Archive for January 4th, 2012
Intense Grief
Grief can be so intense and long-lasting that it sometimes resembles a psychiatric disorder. As many as 50% of widows and widowers, for example, develop symptoms typical of major depression in the first few months after a spouse dies. They may also have hallucinatory experiences — imagining that the dead are still alive, feeling their presence, hearing them call out.
These symptoms, upsetting as they may be, are usually normal responses to a profound loss. In most people, the symptoms ease over time. One review noted that 15% of people who are grieving are depressed one year after a loss. By two years, the proportion falls to 7%.
But if the symptoms are intense enough to interfere with relationships, work, school, and other areas of life, the problem may be complicated grief — a term that describes a grieving process that is particularly difficult. Also known as protracted or chronic grief, it combines features of depression and post-traumatic stress disorder (PTSD) — which is why some professionals call it traumatic grief. One study estimated that nearly 5% of all older adults were experiencing complicated grief.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) does not describe complicated grief as a psychiatric disorder, but a group of experts are reviewing a proposal to include this condition in the manual’s next edition.
Risk factors
Complicated grief is more likely to occur after a death that is traumatic — premature, violent, or unexpected. But in some people, even normal bereavement can produce complicated grief.
Whether that happens depends on how a person copes, not just with trauma, but with loss. Everyone experiences unfulfilled hopes, broken romances, illness, and injury. For anyone who could not respond to earlier losses without losing emotional equilibrium, complicated grief becomes a greater danger. So a person with a history of depression, anxiety disorders, or a personality disorder is more likely to suffer complicated grief after bereavement, as well as PTSD if the loss was traumatic.
Treatment options
While it is hardly necessary for everyone who is grieving to seek professional help, people who develop complicated grief may need treatment. Other reasons to seek professional help include drug abuse, increased use of alcohol or tobacco, gaining or losing a significant amount of weight, experiencing uncontrollable anxiety, and failing to feel somewhat better after a year has passed.
Psychotherapy can help people to identify incompletely mourned losses of the past and draw connections to the present loss. Several options exist, and a review concluded that all were effective — to varying degrees — at improving symptoms and diminishing the level of complicated grief.
Interpersonal therapy, for example, explores the patient’s relationship with the deceased person, emphasizing disputes, role transitions, and grief. Cognitive behavioral therapy can provide people with tools to work through aspects of grief and help people learn to think differently about the loss.
A hybrid therapy known as complicated grief treatment (also called traumatic grief therapy) includes both interpersonal and cognitive behavioral approaches to mitigate the effects of trauma and relieve stress. The therapist provides information about the grieving process, along with an explanation of a “dual process” in which patients concentrate on both mourning (adjusting to the loss) and improved functioning (restoring a satisfying life).
The therapy includes exercises that push mourners to confront situations and people they have been avoiding. They are also asked to retell the story of the death, to relate memories of the deceased, and to hold imaginary conversations with him or her. (The therapist asks the bereaved to take both sides in these conversations.) To help restore some joy to their lives, mourners are encouraged to think about what they would want for themselves if their grief were not so overpowering.
This technique can be overly taxing, causing some patients to leave prematurely. But for those who can tolerate it, it may have advantages. In one study, 51% of people who underwent complicated grief treatment improved afterward, compared with 28% for standard interpersonal therapy. The results also showed that complicated grief treatment was especially effective for people who were mourning a violent death.
These successes are promising, but it’s not clear that the treatment would yield the same results if performed by the average clinician rather than inside a specialized research setting. Nonetheless, the research suggests that there are a variety of helpful options.
Read Full Post | Make a Comment ( None so far )grieving a loved one’s loss
Losing a close friend or family member can be devastating. All the small details of daily life — getting out of bed, making meals, going to appointments, taking care of children, handling responsibilities at work — may seem monumentally hard or inconsequential. It is important for people to let the nonessentials slide and focus on ways to get through this difficult time.
Dr. Michael Hirsch, a psychiatrist at Massachusetts General Hospital and medical editor of Harvard Medical School’s Special Health Report Coping with Grief and Loss: A Guide to Healing, offers the following advice. Although some tips may seem basic, they are vital for enabling people who are grieving to work through the process.
People who are grieving a loved one’s loss may neglect their own health and well-being. In spite of the emotional pain, it’s important that you attend to the basics — making the literal, eat-your-vegetables choices — to maintain your physical health.
Eat well. A well-balanced diet is essential as you withstand the stress of grieving. That means eating plenty of vegetables, fruits, and lean proteins, and drinking plenty of water and other healthy liquids. If your appetite is diminished, try eating small portions more frequently. A daily multivitamin can cover any missing nutrients.
Take necessary medications. Grief makes people more vulnerable to illness, so it’s important that you keep taking your regular medications.
Get enough sleep. Grief is exhausting. If you feel tired, nap to make up for a sleep deficit. Paradoxically, doing more exercise is likely to improve your energy. Watch your caffeine and alcohol intake, as these substances can interfere with sleep.
Exercise every day. A simple walk, a bike ride, yoga, or a harder workout can ease agitation, anger, and depression. Depending on your needs, exercise can provide you with a distraction when you need a break from grieving, or offer you some quiet time to focus on your loss.
Avoid risky behavior. In the wake of a profound loss, people often justify using dangerous coping strategies — such as drinking too much alcohol (more than one drink a day for women or two for men), using drugs, or engaging in impulsive or self-destructive behavior. The short-term relief of pain is likely not to be worth it if the pattern of dangerous behavior persists or intensifies, leading to further losses.
Delay big decisions. Grief can cloud thought processes, and people who make abrupt decisions may regret them later. Many experts suggest that you wait a year, if possible, before moving, changing jobs, clearing out keepsakes, and making other momentous decisions.
Practice self-care. People who are grieving should regularly ask, “What would help me most today?” The answer may vary from day to day and even from hour to hour. Sometimes you need to cry, or talk to a friend, or just take a break from grieving.
Dr. Alan D. Wolfelt, a grief counselor and author of Healing Your Grieving Heart, suggests that people who are grieving identify three friends or family members who can provide support on a regular basis in the first weeks and months after a loss. Perhaps they have practical help to offer (such as cooking meals), or are not judgmental and willing to listen. The following tips may also be helpful.
Tell people what helps. People who are grieving may need to say, “I just need to cry right now,” or “There’s nothing you can do to fix this. It would help if you just stay with me for an hour.” If you want to talk about the person you’ve lost, you may need to let others know. For example, it might help if you say, “I miss her so much. I just want to talk about her, but I feel like everyone is afraid to say her name.”
Embrace mixed feelings. It is entirely normal to have mixed emotions about the loss and about your loved one. It helps to express these so that other people understand what you are going through. Some of the things you can say:
- “I feel so angry about his death. It seems so useless.”
- “I’m relieved that Mom isn’t suffering anymore, but I miss her terribly.”
- “My relationship with my dad was really difficult. I’m feeling a lot of things right now — not just sadness.”
- “I know you think I should be over this, but I’m not.”
Take away uncertainty. Often, people aren’t sure how to act around you when you are grieving. Although it may be difficult for you to express what you need while you are grieving a loss, the following directions might help others understand how they can support you:
- “If you really want to help, clearing up the kitchen or vacuuming would be great.”
- “Hugs just make me feel worse right now. What I need is a little time alone.”
- “I can’t bear to be alone tonight, but I don’t want to talk. Could you stay and just watch TV with me?”
- “I feel so mad about everything. I’m irritated with people all the time.”
Find others who understand. People who have also lost a loved one may be more understanding. Ask them outright: “What helped you? How did you get through this awful time?” When friends and family can’t help in these ways, support groups often can.
Leave the door open. People who are grieving sometimes may wish that everyone else would just go away and leave them alone to sort through their feelings. If you express this need too forcefully, though, you may drive people so far away that they are not going to be there when you do need them. Here are some ways of expressing the need for solitude while leaving the door open to future support:
- “I just want to go home and go to bed right now. Would you call me tomorrow, though?”
- “I feel so upset these days, I can’t settle on anything. Please don’t take it personally.”
- “I’m just not up to that right now. Maybe in a few weeks. Will you try me again?”
Realize that everyone grieves differently. People who experience the same loss often grieve in different ways. For example, one parent who loses a child may need to cry and talk frequently, while the other might work incessantly and act increasingly distant. Both are trying desperately to deal with their pain and loss. Professional insight from a grief counselor can be valuable when grieving drives a wedge between you and your spouse, family members, or other loved ones.
Remembering and honoring the person who died helps people keep memories alive. Sometimes it helps shape meaning from loss. You can commemorate a loved one in various ways.
Artwork. Creating art can help you explore your feelings, chronicle the life of the person who died, or express your ideas of an afterlife. For example, you can create a memory quilt incorporating meaningful scenes and fabrics. Children struggling with grief may find creating art — whether it’s with clay, colored pens, paints, or collage supplies — particularly helpful.
Journal. Some people create a journal to memorialize a loved one’s life. You can also develop a timeline of important dates and events. The journal can include pictures, stories, sayings, and well-loved recipes. Friends and family may want to contribute as well.
Memory box. You can use pictures, objects, and art supplies to make a memory box for display or keepsakes. When you are ready to go through your loved one’s belongings, you can set aside items for the memory box.
Slide show. You can use favorite pictures, songs, and sayings to create a poignant multimedia remembrance of your loved one’s life. Or splice old videos together and copy them onto DVDs for others to enjoy.
Photo wall. You can create a collage or remembrance wall from photos taken at different times and events.
Good cause. Sometimes people leave instructions about how they want to be remembered through memorial gifts to various causes, such as medical research, peace efforts, and scholarship funds. If not, you can think about how best to honor your loved one.
Peaceful spot. A peaceful nook with a comfortable chair, lighting, photos, inspirational books, or other important objects can serve as a spot to honor your loved one. Some people create serene outdoor spots, such as a fountain in a garden. Or you could walk regularly through a nature preserve, or visit a spot your loved one enjoyed.
Garden. Planting a garden or a tree can be a wonderful way to remember someone.
Gravesite. In many cultures, the gravesite is a focal point for commemorating the loved one, particularly on special days such as birthdays, anniversaries, or holy days. You can plant flowers there, say a prayer, or simply visit for a few moments of contemplation.
Prayer. Spirituality is of great comfort to many people. Depending on your own views, spiritual practices can include saying prayers, lighting incense or a candle, creating a shrine, or meditating.
Echo. You can create an “echo” of your loved one, by doing something silly, pleasurable, or solemn that they once did. This might involve giving a holiday toast, traveling, playing well-loved music, cracking a bad joke, or performing acts of kindness.
RESOURCES
AARP
601 E St. NW
Washington, DC 20049
888-687-2277 (toll-free)
www.aarp.org
AARP is a nonprofit membership organization for people ages 50 and older. Its Web site offers many helpful publications on grief.
The Compassionate Friends
900 Jorie Blvd., Suite 78
Oak Brook, IL 60523
877-969-0010 (toll-free)
www.compassionatefriends.org
This national nonprofit organization offers bereaved parents, grandparents, and siblings friendship and understanding delivered by others who have stood in their shoes. The Web site has a chat room and offers many supportive brochures for family members, friends, teachers, and various professionals.
GriefNet
P.O. Box 3272
Ann Arbor, MI 48106
www.griefnet.org
This online community offers e-mail support groups for children and adults. The Web site also includes links to other helpful organizations.
Books
Healing Your Grieving Heart: 100 Practical Ideas
Alan D. Wolfelt, Ph.D. (Companion Press, 2001)
This simple book is packed with thoughtful coping strategies described briefly and compassionately. The author, a psychologist and grief counselor, has written many more titles in this series, including Healing Your Grieving Heart for Kids, Healing Your Grieving Heart for Teens, and Healing a Parent’s Grieving Heart.
Saying Goodbye: How Families Can Find Renewal Through Loss
Barbara Okun, Ph.D., and Joseph Nowinski, Ph.D. (Berkley Books, 2011)
While death used to be a swift act — an event — the act of dying is now a process that family members may have to live with for a protracted time, as modern medicine is increasingly able to keep very sick people alive. Two psychologists guide readers through the complex journey of “living with death” in this reassuring and hopeful book. Real-life stories illustrate lessons about practical matters, such as taking care of finances, and emotional ones, such as talking with children about death.
Seven Choices: Finding Daylight after Loss Shatters Your World
Elizabeth Harper Neeld, Ph.D. (Warner Books, 2003)
This book chronicles the author’s experience of losing her young husband and the experiences of more than 60 other grieving women and men. Neeld describes seven turns in the road and the opportunities she believes each one presents as those who’ve been bereaved seek to honor the past while building a future.
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