Managing Grief

A common emotional difficulty I observe in my patients face is grief. Grief is a normal emotional reaction and is not a mental illness. Yet it is an emotion that most of us would rather not go through. It is often sudden, coming when we are least prepared, and turning our lives upside down.

It is essential to note that the reaction to grief is commonly triggered by the loss of a loved one. But, it can also be triggered by other forms of loss, such as losing a job, losing a pet, or finding out a loved one has a serious illness, and losing our physical health or mobility. This article will focus mainly on the grief reaction triggered by the loss of a loved one.

The Five Stages of Grief by Kübler-Ross is perhaps the most used model in describing the grief process that an individual may go through. The stages described in this model are by no means set in stone, as each individual’s experience is unique.

The Five Kübler-Ross stages of grief are Denial, Anger, Bargaining, Depression and Acceptance. When we first learn that our loved one is no longer with us, shock usually sets in, and it’s difficult to accept or even believe what has happened. This is often followed by anger directed towards the loved one who has passed on, or at ourselves for the things we did or did not do before his or her passing. An individual may bargain with higher powers to bring back their loved ones or to take away their pain. When reality slowly sets in, the mood dips (although the term depression is used in the stages of grief, it is not the same as clinical depression, but a description of low mood). Finally, after a period, life begins to return to some semblance of normalcy, and the grieving individual comes to accept that his or her loved one has left him or her.

From my experience, I have learnt that everyone goes through grief differently. Some bottle up these emotions and barely show their grief. Some are more emotional and can’t control their tears for weeks on end. Some blame themselves for what happened.

While grieving is a normal process, it can become abnormal in some individuals. Some may not experience grief at all, or for some the process may be delayed. Some may experience an abnormally prolonged grief reaction; and in some cases, grief may be so severe that it leads to clinical depression or anxiety disorder.

Cardiovascular disease is a common cause of death and is often linked to grief reactions in the bereaved (i.e., survivors). The suddenness of death from one’s heart condition can increase the risk of survivors developing abnormal grief. I have seen and treated many patients who developed abnormal grief from their sudden loss. Unfortunately, many of these patients waited months before they finding the courage to seek treatment. They were trapped in a cycle of grief – suffering in silence; withdrawing; no longer seeing their friends and unable to function at work.

Heart conditions could also be chronic and prolonged in nature. Oftentimes, grieving starts when we see our loved ones deteriorate even as we struggle with the knowledge that they may soon leave us. Many caregivers also struggle with the weight of caregiving at the same time. I have seen loved ones, after the passing of a family member, who distract themselves with work or even resort to alcoholism to avoid going through the painful process of grief.

How do we treat grief? The answer is that we do not treat it. I must reassert that grieving is a normal process, and everyone should be allowed to grieve. Over time, most will naturally reach the stage of acceptance and be able to carry on with their lives. In Singapore, every ethnicity has its own cultural and religious mourning customs. These customs serve a purpose in bringing loved ones together to support one another and aid in the process of grieving.

While grief is a normal process, abnormal grief is not normal and requires treatment. The most common treatment is grief therapy, where a professional counsellor or therapist helps those affected to overcome the pain, accept the reality of the loss and adjust to life without their deceased loved one. Abnormal grief may give rise to major mental illness, such as clinical depression, anxiety disorders or substance misuse, necessitating the use of medication in addition to therapy, especially if the problem is left untreated.

If you or your loved ones are going through a difficult period of grief and require help, please contact your nearest Family Service Centre, or inform your polyclinic doctor or general practitioner. You could also seek support from community service agencies, such as the Singapore Association for Mental Health (SAMH), which has been supporting mental wellness for all in Singapore since 1968.

Article is contributed by Dr Raja Velloo, Psychiatrist at the Institute of Mental Health and Board Member of the Singapore Association for Mental Health.

Resources

• FAM@FSC
  W: www.msf.gov.sg/what-we-do/famatfsc/family-counselling
• SAMH Insight Centre
  Provides counselling services.
  Toll-Free Helpline: 1800 283 7019
  T: 6283 1576
  E: counselling@samhealth.org.sg
• SAMH Creative Hub
  Activities include creative therapeutic interventions, individual art therapy and counselling with creative approaches for all ages.
  T: 6344 8451
  E: creativehub@samhealth.org.sg