Coping with Death in the Family

By:    Medically Reviewed: Tom Iarocci, MD   Published: March 4, 2014

Grieving is a normal and human process, and it affects family caregivers, patients and their loved ones, very differently.

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“Am I normal?”

It’s an important question heard over and over again by patient advocate Niki Barr, PhD, a Dallas psychotherapist who counsels patients and their families about grieving the loss of a loved one. “Yes, grief is a normal, human process that experts now know more about than ever,” she says.

 

Whether you are the patient, a friend, a loved one or the official family caregiver, grief is an utterly human and normal process, Barr says. In 1969, Swiss-born psychiatrist Elisabeth Kübler-Ross, MD, proposed the five stages of grief model that many medical professionals still use today:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance  

 

These stages — which have no defined order — applied not only to people coming to grips with their own mortality, but also to coping with the death of a loved one. “That was a big breakthrough for the study of death,” Barr says. Since then, even more understanding of sorrow and grieving has emerged.

 

Grief Has No Timetable

 

When it comes to grief, everyone has their own schedule, Barr says. In one study of young adults who had lost a sibling two to nine years earlier, researchers found that the majority still had not resolved their sadness completely. The more recent the loss and the less social support, the more likely the young adults were still grieving, according to the report in “Psycho-Oncology.”

 

Problems often arise when two people who are close, such as siblings or spouses, react very differently to a loss. “Some push on, and when one cannot get on with it, that’s when there’s a lot of tension, guilt and a deepening conflict,” Barr says.

 

Angst among family caregivers is typically more intense, Barr explains. “They grieve but with an added layer of guilt.”  

 

Types of Grief

 

Emotions can be abruptly triggered by hearing a favorite song or seeing flowers you bought for your loved one, explains psychiatrist Matthew J. Friedman, MD, PhD, executive director of the U.S. Department of Veterans Affairs’ National Center for Post-Traumatic Stress Disorder.

 

1. “Anticipatory grief” begins prior to the actual loss when your loved one grasps the seriousness of the illness. As a person grieves, she is working to understand a huge change in the expected outcome. That’s a much healthier attitude, Barr says, than a caregiver who remains “perky and positive” when the odds are squarely against survival.

 

2. Usually, grief declines periodically over time. When it does not, people may be suffering from moderate-to-severe caregiver depression related to the situationThe National Institutes of Health reports that up to 15 percent of family caregivers whose loved ones are in palliative care (or hospice) suffer from this type of burnout. 

 

3. “Complicated grief” does not gradually fade away even years later. “The spouse or caregiver has not found anything else to fill his life,” Friedman says. He’s so hooked into the grief, he can’t move on.” Lack of social support makes complicated grief more likely for caregivers, according to studies in the “American Journal of Hospital and Palliative Care.” 

 

4. Finally, “anniversary grief” is a normal physical and emotional response to remembering — and in some ways, reliving — a distressing event, Friedman says. Akin to milder signs of PTSD, your mind focuses on the damaging, sad memories and your body becomes hyper-aware, producing a mix of symptoms such as insomnia and restlessness. This should gradually diminish within a few days.

 

Next Steps

 

Mental health counseling can help you process grief in a timelier manner, Barr says. “The goal is to make your heartache more bearable so it’s no longer gut-wrenching to think about your loved one.” 

 

  • Let yourself flow. Accept that grief is normal. Expect that you will cry, resent the loved one for dying and have other emotional feelings, even outbursts, says Barr. Grief is often a precursor to rage and depression.
  • Soothe yourself. Do things that feel relaxing: Get massages, take naps, explore new music and read helpful books.
  • Take a grief break. Tell yourself, for the next day or even the next hour, you are not going to “go there.” Plan to fill that time with other activities or with rest.

 

Find support. Talk to others who understand that grieving is a process, not a deadline. 

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sources
  • Barr N., PhD, Dallas psychotherapist and SymptomFind advisory board member. http://www.symptomfind.com/author/niki-barr/. Interviewed December 2013.
  • Elisabeth Kübler-Ross Foundation. “Stages of Grief.” http://www.ekrfoundation.org/. Accessed January 2014.
  • Ando M., RN, PhD, et al. “Difficulties in Caring for a Patient With Cancer at the End of Life at Home and Complicated Grief.” American Journal of Hospice and Palliative Care 2013. http://ajh.sagepub.com/content/early/2013/12/02/1049909113514626.abstract. Accessed January 2014.
  • Sveen J., et al. “They Still Grieve — a Nationwide Follow-Up of Young Adults 2–9 Years After Losing a Sibling to Cancer.” Psycho-Oncology 2013. http://onlinelibrary.wiley.com/doi/10.1002/pon.3463/abstract. Accessed January 2014.
  • Friedman MJ., MD, PhD, executive director of the U.S. Department of Veterans Affairs’ National Center for Post-Traumatic Stress Disorder. http://www.ptsd.va.gov/index.asp. Interviewed January 2013.
  • U.S. Department of Veterans Affairs’ National Center for Post-Traumatic Stress Disorder. “Anniversary Reactions: Research Findings.” http://www.ptsd.va.gov/professional/research-bio/research/anniversary_reactions_pro.asp. Accessed December 2013.
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