Grieving the death of a loved one

Anger: It is common to feel anger, or even rage, after a death. Often, it is connected to sadness that a beloved person is dead. Anger might also be about specific things: words not said before the person died, or some which were said, about which we feel unfinished. There can be anger about the way in which the person died, even when the death occurred. Sometimes people are angry at God or a universe in which such things happen.

We might even be angry at the one who died for leaving us, or for leaving us with unresolved issues or decisions. Like shock, anger can arise for many reasons and in many forms.

Sadness: Perhaps the most common response to a death is sadness. Someone’s life is over. We miss them. We feel alone and lost, or we wanted more with and from them. Sorrow may seem to well up from deep inside and color every part of our lives in the days and weeks after the death of someone we love. Even months or years later, there can still be times of great sadness.

Other feelings and thoughts: There are other feelings and thoughts that often arise when someone dies, including fear, guilt, denial, relief, and disbelief. It is very common to experience many emotions, not just one, or to feel differently on different days.

At times, there may not be any strong emotion at all. We just feel numb!

Draw on the strengths and resources of others.When shock and other feelings are especially strong, it can be hard to make clear decisions. At moments like these, avoid quick decisions. Draw on the strengths and resources of others to help you make wise choices.

Be careful about cheering up too quickly. Be careful about believing that you need to cheer up too quickly. Wanting ourselves and others to feel better is natural, but trying to cheer up too quickly can get in the way of what you need to do, which is to grieve.

• Honest, clear and understandable information
  Children, especially those under the age of 12, are usually quite basic in their thinking and in their use of language. It is important to tell children of all ages the truth in language they can understand.
  
  Do not say the person is "lost," "has gone on a trip" or "is asleep." Such language is likely to confuse and even disturb children. "Why would Grandma go on a trip and not write to me?" Be sure that the child understands what caused the death. Sometimes children can imagine that something they did or said (or even something that they thought or felt, such as jealousy or anger) caused the death. Further, if they hear that someone died in their sleep, they might fear that they, too, might die in their sleep. It is important to be sensitive to such interpretations and to talk about them when they occur. As children grow and mature it will be important to talk with them occasionally about the death so that their understanding of it can grow.
• Reassurance about adult grief
  When a death occurs, it is not necessary for adults to hide their grieving from children. However, children and adolescents can become frightened following a death if it appears that the key adults in their lives are emotionally out of control or distant. It is very important that children be assured that, in spite of the death, they will be cared for and safe.
  
  If you are concerned that your own grief is preventing you from being emotionally available for your children, invite someone you trust to help out for a time.
• Permission to have their own thoughts and feelings
  Adults must be careful about imposing their reactions on children. Children need to have their own responses to the death.
• Normal routine
  In the midst of all that happens following a death, maintaining a child’s routine can help give a sense of security. Avoid making major changes in the first months, unless there is no good alternative. Change often increases stress for children.

Children may have a "short feeling span" as well as a "short attention span." Therefore they may not be able to handle intense feelings for long periods of time and may switch to other activities and play. This does not in any way mean they are less affected by the death than others.

Children, like most of us, need to feel safe, emotionally and physically, before they can share difficult feelings. They need a strong relationship with at least one trusted adult in order to explore their feelings of grief. Help children identify adults with whom they feel secure in sharing their feelings.

Children under the age of five will probably believe that death is reversible. It is not uncommon for a young child who attends a grandfather"s funeral to ask something like, "Will Grandpa be able to come to my birthday party?" For young children, keep answers brief, simple, and repeat when necessary.

Small children may not be able to remember the loved one who has died. Photographs or videos of the person who died, especially ones in which the child is also present, may help the child remember, as well as help the child to express feelings and concerns that need to be acknowledged.

• Continue to remember birthdays and anniversaries to keep the memory alive.
• Tell stories that will show the love, concern, pride, and joy that the person who died had for the child.
• Special possessions of the deceased person might become keepsakes and cherished mementos for the child.

• Listen carefully.
• Listen for underlying feelings and concerns.
• Let the child know that his or her feelings and concerns are OK.
• Respect the child’s views.
• Let the child’s questions guide the conversation.
• Answer honestly, and only after you are sure what is being asked.
• Stories, games, play, art, or music might be natural ways to help children talk about their feelings and thoughts.
• Ask the child to tell you what he or she has heard in order to provide an opportunity to clear up any misunderstanding.

One woman found it hard to stay calm when a dear friend asked her too soon after her husband's death: "When do you figure you're going to be back to your old personality?" After a long and awkward silence, she responded to her friend, "Never! When you have watched your husband die for nine months, you are never the same again." (Coughlin)

Some people describe the transition following a death as moving to a "new normal." In other words, while it can be important to return to familiar patterns and routines, even to believe that life can be good again for us, it is important to realize that our lives change when someone significant to us dies.

Some deaths are more difficult because of the hopes and dreams we had for or with that person: retirement dreams, plans for children or grandchildren, things we had planned to say to, or do with, the person.

For others, the loss of dreams has to do with pictures or expectations we have held for ourselves. One woman yelled, "I don’t want to be a widow!" She liked being a wife and could not yet think of herself differently.

The same can occur for parents, partners, even friends. "I wish I had been there when he died!" represents the loss of a dream for many people.

Still another kind of shattered dream is the manner of death. Some people want to die at home, in their own bed. They may have expressed a desired way or timing for their death. When a death occurs at a time or place which did not fit with the "plan," the death can be more difficult to bear. Be aware that you may be grieving more than the death of your loved one. You may be grieving the "loss of dreams."

Some deaths can be more difficult because of the way they happened or because of prejudices in society. It might not be easy, for example, to tell others that a loved one’s death was self-inflicted or resulted from carelessness, violence, or a disease that is hard to talk about.

In such situations, survivors may have feelings of guilt, blame and embarrassment that complicate their grieving. There can also be tension and conflict among family members as people try to cope with and make sense of the death. Remind yourself that family and friends can have differing opinions and still be able to comfort one another while grieving.

Grieving can be harder if the manner or cause of death is not easy to talk about. If this is true, try to find people with whom you can talk about all your feelings and reactions, especially the difficult ones. Don’t cut yourself off from support and care. Time alone, while good in small doses, can keep you from the care you need.

Experiencing many losses in a short period of time can result in loss overload. For example, some people, in addition to grieving the death of a loved one, may also be dealing with a divorce, the loss of a job, the serious illness of another friend or relative or even a number of recent deaths.

It isn't easy to grieve one loss, especially a death. It’s even harder to deal with many losses at the same time. At such times, one's own health and well-being can be at risk.

If you are experiencing loss overload, remember that each individual loss will need to be grieved. Try to deal with the losses in ways that you can handle, not everything at once. Consider getting some help in sorting through it all and figuring out how best to care for yourself. It may be time for professional support and care to help you through a truly difficult period.

It is not unusual for people who are grieving to feel depressed. They can find it difficult to gather the energy for even the most basic daily tasks. Many times a death follows a long illness that has put enormous strain on the energy and resources of family and friends. As a result, feelings of depression have often been present for families and friends even before the loved one died.

Sometimes depression occurs when people bottle up painful feelings, especially anger. In such cases, it can help to express those pent-up feelings in acceptable ways and to talk about them with trusted people.

If you find that feeling depressed is getting in the way of your being able to function over an extended period of time, it will be important to seek help from your doctor or a counselor.

If you have a history of clinical depression, this is certainly a time to take very good care of yourself and to seek counsel if you need it.

When someone close to us dies, it is normal and natural to ask "what if" questions. Depending on the nature of the illness or injury that caused someone's death, many of those close to the person often look back over the past, wondering:

• "What else could I have done?"
• "What could I have done differently?"
• "If only I had…, then the doctors might have detected the illness sooner."
• "Did I do the right thing in asking that the treatment be stopped?"

Other second guessing may center on the actions of others, such as:
"If only the doctors had…"
"If only my loved one had…"

If you become upset by second guessing of any kind, it is important that you share your concerns and feelings with people who can help.

If you are focusing on your own actions, remember that hindsight is much more clear than foresight. Beyond that, we are human and we have our limitations.

If you are focusing on the actions of others, seek good counsel. Start with friends you trust. Check with them about your reactions and concerns before over-reacting or under-reacting.

If you have any concerns or "what if" questions about the care that was given, or decisions that were made by you or others prior to your loved one's death, contact your doctor, the hospital patient representative, or other hospital or hospice personnel (unit manager, social worker, chaplain) so that your concerns can be addressed.

Feelings of guilt are common when people are grieving. Nearly all relationships have a mixture of positive and negative feelings and experiences. It is natural, after a death, for people to feel regret over what was negative in a relationship. As a result, we can sometimes fail to remember the positive things.

People also may feel guilty about the many emotions they experience in their grief, such as anger at the one who died for leaving them, jealousy of others who don't seem affected by the loss, or relief that the death finally came after a long illness. We may even feel guilty because we could not protect our loved one from death, or because he or she died instead of us.

Blame is closely connected to guilt, especially when our guilt results in blaming ourselves. It is not uncommon to feel a need to blame someone or something for the death, in particular if the person was young or died suddenly, or if we wonder if the death could have been prevented.

Guilt and blame are powerful emotions. If you are experiencing either or both, remind yourself that people usually do the best they can with the information and resources they have at the time. Find people you trust with whom you can honestly share your feelings without fear of judgment.

If you find that feelings of guilt or blame are becoming especially troublesome in your grieving, it might be wise to talk with a counselor, spiritual advisor, or other professional in order to sort out the issues and take the necessary steps to resolve your concerns.

When a relationship with the person who died was complicated, or when there was a great deal of conflict, grieving can be especially difficult. In particular, when relationships have had "secrets" or where there has been abuse, the survivors are often left with troublesome feelings and a belief that they can’t talk about them. This can have serious emotional — and physical — consequences.

In such situations it will probably be important to get professional support and counsel in order for healing to happen. If you need such a referral, the hospital chaplains and social workers, your doctor, or spiritual advisor can help you find the resources you need.

Rituals can help with changes and transitions in life. All cultures have rituals concerning death that are a part of their traditions. You may choose to practice the rituals of your culture or spiritual tradition, alter them in light of your own beliefs, or create new or additional ones.

Along with the funeral ritual, you may want to consider other rituals in response to the death of your loved one. For example, when a father died, his ex-wife brought their children one last time to his home, along with some friends, to tell stories of things that had happened in that place. That was a ritual of closure.

Some people like to plant a tree, or make or give something in memory of the person who died. It's a way of extending the memory of the person beyond his or her death. Others write letters or keep a journal.

Rituals, at their best, promote healing and help mark important life events. consider including some rituals in your journey of grieving. If you need some help in creating or finding meaningful rituals, ask friends or spiritual leaders for assistance.

Keeping some special items, often small things, can be a help in grieving. These things remind us of the person who died and their place in our lives. It is part of the legacy they have given us, for better or worse. It reminds us of those who have played important roles in our lives.