Grief & Loss

If you’ve  recently lost a loved one or have a loved one currently in hospice care, you may be wondering about how “normal” your feelings of grief are. It’s important to realize that grief is different from person to person, so your grief journey is going to look different than anyone else’s (including your close family members). While many people experience “normal grief,” it’s possible that your experience may be different. If your feelings of grief become more intense over time and start to impact your ability to resume your duties at work and at home, then you may be experiencing complicated grief. Let’s take a closer look at what complicated grief is and how to identify this potentially serious detour in the grieving process.

First, Let’s Define Normal Grief

Before we dive into complicated grief (also known as prolonged grief), it’s important that you understand what normal grief looks like. Put simply, grief is your natural human response to the loss of someone or something you love. When you lose someone or something you love, you’re going to experience grief. The emotions of grief vary greatly – sadness, anger, guilt, relief, shock – but these are all normal responses to loss and are healthy signs of grief.

What Is the Normal Progression of Grief?

Immediately after a loss, you will likely experience acute grief. This is the initial period of time just after a loss when your emotions are unpredictable and you can’t concentrate on anything but the loss. In most cases, after a period of time, you are able to move into integrated grief. This is when you have learned to accept the reality of the death, have found ways to cope and adapt to your new way of life, and have begun to hope again, finding renewed meaning and purpose in life. Moving from acute grief (intense initial feelings of loss) to integrated grief (a reconciliation to the loss) is a natural progression through the grief journey.

This movement or reconciliation takes time, but it’s characterized by a lessening of the intensity of your grief feelings. You may bounce back and forth between sadness, shock, and anger for a little while, but then, your grief feelings gradually lessen until they become an ache that only occasionally comes back to visit you (normally around special days and events).

What Is Complicated Grief?

If after some time, your grief seems to be intensifying until all you can think about is the loss you’ve gone through, then you may be dealing with complicated grief.

With complicated grief, a loved one’s death takes center stage in your life. Many of those suffering from complicated grief are unable to resume normal life and are stuck in a state of intense mourning.

Complicated grief may require more of your time and attention and the help of qualified professionals who can walk with you get through a very difficult time.

If six months or more have passed since the loss and grief feelings have only gotten worse, then it’s time to consider seeking help from qualified professionals. Six months is not a hard and fast rule, as some losses will take years to recover from, but it is enough time to determine whether grief symptoms are lessening or worsening.

Symptoms of Complicated Grief

At first, many of the symptoms of complicated grief look like normal grief. However, if grief indicators worsen as time passes, then it could be a case of complicated grief. Here are a few symptoms to look out for months and even years following the loss:

• Intense sorrow, pain, or pining over the loss, focusing on little else
• Problems accepting the reality of the death
• Strong attachment to mementos/reminders or a strong avoidance of them
• Numbness, detachment, bitterness, and/or being easily irritated
• Feeling that life holds no meaning or purpose
• Trouble carrying out normal routines, including personal hygiene
• Increasing isolation and withdrawal from normal activities
• Denial and defensiveness when asked about the grief
• Guilt over feeling that they did something wrong, could have prevented the death, or should have died along with the loved one

Who’s Susceptible?

While doctors and mental health professionals are still learning about complicated grief, it’s believed that as much as 20% of those who lose a loved one will experience complicated grief. Unfortunately, no one is sure what causes complicated grief.

The cause may be related to your environment, personality, genetics, or chemical makeup. Complicated grief occurs more often in women and particularly those of an older age. Outside these factors, other circumstances may increase a person’s risk of experiencing complicated grief, including:

• The death was shocking, unexpected, violent, or premature
• There was more than one death in a short period of time
• You witnessed the death or suffering with the deceased (as with a long illness or hospice)
• You had a close or dependent relationship to the deceased person
• Social isolation or loss of a support system or friendships
• Past history of depression, separation anxiety, or post-traumatic stress disorder (PTSD)
• Traumatic childhood experiences, such as abuse or neglect
• Other major life stressors, such as major financial hardship

Seeking Help

It’s best to seek professional support and care when dealing with complicated grief. If you find that you or a loved one have been unable to make distinct progress toward integrated grief and that your grief feelings are intensifying (no matter how long it’s been), consider whether now is the time to seek help so that you can come to terms with your loss and reclaim a sense of acceptance and peace.

At first, you may think you can handle things, but over time, complicated grief can affect you physically, mentally, and socially. Without the proper treatment, complications could arise, including:

• Depression
• Suicidal thoughts or behaviors
• Anxiety, including PTSD
• Significant sleep disturbances
• Increased risk of physical illness, such as heart disease, cancer, or high blood pressure
• Long-term difficulty with daily living, relationships, or work activities
• Alcohol, nicotine use, or substance abuse

At this point in time, it’s not clear how to prevent complicated grief. However, counseling and grief therapy soon after the loss (especially for those in an at-risk group) is thought to help curb the severity of complicated grief and put you on the path to healing.

What Can Family and Friends Do to Help?

Because those suffering from complicated grief are susceptible to additional complications like depression, anxiety, or sleep issues, the best option is to speak with a professional, who can act as a guide through the entire journey toward recovery.

However, as family and friends, you can do something to help!

Offer your full and loving support to the person dealing with complicated grief. Be there to talk. Be encouraging. Bring small gifts or tokens of your love. Actively listen and don’t interrupt. Plan positive activities, like taking a walk or doing something they’ve always enjoyed.

They don’t need you to try to fix them; they need you to accept them where they are right now. Be there for them. Realize that complicated grief is difficult on both of you and the road to recovery may be long and difficult. But it is achievable! When we do the work of grief, we can find a way to reconcile ourselves to loss and find new hope and meaning for the future.

Whether your loved one’s time in hospice has been days long or weeks long, grief can still take you by surprise.

Grief is the natural result of love. When you love deeply and wholly, you open yourself up to the grief that will come when the person you love dies. And while death is a part of life, the certainty of death doesn’t make it any easier.

The simple truth is that it’s okay to hurt. It’s okay to NOT “be strong” in the face of loss. It’s okay to give yourself permission to grieve, to give outward expression to the internal anguish of your soul. You need to be free to express your emotions, not hide from them or feel ashamed of them. They are what they are, and they are a natural response to what you’ve lost.

It will take time and intentionality to come to grips with everything you think and feel. The following grieving and self-care tips are meant to assist you and give you useful tools for navigating through the ups and downs of the coming months.

10 Grieving & Self-Care Tips

1. Anticipate feeling a range of emotions.

People experience a wide spectrum of feelings at the loss of a loved one: shock, numbness, denial, confusion, yearning, anxiety, fear, guilt, sadness, relief, and more. You will certainly feel some – if not all – of these. It’s normal and natural to do so.

2. Don’t be afraid of your feelings.

You feel what you feel. It is what it is, and there is absolutely nothing wrong with the emotions that may be coursing through you. We all feel loss differently, and there is no comparison because every person and individual relationship is unique. Try not to stifle, ignore, or stuff down your feelings. Instead, accept that you feel what you feel and it’s okay.

3. Give yourself time.

Grief is a journey, not an event. You will need time to come to grips with what life looks like without your loved one. You aren’t necessarily going to spring back into life the way it was before. It’s okay to give yourself a little space and take more breaks. Grief is hard work, and you need time to work through it.

4. Find ways to express your grief.

What you do is going to depend on your personality. For some, it’s helpful to go into the backyard and chop wood or spend time at the batting cages whacking the balls over and over again. For others, creative expression is helpful. Many times, journaling, creative writing, painting, drawing, arts & crafts, or other types of self-expression help you make sense of the seemingly senseless feelings going on inside. And if you are a person of faith, prayer, meditation, or worship, these activities can help you express your grief.

5. Take care of yourself.

Most people feel more tired and less energetic when they are grieving. For this reason, it’s important to practice self-care and get plenty of sleep. If you are having trouble sleeping, stay hydrated, limit your caffeine intake, and sleep with your bedroom dark and relaxing. Additionally, eat healthy foods and participate in some kind of physical activity on a regular basis.

One thing to watch out for is numbing activities. It may start out as a coping mechanism but beware of allowing numbing activities to distract you from dealing with your grief. Common numbing activities are food, alcohol or drugs, anger, excessive exercise, TV or movies, books, isolating yourself, shopping, or losing yourself in work. While these may help you cope, they won’t help you heal and move forward after a loss.

6. Allow others to walk alongside you.

You don’t have to walk this road alone. In fact, it will be much less stressful if you do accept help from others. There’s an incredible scene in The Return of the King, the third installment of The Lord of the Rings. Throughout all three movies, Samwise Gamgee has faithfully walked alongside his dearest friend, Frodo Baggins. Together, as they seek to destroy a powerful ring and save all of Middle Earth, they face danger and hardships, feel lost and hopeless, and at one point, Sam even fears that Frodo has died. And then, the moment comes. Frodo is so near the end of this incredibly taxing quest – this journey that has sapped him physically, mentally, and emotionally – and he says, “I can’t do this, Sam.” After some fortifying words, Sam says, “I can’t carry it [the ring] for you, but I can carry you!” This is why we need friends along the hard journeys in life. They can’t carry our burdens for us, but they can help carry us along; they can provide the support we need to move forward and find new life and new meaning.

7. Take time to talk about your grief.

Sometimes it’s helpful to talk with a safe person about the emotions swirling around inside you. If you aren’t much of a talker or aren’t ready to be vulnerable with someone, write your thoughts down. However, if talking to friends and family simply isn’t working, then consider the benefits of a grief counselor. Sometimes the grief we feel is so incredibly deep that we need help getting back onto solid ground. If that’s you, it’s okay. You aren’t alone, and there is help.

8. Cultivate an attitude of gratitude.

During times of grief, we often turn our focus inward. While this tendency is natural, it may also lead to feelings of isolation and intense, singular focus on the loss we have suffered. Cultivating a lifestyle of gratitude and self-care can help you better process a loss by moving your eyes beyond your pain, allowing you to see the good things in life that still remain. Gratitude increases positive emotions and overall well-being, improves sleep, and fosters resilience.

9. Keep your loved one’s memory alive with traditions.

While death deprives us of a loved one’s physical presence, that doesn’t mean we’ve lost everything we love about that person. Our relationship becomes one based on memory rather than physical presence. So, use traditions to keep a loved one’s memory alive. Our personal traditions encourage us to remember. They comfort us and give us a sense of familiarity and peace. For example, if you and your loved one watched a certain movie every Christmas or birthday, keep the tradition alive as a way to feel close to them.

10. Treasure your memories.

As you grieve and practice self-care, make time to treasure your memories. Write your memories down. Tell the stories to others. Share the essence of the one you loved with those around you and keep their legacy alive. Your memories are your own to cherish forever and will be a continual reserve of peace and comfort. The grief journey is a meandering way, filled with many steps. And part of the journey is traveling back into your memories in order to move forward toward reconciliation. Your loved one may be gone, but their memory need never die.

May these 10 grieving and self-care tips help you along the journey as you grieve the person you love and find your way onto the path of healing.

As you reflect on the loss of someone you love and their journey through hospice, it may be helpful to understand what to expect from the coming weeks and months. So often, we get our understanding of grief from other people, television, or even society, and sometimes, it’s not entirely accurate. To help you in your grief journey, let’s remove the cobwebs from your understanding of grief and talk about common grief myths.

Myth #1: Grief is a burden.

It’s hard to argue with your emotions, but in many cases, they don’t tell you the full story. While grief may feel like a burden when you’re going through it, the emotions you’re feeling are actually healthy and a good sign.

Dr. Alan Wolfelt, a nationally respected grief counselor, author, and educator, puts it this way: “Love and grief are two sides of the same precious coin. One does not – and cannot – exist without the other. People sometimes say that grief is the price we pay for the joy of having loved. This also means that grief is not a universal experience. Grief is predicated on our capacity to give and receive love. Some people choose not to love, and so, never grieve. If we allow ourselves the grace that comes with love, however, we must allow ourselves the grace that is required to mourn.”

So, grief is not a burden. It’s the natural result of having loved deeply and wholly – something we all seek and need to live full lives.

Myth #2: Grief goes away. / Time heals all wounds.

As nice as it would be to say that time will heal your wounds and that your grief will one day go away, it’s simply not true. But take heart! At the beginning of the grief journey, your grief feelings are front and center. However, as you do the work of grief and incorporate the loss into the story of your life, your feelings of grief will decrease in intensity.

Grieving isn’t about “getting over” the loss; it’s about finding a way to move forward. There will be moments, even years down the road, when tears will come to your eyes, and that’s okay. Your feelings of love for that person will never go away, so there will always be a part of you that misses them and grieves their absence.

Myth #3: Grief and mourning are the same thing.

Though both grief and mourning are associated with the death of a loved one, there’s a difference between them. Grief refers to your internal thoughts and feelings. Mourning, on the other hand, is a shared, social response to loss. In other words, we mourn by taking our internal grief and turning it into actions.

The funeral is an excellent example. At a funeral service, you come together with other mourners to offer support, share stories, mark the significance of a life, and find personalized ways to honor your loved one’s memory. As human beings, when we don’t find ways to outwardly express (mourn) what we feel on the inside (grief), complications can occur, often resulting in a longer period of intense grief. Finding a way to express what you feel is an important and necessary part of grieving well.

Myth #4: There’s a set time frame for grief.

Sometimes, you may feel like well-meaning friends or family members are rushing your grieving process. Don’t listen to them. In truth, there’s no set time frame for grief. It takes the time it takes. Ultimately, the journey toward reconciliation – learning how to move forward – often depends on the type of loss and the depth of the relationship.

As long as you are actively doing the work of grief – engaging with your emotions, talking through your loss, and finding ways to honor your loved one’s memory – you will find your way to reconciliation.

Myth #5: Grief is the same, regardless of the loss you experience.

In some ways, it’s easier to relate to someone who has gone through a similar loss, but to say that the grief is the same is untrue. Even if two women have each lost a husband, they are individual people with unique personalities and ways of coping. While both women lost a spouse, they will deal with the loss differently based on their unique personalities, their background, their support group, and even the type of relationship they shared with their spouse. When you take all of these factors into account, there is no way that the experience can be the same from person to person even if the type of loss falls into the same category.

People may experience similar emotions – sadness, anger, relief, regret, guilt – but even the expression of these emotions varies from person to person. Every journey is individualized and should be handled with kindness and compassion.

Myth #6: Moving forward with your life means forgetting your loss.

While the ultimate goal of the grief journey is to find a way to move forward, this doesn’t mean you will forget about the person you love. They are forever a part of you, and you were shaped in some way by your relationship with them. Moving forward is about finding continued meaning and purpose in life following your loss.

Rest assured – learning to live again won’t make you forget your loved one. In fact, living through loss gives you an even greater appreciation for the time you shared and a desire to cherish the time you have left with living loved ones.

Myth #7: There are five stages of grief.

More than likely, you’ve heard of Elisabeth Kubler-Ross’s theory about the five stages of grief: denial, anger, bargaining, depression, and acceptance. This theory puts a nice tidy ribbon on a fairly complex human experience, but unfortunately, it’s often taken wildly out of context.

Kubler-Ross’s research was focused on the grief stages that patients go through following a terminal diagnosis. So, to a degree, you and your loved one in hospice care may have gone through the five stages of grief as you came to grips with a terminal diagnosis. However, the five stages don’t apply to the grief you will feel after your loved one has died.

Grief isn’t quite so simple. Your emotions may be all over the place and come in no particular order. While it would be nice to have a formula for grief, it simply doesn’t exist. You feel what you feel when you feel it, and all you can do is work through it when it comes.

Myth #8: There’s a right way to grieve.

We’ve already established that every grief journey is different because every person and relationship is different. The same principle holds true for how you express your grief. For some, crying comes very naturally as a way to release their emotions. For others, it’s writing, walking, running, painting, or using a punching bag. There’s no “right” way to respond to loss. If you need to cry, cry. If you never cry, that’s okay, too. Simply find what helps you release the emotions you feel inside – whatever that looks like.

Also, though it may be a temptation, don’t try to “be strong” for those around you. There may be moments when you need to keep your emotions in check, but as soon as you can, find a safe place to release what you’re feeling and embrace it. Dr. Wolfelt tells us that, “You don’t get to go around or above your grief. You must go through it. And while you are going through it, you must express it if you are to reconcile yourself to it.” So, face what you feel and grieve in the way that is most beneficial for you.

Myth #9: It’s wrong to feel certain emotions after a loss.

Perhaps it’s an innate response, but there are certain emotions that you may feel an aversion to following a loss. Mainly, anger, guilt, regret, or relief. However, if you’ve felt these emotions, rest assured that you’re not alone, and these are completely normal reactions to loss.

You may feel angry that your loved one didn’t take better care of themselves. You may feel guilty about the final words you spoke to them. Regret may fill you because you didn’t call or visit more often. You may feel relieved because their illness is finally over. These are all normal reactions to the loss of a loved one. Don’t beat yourself up over what you feel. Take time to work through it and give yourself some grace for the journey.

Myth #10: Grief is reserved for the passing of a loved one.

While we most often associate grief with the death of a loved one, this is not always the case. You can feel grief about a loved one going into hospice, a terminal diagnosis, the loss of a life cut short, or the loss of what might have been. Each one of these situations – and so many more – can bring out feelings of grief and loss. And just as with the loss of a person, you must work through your emotions and find a way to move forward with meaning and purpose.