Studies have proven that early intervention with palliative care or hospice is not only beneficial to the patient in achieving the type of death that is most desirable to them, but also for caregivers and loved ones in identifying symptoms of grief early on and providing much needed bereavement support.
A survivor is often faced not only with grieving the loss of their loved one, but also with the loss of the variety of roles the deceased assumed during their relationship. This can be a difficult time of adjustment that affects multiple aspects of the survivors life, not the least of which is increasing financial pressures. Ongoing bereavement counciling can help survivors adjust to the multitude of changes that occur in their lives after their loss. Hospice provides this ongoing support to survivors of their patients for at least one year after death.
Grief is a bereaved person’s internal emotional response to the loss event. It has several components: physical, behavioral, emotional, mental, social, and spiritual. It is often described by those that have gone through it as a heaviness that isn’t easily lifted. It can sometimes be so pronounced that it affects a person’s physical self and can even mimic illnesses. There is a normal response to grief and an abnormal response.
Normal grief is found in the majority of survivors. It describes grief that is eventually lessened as a person readjusts to their loss. This is done with support as one moves through the four phases and the four tasks of the grief process. Grief is usually not something one “recovers” from because the loss is never regained or replaced. A grieving individual doesn’t return to the person they were before the loss; rather they usually describe their lives after loss as “different”. For some, it changes their entire identity and they will divide their lives into “before” the loss and “after” the loss.
Abnormal, often referred to as complicated grief, is found in only 3 to 25 percent of loss survivors. There are different types of abnormal grief:
- Chronic grief – the grieving person has trouble finding closure and returning to normal activities over an extended amount of time.
- Delayed grief – the intentional postponement of grief. Sometime this is related to other life events or losses that drain ones ability to work through the grief process.
- Disenfranchised grief – often occurs when a grieving person’s loss can’t be openly acknowledged or is one that society does not accept as a real. Examples include losses related to AIDS, miscarriage, or loss of a homosexual partner.
- Exaggerated grief – intense reactions of grief that may include nightmares, delinquent behaviors, phobias (abnormal fears), and thoughts of suicide.
- Sudden grief – when death takes place very suddenly without warning. Sudden grief can lead to exaggerated reactions and posttraumatic stress disorder (PTSD).
Mourning is the outward expression of grief. It is usually based on cultural, religious, or personal belief systems. Examples of mourning include visiting the gravesite of a loved one on special dates, keeping a journal or making a photo album of the deceased, and even more dramatic expressions like tearing at hair and clothes. All of these expressions are normal and it’s important to remember that mourning is a very personal expression of grief. There is no right or wrong way to do it.
Kinzbrunner BM., Weinreb NJ., Policzer JS. 20 Common Problems: End of Life Care. 2002. McGraw-Hill.