Walking Through Grief

Have you ever lost someone you love and wanted one more conversation and chance to make up for the time when you thought they would be here forever? If so, you know you can go collecting days your whole life, and none will outweigh the one you wish you had back.

Grief is a very personal journey that must be taken, often tricky and without clear direction. The experience of grieving cannot be ordered or categorized, hurried or controlled, pushed aside or ignored indefinitely. It is as inevitable as breathing, as change, as love. It may be postponed but not denied. Grief is labyrinthine and enigmatic; its implications are emotional, physical, social and interpersonal, economic, spiritual, and existential. Grief is like the ocean; it comes in waves, ebbing and flowing. Sometimes, the water is calm, and sometimes, it is overwhelming. All we can do is learn to swim.

Nothing quite prepares you for the heartache of profound loss. It settles in like a gloomy thump — sometimes louder, sometimes softer — with a volume switch you can't entirely shut off. For me, that heartbreak arrived this past March when my mother died unexpectedly after routine surgery. Fifty days later, my dad passed away. Now, for the first time in my life, I'm experiencing real grief. As a physician, I know this emotional experience comes with the risk of physical side effects. Most of these side effects are the result of emotional distress responses. Whether you're grieving the loss of a loved one, like I am, or losing a job, a home, or a beloved pet, it's essential to understand how the process puts your health in jeopardy.

With mom [Dr. Prabhavati Prasad] and dad [Dr. Birendra Kumar Singh]

Stress and grief

Grieving takes a toll on the body in the form of stress, affecting the entire body and especially the immune system. Evidence suggests that immune cell function falls and inflammatory responses rise in people who are grieving. That may be why people often get sick more often and use more healthcare resources during this period.

Stress unleashes a flood of stress hormones that can worsen existing conditions (such as heart failure or diabetes) or lead to new ones (high blood pressure, reflux, or shingles). Stress can also cause insomnia and changes in appetite. Extreme stress, the kind experienced after losing a loved one, is associated with changes in heart muscle cells or coronary blood vessels (or both) that prevent the left ventricle from contracting effectively — a condition called stress-induced cardiomyopathy or broken-heart syndrome. The symptoms are similar to those of a heart attack: chest pain and shortness of breath.

Depression and grief

Intense feelings of sadness are typical when one is grieving. But some people become depressed. Up to 50% of widows and widowers have depression symptoms during the first few months after a spouse's death. By the one-year mark, the proportion is down to 10%. Depression symptoms include extreme hopelessness, insomnia, loss of appetite, suicidal thoughts, persistent feelings of worthlessness, and marked mental and physical sluggishness. People who are depressed often withdraw from social connections, and they usually stop taking care of themselves properly. They're not as interested in life. They fall on the job, miss doctor appointments, stop exercising, and stop eating correctly. All of these things put their health at risk.

The effect on mind and body

We may differ in how we ritualize grief, understand it, and behave as we work through it, but grief is the singular most unifying aspect of the human experience.

Grief is broadly classified into two types: acute and persistent. Most people experience acute grief, which occurs in the first six to twelve months after a loss and gradually resolves. Some, however, experience relentless grief that lasts longer than 12 months.

The death of someone you love can shake the core of your existence and affect both mind and body. During a period of grief, one can become preoccupied with thoughts, memories, and images of one's friend or loved one, have difficulty accepting the finality of the loss, and experience waves of sadness and yearning. Many people suddenly feel vulnerable since they lost a companion or friend they looked to for support. They also begin looking closer at their mortality, often for the first time.

Chronic stress is also common during acute grief. It can lead to various physical and emotional issues, such as depression, trouble sleeping, feelings of anger and bitterness, anxiety, loss of appetite, and general aches and pains. Some may try to resist grief, but it's important not to ignore these symptoms, as constant stress can put you at greater risk for a heart attack, stroke, and even death, especially in the first few months after losing someone.

Navigating grief: picking up pieces

You are allowed to feel messed up inside and out. It doesn’t mean you’re defective — it just means you’re human. It may seem impossible to think about maintaining good health when it's not easy to get through each day simply. But it's okay to go through the motions at first. That may mean walking for five minutes every day and gradually increasing the amount of time you walk. And even if you don't feel like eating, go ahead and eat three healthy meals per day anyway. Your body needs calories to function, even if you're not hungry. Eating too little may add to fatigue. The following are various tools one can use to walk through grief.

Grief counselor

As a specialist trained to help one make sense of one's feelings of loss, Grief counselors help people understand that there are many ways to express and come to terms with grief. They are particularly attuned to common reactions to grief, whether these reactions are physical, emotional, or cognitive.

Grief support group

Such groups are typically led by a counselor encouraging members to share their feelings and experiences. Being with others, expressing yourself, realizing that you're not the only one going through a particular experience, and learning from others can be especially helpful.

People who experience persistent grief should seek a therapist or counselor to help them work through the grieving process. This may include focused treatments like cognitive behavioral therapy and complicated grief therapy. For the more common acute grief, as with any other highly stressful life event, it is well worth thinking through strategies that can help you overcome or manage the stress of loss.

Mind-body activities

Take up yoga, tai chi, or qigong. These mind-body activities can help you relax and reverse the effects of stress and anxiety on a molecular level. Researchers found that genes that create inflammation in people who regularly engaged in these practices were less active. Many classes are designed specifically for stress reduction. You can find these classes online or inquire at local yoga studios and community centers.

Nature heals

There is a healing quality of nature, which has been known for centuries, be it taking the time to smell the roses, meditating, lying in a wildflower field, strolling by a meandering stream, or hiking a trail.  The father of modern medicine, Hippocrates recognizes this powerful attribute in the simple statement: Nature cures–not the physician.  Nature can aid in facilitating self-awareness and healing.  Time spent outdoors can be restorative and healing. 

Healthy diet

Stress triggers cravings for sugar and fat, which is why you reach for feel-good, high-calorie, and high-fat processed food. Yet these foods can make you feel worse. Instead, focus on keeping up a well-balanced diet: eat plenty of vegetables, fruits, and lean proteins, and drink plenty of water.

Sleep hygiene

Grief is emotionally exhausting. After a loss, people often find their sleep disrupted — they have trouble falling asleep, wake up in the middle of the night, or sleep too much. Going to bed regularly, following a bedtime routine, and avoiding caffeine and alcohol in the evening helps with more restful sleep.

Move

A simple daily walk can help ease depression, agitation, and sorrow related to grief. Finding the energy to exercise is often difficult, so if you lack motivation, enlist a workout buddy or join an exercise group.

Health checkup

It's easy to ignore your general health when grieving. This includes skipping doctor visits and forgetting to take your medications. Schedule all exams for the coming year so you don't miss them, and set timers on your phone or computer to help remind you to take your medications as scheduled, or ask a friend or family member to assist by checking in with you daily.

New responsibilities

The loss of a spouse or family member may mean you have to take over specific routine jobs. For example, you may now be in charge of cooking, general house upkeep, or organizing financial records. While these tasks can be additional stressors, turn them into a positive experience. Taking on a new responsibility can keep your mind focused on a job and distract you from your grief.

Social network

While it can be painful to see people, it is essential to maintain connections with others—social relationships are crucial to good health. Stay in touch with friends and loved ones. Try to get out and spend time with others, even if it's to talk about your grief. This affirms that you are not alone, and even if you feel isolated, there may be family members, friends, or even neighbors who can give a supportive hand. Set up a weekly get-together for lunch or coffee, or invite people over for a monthly potluck. Or try to communicate with someone daily, either by phone or email.

Coping with anger while grieving

If the death of someone you love has left you feeling angry or bitter, you might find it helpful to try the following techniques.

Consider it.

Is anger a stand-in for more painful emotions, or does the situation warrant it? Do you feel abandoned or afraid? If so, could you enlist support from others or spend some time thinking about your fears and putting them to rest? It might help to share your feelings in a grief support group and learn how others have dealt with similar feelings.

Express it.

Set aside a safe time and place each day to defuse angry feelings. Some people yell in the car with the windows rolled up. Some find stress-relief techniques like meditation or yoga helpful. Others find release in punching pillows or spurts of strenuous activity. Consider options for releasing anger and plan how to express it safely when it crops up. Sometimes, writing about situations that make you angry can help you focus on what you feel beneath your anger.

Explain it.

Tell others how short-fused you are right now. If you know you stepped over the line, apologize. Most people will make allowances.

Take one step at a time

Throughout history, across cultures and religions, grief has touched us all. Your grief is uniquely your own. Grief is not something to overcome. It is to experience. In time — and there is no standard period of grief for anyone — the sun will return, and you'll feel a little stronger emotionally and physically each day. I'm counting on this. But we all need a foundation of good health to get there. Let's give ourselves that advantage. Our loved ones would want that for us.