Understanding Grief and Loss

This guide defines loss, offers guidelines for dealing with grief and loss, presents psychological and emotional responses to loss, and describes ways to help people deal with bereavement.

From an article by Herbert G. Lingren

Understanding Loss
Loss is defined as a "separation from, a detachment from something or someone of value." The magnitude of the loss and its meaning and value to the individual affects the intensity of a person's response. Therefore, it is virtually impossible to predict how any one person will respond to a particular loss. But it always causes some change in perception of one's self or lifestyle and some type of adaptation or adjustment is required.
Following a loss of great significance (e.g. death of spouse or child, divorce, loss of farm), a person normally moves from a period of acute emotional pain and sadness to a more comfortable emotional state. This movement through a series of adaptive stages is known as the grief process. It may take from several weeks to several years to adequately complete the process. No one can keep a person from suffering; but you do not have to suffer for the wrong reasons. We must choose what to remember of the past, cherish the joys of the present, and plan a future to which we can look forward.
Ten Helpful Guidelines
These guidelines are presented in the hope that they will help grieving individuals in their journey from helplessness to hopefulness.

• Accept your emotions. Any significant loss, such as death of a loved one, hurts. It is difficult to say goodbye -- to realize that in your lifetime you will never see or touch your loved one again. Why pretend that you are not experiencing turmoil by "keeping a stiff upper lip"? Your emotions are a natural response to the death of a loved one.
• Express your feelings. Deal with your conflicting feelings openly. A feeling that is denied expression is not destroyed; it remains with you and often erupts at inappropriate times. It does hurt to use words like dead and widow; but you must confront reality and put your feelings into words. Cry if you want to. It is a natural expression of grief for both men and women. Crying is the emptying out of the emotions so healing can occur.
• Don't expect miracles overnight. Allow sufficient time for the grieving period to run its course. Don't compare yourself with others in similar positions. Their smiles might not reveal the depth of their sorrow. Be yourself. Don't pretend grief beyond the time you need to grieve. Nor do you need pretend recovery before you are recovered.
• If you have children, bring them into the grieving process. Death is a crisis that should be shared by all members of the family. Children too often are forgotten by grieving adults. Silence and secrecy deprive them of an important opportunity to share grief. When in your heartache you overlook your children's feelings, you heighten their sense of isolation.
• Don't escape into loneliness. If you isolate yourself, stay alone too much, your home will become a protective shell that keeps you from facing the challenges of life. At the same time, look at your priorities so you don't overload your circuits. Stick with what is important and necessary now and don't worry too much about what is down the road.
• Keep in touch with your friends. Let the right people know that you need their support and feedback. They cannot bring you comfort unless you talk with them and share your feelings. They cannot bring you comfort unless you allow them to enter your sorrow. Holidays, birthdays and anniversaries are especially difficult times to be alone. Plan ahead to spend these days with caring and understanding friends.
• Join a support group. At some point you may be disappointed in the reactions of your friends or acquaintances or close friends. Perhaps you don't hear from them as often as in the past. They may seem awkward or uneasy in your presence or even avoid your company. That's why self-help groups have been successful in providing necessary emotional intervention through the crisis of great loss. People in these groups understand your fears and frustrations; they have been there before themselves.
• Counseling may be very beneficial. Sorrow leaves its imprint on the healthiest of personalities. You may need more than the warmth of a close friend or understanding of a fellow sufferer. A professional counselor who is not emotionally attached to you may be more effective to assist you in dealing with your intense feelings or maintaining a clear perspective.
• Be nice to yourself. By treating yourself well, you could become your own best friend. While you need caring and supportive people, you also need moments of solitude to find yourself. A little withdrawal and reflection will allow you to become more relaxed and energized. By taking care of yourself, you will recognize your strengths as well as your weaknesses. You will become more confident that you can manage the challenging days ahead. After all, if you're not nice to yourself, who will be?
• Turn pain into growth. Death ends a life, not a relationship. Through grief, you can become a more understanding, compassionate and sympathetic person. Resolve to live as your beloved would want to live, love as they would want you to love, and serve others as they would have wanted you to serve. The Chinese word-picture symbol for crisis is the same as the symbol for opportunity. This is your new challenge.

Psychological Responses to Loss
Whether an individual copes with a significant loss or death in a positive and constructive rather than in a negative or destructive manner depends on the types of coping mechanisms used and the quality of support being given. There are two major psychological responses by individuals when adjusting to loss: (1) the use of coping mechanisms; and (2) emotional reactions. If we wish to help friends and loved ones in time of sorrow, we need to understand how these are expressed by them.
Coping mechanisms
Coping mechanisms operate to psychologically protect individuals and are used to reduce the level of anxiety they feel at a given moment. This allows them to better adjust to the loss and begin the grieving and healing process.

• Disbelief or denial: This response reduces anxiety by allowing individuals to limit their awareness about the reality of what has happened until the pain can be let in more slowly. Everything inside shouts "NO"! and the mind struggles to escape. Unable to tolerate the pain that would emerge if reality were faced, the individual experiences "emotional anesthesia." Numbness and confusion are often predominant responses. Sighing and crying can be readily observed. Others cannot cry and may withdraw. This stage is relinquished more easily if people will listen to the bereaved person and help them express their whole range of feelings. Listening to feelings without giving advice is the best helping strategy.
• Disorganization and dependence: Characterized by a period of confusion in which the grieving person may feel out of touch with the ordinary proceedings of life. They may exhibit very dependent behavior and a time-orientation that focuses solely on the present. They may become quite demanding, asking others to do things they normally can do themselves. Some of their talk and actions may seem foolish and out of character to others. It is wise not to make major decisions, such as selling one's house or moving, during this period.
• Intellectualization: A coping mechanism in which the grieving person attempts to master the loss by gathering a great deal of knowledge and information and analyzing in detail the situations leading to the loss. They may find out the most intricate medical data of a fatal disease, for example. Or, they may plan in detail what will happen after the loss occurs. Surviving individuals may rationalize the loss by saying "He's better off in the long run," or "She suffered so much." This allows the individual to remain emotionally detached and to become an "observer" of the situation. If it remains within reasonable bounds, intellectualization can give the individual and family members a greater sense of control.

Emotional Reactions
Emotional responses coexist with coping mechanisms, but they do not necessarily protect the person from the trauma of loss. They are means for the individual to express emotions and feelings associated with the loss.

• Anger and resentment are common emotions of bereaved individuals. It is often expressed as a protest against what seems to be a cruel, unfair and incomprehensible fate. It is a reaction to frustration -- the source of which cannot be removed, so the person feels trapped and helpless. When this happens, the individual may project this anger onto more accessible targets (e.g. spouse, family member, hospital, physician, the government) or others involved in the loss chain. Overt expressions of anger, such as verbal outbursts, sarcasm, and unreasonable or persistent demands, should be recognized as an understandable response to a traumatic situation and not necessarily as a personal attack. For most of us, talking openly about our feelings helps reduce the anger.

Friends can help by listening empathetically and resisting the temptation to return anger with anger, or becoming defensive if they make accusations. Unexpressed anger may be turned inward and may be replaced by silent bitterness, indifference, apathy, aggression, and ultimately, depression.

• Guilt feelings are frequently a part of the grief process. These feelings become focused as the individual searches for the cause of the loss thinking thoughts like these:
• "What did I do wrong?''
• ''Could _____ have done anything differently?''
• "If only I hadn't _____."
• "If only I would have _____''.

When you live with someone for any length of time, you will say things you regret. When that person dies, you suddenly realize all the things you wanted to say and didn't. You remember words you wish you had not said or actions you wish you had not taken. It is human to feel guilty and to want another chance to erase neglect or failure. If the individual openly expresses guilt, it is better to encourage talking about it rather than clamming up. Saying ''No, you're not to blame" doesn't really help either. A caring person will encourage the full expression of feelings rather than blocking them, which would make the person feel even more guilty.

• Fear and anxiety is another emotional component of bereavement. The grieving person may exhibit feelings of helplessness, hopelessness, hurt and anxiety. Sudden loss means rapid change and demands great adjustment. Starting over, with a new job, with a new career, new relationships, can be a frightening experience. Since the loss usually is not of one's own choosing, there may be great anxiety about an unknown future. The greater the loss, the greater the potential change, the greater the anxiety and fear. Joining a support group where people can freely express their worries in a supportive environment can help reduce needless anxiety.
• Shame occurs when a person is in a situation that is incompatible with the image that one wishes others to have. Shame, guilt, anger and regret often intertwine and are overlapping. A farmer who involuntarily leaves the farm may believe that this reveals an intrinsic weakness or unworthiness in himself. When friends and family try to be encouraging and reduce guilt, it may undermine one's sense of dignity and self-esteem. Accepting the individual as an "OK" person and being there when needed, is true friendship.
• Loneliness and depression are considered the most painful processes. When a loved one is removed from their lives, people often are overcome by feelings of utter depression and isolation. Gradually the finality of the loss sinks in -- an empty chair near the TV, an unused pillow, a family photo, a missing phone call. Sadness and depression follow and self-pity is frequent.

Problems which are manageable when shared with a partner become magnified when faced alone. Sometimes an individual may search for a quick replacement. However, healing and recovery are more likely achieved if the bereaved person completes the grieving process before seeking a new partner or making any new lasting commitments. Delaying major decisions allows people to see new perspectives, to make decisions more easily lived with during the years ahead.

• Relief and recovery: Feelings of relief are difficult to admit and acknowledge openly. Relief is so intermingled with our sense of loss that we cannot see it isolated enough to take it for what it is -- a normal, human response. A feeling of relief does not imply any criticism for the lost relationship. There is an overlap between relief and recovery -- in fact, feelings of relief may signal recovery. As the individual brings closure to bereavement, and as hope softens the intense feelings of loss, a new life begins. The person reaches out and makes constructive efforts to rebuild by responding more readily to phone calls, attending meetings, and seeing social gatherings as opportunities.

Helping People With Bereavement
Grief has been called the ''sorrow of the soul.'' Grief over death or separation is a fundamental human experience, yet the pain experienced in bereavement excludes no one.
Helping Children
Children seldom have the support and love from sources outside the family. Therefore, a breakup in the family unit, a loss of a loved one or a pet, may be more traumatic than for an adult. When a child is young and cannot understand the loss, their grief work is slightly different from an adult. They experience an initial period of protest, then become quiet, withdrawn and less sociable. They may also revert to behavior of earlier years and ''act like a baby" again. When breaking bad or sad news to children, consider these steps:

• Tell the truth. Children can handle it better than adults realize.
• Offer love and reassurance that you will be there with them and to help them.
• The sooner you explain things, the better.
• Reassure children that they are not the cause of the loss, nor responsible for taking care of anybody but themselves. When adults will not level with children, they are faced to draw their own conclusions -- which are always much worse than the facts. Children are flexible and resilient and can deal with reality.

Fear of Death
In understanding our feelings about a terminated relationship, perhaps we will learn more about what we want from life. Death is the most critical loss and has greater fear associated with it. Fears most often associated with death are:

• Fear of interruption of life goals -- death may keep you or your family from achieving all they hope to achieve.
• Fear of impact on survivors -- a fear of what happens financially and emotionally on the people left behind.
• Fear of physical suffering -- the thought of a lingering, painful death is upsetting, especially to very active people.
• Fear of "not being" -- worrying about the finality of death; of not being around to enjoy people; seeing their kids grow up; of the loss of meaning of their life.
• Fear of punishment -- worrying about not having their spiritual life in order and having to "pay" for unacceptable behavior.
• Fear of death of others -- young people particularly fear the death of others and living without the care and comfort of the one who died.

Tomorrow is Yesterday's Today
Grief is a basic part of life and we cannot totally separate ourselves from it. We can prepare for it by understanding the emotion of grief and the process of bereavement. The stages of grief and bereavement are in no way separate; they intertwine and overlap. Some may last only a few minutes and flashbacks are common in the grieving process. Months or years later certain phases of grief will recur. The causes may be obvious -- Christmas, birthdays, a sudden meeting of mutual friends, anniversaries. Less obvious causes are hidden in the complexity of grief -- it may mean that one phase of grieving has not been complete.
As one widow said, "Acceptance finally comes, and with it peace. Today I am more independent, more understanding, and have more sympathy. I have a quiet love for Martin. I have passionate, poignant memories. He will always be a part of me, but Martin is dead. I am a different woman, and the next time I love, if ever I do, it will be a different man, a different love."
Activities
These activities are designed to help you see your life more clearly and to raise specific issues about the quality of life.

• Lifeline -- Make a time-line of important events in your life, beginning with birth and ending with your death. Write down your age, the event and persons involved. Look at your lifeline to understand how these events have affected your life and the identity of the people involved.
• Obituary -- Write your own obituary using the suggested format below. The purpose is to help you see your life more clearly and to reinforce the fact that we still have a life ahead of us to do whatever we want to with it.

<TBODY>_______	_______	died yesterday from ______________
(name)	(age)
He/she is survived by _____________________________
He/she will be remembered for ______________________
He/she was working on becoming____________________
He/she always wanted, but never got to________________
The world will experience the loss because_____________

Summary
When grief or loss enters your life, remember these guidelines:

• With loss or grief, do not hide your emotions. Share your sadness with others. Don't deny yourself moments of intense grief. Recognizing the loss signals the beginning of the bereavement process.
• Don't isolate yourself or try to lose yourself in your job. Take time to reflect on your sorrow and confront the resulting problems. Don't deny reality.
• Encourage your friends and family to talk to you about your loss. If they don't do it, keep pressing them. Hiding from reality only prolongs the eventual resolution of grief.
• If possible, try to talk to the departing person. If there are things unsaid, say them now! Spend some time with him or her to say a last goodbye. Realize the final separation has come.
• Attend the funeral or the divorce hearing. The finality of the loss may not sink in until you do, and closure will begin.
• Don't build a shrine! It will prolong the grief process and intensify your grief. Rearrange the furniture! Play his or her favorite music! Touch objects that will bring out emotions.
• Rebuild your life. Find new friends, new acquaintances, and get involved in new activities. Don't rebuild your life on the memory of something that once was, but on the courage and strength gained through the bereavement process.

Not everyone who grieves will experience all stages of grief. And, not all people work through their grief the same way. Working through grief takes time. In ancient India, a grieving peasant asked the Yogi, "How long will I grieve?" Instead of an answer, the Yogi gave him an instruction: "Go today from home to home and ask for one-half cup of rice from those who have not experienced grief.'' The peasant did as he was told. At the end of the day, he had no rice, but he had met many happy people. He found his answer.

 

With thanks to the University of Nebraska-Lincoln!