Grief, Loss, and Cancer: Coping With Loss

Grief and mourning are part of the normal process of dealing with a loss. It helps to know what these words mean:

• Grief is the emotional response to the loss of a loved one.
• Mourning is the way we show grief in public. It is shaped by beliefs, religious practices, and culture.
• Bereavement is the period of sadness after a death. People who are grieving are described as bereaved.

Common grief reactions include feeling emotionally numb, being unable to believe the loss occurred, anxiety from being separated from the person, mourning along with feeling depressed, and, over time, a feeling of acceptance. Most people will adjust to the loss over time.

There are three general types of grief.

• Anticipatory grief happens before a death. It may be felt by the person who is dying or by the family. It is different from grief that comes after the death, and it does not affect everyone. Talking with someone trained in grief can help families come to terms with what is ahead.
• Normal or common grief begins soon after a loss, and its symptoms ease over time. The bereaved person accepts the loss and continues with daily activities, even though it is hard. Reactions can include shock, disbelief, anxiety, sadness, anger, loss of sleep or appetite, and guilt.
• Complicated grief is when symptoms do not improve, last a long time, cause extreme distress, and make it hard to take part in daily activities.

Recovery time is different for each person. In normal grief, symptoms occur less often and feel less severe as time passes. For most people, symptoms lessen between 6 months and 2 years after the loss.

Along the way, many people have "grief bursts," or pangs. These are short periods, about 20 to 30 minutes, of very intense distress. They are often triggered by reminders of the person, such as holidays, the anniversary of the death, or giving away belongings. At other times, they seem to come for no reason. Although many people share similar responses, there is no single typical grief response.

When a person grieves, they can have symptoms that overlap with major depression, such as sleep problems, guilt, and lack of interest. But normal grief is different from depression in important ways:

• Painful feelings come and go, instead of being constant.
• There are feelings of emptiness, rather than steady sadness or not feeling pleasure.
• People keep good self-esteem and do not feel worthless.
• If there are thoughts of suicide, they are usually focused on the person who died, such as a wish to join them, rather than thoughts about oneself.

A bereaved person can be diagnosed with major depression if they have symptoms that occur outside of the normal grief process. If you are unsure, it is okay to ask your doctor for help sorting it out.

A person's grief is affected by many things, including their personality, age, cultural and religious background, coping skills and mental health history, the amount of support they have, and their relationship with the person who died.

Support matters a great deal. Lack of social support increases the chance of having problems coping with a loss. Social support includes family, friends, neighbors, and community members who can offer emotional, physical, and financial help.

Most people work through grief and recover on their own, so normal grief may not need treatment. For people who have serious grief reactions or lasting distress, treatment can help.

Cognitive behavioral therapy, which helps a person change negative thoughts and behaviors, may help those with complicated grief. Depression that occurs with grief may be treated with talk therapy and, sometimes, medicine, decided together with a health care professional.

If your grief feels like more than you can carry, reach out to your care team, a counselor, or a bereavement program.

• Call 911 or go to an emergency department if you have a plan to take your own life, or you have already acted on one. The 988 Suicide and Crisis Lifeline also takes calls, texts, and chats at any hour.
• Call or text 988 now if the wish to join the person who died has shifted into wanting to die yourself, even without a plan. The Suicide and Crisis Lifeline answers calls, texts and chats around the clock, and you do not need to be in danger that minute to use it. Call 911 if you cannot keep yourself safe.
• Call your care team the same day if drinking or pills have become how you get through the evening, or you have stopped taking medicines you need.
• Call your care team within a day or two if months have passed and the pain is as raw as week one, or you cannot get back to work, meals, and sleep at all.

Source: NIMH — Suicide Prevention.