Loss and Grief and Depression

“To weep is to make less the depth of grief.”
― William Shakespeare, King Henry VI, Part 3

The information presented in this blog on loss and grief is largely based on the work of grief expert, Dr Sheila Clark, and the Graduate Program in Grief and Palliative Care Counselling at the University of Adelaide in South Australia.

Depression may be triggered by loss in life. Loss may be death-related (death of a person or pet) or non-death-related (divorce or loss of one’s job or health) (Bowlby, 1980). ‘Attachment’ between individuals develops to maintain a state of balance in life (Bowlby, 1980). Loss and grief disturbs this balance – people often describe a sense of their ‘whole world being thrown upside down’. Grief is the response to loss and can affect our physical state, emotions, behaviours, cognitive functions (memory and concentration), social lives and spirituality:

Physical responses to grief may include:

• General muscle pain
• Fatigue
• Loss in appetite/ weight loss
• Difficulty breathing
• Restlessness/ Insomnia
• Crying

Emotional responses may include:

• Confusion/disorientation
• Forgetfulness
• Anxiety
• Agitation/frustration
• Trouble concentrating
• Shock/emotional numbness
• Guilt/regret

Behaviour responses may include:

• Change in social activities – we may either shut ourselves out from the world or conversely, need to be around the people we love to seek support
• Seek refuge in substances – alcohol and/or drugs
• Question our spirituality
• Seem different or “slightly off” to other people

Sometimes we try to hide behind our loss, particularly if there is stigma or shame involved. There may be differences between men and women in grieving, or cultural differences and we may not seek help with our grief because of these factors. Sometimes we can become stuck in our grief and an intense grief reaction continues (Rando, 1984). This can be related to unresolved feelings such as guilt. An ongoing or long-term grief is called chronic grief (Middleton, Burnett, Raphael, et al., 1996; Parkes, 1998). Adjusting to loss takes time and effort. It can be very useful to talk with a GP, therapist or a friend. It is important to find someone who is a good listener and someone whom you trust. There has been a lot written about grief work, and there are a number of different approaches to grief therapy. Several approaches providing a holistic way of dealing with loss and grief will be highlighted here.

Dr Sheila Clark advises:

• Allocating grief time each day – say 15 to 20 minutes in which to have a cry or write about the loss (such as in your journal)
• Naming the problems – emotional or practical
• Looking after general health – endeavouring to eat regularly, and avoiding overindulgence in alcohol or smoking
• Taking time out to walk in the park
• Sometimes spoiling yourself, for example, having a coffee with a friend, or relaxing in a hot bath
• Not making any major decisions before at least one year has passed
• Continuing existing relationships, seeking support.
• Getting some advice on dealing with practical issues, or dealing with special occasions such as Christmas or the anniversary of the loss
• Understanding that your ability to think and remember is reduced – don’t be too hard on yourself, and use reminder lists
• Considering whether you need some time off work or to negotiate reduced working hours
• If possible, finding some meaning out of the loss, such as growing in strength as a result (Clark, 1995)

There are also a number of strategies for dealing with negative thinking that can occur in grief. Fear, guilt, anger, sadness, self-blame or blaming others can all occur in grief. The principles of CBT outlined in Step 5 can be applied in the context of loss and grief, namely:

•  Be aware of your thinking (keep a thought diary).
•  Identify thinking errors, for example, all-or-nothing thinking (‘I’m hopeless –I can’t manage everything.’) or catastrophising (‘What if I lose someone else?’)

• Challenge unhelpful thinking.
• Work on developing more helpful thoughts.

Points to remember:

• Adjusting to loss and grief takes time.
• It is important to understand the process of grief, and share thoughts and

feelings about the loss.

• Allow ‘grief time’ each day.
• Look after yourself.
• Take time out.
• If possible find some meaning out of the loss.
• Challenge unhelpful thinking related to the grief.
• Self-esteem can be affected in grief.
• Achieving a sense of closure is important.

References:

“Physical and Emotional Responses to Grief”. Hello Grief. Last modified 2010.

http://www.hellogrief.org/physical-and-emotional-responses-to-grief/

Bowlby J. Attachment and Loss. Vol. 3: loss, sadness and depression. London, UK: Hogarth Press; 1980.

Rando T. Grief, Dying and Death: clinical interventions for caregivers. Champaign, IL:

Research Press Company; 1984.

Middleton W, Burnett P, Raphael B, et al. The bereavement response: a cluster analysis. Brit J Psychiatry. 1996; 169: 167–71.

Parkes CM. Coping with loss. BMJ. 1998; 316: 1521–4.

Clark S. After Suicide: help for the bereaved. Melbourne, Vic: Hill of Content; 1995.