“Grief Across The Lifespan” March, 2013
(© 2006 Doctors/Grant Family Practice Residencies)
Jeri A. O’Donnell, MA, LPCC and Pat A. Martin, MA,LPCC
CASE:
Margaret, a 38 year old patient who is new to you, presents with her 10 year old son who
has begun to act out, e.g. sassing her, refusing to obey, shouting at his siblings, and
whose grades are falling. She reports being “on edge”, unable to concentrate and
sleeping only 3-4 hours per night. You learn that 4 months ago her husband was killed
by a drunk driver. How would you help this family?
DISCUSSION:
1. Grief: refers to the process of experiencing the psychological, behavioral, social,
and physical reactions to the perception of loss. Mourning refers to the natural
process you go through to accept a major loss.
2. Many people will report physical symptoms during the bereavement period, e.g.
stomach pain, loss of appetite, sleep disturbances, loss of energy are common. In
prescribing to patients who are grieving, remember it is important for them to
grieve, and therefore if put on anti-anxiolytics or sleeping medications to do so for
only a very short period of time. These patients should also be monitored closely.
3. Even though Dr. Elisabeth Kubler-Ross’ book “On Death and Dying” was
groundbreaking at the time, it is a myth that grief and mourning proceed in
predictable or orderly stages. There is no real order to the grieving process, and
patients may feel many emotions at varying times, e.g. denial, disbelief, confusion,
shock, yearning, anger, despair, guilt to name a few. Help your patients realize that
grieving is like a “roller coaster ride” in that one day or week they may be doing
very well, the next minute they are in tears. This is grief.
4. Confusing feelings cont.:
a. Shock, denial, numbness, disbelief: temporarily protect an individual from
the full reality of the loss until they are able to tolerate the reality.
b. Disorganization, confusion, searching, yearning, forgetfulness is common, as
is “feeling crazy”. Dreaming about the deceased is very common. Visual
hallucinations, e.g. other individuals may begin to look like the person who
has died; this is not uncommon and is a normal part of grief.
c. Physiological changes: trouble sleeping, low energy, chronic existing health
problems may become worse, all are seen in patients who are grieving.
d. Anger, rage, resentment, blame, jealously: Help your patient understand that
more often than not underneath these feelings are often the feelings of pain,
helplessness, and fear.
e. Guilt, remorse and regret: Patients feel guilty for something they didn’t say,
or an argument that occurred before the loved one died. Help your patient to
be more compassionate with themselves and recognize normal human
responses.
5. Grieving “too long” or too intensely occurs when the normal grieving period
doesn’t end, but continues to the point of the patient needing treatment for anxiety
or depression. It is especially noticeable if they have never been treated in the past
for these issues. If this occurs it is an indication for medication and therapy.
Extreme reactions may include feeling incapacitated by fear, grief, emotional
numbness that does not go away, increased use of alcohol or drugs, becoming
totally immersed in work, chronic insomnia, loss or gain of appetite, obsessive
thoughts of death or suicide.
6. Major Losses: All loss feels major, but the loss of a child arouses many feelings
that are unique to this loss, e.g. the overwhelming sense of injustice, the loss of
potential, of unfulfilled dreams, senseless suffering. Often parents feel responsible
for the child’s death no matter how irrational it may seem. This loss is kept alive by
the “milestones” experienced by the child’s peers/friends, e.g. school events,
graduations, weddings etc.
a. A spouse death falls under this category as beyond the shock, this death may
cause a financial crisis if the spouse was the family’s main source of income.
There may be major social adjustments necessary, e.g. moving, adjusting to
single life, possibly returning to work, etc.
b. The elderly may be especially vulnerable as it often means losing a lifetime
of shared experiences, 40, 50, 60 years with one person is a long time. Often
too the spouse’s death may be corresponding with the death of close friends.
There may be a loss of independence if the spouse was the most independent.
If the survivor is male, be alert to signs of suicidal ideation.
c. Loss due to suicide, is among the most difficult to bear. Survivors are left
with guilt, anger and shame. Counseling the first few weeks following a
suicide is beneficial and advisable.
7. As pets become a more integrated part of American life attention has been devoted
to the grief people experience on the loss of a pet. Be sensitive to this loss when
patients discuss the loss of a pet.
8. Help your patients remember to: seek out caring people for support, express their
feelings, take care of their health, postpone major life changes, be patient as
grieving is a process, and seek outside help when necessary. Remind your patients
that it is ok to be sad, and that it is not unusual for the grieving process to take a
good year to process the more intense side of grief. This may be difficult as their
friends will expect them to be “better”. Our society tends to rush individuals
through the grieving process.
9. Remember children are not “little adults” and do not express grief in the same
way as adults. Look for confusion withdrawal, anger, reverting to earlier behaviors (very
young children may start bedwetting again), invent games about dying; pretend that the
death never happened. (Remember denial fits adults and children). Children who lose a
parent may feel their security threatened. Also it is important for the surviving parent to
remember that children will grieve through each developmental stage, it will not be
manifested as intensely but it will be there.
Resources:
Divorce Support Groups can be found within many churches and counseling agencies.
Kobacker House – @ Riverside 566-5377 (numerous support groups for all ages)
Mt. Carmel Crime & Trauma Asst Program 234-5000
http://www.aarp.org/families/grief_loss/
http://www.helpguide.org/mental/grief_loss.htm (good web site for patients)
American Cancer Society’s Web site, numerous good links:
http://www.cancer.org/docroot/MBC/MBC_4x_CopingGrief.asp?sitearea=MBC
http://www1.nmha.org/infoctr/factsheets/42.cfm (National Mental Health Association
2000 N. Beauregard Street, 6th Floor, Alexandria, VA 22311
Phone 703/684-7722
Compassionate Friends. Parents, siblings, friends, who are mourning the death of a child.
www.compassionatefriends.org.
Parents of Murdered Children and other survivors of homicide, 888-818-POMC, email:
natlpomc@aol.com.
Pet loss support group, www.petloss.com/groups .
Resources for grieving children and their families:

American Academy of Child & Adolescent Psychiatry. (800) 333-7636
http://www.aacap.org --- professional membership organization of psychiatrists provides
resources for parents and teens.

Center for Mental Health Services. (800) 789-2647 http://www.mentalhealth.org/child.
--- a Federal Government clearinghouse offering mental health English and Spanish
language publications for families, children, and adolescents.

Dougy Center, The National Center for Grieving Children and Families. (503) 775-5683
http://www.dougy.org --- a national support center for grieving children, teens, and
families.

GriefNet. http://www.griefnet.org ---an Internet community of more than 30 Email
support groups and two web sites, offering a moderated chat room for children who are in
grief and their parents, lists of books and other library information, memorials, newsletters,
a directory of suicide prevention and survivors' information, and more.