Topic: 15

Grief: The Stages and How to Cope

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What You Need to Know

When a community member is seriously ill, one of the biggest challenges to mental wellness is how people respond to loss. People experience many different types of losses throughout their life including the death of a family member, loved one or a pet, the loss of a limb due to amputation, the loss of a job or the loss of a relationship through divorce. Within Indigenous communities, there are also many historical and traumatic losses that affect the whole community including the loss of language, identity, and culture due to colonization and the residential school system.

Grief is a natural reaction to loss. For many people it is an experience, which is common to most cultures and people. It is important to understand how past losses affect the individual who is sick, along with their family and community. It is also essential to recognize that a person living with a serious illness may also be grieving present and future losses including the loss of control, loss of dreams for the future, and loss of security and independence.

Grief can be felt in anticipation of a loss that will eventually occur. It is a way of dealing with a crisis that cannot be solved that threatens people’s life goals — a way of striving for balance. Holding onto hope must be balanced with finding ways to let go. It is important that as a caregiver you not detach emotionally from the person that you are caring for even when that person begins to withdraw.

Anticipatory grief is not entirely directed towards the future. It also includes grief for the past and present losses. People grieve for the life, abilities, health and all the other things that have been lost because of a life-threatening illness. (Unconscious preparation for a status change or death, Corles 2015, Oxford Textbook of Palliative Nursing)

What is Grief?

Grief is a natural response to loss. There is no right way to grieve and no set timetable for grieving. Everyone is different. For some people, grief is an intense, emotional, all-consuming experience. For others it is a rather mild process. If mourning is the outward expression of sorrow often shared in a social setting with others, then grief is the inward, solitary or private response.

Early Grief–When a death occurs (walking the edge)

As you accept the fact of the death of someone important, you will feel shock, numbness and disbelief that this has happened.

Panic and strong physical and emotional reactions are common:

  • upset stomach or hollow feeling in the stomach
  • low energy, weakness and restlessness crying, sobbing, wailing
  • indifference, emptiness (“can’t feel anything”) outrage and helplessness
  • confusion, forgetfulness and poor concentration and trouble sleeping
  • denial and daydreaming
  • continually thinking about the person who died and/or the death
  • blaming God or life
  • feeling a lack of meaning, direction
  • wanting to join the person who died
  • withdrawal from others
  • unrealistic expectations
  • poor judgement about relationships
  • shortness of breath and heart racing
  • tightness in the chest or heart palpitations

Middle Grief–Adjusting to Loss (entering the depths)

Later, as the numbness goes away, you will deal with what this loss means to you and the pain of grieving. The strength of feeling may surprise and frighten you, but it is natural and you will move through it.

You may experience:

  • changes in appetite and sleep
  • shortness of breath and racing or pounding heart
  • upset stomach
  • strong and conflicting emotions
  • problems remembering
  • problems with concentrating or understanding
  • vivid dreams or nightmares
  • feeling the presence of the person who died
  • continued lack of meaning
  • rushing into new relationships
  • wanting company but unable to ask
  • continued withdrawal and feeling alone
  • feeling self-conscious

Later Grief–As Life Goes On (mending the heart)

As you adjust to life without the person who died, you will begin to re-connect with the world around you. You have more energy for family friends, work and other interests.

You may experience:

  • Sleeping/eating are more settled
  • Gut-wrenching emptiness begins to go away
  • Emotions are not so strong
  • Feeling of fogginess subsides
  • More peace; less guilt
  • Concentration improves
  • Fewer dreams and nightmares
  • Reconnect with spiritual beliefs
  • You may feel new purpose
  • Acceptance of death as part of life
  • More interested in daily life
  • Able to reach out and meet others
  • More energy for social events

Guidelines to Support People Who Are Grieving

There are a number of things to remember when you are supporting someone who is dealing with past, present, and future losses:

  • Remember grief and bereavement are normal life events. For some they are also transformative and life changing.
  • It is not your job to fix a person’s grief. Supporting a person who is grieving is a collaborative process where you companion or walk alongside the person who is grieving.
  • The true expert of grief is the person who is grieving. We need to learn from that person and bear witness and normalize the grief journey.
  • It is important to maintain a foundation of hope that the individual will find meaning in their grief and move towards healing.
  • The person companioning the griever needs to utilize empathy, warmth, caring, and respect for the individual and their unique experience.
  • Try to focus on the individual’s strengths and level of wellness to understand their experience.
  • Do not try to diagnose or look for complications within their coping.
  • How a person understands their grief is impacted by how other people, groups, and their communities honour their experience.
  • Learning about past life experiences (particularly family of origin influences), and the nature of the relationship between the bereaved person and the person who died helps with understanding the meaning of the death, and the grief and mourning process for this unique person.
  • You will be a more effective helper if you remember to enter into a person’s feelings without having a need to change those feelings.
  • A major helping goal is to provide a “safe place” for the bereaved person to do the “work of mourning,” resulting in healing and growth.
  • A bereaved person does not have an illness you need to cure. You are a caregiver, not a cure-giver!
  • People are viewed from a multicultural perspective. What is considered “normal” in one culture, may be perceived as “abnormal” in another culture.
  • Spiritual and religious concerns and needs are seen as central to the grief processes. We need to support people in their spiritual and religious lives as they search for meaning and purpose in their continued living.
  • As a companion, you have a responsibility to help the bereaved person not return to an “old normal,” but to discover how the death changes them in many different ways.
  • Most people are where they are in their grief journeys for one of two major reasons:
  • That is where they need to be at this point in their journey; or, 2) They need, yet lack, an understanding, safe place for mourning and a person who can help facilitate their work of mourning in more growth-producing, hope-filled ways.
  • Many people are best served, by seeking support from lay companions who have experienced their own grief journey.
  • Self-care is essential for the support person if they are to be an effective, ongoing companion in grief.

 

1. Which of these statements about grief are in fact myths?

Read each statement for yourself and decide if they are fact or fiction. Then check the correct response below.

  • Once you are done grieving, life will return to “normal”
  • There is a consistent and predictable timeline for grief
  • The first year is the worst
  • Grief is the same as sadness
  • You cannot grieve someone who is still alive
  • Staying busy will keep the pain away
  • Time heals all wounds
  • Women grieve more than men
  • Men don’t want to talk about their grief
  • Grief follows a similar path and timeline for everyone
  • If you aren’t crying, then you aren’t grieving
  • The goal of grief is to “get over it”
  • Young children don’t grieve
  • You grieve less when you know in advance someone is going to die

Answer: All of the statements found above are myths or fiction.

 

ADDITIONAL RESOURCES

Use these additional resources to learn more about the topic of the stages of grief.

Two Big Myths about Grief
www.scientificamerican.com/article/grief-without-tears

Bereaved Families of Ontario
www.bereavedfamilies.net/

Grief Treatment Centres in Ontario
www.psychologytoday.com/en-us/ca/treatment/grief/ontario

Completing the Circle: Youth and Grieving (Note: there is a cost to purchasing this resource)
http://www.aboriginalendoflifecare.com/