The unpredictability of grief

Two cases of how differently grief can affect people – and some helpful advice on how to deal with it

sad people  (photo credit: MCT)
sad people
(photo credit: MCT)
Grief is an unpleasant but necessary emotion that people feel as a result of loss. Individuals may suffer from grief following the death of a relative, a close friend, a colleague or any person who is significant in their lives. Many bereaved individuals cry, feel depressed, have trouble sleeping, lose their appetite and very often lose interest in doing things that they previously found pleasurable.
Although the aforementioned symptoms can also be signs of clinical depression, grief reactions and clinical depression are in fact very different. Grief may increase and fade over time; the sadness may be present one day and then not return for days, weeks or even months. On the other hand, symptoms of clinical depression remain fairly constant and impair a per- son’s ability to perform daily activities, i.e. work or household responsibilities. And, although many people go through their bereavement time without requir- ing any professional intervention, there are times when professional counseling can prove helpful, as in the case of providing treatment for a grief-induced clinical depression or to help deal with a grief reaction that causes significant discomfort.
ESTI, AGE 58, a research scientist, was referred to me by her family doctor after her husband suddenly died of a heart attack. Her family physician was very concerned about Esti’s func- tioning following the shiva. Esti’s depression deepened: she was unable to fall asleep, lost her appetite and expressed suicidal feelings, stating that she felt that life was not worth living. Esti and her husband did not have any children. They had both been very involved in their profes- sional careers and spent the majority of their leisure time almost exclusive- ly together.
While there was no question that Esti was in a state of grief and mourning following the loss of her husband, she was unprepared for the intensity of her feelings. The depression completely took over her life, severely impairing her ability to concentrate, and she was unable to muster up enough ener- gy to do her work. She found her suicidal thoughts very disturbing, although she denied that she would actually harm herself. Clear- ly, her symptoms were more severe than standard symptoms of grief. I recommended that her family physician give her an anti-depres- sant medication and I suggested that Esti see me twice a week until she felt better. With the help of supportive and cognitive therapy and medication, Esti began to come out of a clinical depression.
Now our work could focus on her uncomplicated grieving and adjustment to the immense change that was taking place in her life.
SAM, AGE 72, had a different way of expressing his grief. His wife had died of colon cancer and Sam told me that during the shiva period he was unable to feel his feelings or shed any tears. This bothered him because he loved his wife very much and really missed her.
Sam’s children and grandchildren were concerned. Sam came into thera- py to try to reconnect to his feelings.
He acknowledged that this would be a difficult task for him since he had never dealt with his emotions, but rather approached everything from an intellectual and rational perspective.
During our year of therapy, Sam began to get more connected to his feelings and his grief, was able cry more than he had ever cried in his life and was also able to share many happy memo- ries and feelings about his relation- ship. My job was to listen and to watch as Sam struggled through the highs and lows of his grieving. At the end of the year, Sam began to feel that he was ready to meet someone new, something his late wife would have wanted him to do.
THESE TWO cases exemplify how dif- ferently grief can affect people. The following helpful advice can be found in bereavement counseling literature.
• Bereavement is a very individual thing. People are different and go through things differently. They have different DNA, temperament, family histories, vulnerabilities and resiliency.
• Bereavement and grief are influ- enced by one’s attachment to the lost loved one. This attachment is deeply personal and very subjective. It has nothing to do with the age a person died at, old or young, or whether the death was expected or not.
• Bereavement never really ends.
Expect grief to increase and fade over time. It ebbs after a while, but can then emerge on birthdays and anniversaries or be triggered by special things and/or places that are associat- ed with the deceased person.
• Build and use a support network.
Grieving individuals need to speak to others and be taken care of not just during the seven-day shiva period, but over an extended period of time. This is especially true for people who are primary caretakers for terminally ill loved ones.
• Expect to feel depression, some loss of appetite, trouble sleeping and sad- ness, which are all part of the normal grief process and are best not inter- fered with but rather treated by pro- viding the bereaved person with emo- tional support.
• If symptoms of depression increase or you experience suicidal thoughts, serious weight loss or are unable to perform daily functions such as getting out of bed or going to work for more than an occasional day or two, it may be time to seek professional help.
The writer is a marital, child and adult psychotherapist practicing in Jerusalem and Ra’anana.