The universal experience of loss: Everyone experiences loss at some time in life. Loss can come as the death of a spouse, child, or friend; the loss of a marriage through divorce; the loss of a job or position at work; the loss of a home; or the loss of a pet. Loss is a universal experience that occurs when some meaningful part of a person’s life has been taken away.
Loss comes in many ways to cancer patients and their families and friends. Dying patients face loss of function and independence, their role in the family unit, relationships, dreams and possibilities, and finally life itself. They may worry about those left behind. Spouses may show concern for their mates and want to be sure that they will be all right. Some may grieve that they worked too late and too much, that they spent too little time with their spouse and children, that they never got that new car or never took that dream vacation, or that they did not accomplish their life goals and now it is too late.
Watching a person’s health deteriorate because of cancer is difficult. Family and friends may experience anticipatory grief with increased anxiety, fear, or depression. The patient’s family and friends experience tremendous stress as they work through what being without the person may mean to them. They may find themselves unable to concentrate or make decisions. Their work performance may suffer. Physical illness occurs, and aches and pains crop up for no apparent reason. They may imagine how death may happen and hover over the dying person. Family struggles may surface when people are tired and uncertain about their family member’s life.
Anticipatory grief can be useful, as the family can begin to adjust to the death before it actually occurs. Unfinished business can be addressed, and families can say their good-byes. Family roles may be reassigned to fill the anticipated void.
Differences in grief, bereavement, and mourning: Although grief and bereavement are used interchangeably, they are separate concepts. Grief is the normal reaction to death and can be experienced many ways. The person with grief may display mental reactions such as anxiety, guilt, anger, depression, or despair. Grief can produce physical problems such as insomnia, loss of appetite, and illness. The intensity of the grief and symptoms depend on the closeness of the relationship with the deceased person, the impact that the death has on the survivor, and any feelings left unexpressed or unresolved after the person’s death.
Bereavement is the time after the death occurs when the remaining person is grieving. After all the arrangements are made and the funeral is completed, the survivor is left alone in a changed environment. The severity and length of bereavement depend on the closeness of that person to the deceased and whether there was time to process the death through anticipated grief.
Survivors process grief through mourning. Mourning allows the survivor to adapt to the death of another person. Survivors may take part in rituals that vary among cultures and religious beliefs. A funeral or memorial service may be held to honor the memory of the deceased person. Some may wear black or other special clothes, send the family flowers or other gifts, or prepare food. Time may seem to stand still as normal activities of daily living seem to have been put on hold. Survivors may pull away from their usual activities and struggle to resume minimal tasks. Energy to process grief is emotionally and physically draining, so survivors feel tired. They may relive past experiences of loss and find themselves hurting again.
Phases of bereavement: When people experience the death of someone close to them, most go through four predictable phases of grief.
Stage one is shock and numbness. Survivors are stunned and cannot fully grasp that death has occurred. Numbness buffers the harsh realities as what has been lost begins to become evident.
Stage two is yearning and searching. The reality of the death is unacceptable, so anxiety surfaces because of separation from the deceased person. Survivors may desire to see the deceased person again and have dreams about the person. They may find themselves looking for or calling to the deceased person. Feelings of disappointment surface because the deceased person cannot return.
Stage three is disorganization and despair. Depression sets in, and survivors may see no future. Making plans seems hopeless. Focusing or concentrating proves difficult or impossible.
Stage four is reorganization and resolution. Slowly survivors find their way through their desire to have the deceased person back in their lives, through sadness and disorganization, to reorganization and resumption of daily life.
Grief counseling and therapy: Grief counseling provided by trained professionals offers survivors the opportunity to process normal grief reactions. Counseling can help survivors accept the loss by talking about the deceased person. Discussions give survivors time and a forum to express any feelings about the loss, such as sadness, helplessness, or anger. Sessions assist survivors to begin to live without the deceased person and feel strong enough to make decisions for themselves. Separating emotionally from the deceased person can be difficult, but with help the transition may be softened. The counselor can teach survivors to anticipate heightened feelings of loss during holidays or on birthdays or anniversaries. Grief counseling makes resuming normal life easier.
Grief counseling can be provided in a group therapy setting. Sometimes several people who have lost someone to cancer come together and support each other by sharing their experiences. Sometimes they become friends with others who can provide positive support when the group sessions end. Churches, home health and hospice agencies, or funeral homes may offer group grief counseling to support the friends and family of the deceased person.
Grief therapy is needed when survivors have serious difficulty separating from the deceased person. The mourner is encouraged to identify strong feelings such as anger or resentment and to allow those negative thoughts to surface and be spoken. Sometimes guilt is present, or uncomfortable and unresolved thoughts still linger. Mourners can work though their grief to recognize the finality of the death and see a future.
Complicated or unresolved grief results when the survivor cannot progress to reorganization and resolution. Problems develop with major unrelieved depression, severe anxiety, substance abuse, or post-traumatic stress disorder such as flashbacks of the death, panic, nightmares, work instability, parenting or marital problems, family difficulties, memory and concentration loss, sleep disturbances, or suicidal thoughts. Complicated grief requires more intense work from professional therapists.
Grief and bereavement in children: Children and their grief may be overlooked by adults when a death occurs. How children react to a death will depend on their age, stage of development, and personality; any previous experience with death; and the intensity of the lost relationship. Children may wonder if they somehow caused the death, if they too will die, and who will care for them or love them now that the deceased person is gone.
Children express their grief in different ways from adults. Initially some children may throw tantrums or have pronounced mood swings. They may misbehave and seek attention as they wrestle with their feelings. However, other children may withdraw and become reclusive. They may show signs of depression and lose interest in school or normal social activities. Still others may become aggressive, and some seem sad one minute and happy the next. Though children may appear to show symptoms for only a brief time, their grief may actually last longer than that of an adult. Unresolved grief can surface later in the child’s life and may need grief therapy by a trained counselor.
Alam, Rifat, et al. "Bereavement Experiences of Mothers and Fathers Over Time After the Death of a Child Due to Cancer." Death Studies 36.1 (2012): 1–22. Print.
Holtslander, Lorraine F., and Susan C. McMillan. "Depressive Symptoms, Grief, and Complicated Grief Among Family Caregivers of Patients with Advanced Cancer Three Months into Bereavement." Oncology Nursing Forum 38.1 (2011): 60. Print.
James, John W., Russell Freidman, and Leslie Matthews. When Children Grieve: For Adults Who Help Children Deal with Death, Divorce, Pet Loss, Moving, and Other Losses. New York: HarperCollins, 2001. Print.
Lewis, C. S. A Grief Observed. New York: HarperCollins, 1961. Print.
Parkes, Colin Murray, and Holly G, Pringerson. Bereavement: Studies of Grief in Adult Life. New York: Routledge, 2013. Print.
Rando, Therese A. How to Go on Living When Someone You Love Dies. Lexington, Mass.: Bantam, 1991. Print.
Westberg, Granger E. Good Grief. Minneapolis: Augsburg Fortress, 2006. Print.
Wolfelt, Alan. Healing the Bereaved Child. New York: Routledge, 2013. Print.
Worden, J. William. Children and Grief: When a Parent Dies. New York: Guilford Press, 1996. Print.
No comments:
Post a Comment