Grief and Bereavement
What is Grief?
Grief is the deep mental pain that comes from a loss. Bereavement is the period when the grieving happens. During this time, you may have constant thoughts of the person who passed, the way you normally act may change and you may experience guilt.
A normal grief response includes denial, anger, bargaining, depression, and acceptance or resolution. Our first reactions are often shock, numbness, bewilderment, and a sense of disbelief. After a few days, the numbness turns into suffering, which includes feelings of emptiness. A grieving person may have dreams of the person they lost. Despair follows, as the grieving person slowly accepts the loss. The dominant feelings, however, are sadness and inability to feel pleasure. Tense and restless anxiety may alternate with lethargy and fatigue. You will also often see a loss of interest in leisure and social activities.
Symptoms of Healthy Grieving
- Bargaining (attempt to regain the loved one)
- Acceptance or resolution
The Physiological Impact of Grief
Research has shown that loss affects the health of the grieving person. Some physical symptoms common with grief are problems sleeping, loss of appetite, headaches, back pain, indigestion, shortness of breath, heart palpitations and sometimes even dizziness and nausea.
Grief and Depression
Grief and depression have many features in common, including guilt, anger, and certain physical symptoms. A grieving person usually shows more changes in mood and has moments of normal cheerfulness. If you have ever been to a funeral, you may have seen people crying one moment, and then laughing about fond memories the next; a depressed person typically won’t respond that way.
A bereaved person rarely has constant feelings of worthlessness. People who have been depressed before are more likely to respond to bereavement with chronic grief. In a person with depression, the process of grief uses more emotional energy than they have, therefore, none is typically left over for other activities. Eventually, through constant review and reliving of memories and feelings, the energy is gradually turned outward again. How one displays grief through behavior and emotions depends on culture, gender, age, and religion.
Grief & Mental Health
Common reactions to loss are the stages of denial, anger, depression and eventual acceptance. If the cause of the loss was a life-threatening danger, the person may experience a high death anxiety. Often the person relives the situations repeatedly through brief and intense memories, and the attached emotions. These effects are called Post Traumatic Stress Disorder.
In the early stages of recovery there is a constant mood of helplessness. The brain-injured person is often waiting for the doctors or therapist to “make them better.” However, depending upon the type of loss, this may never happen. Dr. Diane was told she had to learn to live with her right- hand tremor. As a guitarist, she had to deal with another aspect of loss.
Brain injury can speed up the stages of the life cycle and puts the brain-injured person into a typical grief reaction. The stages of grief are often not noticed in individuals with brain injury, because they are covered by symptoms of Post-Concussive Syndrome.
Many scientists have written about the “healthy” grief process, such as Bowlby, Engel, Lindeman, Parkes, and Kubler-Ross. Healthy grief can also become prolonged, pervasive and can take more complicated forms.
Grieving the Loss of Self
The losses that cause grief, such as the death of a loved-one or the ending of an important relationship, are obvious. However, there are also losses relating to yourself” that cause grief that many aren’t aware of. Some examples are, losing a job, losing money or experiencing poor health. Also, losses related to aging, like losing the ability to work or to drive, these are often felt as a loss of self. At several points in our lives, we will have to give up our former self-image and move on. As one gets older there is a natural mourning process for the former self. The stages of grieving the self are just like mourning the loss of others. In some cases this process is sped-up in a personal disaster, such as a brain injury (as stated above) or a close encounter with death.
To understand grieving the loss of self, it is important to see the difference between the spirit and the sense of self. The spirit is you; it is your essence and personal energy. Your energy and your genetic DNA formed the beginning of you and what you know as self.
What Makes Up Our Idea of Self?
9 General Factors that make up your idea of self (a brain injury may or may not affect certain factors)
Heritage & Family
How you see yourself is based on what you see, along with what others see. Gender is a major factor of self. When you were born, your gender affected the way your parents interacted with you; a brain injury would not affect this. Race is another factor. When you walk into a room people notice the color of your skin, and how they treat you based on that, affects how you feel about yourself. Our ethnic background is a big aspect of our sense of self; from the food we like, to our sense of humor, to whether our skin may burn or tan, etc. Obviously, our ethnic background is in no danger of being changed by a brain injury.
Relationships are very important to your sense of self. Are you a son or daughter, a father or mother? Maybe you’re a brother or sister, a niece or nephew, a husband or wife, a grandparent, friend, or cousin. Are you a stepmother or stepfather? Are you a half-brother or half-sister? How you interact with these people and how they interact with you builds your sense of self. Brain injuries do not directly affect relationships unless amnesia is involved.
Physical & Emotional
Body type plays a part; you may judge yourself and others may judge you on your physical appearance. Body type can be affected by certain medications or an injury to your brainstem that controls your weight. How we cope with life is another factor. Some people cope well and are resilient, while others are emotional and sensitive. When you are born, your basic personality is there, but a brain injury can alter it.
Sense of Purpose
Another factor is physical and/or academic abilities, such as being graceful, artistic, strong, musical, etc. Some people are good at math, while others are good in the arts. No matter what you’re good at, a brain injury can dramatically affect these areas. Along with these aspects of the self is the role or job we perform. We all have a role or job we identify with, which is a part of who we are and how we see ourselves. For most young and middle-aged men and women, work provides one of the fundamental sources of meaning to life, whatever the nature of that work may be. To many people their job is their concept of self. Consequently, the loss of ability to work can have a demoralizing effect that is perceived as a loss of self.
The solidification of the real self does not truly occur until adulthood. Men tend to gain their sense of self through their work or job. Since the women’s movement in the early 70’s, women also tend to derive their sense of self from the work or job they do, more than from their social duties. Over time, you will eventually be able to look in the mirror and accept yourself by saying: “this is me.” This means that you have a sense of self.
Factors that Affect Grieving the Loss of Self
The steps for mourning the loss of self are affected by many factors. These problems and concerns can leave the griever distracted and unable to focus on their feelings. This should not be mistaken for avoiding grief. Factors include how the injury happened and the personality of the brain-injured person before the injury. For example, the younger the brain-injured person is, the less the feeling of loss of self and level of grieving, because often they haven’t fully formed their sense of self yet.
Role in the Family
How a brain injury affects the financial security of a family is an important factor. If the brain-injured person was the main source of income for the family, and can no longer be that source, the sense of self loss will likely grow. This loss of income also brings financial stress and with that comes emotional pressure. The family may have to relocate or move in with relatives.
For example, a 36-year-old man fell on his child’s toy. In his fall he suffered a mild brain injury which caused him to have uncontrollable fits of rage. The consequence of his injury was the loss of his job, his marriage, and his family. He was no longer able to work and had to move in with his family of origin. His distress and loss of self was enormous, yet no one recognized the grief. The doctors gave him medication for the rage and the family had no idea how to help him cope.
Sometimes psychotherapy can make the issue worse when a therapist doesn’t know that the patient is probably grieving the loss of self and focuses only on changes in behavior. Without awareness, the very people who want to help us are the ones who can prevent a brain-injured person from grieving. Everyone involved with the brain-injured person should recognize the painful mixture of feelings that makes up grief.
Until now, there has been little awareness that a person grieves the loss of self after a brain injury. This is not helped by the denial from doctors, family, and friends, that the person they have known and loved is gone and is, in fact, grieving. Many times, the bereaved brain-injured person gets a clear message that they should hide their true feelings, so they won’t upset others.
Hearing directly from the doctor, family, or friends that they are ready to support the injured person’s real feelings, helps healthy grieving take place. Like grieving a spouse, this does not mean forgetting them, but realizing they can never be with the former you again. In the same way, grieving your former self does not mean forgetting or denying who you once were, but realizing that person no longer exists.
By listening, caring and being there for the bereaved brain-injured person, you are nurturing the spirit and the new sense of self. By listening, caring and being there for yourself in your own bereavement, you will discover a new sense of self, while nurturing your spirit that is truly you.