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Leaflet for patients about loss and grief

Leaflet for patients about loss and grief
Love, loss, and grief

There is little in life as difficult as losing a loved one. People we love are very important in our lives. Being with loved ones makes us happy and helps us feel safe. Close relationships affect us in ways that we are not even aware of in our conscious mind and even contribute to our sense of self. The enormous impact they have when they are alive is the reason their death affects us so much.

Grief is our reaction to loss and you can think of grief as the form love takes when someone we love dies. While it is different for every person, there are certain kinds of thoughts and feelings we all experience during acute grief. These include feelings of yearning, longing, and sadness and a range of other painful emotions, frequent thoughts and memories of the deceased and a sense of role confusion, distance from other people, and difficulty engaging with the world.

Loss is permanent and so is grief. However, grief usually changes over time. It starts out with feelings that are intense and disruptive and sometimes surprisingly unfamiliar, uncontrollable, and unsettling. In the beginning, we often feel confused about ourselves, our role, and what we care about. It can be hard to focus on anything very complex. We may want others around, but it may be hard to contribute to conversation and activities. Painful and disruptive as it is, you can think of acute grief as nature's way of giving people time and guidance to work through a process of adapting to the loss. As we do so, grief is reshaped into a form that is quieter and woven into the fabric of our life. Integrated grief enables us to remember and honor our loved ones in ways that don't disrupt our own lives.

How we adapt to loss

Acute grief can be so strong that it feels like it is going to last forever, but it doesn't. For many people, grief decreases more quickly than expected. We have instinctive processes that helps us adapt to loss. The way we adapt and the time we need is different for each of us and for each relationship we lose. However, there are certain things we all need to do.

Adapting to a loss is a process of accepting its finality and learning what that means to our own lives. This may require starting to do some simple everyday things - like taking out the trash, or doing the laundry - things we may not be used to doing and may not want to do. We may need to find new ways to spend our time, especially if we have been spending a lot of time taking care of our loved one. We may need to find someone new to confide in.

In addition, we need to start thinking about the future and finding ways that we can feel a sense of purpose and see possibilities for happiness. We need to re-establish a sense of connection to the person who died. Also, people who are very close to each other have a bond that is permanent. Our minds have a way of staying connected to people we love even during times when we are apart. Right after a loved one dies it seems like this internal connection can never be enough. But over time, we find ways to feel these deep connections to our loved ones in a new way that can be comforting. We find ways we can think about our loved one and even revisit memories of their death. Making these changes is not easy, but as we do so we can feel greater empathy and understanding of others. We feel a sense of satisfaction and even pride, as we begin to figure this out.

One thing that helps is to find the right balance between enduring the emotional pain and turning away from the pain. Our minds usually do this back and forth naturally. It can feel strange but it's important to allow this oscillation. We need to let the pain in and also take a break from the pain and even allow ourselves to have positive emotions. It helps to practice self-compassion and to allow others to comfort and support us. It's important to be with others who can share the pain.

Prolonged grief disorder

Sometimes there is something that gets in the way of adapting to a loss. Sometimes sorrow and yearning seem very strong and stubborn, and a person can't imagine ever being happy again. Some people feel that they can't accept the death. Some are afraid of their grief or ashamed of it or mad about being so upset. Some feel that grief is a problem that is getting in the way instead of a natural human feeling to accept and even respect. Sometimes people focus so much on what they have lost that they stop caring about themselves or their own lives. Having troubling thoughts and feelings during acute grief is perfectly normal but we need to resolve the things that bother us. Sometimes people can't do that. When this happens people feel "stuck" in their grief and the process of adapting to the loss is derailed.

We call this situation "prolonged grief disorder". In medicine a complication is something that gets in the way of a healing process. Think of losing a loved one as something like a serious injury and grief as like the painful inflammation that occurs with the wound. As people heal the pain and inflammation eventually lessen. A wound complication such as an infection can make the inflammation and pain worse and get in the way of healing. Likewise, certain kinds of thoughts, feelings, and behaviors can make the pain of acute grief worse and get in the way of mourning. Once this happens, it can be very difficult to find your way out of it alone. If you think you might have prolonged grief disorder, it's a good idea to seek professional help.

Reproduced with permission from: Data Supplement: Leaflet for Patients About Loss and Grief from: Shear MK, Muldberg S, Periyakoil V. Supporting patients who are bereaved. BMJ 2017; 358:j2854. Copyright © 2017 BMJ Publishing Group Ltd.
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