Handling Bereavement and Grief

Bereavement is the state of loss, usually the loss of someone who has died. Grief, while often used synonymously with bereavement, is more about the process of going through bereavement - the severe distress involved. When someone close to you dies, you face not only the loss of that person physically, but also the loss of what might have been - the plans, the hopes, and the dreams you had for that person individually as well as a part of your life.

While all loss is painful, the severity of grief depends on four main factors, the first of which is the element of surprise. Your response to an unanticipated death may be very different from the grief you feel when someone dies after a lengthy illness. While you may be just as upset when the death happens, in the later case, you will have had time to begin your grief before the person's death and you may recover sooner than if the death is unexpected. The intensity of the feelings can grow exponentially if the death is not only sudden, but violent such as a murder or even a car crash.

Your grief response will also depend on your relationship to the deceased. You will likely grieve harder and longer over the death of a spouse or a parent than you would the death of a co-worker.

Your personality and style of coping will also affect your grief process. If you are resilient and bounce back from setbacks, your grief cycle will likely be shorter than that of someone who takes the speed bumps on life's road harder.

Your culture and what you have learned about life and death will affect how you grieve. If you have grown up in an environment where death was viewed as a part of life, was talked about, and therefore, not a scary unknown you are far more likely to have a speedier grief process. If you live in a culture where open display of negative feelings in not acceptable, you may spend longer in grief. The movie,

A scene in the movie The Queen demonstrated this kind of culture perfectly as Her Majesty Queen Elizabeth II (played by Helen Mirren) explained the British people's response to the death of Diana, Princess of Wales to then Prime Minister Tony Blair.

"I doubt there is anyone who knows the British people more than I do, Mr. Blair, nor who has greater faith in their wisdom and judgment. And it is my belief that they will any moment reject this... this "mood", which is being stirred up by the press, in favor of a period of restrained grief, and sober, private mourning. That's the way we do things in this country, quietly, with dignity. That's what the rest of the world has always admired us for."

As we will discuss a little later, the most important factor in successfully grieving a loss is support. You must have people in your life who will support you emotionally as your grieve.

While people grieve differently and there is no one correct way to grieve a loss; grief is a process with distinct stages. The bereaved do not pass through these stages linearly, but rather travel back and forth through them as they go through the process. It's important to also realize that grief is not just an emotional response. Grief affects the body, the mind, and the emotions. Children and adults also grieve differently.

The Adult Grief Process

Elisabeth Kübler-Ross studied people's response to death and dying and is perhaps the most well known expert in the field of understanding the grief process. She posited that grief is a process with the five stages of denial, anger, bargaining, depression, and acceptance. John Bowlby, a noted psychiatrist thought these five stages were too simplistic and outlined a grief process consisting of shock and numbness, yearning and searching, disorganization and despair, and reorganization. No matter the labels, grief is painful and the first thing you need to know is that you will live. You will survive the pain and the grief process.

The initial shock and numbness, or denial is your body's way of protecting you. The pain is simply too much to bear so the body denies the event and the emotions are numbed to protect you until enough time has passed that feelings can safely surface. Your mind will likely tell you that this is not happening. You may refuse to accept direct evidence that confirms the death. The phone may ring; you may hear a knock at the door and fully expect either to be the deceased. You may also feel unable to act and a numbing paralysis may temporarily set in.

The next state is typically marked by anger. Many times, the anger is directed at everyone and you may lash out or act out. Often you will become angry at the person who died and/or angry at God and may feel guilty about your anger. This is perfectly normal and okay. You may even become angry at yourself. Your grief process can stall if you do not appropriately express your feelings and get them out, but rather keep them pushed down inside you.

The stage of bargaining or yearning can be particularly painful not only for the bereaved, but also for those closest to the grieving person. This stage feels the most intensely painful as you promise to be a better person if . . . The bargaining comes from the seemingly unbearable pain and the bereaved person's desire to lessen the intensity of the pain. At this point the pain seems like it will go on forever. Again, it is crucial that you reach out to your support group. Some find that extra exercise and journaling help during this stage.

Depression sets is as you become exhausted and just no longer care. Luckily this too shall pass, but it can be a scary stage as you stop caring about aspects of your life. This stage comes with a high risk of isolation, especially since it can come after the funeral and once the well meaning phone calls and visits have slowed as friends and family have become more accustomed to the loss. You may begin to feel abandoned at this stage and must sometimes do the nearly impossible - reach out to others.

Ultimately acceptance comes. You may move back into depression a few times before acceptance truly takes hold. The reality of the loss sinks in and you reengage and begin the journey of your post-loss life. You will be able to think of the deceased person without pain. While there is always a sense of sadness, it lacks the gut-wrenching pain it previously had.

Physical Manifestations of Grief

Stress related illnesses are not uncommon, especially during the first six months of the grief process. Symptoms such as abdominal pain, breathing difficulties, and free floating anxiety have been noted in the bereaved. Normal grief eases after a period of time. Abnormal or complicated grief will be worse after a year or two and is cause for concern.

It is not uncommon to have a loss of appetite or to have difficulty concentrating or sleeping. Some people also develop headaches or general body aches as though they have the flu. While it is important to go through the grief process and avoid the temptation to mask the symptoms with drugs or alcohol, a doctor can prescribe a mild anti-depressant or other medicine to help with symptoms in the short term. Some find that grief/loss support groups or bereavement groups are helpful while others favor work with a therapist or get solace from members of their church. It is critical that your do not isolate or withdraw from life. Keeping a regular schedule, getting out of the house - even if just for a short walk around the block, and staying in touch with friends and family make the difference between moving through grief and wallowing in it. On the other hand, rushing through the grief process can be counter-productive as well, as it ultimately extends the process as buried feelings surface as the most inopportune moments.

Grief and Children

If you are grieving a loss and have children, your children will be affected by your grief process. As with all situations the best way to help your children is by being honest and talking to your child in a language he or she can understand. Watch your child and be mindful of not only what your child is saying, but also what your child is not saying. Your child may not know how to talk about grief and you may need to do some coaching and prompting. You can help your child feel more secure if you maintain usual routines as much as you can and if you show your child affection. Encourage your child to ask questions and do not become cross if the child keeps asking the same question again and again. Death is a huge deal for adults - more so for children. While you don't want to overly burden your child, do let your child comfort you in your grief. It will help your child feel needed and a part of the process.

It will help you to know how children grieve. Children manifest grief in similar ways as adults in that they too may start with shock and disbelief, they may develop headaches or other physical symptoms, and they may feel anxiety, anger, and then move on to sadness.

Children grieving a death also have some reactions that are different from adults. Very young children see the world very literally and do not yet understand the permanence of death. It helps if you explain the death in concrete literal terms - the body stopped working and doctors couldn't fix it. Avoid substituting words. A child told that grandma "went to sleep" may become afraid to go to sleep.

Older children may internalize the death and feel that if they had been "better" the person would not have died. This is similar to the guilt children feel when parents divorce - if they had behaved better, mommy and daddy would still be together. Children also may have a profound fear that someone else close to them will also die. They may cling to parents and caregivers. Children may also regress. They may return to thumb sucking or wet the bed. They may also have nightmares.

In dealing with a child's grief process, time is an important factor. It is generally acknowledged that a child's normal routine should be resuming about six months after a significant death.

As you and your child go through the grief process, remember to be loving, accepting, truthful, and consistent. Also, do not forget to be all of those things to yourself as well. Remember, you will get through the grief process.