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Table of Contents |
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"big death" and "little death" |
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Grieving is usually associated with the death of someone
important in your life. This can be referred to as "big death",
since it usually involves a family member or friend. However, life
is full of "little deaths" as well. They occur unexpectedly
and take many forms such as: the unexplained loss of a job; the loss
of a pet; loss of a budding romance; or an expectation of someone
that is not fulfilled. Little deaths also can consist of such things
as an investment that goes awry, or a dent in the fender of your new
car. And there is always the unexpected illness or injury that forces
an immediate alteration in one's lifestyle and relationships.
Although this article focuses on the "big death", most of
the processes described here also apply to "little deaths".
These "little deaths" can elicit grief, anxiety, and depression
that is every bit as painful and profound as grief associated with
"big death. "Little deaths" can only be measured by
determining the extent to which they are disruptive to lifestyle.
It is important to note that "little deaths" for some people
have more profound effects than "big deaths".
For instance, I know an eminent orthopedic surgeon who walked into
his surgery one day and turned around and walked out. He was so overcome
with anxiety that he might do the wrong thing, that he closed his
practice and collected a support group to help him overcome his grief
and pain from this "little death" experience. |
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Responses to "big death" and grieving |
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There are many who subscribe to a "mature"
attitude toward death. This attitude describes death as simply the
cessation of bodily functions and the end of identity. These attitudes
are mixed with a variety of beliefs of an afterlife, reincarnation,
heaven, hell, and even the wandering of the soul of the deceased in
some form of hyperspace.
With such diverse beliefs and concepts, family, friends, physicians
and caregivers must come together to deal with the reality of imminent
death. One area where clashes in ideas can occur is with regard to
the prolonging of life when someone is extremely ill. Some people
believe that every effort must be made to prolong life, regardless
of the discomfort to the patient or the extreme heroics it may call
for. Others feel that death is a natural event that is merely a part
of life.
Like many other important behaviors, the process of grieving and dealing
with death is culturally determined. In many cultures the gothic trappings
of funerals and the rituals of burials tend to be very specific. Even
the clothing of those in mourning, and the manner in which they should
conduct themselves is stipulated. The response to death is also heavily
influenced by society's attitudes and beliefs and is echoed in media
such as movies and television. |
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Grief across the life-span |
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There are some very different concerns about grieving
among adults, in comparison to adolescents and children. In this discussion
we will confine ourselves primarily to adult grieving. Regardless
of the grieving person's age, counseling must allow for the different
belief structures that underlie the grieving process, as well as the
individual nature of grief.
There are many adults today, who as children never participated in
the death and burial of a parent, thereby missing out on a chance
to resolve the death. Some of these people still harbor the notion
that the parent is out there somewhere, and will return some day. |
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The start of grieving |
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Grieving can start when there is awareness that some
valued person is approaching death. For couples, there are many facets
of life involved in the loss of a spouse. They include going shopping
together, getting ready for bed, waking up in the morning, discussing
the children, planning the future, decorating the house, traveling
together, doing enjoyable things together and sharing affection and
love. Grieving starts when it becomes clear that these activities
are coming to an end. The process of grieving is also intertwined
with the pressure of making decisions about how to care for the dying
person.
Although everyone grieves in their own way, the grieving process often
includes physiological changes, depression, crying and moaning, or
very silent withdrawal. Sometimes the survivor goes on as though nothing
important has really happened. This happens more easily if the survivor
has had a somewhat independent life with many activities. Because
each person has a different approach to grieving, problems may develop
if a person grieves in a way that does not match the expectations
of their family members or friends.
If the illness of the departed person is prolonged, the grieving process
may be over when that person dies. In some instances, it is possible
that the survivor feels more relief rather than grief when the person
dies. |
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The process of grieving |
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The extent of grief and mourning is also associated
with how much of one's world is tied up with the loss. The death of
a spouse can activate the most profound kind of grief. Grief for adults
usually consists of many conflicting emotions. There is anger, powerlessness,
relief, guilt, withdrawal and isolation.
Most people feel the need to engage in the grief process no matter
what the level of their loss. The grieving process can be considered
in two parts. The first has to do with adjusting to the imminent loss
of a loved one, and the second with the future life of the survivor.
These are intertwined so deeply that it is almost impossible to keep
them apart. The loss of a spouse or partner may not be a profound
cause of grief if there has been a prolonged illness, but the contemplation
of the reality of ongoing life may be overwhelming.
Bill Moyers, a well-known television commentator in the US, says:
"America is a wonderful place to get medical care but a terrible
place to die." He is referring to the small number of physicians
who believe in what is called "Palliative Care" and know
how to help families make difficult decisions about dying loved ones.
In general, physicians are trained to try anything that will prolong
life. Unless the responsible person is prepared to make difficult
decisions, the dying process may proceed without much dignity and
often with considerable pain.
It is important that family and friends should participate in every
phase of the dying process. If there has been little discussion about
the wishes of the person who is ill, then there are a host of decisions
that need to be made . If there is a sudden death, this process is
shortened, but it is nevertheless, equally important. |
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Preplanning for loss |
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Nothing can help the survivors avoid grief. However,
the grieving process is greatly helped if lengthy discussions about
preparation for the eventual event take place when both partners are
in good health. (These discussions include topics such as funeral
arrangements, finances, use of life support systems and when they
are to be stopped.) Discussing these matters in advance helps the
surviving family members.
All immediate family members should participate in this discussion,
or at least be informed about their outcome. There can be a living
will and a durable power of attorney. Copies of these documents should
be made available to physicians and attorneys. It is necessary to
research the legal status of the area in which you live since many
countries and or states or regions within countries have different
kinds of legislation about these decisions. For instance, in my state,
New Mexico (US), a written and signed statement by the dying person
is sufficient, and the physician is required to follow these instructions.
Funeral arrangements can be made well ahead of time when both partners
are in good health. It is good practice to plan ahead, before the
need arises. Do some research and comparison-shop. Get a written contract
with cancellation and refund provisions.
People who have completed these tasks in advance attest to a "peace
of mind". If they haven't been done, it is time to call legal
and financial professionals to get things in order. |
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After the loss |
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Expressions of grief such as crying, outbursts, moaning
and silent meditation can go on for a long time. Grieving persons
must be left to their own choice about how they will grieve. Another
aspect of grieving occurs after a few weeks, when family and friends
have departed and the details of the funeral are over.
The survivors are now alone with the tasks of getting rid of clothing
and often making financial decisions. Many people feel the urge to
make important decisions as soon as possible. This turns out to be
a bad idea if all of the tasks of grieving have not been processed. |
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When grieving is too brief |
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Most experts advise waiting awhile before making critical
decisions but a part of the griever may be determined to get on with
life. The survivor may proceed with important decisions and terminate
the grieving process much too soon. When this happens, the loss may
be forgotten but unresolved psychological issues may remain.
If the grieving process is pushed out of one's mind to soon, anguish
can begin to supplement grief. Along with anguish, a person might
experience depression, physical difficulties such as trouble with
breathing, fatigue, sleep disturbances and restlessness.
Improper resolution of grief can also make it difficult for the person
to properly bond towards others in the future.
If the grieving process is pushed out of one's mind to soon, anguish
can begin to supplement grief. Along with anguish, a person might
experience depression, physical difficulties such as trouble with
breathing, fatigue, sleep disturbances and restlessness. |
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When grieving is too lengthy |
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If the grieving and anguish continue for a long time,
prolonged depression, continued physiological changes, and deeper
withdrawal into thoughts and memories of the lost spouse continue.
Friends and family can trust their own intuition when they suspect
the grieving process is too lengthy. If they feel helpless to intervene,
then some kind of bereavement counseling is recommended. This choice
can be discussed with the grieving person.
It is difficult for a survivor to complete necessary tasks when there
is withdrawal and isolation. But good communication and relations
with others helps the grieving person resume their normal functions
more easily.
A more detailed discussion of how to help a grieving person is presented
in Part 2 of this article.
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