Living with Loss: Understanding and coping with grief

Grief is defined as the natural and normal response to loss. Loss refers to the absence and the act of losing something or someone, which could be physical, emotional and social as well. Grief can be unique to each person, and there is no one way of experiencing grief. We would be experiencing the same kind of loss, but grief would be different.

Grief happens to everyone in one way or another (Worden,2009). Grief is said to be an extension of love (Neimeyer, 2015). Reaction and experience of loss are individualised. The basic reason is that each of us is a unique person with our own temperament and experiences (Doka, 2016). Different cultures also express grief in different ways (Buglass, 2010).

Terms related to Grief

Grief can also come from losing a pet, a favourite toy, the death of a movie or TV series character, the ending of a TV series or someone dying by suicide or murder, parents’ divorce, etc. It depends on the relationship and the meaning the individual has attached to the object of loss, and is usually not considered the norm for grieving by society. It is known as disenfranchised grief (Malone,2016).

Mourning is the activities or rituals carried out to aid in the process of grief. It is the outward and active expression of grief (Worden, 2008). Bereavement refers to the period during which grief and mourning occur, a state of experiencing loss (Worden, 2008). Death-based Grief is based on the death of a person or pet, for example parent, sibling, friend, or lover.

Non-death grief refers to experiencing grief in situations like parental separation, losing a friendship, a romantic break-up, a change of school, etc. (Malone, 2016). Uncomplicated grief is the response to loss where the mourning process is completed over time and the loss becomes integrated into life. Complicated grief is having difficulty in adapting to loss and managing daily routine. Barriers are there in integrating loss and moving forward with it (Sanghvi, 2019).

Read More: Stages of Grief

Processing Grief

Rituals help us in confronting reality. Rituals resonate with the need to engage in action and the desire to express your feelings (Doka, 2016).

Rituals of continuity: Continuing the bond with the person lost, such as remembering them on their death anniversary, lighting candles on their birthdays.
Rituals of transition: It is marked by a change in activity after loss. For example, an individual may remove their wedding ring after the death of their partner.
Rituals of reconciliation: An opportunity to accept or give forgiveness or finish unfinished business. For instance, writing a sorry message to a friend who has lost.
Rituals of Affirmation: Allows one to say thank you to the deceased person for memories and learning. Example: looking at an old picture (Doka, 2016)

Read More: The Acceptance Stage of Grief

Responses to Grief

Thoughts while experiencing grief
- Why did they leave me?
- They died because of me
- Will I also die soon?
- Life is so unfair!
- They were fine, but this happened suddenly
- Bad things will always happen to me
- I can’t remember anything (Malone,2016)

2. Feelings while experiencing grief

Angry, Sad, Irritated, Guilty, Depression, Worry, Crying, Shock, Numb, Lonely, Betrayed and Fear (Malone,2016)

3. Actions while experiencing grief

Denying that the loss happened and not showing their actual self

Engage in substance use to cope with loss

Drive rashly and engage in other risky behaviour

Might eat less or eat more

Might sleep less or sleep more (Bad dreams and nightmares)

Might lose weight or gain weight

Might fall sick or face issues in health issues
Isolate themselves from their loved ones (Malone,2016)

Theories to Understand Grief

1. Kubler-Ross’ theory of Grief

This is the most widely discussed theory in grief. It includes 5 stages of grief, which include: Denial, Anger, Bargaining, Depression and Acceptance (Buglass,2010). This theory has also received a lot of criticism because, as we already know that grief is not a straight line and is not the same for everyone. Hence, a number of theories have been given to explain grief and its process.

2. Attachment Theory

This theory states that one experiences grief based on attachment towards the object or person of loss, as they provide safety and security. When the bonds formed are broken, we experience a strong emotional reaction (Worden, 2008).

3. The four tasks of mourning

This approach is to help in resolving grief

To accept the reality of loss.
To confront and work through the pain and grief.
To get used to life without the deceased person.
To withdraw emotionally from or relocate the deceased and move on.

4. The Good Grief model

Understanding: Knowing what happened and why, understanding that the person would never be a part of our lives. It discusses how each age group defines death and how they understand death.
Grieving: This refers to the period of grieving and how grief happens.

Commemorating: Remembering the person who died through formal and informal ways by holding ceremonies, death anniversaries, etc.
Going On: Resuming daily activities and carrying out our usual life with the memories of the deceased (Boston Medical Centre, n.d.).

Strategies to support the grieving process of self and others

Music Techniques: It will use tones, rhythms, sounds and melodies to express the grief. For example, playing drums or recorded music
Body Movement: It refers to expressing grief through movement. For example, imitating an animal they relate to (e.g. lion, mouse, dinosaur).
Bibliotherapy: It refers to narrating stories related to loss and death that can help the person express their feelings by relating to the characters in the stories (Lyles et al., n.d).
Letter or journal writing: Writing a letter or journal for a deceased person to express thoughts, emotions or unsaid things.
Memory book: A concrete visual aid including photographs, poems, stories and other memorabilia (Sanghvi, 2019).
Memory box: It is to store concrete memories. For every object, there needs to be a reason (Calvary News, 2021).
Drawing Grief Tool: It consists of having to draw their grief. It is a non-verbal expression to express oneself. Once the individuals complete the drawing, they will be asked to describe and reflect on their drawing. It is used to explore their feelings and thoughts through drawing. One need not be an artist or require special drawing skills to draw. They can draw however they want. They would not be assessed for the drawing abilities but rather the meaning they attach to the drawing (Pennock et al., n.d.). One should not interpret their drawing. If you notice them getting triggered during the exercise, stop the exercise and allow them to take deep breaths until they calm down. They can either continue or stop the activity. They can maintain a book where they keep records of all their drawings. (Pennock et al., n.d.)

Object of Connections

Some of these strategies might require individuals with certifications and a license to practice to know what to do if the individual gets triggered

This helps to continue the bond with the person they have lost. It is usually done at the beginning of the experience of loss. They try to talk about the objects that they attach to the person they lost. They can just reflect without sharing about it as well (Pennock et al., n.d.). Provide a non-judgmental space for individuals to talk about the objects, as some might find it difficult to share.

Normalise and assure when you notice them hesitate, and also after they finish sharing, they can be provided a space to talk about what the object means to them. It could be a concrete object or anything abstract as well that helps them and reminds them of the deceased person (Pennock et al., n.d.).

Prescription to Grieve Tool

This is similar to a medical prescription. The individuals would be given a structured way to help them process their grief. It helps to grieve on their terms. They are given a particular time and place where they can express their grief freely. This is useful to individuals whose daily activities and functioning are affected. The recommended time is 45 minutes which the individual should not be disturbed (Pennock et al., n.d.).

They first choose an activity to do and then a time slot of 45 minutes during the day, and they are assigned a place where they can be grieving however they want to. They sign at the end, committing to carry out the activity. For the other 23 hours and 15 minutes of your day, the grieving is, in a way, turned “off.” You can go about your everyday life, noting any thoughts or feelings related to your loss. You may also stop the exercise at any time, take a break, and try again the next day if it gets overwhelming (Pennock et al., n.d.).

Grief support groups

Groups should be formed based on developmental stage, needs, and nature of loss. The group needs to be facilitated by a counsellor or clinical psychologist. The group should be of 4-8 members. It should have clear guidelines and a plan. It should address emotions, thoughts and ideas (Heath et al., 2008; Sanghvi, 2019).

Conclusion

Even small changes in someone’s behaviour, thoughts and feelings after they have experienced loss might indicate grief. Hence, make sure you talk to them or inform someone who can help them. We would go through cycles of healing and grieving, and that is okay. Grief can be sudden, unexpected, never-ending and inevitable (Fiorini & Mullen, n.d.). The goal should be to integrate the loss into our lives rather than overcome it (Doka,2016).

There is no fixed time period for grieving, but if you feel you are unable to cope with daily functioning, you must seek help (Worden,2009). It is okay to reach out to someone to ask for help when you are experiencing grief. You should not be ashamed or feel weak to do so. We all need help sometimes. Supporting each other is what helps us get through challenging times.

References +

Boston Medical Center. (n.d.). The Good Grief Program Model. Retrieved October 12, 2022, from https://cdn5-ss2.sharpschool.com/UserFiles/Servers/Server_1037108/File/GoodGriefHandout.pdf

Buglass E. (2010). Grief and bereavement theories. Nursing standard (Royal College of Nursing (Great Britain) : 1987), 24(41), 44–47. https://doi.org/10.7748/ns2010.06.24.41.44.c7834 Calvary News. (2021, September 29). Coping With Grief: Activities for Children & Teens. Calvary

Hospital. Retrieved October 11, 2022, from https://www.calvaryhospital.org/coping-with-grief-activities-for-children-teens/

Doka, K. J. (2016, April 12). Grief Is a Journey: Finding Your Path Through Loss. Atria Books. Fiorini, J. J., & Mullen, J. A. (n.d.). Understanding Grief and Loss in Children. American Counsel Association.

Heath, M. A., Leavy, D., Hansen, K., Ryan, K., Lawrence, L., & Gerritsen Sonntag, A. (2008, May).

Coping With Grief. Intervention in School and Clinic, 43(5), 259–269. https://doi.org/10.1177/1053451208314493

Lyles, M., Kurtz, R., & Snelbaker, A. (n.d.). GRIEF: RECOMMENDATIONS FOR HELPING STUDENTS

WHO HAVE EXPERIENCED A SIGNIFICANT LOSS. University of Delaware. Retrieved October 12, 2022, from https://www.education.udel.edu/wp-content/uploads/2013/01/Grief.pdf

Malone, P. A. (2016, February 24). Counseling Adolescents Through Loss, Grief, and Trauma. Routledge.

Neimeyer, R. A. (2015, October 14). Techniques of Grief Therapy: Assessment and Intervention (Series in Death, Dying, and Bereavement) (1st ed.). Routledge.

Pennock, S., Alberts, H., & Poole, L. (n.d.). 3 Grief and Bereavement exercises. PositivePsychology.com.

Retrieved October 12, 2022, from https://positive.b-cdn.net/wp-content/uploads/2021/12/3-Grief-Berievement-Exercises.pdf

Sanghvi, P. (2019). Grief in children and adolescents: a review. http://indianmentalhealth.com/pdf/2020/vol7-issue1/6-Review-Article_Grief-children.pdf

Worden, J. W. (2008, August 11). Grief Counselling and Grief Therapy, Fourth Edition: A Handbook for the Mental Health Practitioner (4th ed.). Springer Publishing Company.