A CHILD OR PARENT HAS DIED ...How Can the
Doctor Help?
IS GRIEF A DISEASE?
Anton Lazare, a psychiatrist at
the Massachusetts General Hospital, estimates
that 10 to 15 percent of the patients in this
Hospital's mental health clinic have, underlying
their psychological and behavioral symptoms,
as unresolved grief reaction.
Physicians and mental health practitioners
need to understand grief and recognize it as
a source of medical and psychiatric problems.
Psychiatrist George Engel compares the loss
of a loved one (a psychological trauma) to a
wound or burn (a physical trauma). He states
that grief is the re-establishing of psychological
health just as healing is necessary in the physiological
realm, in order to re-establish a system's homeostasis.
Grieving serves the same function as healing:
both are processes necessary to restore equilibrium
and well-being.
Mourning is the name for the long process which
begins at the time of the death of a loved one.
Acute grief is the beginning phase of mourning.
(Mourning ends when the bereaved person is able
to transfer attachment of love and energy from
the dead child to other relationships.)
NORMAL GRIEF REACTIONS
William J. Worden, PhD., a psychotherapist
and researcher in the field of terminal illness
and suicide, divides the manifestation of normal
grief into four categories: feelings, physical
sensations, thoughts and behaviors.
FEELINGS:
- Sadness and loneliness -- often, although
not always, accompanied by crying.
- Anger -- may result from frustrations that
parents feel because they could not prevent
the death or from a sense of abandonment by
a loved one. This is sometimes displaced to
generalized targets such as doctors, police,
the hospital, etc. This anger must be expressed.
- Guilt and self-reproach -- are common experiences
of survivors: the guilt often manifests over
something that happened or was neglected around
the time of the death.
- Anxiety -- arises because bereaved parents
feel they cannot live without their child. Also
there is a salient recognition of their own
and their other children's mortality.
- Isolation -- may be intensive even though
the parent lives in the midst of the remaining
family.
- Fatigue -- or feeling of listlessness, or
apathy. These symptoms emerge in physical behavior
but can have a psychological origin.
- Shock -- occurs immediately and appears to
protect the survivor against the overwhelming
feelings of grief and loss.
- Yearning -- or pining for the dead child
is especially acute within the first year after
the child's death.
PHYSICAL SENSATIONS:
Hollowness in the stomach
Weakness in the muscles
Tightness in throat, chest
Lack of energy
Oversensitvity to noise
Dry mouth
Breathlessness or feeling short of breath
Sense of depersonalization: nothing seems real
THOUGHTS
Common patterns that may trigger feelings of
pressure and anxiety:
- Disbelief -- the death of the child is thought
to be unreal; the parents do not believe their
child has died.
>
- Confusion -- difficulty concentrating, focusing
and ordering one's thoughts.
- Preoccupation -- obsessive thoughts of the
dead child or of regaining the child.
Sense of presence of the child, especially acute
shortly after the death.
- Hallucinations of the dead child both visual
and auditory are usually transient appearing
shortly after the death for a brief period.
BEHAVIOURS
Common behaviours that may be reported by the
bereaved:
- Sleep disturbances -- may require medication
-- however, in the course of normal grieving,
these disturbances are usually self corrective.
- Appetite disturbances, no appetite or compulsive
eating, resulting in weight changes.
- Absent-minded behavior which may result in
inconvenience or harm to oneself or to others.
This behavior is usually self correcting with
time.
- Social withdrawal and isolation may occur
because bereaved parents feel different from
others.
- Dreams of the deceased which can be pleasant
or frightening, may serve a purpose especially
as a diagnostic clue to where the parent is
in the process of mourning.
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HOW THE DOCTOR
CAN HELP
Reknowned psychotherapist and researcher William
Worden, PhD., suggests four key tasks of mourning.
The physican can assist the bereaved patient
by facilitating these four tasks.
HELP PARENTS TO RECOGNIZE THE FINALITY
OF DEATH
Help the parents accept the fact that their
child is not coming back. Encourage the
parents to talk about all aspects of the
child's life and death.
One of the most important tasks of the
physician is to be a good listener.
"When my child
died my doctor was there for me. He couldn't
bring my child back but I could feel his
compassion and concern. I felt that I could
talk about all the guilt and anger I had
bottled up inside when Sarah died. He didn't
judge, or even prescribe pills. He just
listened."
HELP PARENTS TO IDENTIFY AND EXPRESS
THEIR MANIFEST AND LATENT FEELINGS
Encourage parents to express their anger,
guilt, helplessness, sadness, and fears
of their own and their other children's
mortality.
As in all crisis counseling, it is important
to remind the parents that they have coped
with other life crises and that they will
with this one as well.
Bereaved parents may think they are going
crazy, because they are often so distracted
and because they experience things that
are not normally part of their lives. The
physician can reassure the bereaved parents
that their grief experiences are normal.
ASSIST THE PARENTS TO LIVE WITHOUT THEIR
CHILD
Point out to the parents that everyone within
the family has changed since he death of
the child. Encourage them to observe and
adapt to changes within the family.
ENCOURAGE PARENTS TO REINVEST EMOTIONAL
ENERGY IN NEW RELATIONSHIPS
Mourning seems to have 4 component parts.
After the initial shock, numbness and disbelief,
there follows a period of yearning and searching.
When the reality of the death finally sinks
in, there is a period of depression. This
is usually the phase when the parent comes
to the doctor.
The doctor can help parent to express his
or her emotions. These emotions accompany
the recognition that the child indeed is
not coming back, that they will not be the
same people, and that everything in their
life has changed.
At the end of this process the parent may
be ready to go on to the last task of mourning,
which is to reinvest energy in new relationships
and activities.
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HOW DO BEREAVED PARENTS DIFFER FROM OTHER BEREAVED
PEOPLE? Bereaved parents never fully recover
from the loss of their child. But they do learn
to live with their grief and readjust to life
without the child.
"It's been over 10
years since Steven died. But every time I talk
about him my eyes fill up with tears."
Mothers and fathers may grieve differently. Usually
mothers exhibit more of the symptoms of grief
and depression -- while fathers appear to be dealing
with the daily routines of life. Often husbands
and wives may resent each other because of their
differences in grieving. As a physician it is
important to know that once the wife has coped
with her grief, the husband may begin to feel
the full force of his.
HOW BEREAVED FAMILIES CAN HELP There is no
time limit on the grieving period. It can take as
long as 18-24 months just to stabilize after the
death of a child. The family may appear to be coping
rather well at the time of the death and funeral.
In actual fact they are probably in shock, experiencing
numbness and a lack of feeling. It is only later
that manifestations of grief may appear -- tears,
depression, anger and physical symptoms of distress.
Bereaved Families provides a caring support system
designed to help families cope with the painful
reality of their loss and return to the mainstream
of life.
Small group discussions led by trained bereaved
facilitators are available for parents, siblings
(age 3 through 30) and grandparents. Over a period
of three months, small groups of approximately
eight meet each week for two-hour sessions. More
informal meetings with Bereaved Families are available
through family nights, newsletters and individual
contact.
Professionals with expertise in the nature and
dynamics of grief, supervise all group programs
and train the bereaved parents for their sensitive
role as group leaders. Where needed, we can provide
a professional referral.
Bereaved Families also provides educational programs
and workshops for professionals and for the bereaved.
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