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The Perils of Grief

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Grieving the death of someone who has been a significant part of our lives is one of life’s most difficult transitions. Although the grief process profoundly impacts all areas of a person’s life – physical, mental, emotional, social, and spiritual – a person may first contact his or her physician seeking treatment for the physical symptoms of grief.

Like other crises, the life-changing loss of someone we love can cause stress responses such as rashes, gastrointestinal disturbances, headaches, shortness of breath, tightness in the chest, palpitations, muscular aches or weakness, exhaustion, hyperactivity, insomnia, and feeling flushed, dizzy or clumsy. Bereavement has been shown to compromise the immune system. This increased susceptibility to illness can be exacerbated by an uncharacteristic lack of self-care during the grieving process or the patient may go to the other extreme of hypochondria.

If the physician notices the symptoms of stress are getting worse, new symptoms are showing up, or if a disturbance in sleep or eating patterns persists beyond a few months, integrating medical treatment with professional grief counseling may help the patient more quickly and effectively adapt to loss.

The most common reason people seek grief counseling is the feeling that they are falling apart or “going crazy.” Since it takes about 90 days for the numbing effect of shock and denial to wear off, this phenomenon tends to happen just about the time that friends, neighbors and family are tapering off the food, phone calls, and visits.

Although antidepressants may relieve some of the symptoms of grief, they may also delay the mourning process. A multidisciplinary approach to diagnosis can help differentiate between normal grief and complicated grief or depression and help determine the best course of treatment.

The most common symptom of a patient needing professional help with his or her grief is an ongoing preoccupation with guilt that is not rational and that does not become less intense as time passes. Other symptoms or characteristics that generally indicate that professional help is needed are when a patient reports:

Feeling irritable, annoyed, intolerant, or angry most of the time.

Fear approaching the level of panic most of the time.

Feeling restless or agitated most of the time or a need to be constantly busy, beyond what is normal for him or her.

Experiencing an ongoing sense of numbness or of being disconnected from self or others.

Acting in ways that may prove harmful over time, such as continuing use of heavy tranquilizers or new or increased use of alcohol or drugs in order to cope; engaging in unsafe or unwise sexual activity; or driving recklessly.

Feeling highly anxious most of the time about his or her own death or the death of a loved one still present.

Experiencing an ongoing preoccupation with the loved one’s death or certain aspects of it.

Experiencing an ongoing preoccupation with death wishes, which include a plan for carrying out suicide or homicide.

Feeling an ongoing fear of getting close to new people (for fear of losing them, too).

A numbing of all emotional responses or experiencing only a few of the emotions that usually come with grief; or remembering only certain aspects of the loved one or the relationship together. For example, remembering only the good parts, as opposed to a more complete or balanced view of him or her.

Feeling like he or she is going crazy, falling apart, or is stuck in an intense state of mourning that prevents the performance of normal daily activities and is undermining other relationships.

Although grieving is a natural process of life, it has a way of tearing us down physically and emotionally. Whether the grieving patient initially presents in the medical office or in the therapy office, a multidisciplinary approach can improve treatment outcomes for our patients and a collaborative relationship between the physician and psychotherapist can enhance the perceived competency of both professionals.