjoy a reasonable
quality of life after 6 months, this is a signal that you may need help
working through your grief.
If you are
overcome by suicidal thoughts.
If suicidal thoughts become central to your
thinking and you are encountering them every day, seek help from your
family doctor, a counselor, member of the clergy, or a mental health
clinic.
Have the answers to the following questions ready when you call your
family doctor, counselor, or clinic:
1. How much does grief interfere with my
ability to do my job or normal daily activities?
2. Am I having difficulty sleeping?
3. Is my appetite gone, or do I eat
significantly more than before the person died?
4. Is suicide an option I would consider?
Here is an example of what someone might say when calling for help:
"I'm David Winters, son of Katherine Winters, who
died of cancer 6 months ago. Ever since my mother's death, I've been
very upset. I've also been having trouble sleeping through the night
since about 2 weeks after she died, and I never had trouble before. I
think I may need some help."
Top
You can do many things on your own to handle the
emotional stress of grief, and you can get help from others as well. You
may need one or both forms of help to successfully restore your sense of
well-being.
Allow yourself
to experience the pain of grief.
What this means is to work through your emotions
in the best way you can. If this means crying, screaming, talking to the
person who has died, or doing physical activity such as punching a
pillow or lifting weights, do that. To heal emotionally, many people
need to express their feelings. If you are embarrassed about crying in
front of other family members such as your children (whether younger or
adult), you may need to tell them: "It may be upsetting to you, but I
need to cry and express my feelings. I need to work through this grief."
Select a person
to share your grief with.
Find a good listener who has experienced a
similar loss, although it probably is best to choose someone who is not
grieving over the same person as you are. Someone outside of your
immediate family often is a good choice. You want someone who will let
you express yourself, not someone who will try to reason you out of your
feelings. Candidates might be a member of the clergy or a sympathetic
friend or coworker. Although you may expect family members to be
supportive, they most likely are burdened with that very same loss as
well. For example, if your spouse dies and you want to share with your
adult children, remember that they are grieving the loss of their
parent. As a result, they may be unable to give you the compassion you
need. In addition, it often is painful for an adult child to see a
parent grieving, and they may want you to "get over it" so that their
lives can return to some form of "normal."
Be aware that some people, even professionals
such as clergy, may not be personally prepared to deal with death -
perhaps because of their own grief over someone they have lost or
feelings about their own mortality. If you are unable to relate to one
person, find another. Many hospice programs offer a one-on-one
assignment of a bereavement volunteer to aid families after a death, one
of many programs typically extended by hospice to help with grief.
Others might include newsletters, a library of books about grieving, or
information about bereavement support groups.
Find what works
for you in returning to normal routines.
If certain activities such as reading or swimming
were relaxing for you before, try to pursue them now. See if that will
help you to get back to a normal cycle of living. For some people,
losing a loved one is so upsetting that they cannot resume these
activities until their grief subsides to some extent.
Read books or
poetry on the subject.
Many books, including those with first-person
accounts, about working through and overcoming grief are available at
your local public library. As with other techniques, however, this will
not help everyone. Some people will react by saying, "I have enough to
worry about without reading someone else's grief," while others will
find direction, a sense of what is normal to experience, and a feeling
of connection with others who have had this experience. Similarly,
reading poetry, whether alone or aloud in a group, can help by giving
artful expression to feelings that often are hard to express or even
identify.
Keep a diary or
journal.
Some people find it helpful and therapeutic to
write their thoughts and feelings in a diary as they proceed through the
process of grieving. The British author, critic, and novelist C.S. Lewis
(1898-1963), after losing his wife, kept a journal (A Grief Observed)
of how he was feeling. A private person for whom neither a support group
nor reading a book is helpful may find comfort in keeping such a
journal. Some people also find it helpful to write their feelings in a
letter to the person who has died, which can help to resolve unfinished
business or feelings.
Encourage
others to talk about the deceased.
Friends and family frequently avoid discussing
the deceased to avoid upsetting the person who is grieving. If you want
to talk about the person who has died, you should reassure others that
it is okay. All you have to do is say, "I'd like to talk about Dad."
Reassure your visitors that while you may cry or become upset, you would
rather do that than awkwardly skirt the subject, because he or she was
very important to you. Most people can accept your crying or being upset
if you are the one who brought up the subject.
Talk out loud
to the person who has died.
In much the same manner as the letter noted
earlier, it is not unreasonable to want to resolve issues with a person
who has died by holding a one-sided conversation, aloud, with the
deceased. Do this if it makes you feel better.
Find out about
a bereavement support group.
Bereavement support groups can help to make the
process of dealing with loss easier. Signing up for a bereavement
support group may be a difficult decision, however, because many people
think of their grief as something that is private. You may feel uneasy
talking with strangers about your feelings or your loved one. Keep in
mind, however, that such groups have helped many people get through
their grief and, therefore, may help you.
In a bereavement group, participants learn from
each other about normal reactions to grief. Because of their shared
experiences, group members often come to care about and to support each
other emotionally, and they often share practical ideas for working
through their grief as well. In addition, a support group also can help
you to get through difficult times like holidays or anniversaries.
Most support groups meet for a limited time, such
as six weekly sessions. Others run continuously, and people come in and
out as their emotional needs dictate. Most are free; some require a fee.
Call a hospice, counseling clinic, member of the clergy, your local Area
Agency on Aging, or a hospital to find out about bereavement groups. If
that does not work, check your newspaper or the human-services listings
of a phone book. It often is good to talk with the leader of a group in
advance to learn what is expected and how the group is conducted. Some
people attend with a family member or a friend.
If you decide to attend a support group,
understand that you may feel worse when you go home after the first
session. The reason is that you are dealing with your feelings openly
(as well as hearing about everyone else's). In the long run, however,
this can be helpful. It also is important to realize that a support
group will not restore you to the way you were before the person's
death, but it will help you to cope with your new life without the
deceased.
Top
Possible Obstacles
Here are some obstacles that other caregivers have faced:
1. "People say I should be over this."
Response: Everyone deals with grief at
his or her own pace. You may need to say, "We each go at our own
pace. I guess my pace is slower than you expected."
2. "People give me advice that I don't want
to take."
Response: Well-meaning advice is not
always helpful advice. One example might be if you regularly walked
with your deceased spouse and now can no longer bear the thought of
walking alone. When people offer advice to take walks, do your best
to be gracious and thank them, but then do what you feel is
best.
3. "People avoid the subject of Dad when
they're around me."
Response: Take charge of the
conversation, and reassure them: "I want to talk about Dad, and it
makes me feel better to talk about him." Your family and friends may
not know that you feel this way, so it is important to tell them.
Think of other obstacles that could interfere with carrying out your
plan
What additional roadblocks could get in the way
of the recommendations in this plan? For example, will other people
help? How will you explain your need for help to other people? Do you
have the time and energy to carry out the plan?
You need to develop plans for getting around
these roadblocks. Use the
COPE
ideas (creativity, optimism, planning, and expert information), and see
Solving
Problems Using This Guide for a discussion of how to use these ideas
in overcoming your obstacles.
Top
Carrying out your plan
The process of grieving is unique for each
person, so you need to find your own, special way of dealing with it.
Experiment, and let your feelings tell you which are helping.
Checking on results
The important thing to remember is that people
respond to grief in widely varying ways, and that you will have both ups
and downs, good days and bad. Healing takes time. You will know that you
are successfully working through grief when your stronger emotions begin
to dissipate, such as when you no longer feel anger or deep sadness, and
when your interest and involvement in outside activities return to their
normal level.
If your plan does not work
Grieving is a difficult but natural process. If
you cannot resume some of your normal activities or do not seem to feel
better after 6 months, you may want to review When to Get
Help.
You can
download this chapter or the entire Home Care Guide to Advanced
Cancer.
Copyright © 1997 by the American College of
Physicians. The American College of Physicians gives permission to
reproduce and distribute copies of this plan provided it is not altered
and its use is not for profit. Users can remove the left column
(containing the book contents and the word "Top") when making copies for
distribution. For information on translation, subsidiary, and for-profit
use, contact Diane McCabe. Phone: 215-351-2642; fax: 215-351-2644;
e-mail:
dmccabe@mail.acponline.org.
Death and Grief
If someone close to you has died, you may be feeling
many different emotions. You may be sad, worried, or
scared. You might be shocked, unprepared, or confused.
You might be feeling angry, cheated, relieved, guilty,
exhausted, or just plain empty. Your emotions might be
stronger or deeper than usual or mixed together in ways
you've never experienced before.
You might also notice that your loss is affecting
what you're thinking about and how you behave. If you're
grieving, you might be having trouble concentrating,
sleeping, eating, or feeling interested in the things
you usually enjoy. You might be trying to act like you
feel OK (even if you don't) because you want to be
strong for someone else. And you may wonder if you will
ever get over losing someone who means so much to you.
All of these emotions can be natural reactions to the
death of someone close. They're part of the process of
grieving.
What Is Grief?
Grief is the emotion people feel when they experience
a loss. There are many different types of loss, and not
all of them are related to death. A person can also
grieve over the breakup of an intimate relationship or
after a parent moves away from home.
Grief is a natural reaction to the loss of someone
important to you. Grief is also the name for the healing
process that a person goes through after someone close
has died. The grieving process takes time, and the
healing usually happens gradually.
Although everyone experiences grief when they lose
someone, grieving affects people in different ways. How
it affects you partly depends on your situation and
relationship with the person who died.
The circumstances under which a person dies can
influence grief feelings. For example, if someone has
been sick for a long time or is very old, you may have
expected that person's death. Although it doesn't
necessarily make it any easier to accept (and the
feelings of grief will still be there), some people find
that knowing someone is going to die gives them time to
prepare. And if a loved one suffered a lot before dying,
a person might even feel a sense of relief when the
death occurs. If the person who has died is very young,
though, you may feel a sense of how terribly unfair it
seems.
Losing someone suddenly can be extremely traumatic,
though, no matter how old that person is. Maybe someone
you know died unexpectedly - as a result of violence or
a car accident, for example. It can take a long time to
overcome a sudden loss because you may feel caught off
guard by the event and the intense feelings that are
associated with it.
Losing someone because he or she committed
suicide can be especially
difficult to deal with. People who lose friends or
family members to suicide may feel intense despair and
sadness because they feel unable to understand what
could have led to such an extreme action. They may even
feel angry at the person - a completely normal emotion.
Or they could feel guilty and wonder if there was
something they might have done to prevent the suicide.
Sometimes, after a traumatic loss, a person can become
depressed and may need extra help to heal.
If you've lost someone in your immediate family, such
as a parent, brother, or sister, you may feel cheated
out of time you wanted to have with that person. It can
also feel hard to express your own grief when other
family members are grieving, too. Some people may hold
back their own grief or avoid talking about the person
who died because they worry that it may make a parent or
other family member sad.
Grief can cause some people to feel guilty for no
reason. Depending on the circumstances, some people
might wonder if something they did - or didn't do -
caused the person's death. Others might think if only
they had been better people that their loved ones might
not have died. These things aren't true, of course - but
sometimes feelings and ideas like this are just a way of
trying to make sense of something that's difficult to
understand.
All of these feelings and reactions are OK - but what
can people do to get through them? How long does grief
last? Will things ever get back to normal? And how will
you go on without the person who has died?
Coping With Grief
The grieving process is very personal and individual
- each person goes through his or her grief differently.
Some people reach out for support from others and find
comfort in good memories. Others become very busy to
take their minds off the loss. Some people become
depressed and withdraw from their peers or go out of the
way to avoid the places or situations that remind them
of the person who has died. Just as people feel grief in
many different ways, they handle it differently, too.
For some people, it may help to talk about the loss
with others. Some do this naturally and easily with
friends and family, others talk to a professional
therapist. Some people may not feel like talking about
it much at all because it's hard to find the words to
express such deep and personal emotion or they wonder
whether talking will make them feel the hurt more. This
is fine, as long you find other ways to deal with your
pain.
A few people may act out their sorrow by engaging in
dangerous or self-destructive activities. Doing things
like drinking, drugs, or cutting yourself to escape from
the reality of a loss may seem to numb the pain, but the
feeling is only temporary. The person isn't really
dealing with the pain, only masking it, which makes all
those feelings build up inside and only prolongs the
grief.
If your pain just seems to get worse, or if you feel
like hurting yourself or have suicidal thoughts, tell
someone you trust about how you feel.
What to Expect
It may feel impossible to recover after losing
someone you love. But grief does get gradually better
and become less intense as time goes by. To help get you
through the pain, it can help to know some of the things
you might expect during the grieving process.
The first few days after someone dies can be intense,
with people expressing strong emotions, perhaps crying
and comforting each other, and gathering to express
their support and condolences to the ones most affected
by the loss.
Family and friends often participate in rituals that
may be part of their religious, cultural, community, or
family traditions - such as memorial services, wakes, or
funerals. These activities can help people get through
the first days after a death and honor the person who
died. People might spend time together talking and
sharing memories about the person who died. This may
continue for days or weeks following the loss as friends
and family bring food, send cards, or stop by to visit.
Many times, people show their emotions during this
time. But sometimes a person can be so surprised or
overwhelmed by the death that he or she doesn't show any
emotion right away - even though the loss is very hard.
For example, Joey's friends expected he'd be really
upset at his mom's funeral, so they were surprised that
he was smiling and talking with people as if nothing had
happened. When they asked him about it, Joey said that
seeing his friends at the funeral cheered him up because
it reminded him that some things would still be the
same. Joey was able to cry and talk about how he felt
when he was alone with his dad after the funeral.
Sometimes, when the rituals associated with grieving
end, people might feel like they should be "over it"
because everything seems to have gone back to normal.
When people who are grieving first go back to their
normal activities, it might be hard to put their hearts
into everyday things. Many people go back to doing
regular things after a few days or a week. But although
they may not talk about their loss as much, the grieving
process continues.
It's natural to continue to have feelings and
questions for a while after someone dies. It's also
natural to begin to feel somewhat better. A lot depends
on how your loss affects your life. It's OK to feel
grief for days, weeks, or even longer, depending on how
close you were to the person who died.
No matter how you choose to grieve, there's no one
right way to do it. The grieving process is a gradual
one that lasts longer for some people than others. There
may be times when you worry that you'll never enjoy life
the same way again, but this is a natural reaction after
a loss.
Caring for Yourself
The loss of someone close to you can be stressful. It
can help you to cope if you take care of yourself in
certain small but important ways. Here are some that
might help:
- Remember that grief is a normal emotion.
Know that you can (and will) heal from your grief.
- Participate in rituals.
Memorial services, funerals, and other traditions
help people get through the first few days and honor
the person who died.
- Be with others. Even informal
gatherings of family and friends bring a sense of
support and help people not to feel so isolated in
the first days and weeks of their grief.
- Talk about it when you can.
Some people find it helpful to tell the story of
their loss or talk about their feelings. Sometimes a
person doesn't feel like talking, and that's OK,
too. No one should feel pressured to talk.
- Express yourself. Even if you
don't feel like talking, find ways to express your
emotions and thoughts. Start writing in a journal
about the memories you have of the person you lost
and how you're feeling since the loss. Or write a
song, poem, or tribute about the person who died.
You can do this privately or share it with others.
- Exercise. Exercise can help
your mood. It may be hard to get motivated, so
modify your usual routine if you need to.
- Eat right. You may feel like
skipping meals or you may not feel hungry - but your
body still needs nutritious foods.
- Join a support group. If you
think you may be interested in attending a support
group, ask an adult or school counselor about how to
become involved. The thing to remember is that you
don't have to be alone with your feelings or your
pain.
- Let your emotions be expressed and
released. Don't stop yourself from having a
good cry if you feel one coming on. Don't worry if
listening to particular songs or doing other
activities is painful because it brings back
memories of the person that you lost; this is
common. After a while, it becomes less painful.
- Create a memorial or tribute.
Plant a tree or garden, or memorialize the person in
some fitting way, such as running in a charity run
or walk (a breast cancer race, for example) in honor
of the lost loved one.
Getting Help for Intense Grief
If your grief isn't letting up for a while after the
death of your loved one, you may want to reach out for
help. If grief has turned into depression, it's very
important to tell someone. How do you know if your grief
has been going on too long? Here are some signs:
- You've been grieving for 4 months or more and
you aren't feeling any better.
- You feel depressed.
- Your grief is so intense that you feel you can't
go on with your normal activities.
- Your grief is affecting your ability to
concentrate, sleep, eat, or socialize as you
normally do.
- You feel you can't go on living after the loss
or you think about suicide, dying, or hurting
yourself.
It's natural for loss to cause people to think about
death to some degree. But if a loss has caused you to
think about suicide or hurting yourself in some way, or
if you feel that you can't go on living after your loss,
it's important that you tell someone right away.
Counseling with a professional
therapist can help because it allows you to talk
about your loss and express strong feelings. Many
counselors specialize in working with teens who are
struggling with loss and depression. If you'd like to
talk to a therapist and you're not sure where to begin,
ask an adult or school counselor. Your doctor may also
be able to recommend someone.
Will I Ever Get Over This?
Well-meaning friends and family might tell a grieving
person they need to "move on" after a loss.
Unfortunately, that type of advice can sometimes make
people hesitate to talk about their loss, or make people
think they're grieving wrong or too long, or that
they're not normal. Every person takes his or her own
time to heal after a loss. The way someone grieves a
particular loss and the time it takes is very
individual.
It's important for grieving people to not drop out of
life, though. If you don't like the idea of moving on,
maybe the idea of "keeping on" seems like a better fit.
Sometimes it helps to remind yourself to just keep on
doing the best you can for now. If you feel sad, let
yourself have your feelings and try not to run away from
your emotions. But also keep on doing things you
normally would such as being with friends, caring for
your pet, working out, or doing your schoolwork.
Going forward and healing from grief doesn't mean
forgetting about the person you lost. Getting back to
enjoying your life doesn't mean you no longer miss the
person. And how long it takes until you start to feel
better isn't a measure of how much you loved the person.
With time, the loving support of family and friends, and
your own positive actions, you can find ways to cope
with even the deepest loss.
Reviewed by: D'Arcy Lyness, PhD
Date reviewed: April 2004
http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html
also see:
http://death-response.chance.berkeley.edu/griefandloss.html#2
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