T3 - Facets of Grief: Behaviors

This week marks the end of the Facets of Grief series. We've covered the Emotional, Physical, and Cognitive responses in previous posts.

Behaviors should be considered in light of whether they interfere with the bereaved's ability to function. Common behaviors are disturbances in sleep (either too much or not enough), altered appetite (over or under eating), restlessness, absent mindedness, and social withdrawal. Bereaved individuals also commonly go to great lengths to avoid any reminder of the loss, whether that's a room in their house or chair the deceased person sat in. It's worth being noted that each of these behaviors can be symptoms of depression as well.

Fresh grief can be accompanied by any of the above behaviors. The grief subsides as time goes by, and the behaviors generally lessen or stop altogether. If they don't, and the person can't return to their previous level of functioning prior to suffering the loss, that could be indicative of a mental disorder having taken hold.

By far the most common behavior associated with grief and loss is crying, and it's here that I want to camp out a bit. Crying serves all kinds of functions in society, and as a therapist, I'm interested in the functions of behavior. I attended a conference where the healing components of different types of tears was discussed.

In the late 70s, researcher William Frey compared tears caused by cutting an onion with tears brought on by watching a sad movie, which elicited an emotional response missing from the onion-induced tears. He found that the emotional tears eliminated far more chemical toxins from the body than the onion-induced tears.  These toxins build up during times of emotional stress, so crying not only relieves the emotional stress, but almost can bring about a physical relief as well.

The takeaway is that the body knows what it needs to do to get through things, to survive. We should stop at making judgmental decisions about the behaviors someone might engage in when they are grieving. It might seem odd to hear a grieving person call out of the deceased, and creepy to catch them in the act of searching for them, but we have no idea the purpose or function of these behaviors for that bereaved person.

And in the spirit of crying...the good kind you have after reading a good book...

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T3 - Facets of Grief: Cognitions

The cognitive response to grief can be as varied as the Emotional and Physical responses covered earlier.

Initially, the cognitive response is disbelief. I'm not talking about denial, although that can occur if the disbelief persists. But the flat-out rejection of the horrific news is typically the first cognitive defense against grief, especially if the news is sudden. The grieving person believes the death absolutely could not have happened--did not happen. Usually accompanied by shakes of the head and repetitive "no's" even as his or her mind assimilates the new, life-changing information.

Denial in the most severe form can be the person going about their life as if the person never died. This is rare, though, and usually the bereaved exhibits signs of denial like inability to make decisions about a casket or funeral service. Their mind just hasn't yet fully grasped the idea that the loved one is gone, so they will put off even thinking about it at times by distracting themselves with senseless activities.

The mind might want to dwell on particular intrusive thoughts about how the deceased died, or what they were going through/feeling right before they breathed their last. This preoccupation isn't unhealthy in and of itself, but if not tempered with other positive thoughts of the deceased, it could easily slip into a morbid fascination. Other normal cognitive responses are confusion and difficulty organizing thoughts. A bereaved person might have a much harder time making themselves understood.

Maybe the more interesting aspects for writers of the grieving mind would be how the mind can play tricks on us. It's not unheard of for a grieving person to have a sense of the presence of the deceased. It doesn't have to be that they actually think the deceased is still living, and it doesn't have to be some inherently spiritual idea that the soul hasn't gone to heaven because of "unfinished business." (Think Patrick Swayze in Ghost.)

The grieving person might have auditory or visual hallucinations, which is still a cognitive response because it's origin is in the brain. It doesn't mean they are crazy, although they might think that they are. (For an example of this, read Bonnie Grove's Talking to the Dead.) On the other hand, the bereaved might find a strange sort of comfort from this after-death connection, and assign "spiritual or metaphysical explanation to the phenomena, which can help the bereaved to cope with the loss" (Worden, 1991).

Next week, we'll conclude the facets of grief series with a post about the behavioral response associated with grief. Hope to see you tomorrow for the weekly free association chain we do here on Fridays!

T3 - Facets of Grief: Physical Perceptions

We looked at the emotional response of grief last week, and this week we'll tackle physical perceptions or sensations.

While tears might be the most common manifestation of grief, this post will delve more into the result of crying, which would be dry, itchy eyes. The dryness and itchiness would be the physical sensations. What are some other common physical perceptions of grief? You'll want to be sure to include one or two of these, as they have clinical research backing their validity (Barbato & Irwin, 1992).

1) Tightness in throat/chest

When a person is in severe mourning, their face often scrunches up, their mouths turn downward, and they close off their airway at the throat. Give it a try. Make a face as though you are grieving. Feel the movement in the throat, almost a half-swallow. Soreness and tightness in that exact area is to be expected. Also, when trying to staunch tears and remain strong and stoic, that area is again over-utilized.

As for the chest, irregular breathing can cause that tightness, almost as if a heavy weight was pressing against the chest cavity. People experiencing this physical sensation often have trouble breathing (see #3). The joy as a writer is in finding new and fresh ways to say "her chest/throat tightened."

2) Oversensitivity to noise

A person grieving becomes sensitive to the smallest things. It could be argued that this sensitivity is the mind's way of dealing with overstimulation, or it's the person's feeble efforts to distract themselves from the grief. But suddenly, little noises like a tick of a clock can become like pounding drums. Things that never would have woken the person before now send them bolt upright in the middle of the night. Their perceptions are off, some are dulled and some are heightened. Sound is definitely heightened.

3) Breathlessness

Being unable to draw breath is a regular occurrence. Panic-like symptoms follow the perceived inability to breath, which is also a normal component of grief. The heaviness of the chest is also a factor, and many bereaved people will say they feel as if there is an actual weight, but it's psychosomatic (meaning, a physical condition caused or aggravated by a mental factor). Inability to fully fill their lungs is also somewhat psychosomatic, because in most cases the lung capacity didn't diminish, just the perception of breathing did.

4) Muscular weakness/lack of energy

Think about all that goes into a good cry. Body wracking sobs. Fetal position. Soaked pillows. I looked it up online and got the guesstimate that crying burns about 1.3 calories a minute (which the source said was about the equivalent of laughing, interestingly enough). But it's not just the crying that promotes muscular weakness. Usually, it's the lack of regular food intake, which makes the body run off caloric fumes, which, in turn, promotes a lack of energy.

All of these things considered, people who are recently bereaved are much more vulnerable to illness. research supports this, as well.

Next week we'll look at cognitive facet of grief. See you then.

Q4U: What is a fresh way to say "her throat was tight" or "her chest was tight?"

T3 - Facets of Grief: Emotional Response

A person experiencing loss has major changes in 4 areas: Emotional Response, Physical Perceptions, Cognitions, and Behaviors. This week we'll look at the Emotional Response.

The emotions people experience while bereaved range all over the map. The most overwhelming emotion is depression, since grief shares a lot in common with people experiencing a Major Depressive Episode. Sleep disturbances, appetite changes, and intense episodes of sadness and crying are common in both, but usually these behavioral changes are only present for a short period of time in someone who is grieving.

It's important to note that some people have a reactive response to significant loss, and that is not abnormal. By reactive, I mean that their intense feelings of being alone or isolated might become so overwhelming that they withdraw from even the supportive people who love them most. This emotional response is probably most common with an intimate relationship loss, but could be found in any type of loss and usually wanes over a year or so.

But there are a few emotional responses that, while normal, are difficult for others to deal with or know how to approach a bereaved person experiencing them. I've listed them below.

1) Anger 

One of the first solid emotions a person will feel after shock and denial is anger. The anger is frequently directed at the deceased person, either for leaving the grieving person alone or maybe anger at themselves because they couldn't prevent the death. Anger could be directed outwards, like blaming a cop or doctor who "didn't do their job."

How to approach: Let these angry individuals express themselves in as healthy a manner as possible. Provide outlets - like punching pillows or going to the gym. Don't take it personally if they lash out at you. You adding your hurt on top of what they are already experiencing won't help.

2) Guilt

Guilt could be caused by the angry feelings listed above, but maybe they also said or did something they now regret. People could also think they could have done something to prevent the death. "I should have been there," or "What if I'd recognized the signs of the stroke earlier?" Guilt is often internalized, and might make the bereaved withdraw or feel like they don't deserve the well-wishes of others. Guilt can also occur when the survivor feels relief at the death, perhaps in the case of a chronic long-term illness.

How to approach: Try to help the bereaved focus on the positive aspects of their relationship with the deceased, even if you have to go back to toddlerhood. Reiterating that the person did all they could to save the deceased (if, in fact, they did). Explain that relief in that type circumstance is simply the beginning of recovery, since their grief started much earlier than the actual death.

3) Anxiety

This emotion might be more common among those individuals who don't give themselves time to grieve, like the example I used earlier of a mother who doesn't allow herself to grieve because she's got to take care of her children. But anxiety can come from the confusion or uncertainty that the loss casts the survivor in. "How will I possibly pay all the bills?" "Should we move into a smaller place?" "Who can I count on to pick up Billy from soccer practice now?" Little anxieties can prove to be insurmountable obstacles to dwell on.



How to approach: Let them know that you are available to take care of the "little" things like soccer practices and housecleaning. Knowing they have someone dependable on their support team will go a long way in relieving everyday anxiety focused on maintaining the appearance of normality, especially where children are concerned.


Next week we'll look at possible physical perceptions and changes a grieving person experiences.

Q4U: What have you done in the past to bring comfort to someone who was grieving? What has someone done for you?