Thursday, October 15, 2009

Good Grief

Grief is associated with loss of a loved one through death. Bereavement is the result of this. However, grief can come from a loss such as a meaningful job, loss of autonomy, a divorce, or the removal of children from their parents, or a pet dying. This is a normal, healthy reaction to an occurrence that will affect the surviving person's personal world. In fact, to show no pain or healing is actually frighteningly similar to the emotional profile of a psychopath.
There are approximately seven stages to grief. These can come in any order for varying lengths of time depending on the circumstances surrounding the loss, and the person(s) that is affected by the loss (their state prior to the loss, other concerns in their life, the nature of their relationship to the lost). Sometimes only some of the stages manifest. The seven stages are:
1. Shock or disbelief. This is the numbness and "world collapsing" (sometimes actual collapsing), dissociating reaction to the realisation of the event. The person may want to get proof, or another opinion, or check. They may run off or hide, like they have just been attacked by a physical threat. It is best they are sitting down, and receive the news compassionately and clearly. However, life is not always that kind, and don't expect a thank-you note.
2. Denial. For instance, acting as though the person is still alive, that today is the same as yesterday, not hearing references to the loss, making a cup of tea for someone who no longer requires it, introducing someone else as the deceased, leaving something of theirs in the same way as though they are going to come back through the door, are all varying signs of denial. If someone slips and call you by the absentee's name, it is forgivable. If the person hasn't registered the loss has occurred for a year, it is a worry. However, if their shrine to the deceased has gone mouldy over the years, it may be time to suggest professional help.
3. Bargaining. If they are religious the may try to cut a deal with whatever spiritual entity they see fit, swearing they will never do something again so it won't happen again, wondering why it was whatever was lost instead of them, wishing it was them instead of whatever was lost, making bargains with other people affected to do this or that as a memorial or preventative or coping measure.
4. Guilt. If the relationship with the lost was strained it can be worse. If they are young enough to think they are responsible for the loss it can be worse as well. Or if the survivor caused the loss or the person has committed suicide. It can be like survivor's guilt. "I get ice cream at the beach, but they can't". What if I did this or I did that. Why couldn't I have been nicer to them or stopped them from going somehow, or stopped them from drink driving (e.g.), and why couldn't I have died instead of them? Guilt is a regressive thing for when children are developing their social skills by taking cues from the adults, and therefore think a horrible feeling is either their fault or a punishment. Try to keep perspective during this period, and cut some slack. Even if it was some one's fault, they probably don't feel good either, and if it isn't any one's fault (usually), it won't make the pain any better.
5. Anger. This could be wanting to punish anyone seen (rightly or wrongly) as the cause of the loss (doctors, the other driver, fate, God, aunt Fefe's home brew) or anger at yourself, or the deceased. It can come in delayed, "inappropriate" outbursts when the person is feeling safe enough to let it out, but it is a good sign. It means the grief is starting to become more outwards flowing as opposed to inwards, as the other stages are. It can be self-destructive, but if the survivor(s) know it is coming they can channel it into a beneficial form (work into effecting change so they can prevent a recurrence like an appropriate cause, learning self defence, taking it out on a punching bag, go camping and screaming into the hills).
6. Depression. This is crying, feeling lost, empty, lowered mood, isolated, less enjoyment of things that brought the person joy (especially if it is something they did with the lost), and "moping".
7. Acceptance. This is when the survivor realises life has changed for them, but it can continue on. There is not a rewind button, but some things from the past are still there in the present, and somethings are not, and it cannot be changed, simply accepted.

Physical symptoms of grief can sleep and appetite problems, hyper vigilance, changed activity levels and even heart attack.
Social symptoms can include isolation (not wanting to see anyone), and difficulty functioning at home, work or school.

In both children and adults, emotional regression can occur, so less adult ways of processing the situation or behaving, or coping will come to the fore.

Prolonged (or complicated) grief include intense and pointless longing the lost, severe intrusive thoughts of the loss, extreme feelings of emptiness and isolation (basically pining), avoiding activities that bring back memories of the moment of loss or of the lost, sleeping problems, loss of interest in formerly enjoyed activities.

If the loss was a person who committed suicide, the survivors may be preoccupied with the reason(s) behind the suicide, denying or hiding the cause of death, "what if's" (I'd done, said, been this or that), feel blamed for problems proceeding the death, feel rejected by the deceased, feel stigmatized.

If the relationship with the lost was difficult or otherwise unhappy, the grief process still applies, and is compounded by the survivor's guilt (the unresolved fight they had two years ago where they stopped talking) and also how they see themselves (I'm happy such and such is dead, that's pretty dark).

With younger people, their stage of development effects how they cope.

In infants, they cry more and are more irritable.

3-5 yrs old don't realise the permanence of death, and can believe they "magically" caused they death, and can "magically" bring them back. They may have difficulty separating from caregivers.

6-8 yrs old Understand the permanence of death, and feel guilty. They may talk incessantly about the occurrence in an effort to understand and integrate the event. It is very important to tell the younger children, or those who have regressed into a younger state, that they are not responsible and although it doesn't feel nice, they are not being punished.

9-11 yrs old often the event decreases their self esteem. They see themselves as different from their peers, and may engross themselves in other activities like school work, extra curriculum activities (like computer games, or bug collecting) or social scene (other outsiders).

12-14 yrs old As they are starting to establish independence, they will have mixed feelings in a wide range of emotions. They may avoid talking about it.

14-19 yrs old Similar to adults. Sadness, anxiety, anger. Might not want to talk to their parents, but they will definitely talk to their peers.

Grief is not always about the loss of a person or even a good thing. The relationship may have been unhealthy, the job unpleasant, the object undesirable. If something unpleasant that has been there a long time is lost (such as an oppressive, occupying army), the initial joy is complicated by the empty feeling of lack of purpose (resisting or placating the tyrants), and a void called "possibility". Also the years of programming of that particular scenario suddenly made defunct is like when someone let's go of the rope in a tug of war. Although the liberation is good, the occupation and it's losses needs to be grieved.

It is important to keep in contact and openly communicate with others that have survived such as other family or friends or workmates, or others in a similar situation (such as an appropriate support group, victims of crime, divorcee, bereavement, or re-employment groups) or a professional grief counsellor. If you go it alone it is much harder to integrate, understand and have reference points for the process back into some kind of less painful life.
Apparently if the healing process unfolds unchecked and encouraged, it can be a real point of growth for the survivor(s). It is painful and overwhelming, but the process of integrating the experience and dealing with it's effects can really help one have a deeper understanding of life and it's rich tapestry.

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