People may experience different types of grief depending the situation they are experiencing.
We all know that we’re going to die sooner or later. Some of us, however, receive advance warning. We contract a terminal illness and are given a sense of how much longer we will live. Or, almost worse, we develop a debilitating disease that robs us of our faculties, leaving us alive but helpless or unknowing, requiring constant care.
While the prospect of death or profound decline brings intense emotional turbulence, it can also be looked upon as an opportunity to prepare, to reflect, to accept — and to help those closest to us to do the same.
With the knowledge of impending death may come anticipatory grief. This form of grief is a common response to the expected loss, a type of advance bereavement. Anticipatory grief includes many symptoms similar to those that materialize after a death and can involve conflicting feelings and enormous anxiety and stress. This grief may be made more intense by unresolved issues amongst family members, and a desire on the part of the caregivers not to distress the patient. Watching a loved one experience a prolonged illness and wait for death is emotionally exhausting and can strain even the most solid of relationships. At the same time, the patient may be very upset, not only by the prospect of leaving this world but also for being the cause of such sadness, and will also grieve.
Being given the chance to say ‘good-bye’ doesn’t make it any easier to do. Anticipatory grief doesn’t lessen the grief felt after a death, nor does it diminish its duration. Indeed, the grieving process cannot be completed without the actual loss.
A grief counselor may be of great help in such situations, working not only with the person who is dying, but also the caregivers, friends and children to make the inevitable outcome somewhat easier to bear.
Complicated, or unresolved, grief is a term used to describe a prolonged sense of bereavement so intense that the person is unable to move past it. Someone caught in complicated grief may be referred to as ‘stuck’. This indicates a state of being overwhelmed by the emotions brought on by grief and an inability to come to terms with the loss. It is distinguished from a natural, earlier phase of grief in large measure by its duration.
The source of complicated grief may lie in the nature of the relationship before the death, rather than in a failure to process the event itself. When someone dies leaving issues unresolved, during an estrangement, or if the relationship was fraught with conflict, the survivor may have tremendous difficulty accepting that there can be no reconciliation.
Complicated grief establishes itself over the course several months and can become very serious. However, someone in this state is likely to be oblivious, quite unable to recognize their condition. Or, someone suffering from unresolved grief may be able to see the problem, but be unable to take steps to address it. A friend, doctor or family member may be needed to intervene so as to persuade the person that therapy is required and to guide them towards help.
Some indications that a person is suffering from complicated grief include:
- Uncharacteristically engaging in reckless behavior, such as substance abuse, heavy drinking or promiscuity.
- Sleeping habits become severely, consistently, disrupted.
- The quality of work suffers, grades drop significantly at school, or loved ones and friends are shunned.
- Talking about death and loss frequently, often in unrelated conversations.
- In the alternative, steadfastly refusing to talk about death or loss, or to engage in any conversation about the person who has died, even fond and happy memories.
- Minor events or casual observations evoke powerful, uncontrollable grief response.
- Exhibiting signs of severe depression, deteriorating self-esteem, or outright despair.
Complicated grief may develop after a death, but it can be exacerbated by past, unresolved losses. It may come to involve a tangle of long held anxiety and internal conflict that must be addressed before the bereaved person can deal with the grief associated with the recent death.
This kind of deep emotional distress can lead to trouble. A trained therapist may be able to establish a treatment program, possibly in conjunction with a doctor, which will lead the person through the grieving process to recovery.
Caring for a dying or declining loved one can unleash a barrage of conflicting emotions. Guilt, anger, depression, frustration, resentment, anticipatory grief, fear, denial — all these and more affect the caregiver. So much attention is focused on the person who is dying, by doctors, nurses and family members, that the caregiver may easily be overlooked.
A caregiver whose life has come to revolve solely around caring for a dying patient is unlikely to recognize the signs of severe stress, which can include:
- Irritability with a hair trigger.
- Susceptibility to illness; prolonged stress can weaken an immune system, leaving a caregiver vulnerable to colds and other ailments.
- The need to be in control of everything relating to the patient and refusing all offers of help or relief from others.
- Disrupted sleep habits.
- Severe anxiety, brought on by even the smallest things.
- Reclusiveness: a reluctance to be anywhere with anyone, other than with the patient.
- Stubborn denial of the medical prognosis. While a protection mechanism, this unrealistic approach masks underlying trouble.
- Anger: lashing out not just at others, but at the patient as well.
The caregiver is undergoing an intense ordeal and may benefit from some counseling during this difficult time. The responsibility of caring for a terminally ill loved one is a heavy burden. The caregiver may be unwilling or unable to share that responsibility and may, in effect, take ownership of the situation. Talking to a trained therapist, someone outside the immediate family or circle of friends, may afford tremendous relief to a caregiver and, by extension, the patient.