While the death of a loved one is an inevitable part of life, grief and bereavement are rarely discussed openly. People experiencing grief often feel like they're not recovering quickly enough, and friends of the bereaved are often uncomfortable and unsure of how to best help.
It's important to recognize that grief has both physical and emotional ramifications, and that people have to make an extra effort to take care of themselves during periods of mourning. Although rare, depression and other adjustment disorders can sometimes develop out of grief. Dr. Carol Hunt Ott, a certified grief counselor and an assistant professor in the School of Nursing at the University of Wisconsin-Milwaukee, has conducted a number of studies on grief and bereavement. Below, Ott offers guidance on coping with the death of a loved one, as well as advice for friends and family.
What is the difference between grief and bereavement?
Grief is an emotional reaction to a significant loss. People can go through grief if they experience a loss of a body part, through surgery or an accident, or the loss of a job. "But I think generally we look at the term ‘grief' more as related to the death of a significant person," says Ott.
The word "bereaved" refers to someone who's experienced a loss, and then the period of time that they're in grief is usually referred to as bereavement.
What are the emotions that someone usually experiences right after the death of a loved one?
Reacting to the death of a loved one is a total body experience. The initial emotions may involve shock and numbness, intense sadness, anger and bitterness. Behavioral reactions may include crying, social withdrawal and fatigue. People may find themselves preoccupied with thoughts of the deceased and unable to concentrate. They may even have physical symptoms such as loss of appetite and sleep disturbances.
Does the type of death affect how someone reacts usually?
The sudden death is more of a shock; it can take people a while to come to accept that the death has really happened before they actually start grieving. When death is sudden, people don't have time to prepare, but when it takes a long time, it can be a very difficult experience for people to see their loved one wasting away. "However, in a study of bereaved spouses that I did a few years ago, after two years, it didn't make a difference whether the death was sudden or anticipated," says Ott.
Reactions are more difficult when the death is a result of a terrible accident, or somebody's been murdered. When somebody is murdered, for example, people's assumptions about the world are totally violated. So this adds another dimension to their grief.
Health
Are there different stages of grieving?
First there's denial, then there's anger, then bargaining, then depression and then acceptance.
Research has shown that people don't necessarily go from one stage to another. "I have observed that people go through two different kinds of reactions in grief," says Ott. In the beginning of their grief, people spend a lot of time focusing on the intensity of their emotions. And later, they are focused on other consequences of their loss such as new roles. For some bereaved people, certain questions become paramount such as "Who am I without this person? What am I going to do with the rest of my life?"
How can grief affect one's physical health?
Research shows that people, especially in their first year of grief, experience more physical and psychological problems. They tend to see their physicians more frequently. Men have been shown to be at higher risk for sudden death in the first year after their spouse's death, particularly those men whose wives connected them to a social network.
A number of studies have indicated that sleep patterns can be altered in bereavement. Results of some sleep/wakefulness studies suggest that symptoms of stress and depression can make it harder to fall asleep, as well as lead to changes in REM (rapid eye-movement sleep) sleep patterns, when dreaming occurs. There is also a reduction in the overall quality of sleep. If people have significant problems sleeping, they may want to talk to their physician, as sleep is an important part of maintaining your immune system. Talking with a supportive person, getting exercise and eating a nutritious diet are other ways to get better sleep and bolster one's immune system.
But eating healthfully can also be difficult. When a person is in a state of numbness and shock, they don't have an appetite. "However, I think that gets turned around after a while; sometimes people actually gain weight rather than lose weight," says Ott. That may happen because people don't feel like they want to cook. They don't have the energy to do it, so their eating habits and the kinds of foods that they eat are probably not as healthy as they were. People who experience the death of a spouse may lose the motivation to cook for one person, when they're used to cooking for others.
What is the difference between grief and depression?
Grief is not depression; it's a deep, deep sadness. Depression and anxiety symptoms are common in bereaved people, but generally level off during the first year after the death. And a person who's grieving is still able to function in their life roles, whereas people who are depressed may not be able to function.
However, probably 10 to 20 percent of people develop biological depression, anxiety disorders or symptoms related to the trauma of the death. People who may have had mental health problems before the death are at particular risk for problems with grief. People who have these problems should seek out help from a therapist.
What are some practical steps that people can take to help them cope?
It's important to have one other person that really understands them, who can be there for them in a nonjudgmental sort of way. People should also be gentle with themselves. They're not going to be able to function as well as they did in the past, but that doesn't mean it's going to last forever.
It's also important to remember to take care of yourself. Exercise is a great stress reliever, and people should try to eat as healthily as possible. People who are grieving should also accept invitations to be with those people that they feel comfortable with, so they don't get isolated. It also helps to have some structure such as a job or volunteer work.
Sometimes people find writing in journals helpful. As time goes on, they'll look back to those first days and realize how much better they are, even though they may not feel like it. Some people find it helpful to go to a cemetery or a mausoleum. Other people don't find that helpful at all. People have to kind of figure out their own rituals.
Sometimes families put together a memory book after the death, so that they don't forget all the good things about their loved one.
Are support groups available?
Support groups, which are often available at hospitals, funeral homes and churches, are a good way to connect with other grieving people. "I think grieving people find that their friends may not understand what they're going through," says Ott, "and that talking to other people in a similar life situation can be very helpful."
The death of a child is perhaps the worst kind of loss. Parents are supposed to outlive their children. People who lose a child aren't going to have lot of other people who have experienced a similar loss. But there is a group around the country called Compassionate Friends, which is just for people who have experienced a death of a child.
What advice do you have for the friends and family of the bereaved?
The best way to help bereaved people is to just be there for them. An act of kindness, like bringing food to them, calling them up, sending cards, is usually appreciated. And do that not just for the funeral, but for the first month, the third month, the year anniversary.
How long does bereavement usually last?
At one year, the majority of people are a lot better than they were right after the death. But their lives are still being put back together again. If you look at death of a spouse, most people will say it takes about two years. The process takes longer with the death of a child. Some people say that after three years, they are beginning to feel that their lives are more in order.
"One woman shared with me what grief was like for her after her daughter's death," says Ott. "In the beginning, she said it was like her grief totally encompassed her body, mind, spirit and physical being. But after about three years, she was able to put her grief in a place next to her heart. It was still there, but it didn't encompass her whole being anymore."
