Stages Of Grief And How To Cope

Understanding Grief

Loss is an integral part of life, be it of someone we love or something that is of immense value to us. Grief is a normal and natural reaction to any type of loss. Everyone experiences grief irrespective of age, gender, culture or religion, however, its expression may vary from person to person. For example, men may grieve silently, while women may cry. In many western societies, grieving is a private affair and is expressed only in the presence of close family, while in collectivistic societies like East Asian countries, grief is expressed more openly.

Some of the common reactions experienced during grief can be:

·      Emotional – feeling sad or anxious, angry at yourself or the person who left, yearning, crying or becoming tearful, lack of interest in any activity

·      Thoughts – continuous thoughts or preoccupation about the loss or denying the loss altogether, regrets or guilt, hopelessness or helplessness, inability to concentrate or plan for the future and death wishes.

·      Behaviour – Difficulty in carrying out the day-to-day activity, social withdrawal or anxiety in meeting people, avoiding anything that could trigger the memory of the person.

·      Physical Reactions – sleep disturbances, either sleeping a lot or having nightmares or not being able to sleep properly; increased or decreased appetite; feeling fatigued; palpitations, aches, and pains, frequent infections or stomach upsets.

Usually, no specific time is attached to the process of grieving some people can experience grief and deal with it within a few days while others may take months. However, it is usually believed by mental health professionals, that if symptoms persist beyond six months, it is important to seek professional help.

Various Stages of Grief

In 1969, a Swiss psychiatrist Elizabeth Kubler Ross spoke about various stages of grief that an individual goes through when dealing with a loss (either a chronic illness which would result in death or death of a loved one). The five stages are described as follows:

Denial

“This can’t be true”, “He/she/it would come back”, “This cannot happen to me” – are some of the common statements made by a person who is denial stage. He/she has difficulty accepting that the loss has occurred. They may go on leading their life as if nothing has changed.

Anger

“How can this happen to me?”; “This is too unfair”; “I will never forgive him/her”; “How could God do this to me?” – A person in this stage may feel immense anger towards self (e.g., blaming themself for not doing enough), others (e.g., blaming the other person for leaving/dying) or God.

Bargaining

The individual tries to change the loss by trying different strategies, for example – begging the partner to return after a breakup; searching for unlikely cures in cases of terminal illness or making promises to God that they would change their behavior if the deceased person somehow comes back.

Depression

“What’s the point of going on?”; “Nothing I do will ever bring the person back”; “I would always be alone”; “I anyway will die” – The individual accepts that the loss has occurred and no bargaining is going to reverse it. This leads to depression-like symptoms, where the person may become excessively sad, cry, feel hopeless or helpless, have death-wishes.

Acceptance

Grief process is completed when the individual can not only emotionally but also cognitively accept that the loss has occurred and they need to move on. An individual at this stage does not feel any negative emotion towards self or another person, does not avoid trigger situations, has positive memories and feelings and is able to envisage a life without the person physically being in it.

Various Types of Grief

⚠️If you or someone you know is having suicidal thoughts, help is at hand. Please visit this list of helplines and resources for different countries.

Disenfranchised Grief

“Grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, socially sanctioned or publicly mourned” (Ken Doka…). Doka suggested that this can happen due to multiple reasons – for example, the loss isn’t seen worthy of grief (e.g., break-up, voluntary abortion), the relationship is stigmatized (e.g., a partner in an extramarital affair), stigmatized cause of loss (e.g., death due to overdose or by suicide; the person has run away), the person is not recognized as a griever (e.g., ex-spouse) or loss of non-person (e.g., pet). Some other reasons can include – infertility in a couple wanting to have a baby, miscarriage or stillbirth, losing a child to adoption or losing “the person” before a chronic illness changed them (e.g., dementia, accidents, HIV, etc.).

Anticipatory Grief

This happens in the face of an “imminent loss”. It is usually seen in individuals who either have themselves being diagnosed with a terminal illness or have a family member who is dying of a terminal illness. The grieving person may experience similar symptoms that are seen after the actual loss. It has been argued that anticipatory grief is a healthy precursor to coping adequately with the actual loss.

Complicated Grief

This is caused when the healing process is hampered, the natural process of grieving remains incomplete or the individual develops significant mental health issues. Complicated grief entails intense grief symptoms that not only last longer than expected social norms and cause significant dysfunction in personal, social and occupational functioning.

Risk factors for developing complicated grief include 

1. Nature of loss. e.g., a child or parent
2. Cause of loss e.g., sudden death due to accident, suicide or violence or multiple losses
3. Personal characteristics of the grieving person e.g., pre-existing mental illness, drug or alcohol abuse
4. Other factors include the inability to grieve properly due to personal or social pressure. e.g., need to be strong for other family members and lack of social support.

Individuals with complicated grief would not only experience significant negative emotions like anxiety and sadness but would also have continuous ruminations about the deceased person. They avoid all situations, objects or events that may trigger the memory of the deceased. Some people may cling on to the deceased person’s belongings, while others may even avoid looking at the photograph of the deceased person. They are unable to envisage a future without the deceased person and would have a chronic sense of emptiness and hopelessness.

Complicated grief requires intervention by a mental health professional and involves a combination of medicines, like antidepressants and psychotherapy or counseling.

Coping with Grief – Do’s and Don’ts

Tip # 1 Do Seek Social Support

We are social animals and we need maximum support at the time of stress. Therefore, seek out friends and family, or if you are a religious person, you can draw comfort from your faith.

Tip # 2 Do Take care of yourself

The stress of a loss can be debilitating for your physical and mental health. Thus, it is important to take care of yourself by:

1. Accepting that it is OK to grieve and not letting anyone define how you should be feeling.
2. Taking care of your physical health – proper sleep schedule, exercise, eating on time.
3. Expressing your feelings and not bottling them up

Tip # 3 Do Reduce Anxiety

• Eating something (e.g., dark chocolate) has been found to relieve anxiety instantly.
• Deep breathing exercises/meditation can be useful in instantly reducing anxiety (Breathe through the nose to a count of 4, hold for a count of 4 and then exhale through your mouth to a count of 6. Focus on your breath. Do this exercise for about 5 minutes).
• Distract yourself by watching something funny, talk to a friend, go out.
• Take a shower with slightly warm water.
• Listen to soothing music
• Talk to Wysa

Tip # 4 Do Prepare for Triggers

It’s a good idea to prepare yourself for grief triggers, e.g., anniversaries, birthdays, events or festivals. It is usually expected that for a couple of years, these triggers will elicit a myriad of emotions. It’s a good idea to be with friends/loved ones and not wallow alone in misery.

Tip # 5 Do Seek Professional Help

If the grief symptoms are lasting too long, or are becoming intense or are causing significant impairment in your day-to-day life, it is advisable to seek professional help from a mental health professional (psychologist, grief counselors or psychiatrists). You can look for online grief counseling sessions and benefit from it. 

Tip # 5 Don’ts

• Don’t try to do everything at the same time
• Do not expand your energies on things you cannot change
• Do not indulge in risky behaviours, e.g., alcohol, smoking, drugs etc to cope. They may numb the pain for a while, but will negatively impact your mental and physical health in the long run.

What is grief?

Grief is a natural response to loss, which can be losing a person or pet due to death or disability, loss of a relationship, financial losses, or diagnosis of chronic illness in self or a loved one. It affects the person emotionally and physically.

How long does grief last?

There is no fixed duration for which grief must last. However, it is generally believed that with passing time, the intensity of grief reactions decreases and the grieving person is able to envision a future with the loved one. Also, mental health professionals believe that the grief process takes about 6 months to partially or fully resolve.

What is complicated grief?

Complicated grief is diagnosed when the grief process lasts longer than what is culturally and socially acceptable and the symptoms become intense enough to cause dysfunction in personal, social and occupational life.

What to say to someone who is in grief?

When a person is grieving, they don’t want to hear that “all will be ok.” Or “you need to be strong.” The person, at that time, does not require advice. What helps best in such situations is empathy. At times, just willingness to share the silence or a hug can be therapeutic for the grieving person. Some of the helpful statements may include:
“I am so sorry for your loss”
"I may not completely understand how you feel, but I am here to help you in any way I can."
"I wish I had the right words, but I just want you to know that I am here for you."

What does it mean to identify your grief triggers?

It can be tricky to differentiate between grief and depression as both share certain common symptoms like sadness, insomnia, lack of interest in pleasurable activities, hopelessness, etc. However, grief symptoms reduce over time and the grieving person may find relief in the company of friends and family. However, in depression, the symptoms are persistent and pervasive and not just related to the thoughts about the loss.