Stages of grief after the death of a loved one

Life is not all positivity, joy and achievement.
Often we have to deal with difficulties, losses, and grief. How to live further after this? What stages of grief does a person go through? Surely everyone has heard that everything that does not kill us makes us stronger. It’s difficult to say whether this is actually true, but that’s what they say. Perhaps this is how it works, but understanding what happened and digesting events and losses does not happen all at once. This is a long, consistent process and understanding appears only later, over time, after the integration of already lived experience.

But what happens to us and how does it live at the very moment when this shocking event occurs, frightening, as if stopping life? An event after which it’s as if you’re not you at all, completely different from what you were before.

Psychologists call the internal process that starts at this moment – grief. It's about experiencing the grief of some kind of loss. Whether connected with someone or something from the outside, or with our illusions, plans, ideas, beliefs.

Whatever it is, we lose something at this moment, and a certain time must pass, and with it our feelings and experiences change.

But loss is not always a death sentence. Most often, it leads to the acquisition of something new, to changes that can be useful for a person. It has long been known that the new can appear only after the old has gone. This can be compared to a full glass of water. To put something else into it, you need to pour out the water. It’s exactly the same in human life. For example, after losing a job, which was the only source of income, a person may think that this is a death sentence and he will be left on the street penniless. But after a few days of searching, he finds an offer with a much more comfortable schedule and a higher salary. The loss, which seemed irreparable, only pushed him to make positive changes in his life.

After experiencing grief and recovering from what happened, we are renewed. And with us our new world appears, in which it is no longer so uncomfortable and uncomfortable.

Stages of grief after the death of a loved one

2021-02-25

The content of the article:

Stages of accepting grief in psychology Post-traumatic stress - applicable to the death of a loved one Natural reaction to grief Pathological reactions How long to grieve - what does “too long” mean Getting out of grief Is it possible to be prepared for the death of a loved one Allow yourself to move on Help someone else cope with grief “Diary of memories”

No matter how hard you try, you cannot prepare for the death of a loved one, even if he is terminally ill. In essence, this is a biological event, the natural end of life. But we experience deep grief that breaks our hearts and changes our lives. And they deal with it differently.

But when we lose loved ones, we all go through certain stages of grief. Because every loss inevitably triggers the grieving process. Knowing all its stages will help you come to terms with reality and help others cope with grief.

Some people, after grieving for a week, return to their usual routine. Others cope after six months. For some, 20 years is not enough to come to their senses. For them, even one reminder is stress, which often turns into a pathological state.

Grief Factors

In our project we will consider that the work of grief is accompanied by certain factors and symptoms that can, on the one hand, contribute to the process of grief, be its inevitable stages, so to speak, a defense between a person, his psyche, and the terrible fact of loss. To be that natural pain reliever, which, gradually weakening, in stages, allows you to finally accept and survive the loss.

But at the same time, these factors sometimes act as an obstacle that stops the work of grief. Because it’s very painful to move on, to remove protection, exposing yourself more and more to the reality of loss. And then the person seems to get stuck, which leads to complicated or chronic grief.

And we will also work with these factors that create problems and obstacles in the grief process.

So, what factors influence the fact that some people easily cope with loss and recover quickly, while others do not? We can divide them into two large groups: external and internal .

External factors are the influence of the environment:

Sudden, violent, untimely, or tragic death of a loved one
Threatening your life, watching death
Explicit and implicit involvement in the death of a loved one, causing a feeling of guilt.
Social stigmas (death by suicide, AIDS)
Conflicts with a person immediately before his death, unforgiven grievances
Unfinished business, unfulfilled promises towards the deceased
Implicit loss (a missing body when a loved one goes missing and is not buried)
Multiple losses over a short period of time
Lack of social support and understanding
Additional problems, for example, financial difficulties after loss, problems with children

Internal factors are our personal characteristics of behavior, feelings, thoughts:

The most important factor is the significance of the deceased and unhealthy attachments to him. The greater the dependence on the deceased and the less independence, the more severe the grief experienced.
Excessive guilt
Blocking or delaying emotions, avoiding painful experiences
Painful attitude to the topic of death
Ambivalent relationship with the deceased, ambivalent feelings about the loss
Alienation, self-isolation, problems expressing emotions to people
Features of temperament, emotionality and character
Tendency to anxiety, nervousness and depression
Inability to cope with difficulties and problems
Self-doubt and low self-esteem
Pessimism, negative views and beliefs
Unresolved past losses and trauma, especially in childhood

Moving through grief, a person seems to oscillate between two aspirations (see Stroebe and Schutt [3])
Firstly, this is the desire to return everything as it is, to return what was lost, to restore the unrecoverable.
At the same time, secondly, we understand that this is impossible, “life cannot be turned back,” which means we need to move forward, cope, compensate, acquire new connections, gain new strength and resources.
The more faith you have in yourself, the stronger and more flexible you are, the less dependent you are on the departed person, the easier it is for you to follow the second path. The faster the process of grief and adaptation to a new life goes through for you.
And vice versa, the less you believe in yourself, the more you depend on others, the less strength and ability you have to cope, the harder it is to overcome the falsity, the illusory nature of the first desire, the more you get stuck in grief and its negative consequences.

Stages of accepting grief in psychology

Oddly enough, psychologists believe that grief is a necessary process. There is no need to divert the attention of the mourners from a difficult life situation. They must cry, experience all the emotions that accompany bereavement, and go through the inevitable stages of grief. And here it is very important to support those who received sad news or experienced an event, but did not fully accept the fact.

Support will help them not to break down, return to life faster and with less losses - even if it is divided into “before” and “after” for them - and let go of grief. To do this, relatives need to understand at what stage of mourning their loved one is now. Psychologists identify 5-7 most common stages. However, each of them can last differently.

Shock

. The most common emotion. It is experienced in different ways. Some, having closed themselves off, hide the things of the deceased, because the slightest reminder of him causes severe suffering and pain, or they do not change anything in his room. Others, having fallen into a stupor, remain silent or cry, forgetting about food, children and work. Still others are isolated or actively involved in funerals. But emotion is saving, because... is a kind of self-defense. Unless, of course, it drags on for a long time and does not turn into depression, for example.

Negation.

Non-acceptance of death, protest can begin earlier than shock, go in parallel with it and other stages, or appear later. But the death of a loved one is denied in different ways. To the point of categorically challenging a tragic fact, postponing the funeral (“Let him stay a while longer, we’ll have time to bury…”) or behavior that is illogical in relation to the deceased (setting the table for him, putting his things in bed, “noticing” him in the crowd, etc.). Why is this and why, why him and not me - these and other questions and guilt do not leave after the death of a loved one. “Survivor guilt” is a psychological term for this difficult feeling. It manifests itself especially clearly after the death of the closest people. In order for an awareness of the situation to come and the reasons for their departure to be found, the person exposes himself, remembers how he was rude or upset the deceased, did not ask for forgiveness, etc. Unfortunately, some live with this for years.

Anger

. The grieving person unleashes his anger and aggression on many, alternating with denial and shock. He grieves that he is alone in his misfortune, that no one helps or sympathizes with him. He quarrels with friends, colleagues, family. Angry at himself. Swears at Heaven. And he even switches to the deceased, whose death supposedly destroyed the rosy plans. Yes, it’s a bad state, but it’s better than withdrawing into oneself. After all, all accumulated negative emotions spill out through anger.

Bargain

. This reaction to what happened is an escape from pain. The grieving person seems to be trying to make a deal with the given. He plays out different situations, often associated with an obsessive “if only”. (“If I do such and such, it will bring him back...”, “If I were there...”, etc.), and tries to answer. Yes, the stage is exhausting, and let him bargain. After all, this helps not only to realize that the dead do not return, but also to survive what happened and regain a sense of control.

Sadness

or depression. It usually replaces the previous stages. It’s difficult for those who withdraw into themselves and don’t show emotions in public. Exhausting himself from the inside with a feeling of sadness, emptiness, losing control over himself, a person no longer believes that he can return to normal life. He doesn't need sympathy. He's gloomy. Avoids any contact. By suppressing feelings, he accumulates negative energy and feels even more unhappy. Psychologists note that alienation is natural during the period of grief, but prolonged alienation is dangerous.

Adoption

. Time passes, and the understanding that the dead will not return has appeared. But if someone manages to accept grief at the very beginning, then someone, after the second or fourth stage, comes to terms with the grave loss. The main thing is that, having received the necessary support, a person gains clarity and a feeling that he can pull himself together and direct his life in the right direction. All the experiences that have taken possession of him up to this point will gradually weaken. And the mourner himself will feel relief and will gradually restore the destroyed social connections, make new ones, etc. Again, this takes a different amount of time for everyone because everyone experiences grief differently. Believers experience grief differently, knowing that death is a transition to another existence.

What else is important? All this is a generalized behavioral model. No one can say how long this or that stage will last. On average, experts say, it takes one and a half to two years to get through the situation normally. Moreover, a person can live in two dimensions - either return to the past, where his loved one was and where he died, or live in this time.

Another question is how not to cross the dangerous line - when the post-traumatic state, in which people often self-destruct, turns into a clinical pathology.

How to cope with loss and grief

Grief is a natural reaction to loss. This is the intense emotional process of suffering that a person experiences when something or someone who is loved or very important is taken away from him. Loss can affect not only another person, but also categories such as health, abilities, prospects, hope, freedom, work, funds, home or homeland. Almost every person goes through losses and the grief associated with them, each time learning to live anew, without what was so dear to them. Gradually, the pain becomes less and less, the grief decreases, and the person who has coped with the experience of loss begins to live again, rejoicing in what he has, what he can still gain, or simply from the awareness of the fact of his existence in this world.

But, in the beginning, people in a state of grief feel that the pain of loss can be insurmountable. A person in this state may experience complex and unexpected emotions: from shock or anger to disbelief, guilt and deep sadness. The pain of grief can also undermine physical health, making it difficult to sleep, eat properly, and think properly. Severe grief can manifest itself in a rich range of negative bodily manifestations, which usually come in periodic attacks (lasting from a quarter of an hour to a little over an hour). During attacks of grief, a person feels that he does not have enough air, he breathes quickly, constantly sighs, a “lump rolls up in his throat,” a “pulling emptiness” is felt in his stomach, muscle strength is lost (exhaustion and exhaustion), while the body feels like “ binds,” and the soul experiences almost physical pain and tension. During attacks of grief, certain changes in consciousness may occur: a feeling of unreality of what is happening, as if it were a “movie” about someone else, the effect of observing oneself from the outside, a feeling of “emptiness inside,” dullness or absence of emotions, disorganization of purposeful activities. In some cases, visual, auditory or combined illusions may arise - a person will “see”, “hear” or “perceive” in another way the presence of the object of loss. It is also possible to identify oneself with the deceased when the mourner takes on individual traits and characteristics of the deceased. In relationships, most often, the person experiencing grief increases the distance and sharply reduces the intensity of interaction, although at certain stages of grief the opposite effect is possible. When communicating, irritability and hostility may appear. Feelings of guilt often arise.

Grief attacks are more common from time to time, especially when someone or something suddenly reminds you of the loss.

And all this is a completely normal reaction to loss: and the greater the loss, the greater the grief will be.

What Causes Grief?

Coping with the loss of someone or something you love is one of the biggest challenges in life that the vast majority of people go through. The death of a loved one is usually the cause of the most severe grief, but any other loss or bereavement can also cause it:

Divorce or breakup
Loss of health
Job loss
Loss of financial stability
Artificial or spontaneous termination of pregnancy
Retirement
Death of a pet
Loss of a cherished dream
Serious illness of a loved one
Loss of friendship
Loss of security
Selling a family home
Loss of freedom
Loss of abilities, skills

Even minor life losses can cause feelings of grief. For example, grief can overwhelm a person when moving to another city or country, after graduating from an educational institution, or when changing jobs. A loss that can cause acute grief does not have to be irrevocable, such as death. Severe grief can be caused by even a temporary loss, not only real, but even imaginary.

Whatever the loss, it is always very personal, so there is no need to be ashamed of your feelings and believe that you can only grieve about the death of loved ones. If a relationship, a pet, or even a certain situation was important, then it is completely normal to grieve a loss that a person feels so strongly about.

However, whatever the cause of grief, there are healthy ways to cope with heartache that, over time, can ease the sadness and help you come to terms with the loss, find new meaning, and ultimately move on with your life.

The grieving process and the work of grief

Grief is only an individual experience: there is no right or wrong way to grieve. How a person grieves depends on many factors, including personality strength, coping styles, life experiences, faith, and how significant the loss was. The grieving process itself takes time, as healing occurs gradually and cannot be accelerated. Some people begin to feel better within a few weeks or months of their loss, while others continue to grieve for many years.

The process of normal recovery after loss is ensured by the so-called “grief work.” This is a kind of psychological adaptation of a person to a new life in conditions that have objectively or subjectively changed for him, liberation from a state of dependence on what was lost, the formation of new goals and new relationships. The process of grief work performs a number of psychotherapeutic tasks:

1. Helps you accept the reality of loss at the level of feelings (not just with your mind).

2. Helps to survive pain so that it does not transform into painful symptoms.

3. Creates a new identity for a person, helps him find his place in the world.

4. Promotes the transfer of energy from holding losses to the creative aspects of life.

Stages of the normal course of grief (according to Elisabeth Kübler-Ross, 1969)

The model was made famous by Swiss-American psychiatrist Dr. Elisabeth Kübler-Ross, who described her in her 1969 book On Death and Dying, which was inspired by her work with terminally ill patients. These stages are only a reflection of how people typically cope with illness and death, not a reflection of how people grieve. Moreover, this model was described back in the 1940s by such authors as Erich Lindemann, Colleen Murray Parks and John Bowlby. In a book co-written with David Kessler and published posthumously (D. Kessler. Finding Meaning: The Sixth Stage of Grief. Simon and Schuster, 2019), Kübler-Ross expanded her model to include any form of personal loss, such as the death of a loved one, loss of a job or income, relationship breakup or divorce, drug addiction, incarceration, the onset of illness, an infertility diagnosis, and even minor losses such as loss of insurance coverage. Kessler also proposed "Meaning" as the sixth stage of grief and reiterated that the stages of grief are not a linear graph that may have a "norm."

1. Shock + Denial: The shock of the loss suffered and the denial to believe in the reality of what happened can last from a few seconds to several weeks, on average 7-9 days.

“This can’t happen to me.” This phase of disbelief in the reality of the loss, the desire to return the deceased and denial of the irrevocability of the loss can last longer than the first shock stage. In the immediate aftermath of a loss, it can be difficult to accept what happened. The person may not believe that the loss actually occurred or may even deny the truth. A bereaved person may even think that he sees the deceased in a crowd on the street or hears his footsteps in the next room.

2. Anger (aggression): “Why is this happening to me? Who is guilty?". This stage lasts up to 6-7 weeks from the moment of loss, although being stuck in this stage can continue for years. It is expressed in the form of indignation, hostility towards others, in blaming oneself, relatives, friends, and the attending physician for the death of a loved one.

3. Bargaining: “Make sure this doesn’t happen, and in return I will ____.” At this stage, the work of mystical thinking is manifested, faith in miracles is strong (which is actively used by priests, sorcerers, mediums, etc., exploiting grieving people), the hope of somehow returning the deceased does not disappear, and the mourner “meets” him or leads him act as if he were about to appear. You can find statements from children: “if I behave well, he will come back, etc.”

4. Depression: “I’m too sad to do anything.” About six months after the loss, the stage of depression begins. Particularly painful are periods associated with loss (holidays, birthdays, common dates), and everyday difficulties. At this stage, awareness of the loss begins, so melancholy, withdrawal into oneself, and a pessimistic view of the future appear. Deep sadness is probably the most common symptom of grief. The bereaved may experience feelings of emptiness, despair, sadness, or deep loneliness, cry a lot, or feel emotionally unstable.

Often there is a feeling of guilt . A person may regret or feel guilty about something they did or didn’t do or didn’t say. It is not uncommon to feel guilty because of the sense of relief experienced when a person has died after a long, serious illness. It is possible to feel guilty that something was not done to prevent the death, even if it could not have been prevented at all.

A significant loss can cause a lot of anxiety and fear. The person may feel anxious, helpless, or uncertain. There may even be panic attacks. The death of a loved one may raise concerns about one's own mortality, facing life without that person, or responsibilities that will now have to be dealt with alone.

This stage accounts for much of the work of grief, and suicidal thoughts and behavior may arise during this stage.

5. Acceptance: “I have come to terms with what happened.” Acceptance includes not only coming to terms with the loss, but also understanding that with the loss, one’s own life has not lost its meaning. During this period, physiological functions and professional activities are restored. The person gradually comes to terms with the fact of loss. He still experiences grief, but his attacks are becoming less frequent and less intense.

6. Meaning (D. Kessler): the stage of finding hope and new meanings in life.

Anyone who experiences such experiences needs to know that all reactions are completely natural, and that over time the grief will lessen and pass. However, not everyone who grieves will have to go through all these stages—and that’s okay, too. Contrary to popular belief, a person does not need to experience every stage of grief work in order to heal.

Kübler-Ross herself, in her last book before her death in 2004, said this about the five stages of grief: “... there is no typical reaction to loss, because there is no typical loss. Our grief is as individual as our lives.” In fact, some people resolve grief without going through any of these stages, or by skipping stages. Therefore, you don’t need to worry about going through them clearly and sequentially and about what you “should” feel at each stage.

Disruptions to the normal functioning of grief

If the normal process of grief is disrupted, for example, when a person tries to avoid difficult experiences, does not want to come to terms with the loss, then the duration of stay in a state of grief can be significantly prolonged, and grief can take on a pathological form, and instead of gaining hopes and new meanings, the person may find himself and a severe crisis. Existing myths about grief play a significant role in the formation of pathological grief:

Myth: Heartache will go away faster if you ignore it.

Fact: Trying to ignore your pain or stop yourself from expressing it will only make it worse in the long run. True healing requires accepting your grief and actively dealing with it.

Myth: It is important to “be strong” in the face of loss.

Fact: Feelings of sadness, fear, or loneliness are normal reactions to loss. Crying is not a sign of weakness. There is no need to “defend” your family or friends by being brave. Only acknowledging and expressing your true feelings can help everyone.

Myth: If there are no tears, then there are no regrets about the loss.

Fact: Crying is a normal reaction, but not the only one. Those who don't cry can feel pain just as deeply as others. They may simply have other ways of showing it.

Myth: The mourning period should usually last about a year.

Fact: There is no specific time frame for the grief process. How long this will take depends on the individual.

Myth: Moving on with your life means forgetting about your loss.

Fact: Moving forward means accepting the loss, but it is not the same as ignoring or “forgetting.” A person can move on with their life and hold on to the memory of someone or something they lost as an important part of themselves. In fact, as people move forward in life, these memories can become an integral and important part of the self.

Painful (pathological) grief reactions

Grief is a normal process that helps restore personal integrity after a bereavement. However, if the normal grieving process is prolonged, grief can become a “disease” and its healthy function of processing psychological trauma and adapting to new living conditions can be disrupted. In this case, the person who has experienced the loss is, as it were, “delayed” at a certain stage of the work of grief. Most often this occurs at the stage of acute grief (loss syndrome).

Complicated grief. The sadness of losing a loved one never completely goes away, but it should not remain the focus. If the pain of loss is so constant and intense that it prevents you from resuming normal life, you may have a condition known as complicated grief. Complicated grief is similar to a state of intense grief. In this state, one may have trouble accepting death long after it has occurred. Or the sufferer is so preoccupied with the person who has died that it disrupts his daily life and undermines his relationships with other people.

Symptoms of complicated grief include:

Intense longing and longing for a deceased loved one
Intrusive thoughts or images of a loved one
Denial of death or feelings of disbelief
Fantasies that the beloved is still alive
Searching for a deceased loved one in familiar places
Avoiding things that remind you of your loved one
Extreme anger or bitterness over a loss
Feeling that life is empty or meaningless

If the death of a loved one was sudden, violent, or otherwise extremely traumatic, complex grief may manifest as acute stress disorder or post-traumatic stress disorder (PTSD). If extremely distressing experiences do not subside within 72 hours, you may have developed an acute stress disorder that requires help from a mental health professional. If more than 30 days have passed, and the symptoms have been joined by nightmares, excessive reactions (aggression), dulling of emotions, strange sensations of falling out of the world, time or body, memory and attention disorders, constant returns to images of the lost, cravings for alcohol or medications, then Acute post-traumatic disorder may have developed. PTSD always requires the help of a doctor to prevent the disease from becoming chronic.

Delaying the grief reaction. This situation is possible when the loss finds a person in the process of a very responsible job or function, the need to help others who are less resilient. In this case, the grief reaction occurs, but later, when the dominant situation is resolved. In this case, the grief reaction can catch a person “out of the blue” at the most unexpected moment for others, sometimes years after the loss.

Chronic grief. In this case, the psychological trauma is not processed, or it proceeds too slowly. Acute grief syndrome in such cases can occur even years later when reminded of the loss.

Distorted grief reactions. Losses are an integral part of the life of almost every person. However, bereavement can destroy the protective illusions of control and safety of life, blur personal boundaries, which leads to the transformation of the process of grief into the development of illness: These options include:

Hyperactivity, search for thrills and risks, sometimes even fatal.
The appearance of symptoms of the disease, repetition of dangerous situations that led to the death of a significant person.
The appearance of psychosomatic diseases (asthma, peptic ulcer, hypertension, ulcerative colitis, tumors, diabetes mellitus).
Social isolation, aggressiveness, paranoid tendencies.
Self-destructive behavior, self-punishment leading to agitated depression with a risk of suicide.
Conflicted (exaggerated) grief. Most often it is characterized by a distortion towards increased feelings of guilt and anger, which can form a pathological vicious circle of reactions that do not allow one to process the loss. The exit from the state is likely to involve a stage of euphoria, which turns into depression.

Suppressed or absent grief. In this case, symptoms of grief may not be externally observed. In this case, a person can completely deny the loss or mask his experiences. In these cases, suppressed or denied experiences often manifest themselves in the form of psychosomatic diseases, including acute ones.

Distorted, painful forms of grief reactions most often require psychological and sometimes psychiatric help. However, they pass, and grief returns to its normal course, which over time adapts a person to a new life after a significant loss.

How to cope with loss and subsequent grief?

Although the grief of loss or loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and ultimately find a way to put yourself back together from the pieces so you can move on with your life.

Acknowledge your pain. Accept that grief can bring up many different and unexpected difficult emotions. Understand that your own grieving process will be unique. Seek personal support from people who care about you. Support yourself emotionally while taking care of yourself physically. Know the difference between grief and depression.

Look for support! Experiencing heartache during grief can often make you want to withdraw from other people and withdraw within yourself. But personal support from others is vital to healing from loss. Even if you don't feel comfortable talking about your feelings under normal circumstances, it's important to express them when you're grieving. Although sharing your grief with someone can make you feel better, it doesn't mean you have to talk about your loss every time you interact with friends and family. You can get support even just by being close to those who care about you. The main thing is not to isolate yourself.

Reach out to friends and family members. It's time to rely on people who care about you, even if you usually pride yourself on being strong and self-sufficient. Instead of avoiding them, spend time with them and accept the help they offer. People often want to help but don't know how, so tell them what you need - whether it's a shoulder to cry on, help with funeral arrangements, or just someone to talk to. If you don't feel like you have someone you can connect with regularly in person, it's never too late to make new friends or get involved in bereavement therapy groups.

Please note that many people feel uncomfortable trying to comfort the bereaved. Grief can be confusing and sometimes frightening for many people, especially if they have not yet experienced a similar loss themselves. They may not know how to comfort you and end up saying or doing the wrong things. But don't use this as an excuse to withdraw into yourself and avoid social contact. If a friend or acquaintance contacts you, even if it is incorrect or incorrect from your point of view, it is only because they care.

Find comfort in faith. If you follow a religious tradition, do not deny yourself the comfort that its mourning rituals or fellowship with your faith brothers and sisters and spiritual director can provide. Spiritual activities that are meaningful to you—such as prayer, meditation, or going to church—can bring comfort.

Join a support group . Grief most often gives rise to a deep feeling of loneliness, even when there are loved ones nearby. Sharing your sadness with others who have experienced similar losses can help you get your life back on track.

Talk to a specialist. If your grief seems unbearable, find a mental health professional with experience in grief counseling. An experienced psychologist can help you cope with strong emotions and overcome obstacles to your healing.

Using social media for support . Memorial pages on Facebook and other social media have become a popular way to inform a wide audience about the passing of a loved one and seek support. These pages not only allow you to share practical information such as funeral plans, but also allow friends and family to post their own condolences and memories. Reading such messages can often bring comfort to those experiencing loss. For privacy reasons, it is better to make such groups or pages private.

Take care of yourself while you grieve. When you're grieving, it's more important than ever to take care of yourself. Severe stress can quickly drain your energy and emotional resources. Taking care of your physical and emotional needs will help you get through this difficult time. The mind and body are closely connected. When you feel healthy, you cope better emotionally. Combat stress and fatigue by getting enough sleep, eating right and exercising. Don't use alcohol or drugs to numb the pain of grief or artificially elevate your mood.

Face your experiences. You can try to suppress your grief, but you can't avoid it forever. To heal, you must acknowledge the pain. Trying to avoid feelings of sadness and denying the loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse and other health problems.

Express your feelings in tangible or creative ways . Write about your loss in a journal. If you've lost a loved one, write a letter saying all the things you never should have said, and create a scrapbook and photo album dedicated to the person's life. You can continue the work started by the departed, or do what he wanted to do, but did not have time.

Try to maintain your hobbies and interests. Returning to activities that bring you joy and bring you closer to others can help you come to terms with the loss and help the grieving process.

Personal boundaries. Don't let anyone tell you how to feel and don't tell yourself how to feel. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Allow yourself to feel whatever you feel without embarrassment or judgment, accepting yourself as you are. It's okay to be angry, scream at the skies, cry a lot, or not cry at all. It's also okay to laugh, find moments of joy, and let go of loss when you're ready.

Plan to meet grief triggers. Anniversaries, holidays and memorials can awaken memories and feelings. Be prepared for emotional turmoil and know that this is completely normal. If you share a holiday or memorial event with other relatives, talk to them in advance about their expectations and agree on strategies for remembering the deceased.

Let go of the loss. In case of prolonged denial of the fact of loss, fixation on the lost, the Founder of Gestalt therapy, Fritz Perls, developed a five-step scheme for saying goodbye to the departed person:

1 . Acceptance of the fact of loss. Many, being completely healthy adults, do not agree to admit that what happened really happened: that this person really died, that he really moved to live in another country, that the divorce really happened, that his job was lost, etc. . Thus, the psyche tries to protect itself from trauma. It is necessary to face the facts of loss and acknowledge them. Although this is scary, the result will bring relief, as grief that has been stuck in denial can finally continue its healing work.

2. Unfinished business. Unfinished business often gets in the way of letting go of a loss. Analyze what prevents you from saying goodbye to the departed. All these things can be completed in your imagination or played out in reality. Sometimes you need to talk seriously about something, express some feelings, go fishing with him or go to some special place.

3. Farewell ceremony . When all the unfinished business is completed, and you are ready to say goodbye for real, you can imagine or perform a farewell ceremony or ritual, the result of which should be a final recognition and farewell: “You are dead. Goodbye!" Let him go, allowing him to find peace and happiness in another life.

4. Mourning. After saying goodbye, try to cry all the tears you can. It is good and natural to cry, it helps the work of grief to heal your soul. If tears do not want to appear, try a paradoxical tactic, telling yourself that you will not allow the tears to flow, by doing everything in your power to prevent their appearance. Usually, holding back tears ends in soul-cleansing crying.

5. Greetings to today. After mourning, you can move on to a new life and today's affairs. Friends or members of a therapy group can help here. Here you will need distracting activities and conversations, rest, self-care, and, importantly, care for other people. You can even hold an imaginary ceremony to welcome the present day. Imagine a new day, so fresh and sunny, washed by the rain, and welcome it by opening your arms to it...

Difference between grief and depression

It's not always easy to differentiate grief from clinical depression as they share many symptoms, but there are ways to tell the difference. Remember that grief can be a rollercoaster ride. It includes a wide range of emotions and a mix of good and bad days. Even when you experience grief, you will all have moments of pleasure or happiness. With depression, the feeling of emptiness and despair is constant. Other symptoms that indicate depression, not just grief, include:

Intense, pervasive feelings of guilt
Suicidal thoughts or preoccupation with death
Feelings of hopelessness or worthlessness
Slow speech and body movements
Inability to function normally at home, work or school
The ability to see or hear something that is not there

Can Antidepressants Help Grief?

As a rule, ordinary grief does not require taking antidepressants. While medications can relieve some of the symptoms of grief, they cannot address the root cause, which is the loss itself. In addition, by easing the pain that needs to be overcome, antidepressants delay the process of grief and only delay the moment of healing.

When to Seek Professional Help for Grief

If you are experiencing symptoms of severe grief or clinical depression, see a psychiatrist right away. If left untreated, severe grief and depression can lead to significant emotional damage and life-threatening health problems. But treatment can help you get better. Contact a mental health professional if you:

Feel like life isn't worth living
Do you want to die with your loved one?
Blame yourself for the loss or for not being able to prevent it
Feeling empty and isolated from others for more than two to three weeks
Find it difficult to trust others after a loss
Unable to carry out your normal daily activities

If it may be difficult for you to cope with existing problems on your own, you can always seek professional psychological help.

Andrey Demkin

Post-traumatic stress – applicable to the death of a loved one

Psychiatrists and psychologists talk about two types of reactions to acute grief in people after the death of a loved one.

Natural reaction to grief

It is generally accepted that if loved ones worry “too much,” then there is “something wrong” with them. No, they're fine. It makes those around them uncomfortable. It would be strange if a person, having received terrible news, would smile, and not be sad, not grieve. “Normal” grief (and there is such a term in psychology) consists of the following reaction:

physical suffering (tightness in the chest, weakness, spasms in the throat, etc.);
behavioral problems (hurried or slow speech, inconsistency in actions and thoughts, loss of interest in everything, insomnia, etc.);
cognitive signs (confused thoughts, self-doubt, problems with attention);
emotional symptoms (feelings of guilt, loneliness, helplessness).

Pathological reactions

Where does normal grief end and complicated grief begin? Where the death of a loved one is experienced too hard and for a long time (people get stuck, fixating on one state) or where grief destroys those grieving or those around them. Then note:

stupor;
paranoid reaction to loss;
rash decisions;
health problems that are life-threatening or severely harmful.

In a situation that could lead to death from grief, you should seek help from doctors, psychologists or psychotherapists.

Losses

By default, we will mean the loss of a loved one . But not only. Because grief can be different. And the losses may be different.

What else do we lose:

Loss of health
Losses in old age: we lose youth, attractiveness, strength and, ultimately, life
Death of a beloved animal
Parting with friends
Loss of home or homeland
Loss or change of job
Losing money and things
Loss of usual way of life

In these cases, we will also be dealing with the grief of loss.

Moreover, the problems we will work with also occur in many other situations that are not directly related to losses. This could be almost any crisis, any crisis situation.

Examples of crisis situations:

Disasters, road accidents, assaults, thefts, violence, accidents
Change of place: moving to another house, city or country
Deadly disease, brush with death
Marriage, creation of a family and, conversely, divorce and destruction of the family
Betrayal, betrayal
Social upheavals: destruction of the country, economic crises, wars
Personal crises: disappointment in oneself, in one’s capabilities and achievements, loss of meaning, goals and values
Developmental crises: entry into kindergarten, school, puberty, separation from parents, fatherhood and motherhood, midlife crisis

But fundamentally, when we talk about grief, we will probably mean the most terrible and painful loss - the death of a loved one.

How long to grieve – what does “too long” mean?

Grief lasts differently for everyone. On average, shock and denial of loss takes from a day to several weeks. Many return to their business after 2-5 weeks. But after the loss of those closest to them, relatives begin to show signs of acute grief from the loss. They experience longing, grief, and anger for a very long time. The period of helplessness lasts 3-12 months.

Too long is when someone is stuck grieving for up to six months. Some people do not get out of their state even by the anniversary of the funeral, and even after dozens of years.

Way out of grief

The person is forced to accept what happened. But grieving is a long process. It must be lived to the end in order to realize not only the loss itself, but also that it is time to return to life, to return to yourself. Therefore, we need to get together and at the same time:

think about yourself and your health;
give vent to your feelings and emotions through, for example, creativity, tourism, etc.;
do not set boundaries for grief;
do not delve into the past;
be distracted by the living (children or parents, relatives and friends);
accept outside support.

Grief

So what is grief? Grief, in its simplest sense, is a reaction to the loss of someone (or something) significant and important to us, with whom (or what) we were connected. The loss is most often irrevocable, with which we cannot do anything.

The main component of grief is emotional suffering , painful and unpleasant experiences.

The metaphor of a wound is very suitable for this : Imagine that a piece of his body is suddenly torn away from a person. With skin, with blood, with meat. Unpleasant? That's an understatement.

Firstly, it is pain , unbearable and excruciating.
Secondly, this is, excuse the formalism, a loss of functionality . A person cannot perform his functions as effectively as before.
And thirdly, this is a subjective experience of wounding , this is the meaning that a person attaches to his loss.

It’s the same with the loss of a loved one : the person has grown together with you, literally become a part of you (even if not of the body, but of the soul), and occupied a certain important place in your life. And so they tore him out. With roots. You have lost a part of yourself, a part of your life.

And this is pain.
And this is the same loss of functionality.
And this is what conclusions you draw, up to and including “your whole life is now ruined”

Our task will be:

First, introduce a “painkiller” , reduce suffering, reduce pain, so as not to go crazy from it.
Secondly, heal and heal the wound , restore what was lost and compensate for what was lost.
And thirdly, draw the right conclusions from what happened so that you can not isolate yourself in grief and loss, but move on.

Manifestations of grief and consequences of loss

Physical sensations:

Heaviness in the stomach, nausea
Chest pressure Throat spasms
Other sensations of emptiness, pressure, heaviness, fullness, cold, foreign objects in the body
Noise sensitivity
Dizziness
Difficulty breathing, lack of air
Muscle weakness
Dry mouth
Digestive problems
Lack of energy
Tension and physical exhaustion
Decreased immunity

Emotional manifestations:

Anger, resentment
Guilt
Anxiety and fear
Loneliness
Helplessness
Depression, melancholy, sadness, sadness
Numbness and indifference (lack of feeling)
Release and relief

Cognitive manifestations:

Confusion in thoughts, confusion
Problems with memory and attention
Slow reactions
Depersonalization and derealization (“Nothing seems real, including me”)
Disorientation in time and space
Hallucinations
Denial, disbelief in what happened
Intrusive thoughts
Anxious thoughts and loss of security

Behavioral manifestations:

Sleep disorders
Appetite disorders
Absent-minded behavior
Deep breaths
Crying and tears
Sexual dysfunction
Fussy hyperactivity
Addictions: alcohol, sleeping pills, medications

Manifestations associated with the deceased:

Dreams about the deceased
Avoiding reminders of the deceased
Preoccupation with the image of the deceased
Search for the deceased
Feeling the presence of the deceased
Visiting places or keeping objects that remind of the deceased
Preservation of old habits and rituals associated with the deceased

Social changes:

Loss of social contacts
Social isolation and avoidance of new attachments
Trouble expressing grief in public
Conflicts with loved ones and relatives
Social stigmas

Household and economic problems:

Loss of source of income, debts and financial losses
Loss of functions and roles that the deceased played for the person; the need to take on household or work responsibilities, caring for children
Loss of one's roles and functions that a person played for the deceased

Spiritual and ideological changes:

Revision of ideas about the world (about its safety, friendliness) and about one’s place in it
Revision of ideas about justice, ethics, attitude towards people
Questions to God (Why and Why); loss of faith or its strengthening
Questions about the meaning and value of life, the loss of previous meanings and the search for new ones
Identity issues, “Who am I now?”

Functions of grief

We can say that grief is a reaction, a way of reacting to the fact that something bad has happened. Let's return to our wound metaphor : Imagine that you have a fresh wound, but you feel nothing, no pain, no loss, no change, and so you do nothing to fix it: neither bandage the wound, nor go to the doctor, nor somehow compensate. And in the end you die.

It's the same with grief : it indicates an important loss, shows what you've lost, and motivates you to take action: restore what was lost and accept changes in life. Without such painful awareness and understanding of loss, we simply would not be able to adapt to new conditions.

Is it necessary to feel pain and sadness? It seems so. We are not robots who sense loss as a change in functionality or through simple sensors. We are people, we have an emotional mechanism of loss - pain and sadness. It only depends on us what we will do about it, how long we will grieve and adapt. This is what we will try to influence in the project.

Is it possible to be prepared for the death of a loved one?

Is it possible to be prepared for a stunning tragedy that leaves scars on the soul for life? You don’t get used to death, especially if it’s your first time or even if you know about its inevitability. But psychological preparation is possible.

It is advisable to spend more time with a terminally ill person. Let him talk about what is important to him. If he is unconscious, talk in front of him about what has not yet been told to him, etc. He can hear you.
Convince a relative whose work involves a risk to his life to move to another place. But if his work is important to him, just be with him more often.
With elderly relatives, like with all people, this will also happen. This must be taken as a given. Pay more attention to them, listen to their stories, take an interest in their lives, give advice.
Death is always unexpected. But you have to accept the fact. And the sooner, the easier it will be to recover from the blow. Pray for the repose of the deceased, talk about him with those who knew him, apologize to the deceased, tell him everything you would like to say during your lifetime.

Observations from everyday life, outside the therapist’s office

Here is a small example of the natural development of the process of a person’s consistent adaptation to changes in the system (field) in which he finds himself. I watched a scene in which a heavy poplar branch suddenly fell on the roof of a car parked near a house in front of its owner’s eyes due to a slight wind. The branch broke the windshield and damaged the roof. The sequence of experiences of the car owner was an illustration of how successive experiences of loss are described.

At first he walked around the car in a daze and, it seems, could not believe what had happened. Then he began to say to the neighbors who had come running: “Well, how can it be, why was I so unlucky, because I wanted to leave half an hour ago and only accidentally stayed at home!” There was resentment and helplessness in his voice. All this time he touched and pulled his hands away from the branch, without even starting to remove the pieces of wood from the body of the car. Then after about three minutes he almost regained his balance and a sign of this was the developing aggressive pattern. He began swearing at the city authorities and began using obscene language. Here the female part of the audience dispersed, and the men supported him. And against the backdrop of this aggression, he began to drop branches. Then he stopped and became sad. He looked at the car again and said: “Well, what a pity, because I recently painted it!” Then he looked around and said to those who were helping to remove the branches: “There is no need to remove any more branches. I'll call the insurance company now. Suddenly it is important for them to testify to the cause of the damage. They need to pay for everything.” So, we see that the car enthusiast spontaneously went through the five phases of the process of separation and restoration of integrity. And we see the role and contribution of the environment in the fact that these stages were passed without destruction. The environment, in the form of the people and neighbors present, provided support. The neighbors talked and supported the expression of feelings at every stage.

A common example in counseling practice is stories about parting with loved ones. There are often reports that although a person has left the relationship, he retains his place in the soul of a woman or man. The incompleteness of relationships is a phenomenon of forced preservation of the system. A person tries to avoid separation and, due to his emotions, maintains integrity where this integrity no longer exists. “You’re breaking up, and he doesn’t seem to have promised anything, and there seems to be something.” Such everyday examples can provide an illustration similar to examples of loss and bereavement in situations that are traditionally considered causes of stress.

Allow yourself to move on with your life

The living have no alternative. We must live on, building a new life and way of life in which the deceased no longer exists. But how to start enjoying life again! Is it really possible to become happy or fall in love again, because the memories are so fresh, and grief and guilt do not leave you?

We need to start helping ourselves get over what happened. It is important to understand yourself, forgive yourself, decide on your attitude towards the deceased, build your life and become happy.

Don't feel sorry for yourself.
Don't dwell on grief.
Don't forbid yourself to live. There will be no second life, so enjoy it now.
Don't be ashamed of happiness. Give it to others.
Don't be afraid to love. Those who left this world definitely want you to live long and be happy.
Help others by giving them some of your warmth.
Once you admit your mistakes, apologize to those you have wronged and make amends.

All this, when the grief of loss is mourned, accepted and fully experienced, will help fill life with new colors. After all, the main assistant is time.

Depression.

Gradually, aggression, having exhausted the body, subsides and the person falls into deep depression. Acute mental pain occurs, which also causes physical suffering. A person can no longer fully take care of himself, so his health may deteriorate. Despair appears, a feeling of the meaninglessness of what is happening around, loneliness. It seems that there is nothing special to live for. There is a constant desire to be alone. Interest in life is lost, and it is replaced by irritability, anxiety, and depression. Memory helpfully forgets all unpleasant moments, idealizing the past. There is an understanding of how a person was happy before, but did not understand it and did not appreciate it. This will never happen again in life. Unfinished business together and unfulfilled plans can also remind you of loss. Being present in the present, a person seems to distance himself from it, it literally passes by, and he remains in some other time. This stage is the stage of despair. Our colorful world is becoming black and white. It seems that from now on everything will only get worse, and there is no way to change it for the better. A person may begin to fear that he will never be able to leave the area of mental pain. He sees that those around him have become uncomfortable communicating with him, and this further depresses him. There are no forces and decisions are made from this position. The saving grace is the transition to the last stage.

Help someone else cope with grief

Helping people survive a tragedy is not so easy, but it is possible. It is important to know how to help, what to do at each stage of grief. Without support and sympathy, it will be difficult for the grieving person to get through the dark period of life.

If you are delivering terrible news, be close to him. Don’t speak right away, prepare first. And don’t leave him alone with a sedative at the ready.
Don't leave him if he wants to tell his friends and family this news.
Provide assistance in organizing the funeral and everything connected with it.
Help in going through all stages of grief, find sincere words, making it clear that the mourner is not alone and that a reliable shoulder is nearby.
Don't pretend nothing happened. Just support - in word and deed.
After a temporary period of relief, pain and sadness may return. Try to be around more often, if the person wants it, talk to him about something neutral or about the deceased, but don’t force him to say or do something against his will.

The main thing is to respect the mourner's right to all his reactions caused by death, even if he starts breaking dishes. You need to throw out your grief and cry!

Negation.

The stage of denial is characterized by disbelief in the reality of the loss that has occurred. The person refuses to believe what happened. It seems that this could not happen, or could, but not with him. There is bewilderment and confusion. A kind of numbness occurs. Consciousness rebels against this. It does not allow thoughts about the reality of the negative event that occurred, protecting the psyche from unbearable pain. It seems that life during this period is a bad dream. And as soon as you wake up, everything will be the same. Denial serves as a kind of protest. It is not a weakness and its existence is necessary. According to psychologists, it is even necessary to protect the wounded psyche. You can deny not only the problem itself, but also its significance, devaluing it. Denial can also be expressed in the fact that the person who has experienced grief seems to forget about it. There is no exact understanding of the situation.