Grief – How To Deal It In Family Medicine Practice

Introduction
Loosing someone or something that a person really loves and cares for is very heart breaking, painful and emotionally a difficult process to go through. Grief can be defined as an emotional reaction to a significant loss. The term grief and bereavement is usually used in medical practice for a person who has suffered the the death of a beloved one but grief can also be experienced in conditions like when a person is diagnosed with some incurable disease, breakup of a close relationship etc. Grief reaction is normal in all theses circumstances and every individual has its own ways to cope with it and go through it .

Clinical features Of a Grief Reaction:Everyone feels grief in its own way but there are common stages that usually help to describe it. These stages may not occur in a specific order and not everyone experiences all of these emotions.

5 stages of Grief Reaction:

Denial, disbelief and numbness: The first reaction is usually to deny the reality of the situation. It is actually a defense mechanism of the body to protect from the harmful effects of the immediate shock. This emotion is short lived and temporary.

Anger and Blaming others: When the masking effect of denial starts to wear off and the reality begins to get clear the person is still not ready to accept it and it comes out as an emotion of anger. The anger may be aimed at anything, on inanimate objects, friends, family or even strangers. Even the doctor who diagnosed the disease or pronounced the death of the loved one becomes the target and the one to be blamed.

Bargaining: This is a reaction of feeling of helplessness and trying to reverse the situation back to the past. The thought like ‘If we have gained medical attention sooner....’, ‘if we would have taken a second opinion..…’ etc comes in the mind. Secretly the person going through this stage of grief tries to make a deal with God or his higher power that he would do anything just to prevent or reverse the inevitable situation he is grieving for.

Depressed Mood, sadness and crying:
Acceptance and coming to terms: Finally the person starts to accept the situation and come back to the normal self but this stage sometime never comes. It is not necessary that person starts to laugh and be happy to enter this stage it is just distinguished from depression and is usually expressed by calmness and getting back to normal routine life. During this phase still the person may be mourning inside but there are no more expressions or emotions that can be felt.

Signs and Symptoms:

• Shock and disbelief.
• Sadness
• Regret and guilt
• Anger
• Fear and worried for further losses.
• Feelings of insecurity
• Insomnia
• Weight gain/ weight loss
• Lack of appetite
• Fatigue
• Nausea
• Body aches and pains.

Management:

• It is important to identify and diagnose any associated medical condition and treat accordingly.
• Give attention to proper sleep and a healthy diet.
• Help provide a good emotional support from friends and family
• At times social workers and support groups help go through the grieving process and recover quickly.
• As a general rule a grief is normal reaction and does not need any medications and it can be dealt with timely monitoring and emotional support only
• If normal grief reaction gets complicated in a way that the pain of the loss is so severe that it prevents a person from resuming his normal routine life then a professional help from a therapist or a psychiatrist may be needed.
• Left untreated sometimes significant grief may lead to life threatening situations like attempting suicide.