Caregiver Grief and Bereavement
Grief is our normal, natural, and necessary response to loss. Its flip-side, bereavement (or mourning), is the process of responding to, and ultimately surviving loss. Both grief and bereavement are individualized experiences, and experts say everyone's experience is different.
How We Grieve
We tend to grieve along a spectrum of grieving styles. One end of the spectrum has been called "intuitive grieving," characterized by outbursts of emotion and the need to talk about one's feelings. The other end has been called "instrumental grieving," characterized by a focus on doing things that help one cope.
But it's not one or the other for most people. Healthy grieving almost always is some combination of both styles.
Since the 1960s, people have talked about the stages of grief and bereavement -- denial, anger, bargaining, depression, and acceptance. But for most people, grief isn't a linear process of moving from one stage to the next. Instead, stages tend to loop around and come back again and again.
Many factors, including how the loved one's illness progressed, how long the caregiver provided care, and whether the caregiver has a good support system, have an influence on how long people mourn.
Grief symptoms associated with an expected death -- anger, numbness, crying, sleepless nights, mood swings, aches and pains, forgetfulness -- tend to peak around the six-month mark, then taper off.
When symptoms don't fade over time, a person may be suffering from what psychologists call "complicated grief." If it's been several months since the loss and your feelings are still so strong that you can't resume your normal routine, it's time to talk to your doctor or to seek psychological counseling.
A Helping Hand
For caregivers whose loved one is in a palliative care program, the team's social worker, grief counselor, and spiritual counselor are available to help and support caregivers during their loved one's illness and after the loved one has died.
Part of what the palliative care team does is look for situations or triggers that might indicate a caregiver is having difficulty or that might complicate the grieving and bereavement. Then the team will help the caregiver look at options and alternatives to ease the grief and sense of loss.
Handling Grief and Bereavement
Most caregivers who lose a loved one will experience a normal sense of grief and bereavement. Normal, though, does not mean free of emotional, physical, and spiritual pain. Here are things you can do to help with those feelings:
Know the triggers. The first year will have many emotional triggers: first birthday without the loved one, the first Thanksgiving, the anniversary of the death. When these "firsts" occur, the waves of grief can come crashing back.
Know your priorities. It's important to maintain friendships, routines, activities, and other things that nourish you physically, emotionally, and spiritually.
Plan for the unexpected. One way to do this is to think about and rehearse your responses to the questions others might ask. Doing so can keep you from being blind sided.
Don't bottle things up. Talk to the palliative care social worker, counselor, advance practice nurse, and physician. Talking about things helps you acknowledge your feelings and enables you to say good-bye and find emotional closure.
Don't try to do it alone. Before your loved one is gone, make sure you've put together a support system made up of people you can count on to be there, lean on for support, and depend on for help with chores and other things that need to be done.
Don't make big changes. During the first year avoid doing things that will mean a major change in your life. Don't move, don't get divorced, don't cut off communication with people you are close to. Experts say you will be a different person as time passes.
Take care of your health. That doesn't just mean eat well, get a good night's sleep, and exercise. It means doing things that ensure emotional and spiritual well-being, too.
Don't isolate yourself. Loneliness breeds loneliness. Don't turn down invitations, even though going out may be the last thing you want to do.
Deal with anger. Anger is self-perpetuating and can snowball. Grief counseling can help you understand and deal with the anger you feel.
Keep the faith. Religion won't "fix" things, experts say. But it can help normalize them. And belonging to a faith group means you have a community for support.
Take up new activities. New activities help you form new patterns of doing things and new interests that are not associated with the person who has died.
Make humor part of your coping routine. Humor can help provide perspective on the way your life is changing.