Grief and mourning are natural responses to loss. In relation to palliative care and hospice, the process of grieving and mourning begins with the delivery of bad news. Anticipatory grief sets in early as the patient and their loved ones begin to prepare for a tragic loss. Thus, it is beneficial that bereavement care begin as soon as a patient begins palliative care or hospice.
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.
One of the many benefits of hospice care is continuing grief support - bereavement support continues for up to one year after a loved ones death. 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 counceling can help survivors adjust to the multitude of changes that occur in their lives after their loss.
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. While grief is an expected and normal response to loss, severe or prolonged grief can cause problems. So what's normal and what's not?
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.
Theories on Grief
There are several theories on grief and mourning. Probably the most popular theory is the DABDA model made famous by Elisabeth Kubler-Ross. Kubler-Ross developed the theory as the "Five Stages of Coping with Death" and it applied to patients who were given a terminal diagnosis. There actually hasn't been any research that links this popular model to grief after the death of a loved one but it has gained popularity as such anyway.
Another popular theory is the Four Phases and Tasks of Grief. I personally like this model because it describes the work that one must do as they work through the pain of loss. It's important to remember that very few people actually follow one model precisely. Grief and mourning and deeply personal feelings and expressions and will thus be unique to the individual.