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BEREAVEMENT
Bereavement
means, "the loss of something valued." Grieving is a process of
adjusting to that loss and is universally recognized across all
cultures. The process of grieving usually occurs when the loss involves
a death, but it can also be applied to other situations, including
the breakup of a relationship or divorce, loss of a job, or coming
to terms with the loss of health through an illness or disability.
Research into comparative levels of stress connected with important
life events shows that the death of a spouse is regarded as the
most stressful event. Grieving is more difficult if the death is
sudden or violent, or if the relationship was very close or one
in which one or both partners were very dependent. When you experience
a serious loss of someone close, you can experience the following
four recognized stages of grief, each of which is accompanied by
a range of different emotions:
"It is difficult
to come to terms with the feelings of devastation and total loss.
Some days I
don't feel too bad, but other days I feel I cannot go on."
When you lose someone close
to you, it is natural to experience a wide range of emotions that
correspond with a number of recognized stages of grief. The emotions
you feel vary from person to person, and you will not always move
through these stages in a logical progression. Some people might experience
them in rapid succession; other more haphazardly over a period of
months.
- Stage One: Shock
The reality of the loss often takes time to sink in. Your initial
reactions may vary from numbness, denial, disbelief, and hysteria,
to not being able to think straight. These are all natural emotions
that cushion you against the loss and allow you to experience
it more slowly and cope with it better in the short term.
- Stage Two: Protest
At this stage, it is normal to protest that the loss cannot be
real, even though you are being confronted with evidence that
it is. As you struggle between denying and eventually accepting
the reality of what has happened, you experience waves of strong
and powerful feelings, such as anger, guilt, sadness, fear, yearning,
and searching.
- Stage Three:Disorganization
This is the stage when the reality of the loss is only too real.
You are likely to experience overwhelming feelings of bleakness,
despair, apathy, anxiety, and confusion. You may feel that this
depression could go on forever and that there is no way out.
- Stage Four:Reorganization
You begin to rebuild your life and acquire a greater balance.
At last you are able to choose to remember happier times. Gradually
you return to previous functioning, but often with changed values
and new meaning in life.
Face The Pain
Grieving,
though painful, is a natural process that must be acknowledged and
worked through. Some people will wrongly try to avoid that pain
by keeping themselves very busy or burying themselves in work. Other
people might defend themselves against the pain by saying to themselves,
"I have to be strong for everybody else" or "It's no use crying."
The period of grieving cannot be hurried and may vary from days
to weeks, months, or even years. Even when you feel you are over
it, you must be prepared for occasional setbacks, perhaps when you
hear a particular piece of music, smell a certain scent, or remember
a shared anniversary.
It
is understandable to want to spend time alone, but it does not help
to become too isolated. Talking and listening are important throughout
all stages of grief, but it is quite usual for friends and acquaintances
to feel embarrassed and not know what to say. When you are ready,
approach your friends and say, "I need to talk" or "I need some
practical help." There will be days when you prefer not to talk
about it. When this happens, it is best just to be honest and explain
your feelings to other people.
Come to Terms
With Your Grief
- Accept The Loss It is natural
to protect yourself from the full impact of the loss by holding
on to the deceased's belongings. Although it may take time, being
able to release those possessions is a positive sign of acceptance
and reorganization.
- Feel The Pain Recognize
and experience your emotions. Crying helps, since it allows painful
feelings to be expressed.
- Talk About It Talking about
the loss and reminiscing helps you to accept the situation. Expressing
regrets, fears, and anger is helpful. Do not take the attitude
that "it doesn't help to rake it up."
- Take One Day At a Time
Do not try to sort out everything at once. Grieving takes as long
as it takes - there are no fixed time limits and it cannot be
hurried.
- Take Care Of Yourself Get
plenty of rest, eat well, take time to retreat, and time to talk.
Try not to become isolated but seek out social support.
- Adapt To Change This may
mean taking on a new role, learning new skills, or learning how
to live on your own.
- Let GoWhen you are ready,
let go. This does not mean forget.
Many
theorists have discussed the stages of dying, death, and grief.
In general, the stages in the process of dying are culturally determined:
how the patient and loved ones feel about an impending death and
what they do or do not do to prepare for it or fight against it
are in large part determined by the cultural meanings attached to
the cause of death. A sudden death has different meanings for survivors
than does a long, drawn-out death, and the death of a young person
may have different meanings than the death of an older one -- both
for the person dying and for those surviving. For those who see
illness as punishment for bad deeds or bad thoughts or when illness
is seen as a reflection on the larger family or social group, death
and dying present additional layers of meaning.
AIDS
primarily strikes those in the midst of what should be healthy and
productive years. Although there are long-term survivors of AIDS
and advances have been made in the treatment of the disease, it
is still widely considered terminal. Thus, those newly diagnosed
as HIV-positive may feel as if they have received death sentences.
Because
AIDS often brings with it a social stigma, those who are diagnosed
with it face not only the typical end-of-life issues surrounding
the degenerative illnesses and impending death but also issues specific
to social aspects of the disease. In addition, these issues also
affect the grieving processes of their loved ones, who must face
the impending decline and death of a partner, child, parent, or
friend who has become a person with AIDS (PWA).
Although
there are many causes of premature death, the leading causes of
death in young people are accidental and sudden. AIDS, on the other
hand, has a long clinical latency period, during which time the
HIV lies seemingly dormant for years. When a person is diagnosed
HIV-positive, he or she may experience years of asymptomatic illness.
At this point, the psychological process of preparing for death
may or may not begin, depending on the person's willingness and
ability to confront the illness and its implications directly. For
those who can do so, the time between positive diagnosis and the
transition to a full-blown AIDS diagnosis can be a time of personal
growth. For those who cannot accept their diagnosis, this period
may be one of denial. They may pretend for years that the diagnosis
is wrong and may determine not to tell friends, family, and others
of their illness.
The
years in the early stages of disease progression may or may not
feel like a time of preparation for death. For those who are prone
to or are in recovery from alcohol or drug abuse, this period can
easily become a challenge to remaining clean and sober, based on
the feeling that there is no point in staying sober if early death
is inevitable. For a person in a committed relationship, this period
can bring with it additional concerns for the health of the partner
and fear that the relationship may end because of the diagnosis.
For a person without a regular partner, the initial period may bring
with it a need to prove one's desirability and even one's immortality
by engaging in sexually risky behaviors.
Once an AIDS diagnosis has been made, for most PWAs the process
of coming to terms with impending death becomes unavoidable. For
both the PWA and loved ones, the stages in facing death delineated
include denial; shock and anger; bargaining and pleading with God,
the spirits, or the fates to take someone else or to not take anyone,
with promises to do better or live better in the future if the prayer
is answered; resignation that the death is inevitable and depression
or sadness that life will end too soon; and finally, acceptance
of the death and a desire to make it meaningful. Although not everyone
goes through all stages or goes through them in the same order or
for the same length of time, these emotional states are often seen
among surviving loved ones both before and after an expected death;
they are considered normal unless the person gets "stuck" in one
stage or seems cut off from grief, anger, and other typical emotional
responses to death.
For
adults, the period of transition from health to terminal illness
involves both continuing to live a normal life and wrapping up personal
affairs. For those with children, the process is complicated by
the question of how and when to let a child know that the parent
is dying. As the inevitability of decline and death becomes apparent,
making a "good death" and providing for the future of loved ones
becomes increasingly important.
Several
can complicate the process of making death satisfactory external
factors. Legal and financial issues may present increasingly frustrating
roadblocks to stability in final years, and in final months these
troubles may make it difficult to find a place to die with comfort
and dignity. Insurance may be canceled or payments for treatment
limited for PWAs. Although employers are more educated in dealing
fairly and supportively with employees with AIDS than they were
in the early years of the epidemic, some PWAs still face discrimination
by employers and coworkers, including termination before they feel
ready to leave work.
Finding
long-term care presents enormous challenges, whether it is with
family members who may resist care taking someone with AIDS or in
affordable hospice or other institutional facilities. Such problems
put an additional emotional strain on the PWA and may make the process
of coming to terms with the illness and the end of life more difficult.
Another factor with the potential for major impact on the process
of dying for both the PWA and loved ones is the nature of the disease
itself and the physical process of death. Because AIDS destroys
the immune system, multiple illnesses cause a significant physical
decline in the PWA. This is both emotionally devastating and physically
debilitating for the patient, and it is often difficult for loved
ones to watch the patient becoming a shadow of his or her formerly
vibrant self. In addition, the possibility of developing neurological
difficulties that can bring on personality changes can cause serious
emotional distress, including anger and feelings of helplessness.
Waiting for the death of a PWA can become a significant stress for
everyone and can strain and test relationships.
Children
may be ostracized or harassed at school if a relative has AIDS,
and they may not be able to understand what is happening to them
or to there loved one.
As
a result of the issues and pressures that PWAs must deal with, suicide
is often given greater consideration than might otherwise be the
case. A person diagnosed as having an end-stage illness may consider
suicide because he or she fears an extended period of decline. A
person already in serious decline may consider suicide because the
pain, weakness, and hopelessness have become too much to bear. Such
considerations may be tempered by the interventions and support
of loved ones, by religious beliefs, and by fear of death itself,
but the PWA considering suicide needs to feel that others understand
why he or she is contemplating it.
When
death is imminent, the main concern of both the PWA and those caring
for him or her is to enable a comfortable and dignified death. For
those who have been abandoned by loved ones, this often means finding
a community hospice or other institution that will provide a place
to die. However, for most PWAs, the preferred choice for a good
death is at home in bed or, if this is not possible, in a hospital
or hospice, with painkillers as desired and a chance to say good-bye
to loved ones.
Once
the PWA has died, the funeral or memorial service can provide closure
to the emotional process for survivors. Those left behind may feel
not only anguish over the death but also guilt over their relationship
with the dead person or their inability to "properly" interact with
and care for the PWA while that person was alive. For partners of
dead gay men, in particular, the day Surrounding death may be especially
difficult if the partner's relationship with the dead person's family
was not good or if the partner neglected to make a will that included
the surviving partner and their shared property. Community support
for all involved, along with counseling and bereavement support
groups, may be of comfort in this period.
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