Читать книгу Faces of Grief. Overcoming the Pain of Loss - Veronica Semenova - Страница 11

Stages of grieving, as suggested by Elizabeth Kübler-Ross in 1969, are known to many as denial, anger, bargaining, depression, and acceptance. In 1970, Bowlby and Parker suggested that the stages of grieving should be described as numbness, pining, disorganization, and reorganization. Whichever model of separating the stages is examined, it is important to know that the duration and intensity of each stage may vary greatly, that stages can overlap or occur together, and that a grieving individual can miss one or more stages altogether.

It is also not unusual for someone to go back and forth between the stages as important pieces of information about the nature or causes of death, milestone birthdays, anniversaries, and events in the family can newly aggravate grief symptoms and re-launch a grief stage from the past. Getting stuck in a stage or a major variation in the process may be considered pathological and would require a call for action, such as consulting a therapist for help.

Stage 1 – Denial

Loss is always a shock, so the first reaction that follows the death of a loved one is denial of the fact that the loss has occurred. The loss seems unreal. The griever thinks he could turn back time, wake up, and everything will be as it was before the loss. It seems impossible that the person loved and lost could be no more. You know you sound irrational, but you still believe things could go back to how they were before, and that what you lost will return. It may be a way for your brain to shut down in an effort to self-preserve and block the first wave of pain. Thoughts like “He has not died”, “She will be back”, or “He could not have left me” are common in this stage.

Denial is also associated with isolation, where the grieving person will insist on being left alone and will require time to process what happened. This is absolutely normal. Give the person as much space and time as they need. A couple of days or weeks would be enough for this stage, but watch out if it lasts longer than a month. Make sure the person knows you are there for him or her, if they need to talk or just want «silent company». Suggest that you could go for a walk, drive around, visit the cemetery, or go to church together. Any shared activity could help the grieving person feel that life has not stopped and that they need to process their loss. Usually the stage of denial and isolation ends by itself as the grieving person’s mind tapers into the «unsafe» territory of loss and begins to embrace it.

Stage 2 – Anger

After you realize that you have lost something or someone who was dear to you, it is normal to start feeling angry. It is the first realization that the loss is real. When you start looking for something or someone to blame for the loss, you may feel guilty for not protecting your loved one or not being there when they died. Intense emotions enter, and you start to blame everything around you – God, the Universe, your job/or responsibilities that kept you away, doctors, the healthcare system, people who were with the deceased at the time of death – anyone or anything that could have contributed to the death or who, in your opinion, were not “good enough” to save your loved one. Questions come to your mind: “Why me?”, “How could this happen to me?”, “Why would God not protect me and my loved one?”. Anger and rage are normal at this stage; however, anger in grief is not akin to anger in ordinary daily life. The cause of this anger can’t be undone: no one can make it right. Anger in grief is not directed at anyone in particular; therefore, it can involve anyone around the grieving person, even the grieving person him/herself.

If you are dealing with someone in the anger stage of grief, let the person vent their emotions, listen to him/her, and do not advise them to calm down or control themselves. Just be there and support them while looking after them to ensure they are safe and are not contemplating hurting themselves or others.

Stage 3 – Bargaining

This stage comes when you start pondering if there was anything that you could have done differently to prevent the loss. You begin reflecting about how things could have been different: «This would not have happened if I did not do this or did not say that» or «If only we had gone to see a doctor earlier». It is a typical cognitive discussion, and in a way it is even helpful in reconstructing the events and causes leading to the death of a loved one. Often such bargaining processes help the grieving person receive approval from those around them, along with the reassurance that they could not have changed what happened, they did all they could, and that the loss was not their fault. This is one of the most critical stages of grieving and requires the most support from others. Listen to the person in the bargaining stage. Let them tell you all of their conditional thoughts, including what they think could or should have happened. Make sure to encourage them to share as much as possible, but do not interrupt them or tell them that their thoughts are irrational. Be gentle, take time to talk about everything, and reassure them that certain events in life are beyond our control. Suggest undertaking some activity that the deceased enjoyed, or always talked about experiencing, in the future. Be there when emotions start pouring out.

Stage 4 – Depression

This stage is really the time to say good-bye. You have exhausted your anger, bargaining has led nowhere, and you realize the lost loved one is not coming back. There is nothing you can do, no one you can blame, and no reasons, excuses, or negotiations that can bring the lost person back. It is the feeling of sadness, of actual irreversible loss, that is embraced during this stage. According to clinical science, depression can be categorized as low mood, insomnia or hypersomnia, fatigue, feelings of guilt, sadness, hopelessness, diminished interest in usual activities, irritability, or lack of concentration. All of these feelings are normal for grief; however, the major difference between grief and depression is that the above symptoms in grief focus on the absence of the loved person, while in depression they focus on one’s self and feelings of helplessness or hopelessness about current or future situations.

What can you do when someone close to you is suffering from depression? The first rule is to not tell them that you know how it feels. The truth is – you don’t. Everyone carries their own cross, and everyone’s sadness is different. The best you can do is be there, silent or talking, and make your presence felt. Cook a meal, make a cup of tea, and take care of the person going through this stage. Ensure that they feel listened to and that they can talk to you about anything. Watch out for suicidal thoughts – you need to get help, in that case. Often you will hear thoughts like “I’ve lost any meaning in life”: acknowledge that, but be firm in reassuring the person that life also can continue with the memory of the late loved one. Ask the grieving person how their loved one would have liked to have seen them at this moment, and what would they have wanted them to do.

Dealing with depression is not an easy task. There are specific chemical processes happening in the brain and body of a depressed person which are difficult to reverse. In depression, the interaction of the endocrine system with the immune and the nervous systems is altered, as neurological processes activated by chronic stress and by depression are similar. During depression, the levels of catecholamines – serotonin, noradrenaline, dopamine drop, and glutamate – raise.

Depression has been associated with the weakening of the immune system. Depressed individuals suffer from impairments of the sleep cycle such as insomnia, further reinforced by the lack of physical exercise and an alteration of eating patterns. Therefore, the critical task in this stage is to encourage the grieving person to take care of themselves and pay attention to their own health by maintaining a well-balanced diet, taking the necessary medications, getting enough sleep, exercising regularly, and avoiding excessive alcohol, smoking, drugs, or other self-destructive behavior. Exercise is particularly important as it helps restore the chemical balance in a person’s brain by adjusting the levels of neurotransmitters and hormones.

Stage 5 – Acceptance

This stage is the trickiest stage of all. People may think they have accepted their loss, when really they haven’t. In fact, every big milestone and every major event in life will trigger grief again, over and over. This is normal, as it is hard (or even impossible) to accept that someone so important and dear to you is gone. Some people will claim that they have accepted the loss immediately after their loved one has passed away, while others will come to this stage only after passing through all the other stages first. No matter what the timing, the real manifestation of acceptance is the calmness a grieving person will experience as they move on with their life, discovering meaning in continued living and finding the strength and motivation to move on. Acceptance of loss does not mean forgetting the person who passed away or changing your life to avoid any reminders of the loss. Acceptance is more about integrating the loss into your life and moving on while holding onto the heritage of the person you lost and using this as your strength.

Death is a given from the moment we are born. It is the one sure thing that will happen to every one of us, no matter our social position, health status, education, or political values. Grief is strengthened by the realization that we are not immune from death. Awareness of one’s mortality is a conscious perception; an anticipation of the inevitable, which human beings often fear to embrace.

Integration of our own and our loved ones’ mortality is a very important step in achieving psychological wellness and avoiding living in fear. The time of death is beyond our control, much as the time of birth is beyond our control before we are born. Thus, acceptance is a truly powerful and important stage in the grieving process, allowing the person to grow stronger, value life more, and honor the memories of a lost loved one by continuing this life journey.