Grief is a universal experience. At some point in every life, we grieve – and the loss of someone we love can be the most intense grief of all.
Our medical teams see it again and again. So what do the experts say about how to manage grief? We turned to St. Michael’s Hospital’s Psychiatrist-in-Chief Dr. Tom Ungar, for some down-to-earth advice.
We hear about the five stages of grief (denial, anger, bargaining, depression and acceptance) after losing someone we love. How well do those stages reflect what people really go through?
There are no stages. It was a neat theory by a psychiatrist named Elisabeth Kübler-Ross, back in the 1960s. It’s a nice conceptual model for how someone might feel at any one moment, but everyone feels it differently and the reality is that there are no rules.
The problem with the five stages is that people assume they’re supposed to move through stages and if they don’t, there’s something wrong. Research has shown it doesn’t work that way.
Most of us aren’t psychiatrists, but we do want to help friends and family when they’re grieving. Are there things you should absolutely not do?
The worst thing you can do is tell someone what they should be feeling. It’s presumptuous and potentially hurtful.
What about things you can do to help someone who is grieving?
Understand that everyone is different. There is no right or wrong. You feel what you feel. There are no stages and you can be reminded of your loss 10 years later and be sad and that’s fine.
Also, keep in mind that one can grieve and still enjoy life, their families and children. You can feel two different things at once. You can grieve and still watch a sitcom and laugh. You can still enjoy a good slice of pizza even though you’re sad about your loss. One doesn’t cancel the other.
I like to remind people that we are more complicated than one feeling at a time. But people often feel guilt, as in “How can I be happy about one thing and sad too?” If you inherit something, that can really mess you up, because you’re benefiting from someone’s death. Does that make you a bad person? It doesn’t.
Unless it develops into abnormal grief, people don’t need treatment. They can use normal life coping strategies – talk to family or friends, go to your house of worship, get exercise. With time, almost everyone continues on in life. That doesn’t mean you stop mourning, you can still be mourning. It’s a different story if you can’t get back to life and you’re not functioning.
There is a wrong assumption in our society that for any strong feeling, you need a professional. That’s garbage. My job is to differentiate healthy grief, which doesn’t need treatment, from an illness. If you’re really having a hard time and you want support, reach out and get it. See a social worker, a religious leader, or a health professional for supportive counselling. You very likely don’t have an illness. Most people have grief and never develop abnormal grief.
What does abnormal grief look like and what can be done?
It’s called clinical depression or major depressive disorder, and you need five of nine symptoms to persist for two weeks or longer to be diagnosed. (See symptoms below.) Often it affects your functioning in life. That’s not normal grief.
There are treatments for clinical depression, such as psychotherapy, exercise and biological treatments including antidepressant medications. Your family physician is a great start to determine if you are experiencing a clinical depressive episode and can easily offer treatment. Only a small minority of people will be referred to a psychiatric specialist.
Be reassured that sadness and grief are normal human emotions, and no one can tell another what they should feel, or what stage they are in. We all have our normal, healthy, everyday coping methods that help us through life events, including difficult times. But if after a few weeks you’re not functioning, or enjoying anything, then it’s good to know help is available and clinical depression can be treated. You can get back to living your normal life while you continue to honour and experience the loss of a loved one.
Diagnostic criteria for major depressive disorder:
Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful)
Decreased interest or pleasure in most activities, most of each day
Significant weight change (5%) or change in appetite
Change in sleep: Insomnia or hypersomnia
Change in activity: Psychomotor agitation or retardation
Fatigue or loss of energy
Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
Concentration: Diminished ability to think or concentrate, or more indecisiveness
Suicidality: Thoughts of death or suicide