Mourning your loss

An overview: Head-based vs. heart-based grieving

When many of us picture grief, we think of a person wailing uncontrollably. Strong emotions, loud noises, and even thrashing bodies come to mind. Although this behavior, which we could call “heart-based grieving,” may be some people’s natural inclination, others may work through equally strong emotions in a much quieter way. In head-based grieving, people may avoid talking and instead turn to seemingly unrelated physical activities. They may feel compelled to do something productive either to commemorate the person who has died or simply to channel the energy of their emotions. Sometimes their response is to go running or do something very physical. These more private grievers are not grieving any less; they simply process their losses more with the mind and body.

In classic gender stereotyping, women tend to express their feelings of loss in a heart-based manner, and men are apt to be more head-based. As a society, we tend to favor the heart-based approach. Many a man has been sent to a therapist by his wife because she didn’t think he was grieving correctly! Yet, people who cross over a gender stereotype too much can become socially suspect. In some circles, a man who expresses his grief with strong emotions may be ostracized for showing too many feelings. A woman who leans more to the head-based approach may receive meager support. In fact, she is likely to be labeled cold and uncaring, a difficult burden to carry in addition to the grief she is processing.

Research has shown that both heart-based and head-based approaches are very effective ways to process the emotions of loss. Grieving is very personal. It is best to respect the approach that feels most natural to you and allow others in your family to work through their feelings in their own ways.

Confused and unsettled thinking

The period of mourning is a time when our thinking processes are interrupted. People who are grieving often find themselves unable to concentrate for long periods of time. They may go into a room and forget why they went there, or they feel generally disoriented and confused. These behaviors are a normal part of the process and not something that is likely to continue at the same intensity for months on end. Still, it is unsettling while it is happening.

Another change in our thinking is the tendency to idealize the deceased. Whenever we lose something, it is natural to become more acutely aware of all the positives we miss. Indeed, the good side of a person may be the essence of who they were. Still, it is good to keep a perspective if you can, as other family members may be struggling with feelings of anger, resentment, or unresolved issues. Making your loved one into a saint may not be the healthiest way for the family to come to terms with his or her passing.

It is not uncommon to spend a lot of time thinking about the person who has died. He or she probably touched your life in many ways, and if you had a close daily interaction, there will be daily reminders of this hole in your life. A smell, a scarf, a strain of music-the smallest things may touch off memories and feelings. Many people report feeling that their loved one is present from time to time. Do not be concerned that you are mentally ill if you have these perceptions. These experiences can be uncomfortable to acknowledge, but they are extremely common.

Following the death of someone we care about, we begin to ask questions we do not usually consider. “Why is there suffering? What’s the point of living if we simply die? What was the meaning of my loved one’s life? What is the meaning of my own life?” To reflect on these existential concerns is a universal reaction to death. Many see it as a gift of the person who died. It becomes an opportunity to reevaluate priorities and ensure that we are living in a way that is meaningful to us. Those with a spiritual practice may find comfort talking with clergy, praying for guidance, or meditating to discover or rediscover inner wisdom.

Emotional "waves" of feelings

People grieve by feeling and expressing many emotions, even some that are conflicting. Sadness is an emotion that comes immediately to mind, but anger is also common. People may feel angry at God, at the doctors, and at the person for dying. These feelings may not seem rational, but emotions by their very nature are not rational. All emotions are normal and to be expected.

It is also common to feel relief after a loved one dies, and then to feel guilty. If the person has suffered, it’s easy to feel relieved that he or she is no longer in pain. But feeling relief for yourself is perfectly natural as well. Whether you have been a primary caregiver or not, a terminal illness is likely to have disrupted your life and may have caused tension as you juggled and rescheduled your ongoing responsibilities. Or, you may inherit money from the deceased, which can help relieve stress and result in an easier lifestyle for you. It’s not your fault that you benefited from the death.

And then there is guilt. Many family members are left wondering if the right medical decisions were made. Others may feel distressed about unspoken words or unfinished conflicts with the deceased that cannot be repaired. You may find yourself haunted by thoughts that you were not the spouse, child, parent, or sibling you wish you had been. Or you may simply feel guilty because you are living and the one you cared about died.

Sometimes it helps to write a letter to the person who died. Many people find great solace in talking with others who are also mourning a loss. Hospitals frequently offer bereavement support groups, usually free of charge. These groups offer a safe place where people in mourning can discuss their feelings with an individual trained in grief resolution. You might also find a support group helpful. There, members share a wide variety of tips that have helped them cope with the more difficult aspects of bereavement.

Physical reactions to grief

Insomnia, loss of appetite, headaches, menstrual irregularities, tightness in the chest, and exhaustion are some of the ways the physical body grieves. Although these may be natural responses, it is important to be checked by a doctor just in case other causes are at work. Be sure to let the doctor know that you are coping with a recent death. If you have been giving care to an ailing person for a long time, you may well have neglected your own health for months or even years. A physical exam will help confirm your basic health and reestablish a stable order.

The "tasks" of grieving

Just as there is no right way to grieve, there is no set timetable for grieving. The process varies with each individual. The feelings often come in waves, and as time goes on, the lows will be less frequent and usually less intense. Holidays and anniversaries are likely to be difficult, especially during the first year when you relive the seasons without your loved one. The anniversary of the diagnosis and the anniversary of the death will also be vulnerable moments. Activities that signal closure such as giving away your loved one’s clothes or selling a house are likely to trigger feelings of grief. Be gentle with yourself and acknowledge that you may have times when you are especially tender.

Most people notice that during the first week or so after the death they are so caught up in handling logistics that they don’t have time to feel sad. Perhaps it is a blessing of nature that we are a bit numb at the beginning. Then too, if relatives are gathering and you are receiving an outpouring of social support, the realities of your loss will not be as evident. A funeral or other ceremony will help bring closure, but it also marks the return to daily life and the beginning of the work of grieving.

• Accepting the death of your loved one. This is the first task in the grieving process. It is something of an intellectual exercise, although ceremonies such as a funeral can help spiritually and emotionally confirm that the person is gone. Talking a lot about the person helps ease the pain and process the death.
• Learning to cope with your emotions. As mentioned earlier, some people are outwardly expressive. Others process their feelings more privately, less with words than with thoughts or deeds. If your feelings seem overpowering, you might find it helpful to talk with a counselor or clergy member. Sometimes, expressing your feelings to other grieving family members is too much for them to handle. Someone who is more objective can be a better listener. Plus, you don’t have to worry about affecting their feelings. Support groups also provide a safe place to express your emotions. People in these groups know what you are going through, but they don’t have ties to your loved one, so they are able to offer perspective, good listening, and valuable tips.
• Adjusting to life without the person who died. This task can take years, especially if the person was a significant part of your daily life. He or she fulfilled roles in the family: breadwinner, nurturer, source of wisdom, source of laughter, cook, gardener, car mechanic, bill payer, for example. You will probably take on some of those roles yourself, and others may require outside help. These changes may alter your sense of yourself and your relationships with other people. Start the process with small steps. Prioritize what you need help with immediately and let the less-important things slide for a while. If at all possible, avoid making significant or permanent life-changing decisions for at least six months. You’ve already gone through one enormous change-give yourself time to see how things settle and determine what your needs really are.If the adjustment is difficult, try keeping a diary of your day or even a simple descriptive list. Look for patterns to your distress. Does it tend to surface at a particular time of day (for example, at dinner)? Do certain events trigger it? What tends to help? What have you done in the past, during other periods of stress, that has been constructive? What responses do you wish to avoid this time (for example, increased eating, substance use, yelling)? Keeping a diary and being mindful of your productive and unproductive tendencies will help you adjust to life without your loved one.
• Finding ways to remember the deceased. Rituals such as a funeral can help with this task. You may also decide to choose a corner of a room or the mantle as a place for photographs and cherished items such as eyeglasses, knitting needles, a wedding ring, or a memento from a fun time you had together. Some people establish a memorial fund that honors the deceased and benefits the community in some way. One man continued his wife’s tradition of planting a tomato garden each year. Celebrating our loved ones not only acknowledges their legacy, but gives us a way to remember them while we also move on.
• Creating a new identity. This is the ultimate task. You are a different individual now because of your loved one’s death-you cannot go back entirely to who you used to be. Focus on investing in life and in your own future. This does not mean you are disloyal or that you should forget the dead. It simply means that you seek a way to keep them in your heart while you continue to live and flourish. In the process you choose what to bring forward and what to leave behind. The experience can be liberating at the same time that it is scary. In the end, you remain among the living, for it is not yet your time to die.As part of the process of creating a new identity, you may wish to become involved with organizations that draw upon your experience. For instance, many parents whose children have died are drawn to the group Compassionate Friends, a support group for bereaved parents. Those who are a few years beyond the death of their children assist those who are newly bereaved. You might choose to become involved with national organizations devoted to chronic and terminal conditions such as hospice, Alzheimer’s Association, American Cancer Society, or American Heart Association.

When grief becomes a problem

Sadness-even extreme forms-is a normal part of grieving. But for about 20 percent of the population, grief can become clinical depression. People with a history of depression and those who have very little support, other significant life stressors, or a tendency toward substance abuse are most likely to become depressed after a death.

The good news is that depression is a highly treatable condition. You don’t have to live with the sinking feelings of depression in addition to your grief. With medication and counseling, you can interrupt the downward spiral and liberate your energy to work toward processing your bereavement in a healthy way.
Signs of depression are

• feelings of worthlessness or hopelessness
• ongoing thoughts of suicide
• persistent inability to perform your day-to-day activities
• holding onto beliefs that are not true
• uncontrolled crying
• significant weight loss
• slowed physical responses.

In addition to becoming depressed, some people get stuck in their grief or experience complications of bereavement. Although everyone grieves in their own way and on their own timetable, these are signs that a bereaved person should consider getting help:

• inability to accept or believe that the person has died
• ongoing nightmares or flashbacks
• feelings that the deceased is always present and watching
• breaking off all social contact.

If you notice any of these symptoms or feel that you are “stuck,” consider talking with your doctor or a counselor. Help is available. You don’t have to go through this alone.