Severity, stages of grieving – Health Clinic

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Published: May 15, 2003

Q: My sister recently lost her husband after a long illness. I am concerned about her method of grieving, as she does not seem to be as depressed as I would have expected. She did cry a little at the funeral. Is this abnormal? Does she need professional help? Can you please explain the stages of grief?

A: There are several theories about the different stages a

person experiences when going through the grieving process.

Elizabeth Kubler Ross published a book On Death and Dying in 1969 (Macmillan and Co.) in which she proposed a five stage process of denial and isolation, anger, bargaining, depression and acceptance.

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However, there are problems with this theory. Grief is a complicated process and depends on the individual’s culture, personality and the possibility of pre-existing psychiatric conditions or personality disorders.

It also depends on the relationship the person had with the departed.

For example, if there was a hostile or dependent relationship, grieving will be more complicated and possibly prolonged. In your sister’s case, she would have had time to adjust gradually to the idea that her husband was going to die. Sudden or accidental deaths tend to cause more problems for the survivors.

There are some other theories. There is a useful equation: Grief=loss=change.

The intensity of the grief reaction is a function of how change-produced loss is perceived. If the loss is not seen as significant, the grief reaction may be minimal or barely felt.

If significant grief reactions remain unresolved, this can lead to mental, physical and sociological problems and contribute to family dysfunction across generations. For example, Mary Tyler Moore in the film Ordinary People unconsciously blamed one son for the drowning death of the other, leading to all kinds of family problems.

Another way of coping with grief is to use the acronym TEAR.

T = To accept the reality of the loss.

E = Experience the pain of the loss.

A = Adjust to the new environment without the lost object.

R = Reinvest your emotions and feelings in the new reality.

Here is an example: If the car won’t start on a cold morning, T = My car won’t start. E= Oh dear, I won’t get to work on time. Maybe the battery is dead. Can I afford a new one? A = I have to take a taxi or get a ride with a neighbour. R = I can afford a new battery. It isn’t the end of the world. I will buy one on my lunch break.

You can tell if someone is having an abnormal grief reaction requiring medical help if she has significant physical distress – not eating or sleeping for a prolonged period, or suffering hallucinations of the loved one’s presence for a prolonged period. The symptoms can be normal in the early stages.

There may be an unusual amount of guilt or anger associated with the bereavement. There would be no reason for your sister to feel guilty if she nursed her husband for a long time.

Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.

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