when a loved one dies: coping with grief

FAMILY & LIFE

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The Individuality Of Loss ..................................................... 02

Understanding Grief: In Adults & Teens .............................. 04

Understanding Grief: In Children ......................................... 07

Special Loss: Family & Friends ........................................... 09

Sudden Loss ....................................................................... 12

Steps Forward ..................................................................... 15

table of contents

the individuality of loss

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Of the many trials you may confront in life, none

is perhaps more difficult and challenging than

being faced with a personal loss, whether that

of a spouse or partner, a family member or close

friend. How you deal with grief and move toward

recovery depends on many things that are truly

unique to your situation. You cannot, and should

not, measure your own depth of feelings or ability

to handle a complexity of issues by comparing

your reaction to anyone else’s.

Loss and grieving are usually specific to the

individual, even within the same family — try

to remember this when seeking appropriate

counsel or other resources, a number of which

are included in this guide for your consideration.

But please keep in mind that you should always

talk to a physician or trusted adviser if you need

any additional support or information, either now

or in the weeks and months ahead.

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understanding grief: in adults & teens

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Note: Complicated grief is NOT the same thing as feeling sad about a loss long after the fact, perhaps in conjunction with an event at which the person who has died is more keenly missed. This type of response is to be expected with normal grief that can resurface from time to time but doesn’t interfere with your ability to carry out daily activities. Symptoms of complicated grief may mimic that of major or severe depression, anxiety disorders and even post-traumatic stress syndrome — none of which should be ignored.

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The National Cancer Institute (NCI) at the National Institutes of Health (NIH) reports that there are generally three defined types of grief you may experience:

Anticipatory grief occurs when a death is expected but before it

actually happens. This may be the case when someone is terminally

ill, it might even be felt by the person who is sick. While anticipatory

grief is thought to be a means of coping with the eventuality of

death, you may reject the idea of grieving or attempting to accept

a loss while a loved one is still alive — anticipatory grief doesn’t

replace the type of “normal” or common grief experienced once

death has occurred. As with any kind of grief this is completely

unique to the individual who must deal with their own feelings and

response to an emotionally charged situation.

“Normal” or common grief is the period of moving toward accepting

a loss, even while going through daily activities and still being able

to function. You may experience any or all of the following emotions

or reactions as part of normal grieving:

•Shock, disbelief, denial, a sense of numbness

•Sadness, anxiety, distress

•Anger or guilt

•Loss of appetite, inability to sleep

or focus on tasks, fatigue

This is by no means an all-inclusive list — your grief is personal and

so are your emotions. Nor is there a set period of time to grieve

although typical bereavement can last anywhere from several weeks

or months up to a couple of years. Your emotions may rise and fall

during this time, with bursts of increased sadness or anger based

on your mood or health, certain events such as holidays, or other

external factors.

Complicated grief manifests in ways that are distinct from normal

grief, with either minimal signs of emotion or response following

a loss or chronic, long-lasting sadness that doesn’t diminish over

time. Studies have looked at this type of grief and how it can

beinfluencedbypersonalityofthebereaved,gender,ageand

strength of a support system that includes friends, family and

other members of a community who can provide counsel and

evenfinancialhelp.

Bereavement is the period of sadness upon

losing a loved one while grief is the emotional

response to this loss — and being an adult

doesn’t negate your need to acknowledge

a loss and react to it in your own way.

Remember that your response to a death may

be completely different from that of another

familymemberorfriend,andinfluencedby

beliefs, spiritual practices or even cultural

customs. The act of mourning, or how you

choose to mark the loss of a loved one through

visitations, a memorial service or funeral, is as

equally personal as grieving and just as distinct

from one person to another.

Give yourself permission to grieve

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The National Institute of Mental Health (NIMH)

states that a depressive disorder, or major

depression, is characterized by a combination

of symptoms that interfere with a person’s

ability to work, sleep, study, eat and enjoy

once-pleasurable activities. Major depression

is disabling and prevents a person from

functioning normally. While the signs of normal

grief may seem similar at least at first, the

symptoms of true depression are typically more

pronounced and long-lasting. Treatment for

depression can include medication, behavioral

therapy and other supportive intervention

appropriate to the grieving individual. For more

detailed information, see nimh.nih.gov

Grief or depression?

While teenagers or older preteens may be more capable of under-

standing the concept of death and the implications, as compared

to young children, it’s important to remember that teens are not adults

— no matter how mature they may appear to be. Teen emotions may

be very similar to yours ranging from sadness and anxiety to anger

or guilt. The Dougy Center, The National Center for Grieving Children

andFamilieswith25yearsexperienceasthefirstcenterintheU.S.to

provide peer support for grieving youth, suggests that you pay close

attention to your teen for signs that can be similar to adult responses

but more pronounced and troublesome:

Using alcohol or drugs to escape or

avoid talking about the loss.

Failure to acknowledge the death or acting

as if it hasn’t occurred.

Decline in school performance or attendance.

Withdrawal from friends and family or social activities.

Excessive sleeping.

Marked or prolonged decrease in appetite accompanied

by weight loss or other health problems.

Change in personality or appearance.

Teenagersoftenhavedifficultyexpressingtheirfeelingsunderanycir-

cumstance to parents or even peers — boys in particular may think it isn’t

appropriate to cry or show any true emotions that may be perceived as

“weak.” If your teen isn’t comfortable talking to you, try not to take it per-

sonally or overreact — but don’t ignore the situation. It may be time to con-

sider professional help to address your concerns before things get out of hand.

Teens need special attention

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understanding grief: in children

TheNationalCancerInstitute(NCI)identifiesthree

common worries many children experience when

coping with loss: “Did I make the death happen?”;

“Is it going to happen to me?”; and “Who is going

to take care of me?”. While you cannot expect to

resolve these worries immediately, there are things

to consider when talking to a child about death

that may help with time to relieve their concerns:

•Answer questions honestly and directly, using

age-appropriate language.

•Keep your explanations simple and factual,

including details only as needed.

•Provide reassurance that your child will be safe

and secure.

•Many experts recommend the use of direct

words, such as “died” and “death.” Saying

things like “he/she passed away” or “we lost

him” — terms adults understand — can create

confusion and unintentionally promote the idea

that the loved one may return.

SOURCE: National Cancer Institute: PDQ® Grief,

Bereavement, and Coping With Loss. Bethesda,

MD: National Cancer Institute.

Talking to children about death

Children, as compared to adults and older youth, have a unique way of

looking at the world and events around them, which makes it particularly

important you understand the kind of grief your child may experience.

The American Academy of Child and Adolescent Psychiatry (AACAP)

states that preschool children may view death as something temporary

and reversible, a belief that stems from seeing cartoon characters “die”

andcomebacktolife.Childrenagesfivetoninemaybegintothink

more realistically about death yet they still think it will never happen

to them or anyone they know.

You can expect your child to display normal grief such as immediate

sadness and crying, confusion and anxiety, increased fearfulness or

even insistence that the person who has died will come back or is still

alive. If a funeral or memorial service is planned and your child is afraid

or just doesn’t want to attend, don’t force the issue. Instead, consider

an alternative way to let your child honor the memory of a loved one,

such as drawing a picture of the person, making a scrapbook or lighting

a candle with you. Use your judgment as to what is in the best interest

of your child — try not to be swayed into doing what you think other

people may expect or think is “right.”

How children view loss

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The loss of a parent or older sibling who has

been deployed for some time may create

evenmoredifficultiesforyourchildasfar

as accepting the permanence of the loss or

grieving with the rest of your family. Military

deaths, and subsequent observances, during

wartimes are often public events and the lack of

privacy can cause additional problems for your

child in dealing with the loss. Don’t hesitate to

set limits on visits or overtures by even well-

meaning friends or other relatives — your child’s

wishesandemotionsalwayscomefirst.For

more information, see “Traumatic Grief in Military

Children: Information for Families” The National

Child Traumatic Stress Network at nctsn.org

Children’s grief in military families

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The American Academy of Child and Adolescent Psychiatry (AACAP)

notes that young children who have lost a parent may experience guilt

or blame themselves for the loss if at some point in time they were

angry and wished the parent would “go away” or perhaps even die.

Additionally, there are several signs that could indicate more serious

grief responses such as:

Extended period of depression and sadness where your child loses

interest and involvement in play or daily activities.

Inability to sleep or eat.

New or increased fear of being alone, either during the day or night.

Excessively “imitating” the person who has died.

Statements of wanting to “be with” the loved one.

Refusing to attend school or a decrease in performance.

Note that young children may not be able or want to fully express grief

through words — so examine any drawings or pictures for indications that

yourchildishavingagreatdealofdifficultycopingwiththeirfeelings.Ifin

doubt, talk to your pediatrician right away and get appropriate counsel.

More serious responses in children

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special loss: family & friends

Regardless of how long you may have been with

your spouse or partner, there is no simple way to

surmount the loss of this person or to deal with

the ensuing grief and related issues. Faced with

your emotions, you may also have to help children,

elderly parents or other relatives cope with this

same loss.

While your initial reaction might be to attend to

the needs of everyone else, don’t neglect yourself.

Know there is support for you as well as your

family through a variety of resources:

• Close, trusted friends

• Spiritual adviser

• Mental health counselor or organization

• Grief and other support groups

• Counseling options provided by employee

assistanceorworkplacebenefitsprograms

Many couples often split tasks at home, making it

thatmuchmoredifficulttosuddenlyfindyourself

as the person with sole responsibility for taking

care of all the day-to-day details or things your

spouse typically handled. Remember you don’t

have to go it alone — enlist a friend, neighbor or

relativetolendahandespeciallyduringthefirst

few weeks following a loss.

Losing your spouse or partner

Any loss that is meaningful to you will be a difficult loss

to bear. But there are certain losses that present special

challenges including that of your spouse or partner,

a parent, your child, a sibling or close friend. If you

have experienced a loss of this nature it’s particularly

important for you to be mindful of certain considerations

and be aware of the need to consult a professional for

help if you feel overwhelmed or hopeless at any time.

Please don’t wait to take care of yourself and know

there is support for you and other family members.

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The National Institute on Aging (NIA), U.S.

Department of Health & Human Services,

recommends waiting to make any major

decisions about things like moving, new jobs

and other changes that will require even more

acclimation. It’s better to cope with your

emotionsfirstandthenwhenyou’reready—

whenever that feels right for YOU — consider

other tangible issues that may need to be

addressed. However, there may be certain

legal or administrative issues that must be

addressed right away so don’t hesitate to

involveafamilyattorneyorfinancialadviser

to step in and provide their expert assistance.

Then when you are ready, you can participate

in making critical decisions with a clearer head

and more rational perspective.

There are really no words to describe the extent of sorrow that comes

from losing a child, whether to illness or a traumatic event. You and your

spouse may grieve very differently from one another, all the while having

to care for other children or deal with the grief of other family members

and close friends.

The American Association for Marriage and Family Therapy (AAMFT)

stresses that parents can often feel very isolated in their sorrow as

other people may be unsure of what to say or how to act. You and

your spouse could also experience more anger, guilt, depression and

associated physical symptoms compared to those grieving other types

ofloss.Conflict,eitherneworfrompreviousissues,maybecomemore

pronounced so talking to one another may not be helpful at this time —

but it’s important to communicate with someone who can help you deal

with your emotions and to consider:

• Counseling for yourself, your spouse (either separately or together) and

for other children.

• Joining a support group with other parents who are going through similar

experiences.

• Keeping a journal to chronicle your emotions and thoughts.

• Doing “good works” or some type of community service if appropriate to

honor the memory of your child, either on your own or as a family.

• Staying involved in familiar activities if at all possible. Even shopping

for groceries or helping other children with homework can be more

productivethanyourealizeatfirst.

If you simply cannot face others or attend to things like paying bills, driving

carpool or preparing meals, then don’t do it. Ask for help or accept it if

offered. Make sure your employer is aware of what’s happening and take

advantageofanyavailableleave—ifthatwouldbebeneficial—outside

of the usual bereavement policy at your workplace. Keep in mind that your

spousemayfindsolaceinworkevenifyoudon’tandtrytoberespectfulof

their need to grieve in their own way. The death of a child is not something

people “get over” or the type of grief that goes away, regardless of the age

of the child.

Loss of a child

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The loss of a parent is not only a time of sadness, it can also

be an event that causes a variety of other emotions ranging

from guilt and remorse for relationships that were not ideal to

anger and blame because your parent has been taken from

you “too soon.”

These are normal reactions of adult children to losing a

parent, now faced with your own mortality and potentially the

responsibilities for another aging parent. Grief at this time is

unique to your personality, your relationship with your parent

and any siblings, your age and even your gender. In addition:

• Parents are often a primary source of comfort during times

ofturmoilordifficultsituationsinlife—youmaythinkthat

this kind of unconditional love and support is irreplaceable.

• Thelosscancauserenewedfamilyconflictsasold“hurts”

are recalled.

• Ifyouhavelostyourlastsurvivingparent,itcanbedifficult

to acknowledge your new status as both motherless and

fatherless, no matter how old you are.

• Even if your parent was ill for a long time or very advanced

in years, death is always a shock.

Talking to others outside the family may prove to be especially

helpful,includingsupportgroupsspecifictothelossofa

parent, a counselor or spiritual adviser. Just because you

are an adult doesn’t make your grief any less painful or real

— don’t deny your feelings or get so caught up in the many

administrative issues that are often inherent to losing a parent.

The USAA Educational Foundation publication “When A

Loved One Dies: Legal and Financial Concerns” addresses

a number of topics and information to help you understand

estate matters, executor duties and more — there is a special

section as well for military-specific concerns.

Losing a parent

Losing a sibling may be particularly painful as the loss can

create a void in your life on many levels and potentially

changes your own role in a family’s dynamics along with

the responsibilities your sibling may have shouldered. You

can expect to feel the same type of normal grief as with

any other loss — but you could also grieve the absence of

someone who’s been your friend since childhood, a source

of support during challenging times and a connection to

shared memories and events, both good and bad. Often,

siblings can be overlooked during mourning as others focus

on acknowledging the emotions and needs of any surviving

parents or grandparents. If you have other siblings, try to stay

in touch during this time as you also consider opportunities to

honor your loved one’s life or interests with charitable works or

contributions, for example.

The loss of a close friend is a death that can impact you as

much as the loss of a sibling; with so many families today

scattered around the country, it may be your friend who has

shared holiday meals or been there for you when your relatives

were just too far away. Others may not realize the depth of

your loss. So try to reach out to your friend’s family as well

as mutual acquaintances, seeking comfort for yourself while

communicating to them how much their loved one also meant

to you and the value of your friendship. Remembering your

friend through photos and keepsakes can provide a great

deal of comfort during the initial bereavement period and even

years later. And don’t hesitate to seek counseling if your grief

continues or worsens — losing a friend is no less meaningful

than another loss.

Other significant losses: siblings & friends

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sudden loss

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While you may hesitate to talk to children about suicide, the American Foundation for Suicide Prevention (AFSP)

suggests that honest discussion does not give others the idea to take their own lives. Rather, understanding

mental illness and suicide helps surviving family members to be watchful about their own health, and to take

preventative steps when something is wrong. When talking about the loss to your children, be truthful, be

reassuring and encourage questions. For more information and links to local resources in your area visit afsp.org

HeLPING

ChildrenUNDeRStAND

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Any loss of a loved one can be devastating in many ways

— but a sudden loss that allows no time for any mental or

otherpreparationcanbeparticularlydifficult.Thistypeof

loss may result from an accident, suicide, natural disaster,

criminal act or casualty of war. In this instance, you may be

faced with a far more complicated grief and resulting issues.

Remember that complicated grief is distinct from normal or

expected grief in its:

• Heightened response or minimal reaction.

• Duration of grief and sadness.

• Inability to carry out daily activities.

• Extreme anxiety or agitation.

• Hyper-focusing on the loss itself or the person

who has died.

Complicated grief may require the intervention of a physician

or trained counselor to help you deal with your emotions and

learn to cope with your grief — it is not something to ignore

as it can lead to severe and debilitating depression.

Unexpected losses present different challenges Complicated,confusingandfilledwithabreadthofdifferent

emotions,thelossofalovedoneduetoasuicideisdifficult

tocomprehendandaccept.Youmaybefilledwithguilt,

anger, denial, and embarrassment or shame that others may

fault you for the loss — even though the greatest percentages

of suicides are attributed to an underlying and often

undiagnosed mental disorder.

Grief that accompanies an event of this nature is profound

on so many levels and while it may require the involvement

of a professional to administer treatment or therapy, there are

some things you can do to help cope with this tragedy.

The American Foundation for Suicide Prevention (AFSP)

recommends that you:

CoNNeCT — to other survivors of suicide loss,

through support groups or outreach programs.

LearN — about suicide and the factors that

may have precipitated it and which you could

not have prevented.

CommuNICaTe — with friends, other family

members and trusted advisers who will listen.

Grief after suicide

Every loss can be traumatic to you, your family, and your friends. But

losing a loved one as a casualty of war or due to a public tragedy is

something for which you can’t prepare and that often sparks a range

of emotions outside of normal grief. For example, you may be resentful

of survivors as well as their families, angry at circumstances beyond

your control and at people who may invade your privacy, or experience

irrational fear that you and other loved ones will never be safe again.

Coping with the grief associated with traumatic loss is potentially

moredifficultandlonger-lastingthanothertypesofloss.

• You may be faced with unwanted attention from news media

or even well-meaning strangers who after a tragic event feel

collectively “responsible” for grieving along with you and the

families of any other victims.

• If your loved one was a servicemember, there may be military

memorials or other observances you will need to attend and

subsequently have to cope with additional stress.

• A tragedy may be public but your grief is personal and you may not

wish to have your family’s privacy compromised in any way.

One of the best things you can do in the wake of traumatic loss

is to try and maintain your normal routine as much as that is possible.

For children especially, sticking to a schedule and taking part in regular

daily activities can be very healing both long and short-term. If you do

not want to talk to or deal with anyone outside your family, such as the

news media, enlist the aid of a trusted friend or your legal adviser who

can serve as a family spokesperson. Give yourself permission to rest

when you need to but try to engage in some exercise when you feel up to

it. Traumatic loss can be accompanied by extreme stress reactions so do

not hesitate to get help from a professional counselor or your physician if

you feel totally overwhelmed for any extended period of time.

Traumatic loss

The Mayo Clinic reports that stress following any

kind of traumatic loss can lead to Post-traumatic

Stress Disorder (PTSD), with symptoms typically

occurring within three months of the events; in

a smaller number of cases, symptoms may not

appear for several years and are grouped into

three major types:

•Intrusivememories(flashbacks)

•Avoidance and numbing (denial, avoidance

of social or other activities)

•Increased anxiety (anger,

self-destructive behaviors)

The United States Department of Veterans Affairs

at ptsd.va.gov offers resources for the general

public as well as members of the military. There

is help for you and your family so don’t delay

seeking counsel or treatment. Mayoclinic.org

also provides extensive details and information

for understanding and dealing with this disorder.

Post-traumatic stress disorder affects civilians & servicemembers

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steps forward

Reconciling your feelings of sorrow but still making efforts to

moveonwithdailylifeinnowaydiminishesthesignificanceof

losingalovedone.Itispossibletohealandevenfindyourself

enjoying activities or returning to work — it doesn’t mean you

have forgotten the person you lost. Reassure your children —

and remind yourself — that it is okay to laugh or have a good

time again. Your loved one would not want it any other way.

Just remember there is no set period for mourning and grief is

cyclical, receding and possibly resurfacing at times over the

course of several weeks, months or even years.

There are a number of ways you can help yourself or family

members cope with grief and loss:

Take time to rest, meditate and be alone if you are

overwhelmed by the attention of others.

Eat a healthy diet, get some exercise and if you can’t

sleep, talk to a doctor about your physical or emotional

state. Extended or inconsolable grief may require

contacting a mental health practitioner, whether for

yourself, your spouse or children.

Communicate to teachers, employers or coworkers what

has occurred and be aware of any policies regarding

absences or requirements for missed work. Share only

what is comfortable but do let others know when you or

your children can be expected to return to work or school.

Ask for or accept any offers of help from friends,

neighbors or other relatives. If you can’t deal with things

like paying bills or any sensitive paperwork, enlist the aid

ofyourlegalorfinancialadviser.

Pay tribute to the memory of your loved one with a

charitable contribution in their name.

Take the time you need to grieve and understand that

ultimately the sadness will lessen, replaced by fond

memories of your loved ones and an ability to enjoy the

people you still have around you.

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