- the various stages of the grief process (anger, depression etc)
- a two-part consideration of the components of reaction to stress (behavioral, emotional, cognitive and physiological). What is normal and what is abnormal? When should we seek professional assistance?
- some dos and don’ts of helping others who are grieving
Nearly 6 months ago we talked about how the brain handles the stress involved in an earthquake, because of the 7.1 earthquake that struck Christchurch. Sadly, with last week’s 6.3 shock, Christchurch is suffering again.
This time, people have died. Nearly 150 at last count and more expected. And the damage is worse. Much, much worse.
Consequently, readers have asked me to take a diversion for a short time into the area of grief. To oblige, we’ve a few posts to cover off. We’ll begin today with a general introduction to some major themes, before unpacking some more detail over the next few posts.
Please ask any questions you want.
A couple of terms
Grief and bereavement are terms we often confuse although they are closely related. At its most fundamental, grief is our reaction to a loss of some kind. For most of us, bereavement is the most familiar form of grief as it involves the loss of people close to us through death.
But we also grieve when we lose other things. We grieve when we lose employment, limbs, opportunities, possessions, our sense of identity, hope and so on.
How bad is the grief?
Naturally, the more important the person or thing is to us, the stronger our reaction to the loss. As different things assume a different importance for all of us, it is impossible to determine how severe someone’s grief will be merely by identifying what has been lost. One of the key determinants of the severity of the grief reaction is the strength of that person’s feelings of attachment to the thing they have lost.
Losing a job may be enough to send one person into depression, while a second is extremely matter-of-fact and barely grieves at all. However, the second person may suffer interminably through the loss of a pet, while the first would barely register the loss.
In the earthquake environment, loss of property was common the first time around. Now, loss of limbs, mobility, senses, work and, sadly, life, are prevalent.
In addition, there is an all-pervading loss of safety and security. Every day brings new threats.
It’s completely personal
We can’t therefore provide a simple template of grief, because it’s is a highly individualised experience, comprising such things as our unique backgrounds, values, idiosyncrasies, experiences, biology, genetics, ability to express emotions, support networks, skills and resources, without even considering the relative importance to each of us of the things that we lose.
People’s reactions to loss differ enormously and the coping strategies we employ to deal with the loss also vary significantly. At best, then, we can identify some central themes to the grief process, our reactions and expressions of grief, and how best we might assist others.
Unfortunately, we often have stereotypical views of what grief is and how we should grieve, which then conditions the help we might offer others who grieve. Historically stages of grief have been the most popular model for how we grieve, suggesting that we progress through an ordered sequence of reactions.
It’s generally accepted today that, while we certainly do progress through mostly identifiable stages, they are in no particular order and we may experience some of them more than once, and some more intensely than others.
Moreover, there is no guide to how long each stage should take as, again, this is dictated by so many individual variables. Artificial estimates are usually employed in the absence of strict boundaries in such situations as employment law, which offers three to five days as usually enough time to grieve and get back at work.
Obviously this sets an arbitrary limit on a normal process which can be entirely unrealistic. In truth though, most people actually cope remarkably well for the first few days after such an event as a death and generally do feel well enough to head back to work or to resume normal duties at home. Superficially this seems reasonable.
It is, however, completely artificial. In the early days most of us have access to support from others, enough things to do to keep us occupied and therefore distracted, and substantial amounts of stress hormones that enable us to keep going during times of stress such as this.
Do we just get over it?
Where problems tend to occur is in the days, weeks and months after the visits stop, the phone calls stop, no more meals are delivered, cards and flowers stop, everyone else’s life has continued at the same pace as previously and there becomes an unspoken opinion that we should be ‘over it’ and getting on with life.
You’ll find this almost regardless of the kind of loss.
Then comes the realisation that we never in fact ‘get over it’, but that we learn to live with our new situation. It is during these times that we need to be alert for symptoms of anxiety or depression and to look for physical ailments.
Most commonly, symptoms like anxiety or depression are directly related to the loss, but are often missed as symptoms or ascribed another cause because of the time between the loss and the appearance of the symptoms.
Fulfilling most of one’s responsibilities, such as going back to work, is no indication that grieving is over or that someone is in fact coping. Depression for example may not be evident until six months later. The depression may lead to agoraphobia and a range of physical problems.
Having said this, there is a point at which continued grief is considered to be unhealthy, even damaging. In strictly clinical terms, a minority of people suffer from pathological grief which is observed at the extreme end of the grieving continuum. Here, the grief reaction seems disproportionately long and intense to be considered normal. This in turn can lead to other complications such as psychosis (split from reality characterised by events such as delusions, hearing voices etc) or profound depression.
Fortunately, this is uncommon for most people and, while it is somewhat subjective to pigeonhole normal and abnormal grief, usual clinical experience would suggest a timeframe of up to two years to resume normal functioning. Most people seem to need somewhere between six months and two years for the loss of a loved one, and generally less than that where the loss has a lesser impact.
What seems to be one of the key features in coming to terms with any form of loss and other stressful events is how we come to grips with the meaning of the event. A common component of any grief reaction or process is to ask the rhetorical question “Why me?”.
Naturally we would like to be able to place some order on the events that have happened, particularly if the loss is sudden or unexpected, just so that we can understand the “why”. This is not to say that we must find the right meaning in order to ‘move on’, but that we are comfortable with whatever level of meaning we find. In some cases, people find no meaning at all and still appear better adjusted than others at one and two-year intervals.
Of course, an equally valid question to ask, but one which gets significantly less coverage is, “Why not me?”. Realising that this, too, is a valid question, provides all the meaning one person might need, while another engages in a long-term, intensive search for an ever-elusive better answer.
Again, the meaning is extremely individual. At its root is that finding meaning helps us regain a sense of control, particularly in situations where so much seems out of our control.
The importance of support cannot be overstated, provided it is delivered in appropriate ways and at appropriate times. Assistance, given well, eases the process. Done poorly, it tends to lead to greater complications. We’ll cover this in coming blogs, as well as the following
So here’s the take home bit
Grief is a rollercoaster. It’s a messy, confusing time and not necessarily well understood by people who want to help.
First step – recognize that grief is a reaction to loss. Understanding that you’re experiencing grief in the first place is a great start in managing the coming months. If we lose a loved one, grief seems an obvious and expected reaction. It’s less obvious in response to events like this one but, sure enough, there will be grief all over Christchurch.
Impressive words to drop into the morning coffee chat
Grief, social support
What do you think?
Like it? Share it on Facebook!
Want to tell others? Digg it!
Subscribe for FREE (top right) to get Bite sized brains in your inbox.