Loss and Grief

This blog is based on the section on loss and grief in my book, ‘Keeping the blues away’. Some of the texts used are older, but the ideas are still valuable, plus some newer texts and ideas have been incorporated.

Loss and grief are part of life. We may experience loss which is death-related (death of a person or pet), or non-death-related (divorce, loss of one’s job or health). ‘Attachment’ between people develops to maintain a state of balance in life, and loss and grief disturbs this balance – people often describe a sense of their ‘whole world being thrown upside down’ (Bowlby, 1980). There can be a roller-coaster of emotions, from sadness to numbness, anger, guilt, loneliness or anxiety.

Grief is the response to loss, and it affects many aspects of the individual: physical,
emotional, behavioural, cognitive (such as memory and concentration), social and spiritual. It involves adaptation to the loss, and it takes time to re-adjust (Corr, 1998; Parkes, 1988). Loss may be hidden by individuals, particularly if there is stigma or shame involved. Loss may be gradual, such as adapting to dementia in a parent. There may be differences between men and women in grieving, or cultural differences. Individuals may not seek help with their grief because of these factors.

Adjusting to loss takes time and effort. It can be very useful to talk with your 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.

Grief therapy (Worden, 2008) involves:
• Understanding the process of grief, and that it is normal to have positive as well as negative feelings about the lost person or object.
• Sharing thoughts and feelings about the loss and reviewing what it means to the individual. It can be helpful to look at photographs or mementos of the lost person together, for example.
• Identifying and expressing negative emotions associated with the loss – such as self-blame or anger. One way to do this is to talk about things that we miss or don’t miss about the person.
• Problem-solving ways of coping with the troublesome feelings resulting
from the loss, practical problems, or new ways of coping in life.
• Eventually moving forward in life – this does not mean giving up on the lost person or object, but rather ‘finding an appropriate place’ for them in our emotional lives (see discussion about ‘continuing bonds’ with the deceased and finding meaning below).

Dr Sheila Clark, a GP with expertise on grief and author of ‘After Suicide Help for the Bereaved’, advises:
1. Allocating grief time each day – say 15 to 20 minutes in which to have a cry or write about the loss (such as in a journal).
2. Naming the problems – emotional or practical.
3. Looking after general health – endeavouring to eat regularly, and avoiding
overindulgence in alcohol or smoking.
4. Taking time out to walk in the nature.
5. Sometimes spoiling yourself, for example, having a coffee with a friend, or
relaxing in a hot bath.
6. Not making any major decisions before at least one year has passed.
7. Continuing existing relationships, seeking support.
8. Getting some advice on dealing with practical issues, or dealing with special occasions such as Christmas or the anniversary of the loss.
9. Understanding that your ability to think and remember is reduced – don’t be too hard on yourself, and use reminder lists.
10. Considering whether you need some time off work or to negotiate reduced working hours (Clark, 1995).

Sometimes thoughts can be intrusive in grief. Sometimes you need to challenge them, but at other times you may not want to deal with them at the time. Work on imagining putting the thought aside, perhaps into a box on a shelf, or letting them float away down a stream. You can then come back to the thoughts later, such as in your grief time.

If possible, focus on finding some meaning out of the loss and grief. We often hear about parents who have lost a child to an illness or accident, working to raise awareness or funds in the area. This is a wonderful way of finding meaning, but finding meaning does not have to be as public. It may be quite personal – perhaps you have learnt something about yourself or others, or really valued the relationship. Perhaps you have grown in strength through the loss.

Sometimes there are still things that need to be said to the deceased, and it can help to say these at the graveside or in a poem or letter. Narrative therapy speaks of ‘saying hullo again’ to the deceased, rather than saying goodbye (White and Denborough, 1998). This refers to incorporating what has been lost into the present, for example, holding on to the influence (or some other aspect) of that person that is meaningful. Although someone may no longer be alive this does not mean they no longer exert influence. What would they have said or done in certain situations? Can you see their characteristics in your sibling or child for example?

Robert Neimeyer has done some wonderful research and writing on ‘continuing bonds’ with loved ones who have died. This involves continuing the attachment with the person who has died in some ways, exploring meaning of the and thereby further developing your own identity after the loss.

It can also be helpful to focus on creating positive memories of the lost person or object. (Note – if the person was abusive this may not always be appropriate.) You may choose to look at photos and talk about the loss. Creating a special scrapbook or memory box with photos and mementos can also help. Focusing on what was special about the person and the things they brought into your life
is part of discovering meaning.

Consider what you have learned through the loss – have you grown in any way, developed strengths or discovered true friends? What about spiritual beliefs? There are studies that indicate that spiritual beliefs assist in resolving grief (Walsh, King, Jones, et al., 2002). Spirituality can be based on differing beliefs, but usually it is focused on relationship with a higher power. Have your beliefs been challenged, changed or strengthened?

Reviewing progress can be a powerful tool in recovering from a loss – could you have coped as well three or six months ago, for example? What resources have you found within yourself that have helped you cope?

Sometimes individuals can struggle to recover from their grief and an intense grief reaction continues. An ongoing or long-term grief is called ‘prolonged grief.’ Grief is often accompanied by sad and low feelings. Many of the symptoms experienced in normal grief overlap with symptoms of depression, such as sadness, crying, loss of appetite, disturbed sleep and poor concentration. However, these symptoms gradually lessen over time. On some occasions though, a depressive illness may develop. Please seek help if you think this may be your experience.

Further information is available at www.grieflink.org.au or if you wish to speak with someone about your grief, you can contact Lifeline on 131114 or Beyondblue on 1300224636. You may choose to seek assistance from your GP or a grief counselor.

Useful resources are outlined at: http://www.bereavementcare.com.au/resources/books.htm
And http://www.openleaves.com.au/categories/Loss-and-Grief/Grief-Counselling/ These include ‘Coping with Grief’ by Mal McKissock (4th Ed) and several books about children and grief, and also books for therapists.

References:

• Bowlby J. Attachment and Loss. Vol. 3: loss, sadness and depression. London, UK: Hogarth Press; 1980.
• Clark S. After Suicide: help for the bereaved. Melbourne, Vic: Hill of Content; 1995.
• Corr C. Enhancing the concept of disenfranchised grief. Omega: J Death Dying. 1998; 38: 1–20.
• Howell, C. (2010). Keeping the blues away: The ten step guide to reducing the relapse of depression. Radcliffe, Oxford.
• Neimeyer, R. A., Baldwin, S. & Gillies, J. (2006). Continuing bonds and reconstructing Meaning: Mitigating complications in bereavement. Death Studies, 715-738.
• Parkes CM. Bereavement as a psychosocial transition: processes of adaptation to change. J Soc Issues. 1988; 44(3): 53–65.
• Parkes CM. Coping with loss. BMJ. 1998; 316: 1521–4.
• White C, Denborough D. Introducing Narrative Therapy: a collection of practice-based writings. Adelaide, SA: Dulwich Centre Publications; 1998.
• Worden J. Grief Counselling and Grief Therapy: a handbook for the mental health practitioner. 4th ed. New York, NY: Springer Publications; 2008.