What is grief?
This is a term that describes all the feelings, thoughts and behaviour that someone goes through after bereavement.
What is bereavement?
This is a term that can be used to describe any event that includes loss, so this could mean losing your job, finances or the death of someone you know. In this case, it refers to the death of a person.
There is no right way of coping with a death; people respond to a loss in their own individual way. The way a person responds is partly dependent on their relationship with the deceased, but it also depends on their own personality and upbringing. In particular, holidays and anniversaries serve as reminders of the loss, and many people experience a severe worsening of their grief during these times.
Debate still continues as to what normal grief consists of and whether it is distinct from depression. It is very common for people to have symptoms that are often used to diagnose depression after bereavement. It is less common for people to experience a depressive illness and require treatment for this.
A psychological understanding of grief
People need strong affectionate bonds with other people for their emotional well-being, and they try hard to maintain these ties. Loss through death permanently breaks this bond.
Grief can be seen as a person's struggle to maintain the emotional bond, while simultaneously experiencing the reality of loss. 'Grief-work' is the process that a mourner needs to complete before resuming daily life; it involves separating from the deceased, adjusting to a world without them and forming new relationships.
People grieve not only for the deceased, but also for the unfulfilled dreams and plans for the future that they hoped to share with them.
Phases of grief
Grief usually passes through three stages, but these stages are not separate, nor do they necessarily follow in sequence.
An initial stage of shock or disbelief when it is difficult to believe that the death has occurred. This stage may last minutes or weeks.
A stage of acute anguish that usually lasts from weeks to months when feelings of depression occur; planning the future may be difficult.
A phase of resolution after months, or even years.
What is normal grief?
This is a term used to describe the typical symptoms somebody experiences after bereavement. It can include:
- disbelief, shock, numbness and feelings of unreality
- anger
- feelings of guilt
- sadness and tearfulness
- preoccupation with the deceased
- disturbed sleep and appetite and, occasionally, weight loss
- seeing or hearing the voice of the deceased.
The initial disturbance the above ‘symptom causes’ is gradually reduced and people begin to accept the loss and readjust.
A grief reaction can last for up to 12 months, but can vary within different cultures. The average is probably around six months. A resurgence of symptoms can also occur briefly on anniversaries of the bereavement and on birthdays, etc of the deceased.
Depression and grief
Grief and depression are different. It is possible to grieve without being depressed, but many of the feelings are similar.
However, about 33 per cent of bereaved people also have a depressive illness one month after the loss, and 15 per cent are still depressed a year later.
- Symptoms that suggest a bereaved person is also depressed include:
- intense feelings of guilt not related to the bereavement.
- thoughts of suicide or a preoccupation with dying.
- feelings of worthlessness.
- markedly slow speech and movements, lying in bed doing nothing all day.
- prolonged or severe inability to function (not able to work, socialise or enjoy any leisure activity).
- prolonged hallucinations of the deceased, or hallucinations unrelated to the bereavement.
Who is likely to get depression after a bereavement?
It is difficult to judge who will or won't suffer depression after a bereavement. However, risk factors thought to increase the chance include the following:
- a previous history of depression
- intense grief or depressive symptoms early in the grief reaction
- few social supports
- little experience of death.
Treatment for grief and depression
The support of family and friends is invaluable to anyone - especially at difficult times. Sadness after bereavement is natural: it is normal to want to discuss the deceased and become upset while doing so. Expressing feeling does not make things worse.
If depression is thought to be present then antidepressants are very likely to be used. Antidepressants will treat the depression, but they do not have any effect on the underlying grief. Untreated depression, however, makes it extremely difficult to grieve effectively.
GPs, counsellors and psychiatrists are aware of the many different normal responses to loss and are reluctant to diagnose a person as mentally ill during bereavement. They will usually provide support to help the person grieve. A psychiatrist is only likely to be involved if the bereavement is complicated by a depressive illness.
Grief counselling helps mourning by allowing someone to work through the stages of grief in a supported relationship. The goals of grief counselling include:
- accepting the loss and talking about it.
- identifying and expressing feelings related to the loss (anger, guilt, anxiety, helplessness, sadness).
- living without the deceased and making decisions alone.
- separating emotionally and forming new relationships.
- the provision of support.
- identifying ways of coping that suit the bereaved & explaining the grieving process.
Seeing a therapist has been proven to be invaluable to people who are finding it difficult to cope with the grieving process. Don’t suffer in silence. Talk to someone. If you don’t feel that you are able to talk to anyone you know about your feelings then speak to a therapist or grief counsellor. You will never look back and it will help you to move forwards.
