Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: March 2009

Coping with Grief and Loss

Nicole Cain, MS

Losing someone or something that you love can be very painful and after a significant loss you may experience grief. Grief is a natural response to loss and involves a variety of difficult and overwhelming emotions, such as shock, sadness, anger, and guilt. While it may feel as though your grief will never end, it is important to recognize that these various emotions are a normal part of the grieving process. Quite often, grief is associated with the death of a loved one, but any loss can cause a grief reaction such as a relationship break-up, the loss of health, the loss of a job, or the loss of a pet. Typically, the more significant the loss, the more intense the grief; however, even subtle losses can lead to significant grief reactions.

Grieving is a highly personal and individual experience. Your personal grief process depends on a number of factors including personality, coping style, social support system, faith, and the nature of the loss. It is important to note that the grieving process takes time and how long it can take varies from person to person. Healing from grief happens gradually and it should not be forced or rushed. There is no "normal" timeline for grieving; some people will start to feel better within weeks of the loss while others will continue to grieve for many years. It is important to be patient with yourself and allow your grieving process to naturally unfold.

While loss will affect people in different ways, there are some common symptoms that people often experience when grieving. Immediately following the loss, it can be hard to accept what happened and many people describe feeling shock and disbelief. You may feel numb, have trouble believing that the loss actually happened, or even deny the truth. Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness following a loss. You may also cry a lot or you may not cry at all. Crying is a normal response to sadness, but it is not the only response and some people find that they cannot cry even though they experience significant sadness. Following a loss, it is also common to feel guilt. You may regret or feel guilty about things that you did or didn’t do or say. People often comment that they feel guilty for not doing more to prevent the loss, even if there was nothing more that they could have done. Anger is another common symptom of grief and you may feel angry at yourself, at the person who died, or even at the world. A significant loss can also trigger worry and fear. In particular, you may feel anxious, helpless, or insecure. The death of a loved one can trigger fears about your own mortality, your ability to face life without that person, or the responsibilities that you now face alone. Finally, grief can also trigger physical symptoms such as fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia.

One of the most important factors in recovering from a loss is social support. Even if you don't usually share your thoughts and feelings with others, it is important to seek out social support following a loss. Many people turn to family and friends for support, though there are other sources of social support that can be helpful as well, such as support groups and faith-based organizations. Grief can feel very lonely, even when you have loved ones around you; therefore, it is important to seek out multiple sources of social support following your loss. During the grieving process, you may want to withdraw, isolate, or avoid family and friends. However, connecting to others and accepting assistance will actually facilitate your healing process. Quite often, following the death of a loved one, some people will begin to question their faith. If this happens, it is important to seek out individuals within your religious community or family and friends for support.

When you are grieving, it is incredibly important to take care of yourself. The stress of a major loss has a significant impact on both your physical and emotional well-being. It is important to take care of your emotional well-being by expressing your feelings about the loss. Some people find it helpful to talk with family and friends, to talk with a mental health professional, to write about your loss in a journal, or to create a photo album or scrapbook celebrating the life of your loved one. It is also important to plan ahead for "grief triggers," which can be anniversaries, holidays, and other milestones that can re-awaken memories and grief reactions. It is normal to feel heightened grief surrounding an anniversary or holiday and it is important to plan how you will cope with such milestones. It is also important for you to take care of your physical health by sleeping, eating well, and exercising. Many people will turn to alcohol or drugs to help them cope; however, these substances will only numb the pain temporarily and are maladaptive ways of coping with stress. If you find yourself using alcohol or drugs to cope with grief, please seek help from a mental health professional.

Finally, while it is normal to feel sad, numb, angry, or guilty following a loss, as time passes these emotions should become less intense as you accept the loss and move forward. If you don't feel better with time or if you find that your grief is getting worse, this may be a sign that your grief has developed into a more serious problem such as major depression. Grief and major depression share many of the same symptoms. With grief, you will experience both good and bad days; you may feel as though you are on an emotional rollercoaster with many ups and downs. With major depression, the feelings of emptiness and despair are constant, with few or zero good days. Other symptoms of major depression include: an intense and pervasive sense of guilt, thoughts of suicide or preoccupation with death, feelings of hopelessness or worthlessness, slow speech or body movements, and an inability to function at home, work, or school. If you experience any of the symptoms of major depression, it is important to seek help from a mental health professional right away. It is important to note that talking with a mental health professional about your grief can be helpful at any stage of your grieving process, even if you are not currently experiencing major depression. An experienced mental health professional can help you to work through your intense and overwhelming emotions and to overcome any obstacles to your grieving process.