Читать книгу Faces of Grief. Overcoming the Pain of Loss - Veronica Semenova - Страница 6

The death of a loved one always brings sadness and overwhelming feelings of loss, loneliness, and despair. Before we proceed, I would like to explain a few terms used in this book, which are often confusing. Bereavement refers to the loss of a loved one. Grief is a reaction to bereavement: a severe and prolonged distress in response to the loss of an emotionally significant figure which may manifest itself in psychological and physical symptoms. Grief is what you feel inside. Mourning is what you show outside, it is the external display of grief. Mourning is crying in public, wearing black clothes (common for widows and other close relatives, in many cultures), and avoiding events.

But if someone does not mourn their loss publicly, doesn’t cry, or doesn’t want to talk, this does not mean that the person doesn’t experience grief. What you show and what you feel can be two different things. Grief will usually present itself through psychological and physical symptoms. I emphasize, again, that many feelings of grief may be hidden, and a grieving person may only share a part of what they feel inside.

Symptoms of grief can be divided into affective, behavioral, cognitive, and physiological (or somatic) manifestations.

Affective symptoms may include depression, despair, anxiety, guilt, anger, disbelief, numbness, shock, panic, sadness, anhedonia (loss of ability to enjoy pleasurable activities), and feelings of isolation and loneliness.

Behavioral symptoms may include agitation, fatigue, crying, change in social activities, absent-mindedness, social withdrawal, or seeking solitude.

Cognitive symptoms may include preoccupation with thoughts of the deceased, lowered self-esteem, self-reproach, helplessness and hopelessness, inability to believe in the loss, and problems with memory and concentration.

Physiological symptoms may include loss of appetite, sleep disturbances (feeling lethargic or not being able to sleep through the night), loss of energy and exhaustion, physical complaints similar to those the deceased had endured when alive, drug abuse, and susceptibility to illness and disease.

Grief may also lead to spiritual emptiness and pessimism.

Grief symptoms can be overwhelming and distressing. However, it is important to accept them and not avoid them. It is helpful to keep in mind that all of your symptoms and reactions are common and natural, and that you are not alone.

Grief as a reaction to an immediate loss can present itself in two forms. The first one is protest, defined as a preoccupation with loss, the feeling of pain, agitation, and tension, and accepting the possibility that the deceased may reappear. The second is despair, defined as the opposite of protest and characterized by depression, persistent sadness, and a withdrawal of attention from real life. Protest and despair may come and go in phases. Often protest sets in first and then despair takes over. In both the protest and despair states, feelings of guilt, anger, and anxiety are present and are experienced by grieving individuals.

Grief symptoms may be different, depending on the type of loss. For example, the loss of a spouse awakens feelings of loneliness and abandonment, while the loss of a child evokes feelings of having failed to protect the child, and self-blame. We will look at the differences in grief, depending on the type of loss, in further chapters.

Grief has been described as an emotion; however, it is currently being regarded more and more as a disease. As this trend continues, grief will accrue more and more definitions particular to disease and will lose the definition of being an emotion.

Earlier research provides solid evidence of biological links between grief and an increased risk of illness and mortality. Bereaved individuals are at higher risk for depression, anxiety, and other psychiatric conditions, and are highly susceptible to infections and a variety of other physical illness due to a considerable weakening of the immune system. Bereaved individuals have higher consultation rates with doctors, use more medication, and are more often hospitalized. An increased risk of mortality and suicide is associated with medical conditions in bereavement.

Needless to say, people in grief will neglect their own health by not maintaining a well-balanced diet, forgetting to take necessary medications, not getting enough sleep, and not exercising. Some may abuse alcohol, smoke excessively, use drugs, or engage in other self-destructive behaviors.

Social support is very important in grief. However, a grieving person should be advised to designate their own comfortable boundaries of support (for example, by telling people what exactly they can do to help them, when, and for how long they would like to be together, or sharing that they may not want to do certain activities now, but would consider doing them later).

Finally, the grief process may be different for every individual. It is important for the bereaved to do as they feel, especially during the mourning phase: to be left alone if they so wish, or allowed to cry or to have a chance to talk to someone when they feel the need. It may be helpful to engage in activities that help commemorate their loved one: for example, through attending religious services, visiting the gravesite, praying, creating a memory book with photos and stories, or assembling a memory box with the belongings of the deceased, or by giving to a good cause such as medical research, a scholarship fund, or charity.

Grief is often compared to Post Traumatic Stress Disorder (PTSD), particularly in the acute phase of traumatic grief, which holds similar symptoms such as re-experiencing, avoidance-numbing, increased arousal, guilt, shame, changes in value systems and beliefs, and a search for meaning. Often, in traumatic grief, the relatives of the deceased are preoccupied with issues surrounding the trauma such as the pain of dying, the cause of death, and self-blame for not being able to protect/save or for having survived. Traumatic images flood the consciousness of survivors.

In grief, it is important to resolve feelings of guilt, anger, anxiety, and depression. Sadness occurs both in depression and grief. The difference is that in grief, sadness is focused on missing the person who died, while in depression, sadness is focused on hopelessness and helplessness about self, the world, and the future. Sadness is normal in grief; however, depression in a time of grief can make it very difficult to come to terms with loss and reconstruct a life going forward.

There are a lot of examples of unhelpful thinking that can block the normal bereavement process and cause emotional distress. Negative thinking can lead to the symptoms of complicated grief and depression. For example, self-blame or self-reproach can heavily impact the emotional condition of the bereaved.

In overcoming the pain of grief, it is critical to consider what is causing self-blame and other negative thinking about self, the world, life, the future, and what causes anxious and depressive avoidance behavior. Often patients with complicated grief continue to perceive their loss as “unreal” or remain preoccupied with thoughts and recollections of the deceased or the death event. Working through grief in therapy helps patients change the perception of loss into something more “real”, helps them to acknowledge their loss, and ensures the loss is recognized as permanent and not reversible. Unless this is done, thoughts of the deceased will constantly bring fresh emotional distress and sorrow.

Let’s look at some myths and negative thoughts that may be obstacles to recovery, and consider how to handle them.