Coping With Bereavement

Coping With Loss

The loss of a loved one is life’s most stressful event and can cause a major emotional crisis. After the death of someone you love, you experience bereavement, which literally means “to be deprived by death.”

Knowing What to Expect

When a death takes place, you may experience a wide range of emotions, even when the death is expected. Many people report feeling an initial stage of numbness after first learning of a death, but there is no real order to the grieving process.

Some emotions you may experience include:

Denial
Disbelief
Confusion
Shock
Sadness
Yearning
Anger
Humiliation
Despair
Guilt

These feelings are normal and common reactions to loss. You may not be prepared for the intensity and duration of your emotions or how swiftly your moods may change. You may even begin to doubt the stability of your mental health. But be assured that these feelings are healthy and appropriate and will help you come to terms with your loss.

Remember — It takes time to fully absorb the impact of a major loss. You never stop missing your loved one, but the pain eases after time and allows you to go on with your life. (Included in a call out box)

Mourning A Loved One

It is not easy to cope after a loved one dies. You will mourn and grieve. Mourning is the natural process you go through to accept a major loss. Mourning may include religious traditions honoring the dead or gathering with friends and family to share your loss. Mourning is personal and may last months or years.

Grieving is the outward expression of your loss. Your grief is likely to be expressed physically, emotionally, and psychologically. For instance, crying is a physical expression, while depression is a psychological expression.

It is very important to allow yourself to express these feelings. Often, death is a subject that is avoided, ignored or denied. At first it may seem helpful to separate yourself from the pain, but you cannot avoid grieving forever. Someday those feelings will need to be resolved or they may cause physical or emotional illness.

Many people report physical symptoms that accompany grief. Stomach pain, loss of appetite, intestinal upsets, sleep disturbances and loss of energy are all common symptoms of acute grief. Of all life’s stresses, mourning can seriously test your natural defense systems. Existing illnesses may worsen or new conditions may develop.

Profound emotional reactions may occur. These reactions include anxiety attacks, chronic fatigue, depression and thoughts of suicide. An obsession with the deceased is also a common reaction to death.

Dealing with a Major Loss

The death of a loved one is always difficult. Your reactions are influenced by the circumstances of a death, particularly when it is sudden or accidental. Your reactions are also influenced by your relationship with the person who died.

A child’s death arouses an overwhelming sense of injustice — for lost potential, unfulfilled dreams and senseless suffering. Parents may feel responsible for the child’s death, no matter how irrational that may seem. Parents may also feel that they have lost a vital part of their own identity.

A spouse’s death is very traumatic. In addition to the severe emotional shock, the death may cause a potential financial crisis if the spouse was the family’s main income source. The death may necessitate major social adjustments requiring the surviving spouse to parent alone, adjust to single life and maybe even return to work.

Elderly people may be especially vulnerable when they lose a spouse because it means losing a lifetime of shared experiences. At this time, feelings of loneliness may be compounded by the death of close friends.

A loss due to suicide can be among the most difficult losses to bear. They may leave the survivors with a tremendous burden of guilt, anger and shame. Survivors may even feel responsible for the death. Seeking counseling during the first weeks after the suicide is particularly beneficial and advisable.

Living with Grief

Coping with death is vital to your mental health. It is only natural to experience grief when a loved one dies. The best thing you can do is allow yourself to grieve. There are many ways to cope effectively with your pain.

Seek out caring people. Find relatives and friends who can understand your feelings of loss. Join support groups with others who are experiencing similar losses.
Express your feelings. Tell others how you are feeling; it will help you to work through the grieving process.
Take care of your health. Maintain regular contact with your family physician and be sure to eat well and get plenty of rest. Be aware of the danger of developing a dependence on medication or alcohol to deal with your grief.
Accept that life is for the living. It takes effort to begin to live again in the present and not dwell on the past.
Postpone major life changes. Try to hold off on making any major changes, such as moving, remarrying, changing jobs or having another child. You should give yourself time to adjust to your loss.
Be patient. It can take months or even years to absorb a major loss and accept your changed life.
Seek outside help when necessary. If your grief seems like it is too much to bear, seek professional assistance to help work through your grief. It’s a sign of strength, not weakness, to seek help.

Helping Others Grieve

If someone you care about has lost a loved one, you can help them through the grieving process.

Share the sorrow. Allow them — even encourage them — to talk about their feelings of loss and share memories of the deceased.
Don’t offer false comfort. It doesn’t help the grieving person when you say “it was for the best” or “you’ll get over it in time.” Instead, offer a simple expression of sorrow and take time to listen.
Offer practical help. Baby-sitting, cooking and running errands are all ways to help someone who is in the midst of grieving.
Be patient. Remember that it can take a long time to recover from a major loss. Make yourself available to talk.
Encourage professional help when necessary. Don’t hesitate to recommend professional help when you feel someone is experiencing too much pain to cope alone.

Helping Children Grieve

Children who experience a major loss may grieve differently than adults. A parent’s death can be particularly difficult for small children, affecting their sense of security or survival. Often, they are confused about the changes they see taking place around them, particularly if well-meaning adults try to protect them from the truth or from their surviving parent’s display of grief.

Limited understanding and an inability to express feelings puts very young children at a special disadvantage. Young children may revert to earlier behaviors (such as bed-wetting), ask questions about the deceased that seem insensitive, invent games about dying or pretend that the death never happened.

Coping with a child’s grief puts added strain on a bereaved parent. However, angry outbursts or criticism only deepen a child’s anxiety and delays recovery. Instead, talk honestly with children, in terms they can understand. Take extra time to talk with them about death and the person who has died. Help them work through their feelings and remember that they are looking to adults for suitable behavior.

Looking to the Future

Remember, with support, patience and effort, you will survive grief. Some day the pain will lessen, leaving you with cherished memories of your loved one.

Helping Children Cope With Loss

The death of a loved one is always difficult. For children, the death of a loved one can affect their sense of security. Like adults, children express loss by grieving. Yet children may not demonstrate the grief in the same manner as adults. Pre-schoolers usually see death as temporary; between the ages of 5 and 9, children begin to experience grief more like adults. NMHA provides the following information for parents, educators and others who may help a child overcome loss.

Signs of Grieving in Children & Adolescents

Sadness
Profound emotional reactions-anxiety attacks, chronic fatigue, anger, thoughts of suicide
Feelings of anger, denial, shock and confusion
Extended depression with a loss of interest in daily activities and events
Boisterous play
Inability to sleep, nightmares, loss of appetite, prolonged fear of being alone
Withdrawal from friends
Sharp drop in school performance or refusal to attend school
Excessively imitating or asking questions about the deceased; repeated statements of wanting to join the deceased; inventing games about dying
Acting much younger for an extended period or reverting to earlier behaviors (e.g., bedwetting, baby talk, thumb-sucking)
Loss of concentration and/or irritability
Humiliation or guilt over personal failure to prevent loss of life
Frequent physical complaints such as stomachaches and headaches

Helping Children & Adolescents Grieve

Long-term denial of death or avoidance of grief is unhealthy for children and may resurface later with more severe problems. Here is a list of things you can do to help a child overcome loss.

Children are concrete in their thinking. To lessen confusion, avoid expressions such as quot;passed on" or "went to sleep." Answer their questions about death simply and honestly. Only offer details that they can absorb. Don't overload them with information.
Children can be fearful about death and the future. Don't offer false comfort. Give them a chance to talk about their fears and validate their feelings. Offer a simple expression of sorrow and take time to listen.
Children are repetitive in their grief. Respond patiently to their uncertainty and concerns. It can take a long time to recover from a loss.
Children are physical in their grief. Watch their bodies, understand and support their play and actions as their "language" of grief. Offer reassurance.
Children grieve cyclically. Expect their grief to revisit in cycles throughout their childhood or adolescence. A strong reminder, such as the anniversary of a death, may reawaken grief. Make yourself available to talk.
Children need choices. Whenever possible, offer choices in what they do or don't do to memorialize the deceased and ways to express their feelings about the death.
Children grieve as part of a family. Expect children to mourn the deceased and the environment that existed before the death. Children may grieve the "changed" behavior of family and friends. Keep regular routines as much as possible.

Resources

Help is available. Organizations and resources that can provide useful materials and referral information are listed below.

American Academy of Child & Adolescent Psychiatry. (800) 333-7636 http://www.aacap.org --- professional membership organization of psychiatrists provides resources for parents and teens.
Center for Mental Health Services. (800) 789-2647 http://www.mentalhealth.org/child. --- a Federal Government clearinghouse offering mental health English and Spanish language publications for families, children, and adolescents.
Dougy Center, The National Center for Grieving Children and Families. (503) 775-5683 http://www.dougy.org --- a national support center for grieving children, teens, and families.
GriefNet. http://www.griefnet.org ---an Internet community of more than 30 Email support groups and two web sites, offering a moderated chat room for children who are in grief and their parents, lists of books and other library information, memorials, newsletters, a directory of suicide prevention and survivors' information, and more.
National Institute of Mental Health. (301) 443-4513 http://www.nimh.nih.gov ---the mental health research component of the National Institutes of Health, which provides printed and online materials.
UCLA School Mental Health Project. (310) 825-3634 http://smhp.psych.ucla.edu --- a resource center that provides schools and teachers with resources for helping children.

Helping Children Cope With Loss Resulting From War or Terrorism

The death of a loved one is always difficult. When the death results from a war or a disaster, it can be even more troubling given the sudden and potentially violent nature of the event. For children, the loss of a parent, sibling, relative or friend can affect their sense of security. Helping children cope with their loss is crucial in enabling them to resume their lives more fully at home and school.

Responses to Loss

Children deal with death in many different ways, and not necessarily in the same manner as adults. Here are some common ways children might respond to a death:

Sadness
Denial, shock and confusion
Anger and irritability
Inability to sleep
Nightmares
Loss of appetite
Fear of being alone
Physical complaints, such as stomachaches and headaches
Loss of concentration
Guilt over failure to prevent the loss
Depression or a loss of interest in daily activities and events
Acting much younger for an extended period or reverting to earlier behaviors (e.g., bedwetting, “baby talk” or thumb-sucking)
Excessively boisterous play
Withdrawal from friends
Sharp drop in school performance or refusal to attend school
Repeatedly imitating or asking questions about the deceased or making repeated statements of wanting to join the deceased
Inventing games about dying
Profound emotional reactions (e.g., anxiety attacks, chronic fatigue or thoughts of suicide)

Tips for Helping Children and Adolescents Grieve

Children express their grief in a variety of ways and may even appear to be unaffected by the death. While pre-schoolers have difficulty understanding that death is not temporary, children between the ages of five and nine begin to experience grief more like adults.
Don’t push children to talk about their feelings. Children, like adults, need time to grieve and be upset. Let them know you are ready to listen, and provide reassurance and validation of their feelings when they express them.

Here are some issues to consider when helping a child overcome loss:

Children are concrete in their thinking. To lessen confusion, avoid such expressions as “passed on” or “went to sleep.” Answer their questions about death simply and honestly. Only offer details that they can absorb. Don’t overload them with information.
Children are physical in their grief. Watch their bodies, and understand and support their play and actions as their “language” of grief. Offer reassurance.
Children can be fearful about death and the future. Give them a chance to talk about their fears and validate their feelings. Share happy memories about the person who died. Offer a simple expression of sorrow and take time to listen.
Children need choices. Whenever possible, offer choices in what they do or don’t do to memorialize the deceased and ways to express their feelings about the death. Help the child plant a tree or dedicate a place in memory of the person who died.
Children grieve as part of a family. Children grieve the person and the “changed” behavior and environment of family and friends. Keep regular routines as much as possible.
Children are repetitive in their grief. Respond patiently to their uncertainty and concerns. It can take a long time to recover from a loss. Expect their grief to revisit in cycles throughout their childhood or adolescence. A strong reminder, such as the anniversary of a death, may reawaken grief. Make yourself available to talk.