Mental Health Information

Grief is the reaction people have to any loss in their lives. It includes a wide range of responses which vary with each person, the type of loss and its meaning to them, and their particular circumstances and experiences. The death of a significant person in one's life is a major loss but grief can be felt about any loss. When people grieve they are coming to terms with changes in their lives and how to manage the gaps created by the loss.

Symptoms

The experience of grieving may last for weeks or years and may be accompanied by physical symptoms like headaches and fatigue, withdrawal and reduced mental capacity such as poor concentration and memory).

Additional symptoms are commonly known as the five stages of grief:

• Denial, disbelief, numbness
• Anger, blaming others
• Bargaining (for instance "If I am cured of this cancer, I will never smoke again.")
• Depressed mood, sadness, and crying
• Acceptance, coming to terms

Grief is a normal reaction, however if someone is feeling overwhelmed by their grief or is experiencing difficulty in returning to their usual level of functioning it is important to seek professional help. Taking time out, establishing routine, and engaging in activities which allow for emotional expression are suggestions for coping.

Adapted from Grieflink , Department of General Practice, Adelaide University

Perceptions of Loss

It is very important for the therapist to be aware of the various views an individual has about the loss and the process of grief.  Specifically, the psychological, spiritual, sociological and philosophical perceptions of the client have to be understood to ascertain the unique experience of their loss and grief.

Psychological Perspectives include personality, coping styles, affective and cognitive domains, present stressors and overall mental health factors that have the potential to influence the grieving process.

Social perspectives include factors such as culture and society norms, nuclear family, family of origin, economic status, and gender. These may influence how one grieves as most individuals will refer to these factors in their attempts to make sense of the loss experienced.

Spiritual perspectives are of common interest in the literature of loss and grief. It is widely believed that the person's spiritual perspective has a profound influence on their grieving experience. People who profess strong spiritual beliefs have been shown to resolve their grief more rapidly and completely after the death of a loved one compared to people with no spiritual beliefs.

Physical perspectives include all aspects of biology, physiology, pharmacology and general functioning of the bereaved person. Because grief can hide behind somatic complaints it is important to rule out and separate physical problems from grief (Humphrey and Zimpfer, 1998).

Manifestations of Normal Grief

With a number of people undergoing grief, it is important to understand signs of normal grief. Worden (2005) identified four categories that demonstrate normal grief. This includes feelings, cognitions, physical sensations and behaviours. It is also important to remember that these signs of grief will vary from individual to individual.

Feelings

Sadness is a common feeling experienced after the loss of a loved one. This is often demonstrated by crying, a gesture that evokes a sympathetic and protective reaction from others. Not allowing sadness to be experienced with or without tears has the potential to lead to complicated grief.

Numbness or shock is often experienced immediately after a loss. This serves as a defense to block pain and to protect the bereaved from being overwhelmed. It allows opportunity to be gradually introduced to the reality of the loss.

Anger is frequently associated with loss. It is not uncommon for the anger experienced to be directed at either the deceased of the bereaved, the bereaved themselves or both. Worden (2005) suggests that anger comes from a sense of frustration due to an inability to prevent the death and as a regressive experience that occurs after losing someone close. Anger experienced by the bereaved needs to be appropriately identified in order to bring it to a healthy conclusion.

Guilt is also common in the process of grief (Worden, 2005). The bereaved might feel guilty about being alive while the loved one is dead. Guilt is often manifested over something that occurred during the time of death that the bereaved individual feels they could have prevented somehow. Most guilt is irrational and can be overcome by "testing reality" except where the bereaved is responsible for the death, then other interventions will be more appropriate. Guilt may also relate to unfinished business the bereaved might have with the loved one. For example, things left unsaid, a longing to have done things differently and other potential regrets can all encourage the bereaved to feel guilty.

Anxiety is a common feeling associated with loss and it comes primarily from; a fear that they will not be able to take care of themselves and a heightened sense of personal death awareness. The anxiety experienced may vary from mild anxiety to more extreme panic attacks. In this sense, being confronted with the reality of death can be a little frightening.

Other feelings associated with grief include loneliness, fatigue, helplessness, yearning and emancipation (Freeman, 2005; Worden, 2005).

Cognitions

The most common cognitive response to death is a preoccupation with the deceased, which occurs as a form of obsessional thinking. Some preoccupation may be in the form of intrusive thoughts that may be related to guilt or other unresolved issues. This commonly occurs in the early stages of grief and disappears after a short while. Prolonged experience of these thoughts may trigger depression.  Hallucination (visual and auditory) of the deceased loved one is also a frequent experience of the bereaved. Other cognitive responses may include confusion, disbelief, and passive suicidal thoughts.

Physical Sensations

In addition to feelings and cognitions associated with grief, there are also physical sensations that transpire during the grieving process. Although often overlooked, they may be key indicators of the individual's grief reaction. Examples of commonly reported physical sensations are listed in the table below.

Physical sensations of grief:

• Hollowness in the pit of the stomach
• Tightness in the chest and throat
• Oversensitivity to noise
• Breathlessness
• Lack of energy
• Dry mouth
• Muscular weakness

Source: (Worden, 2005)

Behaviours

There are a number of behaviours associated with a normal grief reaction too. These are often experienced immediately after a loss and correct themselves over time. Disturbances in sleep and eating patterns are very common during times of grief. Absent mindedness and social withdrawal are also common behaviours that are evident in the grieving process. Behaviours such as dreams of the deceased and avoiding reminders of the deceased are also reported in the early stages following loss.

There is a wide variety of feelings, cognitions and behaviours that are associated with loss. As such, it is imperative for counsellors to understand behaviours of normal grief (Freeman, 2005; Worden, 2005).

References:

Freeman, S (2005). Grief and Loss: Understanding the Journey. Belmont, CA: Thompson Brooks/ Cole.

Humphrey G.M., & Zimpfer, D.G. (1998). Couselling for Grief and Bereavement. London: SAGE Publications

Worden, J.W. (2005). Grief Couselling and Grief Therapy: Handbook for Mental Practitioners (3rd ed.). New York, NY: Springer Publishing Company.

Information provided by the Mental Health Academy