Anticipatory Grief and Mourning
When a patient or family is expecting a death, it is normal to begin to anticipate how one will react and cope when that person eventually dies. Many family members will try to envision their life without that person and mentally play out possible scenarios which may include grief reactions and ways they will mourn and adjust after the death. Anticipatory grief reactions many include feelings of depression, extreme concern for the dying person, and preparing for the death. Anticipatory grief is a natural process that enables the family more time to slowly get used to the reality of the loss. People are able to complete unfinished business with the dying person
(for example, saying “good-bye,” “I love you,” or “I forgive you”). Anticipatory grieving may or may not occur and feelings following the death may be much different from what was anticipated before the death.
Sudden Loss Grief
The grief experienced after a sudden, unexpected death is different from anticipatory grief. Sudden, unexpected loss may overwhelm the coping abilities of a person which may result in the sense of feeling overwhelmed and/or unable to function “normally.” A person may not be able to realize the total impact of their loss. Even though one may be able to acknowledge the loss has occurred, the full impact of this loss may take much longer to fully comprehend than in the case of an expected loss.
Complicated grief reactions are different from the grief reactions described above. Depressed or anxious mood, disturbed emotions and behavior, major depression substance abuse, and even post-traumatic stress disorder are some of the ways in which grieving can become complicated. Grief becomes complicated when it is masked by significant physical or behavioral symptoms, or when it is exaggerated. If an individual has personality, developmental, or emotional issues, grief therapy may be needed.
If a person suspects they are clinically depressed in addition to their grief they should seek professional assistance. One who avoids any reminders of the person who died, who constantly thinks or dreams about the person who died, and who gets scared and panics easily at any reminders of the person who died may be suffering from post-trauma disorder. In cases such as these, professional assistance may be needed.
Generally Speaking…Grief is how one reacts to a loss. Grief reactions may be experienced in response to physical losses, such as a death or in the response to symbolic or social losses such as divorce or loss of a job. All loss involves the absence of someone loved or something that fulfills a significant need in one’s life.
Grief may be experienced in the combination of mental/emotional, physical, or social reaction. Mental/emotional reactions can include anger, guilt, anxiety, sadness, and despair. Physical reactions can include sleeping problems, changes in appetite, physical problems, or illness. Social reactions can include feelings about taking care of others in the family, returning to work, or differences in social situations.
There is no right or wrong way to grieve after a significant loss. Most discover how to eventually move on with life, even though the grief experience is a difficult and trying time.
Coping styles depend on one’s personality and their relationship with the person who has died. This experience can also be affected by one’s cultural and religious background, coping skills, mental history, and their support system. Taking care of yourself, accessing the support of friends and family can help a person get through difficult times.
Bereavement is the period after a loss during which grief is experienced. The time spent in a period of bereavement depends on how attached the person was to the person who died and how much time was spent anticipating the loss. Some view the process of bereavement as having four phases:
(1) Shock and numbness: Usually occurring soon after a death, this is evident when the person finds it difficult to believe the death has occurred; is feeling stunned and numb;
(2) Yearning and searching: As shock and numbness recede, there remains the tendency to “forget” the person has died. Perhaps one catches a glimpse of somebody who reminds them of the deceased, or you expect them to be there when you first arrive home;
(3) Disorganization and despair: As the reality of the absence of the person who died settles in, it is common to feel depressed and find it difficult to think about the future. You may be easily distracted, or have difficulty concentrating and focusing on any one task;
(4) Reorganization: As one slowly makes the adjustment to all the ways in his or her life that have changed as a result of the loss, a sense of reorganization and renewal begins to evolve. Life is forever changed after a significant loss, but you slowly learn how the different aspects of your life become re-prioritized as you “pick up the pieces” and begin to move on. It is not that you forget about the person who died, but you have begun to learn how to live with this knowledge.