Understanding grief and loss

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Each day, many people struggle with the loss of someone or something they care deeply about. A person may experience different kinds of emotions and it may feel like the pain or sadness may never let up. There is good news! With the right treatment, support and self-care a person can recover from grief and take back control of their life.

What is Grief?

“Grief (also called bereavement) is the experience of loss. Many people associate grief with the death of an important person or pet. However, people experience grief after any important loss that affects their life, such as the loss of a job or relationship. Grief after diagnosis of an illness or other health problem is also common." (Canadian Mental Health Association)

Symptoms of grief

“People experience grief in many different ways—and experience many different thoughts or feelings during the journey. People may feel shocked, sad, angry, scared, or anxious. Some feel numb or have a hard time feeling emotions at all. At times, many people even feel relief or peace after a loss." (Canadian Mental Health Association)

Normal grief reactions may include any of these symptoms:

Emotional:

  • Feeling discouraged, worthless, empty, hopeless
  • Increased irritability (bitterness, detachment, preoccupation with loss)
  • Loss of pleasure from activities that are normally enjoyable
  • Guilt and confusion
  • Crying

Physical:

  • Fatigue and change in sleeping patterns
  • Loss of appetite and weight
  • Headaches, chest pain, sore muscles, digestive problems

Behavioural changes:

  • Withdrawal from family and social interactions
  • Agitation
  • Slowness/sluggishness
  • Increased use of mood-altering substances (e.g., alcohol, recreational drugs)

Cognitive:

  • Inability to make decisions, trouble concentrating
  • Over-focus on work or inability to focus on work
While these symptoms are normal in the days and weeks after a significant loss, they can be indicators of a more serious disorder if they do not fade over time.

If a person feels that life is no longer worth living, they need to get help as soon as possible. They should call a crisis line, visit the Emergency Room of a hospital or call a health care provider.

Grief is a complex experience as feelings, thoughts, reactions and challenges related to grief are very personal. To help better understand a grieving process someone may be going through, here are five phases:

Denial/numbness – The grieving person feels numb, which is a defense mechanism that allows them to survive emotionally.

Searching and yearning – Many emotions are expressed during this time and may include weeping, anger, anxiety, and confusion.

Bargaining – The normal reaction to feelings of helplessness and vulnerability is often a need to regain control. Secretly, the grieving person may make a deal with a higher power in an attempt to postpone the inevitable and to protect themselves from the painful reality.

Disorganization and despair – Feelings of pining and yearning become less intense while periods of apathy, meaning an absence of emotion, and despair increase.

Reorganization and recovery – the grieving person begins to return to a new state of “normal.” Energy levels increase and an interest to return to enjoyable activities returns. Grief never ends but thoughts of sadness and despair are diminished while positive memories of the deceased take over.

Remember that grieving is a personal process therefore the way and pace of the mourning may vary depending on the culture, circumstances of loss (whether it is sudden or expected) and the nature of relationship with the deceased.

Finding support while you grieve

"People express or talk about grief in different ways, but we all feel grief after a loss. In most cases, people navigate through grief with help from loved ones and other supporters and, in time, go back to their daily life.” (Canadian Mental Health Association)

About counselling

"Some people need extra help from a mental health professional. Grief can be more complicated when the loss is sudden or unexpected, frightening, the result of an accident or disaster, or the result of a crime. Other factors also play a role. A person’s experience of mental illness, lack of personal and social supports, and difficult personal relationships can also affect the impact of grief. Grief counselling supports people through difficulties around grief." (Canadian Mental Health Association)

Depending on the needs and preferences of the grieving person it is possible to have access to individual and/or group therapy.

About medication

As explained in the Diagnostic and Statistical Manual of Mental Disorder (the DSM-5); "Part of their reaction to such a loss, some grieving individuals present with symptoms characteristic of a major depressive episode - for example, feelings of sadness and associated symptoms such as insomnia, poor appetite, and weight loss. The bereaved individual typically regards the depressed mood as "normal," although the individual may seek professional help for relief of associated symptoms such as insomnia or lack of appetite."

Medications are sometimes used: these may include (but not limited to); antidepressants, anti-anxiety medications and/or sedative medication may help manage the reactive symptoms. A treating physician will prescribe the most suitable treatment, if needed.

Questions to ask a health care provider about medication

It is important to be educated about any medications that are taken for any illness, and it is no different for medications taken for any symptoms related to grief.

  • How long will it take before I feel better?
  • How often, and how much, do I take?
  • What are the possible side effects, if any, and what can I do to best manage them?
  • What is the best-tolerated treatment for my particular situation?
  • Will this medication interfere with other medication(s) or herbal remedies that I take?
  • Do I have allergies to this medication?
  • What should I do if I don’t feel better or if I miss a dose?
  • Is there any written information I can get about this medication?
  • Is there anything I should not do when I take this medication (e.g., operate heavy machinery, consume alcohol)?

The importance of self-care

"It is important to maintain healthy habits as this can help relieve tension and stress and make you less vulnerable to depression and mood changes."

It is very important for grieving people to take care of themselves during this time. Here are some tips from the Canadian Mental Health Association that may be helpful:

  • Connect with caring and supportive people.
  • Give yourself time.
  • Let yourself feel sadness, anger, or whatever you need to feel. Recognize that your life has changed.
  • Reach out for help. Holidays and other important days can be very hard.
  • Take care of your physical health.
  • Offer support to other loved ones who are grieving.
  • Be honest with young people about what has happened and about how you feel.
  • Work through difficult feelings like bitterness and blame.
  • Make a new beginning. Think about waiting before making major life decisions.

Grief can have a dramatic effect on life style habits, and it can be challenging to maintain adequate nutrition, get regular exercise and physical activity as well as sticking to a proper sleep schedule. It is important to maintain healthy habits as this can help relieve tension and stress and make you less vulnerable to depression and mood changes.

Some self-care activities that may help relieve or prevent heightened symptoms throughout a grieving process and help other treatments work more appropriately.

Stick to a regular sleep schedule

  • Establish a regular, consistent time for sleeping and waking.
  • Do something relaxing before going to sleep like reading (in a different room) or taking a warm bath.
  • Don’t use the bedroom for non-sleep activities (e.g., watching TV or eating in bed).
  • Avoid strenuous exercise, caffeine, alcohol or tobacco a few hours before bedtime.
  • Avoid naps during the day. Get outdoors for some activity. (e.g., a short walk) to refresh.
  • Talk to a health care provider about whether a sleep medication is right for you.

Stay active

  • Choose activities that are enjoyable.
  • Plan activities for the times when they can be performed consistently.
  • Be active on a regular basis. Aim for 10 minutes of continuous activity, three times a week, as a start. As fitness increases, the duration and intensity of activity can be increased.
  • Take advantage of opportunities to be more active by making small changes each day (e.g., take stairs instead of an elevator, exit a bus one stop earlier than a destination and walk).

Keep up with proper nutrition:

  • Meals should be eaten at regular times (breakfast, lunch, dinner with a mid-morning and a mid-afternoon snack).
  • Include a variety of healthy foods at mealtimes (e.g., whole grains, dark green vegetables, brightly coloured fruits, lean proteins, milk products). Avoid food with added fats, sugar and salt.
  • If you drink alcohol and caffeine, do so in moderation.
  • Drink several glasses of water each day (five to eight glasses is a good goal).

It is always easier to make positive lifestyle changes with the support of others. Involving friends and family in the “get-better” plan may be helpful if a person is comfortable discussing their goals and treatment plan with them. For example, exercise with a friend, make healthy recipes for the entire family at mealtimes and participate in group activities.

Maintain gains and prevent setbacks

The grieving process is different from one person to another and can be affected by biological, psychological and social factors. Symptoms may sometimes return months or years after they first go away. This is called relapse. The good news is that relapse can be prevented if the right plan is put into place. Here are some tips that we believe are part of a good relapse prevention plan.

  • Continue with self-care. Anything that helps reduce anxiety and or depressive symptoms (as long as it is a healthy choice) should be continued on a regular basis.

  • Follow health care provider advice. As grieving gets better, or when symptoms are no longer a problem, it can be tempting to stop medication or counselling. But sudden stops to treatment can lead to relapse (or withdrawal symptoms in the case of medication). Therefore, changes to a treatment plan should only be made inconsultation with a health care provider.

  • Avoid alcohol and recreational drugs. These substances can slow or prevent full recovery and they can become problems if relied upon for symptom relief.

  • Take part in social activities. Staying connected to others (e.g., getting together to share activities, socializing with friends) is a powerful way to prevent recurrence of symptoms.

  • Take it slow. If roles and responsibilities have been reduced, return to them in a gradual, step-by-step fashion rather than all at once.

  • Arrange for continued support. Ongoing support can help maintain a healthy life balance. Self-help groups organized by mental health advocacy associations are a great resource for information, counselling, and support. Self-help workbooks and websites (from a trusted source such as a national mental health association) can provide practical advice.

Make the return to work easier

If there has been an absence from the workplace, preparing to return to work may seem overwhelming, especially after being away for an extended period of time. To help make the return to work successful, the following tips may help.

  • Think about what helps the most. Each person is different. Some people need more flexible work arrangements (e.g., reduced hours, modified job duties) and others feel capable of returning to full capacity immediately.

  • Clearly understand the return to work plan and be an active participant in its creation. What are the hours? What are the expectations, roles, and responsibilities? Who needs to be informed?

  • Understand privacy rights and be prepared for any disclosure (if necessary). Details of an absence are private and confidential. However, there may be workplace policies that require that certain kinds of information be reported (e.g., safety sensitive positions, information needed for job accommodation purposes). If any disclosure is required, plan what to say and how much information to share. Questions about who to disclose information to, and how much information to disclose, should be directed to a third party such as a human resources representative or employee health professional.

  • Learn about support options. Good support is essential to a successful return. Find out what resources are available.

  • Continue self-care efforts.

  • Apply the tools developed in counselling.

  • Be aware that symptoms (agitation, worry) may fluctuate throughout the return to work process. Adjustments in the return to work plan, or the treatment plan, may be necessary.

Support and education

Visit these websites for more information:

Recover from grief:

References

Canadian Mental Health Association Mental Health for all (cmha.ca)
Axelrod, J. (2006). The 5 Stages of Loss and Grief. Psych Central. Retrieved on October 8, 2014
American Psychiatric Association (2013); Diagnostic and Statistical Manual of Mental Disorder; Fifth Edition
Grief Cycle model first published in On Death & Dying, Elisabeth Kübler-Ross, 1969