Although grief can become prolonged or complicated, it is not an intrinsically pathologic state, but rather, a normal and needful adjustment response. What are some common, predictable grief reactions? Every one of us has experienced them to some degree in the face of loss. In the cognitive-emotional realm, there may be disbelief, sadness, anger, guilt, and self-reproach, panic, anxiety, loneliness, listlessness, and apathy, shock, yearning, numbness, depersonalization, and, depending on the circumstances, relief.
Grievers may become preoccupied with their loss, and their thought processes can become confused. There may be a sense of timelessness. If someone has died, there is often a sense of presence, or of seeing or hearing the deceased. Physical sensations might include muscular weakness, fatigue, tightness in the chest and throat, dry mouth, nausea, and sensitivity to noise. There may be sleep and appetite disturbances, social withdrawal, sighing, searching, and crying, restless overactivity, reminiscing, and laughing, treasuring objects that belonged to the deceased, or avoiding such reminders.
3
However it proceeds, the grief process poses a challenge to human systems at each level—through personal, interpersonal, family, and caregiver systems. Inherent in this process is the demand for change and substantial potential for growth—and/or decline. Loss disrupts equilibrium, and subsequent readjustments are multifaceted and complex involving somatic, psychological, social, cultural, spiritual, and historical components. Practically speaking, this means that besides somatic changes due to illness, one must be aware of a patient's grief-associated symptoms. The impact of disease or loss on total functioning of a patient or family system must be considered. How is self-concept affected? Identity, expectations, and sense of the future all may need adjustment. What is—or was—the role of the patient in the family system? This role may change. There may be a loss of roles, of accustomed activities, capabilities, and personal dignity. In a culture that strongly emphasizes health and youth, disease and demise are isolating.
Many people see suffering and loss as spiritually related. There may be a feeling of being punished or forgotten by the Diety, or of being purified and strengthened. Since there is a strong connection between spirituality and wellbeing, it is important to allow or provide for spiritual exploration and support during grief. It is also important to ask what personal history of losses provides the context or foundation for this one. What is the family context, community context, or racial-ethnic context? What “undigested” grief is there that will become a part of the matrix for this new experience?
Other contributing factors to the grief process include suddenness versus expectation of loss, causes and course of the illness, and whether there is a sense of hope and purpose through it all. Especially difficult is “ambiguous loss,” essentially living with frozen grief, as in brain injury, dementia, serious addiction, or mental illness. Since the person being lost is neither clearly absent nor clearly present, it can be difficult for survivors to know how to move through the grief.
4