Enhancing Well-Being By Understanding Grief & Taking A Loss History
2004: Volume
1,
Number 2
Kirsti A.
Dyer, MD, MS, FAAETS,
FACW, NCBF, CWS
Loss—the
disappearance of something cherished by an individual (i.e., person
or property)—is a byproduct of living. Most people have experienced
some type of personal or professional loss at some point in their
lives. Many times these losses are never announced or acknowledged
publicly. Instead, the person endures very private sorrows that can
impact his/her health and well-being.
Health is the optimal state of wellbeing—being well physically,
emotionally, spiritually, and mentally. Wellness is considered to be
the state in which the physical, emotional, mental, and spiritual
dimensions are balanced so that energy is used effectively.
Experiencing a loss or a life challenge upsets this balance and
reduces a person’s energy.
Grief is the normal reaction to a
loss. Therefore, grieving is the process a person goes through while
restoring his/her balance and energy. During this process the
grieving person may experience significant and subtle changes that
can impact his/her physical, emotional, mental, behavioral, and
spiritual health thereby compromising overall well-being. Grieving
losses is an important step toward restoring balance, because,
according to Elaine Childs-Gowell, if we don’t grieve the old
losses, when faced with a new loss, we will have to use our energy
to face the past as well as the current loss.
The Impact of Grief on a Person's Well-Being
Although grief and wellness seem unrelated, unrecognized acute loss
or unresolved grief can mimic various medical conditions, lead to
illness, and result in a decline in wellness. A grieving person may
experience a variety of somatic complaints: fatigue, insomnia, pain,
gastrointestinal symptoms, chest pressure, palpitations, stomach
pains, backaches, panic attacks, increased anxiety, or a generalized
feeling of not being quite right. These symptoms may be due to a
medical disorder or a grief response following a loss. Potentially
serious medical complaints require a thorough evaluation to exclude
serious medical disorders before a grief response or depression can
be diagnosed.
Loss and the resulting grief response can impact a bereaved person’s
mental and behavioral well-being. Repressed, unrecognized, or
unresolved grief can cause personal anguish, increased anxiety,
multiple physical complaints, functional impairment, strained
relationships, marital discord, disrupted sleep, impaired childhood,
increased substance abuse— tobacco, alcohol, drugs, tranquilizers—
clinical depression, and an increased mortality from heart disease
and suicide. The death of a spouse has been shown to have a negative
impact on the health of the surviving bereaved spouse. This includes
an increased risk of death.
Studies have shown that bereavement can lead to increased mortality
from ischemic heart disease, development of high blood pressure,
depression of the immune system, and increased depressive and
anxiety disorders, including post traumatic stress disorder.
The Personal and Economic Impact of Loss
Each year, loss and life challenges have an enormous personal
impact. In 2000 there were over 2.4 million deaths in the United
States. Each individual death is estimated to affect between 8-10
family members resulting in at least 19— 24 million new mourners
created each year. Some estimates place this number as high as 30
million.
However, these figures do not include
the millions of additional mourners created by the friends,
neighbors, colleagues, coworkers, social contacts, students, and
others outside the immediate family of those who have died. These
numbers also do not include the millions of mourners who have
experienced one of myriad of losses other than death or those still
grieving a longstanding loss.
Loss and the resulting grief response
also have a significant economic and societal impact. This is
manifested in the high costs of absenteeism, decreases in worker
productivity, lower product quality, increases health insurance
premiums, escalating social violence, substance
abuse among workers, and problems from driving under the
influence of drugs or alcohol, including accidents and increase in
suicides or suicide attempts. A November 2002 report placed losses
in the U. S. linked to grief at more than $75 billion. The study,
conducted by the Grief Recovery Institute, included losses from
emotional pain ranging from miscarriages to pet loss.
Distinguishing between Grief and Depression
Manifestations of depression and symptoms of distress can be part of
a normal grief response to a major loss or prolonged bereavement
response, which make it challenging for the
practitioner to determine between a grief response and true
clinical depression.
The tables
below summarize key characteristics of grief and depression to help
the practitioner distinguish between these two related but
distinctive conditions.
Key
Differences Between Grief And Depression
|
Key Characteristics |
Grief |
Depression |
Vegetative signs or
symptoms |
Subside with time |
Persist > 2 months after the loss |
Pathology in mental
function |
Lacking |
Severe, distorted, negative perceptions
of self, world, and future |
Sense of loss |
Recognized and acknowledged |
Unrecognized and denied |
Energy level |
Agitated, restless, transient |
Persistently
retarded or no energy |
Suicide gestures |
Rare in uncomplicated mourning |
Not atypical |
Reactions from others |
Elicit sympathy, concern, desire
to embrace |
Elicit irritation, frustration, and
desire to avoid |
Responds to warmth and support |
Yes |
Often does not |
Past or family history of depression |
None |
Common |
Preoccupation |
With the deceased |
With self |
Mood |
Fluctuates |
Stays down |
Overexpression of anger |
More common |
Less common |
View of pain |
Acknowledgment of the loss |
Useless or meaningless |
Gender |
Equal |
More often in females |
Recognizing Depression
Stress can contribute to depression
and may complicate its symptoms. Depression is a major health
problem that is commonly underdiagnosed and undertreated. Yet, 80
percent of those with depression can be treated successfully.
Clinical depression is diagnosed if a patient has at least one of
these two symptoms every day for 2 weeks or more:
-
Feeling sad,
blue, or down in
the dumps
-
Loss of
interest in things that were once enjoyable
With at least four of the following,
nearly every day:
-
Losing or
gaining weight
-
Feeling tired
or having low energy all the time
-
Difficulty
concentrating or making decisions
-
Racing
thoughts or slowed thinking
-
Feeling
worthless or guilty
-
Trouble
sleeping or sleeping too much
-
Thoughts of
death or suicide
(Adapted
from Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Taking a Loss History
On a daily basis, physicians and other healthcare providers care for
patients who are experiencing a life challenge or have experienced
various losses; yet they may be completely unaware that the patient
is grieving. In order to enhance our patients’ well-being, we need
to identify their present and past losses, life challenges, or
experiences that can be impacting their
health.
Current or prior losses typically are not included when asking a
patient’s medical history. These losses can result in an acute grief
response that can mimic different medical conditions. A loss history
may also reveal contributing factors for many patients with multiple
medical complaints.
By asking the right questions, a
health care provider may uncover losses that are impacting the
patient’s health and well-being. Additional questions can determine
any coping strategies used by the patient in the past, which can be
helpful in revealing how the person has handled prior losses and may
indicate how he/she might handle future loss. A loss history can be
included as a routine part of a history
and physical questionnaire and updated at follow-up appointments.
The patient’s major losses can be
listed either chronologically or in order of importance. All major
types of losses should be included, both
current and distant:
-
Deaths
-
Divorce
-
Loss or
impairment of bodily function
-
Job losses
-
Illnesses—mental and physical, both personal
and in the family
-
Major moves,
relocation
-
Other
significant losses for the person (e.g.,
miscarriage, pet loss)
Coping with Life's Challenges
Following a sudden loss, death, or tragic event, it is important for
the grieving person to remember to take care of him/herself.
Focusing on basic survival needs of the body is especially necessary
during times of stress and uncertainty:
-
Take it one
hour at a time, one day at a time.
-
Maintain a
normal routine. Keep up your regular
activities.
-
Get enough
sleep or at least enough rest.
-
Regular
exercise, even walking, helps relieve
stress, tension, and improve your mood.
-
Maintain a
healthful, balanced diet. Limit high-calorie
food, especially junk food
and comfort food binges.
-
Drink plenty
of water.
-
Avoid using
alcohol, medications, or other drugs to mask
pain.
-
Talk to
others, especially those who have lived
through and survived similar experiences.
They may provide valuable insights for
coping.
-
Do things
that—and be with people who—comfort,
sustain, and recharge.
-
Recall coping
strategies used to survive past losses. Draw
on these inner
strengths again.
Conclusion
Failing to identify a grief response to loss may result in a poor
response to therapy because the correct diagnosis (grief) was not
made, nor was the underlying etiology for the symptoms ever
identified. By not identifying the grief response, the patient may
not receive the proper support to help him/her cope with a life
changing event.
Taking a loss history may help the
practitioner identify and diagnose a grief response correctly. Then
the practitioner can educate the patient about their symptoms and
how they relate to the life challenge, which in turn helps the
patient process the change, integrate the loss, begin living again,
and restore balance, energy, and well-being.
Resources available on request.
Contact Dr. Dyer at
griefdoc@journeyofhearts.org. |