my mental health - grief - University of Alberta (PDF)

identification Grief can occur from a variety of losses, not just the loss of a loved one. Other losses might include: • moving away from your home town or city • changing or losing a job • a relationship break-up, separation or divorce • loss of a close friendship • selling your family home • your parents divorcing • the death of a pet • loss of financial security • a miscarriage or abortion • a major change in your health • being asked to withdraw from university/college This handout will focus most specifically on the loss of a loved one, but many of the strategies may apply to these other losses as well. Grief is often conceptualized as occurring in stages, as was first described by Elisabeth Kubler-Ross in 1969. The stages she outlined included: denial, anger, bargaining, depression, and acceptance. Since then, many other stage models have been developed with as many as ten stages. However, more recent literature questions the usefulness of the stage model of grieving, since not all people go through these stages, not everyone goes through them in the same order, and many people cycle back through these stages over time. It might be more helpful to instead describe grieving as having common feelings, reactions and symptoms. These include: • shock • fear • disbelief • denial • sadness • anger (at God, the deceased, yourself, or at the unfairness) • guilt • confusion • memory problems • difficulty concentrating • irrational thinking • hyperactivity • sense of unreality • obsession with the deceased emotional reactions: psychological /cognitive reactions: 1 grief can occur from a variety of losses common feelings, reactions and symptoms There are a number of variables which will influence your experience of grief. Some of these include: • how connected you were to the person • how healthy the relationship was with the deceased • whether you had unresolved issues in the relationship • whether the death was sudden or progressive • the exact nature of the death (i.e., illness, accident, suicide, homicide) • the age of the person who died • the support system you have • your personality • cultural practices related to grieving • the number and type of previous deaths you have experienced • what you have learned about death over your lifetime • your religious beliefs related to death • other stressors you are experiencing at the time of the death variables which will influence your experience of grief • the type of relationship you had (i.e., parent, spouse, child, partner, relative, friend, boss, etc.) with the deceased • your emotional stability prior to the death Since there are so many factors which influence the grieving process, you can see why your response to the death will be completely unique to you, and no one else will fully understand it. • anxiety • numbness • yearning • apathy • emptiness • resentment • helplessness • relief • sense of loss of purpose • dreams or nightmares relating to the death • the illusion of your loved one’s presence grief my mental health  2 • insomnia/oversleeping • tightness in the throat • shaking • loss of appetite/ overeating • loneliness • sense of detachment from others • feeling abandoned • need to be alone • easily irritated by others • anger at God • loss of faith • connection with nature/ sense of something larger than ourselves Physical Reactions: Social Reactions: Spiritual Reactions: • pain in different body parts • nausea • fatigue • panic attacks • loss of interest in daily social activities • not wanting to return to work or school • greater connection with God or religion • negotiating with God Remember, all of these feelings, symptoms and reactions are normal and common when we experience a loss. Remind yourself that even if these changes are intense, you are not going “crazy” and that they are appropriate under the circumstances. coping strategies Unfortunately, because there is a lot of misinformation out there about dealing with loss, a lot of people simply won’t know how to help you. This doesn’t mean that you shouldn’t try to get their support, just don’t be hurt or too disappointed when they are not able to give you what you need. Some of the difficulties encountered by people around you include: not knowing what to say to you, being uncomfortable discussing feelings, generally, let alone grief, feeling a need to change the subject, feeling that keeping busy is the best way to deal with your pain, feeling they can talk you out of your pain on an intellectual level, not even being able to use the word “death”, or suggesting that you need to simply keep your faith in God. In our society, we have come to believe that everyone else or events (outside of our control) are responsible for what we feel. We often make statements like “he made me so angry” or “I can’t believe she did that to me, she ruined my day.” The same lack of responsibility can apply to the grieving process. However, by making others responsible for our feelings, they also become responsible for ending them, making the process out of our control. Therefore, if a loss is responsible for our pain, we also feel little control over recovering from it because we have no way to replace the loss. Instead, it is essential that we take responsibility for our feelings, including the pain of a loss. Therefore, in this way, what we do to recover can make a significant difference. 1 understand that not everyone will know how to help you 2 take responsibility for your recovery It is important to remember that we are forever changed by the death of someone we are very close to. Our life will be forever affected, but the good news is that grief can also produce significant psychological and spiritual growth, depending on how we handle it. We can heal from the loss and the more severe pain will fade, but it will forever leave an emotional scar. Grieving is considered by many as a lifelong process. It affects your life direction and even your identity if the loss is significant. Also, in death, you develop a new type of relationship with your loved one, not based on their physical being but more on their memory and spirit. All of us have received messages and information about death and dying, but unfortunately a lot of what we have learned isn’t very helpful. Try to determine whether you have come to believe any of the following misinformation or myths regarding grieving, and begin to challenge these ideas. Just ignore or bury the pain and it will go away in time. We move fastest through the pain of loss by acknowledging and experiencing it. Time alone will heal all wounds, including grief. Time doesn’t necessarily move us through the grieving process. It is what we do in this time that matters. 3 accept that your life will likely change 4 identify any myths you hold about grieving Myth: Fact: Myth: Fact:  Being strong (especially for others) is the best way to get through grief. Allowing ourselves to be vulnerable and in touch with our emotions allows us to move through the grief process. Myth: Fact: It is best to grieve alone. The support of others can greatly facilitate the grieving process. Myth: Fact: If you lose something or someone, just replace the loss and everything will be fine. Many losses can’t simply be replaced, especially when it comes to relationships or people. Myth: Fact: The best way to cope with a loss is to just keep busy. It is most helpful to give yourself time to grieve, even if this means scheduling a time on a daily or weekly basis. Myth: Fact: Grieving usually takes about a year. There are many factors that affect the grieving process, and the time frame varies significantly. Myth: Fact: If you are not crying, you don’t care about the person who died, or the loss you endured. There are many responses to a loss and crying is only one of these. Myth: Fact: Grief appears in predictable stages that occur in the same order. New models of grief challenge the stage model, and see grief as involving numerous feelings and reactions that come and go like waves on an ocean. Myth: Fact: The goal of grieving is to “get over” or “let go” of the person who has died. Healthy grieving is more about how to stay connected to the person who has died and to learn how to integrate the loss into one’s life so you can move forward. Myth: Fact: Expressing tears is a sign of weakness. Tears are a healthy expression of your loss and serve the function of releasing our body’s tension and emotion. Myth: Fact: More important than anything else when we grieve is to be able to be open about your feelings to someone else you trust and value (or more people if we can). Healing will not and cannot occur if you keep all of your feelings inside. This may be very different for anyone who is not used to talking about emotion, but is equally as beneficial. The expression just needs to be honest. Talk about what you miss, what you don’t miss, what kind of person they were, your loss of shared hopes and dreams for the future, your loneliness, anger and sadness. Throughout your lifetime you have likely experienced a number of events that are considered losses. Take some time to write these out on a line that is based on the time in your life they occurred. For example: Part of the reason we can get stuck in our grief is because the relationship we had with our loved one is in some way emotionally incomplete. To try and complete the relationship, it can be very helpful to communicate unacknowledged aspects of the relationship through a letter. These might include things that we have done or said, or didn’t do or say, that we regret; those things that we need to forgive others for; and emotional statements such as “I was proud of you” or “I love you.” By expressing these kinds of statements, we can finally bring some emotional completion to the relationship. This may require really analyzing the relationship for what feels emotionally incomplete and allowing the writing of the letter to be an Once you are done the graph, take some time to think about what you learned about loss from each of the events on the graph. It might also be helpful to share this learning with a supportive friend, family member or counsellor. This will help you in understanding your reactions to the most recent loss and challenge any unhelpful beliefs or misinformation you acquired. Dog died (1990) Moved to Edmonton (1994) Friend died (1998) Grandmother died (2003) Breakup with girlfriend (2008) Mother’s death (2010) 5 talk about how you feel 6 develop a line graph of your significant loss experiences 7 write your loved one a letter 3  4 There are a number of rituals that can help you in the grieving process including the funeral or memorial service, wakes and prayer services. There are other more unique rituals that you may decide to develop such as visiting the cemetery, lighting candles on special days, spreading the remains of your loved one after their cremation, or releasing balloons as a way to say goodbye. These can all be healthy aspects of your grief. However, some rituals can be too rigid or extensive and, in fact, be unhealthy expressions of the loss, such as building a shrine or keeping their room exactly as it was at the time of the death. These kinds of rituals may keep you too stuck in the past and not able to engage in life in the present. 8 participate in grief rituals To cope with anything that is highly emotional, particularly grief, it is essential that you focus on basic self-care activities. These include getting adequate sleep, ensuring that your diet is healthy and balanced, exercising regularly, and building fun activities into your day. When people are grieving, self-care is often neglected because people are feeling depressed and don’t have the energy or will to take care of themselves. Unfortunately, this will make your suffering even worse, since how we feel physically greatly affects how we feel emotionally. 10 focus your energy on self-care activities Although the overriding feeling of grief usually involves sadness, as the days, weeks and months progress, you may have moments or periods of happiness again. Don’t feel guilty when you do. You don’t need to feel bad all the time to honor the deceased. In fact, there is a very good chance that they would want you to start to enjoy life again. Returning feelings of happiness are your natural gift and indicate that you are slowly adapting to the loss in a healthy way. 12 allow yourself any potential happiness After a loss, it is very helpful to re-evaluate the expectations you place on yourself, in terms of a variety of life activities. If you are working, consider reducing your work hours for awhile. If you are taking five courses, it wouldn’t be unreasonable to take four instead. If you are used to doing a lot of volunteering, maybe this semester you give yourself more time for self-care. How much you reduce your load will be a function of how much emotional distress you are experiencing. If your connection with the person you’re grieving was very limited, then you may not need this kind of accommodation. 11 reduce some of your expectations for yourself When you’re grieving and in a lot of emotional pain, it tends to be a bad time to make major life changes or decisions. Our ability to see issues or situations clearly is often compromised, given all the potential feels, symptoms, or reactions we may be experiencing. Letting things settle down first, if possible, can avoid potential choices that you may later regret. 11 hold off on making major life decisions or changes Major events such as anniversaries, birthdays or holidays have a way of intensifying our feelings and memories of our loved ones who have died. Memories of past celebrations naturally have a way of reminding us even more vividly of what we have lost. Since these tend to be days where we have spent time in the past with our loved ones, we realize even more what we are missing and will miss in the future. Don’t be surprised if your feelings intensify and use it as an opportunity to celebrate your past connection. Maybe you need to have a ceremony or visit their grave site. Whatever you feel like you need to do that day, do it. 13 understand the likely impact of anniversaries, birthdays, holidays, and milestones One of the great benefits of having spiritual or religious beliefs is that they can provide one with great comfort in dealing with any kind of adversity, particularly when it comes to issues such as death. Depending upon your beliefs, you may strongly feel that your loved one is going to a better place or will transcend the realities of their physical presence on earth. This could in turn mean that there is the opportunity to be reunited some day with your loved one. As well, just the acts of going to church, praying, talking to a clergy member, or meditating can provide considerable comfort in dealing with your grief. Connecting with nature and having a sense of something larger than ourselves can also be helpful. 9 find comfort in your spiritual/religious practices emotional experience, not just an intellectual exercise. The letter needs to be completely honest and written as if your loved one were still alive and available to talk to. It might also be helpful to read the letter out to someone who has been most supportive to you during the grieving process.  4 Expressing yourself in a creative way may be a very important part of your healing journey. The type of expression this could take might vary significantly based on what you feel might be personally meaningful. It could involve creating a scrapbook of pictures and mementos of your loved one, to keep and hold your connection to them. It could be a journal of all your favorite memories of your loved one. It might involve creating some type of artwork, whether this be a picture or sculpture of some kind. You also might want to meet with friends and family and talk as a group about all of the positive memories you have of the deceased. 14 honor your loved one in some creative or meaningful way Alone time may be an essential part of your healing journey. Death has a way of getting us to reflect on all the things we know and value. It gets you to question your own mortality and sense of life meaning and life goals. This process may require some real reflection on your part, which sometimes can only be done on your own. 15 spend some time on your own if you need it Realize that dealing with a loss is neither easy nor entirely predictable, and the length of the grieving process is hard to estimate. Depending on the many factors previously outlined in this handout, the length of the grief you experience could be weeks, months or years. Trying to speed through the process is unlikely to be helpful and may ultimately lead to unresolved grief. Know that if you allow yourself to truly feel the pain, the pain is rarely endless and its intensity will usually go down over time. Trying to avoid the pain, however, will not be a useful strategy. 16 be patient with your grief Finding people who can understand what you are going through after a major loss can be difficult, and that’s why a support group can be so helpful. Someone who is grieving themselves has first-hand experience with the depth of the feelings you may be experiencing and can in turn give you some of the support you need. You can feel very lonely after a death and this sense of isolation will only compound your suffering. To get contact information for a bereavement group, you can google it on-line; phone a hospital, funeral home or hospice; or contact a counselling service. 17 join a support group If your grief feels like it is just too much for you to handle, don’t be afraid to ask for some professional assistance or support. This might be through a University counsellor or psychologist, a grief information session or workshop, or someone who specializes in grief counselling. Asking for help is a sign of strength, not weakness, and anyone can struggle with the overwhelming experience of grief. Also, there are a lot of good books and DVDs out there on how to cope with grief, which may help. The Canadian Mental Health Association can also help you with information and support and their website is www.cmha.ca. 18 seek professional help 3 5 * Created by U of A Counselling and Clinical Services. For additional resources, visit: uofa.ualberta.ca/current-students/wellness/mentalhealth  3 5 * Created by U of A Counselling and Clinical Services. For additional resources, visit: uofa.ualberta.ca/current-students/wellness/mentalhealth