What is grief?

Grief is the natural reaction to loss. Grief is both a universal and a personal experience. Individual experiences of grief vary and are influenced by the nature of the loss. Some examples of loss include the death of a loved one, the ending of an important relationship, job loss, loss through theft or the loss of independence through disability.

Grief is a strong, sometimes overwhelming emotion for people, regardless of whether their sadness stems from the loss of a loved one or from a terminal diagnosis they or someone they love has received.

They might find themselves feeling numb and removed from daily life, unable to carry on with regular duties while saddled with their sense of loss.

• Grief is a reaction to loss.
• The way we experience grief is very individual; we each grieve in our own way.
• There are no universal “stages” to grief—grief is as individual as a fingerprint or a snowflake.
• People may have different “styles” of grieving. Some people may express their grief verbally or cry easily; other people may channel their grief into activity. All these responses are normal; how we grieve is not a measure of how we love.
• There is no timetable to grief. Over time the pain lessens, and we return to similar – sometimes better – levels of functioning.

Symptoms of grief
Grief can be physical. Your heart literally aches. A memory causes your stomach to clench or a chill to run down your spine. Some nights, your mind races. Other nights, you’re so tired that you fall asleep right away. You wake up the next morning still feeling exhausted and spend most of the day in bed.

A range of studies reveal the powerful effects of grief on the body. Grief increases inflammation, which can worsen health problems you already have and cause new ones. It batters the immune system, leaving you depleted and vulnerable to infection. The heartbreak of grief can increase blood pressure and the risk of blood clots. Intense grief can alter the heart muscle so much that it causes “broken heart syndrome,” a form of heart disease with the same symptoms as a heart attack.

For some people, feelings of loss are debilitating and don’t improve even after time passes. This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble recovering from the loss and resuming your own life.

Different people follow different paths through the grieving experience. The order and timing of these phases may vary from person to person:

• Accepting the reality of your loss
• Allowing yourself to experience the pain of your loss
• Adjusting to a new reality in which the deceased is no longer present
• Having other relationships

These differences are normal. But if you’re unable to move through these stages more than a year after the death of a loved one, you may have complicated grief. If so, seek treatment. It can help you come to terms with your loss and reclaim a sense of acceptance and peace.

Causes of grief
While it is not clear exactly what causes prolonged or complicated grief, the cause of normal grief can most commonly be attributed to the death of a loved one. The loss of anything important to you can cause feelings of grief.

• Loss of a job
• Loss of a beloved pet
• Loss of a friendship
• Loss of a personal dream
• Loss of a romantic relationship

How to treat grief
Your doctor or mental health professional considers your symptoms and circumstances in determining what treatment is likely to work best for you.

Psychotherapy
Complicated grief is often treated with a type of psychotherapy called complicated grief therapy. It’s like psychotherapy techniques used for depression and PTSD, but it’s specifically for complicated grief. This treatment can be effective when done individually or in a group format.

During therapy, you may:

• Learn about complicated grief and how it’s treated
• Explore such topics as grief reactions, complicated grief symptoms, adjusting to your loss and redefining your life goals
• Hold imagined conversations with your loved one and retell the circumstances of the death to help you become less distressed by images and thoughts of your loved one
• Explore and process thoughts and emotions
• Improve coping skills
• Reduce feelings of blame and guilt

Other types of psychotherapy can help address other mental health conditions, such as depression or PTSD, which can occur along with complicated grief.

Medications
There’s little solid research on the use of psychiatric medications to treat complicated grief. However, antidepressants may be helpful in people who have clinical depression as well as complicated grief.

Coping and support
Although it’s important to get professional treatment for complicated grief, these strategies also may help you cope:

• Stick to your treatment plan. Attend therapy appointments as scheduled and practice skills learned in therapy. If needed, take medications as directed.
• Practice stress management. Learn how to better manage stress. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
• Take care of yourself. Get enough rest, eat a healthy diet, and take time to relax. Exercise regularly. Physical activity can help relieve stress, depression, and anxiety. Don’t turn to alcohol or recreational drugs for relief.
• Reach out to your faith community. If you follow religious practices or traditions, you may gain comfort from rituals or guidance from a spiritual leader.
• Stay connected with people you enjoy being around. They can offer support, a shoulder to cry on or shared laughter to give you a little boost.
• Plan ahead for special dates or anniversaries. Holidays, anniversaries, and special occasions can trigger painful reminders of your loved one. Find new ways to celebrate, positively reminisce or acknowledge your loved one that provide you comfort and hope.
• Learn new skills. If you are highly dependent on your loved one, for example, to handle the cooking or finances, try to master these tasks yourself. Ask family, friends, or professionals for guidance, if necessary. Seek out community classes and resources, too.
• Join a support group. You may not be ready to join a support group immediately after your loss, but over time you may find shared experiences comforting and you may form meaningful new relationships.

Telehealth opens the door to better treatment
Telehealth may be the perfect solution for the older population that may be restricted by quarantine in a nursing home, health issues or transportation issues. Also called telemedicine, there are several ways that people with depression may benefit from telehealth.

Telehealth is Convenient
Telemedicine eliminates the hassles of securing transportation and traveling to the doctor’s office. This works because your appointment is made on your smartphone or laptop, so you can be anywhere in the world and still see your doctor. It also frees up more time to take care of other daily tasks and duties.

Telemedicine Increases Accessibility
Many people who are depressed must travel more than 10 miles to see their health care provider. This can be especially difficult for those who do not have a car as riding public transportation can be very time-consuming. Furthermore, those with mobility challenges do not have to worry about if the doctor’s office is accessible.

Telepsychiatry Offers More Privacy
Making your appointments online means more privacy because you can easily do them from the comfort of your home or workplace.

Insurance Should Cover the Cost
One of the positive outcomes of the pandemic is that insurance companies have been forced to cover the cost of telehealth appointments. If you are on Medicaid or Medicare, there is much more flexibility in getting your appointments covered than at any time in the past. Additionally, if you do not have access to insurance, you may find more opportunities to work with a clinic that has a sliding fee scale.

Telehealth Is More Comfortable
Most patients with depression report that they feel more comfortable seeing the doctor online because they are surrounded by their things and in their own space. This may help you dive deeper into the challenges you are facing to find workable solutions sooner.