Grief and loss

Overview
Grief is a difficult emotion, but a normal and healthy response to loss. It touches nearly everyone at some point -- physically, emotionally, mentally and spiritually. Everyone experiences grief differently, however.
Grief is defined as deep sorrow over a loss, such as a death, divorce, separation, move, disaster or overwhelming trauma. You may also grieve in response to the loss or change of a job, financial status, social standing, security, friendship or treasured object. Changes in ambition, dreams, goals, abilities, health, identity, and freedom or independence, among other things, may have the same effect.

You may experience disenfranchised grief if a loss is not or cannot be openly acknowledged, publicly mourned or socially supported. For example, the loss of a pet, a miscarriage, an abortion, being the target of a crime, experiencing rape, learning of an extramarital affair, losing money in a scam or illegal activity, or having your uterus, breast or testicle removed may all lead to disenfranchised grief.

You may experience ambiguous loss if a loss remains unclear because there is no verification that the person is alive or dead (such as a soldier missing in action). An ambiguous loss may also occur when a loved one is physically present, but psychologically absent (such as a parent with severe dementia due to Alzheimer's disease.) An ambiguous loss can be particularly difficult because grief and coping can become frozen or stuck due to the uncertainty of the loss.


Experiencing grief
The emotional process of grieving a significant loss may cycle several times through various stages. For example:
Stage one: Protest
You may be shocked, confused and angry. You may be in denial over the loss or experience decreased self-esteem. Crying, pain, weakness, nausea, appetite loss and sleep disturbances are common responses in the protest stage.

Stage two: Despair
You may be agonized or anguished over the loss. You may feel grief or depression. During the despair stage, you may have an urge to recover what was lost, slowed thinking and actions, and a continuation of physical symptoms.

Stage three: Detachment
You may feel apathetic and indifferent. You may lose interest in routine activities or simply want to withdraw and "give up." During the detachment stage, you may not socialize as much. You may avoid forming new relationships, develop a "bland" expression and lose your sense of spontaneity.

In Elisabeth Kubler-Ross' classic work on grief, the psychologist identified five stages of grief: denial and isolation, anger, bargaining, depression and acceptance. It's important to note that these stages occur in no particular order and not everyone who faces a loss will experience each stage. The stages can help you identify the possible thoughts, feelings and actions grief may inspire, however.


Understanding the individuality
Grieving is a profoundly individual experience. There is no time limit or universal rule for when you should feel "better." Sometimes a loss brings up memories of previous losses, making the situation seem even more profound. Anniversaries of losses, as well as birthdays and special holidays, can be especially difficult times when feelings and memories are recycled. The nature of the loss (a death, divorce, career upset or loss of physical capability, for example), your age and health, how many other losses you've already sustained, how much the loss changes your life, and how much support is available also impact your grief.
Grief is also shaped by religious beliefs, family values and cultural norms. For example, Western cultures often view death as separate from life, and Eastern cultures typically regard death as part of life. In some parts of the world, a period of mourning is expected when a loved one dies. In the United States, grief is often expected to be processed more quickly.

You may want to defer or consider deferring any major life decisions until your grief has become less acute.


Grief and older adults
With age, the likelihood of losing friends or loved ones through death increases. Logically, these losses can affect many aspects of an older adult's life. Social interaction and companionship may decrease most dramatically when a spouse, partner or close friend dies. Statistically, the impact may be greatest for widowed men -- their mortality rates increase for two years after the wife's death. Widowed women do not seem to be affected in the same way.

Characteristics
Physically, grief may leave a hollow or heavy feeling in your stomach. You may experience headaches, gastrointestinal disturbances or dry mouth. You may also have a decreased resistance to common illnesses or infections, especially if you don't take adequate care of yourself.
Psychologically, you may be angry, sad, numb, nervous, forgetful or confused. Mood swings, denial, disbelief, shock and guilt are also common. You may be lonely, confused about the future or feel detached from the situation. You may have dreams or nightmares about the deceased person, or see, hear or sense his or her presence.

Socially, you may withdraw or isolate yourself from friends or loved ones. You may also express aggressive behavior, or turn to alcohol or drug abuse.

Spiritually, you may have a crisis of faith or become angry. You may attempt to find meaning in the loss and struggle with existential questions about the purpose of life. You may simply ask yourself, "Why?"

Sometimes grief can be more than you are able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult your medical health care provider to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Remember that grief is a normal and healthy response to any loss. To help cope with your grief, keep the following suggestions in mind:
Maintain your social connections. Share your feelings with a trusted family member or friend. You may also want to join a support group for people dealing with similar losses.

Give yourself permission to cry. It is OK to feel sad or frustrated or have the need to take some time for yourself.

Set short-term goals for your future. Remember, at first, you may need to take it day by day.

If you're dealing with a loved one's death, it is normal and healthy to want to remember and honor his or her memory. For example, you may choose to care for the grave site, make a memory book, share cherished stories or plant a tree in the person's memory.

Consider individual, family or group counseling if your symptoms intensify or last for a prolonged amount of time. Although grief does not have a specified time frame, you may reach a point when professional assistance would be helpful. Religious, clergy or pastoral counseling may be useful as well.


Summary
Whether grief leaves a knot in your stomach or prompts you to question the meaning of life, remember that your feelings are natural and healthy. Learning to cope with grief is part of being human. Concentrate on finding the coping strategies that work best for you.