Grief and Bereavement - Lifesharing (PDF)

A LifeCare® Guide to Grief and Bereavement  This publication is for general informational purposes only and is not intended to provide any user with specific authority, advice or recommendations. Copyright © 2001 LifeCare®, Inc. All rights reserved. LifeCare®, Inc. is a worldwide leader in professional work and life services. http://www.lifecare.com Printed on recycled paper. C Cover Photo by: ©Bill Brooks/Masterfile Treasure each other in the recognition that we do not know how long we should have each other. — Joshua Loth Liebman � �  Thanks go to the following professionals for their contributions and editorial support: Nancy E. Crump, M.S. Coordinator of Aftercare Services Certified Grief Counselor D.W. Newcomer’s Sons 1331 Brush Creek Boulevard Kansas City, MO 64110 Telephone: 816-561-0024 Fax: 816-931-7246 Stewart Enterprises, Inc. 110 Veterans Boulevard Metairie, LA 70005 Telephone: 800-535-6017 Fax: 504-849-2294  Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 When Does Grief Begin? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Terminal Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Unexpected Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Understanding the Grieving Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 The Grief Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Symptoms Associated With Grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 As Grief Evolves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Mourning Specific Losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Loss of a Spouse or Partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Loss of a Parent as an Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Loss of a Sibling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Loss of a Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Loss of a Friend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Loss of a Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Loss of a Co-Worker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Loss of a Pet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Changes in Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Relationships With Family Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Relationships With Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Relationships With Co-Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Spiritual Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Taking Care of Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Identify Your Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Have Realistic Expectations and Be Patient With Yourself . . . . . . . . . . . . . . .32 Talk About Your Grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Rely on Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Take Care of Your Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Put Off Major Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Join a Support Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Seek Professional Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36  Remembering Your Loved One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Develop and Use Rituals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Holidays and Anniversaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 As Time Goes On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 Suggested Reading on Grief and Bereavement . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Helpful Resources Index  Page 5 I f you are reading this guide, you have probably lost a loved one—an event that can be devastating to you and those close to you. Grieving is a personal and unique process. There are no right or wrong ways to grieve, but there are ways of getting support and taking care of yourself that can ease your feelings of loss. This guide includes practical information on feelings associated with grief; mourning specific Introduction “I will open my heart in trust that, In ways I do not now understand, My loved one will continue to be present in my life.” —Martha Whitmore Hickman  A LifeCare® Guide to Grief and Bereavement Page 6 losses; changes in relationships; taking care of yourself; and remembering your loved one. The more you learn about grief and bereavement, the better you will be able to cope during this difficult time and in the years to come. If you would like information on how to help someone else cope with the loss of a loved one, please refer to A LifeCare® Guide to Helping Others Cope With Grief.  Page 7 T he process of grief is unique to each individual who experiences it. The moment you begin to grieve for a loved one may depend on many different circumstances, such as whether the death was sudden and unexpected or whether it occured after a prolonged terminal illness. When Does Grief Begin? “The most essential thing in life is to develop an unafraid, heartfelt communi- cation with others, and it is never more important than with a dying person.” —Sogyal Rinpoche  A LifeCare® Guide to Grief and Bereavement Page 8 Terminal Illness What many people don’t real- ize is that grieving can begin simply with the realization that your loved one will die. The minute the doctor says there is an abnormality on the mam- mogram, or a suspicious spot on the lung X-ray, fear sets in. “What if this is serious?” “What if he has cancer?” “What if she dies?” This is the grief process—fearing the loss, and reacting emotionally to the reality of the threat—“It can’t be, there must be some mis- take,” or “This isn’t right!” A roller coaster of emotional ex- periences—from hope to despair—may begin when you first hear the news, and can continue over the course of the illness and long after the passing of your loved one. Coping with a terminal illness may leave you feeling many things. Along with the difficulty and demands of the illness and the impending death, there is opportunity. You may find that the diagnosis forces you to stop and think about your relationship in new ways. You may make different choices than you might have otherwise, such as spending more time with your loved one, sharing things that you never have before, expressing your love directly, or resolving old conflicts. Caring for a terminally ill loved one can give you a sense of connection and the ability to share love. And, having had the opportunity to say goodbye can provide a great sense of comfort. At the same time, watching the physical effects of a disease take their toll on your loved one can be difficult. If you are also his or her caregiver, the round-the-clock physi- cal demands can be exhausting as well. As a result, after your loved one’s death, your only clear memories may be of your loved one’s decline and suffering. In time, howev- er, memories of the good times you shared, and of the person he or she was before the illness, will resurface. Along with the difficulty and demands of the illness and the impending death, there is op- portunity. You may find that the diagnosis forces you to stop and think about your relationship in new ways.  Page 9 Grieving involves mourning the losses that occur as your loved one becomes weaker and sicker, and mourning the anticipated death. Following are some suggestions for how to cope if your loved one is terminally ill. Coping When Caring for a Terminally Ill Loved One � Share responsibilities. When others offer to help, accept. If they ask what they can do, give them specific tasks—bringing over dinner, sitting with your loved one to give you a break, making phone calls—whatever it is you need. This is no time to be totally independent; you’ll wear your- self out. � Seek support. Talk regularly with a friend or family member about how you are feeling and managing; seek professional help from a counselor, therapist or clergy member; or join a support group. Sharing your emo- tions with others may help relieve some of the stress you may be feeling. (For more information on professional help and support groups, please refer to the chapter Taking Care of Yourself.) � Resolve differences. Try to work through any conflicts, old or new, in your relationship with your loved one. Recognize and respect your loved one’s opinions and put them in perspective. Some conflicts may no longer seem important. � Share what is important. Tell your loved one what he or she means to you and say things that may have gone too long unsaid. This can be very fulfilling for both of you. Sometimes the difficulty of communicating with a terminally ill loved one can add to your feelings of helplessness or anxiety. Consider the following suggestions for communicating with your loved one. Communicating With a Terminally Ill Loved One � Ask your loved one what you can do. Speak to your loved one about his or her personal wishes. Are there any projects he or she wants com- pleted such as a garden or a family album? If you feel comfortable, this may be a good time to discuss your loved one’s preferences about funeral arrangements. For more information about planning funeral arrange- ments, please refer to A LifeCare® Guide to Funeral Planning. � Listen. Allow your loved one to talk about his or her feelings, including his or her fears and sadness. � Spend time at the bedside. Your loved one may not want to talk, but your presence, whether you are quietly reading, knitting or doing cross- word puzzles, can be very comforting. � Be honest. Don’t offer false hope or say things you don’t mean to “protect” your loved one from painful realities. Most people want the truth, even if it is difficult or painful. For example, don’t try to gloss over your loved one’s illness by pretending he or she will be fine. If you are dishonest, it may make your loved one feel even more isolated. When Does Grief Begin?  A LifeCare® Guide to Grief and Bereavement Page 10 � Reminisce. Time spent reminiscing can be of great value, to both you and your loved one. Look at photo albums, share favorite stories and memories, and enjoy your time together, if possible. � Help your loved one organize his or her estate and legal affairs. Help with drafting/updating a will, choosing an executor, setting up a trust or guardianship and executing advance directives. Make sure that at least one person knows where these important documents are located. For a comprehensive discussion on estate planning, please see A LifeCare® Guide to Retirement and Estate Planning. Unexpected Deaths Accepting the reality of death—whether the death is expected or sudden is equally chal- lenging. When a death is sudden, there is no process of mourning losses along the way, or preparing for the adjustments and, oftentimes, no opportunity for goodbyes. The emotions you may feel can vary dra- matically depending on your relationship— and the cause of death. If, for example, an elderly loved one dies in his or her sleep, you may find comfort in the fact that he or she died peacefully. In other situations, you may experience anger at whatever caused your loved one’s untimely death; or feel guilty that you didn’t prevent it (even if it was impossible for you to have done any- thing); or you may feel vulnerable since you had no warning. No matter how your loved one dies, you will most likely go through a process of grieving. We hope this guide helps you better understand the griev- ing process and the resources that are available to help you. Sudden deaths can also happen during the course of a terminal illness. For example, if your loved one was battling cancer for years, then died suddenly, you may experience this as an unexpected “sudden death.” This may be particularly hard if your support system assumes you were well prepared. Accepting the reality of death—whether the death is expected or sudden is equally challenging.  Page 11 M any people expect that grief has a beginning and an end; that it is some- thing they can “work through” or “get over.” Similarly, many people often think of grief as a process that occurs in stages, however, most of these beliefs about how grief occurs are outdated. Over the past few decades, as researchers and those who care for the dying have listened to those grieving, the understanding of how grief works has changed significantly. Understanding the Grieving Process “One often calms one’s grief by recounting it.” —Pierre Corneille  A LifeCare® Guide to Grief and Bereavement Page 12 It is now generally accepted that the grief process is not linear—painful at the beginning and getting progressively better over time. It is a chaotic, cyclical process with good days and bad days, or good moments and bad moments. Feelings tend to come in waves—sometimes expected, and sometimes not. A smell, a song on the radio, or something else you associate with your loved one may evoke strong feel- ings. Other times, feelings seem to come from nowhere. You may find yourself sud- denly in tears while sitting at your desk, or doing the dishes, even when you weren’t aware you were thinking about your loved one. This is not evidence that you are losing your ability to cope, but rather, a common response to loss. This chapter focuses on the different aspects of the grief process, including symp- toms commonly experienced and tips for coping. For additional suggestions on cop- ing with grief, please refer to the chapter Taking Care of Yourself. The Grief Process To help explain the grief process, psychologist William Worden outlined four “tasks” of grieving. This framework offers a way to identify all that is involved in grieving, but keep in mind that the tasks are not separate aspects of grief. You may work through the different aspects of the grief process again and again in different ways, as you move through the tasks. The Tasks of Grief � Accept the reality of the loss. From the moment you are told that a loved one has died, or may die, you know it mentally. However, it may take a much longer time to accept it emotionally. For weeks or months after the death, you may reach for the telephone, or even dial the number to call your loved one, only to realize he or she is gone. It is then that you have to remind yourself of your loss—and accept that your loved one is gone. However, even after adjusting to life without your loved one, you may have a new surge of disbelief. You may feel torn between wanting to accept reality, and feeling disloyal to your loved one for doing so. Remember, accepting the loss does not mean letting go. � Experience the pain of grief. How long does normal grief last? The answer is different for everyone and every situation. It can take several years to establish a new sense of normalcy. But life does go on; the process of grieving can help you restore harmony and balance to your life. � Adjust to life without your loved one. Each day you may be confronted in small or large ways with the absence of your loved one. He or she is not there to go to lunch with, to call in the evening, to celebrate the holidays, to go on vacation or to do the taxes. The process of adjusting may go on over the course of a lifetime. You may have to adjust to the loss of your child, for example, when his or her friends graduate from high school, get married or have children. Holidays and other traditions you would have shared may also be constant reminders—as are daily rituals—and each one requires adjustment. The empty chair at the dining room table, the per- sonal belongings in the closet are all reminders of your loss. Some things you may choose to keep as a comforting reminder of your loved one, and some things you may change and adapt as your life moves on.  Page 13 � Find ways to remember. At first, you may struggle to adjust to life with- out your loved one, but as time goes on, your life will continue to evolve, just as you do. It is not so much a matter of “letting go,” rather, it means shifting from being with that person to just having thoughts of that per- son. This simply means that, as time goes on, you will be choosing mem- ories, rituals and other ways of remembering and relating to your loved one. As you grow and change, your memories of your loved one will grow and change as well. Symptoms Associated With Grief As you grieve, you may experience a variety of symptoms—emotional, physical and cognitive—unique to your situation. By understanding what symptoms are common among grieving people, you may take some comfort in knowing that you are not alone. Following are common symptoms and tips for coping. For additional coping tips, please refer to the chapter Taking Care of Yourself. Physical Symptoms Associated With Grief Following the death of a loved one, you may expe- rience grief through physical reactions such as shortness of breath, headaches, nausea, loss of appetite, insomnia and fatigue. Intense grief also places the immune system under more stress, and therefore you may have an increased tendency to get sick. Your body is vulnerable now because much of your energy is being used for grieving. Even though it may be the last thing on your mind, taking care of your body is essential to keep you physically strong enough to deal with the emotional crisis you are experiencing. Note—If you are having physical symptoms that are new or extreme, such as chest pain, consult your physician. Cognitive/Emotional Symptoms Associated With Grief The mental and emotional symptoms experienced during grief may include confu- sion, sadness, guilt or anger. Some of the most common symptoms include: Denial Immediately after the death of a loved one, you may experience shock, numbness and disbelief. At first, denial may help you process the news so you don’t fall into shock. Some people report that the denial and resulting numbness help them get through those first days surrounding a loved one’s death. If you are experiencing denial, realize this is a coping mechanism—but also realize that you need to accept your grief to heal. Share your feelings with others and give yourself time to let the loss make sense. Sadness You generally expect to feel sad when you are grieving, but what you often don’t expect is to feel even sadder as time passes. The early days or weeks after the death of a loved one are usually occupied with the demands of funeral planning, attending Understanding the Grieving Process As you grieve, you may experience a variety of symptoms—emotional, physical and cognitive— unique to your situation.  A LifeCare® Guide to Grief and Bereavement Page 14 to financial and legal affairs or adjust- ing to a different schedule. You are often surrounded by friends and rela- tives, all of whom tend to be most attentive in the early weeks after the death. As the weeks pass, however, most return to their daily lives, and your support system may diminish to some extent. It may be several months or more before you feel the full impact of your feelings. At this point, the death of your loved one may seem more real. You may be attempting to resume your daily routine as the absence of your loved one from your life becomes more intense. At this time, ask for help and support from others. If your support network is limited, seek professional help or join a support group. Additionally, allow yourself to cry; the best way to deal with the sadness is to accept your feelings as normal and express them in a way that helps you. Don’t try to find a quick fix—allow time to grieve your loss. Anger Anger is a common response to grief; it is our normal human reaction to being hurt. You may feel anger toward a higher power, friends, rela- tives—even your loved one for leav- ing you alone. There is nothing wrong with having these feelings. The important thing is to find con- structive ways to release your anger. Letting your anger out anywhere, and at anyone, is not a healthy response to grief. Are You Suffering From Depression? Extreme grief may cause a chemical change in your body that can lead to depression. If you recognize any of the following warning signs of depression in yourself—or others— consult a doctor or mental health professional. (Please see the chapter, Taking Care of Yourself, for informa- tion on professionals who can help): � Feelings of sadness or intense depression, hopelessness or apa- thy over an extended period of time. � Decreased interest and participa- tion in activities, particularly those you previously enjoyed. � Inability to keep up with crucial work and life tasks. � Noticeable physical changes (stomach problems, extreme loss of appetite, confusion, severe headaches and/or sleep changes) for an extended period of time after the loss. � Suicidal feelings. (Seek profes- sional help immediately if you have suicidal feelings.) Although not direct symptoms of depression, you may also want to seek professional help if you are experiencing violent outbursts directed at yourself or others or you are using drugs or alcohol to avoid or numb the pain of a loss.