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Grief & Bereavement

Unfortunately loss is unavoidable. However people respond to loss differently. Some get stuck in cycles of reminiscing and resentment for years and end up by losing much more than they have to. Others can appreciate the bitter-sweet feeling of a hug at funeral, knowing that despite having lost a loved one, they are not alone. Sometimes the sense of loss is so chronic and painful that adjustment might be extremely difficult without additional help.

From cognitive behavioural perspective, we take a look at the beliefs that the bereaved has about grief, the impact that the nature of the relationship had on their grief reactions, the impact of the manner in which death occurred and perceived obligations towards the deceased.

There is no such thing as grief trajectory that unfolds in preordained stages. We can’t just grieve and be done with it. Losing someone can get easier with time as we get used to functioning on our own and form new relationships that take away our focus from bereavement. Still, loss stays. Having “dealt with grief” means that our days are not filled with thinking about death but it does not mean that we are free from occasional longing for people who are no longer there. A widow who attends her children wedding is bound to think about her spouse. A friend who takes his family on a hike through his childhood countryside is likely to remember the accident that took away his childhood buddy. A mother who proudly watches graduation of her daughter might wonder how would her little boy do in school if it were not for cancer that ended his life. Those occasional reminiscences will always happen at reference points in our lives. The key is to have a life despite grief.  

The nature of the relationship with the deceased brings another layer into the process. It is easy to feel at fault when the person who died is someone we had the responsibility to protect. Yet people also feel guilty or plainly puzzled by their reactions to death of an abusive parent or spouse. People rarely wish death on anyone so some form of regret will occur but regret over a death of someone with whom you did not have an emotionally close relationship is different from bereavement and there is no use blaming yourself for not grieving the way you should. The extent of grief depends on the extent of emotional attachment and not on the role that the person has played in our lives. This is not to say that the role has no impact. If you were in an emotionally distant relationship with an individual who made you fully dependent on them and you believe that you are unable to take care of yourself without that individual in your life, their death will produce anger and fear. Loosing someone we loved and were depending upon while we believe ourselves not up to a challenge of facing the world independently can be incredibly confusing. The reaction would consist of longing for the departed, anger over perceived abandonment and fear of the independent future.

The manner of death impacts our view of the world. Losing someone to an accident or assault can tint our own sense of safety. Watching a person struggle with terminal illness and having to make end of life decisions about the palliative care is something very different. Family often struggle with giving consent to disconnect their loved ones from respirators and feeding tubes as it can leave some of them with a sense that they had a part in someone else’s death. Some mourners try to imagine how the final moments might have felt like. The truth is that we will never know and we won’t be able to take away the other person’s no matter how often we go through these events in our minds.

After someone dies we are left with concrete and emotional obligations. Concrete obligations would include making respectful funeral arrangements and doing whatever we need to do in order to take care of the estate. The other obligations are all emotional and generally center on preservation of that person’s memory and upholding of whatever promises we might have made before they died. There is nothing wrong with making a donation to a cause that was important to the deceased or in following through with their wishes by offering assistance to people that this person left behind. There is no need to worry that the person will be forgotten unless you think about them all the time. If someone has been an integral part of your life, you will remember it without reminders and you can trust that the reminders will stay with you in the form of pictures, stories you shared with others, life events that would bring to mind similar situation that you shared with the person you have lost. Following through with wishes might be more difficult as these wishes can range from your taking the person’s ashes to a certain location to your remaining fateful to their memory which to some implies not allowing yourself to have a new relationship. The simple rule of thumb is to follow through with the requests that are not hurtful to the living. Enjoying aspects of your life from taste of a morning coffee to a new relationship should not make you feel guilty. You have already lost enough and life is about developing an ability to appreciate moments of joy whenever possible. I am talking about rushing out to find a substitute for a person you have lost. This actually does not even work. I am talking about being able to find solace and a sense of connection within the comforting hugs that you might receive at the funeral and the relationships that still remain.