Grief And The End Of Life Process

Even though we all miss people in different ways, grief is actually one of those unique feelings that unite all of us as humans, whether we live in Cedar Rapids or anywhere else in the world. These feelings can also extend into saying good-bye to people when they’re receiving end-of-life care.

The team at Above and Beyond Home Care and Hospice are familiar with the process of and the result of grief. We’ve worked with patients and family members who sometimes have a difficult time before, during and after someone’s passing, and we’ve worked with families who have a different perspective and are able to celebrate beside them without feeling emotionally devastated. And we’ve also seen everything in between over the years: there are many different ways people mourn and remember loved ones, whether their loss took place a few days ago, years ago or even decades ago.

Our conclusion is that there’s no right or wrong way to grieve or a certain way that everyone is supposed to feel when someone they love dies or is moving into hospice care.

Since we work in the medical, health care and hospice fields, we’re in the position to encounter death and grief as part of our regular daily duties, but we know that the process can sometimes be something new, unfamiliar and even a little scary to our patients and their families.

At the same time we also know that this time of life can be highly stressful, so we encourage people to seek resources anywhere they can, whether it’s a support group in their community, reliable online information, mental health professionals in their area or spiritual advisors, especially someone who is part of a faith tradition, like an official from a local church.

Learning more

A big part of what we know about grief and loss today comes from research in the 1960s by Elisabeth Kubler Ross and David Kessler. They identified five phases that people typically follow in their grieving process, whether it’s one person and their own life, or trying to cope with someone around them.

The process starts with denial, and simply not believing information that the loss is happening or has happened. The brain is amazing in how, in order to avoid pain, it comes up with many reasons why the information is not accurate, such as a terminal diagnosis.

The American Cancer Society adds isolation to Step 1, especially the feeling of being alone and general numbness after someone passes. People may feel removed from the world, almost like they’re the ones in denial.

Next is anger, when you feel that things aren’t fair and generally become frustrated and anxious about your current situation.

Feelings of loss are especially painful and negative.

This is followed by bargaining when you look for ways to undo or spare you the pain, or perhaps find meaning or justification for your loss or pending loss.

The next stage is depression when you simply feel sad, overwhelmed and helpless about the situation. This also may manifest in other parts of your life, including your relationships.

Finally, acceptance comes and you begin to experience life with that loss.

Different views

Of course, many mental health professionals and grief specialists will say that the list of five items is more of a guideline rather than a firm recipe or blueprint. Additionally, there’s no schedule or timeline. Some people may move through several stages quickly and then stay in another stage for years.

In cases where a loss takes place quickly, like an unexpected death, people may feel more confusion or be stuck in the early stages or not know how to feel for a long time. On the other hand, a slower process, such as a death in a hospice program, where people are able to say good-bye and have time together will still hurt but ultimately may be easier to deal with. Essentially, some of the earlier stages may have been experienced while the loved one was still living, a sort of anticipatory grief.

There are a variety of other factors and one size rarely fits all. The American Cancer Society, for instance, said a period of mourning, or at least public grief, may be slightly different than the period of grief which someone might feel at a personal, internal level, often long after someone passes away.

Interestingly, some contemporary mental health researchers are now promoting the view that the “five stages” viewpoint may need to be adjusted or updated to reflect newer knowledge about how the brain and body perform under stress and trauma.
In general terms, this theory proposes that the sequential five-step process of grief is too simple. Instead, some believe that grief regularly moves back and forth through all the periods of denial, acceptance, and everything in between depending on the individual and his or her circumstances. Sometimes, grief or at least a significant loss, can also alter the character of our lives and our world views, and result in something more significant than just acceptance.

This month is a great time to learn more about how and why grief occurs, and maybe even learn strategies for the next time it comes your way. Aug. 30 is National Grief Awareness Day, an occasion to learn more about resources in your area.