Overview of the grieving process

Grief is a natural human response to the loss of a loved one. It can show itself in many types of grief reactions.

It's normal for both the dying person and the survivors to experience grief. For survivors, the grieving process can take many years. The challenge of accepting death and dying as the end stage of life is what the grieving process is all about.

What is anticipatory grief vs. sudden loss?

• Anticipatory grief. This happens when someone has a prolonged illness, and the patient as well as the family anticipates death. Anticipating the loss of a loved one can be just as painful and stressful as the actual act of losing that person. Anticipatory grief allows the family to prepare for the inevitable death. This can be a time to resolve issues and concerns. And a time to seek the support of spiritual leaders, family, and friends. It's also a time to clarify the loved one's wishes for funeral and burial arrangements and other end-of-life issues.

• Sudden loss. This is a death that happens unexpectedly and suddenly, like a fatal accident or heart attack. Such tragedies can leave survivors feeling shocked and confused. Loved ones are often left with many questions, unresolved issues, and a range of emotions. These include anger, guilt, and pain. Support from family, friends, and clergy is important to people experiencing sudden loss.

What may happen in the case of anticipated death?

Many, although not all, people facing their own death are willing to discuss issues of death and dying. This can be a time to discuss spiritual issues, resolve family concerns, reflect on a loved one's life and accomplishments, and express gratitude. It also provides an opportunity to put practical matters in order. These include the following:

• Can funeral expenses be prepaid?

• Which funeral home would the person prefer to handle arrangements?

• Can the person help with obituary information to make sure it's accurate and complete?

• What are their specific funeral wishes?

• If a church service is planned, can the person facing death help plan favorite Scripture passages or hymns?

• Is cremation or burial preferred?

• Has a cemetery plot been purchased?

• Does the person wish for memorial contributions to be made to a particular charity or benevolent organization?

• Can the person direct others regarding important practical issues? These include wills, bank accounts, lawyer's name, pension plans, retirement funds, and life insurance policies.

What are the symptoms of grief?

For both the person facing death and survivors after the death of a loved one, it's natural to have many symptoms of grief. These can include:

Physical symptoms:

• Lack of energy or fatigue

• Headaches and upset stomach

• Excessive sleeping or overworking and excessive activity

Emotional symptoms:

• Memory lapses, confusion, distraction, and preoccupation

• Inability to concentrate

• Irritability

• Depression and feelings of euphoria

• Extreme anger or feelings of being resigned to the situation

Spiritual symptoms:

• Feelings of being closer to God or feelings of anger and outrage at God

• Strengthening of faith or questioning of faith

What are different types of grief reactions?

It's natural for people who are facing death, as well as those they leave behind, to experience different types of grief reactions. Public and private grief reactions are based on a complex interaction of the individual's personality, spiritual beliefs, cultural background, and family and community dynamics. For survivors, the grieving process can last for several months. Or for 2 to 3 years or more. Some types of grief reactions include:

• Shock

• Depression

• Physical symptoms, such as headaches, body aches, or stomach distress

• Feelings of panic

• Guilt

• Anger

• Inability to return to daily routine

• Return of feelings of hopefulness

• Acceptance

If you or a loved one is grieving longer than you feel is normal, you may want to seek professional counseling to help you through the process. Or, if appropriate, make suggestions to your loved one. Your healthcare provider may be a good referral source. You may also want to speak with your spiritual leader (like priest, rabbi, and minister) for advice.

When providing support for the bereaved

Bereavement refers to the length of time a person feels sadness after a loved one dies. There are many things you can do to help a bereaved person. These include:

• Sending cards or flowers

• Preparing food

• Providing childcare

• Doing household chores

• Contributing to a cause that is meaningful to the family

• Offering transportation

You may also consider the following when providing for the bereaved:

• Be available. Sometimes, when people are grieving, they don't want to talk or listen. They simply want you to be there for them.

• Let the grieving person express the full range of their emotions. These include anger and bitterness, which may sometimes be expressed against the healthcare providers, God, or even the loved one who has died.

• Be patient and understanding, but not patronizing. Don't claim to know how the other person is feeling. Don't force the person to talk or share feelings.

• Don't be concerned about mentioning the deceased person's name or sharing a fond memory of the person while in the company of the bereaved. They, too, are thinking about their loved one. It's acceptable and natural to bring the name into conversation.

• Remember that grieving takes time and is a natural human process. No matter how much you want to "stop the hurt," the bereaved must endure the grieving process. Allow them time and care for them as they move through it.

Abnormal bereavement

The primary healthcare provider can help the bereaved person adapt to their loss. Even though they may experience ill health, people with abnormal bereavement are less likely to use health services. Because of this, outreach efforts by family and friends are important to help those in need of these services.  Depression, suicide, and anxiety are the most common negative psychological traits associated with loss. Prolonged grief disorder refers to a situation where a person who has experienced the death of a loved one at least 12 months earlier, still yearns for the deceased. Other emotions can include feeling life is unbearable, having preoccupying thoughts of the deceased, and experiencing intense loneliness. In these situations, professional grief-specific counseling can be very helpful.