For Doctors

Is Grief a Disease?

Anton Lazare, a psychiatrist at the Massachusetts General Hospital, estimates that 10 to 15 percent of the patients in this Hospital's mental health clinic have, underlying their psychological and behavioral symptoms, as unresolved grief reaction.

Physicians and mental health practitioners need to understand grief and recognize it as a source of medical and psychiatric problems. Psychiatrist George Engel compares the loss of a loved one (a psychological trauma) to a wound or burn (a physical trauma). He states that grief is the re-establishing of psychological health just as healing is necessary in the physiological realm, in order to re-establish a system's homeostasis. Grieving serves the same function as healing: both are processes necessary to restore equilibrium and well-being.

Mourning is the name for the long process which begins at the time of the death of a loved one. Acute grief is the beginning phase of mourning. (Mourning ends when the bereaved person is able to transfer attachment of love and energy from the dead child to other relationships.)

Normal Reactions to Grief

William J. Worden, PhD., a psychotherapist and researcher in the field of terminal illness and suicide, divides the manifestation of normal grief into four categories: feelings, physical sensations, thoughts and behaviors.

Feelings

  • Sadness and loneliness often, although not always, accompanied by crying.
  • Anger may result from frustrations that parents feel because they could not prevent the death or from a sense of abandonment by a loved one. This is sometimes displaced to generalized targets such as doctors, police, the hospital, etc. This anger must be expressed.
  • Guilt and self-reproach are common experiences of survivors: the guilt often manifests over something that happened or was neglected around the time of the death.
  • Anxiety arises because bereaved parents feel they cannot live without their child. Also there is a salient recognition of their own and their other children's mortality.
  • Isolation may be intensive even though the parent lives in the midst of the remaining family.
  • Fatigue or feeling of listlessness, or apathy. These symptoms emerge in physical behavior but can have a psychological origin.
  • Shock occurs immediately and appears to protect the survivor against the overwhelming feelings of grief and loss.
  • Yearning or pining for the dead child is especially acute within the first year after the child's death.

Physical Sensations

  • Hollowness in the stomach
  • Weakness in the muscles
  • Tightness in throat, chest
  • Lack of energy
  • Oversensitvity to noise
  • Dry mouth
  • Breathlessness or feeling short of breath
  • Sense of depersonalization: nothing seems real

Thoughts
Common patterns that may trigger feelings of pressure and anxiety:

  • Disbelief the death of the child is thought to be unreal; the parents do not believe their child has died. >
  • Confusion difficulty concentrating, focusing and ordering one's thoughts.
  • Preoccupation obsessive thoughts of the dead child or of regaining the child. Sense of presence of the child, especially acute shortly after the death.
  • Hallucinations of the dead child both visual and auditory are usually transient appearing shortly after the death for a brief period.

Behaviours
Common behaviours that may be reported by the bereaved:

  • Sleep disturbances may require medication however, in the course of normal grieving, these disturbances are usually self corrective.
  • Appetite disturbances, no appetite or compulsive eating, resulting in weight changes.
  • Absent-minded behavior which may result in inconvenience or harm to oneself or to others. This behavior is usually self correcting with time.
  • Social withdrawal and isolation may occur because bereaved parents feel different from others.
  • Dreams of the deceased which can be pleasant or frightening, may serve a purpose especially as a diagnostic clue to where the parent is in the process of mourning.

How Doctors Can Help

Renowned psychotherapist and researcher William Worden, PhD., suggests four key tasks of mourning. The physician can assist the bereaved patient by facilitating these four tasks.

Help Parents to Recognize the Finality of Death
Help the parents accept the fact that their child is not coming back. Encourage the parents to talk about all aspects of the child's life and death.

One of the most important tasks of the physician is to be a good listener.

"When my child died my doctor was there for me. He couldn't bring my child back but I could feel his compassion and concern. I felt that I could talk about all the guilt and anger I had bottled up inside when Sarah died. He didn't judge, or even prescribe pills. He just listened."

Help Parents to Identify and Express their Feelings
Encourage parents to express their anger, guilt, helplessness, sadness, and fears of their own and their other children's mortality.

As in all crisis counseling, it is important to remind the parents that they have coped with other life crises and that they will with this one as well.

Bereaved parents may think they are going crazy, because they are often so distracted and because they experience things that are not normally part of their lives. The physician can reassure the bereaved parents that their grief experiences are normal.

Assist the Parents to Live Without their Child
Point out to the parents that everyone within the family has changed since he death of the child. Encourage them to observe and adapt to changes within the family.

Encourage the Parents to Reinvest their Energy in New Relationships
Mourning seems to have 4 component parts.

After the initial shock, numbness and disbelief, there follows a period of yearning and searching. When the reality of the death finally sinks in, there is a period of depression. This is usually the phase when the parent comes to the doctor.

The doctor can help parent to express his or her emotions. These emotions accompany the recognition that the child indeed is not coming back, that they will not be the same people, and that everything in their life has changed.

At the end of this process the parent may be ready to go on to the last task of mourning, which is to reinvest energy in new relationships and activities.

Help Them Find the Appropriate Resources
Sometime the grief can be too much and it can help the parents to talk to a professional about how they are grieving and what they are feeling.

You can connect them with a professional therapist, covered by OHIP that can help them address these emotions in a healthy way and move forward in the grieving process.

How Do Bereaved Parents Differ From Other Bereaved People?
Bereaved parents never fully recover from the loss of their child. But they do learn to live with their grief and readjust to life without the child.

"It's been over 10 years since Steven died. But every time I talk about him my eyes fill up with tears."
Mothers and fathers may grieve differently. Usually mothers exhibit more of the symptoms of grief and depression -- while fathers appear to be dealing with the daily routines of life. Often husbands and wives may resent each other because of their differences in grieving. As a physician it is important to know that once the wife has coped with her grief, the husband may begin to feel the full force of his.

How Bereaved Families of Toronto Can Help
There is no time limit on the grieving period. It can take as long as 18-24 months just to stabilize after the death of a child. The family may appear to be coping rather well at the time of the death and funeral. In actual fact they are probably in shock, experiencing numbness and a lack of feeling. It is only later that manifestations of grief may appear -- tears, depression, anger and physical symptoms of distress.

Bereaved Families provides a caring support system designed to help families cope with the painful reality of their loss and return to the mainstream of life.

Small group discussions led by trained bereaved facilitators are available for parents and siblings. Over a period of three months, small groups of approximately eight meet each week for two-hour sessions. More informal meetings with Bereaved Families are available through family nights, newsletters and individual contact.

Professionals with expertise in the nature and dynamics of grief, supervise all group programs and train the bereaved parents for their sensitive role as group leaders. Where needed, we can provide a professional referral.

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