Grief & Loss

When someone you love dies, you expect to grieve. Did you know you may also experience the same feelings of loss before the death occurs? Known as anticipatory grief, these feelings of sadness, depression, regret and anger may come about when someone you care about is terminally ill.

In many ways, anticipatory grief is like a rehearsal for the real thing; it’s a way to prepare for the worst. It can also give you time to get used to the reality of the loss, to say goodbye and to complete any unfinished business. However, it doesn’t replace grief after a death and it can be just as painful as the death itself.

Some people may feel guilty mourning a death that hasn’t occurred yet. Accept that these feelings are normal ways to manage your emotions. Here are some other ways to cope if you’re experiencing anticipatory grief:

• Acknowledge your loss. You might think you should be grateful that the person you love is still alive, but the truth is that the losses that come while battling a life-threatening illness are very real. Allow yourself to grieve the changes caused by the illness as well as the end of your future together.
• Turn to your support network. If you’re anxious and feel isolated and alone, connect with friends, neighbors and family. Sometimes, just talking about your fears can ease anxiety. Don’t be shy about asking for help. You may need a break from day-to-day responsibilities, especially since you are also dealing with a great deal of emotional stress.
• Communicate. If your loved one is dying, talk openly about how to spend your remaining time together.

Supporting your child

Children can also experience anticipatory grief. They may mourn the changes in a relationship with a seriously ill parent or other loved one, or may grieve as if their parent has already died.

Here are some ways to help your child cope with anticipatory grief:

• Talk openly. Your impulse as a parent may be to shield your child by not talking about a loved one’s illness. But without solid information, your child will likely use their imagination to fill in the gaps. Speak to them about the situation, using age-appropriate language. Children tend to worry that death will be painful or scary, so talk about the ways doctors are keeping your loved one comfortable.
• Be aware of what you say. Your child may pick up on adult conversations so be careful about what you say when they are within earshot. Even when it seems that your child isn’t paying attention, they may be registering your words and actions.
• Keep the connection alive. Create opportunities for your child to interact with your loved one. Your child might read aloud to them, bring them soup or simply keep them company. Prepare your child ahead of time for what they will see. Try not to force interaction if your child is uncomfortable or frightened.
• Talk about the future. Reassure your child that they will be safe and cared for, no matter what happens. Let them know exactly what the plan is for their care.

If you or your child experience anticipatory grief, remember that these feelings are normal. Try different coping strategies and be sure to take care of yourself as well as your child. Make sure you both eat well, stay active and get good sleep.

Source: Military OneSource

Summary

• The feelings surrounding the loss of a pet are real and significant and should not be minimized.
• Have faith in the grieving process, which can take weeks or months, and allow it to happen naturally.

When Irene’s 12-year-old dog, Sport, died, she was overcome by strong grief. Sport was an old dog, so his death didn’t come as a complete surprise. What did surprise her were the overwhelming and strong emotions she felt.

Irene’s experience is not unusual. In fact, mourning the loss of a pet often is harder than the death of some family members and friends. Grief can entail not only feelings of deep sadness and loss, but also guilt, failure, and anger. Many pet owners are caught off guard by the intensity of such reactions and are unsure about how to deal with them. Compounding this is the way society tends to trivialize the pet-owner bond.

The grieving process

It’s important to realize that the feelings surrounding the loss of a pet are significant and should not be minimized. These feelings are a normal part of the grieving process, which involves these stages:

1. Stage 1: numbness or impact
2. Stage 2: recoil or depression
3. Stage 3: recovery

Even though death is natural and inescapable, suppressing the grief response will preclude emotional healing—and likely make more problems down the road. It’s important to have faith in the grieving process, which can take weeks or months, and allow it to happen.

Coping

Grieving is hard. Yet, you can take steps to move through the grieving process and keep your grief from taking an unhealthy turn. Try these ideas:

• Talk about your pet, your loss, and how you are feeling about it with supportive friends and family members. Many communities have pet bereavement support groups. Involving other people is particularly important for people who are more isolated—such as elderly people—who count on a pet to fulfill emotional needs.
• Remove everyday reminders, such as a food bowl, bed, and toys.
• Change your routine. Now that you are not beholden to your pet’s needs and schedule, spend your liberated time differently. For example, if you used to wake up at 6:30 to fit in your dog’s walk before going to work, try waking a little later and enjoying a relaxed breakfast.
• Make a scrapbook, write a song, or express your feelings in a journal. Such mementos can help you think about the good times shared with your pet.
• Memorialize your pet through a ceremony or by making a donation to a charity or worthy cause in your pet’s name. If your cat loved to watch birds, hang a birdhouse embellished with a plaque reading “In memory of Cleo.”

Children as grievers

Don’t try to protect your child from the experience of mourning a pet by hiding your feelings or avoiding the topic altogether. Children experience death differently than adults. It’s important to adjust your discussion to your child’s level of understanding while being as honest and frank as possible. Emphasize that death is a normal part of the life cycle.

Time for a new pet?

Only you will know when you are ready to get a new pet. Do not let others convince you otherwise. Consider your child and others in the household who are affected by the pet’s death. Hasty decisions to “replace” a deceased pet before grieving the loss can lead to problems.

Getting professional help

Bereaved people sometimes need professional help. If you are showing signs of depression or are not moving through the phases of the grief cycle, consider talking with a mental health professional with experience in pet bereavement. Your veterinarian also may be able to point you to the right help.

Resources

Association for Pet Loss and Bereavement

International Association of Pet Cemeteries and Crematories

By Christine P. Martin

©2005-2019 Carelon Behavioral Health

Source: Association for Pet Loss and Bereavement, www.aplb.org; The Loss of a Pet: A Guide to Coping With the Grieving Process When a Pet Dies by Wallace Sife, Ph.D. Wiley Publishing, 2005.

Summary

• Grief after the loss of a child can feel overwhelming.
• Over time and with the right support, it is possible to overcome this grief.

Death is a natural part of life, but we expect our children to outlive us. Our love is so strong that losing them seems impossible. But it is possible. A child’s death breaks this bond and shatters our expectations. The resulting grief is hard, but it can be overcome.

What to expect

Losing a child causes a super-sized version of grief. Emotional and physical symptoms may be more intense. It can be complicated and long lasting. Parents who lose a child may have waves of grief their whole lives.

Some feelings are common. You may:

• Have a hard time catching up to this terrible reality, even if your child was sick and expected to die
• Feel he is near, waiting to be found
• Swing from one emotion to another or get stuck in one emotion
• Be angry that your child is gone or think you or someone else should have died instead
• Resent people who have not lost a child
• Blame yourself for not preventing the death and second-guess your actions and decisions
• Feel guilty for living when your child cannot
• Fear something bad will happen to you or your other child(ren)
• Question your identity as a parent

Some physical symptoms are common. You may:

• Have trouble sleeping or want to sleep all the time.
• Not be able to eat or to stop eating
• Feel sick, tired, or achy, like you are carrying something heavy
• Have anxiety or panic attacks

Parents grieve the loss of miscarriages, abortions, and stillborn children, too. Leslie Delp, Founder and Bereavement Specialist at Olivia’s House, a nationally recognized grief and loss center for children, says these parents get little grief support. People may not understand how much these losses hurt.

How to cope

During this time, you may feel alone in your misery or that no one understands you. All bereaved parents benefit from support.

Friends and family

You may be able to share your feelings with friends or family. Sometimes their company is soothing. They may understand the big picture, too. They can see how your loss affects your life and identity. Your grief will take a lot of time and energy. If people offer to help with dishes, laundry, or other daily tasks, think about saying yes.

Some people may not know what to say or accidentally say hurtful things. They may worry you with false information. Susan’s friend told her that most marriages fall apart after a child dies. Kate became afraid her husband was going to leave her. But losing a child only slightly raises the risk of divorce. This myth made Susan’s grief harder.

People may not understand the depth of your grief. They may urge you to accept your loss and move on. You may pull away from friends and family who do not support you.

Religion and spirituality

Look for comfort in your religion or spiritual beliefs. Mourning customs may give your grief an outlet. Prayers and other rituals help people find hope. Clergy people and congregations often help members through this hard time.

Some bereaved parents question their beliefs. They cannot believe in a god or higher power that would let their child die. They may feel abandoned or unsure of where to turn.

Support groups

It can help to talk to people who have gone through this. Support groups can be found locally and online. Medical groups and local organizations may host support groups for bereaved parents.

Professional help

Therapists, counselors, and other professionals are trained to help people deal with grief. Grief centers are usually professionally run. Some centers have a specific focus, like child or family grief. Delp says Olivia’s House is for grieving children. However, their programs address the whole family’s grief. If you have other children, make sure they have help grieving for their sibling. Find recommendations through your doctor, your health plan or other bereaved parents. If your grief becomes overwhelming or you feel hopeless or that you might want to end your life, seek professional help right away.

By Beth Landau

©2015-2019 Carelon Behavioral Health

Source: American Psychological Association, www.apa.org; American Society of Clinical Oncology, www.cancer.net; The Compassionate Friends, www.compassionatefriends.org; Leslie Delp, Founder and Bereavement Specialist at Oliviaﾒs House; Substance Abuse and Mental Health Services Administration, www.samhsa.org; The Wendt Center for Loss and Grieving, www.wendtcenter.org

Summary

You might be stuck somewhere in the grieving process. Here are some ways to get through it.

Chances are that you have known somebody who has considered suicide. But what happens when you lose someone that way? How do you move on with your own life?

The stigma of suicide

Your family member, loved one or friend may have chosen to end their own life suddenly due to depression, a chronic health condition or another difficult situation. They might have made it known they wanted to take their life. They might have kept their internal misery to themself. It is usually not a selfish act to hurt others—rather, the only way a person can see a way out from their pain.

Each suicide can touch several other lives, especially if it’s publicized or a famous person. Many survivors experience a range of complex grief reactions. These can include:

• Guilt that you didn’t know it was coming, or that you couldn’t save them
• Anger that your loved one or friend could be so selfish
• Abandonment from them
• Denial that they would choose to die in such a manner
• Helplessness that they are gone and you have to continue without them
• Shock at how it was done, or that it was sudden

Give yourself time to go through any and all of the reactions. It’s possible how you feel is even further complicated by religious beliefs. Or, maybe you were the one who found the person—or were with them when it happened. This can make the suicide especially personal and hard to get over.

How to help yourself

You might be stuck somewhere in the grieving process. Here are some ways to get through it:

• Give yourself time. Everyone handles death in their own way and suicide is no different. You don’t have to follow a particular timeline or traditional path of grief.
• Experience your feelings of guilt and anger at the person. Try to remind yourself that it was not your fault and it was not done to hurt you.
• Reach out to others. Know that their family members and other friends are probably having many of the same reactions. You could let those in your inner circle support you too, even if they didn’t know the person. Know that you don’t have to be ashamed or embarrassed to share your feelings.
• Realize that the grief will likely come in waves. There will be reminders of the one you lost. Those first anniversaries, birthdays and holidays can be tough. Don’t feel as though you have to celebrate the same way if it’s too painful.
• Find professional help through a support group or counselor. Take a step back and tell people what you need to move on. Sometimes, it’s just a listening ear.

It might be hard to imagine that life can be joyous again. Eventually, you may even be able to experience the highs and lows of daily living again. Your loved one or friend won’t ever be forgotten. Once the rawness and anger fade, you will hopefully be able to remember the good times you shared together.

Resources

Alliance of Hope
www.allianceofhope.org/

Parents of Suicides – Friends and Families of Suicides
www.pos-ffos.com/

Suicide Support Group
https://afsp.org/find-support/ive-lost-someone/find-a-support-group/

By Andrea Rizzo, M.F.A.

©2017-2021 Carelon Behavioral Health

Source: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5); “Feeling Suicidal,” www.girlshealth.gov/feelings/suicidal/index.html#why; “Suicide Prevention,” National Institute of Mental Health, www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml#part_153176; “Increase in Suicide in the United States, 1999-2014,” Centers for Disease Control and Prevention, www.cdc.gov/nchs/products/databriefs/db241.htm; “Preventing Suicide,” Centers for Disease Control and Prevention, www.cdc.gov/Features/PreventingSuicide/index.html

Summary

Gather basic information about your financial condition and make sure you have enough cash for your current needs.

Financial planning may be the last task you want to think about after the death of a loved one, but it’s an important issue to face. The loss of a spouse or partner can mean a big loss of income, new assets to handle, or both. The shock of having to deal with such matters can be especially hard for someone whose deceased partner had been handling the family’s financial matters.

Experts in post-bereavement planning have some words of advice: Go one step at a time, and don’t make hasty decisions. Here’s a checklist to help you deal with first things first:

• Gather basic information about your financial condition. Find out who is responsible for executing estate documents such as wills and trusts. Learn what you own, in what form you own it (whether the asset is held in common or through joint tenancy, for instance), and what debts need to be paid. Find out whether the estate will have to go into probate and whether it’s large enough to be taxable.
• Make sure you have cash for your current needs, such as funeral costs.
• Once the legal process of settling the estate is in motion, take a look at your income and expenses. Go through the checkbook for the past year. Everything should be there so you can categorize where all the money has gone. You can also figure out which costs are fixed and which you can cut.
• If you’re new to money management, start learning—and take your time. If an investment doesn’t make sense to you, don’t let someone put your money there. If a person is telling you things you don’t understand or suggests things that you’re not comfortable doing, run, don’t walk, to the nearest exit.
• Invest to meet your needs. That means not jumping into the stock market if you can’t afford to lose any of your assets. Consider your “time horizon,” as financial planners call it. For any investment, this is the number of years you can wait before you may need to sell it for living expenses. The shorter the horizon, the more conservative you should be.
• Don’t be afraid to seek professional advice. An accountant should be able to “quarterback” the process of settling an estate. If you don’t have an accountant, talk to people you know for help in finding an advisor you can trust.

By Tom Gray

©2000-2019 Carelon Behavioral Health

Summary

• Your loved one’s grief will be personal and unique.
• Listening and talking are useful support skills.

The grief cycle applies to any loss. Many life changes, such as death, divorce, or disability, cause feelings of loss. Even good changes, such as a child going away to college or a job promotion, cause loss. There are many descriptions of grief, but most of them include shock, pain, and acceptance. Common symptoms include:

• Trouble concentrating
• Anger and sadness
• Anxiety and fear
• Guilt and remorse
• Drawing away from loved ones
• Nausea or dry mouth
• Sleeping problems
• Changes in eating habits
• Endless crying

It helps to know what your loved one may experience. However, grief is personal and varies in length and strength. There is no way to predict how your loved one will grieve. However, there are ways for you to support your loved one through the grieving process.

How to help

Let your loved one know you care and offer your support. You can mention the loss and be honest about your emotions. Try to keep the focus on your loved one. Do not give your loved one advice. You are not there to fix a problem or help your loved one “get over it.” Instead, offer to take care of daily chores or other tasks. Be available if your loved one wants help. Always respect your loved one’s wishes.

Let your loved one express his feelings. Some people want to talk. Others need to cry or simply sit with someone who cares. Do not assume you know how your loved one feels. Ask him about it. Your loved one may feel no one really understands. Instead of saying, “I understand,” try, “This is hard. I am sorry you have to go through this.” Some people find comfort in telling the story of the loss. For instance, after the death of his father, Bruce told everyone he met about his father’s illness. He told it so often that his friends and family avoided him. They did not understand that, with each retelling, Bruce was working out his feelings about losing his father. He told the story less often as he recovered from the loss. Be patient with your loved one.

Let your loved one know she is not alone. Encourage her to reach out to other people who care. Many people find it is helpful to talk to others who are going through the same loss. If your loved one is interested, help her find a support group. Local organizations may have in-person meetings. Other groups can be found online. She may also find solace through her church, temple, or mosque. Grieving can sometimes cause people to question their religious beliefs, but for some, religion is a great comfort. If the grief is severe, a counselor or therapist can help. Professional help is needed if your loved one threatens to take her own life. Get help right away. In general, be gentle and respect your loved one’s wishes. There is no way to hurry her through the grieving process.

Let your care extend to yourself. You cannot help others if you are unwell. Good eating and sleeping habits are important. Many times we share our loved ones’ losses. Let yourself grieve. You may need support, too. Pay attention to your own life. Supporting your loved one is only one part of your life.

A gentle reminder

Part of supporting loved ones is not judging them or their losses. Things like abortion, suicides, or deaths from HIV often carry a stigma. Mila Tecala, MSW, at The Center for Grief and Loss in Washington, DC, says people who deal with these types of losses often have trouble finding enough support. Remember that your goal is to support your loved one through a difficult time. Your opinion about the circumstances of the loss is your opinion. It should not change the way you support your loved one.

By Beth Landau

©2015-2019 Carelon Behavioral Health

Source: American Psychological Association, www.apa.org; Mila Tecala, MSW, Center for Grief and Loss in Washington, DC; R. Friedman, C. James, J.W. James. The Grief Recovery Handbook for Pet Loss. 2014. Taylor Trade Publishing; Substance Abuse and Mental Health Services Administration, www.samhsa.gov

Summary

• Each age group expresses grief differently.
• Children and adolescents may not truly understand death.
• Older adults may have fewer resources.

Every age group grieves differently, depending on how much they understand. As people develop, they learn what death is, how it affects them and what it means for the future.

Children

Very young children understand loss but not death. They may notice if someone is gone or pick up on adults’ moods. They may be fussy. Between 3 and 6, children believe death is like sleep, not permanent. Children may think they caused the death or made people sad. They may regress, sucking their thumbs or wetting the bed. Offer comfort to the child. Reassure her. Let her know she did not do anything to make people sad. When a parent is very sick or dying, it is important to tell children who will be there for them when the parent is not available.

School age children understand that death is permanent. They are curious and ask a lot of questions. Their actions do not always match their feelings. Children seem fine when they are not. They may act out or have problems with focus or aggression at school. Leslie Delp is a founder and bereavement specialist at Olivia’s House, a nationally recognized grief and loss center for children. She says kids mourn through energy. She recommends child-focused grief programs for all grieving children and teens.

Pediatricians and child psychologists believe family and friends are mainstays for helping children through such a difficult period. Sometimes child- and family-focused grief programs are recommended.

Adolescents

Adolescents’ brains are still developing. By middle school, adolescents understand what death is physically. Their thinking is still concrete. Their concerns are often about how death affects them. For example, the loved one will not see them graduate. By high school, teens understand death the way adults do. However, they may not have the coping skills of adults.

Most adolescents believe nothing bad can happen to them. The death of someone they know shakes that belief. They may feel unstable or betrayed. Negative reactions may include:

• Pulling away from friends and family
• Drinking alcohol or using drugs
• Reckless sexual activity
• Ignoring laws or safety rules
• Cutting or hurting themselves
• Depression
• Increase in existing behavioral health issues
• Suicide

At the grief center, Delp met a girl whose mother had cancer. The girl made a mask to show how she felt. The front of the mask she painted was what she showed the world. It was calm, positive, and in control. The back was how she felt. It was black and white with gashes of colors. She wrote the words death, anger, and fear.

Adolescents need to express their grief. Spending time with friends or other grieving teens makes them feel less alone. Children’s grief centers often have programs that use this and other methods to help teens with grief.

Adults

Most information about grief describes adult grief. Experts describe adult grief in stages, steps, or tasks. Feelings like shock, sadness, anger, insomnia, nausea, and confusion are common. There is no wrong way to grieve. Most adults work through grief and adjust to life after a loss. Others get stuck or feel worse. They may need professional help. Information about adult grief is widely available.

Older adults

Older adults may have a hard time with grief. Their friends may be dead or far away. Family members are not always around. Poor health, isolation, and dependence on others increase grief. Seniors may have lost the person they always turn to—their spouse or partner. They may question their identity now that they are alone. End-of-life decisions can be stressful or confusing, especially if they are in shock.

Mila Tecala, MSW, at The Center for Grief and Loss in Washington, DC, warns that grief causes “physical havoc” for older adults. They may have new health issues or pre-existing conditions can worsen. Tecala says these are physical signs of built up stress.

Loneliness, low energy, and anxiety are common among grieving seniors. Studies suggest many seniors report seeing, hearing, and talking to loved ones who have died. It may seem strange, but experts say these thoughts and actions are comforting and can help seniors feel connected to loved ones. This may help them continue living satisfying lives.

By Beth Landau

©2015-2019 Carelon Behavioral Health

Source: American Cancer Society, www.cancer.org; American Psychological Association, www.apa.org; American Society of Clinical Oncology, www.cancer.net; Grimby, A. (1993) ﾓBereavement among elderly people: grief reactions, post-bereavement hallucinations and quality of life.ﾔ Acta Phsychiatra, 87(1):72-80; Leslie Delp, Founder and Bereavement Specialist at Oliviaﾒs House; Mila Tecala, MSW, Center for Grief and Loss in Washington, DC

Reviewed by Joan Narad, MD, FAACAP, FAAP, Medical Director, Beacon Health Options

Summary

• Children’s behavior may not match their feelings.
• Being straightforward and honest will make them less scared.

Children’s brains are not fully developed. They do not grieve the way adults do. Though it can be hard, you can help a grieving child. Children usually grieve a little at a time.

Children’s grief

Leslie Delp is a founder and bereavement specialist at Olivia’s House, a nationally recognized grief and loss center for children. She says children have their own process when they lose a loved one:

• Shock and numbness: Children may have no immediate reaction. Their brains cannot process this new information.
• Reboot: Their brains catch up. They experience a wide range of good and bad emotions. Anger is common. They begin to think about the loss.
• Mourning: Their grief comes to the surface. They outwardly express their pain with their behavior.

Also, Delp says, children will revisit their grief and need support as they grow, including important dates or events.

Children’s actions may not match how they feel. Delp calls to mind a duck gliding across the water. On the surface, the duck glides along. Underneath, his legs and feet work furiously. Even children who seem fine need help coping.

Be honest

Be honest about death, or your child may fill the gaps with incorrect and dramatic ideas. Trade unclear terms, like passed away, for real terms, like died. Share your family’s beliefs about life and death. Books may be helpful. There are many age-appropriate children’s books on grief and death.

Ask your child if she wants to go to the funeral, and respect her wishes. Tell her what will happen. Delp compares bringing an unprepared child to a funeral to a woman having a baby with no preparation. Fear and uncertainty make the experience harder. Viewings and upset adults may seem scary. Arrange for her to leave whenever she wants under the care of a designated friend or relative. Children often want to share in the ritual or observance that may even include a drawing or memento.

Communicate

Talk to your child about how he is feeling. Share your feelings. Some good things to say are:

• I care about you.
• I am sorry your loved one died.
• I do not know how you feel but I want to know.
• I am here if you want to talk.
• It is OK not to talk about it all the time.
• Tell me about the loved one.
• Tell me how you are doing.
• Tell me what else is happening in your life.
• I would love to do something fun with you.

Be consistent

Children need to know life will go on. Routines, schedules, and limits make children feel safe. Be kind and help your child cope, but return to routines, schedules, and limits as soon as possible. Encourage your child to return to their regular activities. Your child needs to know that not everything has changed.

Find coping activities

Help your child express his grief in a safe and useful way:

• Cut out random words and pictures, and let your child show you his story.
• Older children can talk to peers or digitally record their story in a video to share or keep private.
• Plant a tree.
• Keep a scrapbook.
• Find opportunities to exercise to express angry feelings.

Join your child. Do the activities together. Or do them separately and share the final product, how you did it, and how it made you feel.

Get help

Talk to your child’s pediatrician. She may have some good ideas. Not everyone needs professional help, but behavioral health professionals can offer guidance and treatment. Also, grief centers can give your child a safe and neutral space to explore her grief. Some grief centers have programs for parents of grieving children, too.

By Beth Landau

©2015-2019 Carelon Behavioral Health

Source: American Psychological Association, www.apa.org; Leslie Delp, Founder and Bereavement Specialist at Oliviaﾒs House; Substance Abuse and Mental Health Services Administration, www.samhsa.gov

Summary

• Support is crucial when grieving makes daily life hard.
• Expressing your grief, honoring your loss, and taking care of yourself can help you cope.

Grief is a natural reaction to loss. As we grieve, we must deal with our grief and continue with day-to-day life. This can be hard when we feel strong emotions or physical symptoms of grief. These coping tips will help you during the grieving process.

Get support

Do not grieve alone. Even strong people need help in hard times. Find support from friends and family. You may want to talk about the loss with them. Accept help. It is OK to let someone else do the dishes or bring in the mail.

Your support network may be bigger than you think. Do you go to a church, temple, or mosque? Religious communities can be a source of support after a death. Clergy and congregation members often want to help. Familiar traditions or prayers can be soothing.

Consider joining a support group or finding a grief center. It can be comforting to be around other people who have had a similar loss. Look locally and online.

Grief counselors or therapists can be helpful. These professionals understand what you are going through. Their job is to support you while you grieve.

Grieve your own way

Each person’s grieving process is unique. You may feel shock, anger, and sadness. You may have a dry mouth, nausea, and shortness of breath. These feelings are temporary.

Let yourself feel the emotions of grief. Trying to skip grieving can cause behavioral and physical health issues, like depression or unhealthy drug or alcohol use.

Express what you are feeling or thinking. Keep a journal or speak to a close friend. Consider sharing your loss story with multiple people by talking or writing in a journal or blog. Create art that expresses your feelings.

Take care of yourself

Grief is stressful. Take care of your body and mind. Rest and nutrition are key. Eat healthy food. Sleep can be difficult, so rest when you can. Exercise helps with sleep, appetite, and mood. Take care of any health conditions you have. Pamper yourself with hot baths or a massage. Do an activity you enjoy. Drugs and alcohol can be dangerous crutches in hard times. Treat yourself the way you would treat a beloved friend.

Honor your loss

Moving on can be scary or feel like a betrayal. Finding small ways to honor your loss can help you move on.

A token is a small item that stands for something larger. People collect magnets from places they visit. They remember their trip when they look at their magnets. A token can stand for whatever you have lost. Elise kept her grandfather’s coffee cup when he died. Using it makes her feel closer to him. A nameplate from your old office can symbolize a job. A picture of your childhood home can symbolize your youth or family.

A ritual is an action that stands for ideas or thoughts. They help people feel connected to people or things they have lost. Rituals can be single or repeated events. Examples are:

• Planting a tree of remembrance
• Writing your loved one a letter
• Keeping a scrapbook
• Designing or sewing a memory quilt
• Wrapping and donating a gift to a charity for birthdays or holidays

When to seek professional help

Most people go through the natural grieving process and move on. Sometimes grief becomes complicated. Instead of fading, it may get stronger or turn into depression. Mila Tecala, MSW, at The Center for Grief and Loss in Washington, DC, says people dealing with complicated grief usually need professional help.

Signs you need professional help include:

• Obsessing about the loss
• Strong anger, sadness, guilt, or self-blame that does not fade
• Pretending or believing the loss did not happen
• Avoiding reminders of the loss
• Feeling life is empty or meaningless
• Thoughts of suicide

Do not ignore symptoms of complicated grief or depression. Without treatment, they can cause long-term emotional and physical issues. Treatments include cognitive, behavioral, emotion-focused, solution-focused, and narrative therapies. Treatment may also include the use of antidepressants or other medications. A mental health professional will help find the right treatment for you.

By Beth Landau

©2015-2019 Carelon Behavioral Health

Source: American Cancer Society, www.cancer.org; American Psychological Association, www.apa.org; Humphrey, K.M. (2009) ﾓCounseling strategies for loss and grief.ﾔ American Counseling Association; Mila Tecala, MSW, Center for Grief and Loss in Washington, DC; Substance Abuse and Mental Health Services Administration, www.samhsa.gov; The Wendt Center for Loss and Grieving, www.wendtcenter.org

Grief is the normal response of sorrow, emotion and confusion that comes from losing someone or something important to you. It is a natural part of life. Grief is a typical reaction to death, divorce, job loss, a move away from family and friends, or loss of good health due to illness.

How does grief feel?

Just after a death or loss, you may feel empty and numb, as if you are in shock. You may notice physical changes such as trembling, nausea, trouble breathing, muscle weakness, dry mouth or trouble sleeping and eating.

You may become angry—at a situation, a particular person, or just angry in general. Almost everyone in grief also experiences guilt. Guilt is often expressed as “I could have, I should have and I wish I would have” statements.

People in grief may have strange dreams or nightmares, be absent-minded, withdraw socially or lack the desire to return to work. While these feelings and behaviors are normal during grief, they will pass.

How long does grief last?

Grief lasts as long as it takes you to accept and learn to live with your loss. For some people, grief lasts a few months. For others, grieving may take years.

The length of time spent grieving is different for each person. There are many reasons for the differences, including personality, health, coping style, culture, family background and life experiences. The time spent grieving also depends on your relationship with the person lost and how prepared you were for the loss.

How will I know when I’m done grieving?

Every person who experiences a death or other loss must complete a four-step grieving process:

• Accept the loss
• Work through and feel the physical and emotional pain of grief
• Adjust to living in a world without the person or item lost
• Move on with life

The grieving process is over only when a person completes the four steps.

How does grief differ from depression?

Depression is more than a feeling of grief after losing someone or something you love. Clinical depression is a whole body disorder. It can take over the way you think and feel. Symptoms of depression include:

• A sad, anxious or “empty” mood that won’t go away
• Loss of interest in what you used to enjoy
• Low energy, fatigue, feeling “slowed down”
• Changes in sleep patterns
• Loss of appetite, weight loss or weight gain
• Trouble concentrating, remembering or making decisions
• Feeling hopeless or gloomy
• Feeling guilty, worthless or helpless
• Thoughts of death or suicide or a suicide attempt
• Recurring aches and pains that don’t respond to treatment

If you recently experienced a death or other loss, these feelings may be part of a normal grief reaction. But if these feelings persist with no lifting mood, ask for help.

Source: U.S. Department of Health and Human Services

Summary

• Take care of your body immediately.
• Let go of blame.
• Expect a variety of emotions.
• Try to express to loved ones how they can help you heal.

Someone who means well may tell you it’s for the best. It wasn’t meant to be. You’ll have more chances. It’s nature’s way. It’s common.

But these words may not bring you solace if you’ve had a miscarriage. You may not find quick comfort in this article either, but read on to learn more about the physical and emotional aspects of miscarriage, including feeling alone in your grief. Try to accept that whatever you go through after such a loss is likely normal and will get better over time.

The body

One aspect of miscarriage is the potential trauma to the body. The nature and severity of symptoms vary for each woman and depend on how advanced the pregnancy is. (After 20 weeks, the loss is called a stillbirth.) Miscarriage may include some of these symptoms:

• Vaginal bleeding and/or passing of clots
• Mild to heavy abdominal cramps
• Back pain
• Fever

If you are pregnant and have the above symptoms, call your doctor right away. Please be aware that not all vaginal bleeding and cramping signify a miscarriage. Your doctor may recommend an ultrasound and blood test to determine if you are still pregnant. If you’re not still pregnant and she suspects that not all pregnancy tissue was expelled, she may suggest a D & C (dilation and curettage).

You may need emergency care if you have:

• Heavy bleeding with more than two soaked pads an hour for more than two hours
• Fever and chills: although rare, this may indicate an infection in the uterus

The mind

It’s normal to focus on your physical symptoms at first. A miscarriage can be painful and involve a scary amount of blood loss. Over time you may focus on other thoughts. While the following are normal, they are not necessarily valid or helpful:

• Blaming yourself or someone/something else for the loss
• Worrying about future miscarriages or infertility
• Feeling overprotective of children you already have; worrying about another loss

It is highly unlikely that you or anyone else is responsible for the miscarriage. Miscarriage is considered a natural process that ends what would not have been a healthy pregnancy. It doesn’t mean you will be unable to conceive and have healthy children in the future.

The heart

You weathered the storm of physical loss and perhaps have quieted the blaming, fearful thoughts. But the fact is, you lost a baby. Even if the doctor tells you that your body produced and expelled an empty placenta, you lost the hope and dream of that baby. You can expect just about any emotion after having a miscarriage. Grief and stress play themselves out in our hearts and feelings in different ways. It’s important that you allow yourself to feel. After a loss, you may feel:

• Sadness: from mild sorrow to overwhelming despair
• Crying/mood swings
• Anger
• Anxiety
• Relief: don’t feel guilty for this one
• Guilt
• Isolation/loneliness
• Exhaustion/listlessness
• Depression/hopelessness

Find a loved one or counselor and talk about your feelings. Many areas have support groups and help lines for women who miscarry. Although the above feelings are normal while grieving, you need medical attention if the depression doesn’t lift over time or if you feel like taking your own life.

Recovering

Losing a baby that has yet no form nor face is hard for others to relate to. But you may feel the loss as deeply as losing any loved one. Unfortunately, you may feel alone in your grief. Let others know how they can help you heal. Only you know whether you need time to yourself or to be with loved ones.

You might try some of the following:

• Let yourself cry about the loss.
• Say a special prayer or have a time of devotion for the little one you lost.
• Keep a journal and write down all of your feelings during this time.
• Write a letter to the child you never got to know.
• Make a donation to a local pregnancy center in honor of the baby you lost.
• Take time off work for a few days or even weeks and let yourself grieve.
• Plan what you will do to support a woman you love if she has a miscarriage.

Include your spouse or partner in your healing process. He or she needs to know how you feel and what he or she can do to help. Allow him or her to grieve as well. Such a loss can cause stress in your relationship. You both need to make an effort to support each other and to allow each other to cope in different ways.

Nurture yourself and let others pamper you for a little while. Your body, mind, and heart need time to get better. It’s easy to accept TLC right after giving birth to a healthy baby. You may need just as much love and support or more after losing the baby that you never held in your arms.

Resources

International Council on Infertility Information

Compassionate Friends

Miscarriage Association (U.K.)

By Laurie M. Stewart

©2002-2022 Carelon Behavioral Health

Source: International Council on Infertility Information, WebMD

If you or your loved one experienced the devastating loss of a baby to stillbirth, you know the shock and heartbreak of a shattered dream. Expect to grieve. Expect to go through a time of blaming yourself or others. Expect your heart’s cry to be, “Why?” And, expect, over time, to heal—and not to forget or ever completely fill the hole in your heart reserved for the child you lost. This article offers some guidance and comfort as you attempt to cope with your loss.

For the parents

The highest concern after a stillbirth must be the parents, whether that is you or loved ones.

As the mother, you are not only overwhelmed by grief, but also going through stressful hormonal changes. You must take care of you body as you cope with shock and grief. Eat well, get plenty of sleep and go for walks or get other exercise as soon as your doctor allows.

As the partner, you must allow yourself to grieve and draw support from your loved ones.

You both must take care of your emotional needs. Talk, cry, write in a journal, pray—find helpful ways to express your grief. If possible, meet with a grief counselor for extra support in this difficult time.

For everyone who grieves

Do not let the siblings, grandparents, etc. go ignored. Everyone who loves the parents likely had dreams of holding, knowing and loving the baby. Each person will need, like the parents, to express their grief in a unique and beneficial way. As a family, decide how you will honor the one you lost. Some suggestions are:

• Have a funeral or memorial service for the baby.
• Plant a tree or garden in the baby’s memory.
• Write a letter to the baby.

These suggestions may not fit your family’s way of grieving at all. Never force yourselves to cope with the loss in a way that has no meaning to you. However, try not to argue about this—compromise where you can.

Some aspects of grief

From feeling flat to full-blown rage, the grief over losing a baby can throw anything your way. Some common feelings to manage when coping with a stillbirth are:

Guilt and blame: By now your doctor has probably discussed with you the potential causes of the stillbirth. This may open up an entire world of “if onlys” and blame. Medical studies suggest that a clear cause of stillbirth is determined in only half of the instances. And, few of those causes are preventable by the parents. Parents often blame a health care provider—rarely with justification. This is probably because they need to direct their grief and anger somewhere.

Simply put, you may blame yourself, a loved one or the medical staff for the tragedy. This is a normal part of grieving, and should diminish over time, especially with support from a grief counselor. Forgiveness (even when the death is no one’s fault) is an important part of your healing, so be sure to let your counselor know if you cannot let go of guilt or blame.

Depression and anxiety: It is normal for anyone affected by a stillbirth, especially the mother, to have symptoms of depression and anxiety during this time and for months to come. Your doctor, grief counselor or mental health provider can help you with these symptoms. Get immediate help if you feel suicidal. Call 988 to connect with free crisis support.

Accepting painful choices

Adding to your distress might be doubts about whether you made the right decisions about factors such as:

• Holding your baby at the hospital
• Having yourself and/or the baby tested after the stillbirth to search for causes
• Keeping hospital photos, footprints or other mementos of your baby
• Naming your baby

Be kind to yourself and accept that, in the midst of your shock and heartbreak, you did the best you could at the time. If you change your mind, some decisions may be reversible. The hospital may still have the photos and footprints, for example.

You will continue to encounter choices that affect your grief:

• How to let everyone know—be prepared for well-meaning casual acquaintances to ask joyfully about your new baby
• What to do with the crib, clothing and other baby items you might have at home
• How you will deal with close family members and friends who have babies shortly after your loss
• Whether you want to get pregnant again in the future

You don’t have to have all the answers or perfect responses now, if ever. Right now you need to take care of your health, surround yourself with all the loving support that you can, and allow your grief to run its course over the next days, months and years.

Resources

Pregnancy and Infant Loss Remembrance Organization

Share: Pregnancy and Infant Loss Support

By Laurie M. Stewart

©2007-2022 Carelon Behavioral Health

When a loved one dies by suicide, emotions can overwhelm you. Your grief might be heart wrenching. At the same time, you might be consumed by guilt, wondering if you could have done something to prevent your loved one’s death.

As you face life after a loved one’s suicide, remember that you don’t have to go through it alone.

Brace for powerful emotions

A loved one’s suicide can trigger intense emotions. For example:

• Shock. Disbelief and emotional numbness might set in. You might think that your loved one’s suicide couldn’t possibly be real.
• Anger. You might be angry with your loved one for abandoning you or leaving you with a legacy of grief, or angry with yourself or others for missing clues about suicidal intentions.
• Guilt. You might replay “what if” and “if only” scenarios in your mind, blaming yourself for your loved one’s death.
• Despair. You might be gripped by sadness, loneliness or helplessness. You might have a physical collapse or even consider suicide yourself.
• Confusion. Many people try to make some sense out of the death, or try to understand why their loved one took their life. But, you’ll likely always have some unanswered questions.
• Feelings of rejection. You might wonder why your relationship wasn’t enough to keep your loved one from dying by suicide.

You might continue to experience intense reactions during the weeks and months after your loved one’s suicide, including nightmares, flashbacks, difficulty concentrating, social withdrawal and loss of interest in usual activities, especially if you witnessed or discovered the suicide.

Dealing with stigma

Many people have trouble discussing suicide, and might not reach out to you. This could leave you feeling isolated or abandoned if the support you expected to receive just isn’t there.

Additionally, some religions limit the rituals available to people who’ve died by suicide, which could also leave you feeling alone. You might also feel deprived of some of the usual tools you depended on in the past to help you cope.

Adopt healthy coping strategies

The aftermath of a loved one’s suicide can be physically and emotionally exhausting. As you work through your grief, be careful to protect your own well-being.

• Keep in touch. Reach out to loved ones, friends and spiritual leaders for comfort, understanding and healing. Surround yourself with people who are willing to listen when you need to talk, as well as those who’ll simply offer a shoulder to lean on when you’d rather be silent.
• Grieve in your own way. Do what’s right for you, not necessarily someone else. There is no single “right” way to grieve. If you find it too painful to visit your loved one’s gravesite or share the details of your loved one’s death, wait until you’re ready.
• Be prepared for painful reminders. Anniversaries, holidays and other special occasions can be painful reminders of your loved one’s suicide. Don’t chide yourself for being sad or mournful. Instead, consider changing or suspending family traditions that are too painful to continue.
• Don’t rush yourself. Losing someone to suicide is a tremendous blow, and healing must occur at its own pace. Don’t be hurried by anyone else’s expectations that it’s been “long enough.”
• Expect setbacks. Some days will be better than others, even years after the suicide, nd that’s OK. Healing doesn’t often happen in a straight line.
• Consider a support group for families affected by suicide. Sharing your story with others who are experiencing the same type of grief might help you find a sense of purpose or strength. However, if you find going to these groups keeps you ruminating on your loved one’s death, seek out other methods of support.

Know when to seek professional help

If you experience intense or unrelenting anguish or physical problems, ask your doctor or mental health provider for help. Seeking professional help is especially important if you think you might be depressed or you have recurring thoughts of suicide. Unresolved grief can turn into complicated grief, where painful emotions are so long lasting and severe that you have trouble resuming your own life.

Depending on the circumstances, you might benefit from individual or family therapy, either to get you through the worst of the crisis or to help you adjust to life after suicide. Short-term medication can be helpful in some cases, too.

Face the future with a sense of peace

In the aftermath of a loved one’s suicide, you might feel like you can’t go on or that you’ll never enjoy life again.

In truth, you might always wonder why it happened, and reminders might trigger painful feelings even years later. Eventually, however, the raw intensity of your grief will fade.

Understanding the complicated legacy of suicide and how to cope with palpable grief can help you heal, while still honoring the memory of your loved one.

©2020 Mayo Foundation for Medical Education and Research

Men are sometimes called “the forgotten grievers” when it comes to miscarriage because attention tends to be focused on the woman, who has experienced the physical loss. However, research indicates that men experience an acute emotional response to the loss of the pregnancy as well, including the following:

• Shock and sadness
• Worry and concern for the well-being and health of their partner
• Feelings of helplessness at not being able to fix things
• Expectations that they be strong for their partner
• Fears that intimacy within the relationship may change
• Increased time spent on work or other practicalities that feel “controllable”
• Difficulty concentrating and drop in work performance

These natural responses coupled with societal expectations that men “get on with it” can lead men to suppress their feelings, making the grief process longer and harder. By contrast, when men’s experience of loss is acknowledged and validated and they are given permission, time and space to grieve, their functioning at home and at work improves. This is especially true in the workplace, as studies show that when an employer makes efforts to support an employee in their grief, the employee’s productivity and loyalty to the company increase over the long-term.

Coping tips for men

• Talk to your partner about your feelings as a way to keep the lines of communication open. Remaining silent in order to protect your partner’s feelings can end up creating more distance and disconnection instead.
• Consider seeking out a couples’ grief support group that you can attend with your partner. Your employee wellbeing program may be able to assist you with identifying a local or virtual group.
• Write out your feelings in order to label and better understand them.
• Design a ritual that you can do with your partner to honor the pregnancy and the baby you had hoped for such as naming the baby, creating a memory box for ultrasound photos and baby items, planting a tree, creating a piece of art or jewelry, or making a donation to a charitable organization or cause.
• Ensure you are getting adequate nutrition, sleep and exercise.
• Consider reaching out to your employee wellbeing program for support.

How can employers help?

While a manager might be uncomfortable discussing the topic of miscarriage, it can be a tremendous way to support an employee’s recovery process. Above all, managers manage people and people bring a wide range of emotions to the workplace, including grief, anxiety and depression. Therefore, managers are urged to work through their own discomfort in order to support their team.

• Establish an open-door policy and demonstrate investment in and care for the employee.
• Offer a simple “I am so sorry” rather than searching for the “right” thing to say.
• Avoid statements that minimize the loss, such as “It was God’s will” or “At least you still have your other children”.
• Be sensitive in assigning new work responsibilities and consider whether existing responsibilities can be temporarily reassigned.
• Send a condolence card/flowers to acknowledge the loss.
• Be flexible in giving the employee extra time off to the extent possible.
• Recognize that grief is not linear, so emotions can ebb and flow over time.
• Provide the employee with information on the support available through the employee well-being program and encourage him to reach out confidentially.

©2020 Workplace Options

Summary

• The grieving process can be described as steps, stages, or a fluid experience.
• People usually move through the symptoms of grief and go on with their lives.

Grief, a reaction to loss, is a process. When people have a loss, they go through many feelings and behaviors. Experts have described the grieving process in many ways.

The five stages of grief

The most well-known description is Dr. Elizabeth Kubler-Ross’s Five Stages of Grief. In the 1960s, Kubler-Ross saw patients adjusting to death in sets of emotions in stages. Later, she said they apply to people with any loss. Common thoughts during the stages include:

• Denial: “This can’t be happening,” or, “It’s no big deal.”
• Anger: “It’s not fair,” “Why me?” or, “Whose fault is this?”
• Bargaining: “Let it be me, instead,” or, “If he gets better, I will never complain again.”
• Depression: “I can’t go on without her,” or “What’s the point of trying?”
• Acceptance: “If I can’t change it, I have to deal with it,” or, “I can handle this.”

Stages may not happen in order. People move in and out of each stage, sometimes repeating stages.

Three-stage model of grief

In the 1970s Dr. Roberta Temes created a three-stage model of grief. They are:

• Stage 1: Numbness or impact. At first, people may not understand the loss. They may feel shock, disbelief, or like time is moving too fast or too slowly. Decision-making is hard.
• Stage 2: Recoil or depression. Then, people begin to understand their loss. They react with many emotions, such as anger, sadness, anxiety, or a wish for life to be normal again. Socializing and staying organized may be hard.
• Stage 3: Recovery. Eventually, people accept the loss and move on. Memories of their loved ones do not get in the way of daily life.

Four tasks of mourning

In recent years, Dr. J.W. Worden studied why people grieve. His Four Tasks of Mourning describe things people must do to adjust to death or other losses. They are:

1. Accept the reality of the loss. People must understand the loss is real.
2. Experience the pain of grief. People must let themselves feel bad.
3. Adjust to an environment in which the deceased is missing. People must learn to live without the person who has died.
4. Find an enduring connection with the deceased and move on with life. People must find a way to stay connected to the person who has died.

Complicated grief

Generally, people go through the grieving process and adjust to their losses. Mila Tecala, MSW, at The Center for Grief and Loss in Washington, DC, gives the example of a boy’s 90-year-old grandfather who died after a long illness. The grandfather lived a long, full life and his death was expected. The boy will likely have a simple grief. He will work through his grief and move on.

Sometimes people have a hard time adjusting to their losses. This is complicated grief. People with complicated grief may act like their loss did not happen. Others obsess about the loss. Sadness and guilt may change to depression. People may avoid work, school, or social events. Other symptoms of complicated grief include:

• Long lasting numbness, guilt, anger or blame
• An unrealistic desire for the lost person or thing to return
• A wish to die with the lost loved one
• Avoiding reminders of the loss
• Feeling life is over or no longer has meaning

Ms. Tecala gives the example of a young man who dies in a car accident. His mother, who gave him the car for graduation, is shocked. She raised her son and he was just starting his adult life. She loves her son very much. She also feels responsible because she gave him the car. She is likely to have more complicated grief. Her guilt may make it hard for her to adjust, and she may need professional help.

Some deaths are more likely to cause complicated grief. Some causes of complicated grief include:

• Sudden or violent losses
• New disabilities
• Loss of a child or sibling
• LGBT-related losses
• Homicide
• Suicide

People with complicated grief usually need professional help to adjust to their losses. Options include grief centers, counselors, and therapists. Some people find it helpful to talk to their pastor, priest, rabbi, or clergy members.

By Beth Landau

©2015-2019 Carelon Behavioral Health

Source: American Cancer Society, www.cancer.org; American Psychological Association, www.apa.org; Mila Tecala, MSW, Center for Grief and Loss in Washington, DC; The Wendt Center for Loss and Grieving, www.wendtcenter.org

Summary

• Grief is a reaction to loss of any kind.
• Every person grieves differently so there is no normal, right, or wrong way.
• Understanding grief and finding the right support helps people adjust to loss.

Grief is a reaction to loss. It is how people feel when someone dies or when they have other life changes. There are many emotional and physical symptoms. People may feel numb, sad, shocked, angry, guilty, or afraid. They may have a dry mouth, nausea, insomnia, or lack of hunger. They may experience dreams or nightmares. These feelings may last for days or months.

Grief is very personal. People grieve in their own ways for different lengths of time. The symptoms and intensity varies. The relationship, the conditions of the loss, the person’s personality, and culture all affect how a person grieves. Mila Tecala, MSW, at The Center for Grief and Loss in Washington, DC, is a nationally recognized grief and loss expert. She says the relationship and the conditions of the loss affect a person’s grief the most.

For instance, Sidney was very sad when his daughter left for college. He knew it was a good change, but he missed talking with her. He felt that a part of his life was over. Luckily, he knew this was coming. He had spoken to other parents and knew what to expect. His daughter called home for advice and came home for visits so he was able to adjust to this loss.

Meanwhile, Gina and her family lost their home and belongings in a fire. Their lost jewelry, pictures, and documents could not be replaced. The fire was unexpected, so Gina was not prepared. They had nowhere to go. Her sense of security was gone. Everything that comforted her and her family was lost. Gina’s grief lasted long past the time it took to restart their lives. It took over a year and professional support to adjust to this loss.

Loss

Most people associate grief with death. There is a name for this kind of grief: bereavement. But many types of losses cause grief. They include loss of a job, a pet, or a friendship. Divorce and rejection are also common causes of grief. Even positive changes can create loss. A job promotion to a new city may be good, but you are leaving your home. You are losing your daily routine. Grief applies to any loss, good or bad.

Some examples of other losses include:

• Miscarriage or abortion
• Rape
• New disability
• Loss of financial security
• Loss of lifestyle
• Graduating from school
• Friends moving away
• Physical or mental changes due to age

Ways to look at grief

Grief is a process. People pass through different feelings as they adjust to losses. Experts do not agree about how to describe grief. Some experts see grief as a cycle or ordered stages. In the 1960s, Dr. Elizabeth Kubler-Ross saw a pattern in the way people grieve. Her Five Stages of Grief describes a cycle of stages. They are denial, anger, bargaining, depression, and acceptance. In 1977, Dr. Roberta Temes shared her three-stage model. The stages are: numbness or impact, recoil or depression, and recovery. Still others describe grief as a fluid process that cannot be put into steps.

Child and adolescent grief

Children grieve in different ways, and might change quickly. For example, they may express sadness with tears or withdrawal but then go out to play. Much depends on the closeness of the lost relationship or suddenness of change to which they must adapt. Children may seem fine when they are not. But it is important that they receive support to help them adjust.

Adolescents’ brains are still developing, and they do not always know how to cope with strong feelings. They frequently go beyond the immediate family to seek comfort. They may share feelings with friends, teachers, or coaches. That support system could be very strong. Where coping skills are less developed, adolescents may resort to risky behaviors such as using alcohol or drugs, or ignoring safety rules. Music, drawing, writing, and exercise can be used to express feelings.

Understanding loss, death, grief, and mourning are skills that all children and adolescents need to develop as they grow up.

Complicated grief

Some people have a hard time adjusting to their losses. Their feelings and behaviors of grief may linger or not go away. This is called complicated grief. People with complicated grief may act like their loss did not happen. Others may not be able to stop thinking about the loss. Sadness and guilt may change to depression. Complicated grief makes it hard to get back to daily life. People may avoid work, school, or social events. People with complicated grief need professional help to learn to live with their losses.

By Beth Landau

©2015-2019 Carelon Behavioral Health

Source: American Psychological Association, www.apa.org; Goodman, Robin; Mila Tecala, MSW, Center for Grief and Loss in Washington, DC; Temes, R. Living with an Empty Chair. Irvington Publishers, 1991; Wright, P.M., Hogan, N.S. (2008) ﾓGrief Theories and Models: Applications to Hospice Nursing Practice.ﾔ Journal of Hospice and Palliative Nursing. 10(6): 350-356; Zisooki, S., and Shear, K. (2009) ﾓGrief and bereavement: what psychiatrists need to know.ﾔ World Psychiatry, 8(2): 67ﾖ74.

Summary

• Know what not to say.
• Be there and listen.
• Offer specific help.
• Accept that they are changed forever.

The death of a child may be every parent’s worst nightmare. For the parent’s friends and loved ones it’s something less, but it still can be painful, frightening and disruptive to longstanding personal relationships. No one really wants to think about it, few seem willing to talk about it, and old friends often seem suddenly uncomfortable in the presence of the bereaved.

Experts in dealing with bereavement, including parents who have been through the loss of a child, say parents need and welcome contact with others. Social isolation worsens the pain of grief and makes healing that much harder. 

But what should you say? That question makes many people so uncomfortable that they start avoiding anything more than casual contact with the grieving parent.

What not to say

There are certain things you should not say. Topping the list is “I know how you feel.” You certainly don’t know if you’ve never lost a child.

Fellow bereaved parents can be valuable for emotional support, but even those who have been through similar tragedies are advised to tread lightly in trying to claim some emotional common ground. People who’ve lost children might say, “I share your grief,” but they shouldn’t presume to go further, because everyone’s experience is different.

Some well-meaning comments can be more hurtful than helpful. Examples are: “Time heals all wounds,” “It was God’s will,” “You should have another baby,” “Aren’t you over it yet?”

Be there

In spite of these pitfalls, however, the task of giving comfort is actually quite simple. One does not need to say much at all, since what grieving parents really need is someone who will listen—and not be frightened away by their grief.

Say “I’m so sorry,” and be there for them. And when you offer to help, be specific. Say you’re going over to their home at a specific time, for instance, for a specific task. Don’t say, “If there’s anything I can do, just let me know.” You won’t be called.

Share memories

It’s also comforting to share memories about the child—mentioning them by name. Parents want to hear the name. Memories could well bring tears, but tears are better than silence.

Keep in mind it’s a lifelong change

Parents never really “get over” the death of a child. The tragedy changes them forever, and old friends sometimes cannot accept the change.

Many people, with the best of intentions, fail to grasp how long the grieving process takes. They may figure that a year is about enough, but the second year in some ways can be even harder than the first. It is then that grieving parents begin to realize that this is a lifelong thing. People will still ask how they’re doing, but this time they hope they’re doing OK. But things may actually be getting worse. Don’t  assume that the calendar dictates.

By Tom Gray

©2002-2021 Carelon Behavioral Health

Source: Rob Zucker, editor, Grief and Healing newsletter, Northampton, MA; Tom O’Neill, family support specialist, Children’s Care and Comfort Program, Children’s Medical Center, Dayton, OH; Julane Grant

Summary

• Losing a child, a spouse or partner, or a sibling leaves a hole in your life.
• Each type of loss comes with its own special concerns.

When our loved one dies, the death leaves holes in our life. Losing a spouse or partner, a child or a sibling may seem unbearable. Each loss is hard for different reasons.

When a spouse or partner dies

We have intimate relationships with our spouse or partner. When your spouse or partner dies, you may feel abandoned or angry. You may not remember what it is like to be alone.

You will have to deal with end-of-life paperwork and decision-making. Even if you are in shock or want to grieve privately, these tasks must be done. Many legal and financial matters cannot wait. This can be very stressful, so bring support. Consider friends, family, or professionals you have worked with before.

Couples play different roles and have their own family duties. When your partner dies, you have to handle it all. These changes may make you feel out of control. If you become overwhelmed, slow down. You do not need to figure out every detail right away.

You may feel scared or vulnerable after your partner dies. This feeling may pass, but you can double-check your home security. Lock up at night. Get outside lights. Adopt a dog. Spend time with other people to feel less alone and more secure.

You may not know how to spend your time without your partner. Return to previous work or activities as soon as you are ready, or seek new ones. Take a class. Volunteer. Find a way to help others. Get a part-time job. Having something to do every day will give you a sense of purpose and keep you from feeling isolated.

If you need help adjusting, look to bereavement groups. Other people who have lost spouses or partners understand the highs and lows of your grief. Counselors and social workers can also help you transition to a more independent life.

When a child dies

No one is prepared to lose a child. Even if the child has been ill and the death was expected, it is a shock. Expect strong emotions and physical symptoms of grief, such as:

• Disbelief
• Extended numbness or shock
• Anger at others or yourself
• Guilt for not saving the child or that you are still alive
• Anxiety or panic attacks
• Feeling that your life is crumbling
• Questioning your identity
• Being overly protective of other children

If you have a miscarriage, a stillborn child, or an abortion, you can expect to grieve. It does not matter that you never met your child. Leslie Delp, Founder and Bereavement Specialist at Olivia’s House, a nationally recognized grief and loss center for children, says these losses are disenfranchised. People do not want to talk about them or do not know what to say. They may not understand the depth of your loss. There are support groups specifically for these types of losses.

Do things in your own time. Clean out your child’s room or give away her belongings only when you are ready. They may comfort you at first. When it is time, have someone you trust keep you company.

When a sibling dies

People have special bonds with their brothers and sisters. No one understands you or your family like your siblings. Sadly, you may find you get little support when your sibling dies. Find someone who understands this is a significant loss. You have as much right to grieve as your parents or your sibling’s partner or children.

Rivalry is a natural and common among siblings. You may feel guilty about the way you treated your sibling or regret times you were unkind. Remind yourself that you and your sibling loved each other even when you were not getting along.

Your role in the family may change when your sibling dies. If you become an only child, you may worry about taking care of aging parents by yourself. You may be pressured to take over your sibling’s role. This can be stressful and cause distress in your family. Do not panic. You will figure out where you stand as time passes.

By Beth Landau

©2015-2019 Carelon Behavioral Health

The word grief is most often used to talk about how people feel when someone dies. Grief is actually a reaction to any loss. Some losses are easy to recognize. Examples include the death of a loved one, divorce, or the loss of a pet. Other losses are harder to recognize or understand. Examples include getting a dream job, moving to a nicer house, or graduating from school.

Other common life changes that cause grief and loss include:

• Serious illness or disability
• Social rejection
• Loved one sent to jail
• Job promotions or rejections
• Relocating
• Retirement
• Adopting or having a baby
• Losing a beloved pet

Most life changes interrupt day-to-day life and disrupt daily routines. People rely on routines to make sure they get to work, take children to school, or eat nutritious meals. They know what to do and how to behave because they do it that way every time. It helps people feel secure. Losing a routine means losing the security. People may not know how to do things differently. Their roles or responsibilities may change. The loss of a routine often affects every part of our lives.

When life changes, so do relationships. Relationships within families or friends change after a death. Friends or family may pull away from each other. A person would become an only child if a sibling dies. Other children may feel forgotten when a new child is born or adopted. Also, moving means finding new friends and building new support systems. Retirement can shift roles within the family. Graduating from school can mean starting a new life from scratch.

Types of changes that cause loss

Changes at work include getting fired, getting a promotion, retiring, and moving. Losses can include:

• Job security
• Financial safety
• Lifestyle
• Home or community

Changes in your family include marriage, divorce, having or adopting a child, a child moving out, and a loved one’s drug use disorder. Losses can include:

• Lifestyle
• Financial stability
• Sense of self
• Trust
• Personal safety

Serious illnesses and new disabilities often cause many life changes. Losses can include:

• Independence and self-care
• Work
• Financial
• Roles or identity
• Social life
• Hobbies
• Friends or family members who do not understand
• Desired appearance

Violent or upsetting events can be personal or community-based. They may cause physical losses. They also change the way people see themselves or the world. Losses can include:

• Feeling of safety
• Sense of self or confidence
• Trust in people, the community, a god, or a higher power
• Daily life as it was prior to the event
• Control of one’s own body
• Power

Coping with change

It can be hard to deal with day-to-day life when change causes loss and grief. Finding the right support can help.

Friends and family. People often turn down help from friends and family members. They want to look strong. But it is not weak to accept support. Letting someone help with chores or errands can make life simpler during this hard time.

Support groups. Some people like to talk to others who have had the same loss. In-person or online support groups are good places to find this type of support. Local organizations or health care systems groups may offer free or low cost support groups.

Religious or spiritual support. Many people find support in their religious or spiritual communities. Rituals and shared beliefs can be comforting. Clergy people or other spiritual leaders may offer one-on-one or group counseling services. Many people find comfort in prayer or meditation.

Professional support. Therapists and counselors can help people who need more support. Some professionals specialize in grief services. Grief centers help people deal with grief caused by any loss. A primary care physician as well as a child’s pediatrician can offer good resources.

Decision-making

People may need to put off or get help making important decisions. Grief can make it hard to focus or see the big picture. They should see if making the decision can wait until they feel more like themselves. If decisions cannot wait, it is a good idea to find an advocate to help guide them.

By Beth Landau

©2015-2021 Carelon Behavioral Health

Source: American Psychological Association, www.apa.org; American Society of Clinical

It is never easy to console someone whose spouse has died, but it can be especially challenging when the deceased is your parent. How can you comfort your surviving parent while dealing with your own loss?

It may help you to remember that every person experiences grief differently, and that losing a spouse isn’t the same thing as losing a parent. You shouldn’t assume that you know exactly how your surviving parent feels. Try to be understanding and patient.

You can help by:

• Attending to their physical needs
• Listening and encouraging your parent to talk about the spouse who passed away
• Making sure your parent gets the care they need
• Patiently allowing your parent to express their grief
• Remembering and acknowledging important dates and anniversaries

It’s not always easy to do these things, however. And because you have to deal with your own loss, you may be frustrated as you try to help your parent move on with their life. As part of the grieving process, your parent may experience depression, forgetfulness, disorganization, preoccupation with the loss and a lack of interest in or motivation to pursue activities that were previously enjoyed. Or maybe you’re having trouble letting go, and you resent the fact that your surviving parent has given away your late parent’s clothes. In either case, tensions may be driving you apart at a time when support is most needed.

In addition to support and time to mourn, both you and your surviving parent need plenty of rest, nutritious meals and exercise. Try to make sure you both get these things. Staying healthy will help your body handle the stress these emotions can cause.

Take care of yourself

A lot of responsibilities may be thrust upon adult children when a parent dies. They may be expected to make funeral arrangements, do all the paperwork or start caring for surviving parents.

However, it’s important that you take time for your own grief. You might want to join a support group. You should also let your friends and other family members know what your needs are: Do you need to talk or blow off steam about your surviving parent?

As you watch out for your parent, don’t forget your own daily health routines. You should eat well, exercise and get plenty of sleep. And make sure your doctor knows what’s happened and can help monitor your health if necessary.

Finally, remember that in addition to your grief, you may also be facing feelings about your own aging and death. The death of a parent brings people face to face with their own mortality and reminds them that they are no longer children. This adjustment can be difficult.

Express your feelings appropriately, and encourage your parent to do the same. You may both feel better after a good cry, especially if you’ve shared your tears. You might also seek professional guidance. If your emotions are overwhelming, consider seeing a licensed therapist who specializes in grief.

©2021 Workplace Options