Source: topinfopost.com
Bereavement is one of the most traumatic situations individuals can find themselves in. Unfortunately, most of us have been in the painful position of losing someone we cherish dearly. Grief is a strong, complex emotion that accompanies any forms of loss.
Grief not only happens in the presence of death, but also in the ending of a relationship, loss of a job, or after losing a beloved pet. Every individual grieves differently; the grieving process is as unique as a fingerprint.
The following scenarios are real life situations that some of us may encounter as medical practitioners.
Scenario 1
Komal is a 40-year-old teacher whose older sister was suddenly killed in a motor vehicle accident. Her sister shared a close bond with Komal’s children, aged 5 and 7 respectively. Her children seem to understand that “something bad” has happened but keep asking for their aunt. They do not comprehend that she is gone from their life permanently.
In the above situation, Komal should be aware that just as adults grieve, children do so as well, particularly when the child has forged a relationship with the deceased. In young children it may be the first time experiencing a loss and they consider it profound abandonment.
Children may withdraw, experience bedwetting or display disruptive behaviour at school throughout this process. It is advisable to allow their participation in the grieving process and rituals but also to maintain their routine as much as possible to give them a sense of safety.
They may also have questions related to death and dying. Some of these may include:
- Did I do something wrong that made aunty go away?
- What if the same thing happens to my mummy and daddy?
- Why did aunty go away?
- Will I be able to talk to her again?
Answering their questions in a sympathetic, honest but reassuring manner is ideal. Reassure the child that their needs will be met. For example, if their aunt used to ferry them to school daily, someone else should now assume this role.
Scenario 2
Mrs S confides in her GP that she is worried about her husband ever since the death of their son 2 years ago. Mr S’s son committed suicide by hanging himself in his bedroom following a broken relationship. Mr S has withdrawn from his friends and family and spends his days in his son’s bedroom, drinking whiskey. He berates Mrs S for moving on and “forgetting” their son. Mr S feels guilty about his son’s death and talks about it incessantly. Recently, Mrs S has also heard him talking to his deceased son, begging him to come back. Several family members have ostracized them due to the suicide and the once pious couple is ashamed to go to the temple.
Mr S is suffering from traumatic or complicated grief. 1 in 5 people in bereavement experience this. In Mr S’s situation, it is alarming that he has developed a substance use disorder as a form of self-medication. Although most individuals experiencing bereavement do not require psychiatric intervention, in this scenario Mr S should be assessed by a mental health professional and treated accordingly. Traumatic grief has numerous potential complications as illustrated by the table below.
Grief therapy (GT) could be useful for Mr. S. The first step of GT is loss orientation – to assign the correct emotion to the loss. The second stage is restoration oriented which helps focus on resolution and the ability to relinquish the loss to the past and concentrate on the future. This can help Mr. S identify new roles for himself and forge new relationships. Mr. S should be reassured that he is not betraying his son by looking forward and making plans for the future. Mr S may benefit from a short course of Selective Serotonin Reuptake Inhibitors (SSRI), which are first line antidepressants. Complications of traumatic grief such as substance abuse and risk of suicide have to be screened for and treated accordingly.
Most individuals grieve deeply but experience natural healing. There is usually no indication for psychiatric intervention as it may hamper the natural course of this process. However in individuals experiencing complicated grief, consultation with a mental health practitioner is highly advisable. Some of the risk factors that predict complicated grief are stigmatising situations, multiple deaths, and death of a spouse or child. Complicated grief is manifested by long term functional impairment and symptoms that do not abate after 6 months.
If you or anyone you care about is experiencing symptoms of complicated grief, do not hesitate to seek professional help.
Dr Sumeet Kaur is a psychiatrist working in Malaysia and a member of The Early Career Psychiatrists.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]