Where is My Valentine? Grief and Holidays

I read a brief, interesting article online today about Valentine’s Day related to grief and loss.  Most people think about those who have experienced the loss of a loved one having to deal with the first major holidays such as Thanksgiving or Christmas or commemorating the first birthday following the death.  However for the grieving individual even the small holidays may bring back memories that cause a tsunami of emotions that are unexpected. 

I know that for me, personally, the first Halloween was difficult because it had always been an especially fun holiday in our house and my son had enjoyed it so much.  Five months after his death I walked into a craft store, saw the Halloween display and had feelings of gut-wrenching, unexpected grief.  I had to immediately leave the store and sat in my car in tears.  Now almost seven years later I can remember the holidays with my son with happy memories.  I still will remember him on Valentine's Day and think about previous Valentine's Days we spent together but there will be more smiles and less tears.

Grief is not a nice linear progression.  I have heard  grief explained like a walk along a beach. Sometimes the waves of grief merely come up and lap across your feet, at other times the waves swell up and almost carry you away.  Then there are times when the wave is so big and engulfing that it surprises you with its intensity and knocks you down and takes your breath away.  The longer you walk along the beach…or the more time into your grief journey the more you are able to expect the waves and ride them out.  It does get easier to ride the waves.

7 Signs of Complicated Grief

Part 2 of Could It Be Complicated Grief?

Now to the 7 signs of Complicated Grief.  This is just a brief list of what I consider the most serious signs that should warrant at least a consult with a professional.  There are more signs (symptoms) that you can read about on the Mayo Clinic site.

1) Suicidal thoughts or actions

One of the most alarming signs of complicated grief can be suicidal thoughts or actions.  This is different from the thoughts in uncomplicated grief of wanting to join the deceased love one or wishing to change places with the deceased in order for them to live.  This is not a sign that should be taken lightly. If there are ANY concerns regarding suicide ideas, plans, or attempts—DO NOT WAIT—contact someone immediately.  Suicide is one of the top causes of death in the U.S. and most people will tell someone about his or her plans within days of the event.  It is better to err on the side of caution and save a life.  NationalSuicide Prevention Lifeline 1-800-273-TALK (8255)

2) Depression or unrelenting sadness

This is not the initial sadness when thinking about the deceased loved one.  This is a deep sadness that you can’t shake after many months that affects every part of your life and isn’t getting better.  Depression is often a complication of complicated grief and may require professional support and treatment.  Often in our society we say we are “depressed” when what we mean is that we are sad or upset about a singular event—this is not the same thing as a true depressive disorder.  If you aren’t sure what you are feeling is depression you can consult a professional who can do an assessment with you to help you to understand what you are feeling.  Depression is treatable with either talk therapy or behavioral therapy to change the negative or faulty thinking that lead you to be depressed and keeps you there.  In addition there are medications that have been found to be effective in treating some forms of depression.  The National Institute of Mental Health has a website with a great deal of helpful information about depression and where to seek help.

3) Life is No Longer Enjoyable

This sign is often associated with depression as many of the signs/symptoms of complicated grief do overlap with depression symptoms.  For this sign the person suffering from complicated grief may feel like they will never feel like they did before and are merely putting one foot in front of the other as they trod through each day.  Activities and people that they use to enjoy no longer have that same feeling.  If asked, the individual would find it practically impossible to name anything they would want to do that would bring them joy.

4) Withdrawing from Social Activities

As the time goes by after the death of the loved one and other people continue on with their lives, the person with complicated grief may feel like they are alone in their grief and that they are the only one who still cares about the loved one.  This also makes the person feel like the world around them is foreign to them because they no longer no how to act/react in public situations.  These feelings along with the feelings of depression will keep the person from wanting to participate in social activities and lead to isolation.  This becomes a dangerous loop because isolation makes it more difficult to move beyond the constant thoughts about the loss and therefore keep the person from venturing out into the world.

5) Bitterness, Anger, Irritability, Agitation

There is often guilt and anger surrounding the death of the loved one, especially if this was a violent death.  These negative feelings are not assuaged by positive feelings and just feed upon each other and this leads to the irritability and agitation that the person with complicated grief experiences. 

6) No Hope in the Future

The person with complicated grief cannot imagine a future without the loved one in it.  Trying to think about a future like that can bring on feelings of guilt and anger.  This can further exacerbate the depressive feelings and make the individual feel hopeless and helpless.  Without meaning or purpose for life the individual can see no future and is incapable of hoping for a different future without the loved one.

7) Difficulty handling normal activities and routines

When there is no hope or meaning, the individual has trouble accomplishing even the most routine activity.  It can be rough for the person with complicated grief to take care of their needs, to handle daily chores, or to concentrate enough to hold down a job.  Some people will look from the outside as if they are coping and handling their responsibilities adequately but enternally the person is struggling to just keep up.

Once again I would like to mention how important it is to know the signs of complicated grief in order to seek out treatment to prevent more serious psychological or physical disorders.  In addition I want to reiterate this post and the previous post were strictly informational and that I am neither a psychiatrist nor a medical doctor.  I have provided links to well-known and respected sites if you would like more information on the subject. Whenever there is any question about an individual’s well-being a trusted member of the medical community should be consulted.

Could It Be Complicated Grief? Part One

This is Part One of a two-part post about complicated grief.  This part will define uncomplicated grief and complicated grief and discuss the risk factors that may make someone more likely to experience complicated grief.

It is important to know the signs of complicated grief in order to seek out treatment to prevent more serious psychological or physical disorders.  However before discussing these signs it is important to note that I am neither a psychiatrist nor a medical doctor.  Whenever there is any question about an individual’s well-being a trusted member of the medical community should be consulted.

The Psalm tells us that there is “…a time to weep, and a time to laugh; a time to mourn, and a time to dance.” (Ecclesiastes 3:4, King James Version).  If we live long enough most of us will experience the feelings of grief when we lose a loved one.  It is socially accepted that after the death of a loved one that those left behind will participate in a short period of public mourning. It is pretty evident by the typical business policy for funeral leave of between 1 to 3 days off no matter the relationship of the deceased loved one that our culture expects people to “get over it” and “move on.”  However that isn’t the reality and private grief is veiled in mystery because it is different for each individual and the type of relationship that individual had with the deceased loved one. 

There has been research into “normal” grieving or better termed uncomplicated grief and the similarities in experiences among those grieving.  From this research and reports from the grieving individuals themselves there have been a loosely agreed-upon definition of grieving and the experiences of grieving (Bolen, P. A. & van den Bout, J., 2008, January 15).  With uncomplicated grief the grieving person begins to adjust to life without the deceased love one.  It isn’t a recovery but a process of changes and adjustment that now allows the individual to live a different life.  It can dramatically alter the person however they are able to find meaning and purpose and allow themselves to have hope for the future.

Some of the study results have shown that treatment or intervention for uncomplicated grief is not helpful and there are professionals who believe it is not only unnecessary but harmful to the natural progression.  My personal opinion is that grief is different for each individual and therefore options for support and treatment are individual and should be decided by the grieving individual. 

There are some people who may find grass-roots support groups, run by those who have also experienced loss, most helpful; others may find more formally-run bereavement educational groups, usually held at funeral homes, hospitals, and hospices, a good fit; and others may find talking to a grief counselor or mental health counselor something that is helpful and fits their needs.  There are other individuals who have family and friends’ support that don’t feel the need for other support but many people don’t have this type of support and may need to reach out to these other avenues of support.

Approximately 10% to 20% of all bereaved individuals will develop complicated grief (Lobb et al., 2010).  Complicated grief is sometimes called abnormal grief, chronic grief, or prolonged grief. Complications that can co-occur or happen during complicated grief are depression, anxiety, post-traumatic stress disorder, risks of heart disease, high blood pressure, and cancer.  In addition the individual may continue to struggle with coping with daily life functions and may also begin to abuse drugs, alcohol, and nicotine.

There may be some risk factors that can cause someone to be more susceptible to moving into chronic grief.  Some of these risk factors include when the death is unexpected, violent, or due to suicide; when there is a minimal support system of family and friends, when the individual had a close or dependent relationship with the deceased person.  In addition there are some characteristics that the individual possess that may predispose them to complicated grief, some of these characteristics include, trauma at a child including abuse or neglect, history of separation anxiety in childhood, difficulty adapting to life’s changes and lack of resiliency, and prior psychological problems.

References:

Lobb, E. A., Kristjanson, L. J., Aoun, S. M., Monterosso, L., Halkett, G. B., & Davies, A. (2010). Predictors of complicated grief: A systematic review of empirical studies. Death Studies, 34(8), 673-698. doi:10.1080/07481187.2010.496686

Next –Part Two--7 Signs of Complicated Grief

Through A Child's Eyes-2 Grief Books for Children

Tear Soup: A Recipe for Healing After a Loss by PatSchwiebert and Chuck DeKlylen; Illustrated byTayler Bills.  The story follows Grandy, an old, wise woman and how she copes with grief.  In the book Grandy makes a giant pot of tear soup--an analogy to the size of her grief.  The book is beautifully illustrated and that will draw in the younger family members, but the story told is more sophisticated and palatable for adults.  

I have given it to families to share with their children to help them understand death and grieving and the adults have gained much from reading it to their children. In additon, bBecause of its ease of reading it is good for someone in the early stages of grief who is having trouble concentrating and reading anything lengthy.

Saying Good-bye to Grandma, by Jane Resh Thomas.  This book tells the story of seven-year old Susie and her first experience with death, grief, and the traditional mourning process.  It is a good, straight-forward explanation for the child who is asking what's going to happen.  This is a good book to read with your child to encourage questions and start a conversation.  Throughout the book the love of the family is evident and this in itself is comforting.

Elephants Never Forget and Neither Do Grieving Parents

An excellent book that explores life after the loss of an adult child is Our Walk With Elephants by Peggy Boon, Ph.D. and Bonnie Headington, Ph.D.  These authors have the distinction of not only being mental health professionals but also bereaved mothers.  One of their most salient points is the fact that bereaved parents continue to grieve over the years.  Once the acute grief is over there are reminders that happen daily, monthly, yearly, that awaken the pain of the loss. A reminder may be as simple as another child's college graduation, a wedding, or a birth.  All of these things will remind the parent of the events they will never experience with their child. The authors approached their need for answers as a research project.  They obtained participants and decided on questions they wanted to examine.  They then conducted structured interviews with the participants and the result is this book.  Although they took a scientific approach to the subject the book is a sensitive, narrative of personal stories of loss and common themes experienced by bereaved parents.

Grieving on Mars--Do Men Experience Grief Differently?

When Men Grieve: Why Men Grieve Differently and How You CanHelp by Elizabeth Levang, Ph.D.  Dr. Levang, a psychologist and consultant on grief and bereavement, explained the unique way men grieve and in addition she included men’s personal accounts of their experiences with grief.  Dr. Levang discussed the different languages of grief that men and women have.  While women will talk about their feelings men are more likely to try to think their way through the grief.  Dr. Levang stated that the differences in coping style can cause a division between the two genders.  She explained that at a time when we are most in need of compassion and understanding these differences can isolate husband and wife and make communication even more difficult.

It is so important for grievers to understand how individual grief is.  How we process the grief can be affected by our gender, culture, social status, and family background.  Understanding and allowing others to grieve in their own way, time, and space is paramount to allowing ourselves the freedom to grieve as we need.  This book can help the man who is grieving to be able to honor his way of grieving and for the women in his life to understand him better.

Bereavement or Depression--The Great Debate Continues

Lately the mainstream media has picked up on the discussion that has been raised regarding the changes in how depression and bereavement are going to be designated in the revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  This manual and its revisions, have been published since 1994 by the American Psychiatric Association and is used by all mental health professional in the United States to categorize and diagnose mental health disorders in adults and children.

What has caught the attention of professionals and lay-people alike is the changes that are being made in the categorization of depression.  In the current edition of the DSM, bereavement has been carved out as a separate category from a Major Depressive Episode. The guideline states that diagnosis of Major depressive Disorder would not be given until the symptoms had been experienced for at least 2 months after the loss.  Symptoms include: feelings of sadness, insomnia, poor appetite, and weight loss. The DSM differentiates between normal grief and a Major Depressive Episode by advising the professional to look for subtle differences in symptom presentation.

The removal of the bereavement category was explained by the American Psychiatric Association in a news release of 12/1/12 that stated:

Removal of bereavement exclusion: the exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one. 

"Grief is an equal opportunity human reaction; grief affects everyone." explained J. Shep Jeffreys in his book   "Helping Grieving People: When Tears Are Not Enough."  This is an accurate statement.  Everyone will eventually experience bereavement if they live long enough.  However each person reacts differently to the stressors of grief and just as with physical illness some people will be resilient and able to bounce back while others may have a more difficult time and may need support and treatment.  The thing is to not spend so much time debating whether this change is "pathologizing" grief but to spend the time helping those who need it.