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Understanding the Grief Process
What is Grief?
Sooner or later, most adults will experience the death of a loved one. Whether
it is a parent, spouse, sibling, friend, or a child who has died,
the eventual necessity for saying goodbye forever to someone close
to us is one of the so-called realities of life - like old age, it
is an unavoidable consequence of existence on this earth. Grief is
the natural psychological response to loss of such a person.
The
intensity of the complex emotions aroused by grief may be very different
from one person to the next, as may be the length of time grief lasts.
Such factors as general health, maturity, family and financial stability,
previous experience with death, and the availability of understanding
and supportive relatives and friends can have a significant influence
on the way grief is experienced by an individual, as will the nature
of the loss itself. The death of an elderly loved one, for example,
is usually not unexpected, and mourners can in this case take some
comfort in the fact that the life which has ended was a full and productive
one. When a child dies, parents are taken by surprise. The association
of children - especially babies - with the barren finality of death
seems to violate the fundamental order of nature. Grieving parents
of very young or unborn infants have little or nothing to hold on
to in the way of memories or tangible mementos. It is their dreams
and hopes - their future itself - which have been destroyed.
The Grief Process
Even
when individual differences in grieving are taken into account, there
are some general patterns which are similar for everyone. Psychologists
who work with the bereaved have identified four clusters of emotions
which their clients seem to experience:
- Denial
- Resentment (also called "Anger and Guilt"
or "Searching and Yearning")
- Despair
(also called "Disorientation")
- Resolution
(also called "Reorganization")
Mourners
do not necessarily progress in an orderly fashion from Denial to Resolution.
Some may bounce from Despair to Resentment and back again several
times before moving on. For others the sequence is more of a spiral
than a straight line. They cycle repeatedly through different sets
of feelings while their pain gradually decreases in intensity, and
acceptance of their loss gradually increases.
No
matter how bizarre and confusing our emotions and impulses may seem,
no matter how crushing our pain, each step we take on the path of
grief is a step toward healing. It may help to think for a moment
about how the body responds to a physical injury. Initially, a severely
injured person experiences traumatic shock. Bodily sensations are
blocked and the person may be semi-conscious and unable to move, which
is just as well if bones are broken or internal organs bruised. As
full sensation returns, the body brings pain to the injured person's
consciousness, assuring that the parts of the body which have been
damaged will remain motionless and less likely to undergo further
harm. If there are open wounds, the body mobilizes its immune system,
which may bring swelling and additional pain. Finally, the body is
ready to complete the healing process by generating new tissue to
repair the damage. The various steps taken by the body to preserve
life and repair injury may not represent its "normal" mode
of operation, but they are the expression of natural, built-in mechanisms
available to every body. Grief works the same way on the psychological
level. A body that has healed itself is not necessarily "as good
as new". There will always be a scar on the skin, a weak place
in the bone, a twinge of pain that returns on cold winter days. Grief,
too, leaves behind its scars.
Denial
Our
first reaction as parents after the death of a baby is often disbelief
- "This can't be happening", "There must be some mistake",
"Are you sure the machine is plugged in?" This response
usually goes along with a kind of numbness - a sense of unreality,
of "being in a dream" or of watching someone else go through
the motions without the parent really being emotionally involved.
These reactions are instinctive and help to soften the initial impact
of the death. It is easy for outsiders unaccustomed with the grieving
process to be deceived by our behavior while we are in denial. They
may incorrectly assume that we are holding up well or are insensitive
or incapable of expressing emotion. What is actually happening during
this period, which may last for hours, days or weeks, is that our
mind is blocking out pain, just as the body does during traumatic
shock. When we are better able to face the death, emotion will come
flooding back, often accompanied by crying or some other form of release.
Resentment
Once
our child's death becomes a reality to us, we begin to experience
feelings of frightening intensity. Anger is very common as the full
impact of what has happened becomes clear. "Why did it have to
be us?" "It's not fair!" Our anger may be directed
at the physician and hospital staff, who should have done more sooner
to save the baby; at other expectant parents, who seem to flaunt their
naive joy and pride; at the spouse, who must have done something wrong
to cause the baby's death; at God (in the case of a religious family)
for allowing such a thing to happen; even at the child, for abandoning
the prospective parents. Directed inward, anger may turn to guilt.
"If only I had stayed in bed that day." "If only I
had eaten better." "If only I hadn't smoked those cigarettes."
"If only I had supported my partner better during her pregnancy."
Anger
and guilt aren't good or bad - they just are. It is important for
us to give these and the other intense emotions experienced during
grief full expression rather than reserving them for a "correct
time". Holding back only prolongs grief and slows our progress
toward acceptance and resolution. Suppressed anger may surface at
an even more inappropriate time in an even more inappropriate manner.
There are many different ways to release anger safely. The mode of
expression we choose - screaming in private, hitting a pillow, engaging
in strenuous exercise, writing a journal - is not important as long
as our anger is acknowledged in some way and not denied.
Despair
This
is in many ways the most difficult aspect of grief, especially since
it typically lasts long enough after the initial loss that friends
and family, as well as we ourselves, expect mourning to be over. It
is the dull, nagging pain eating away at the base of our heart. It's
the jagged hole in the fabric of our life, the gray emptiness which
greets us every morning as we emerge from our gray, empty dreams.
Life loses whatever meaning it had, and even the simplest tasks seem
impossible. Pain associated with past losses - divorces, layoffs,
previous deaths of relatives and friends - is often reawakened. We
may feel worthless, may feel we are complete failures as human beings.
We may contemplate ending our own lives either to escape from the
seemingly unending pain of grief or to be with our dead child. It
is common for us to be preoccupied with our lost child, to hear it
crying in the night, to feel our arms literally ache to hold a baby.
It is even within the range of what is "normal" at this
stage to pick up a cat, a doll, a pillow -- anything to put a child-sized
weight on our arms. We may speak of our child as if it were still
alive or have vivid dreams in which we are allowed to visit the child.
Fear
is also a common emotion during this phase. We may experience an overwhelming
sense of foreboding, a feeling that another horrible thing is about
to happen. We may be obsessed with fantasies involving the death of
another family member, including that of our spouse or partner. We
may become overly protective of any surviving children and at the
same time doubtful of our ability to continue protecting their welfare
when we have already proven ourselves incapable of preserving the
life of the child we have lost. Many of us find that it is hard to
concentrate for any length of time. Our minds wander and it is impossible
to read, write, or even to make trivial decisions.
Resolution
There
is no clear-cut boundary separating those who have healed their loss
from those who are still in the process of healing. In a sense, no
one is ever completely "healed", for grief is a journey
of transformation, and we are different now from the people we were
before our encounter with death. We will never forget the child we
have lost or the pain we have endured, but we find that as time passes,
our burden lightens slowly - very, very slowly - but surely. The "good
days" begin to outnumber the "bad days". We find that
we have more energy to put into the other parts of our lives, that
we are able once again to deal with everyday chores and aggravations.
We still get choked up when we talk about our child, but we do not
break down. Holidays, due dates, and the
anniversary of our baby's death still trigger tears and waves of sadness,
of course, but in general we are no longer incapacitated by grief.
We are coping.
Unfortunately,
there is no way to know ahead of time how long it will take any of
us to reach this approximation of normalcy. A lot depends on the intensity
of our feelings and on how we express (or fail to express) them. We
can only know that eventually, in its own time, healing will come.
The entire process generally takes at least six months to a year and
many parents find they need two years or more before they are ready
to let go of their grief.
Physical Responses
Grief
is not only a mental and emotional process. Our bodies, too, participate
in our anguish. Sleep is often disrupted, and when it does come it
may do little to relieve a persistent feeling of exhaustion. This,
along with prolonged psychological stress, takes its inevitable toll
on a body whose immune system may not be functioning up to par, making
it more susceptible than normal to flus, colds, and other diseases.
During the stage of despair, our body's dietary and hygienic needs
may be neglected. Physical symptoms centering around the heart or
in the stomach or muscles are fairly common. A medical examination
can prevent a minor health problem from becoming a serious one. Sleeping
pills, anti-depressants, and other medications should be used only
on the advice of a physician, and even then it is wise to use such
drugs sparingly, since they can interfere with healthy expression
of emotion and may even make depression worse. Regular exercise is
also a good idea, since it helps to maintain our body's tone while
reducing stress and releasing pent-up energy.
The Importance of Expressing Feelings
The
powerful emotions kindled by grief can be overwhelming and terrifying,
especially for people who have always prided themselves on their self-control.
Many of us feel that we are literally "going crazy", that
once we let ourselves start to cry we may never be able to stop. Grief
therapists, however, stress the importance of allowing full expression
of these emotions at the time they are first experienced. Such expression
can take many forms, as long as it is safe and feels comfortable for
us. Many parents have found keeping a journal to be valuable both
as a creative outlet and as a record of their progress over time.
Others turn to poetry or find non-verbal modes of expression - sculpture,
painting, music, crafts - equally eloquent of their inner experiences.
Sharing feelings with friends, family, clergy, physicians, therapists,
anyone who can listen without passing judgment or withdrawing from
the reality of death, is also a powerful tool for healing. Attending
support groups composed of parents who have undergone similar losses
and are themselves dealing with grief is a good way to find listeners
with these abilities, people who are telling the truth when they say
they "know how you feel".
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