Overview
Health care providers will encounter grieving individuals throughout their
personal and professional lives.[1] The progression from the final stages of cancer to the death of a loved one is experienced in different ways by
different individuals. In fact, one may find that the cancer
experience, although it is difficult and trying, has led to significant
personal growth. Coping with death is usually not an easy process and cannot
be dealt with in a cookbook fashion. The way in which a person will grieve
depends on the personality of the grieving individual and his or her
relationship with the person who died. The cancer experience; the manner of
disease progression; one’s cultural and religious beliefs, coping skills, and
psychiatric history; the availability of support systems; and one’s
socioeconomic status also affect how a person will cope with grief.
Distinguishing between the following terms is important: grief, mourning, and bereavement.
These terms are sometimes used interchangeably, yet often with different
intentions.[2]
Grief: The normal process of reacting both internally and externally to the
perception of loss.[3] Grief reactions may be seen in response to physical or
tangible losses (e.g., a death) or in response to symbolic or psychosocial
losses (e.g., divorce or losing a job). Each type of loss implies experience of
some type of deprivation. As a family goes through a cancer illness, many
losses are experienced, and each prompts its own grief reaction. Grief
reactions can be psychological, emotional, physical, or social. Psychological/emotional
reactions can include anger, guilt, anxiety, sadness, and despair. Physical
reactions can include sleep difficulties, appetite changes, somatic complaints,
or illness. Social reactions can include feelings about taking care of others
in the family, the desire to see or not to see family or friends, or the desire
to return to work. As with bereavement, grief processes depend on the
nature of the relationship with the person lost, the situation surrounding the
loss, and one’s attachment to the person. One author [4] noted five
characteristics of grief:
- Somatic distress.
- Preoccupation with the image
of the deceased.
- Guilt.
- Hostile reactions.
- A loss of the usual
patterns of conduct.
Mourning: The process by which people adapt to a loss. Different cultural customs, rituals, or rules for dealing with loss that are followed and influenced by one’s society are also a part of mourning.
Bereavement: The period after a loss during which grief is experienced and
mourning occurs. The length of time spent in a period of bereavement depends on the intensity of the attachment to the deceased and how much
time was involved in anticipation of the loss.
Grief work includes three tasks for a mourner.[5] These tasks include freeing oneself from ties to the deceased,
readjusting to the environment from which the deceased is missing, and
forming new relationships. To emancipate from the deceased, a person must
modify the emotional energy invested in the lost person. This does not mean
that the deceased was not loved or is forgotten, but means that the mourner is able
to turn to others for emotional satisfaction. In readjustment, the mourner’s
roles, identity, and skills may have to be modified to enable him or her to live in the
world without the deceased. In modifying emotional energy, the mourner invests the energy that was
once invested in the deceased in other people or activities.
Because these tasks usually require significant effort, it is not
uncommon for grievers to experience overwhelming fatigue. The grief
experienced is not just for the person who died, but also for the unfulfilled
wishes, plans, and fantasies that were held for the person or the
relationship. Death often awakens emotions of past losses or separations. One
author [6] describes three phases of mourning:
- The urge to recover the lost
person.
- Disorganization and despair.
- Reorganization.
These phases
grew out of the attachment theory of human behavior, which postulates that people
need to attach to others to improve survival and reduce risk of harm.
References
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Casarett D, Kutner JS, Abrahm J, et al.: Life after death: a practical approach to grief and bereavement. Ann Intern Med 134 (3): 208-15, 2001.
[PUBMED Abstract]
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Rando TA: Grief, Dying and Death: Clinical Interventions for Caregivers. Champaign: Research Press Company, 1984.
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Corr CA, Nabe CM, Corr DM: Death and Dying, Life and Living. 2nd ed. Pacific Grove, Calif: Brooks/Cole Publishing Company, 1997.
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DeSpelder LA, Strickland AL: The Last Dance: Encountering Death and Dying. 2nd ed. Palo Alto, Calif: Mayfield Publishing Company, 1987.
-
Lindemann E: Symptomatology and management of acute grief. 1944. Am J Psychiatry 151 (6 Suppl): 155-60, 1994.
[PUBMED Abstract]
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Bowlby J: Processes of mourning. Int J Psychoanal 42: 317-40, 1961.
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