October was the one-year anniversary of my father's passing. I found myself throughout the course of that day experiencing sorrow, tearfulness, laughter, peace and an overall air of solemnness. An assortment of emotions concocted together, vacillating back and forth and back and forth again. I found myself reflecting back on the day of his death one year ago, recounting the details, remembering the emotional despair I felt and becoming tearful at most inconvenient times as I made my way through the day's tasks and was missing my father, and then laughing to myself as I recalled childhood memories of our time together. It was emotionally draining. It was also a normal experience within the stages of grief.
Grief is a normal and natural emotional and behavioral response to experiencing a significant loss. We define loss most commonly as the loss of a loved one to death, or bereavement. Grief is also evoked when someone we care about suffers a significant or terminal illness; the person as we knew them is no longer the same due to the illness and we grieve the loss of that person as they once were, or in the case of a terminal illness, it is the anticipation of certain death that triggers our grieving process. Loss may also be the end of a relationship due to a break up, divorce, or abandonment. What once was, no longer is. Let us not forget that often times, the loss of a favorite pet saddens us considerably as well, particularly in children. The loss of a job, a way of life or being or of a landmark of sorts that carried some significance to us are all also losses that can lead to feelings of grief. Often times, there are secondary losses that stem directly from the death of a loved one, such as loss of financial stability, faith, confidence, support system, or dreams for the future. It is the meaning of the particular loss that carries significance for us and we grieve accordingly.
Grieving is an emotional process and it is how we heal. What grieving looks like varies widely between cultures, individuals and circumstances. While there is no one correct way to grieve or express grief, there is a general path that one can expect to experience during the grieving process. The Kubler-Ross (1969) model of grief remains prominent today and consisted of five stages: Denial, Anger, Bargaining, Depression and Acceptance. Keep in mind that not everyone experiences each of these stages and they may not necessarily occur in order and may include some bouncing back and forth between stages.
The first stage of grief, denial, most commonly starts with shock that a loss has actually occurred. This may manifest as outright denying that the loss occurred at all, refusing to accept facts, and denying that it is true. This stage also most commonly occurs with a sense of fear, confusion or even numbness (feeling nothing at all).
Anger is the second stage of grief and is characterized by the realization that the loss has occurred. This may include placing blame on self or others (or one's faith) and feeling self-pity and questioning "why has this happened to me?!" Anger may be targeted at self and/or others. Anger may be a surface emotion protecting more vulnerable emotions of shame or anxiety. Anger may be manifested as increased irritability, outbursts (verbal or physical), or a sense of agitation or rage.
This third stage of grief, called bargaining, is a desperate attempt at undoing the loss or the emotional turmoil associated with it, the idea that "I would do anything to change this." This may be adamant attempts to convince a break-up partner to return to the relationship or searching for implausible cures to the terminal illness or seeking in vain for a way out of the experience of the loss or the emotions. This may also manifest as reaching out to one's support system in an attempt to seek validation.
The fourth stage of grief is marked by depression at the realization that the loss or pending loss as in the case of a terminal illness or end of relationship, cannot be changed or stopped. This is a critical step toward acceptance as it is acknowledgement of what is. People experience depression in different ways. This may include spending time crying, isolating from others or usual activities, being emotionally withdrawn, lack of interest in things usually of interest. In adolescents and children, depression is commonly expressed as irritability or anger, not to be confused with the second Anger stage of grief. It is important to note that depression within the context of grieving is diagnostically different than what we would typically call "depression" in and of itself.
Acceptance is the fifth and final stage of grief. It is characterized by accepting the loss, "coming to terms" with one's emotions about the loss, an ability to think logically about the loss and a return to "normal" functioning. Coming to terms with one's emotions is simply acceptance of how one feels about the loss and feeling less intense emotions about the loss. It is often a sense of peace with the loss with acknowledgement that the loss still is a loss. The loved one is still missed, but the loss is not a controlling force in one's life.
Immediately following a significant loss and for several months thereafter, it is normal to expect a multitude of reactions as the stages of grief ensue. This may include bouts of crying or laughter, loss of or increased sleep, decrease or increase in appetite, loss of interest in normal activities or keeping extra busy, feeling intense emotions or feeling nothing at all. It is common for a grieving person to still experience moments of happiness. It is important to remember in caring for your own grief or in helping someone you know to deal with their grief, that all of these reactions are quite normal. Remember, there is no one way to grieve and people grieve differently. What one person does to grieve may not at all be what another person does in their grieving. It is important to acknowledge that even if these reactions and the intensity of the grief seems to have subsided through time, holidays, anniversaries or other reminders may trigger this "acute grief" again and again throughout the life span even after life seems to have gone back to normalcy. This is an expected part of the grieving process called "integrated grief." This grief reaction to a reminder, anniversary or holiday does not mean that the stages of grief are occurring again, but is simply an emotional reminder that a loss occurred and a loved one is missed. This grieving subsides much quicker than with the original loss event itself, as the heartache of losing someone remains, but the symptoms of grief are significantly decreased as the person has integrated the loss into their life. There are times, however, when a grieving person becomes stuck in a stage of grief, is unable to move forward and may experience years of overwhelming and unmanageable feelings of grief, inability to accept the loss and remaining in their pain, sometimes out of guilt associated with allowing themselves to move forward, or sometimes wondering why they have not been able to heal. In such cases, psychotherapy can be helpful in working through this type of complex grief.
If dealing with your own grief and loss issues, it may be helpful to keep in mind what to expect with the grieving process, its stages and acute reactions to experiencing a loss as discussed above. Accept that how you feel is how you feel and do so without judgement of it being good or bad or questioning whether it is normal or not. It is all normal. Acknowledge the process and try to identify what stage of grief you are in if you can. Remember to do what feels right in taking care of yourself without pressure to do what someone else thinks you need to do because it happens to be what would make them feel better in their grieving. Grieving is an individualized experience even when grieving with a group of others who have experienced the same loss. Reach out to a supportive person to help with the grieving process.
Often times losses are unexpected and abrupt or there was otherwise a lack of opportunity or ability to say what needed to be said to our lost loved one. Consider writing a letter to your lost loved one saying what you need to say and even creating a letter back to you hearing what you needed to hear from the person you lost. Consider creating a ritual around this, such as attaching the letter to helium balloons and releasing them into the sky, burying them in a special place or creating a special decorated keepsake box. Remember and hold on to what you admired or loved most about the person you lost. Find a way to honor this and their memory that empowers you to express yourself and facilitates your ability to heal.
Watch out for destructive behaviors and try to curb these quickly. Behaviors that are harmful or deadly to yourself and/or others require intervention. Seek out professional help if you are feeling unsafe with yourself, cannot trust yourself to behave safely, or have thoughts of suicide. Grieving can create intense feelings of despair and it is important to respond to these quickly with professional help if safety is in jeopardy. If you are in more imminent danger to yourself or someone else, call 911 or take yourself to the nearest emergency room. Likewise, seek professional help if your grieving is showing no improvement in several months or even if you feel like you would benefit from a therapist's help with the entire process.
*Accept how you feel as normal
*Acknowledge grieving as a process
*Reach out to your support system
*Find creative forms of self-expression and empowerment
*Take precautions to keep yourself safe
*Seek professional help if suicidal or if grief reactions are showing no improvement after several months
*A therapist can help you through the entire grieving process
If you are supporting someone you know who is experiencing grief, it is important to remember that everyone grieves differently. Try not to have expectations for how someone should or should not express their grief. Be available to provide support, but do not force unwanted support. Provide a listening ear that is non-judgmental. Provide validation that you recognize that the person you are supporting is in pain and normalize what is being experienced, which is not to say that you fully understand since each person's experience with grief is unique to them. When dealing with someone in denial that a loss occurred, it is important to be forthright and honest that the loss has indeed occurred in order to not prolong the denial stage of grief. Your role as the support person may include encouraging professional help and assistance with finding or getting to a therapist. This support may also include calling 911 or driving someone to the emergency room if suicide is a concern. Take suicide comments or threats seriously. Remember to also take good care of yourself as supporting someone else can feel overwhelming and create heightened emotional reactions for the helper too!
*Allow for individualized grieving
*Listen and Validate
*Be available, but do not force support
*Be candid and honest about the loss to prevent prolonged denial
*Help maintain safety
*Take care of yourself
The information contained herein is not therapeutic advice nor a substitute for therapy. It should not be used to diagnose or treat any mental health problem. If you are located within the United States and you need emergency assistance please call 911 or go to your nearest emergency room. If you are located within Colorado you may also call the Colorado Crisis Line at 844-493-TALK (8255).
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