Waiting for the death of a loved one. When specialist help is needed. Pathological reactions of grief

Every day on Earth, for various reasons, a huge number of people die, leaving behind loved ones who sincerely mourn them. Bereavement in the form of depression or even deep grief after death loved one (for example, mom or husband) is a completely normal reaction to such a loss. And especially acutely people experience the death of a child (son or daughter).

However, in some people, the natural manifestations of grief, such as guilt, insomnia, numbness, and sobbing, can lead to more serious manifestations, including grief (deep grief) and depressive mental disorder (Clinical Major Depression).

Symptoms of Natural Mourning

Grief differs from natural grief in its duration and intensity. People who experience normal grief can most often explain why they are sad. They continue to function normally in society and are usually able to overcome their intense sadness within a relatively short period of time (usually a month or two).

Usually, after the death of a very close person (husband, mother, son or daughter, brother or sister), such intense experiences as grief or depression can intensify over several days, weeks or even months. And sometimes such depression can develop even after the death of a loved one.

Almost every person, faced with the death of a loved one (especially a child, mother, beloved husband), will experience such natural symptoms:

• feeling of guilt for what they did (or did not do) before the death of a loved one. So, a mother can reproach herself for not saving her son;
• obsessive thoughts like this: "I would rather die instead of my husband!" Thus, parents may regret that death did not take them instead of the child;
• the imaginary feeling that they see or hear the deceased;
• sleep problems;
• changing eating and exercise habits;
• desire to be in social isolation.

The stages of loss and grief

To understand how real clinical depression can develop from ordinary grief, you need to know what stages people go through after the death of a loved one (husband, mother, child, etc.).
In 1969, psychiatrist Elisabeth Kubler-Ross presented in her book On Death and Dying 5 stages of grief after the death of a loved one. These stages of grief are universal and are experienced by people from all walks of life.

In case of loss, the person spends a different amount of time at each stage. In addition, each stage can differ in its intensity. These five stages can occur in any order. We often move between these stages until we come to terms with death. All people grieve in different ways. Some people are outwardly very emotional, while others will experience grief in themselves, perhaps even without tears. But, one way or another, all people go through five stages of grief:

The first stage is denial and isolation;

The second stage is anger;

The third stage is bargaining;

The fourth stage is depression;

The fifth stage is acceptance.

While all the emotions that people experience at any of these stages are natural, not everyone who grieves goes through all of these stages - and that's okay too. Contrary to popular belief, you don't have to go through all these stages in order to move on. In fact, some people are capable of grieving without going through any of these stages. So don't worry about how you “have to” feel or where you should be right now.

When does Grief become Depression?

All of the above symptoms and stages of grief are completely normal. They help people adapt to loss and accept new living conditions after the death of a loved one.

The distinction between grief and clinical depression is not always easy to see because they have many symptoms in common, but there is still a difference.

Remember, grief comes in waves. It includes a wide range of emotions and a mix of good and bad days. Even when you are grieving very much, you can still have moments of joy or happiness. And with depression, the feeling of emptiness and despair is constant.

If the grieving person is experiencing severe symptoms of depression, then it is time to seek help. This must be done if the grieving person has:

• lack of concentration and complete inability to concentrate;
• the unusually thrill of your own worthlessness or guilt;
• anxiety or depression that does not go away, but only gets worse over time;
• sleep problems that last more than six weeks;
• obsessive memories during the day and nightmares at night, which constantly keep a person in suspense;
• sudden weight gain or loss;
• unexplained physical symptoms, such as unnecessary pain in a part of the body, rapid heartbeat, profuse sweating, digestive problems, or difficulty breathing
• thoughts that the deceased continues to be nearby, visual or auditory hallucinations;
• strange or antisocial behavior;
• thoughts of suicide, which can only be stopped by very serious arguments (for example, the mother has another child);
• severing all social contacts.

All of these symptoms can indicate the onset of clinical depression due to the death of a loved one. If any of these symptoms persist for more than two months after the death of a loved one, it serves as a signal that the person needs professional help.

Symptoms of depression or post-traumatic shock will be most pronounced if a person witnesses the sudden death of loved ones, or was nearby during the death of a loved one, such as a child.

Depression as a complication of mourning

Negative feelings such as hopelessness and helplessness are part of the normal mourning process, but they can also be symptoms of depression or other mental disorders. But sometimes the normal grief in this situation turns into a mental disorder. Depression is just one of a number of mental disorders that can be associated with the death of a loved one. Other disorders include generalized anxiety disorder and post-traumatic stress disorder.

No wonder one of the proposed future changes in the classification of mental illness, proposed by American psychiatrists, is the introduction of a new category of mental illness - aggravated experience of grief. Complicated grief, also sometimes referred to as traumatic or long-term grief, has been suggested as a complex mental disorder. It will be diagnosed if the general symptoms of severe grief, such as longing after the death of a loved one (husband, child or other relatives), difficulty moving on, depression or anger after such a loss, last more than six months.

The diagnosis of Complicated Grief Disorder is expected to be based on two criteria:

First criterion. The grieving person yearns for the deceased daily and very intensely.

Second criterion. A person must have, and also interfere with his normal functioning, at least five of the following symptoms:

• the impossibility of accepting this death;
• feeling overwhelmed or shocked after the death of a loved one;
• anger or bitterness experienced after the death of relatives (for example, anger at the husband that he left his wife);
• numbness or stupor (this happens especially often after the loss of a child);
• difficulty defining the purpose of life after loss
• extreme uncertainty about their role in life;
• avoiding anything that is a reminder of death;
• inability to trust people, since such a person believes that a loved one betrayed him by his death;
• feeling that life has lost all meaning.

Preventing depression after loss

After grief becomes clinical depression, it can no longer be overcome by ordinary mourning, so in this case, you cannot do without consulting a psychotherapist.
Treatment for such depression usually includes antidepressants and interpersonal or cognitive-behavioral therapy.

However, there are ways in which people themselves can prevent grief from turning into depression.

Live the reality, accept the reality of loss, and realize that even in grief it never ceases to be a part everyday life... Talk to family and friends more often.

Go the other way. Try to adjust to the new reality by doing things differently. For example, take up a new hobby, or give up activities that are painful reminders of a loved one. Move forward - push yourself to move, communicate and participate in pleasant events.

The post-traumatic syndrome that accompanies the death of loved ones is called acute grief reaction... This condition is a clinical nosology, it has its own stages, pathogenesis and methods of therapy.

Types of grief

The loss of a loved one is always unexpected and scary. It does not matter whether the person was sick, or his death came suddenly. People facing loss are faced with grief in one way or another. Everyone experiences grief in different ways, some isolate and become asocial, while others, on the contrary, tend to maximize their involvement in activities so as not to face pain.

It is difficult to define the concept of "normal grief", it is a very individual process. However, there is a line after which the post-traumatic stress state becomes a clinical pathology and requires obligatory medical and psychological support.

Psychiatrists and psychologists distinguish two types of post-traumatic state of patients who survived the death of loved ones:

1. Normal reaction of acute grief.

2. Pathological reaction of acute grief.

In order to talk about the line between them, it is necessary to understand the clinical course and features of each stage.

Experiencing Natural Grief

The reaction of depression and deep grief associated with the death of a close relative is a normal reaction, it takes place and often, if it proceeds freely with the support of loved ones, a person returns to social life without the help of specialists. There are so-called stages of grief. These are periods characterized by the experience of certain emotions and corresponding behavior. The stages can be of different duration and do not always go in order, but they always take place.

Stage I of denial - this is the period that comes when the news comes about the death of a loved one. This stage is sometimes called shock stage. It is characterized by the following signs:

• disbelief;
• anger at the "messenger";
• an attempt or desire to change the situation;
• challenging the fact of the tragedy;
• illogical behavior in relation to the deceased (they set the table for him, go to the apartment, buy gifts and call);
• the conversation about the person goes as if he is still alive.

Stage II Anger - when the awareness of the tragedy reaches the understanding of a loved one, he begins to be angry at others, at himself, at the whole world for not having prevented the loss. This stage is characterized by:

• search for the culprit;
• antisocial behavior;
• isolation from loved ones;
• angry reaction to neutral or positive states of others.

Stage III Bidding and Compromises - this is the stage when a person begins to think that perhaps there are forces in the world that can “cancel” the death of a close relative, mainly religious rituals and prayers are included here. The grieving person seeks compromises with God, tries to "bargain" with him for the opportunity to return a loved one. This stage is usually accompanied by the following feelings and actions:

• hope for the return of a loved one;
• seeking religious support;
• contacting religious or occult societies to find an answer to a question;
• frequent visits to churches (or other religious centers);
• bargaining with death (I will change if he comes back to life).

IV Depression - when anger and attempts to change the tragic situation pass, when the whole weight of loss reaches the consciousness of the grieving person, the stage of depression begins. This is a long and very difficult period. The period is indicated by such feelings:

• feeling of guilt for the death of a loved one;
• obsessive thoughts and states;
• existential questions (why do people die in their youth? What is the point of living now?);
• insomnia or hypersomnia (increased sleep duration);
• lack of appetite, or vice versa, pathological "seizing" of grief (anorexic or bulimic experience);
• social isolation;
• loss of desire and ability to take care of yourself and others;
• abulia (volitional powerlessness);
• a sense of the meaninglessness of life after the death of a loved one;
• fear of loneliness when it is impossible to be in society.

V Acceptance - this is the last stage of resignation to loss. The person is still in pain, he is fully aware of the significance of the loss, but he is already able to solve everyday problems and get out of isolation, the emotional spectrum expands and activity grows. A person can be sad, afraid, with pain to remember the deceased, but he can already be socially active. These are normal symptoms of grief... The depression stage can last for a very long time, but the condition gradually improves. This is the main criterion for the "normality" of mourning. Even just knowing all these stages, you can understand how to survive the death of loved ones safely and completely.

Pathological reactions of grief

The main criterion for pathological mourning is the duration, intensity and progression of the depression stage. Depending on the response to the grievous event, the 4 types of pathological reactions of grief:

1. Delayed mourning - this happens when the reaction to the loss of a loved one is very weak compared to the reaction to small everyday situations.
2. A chronic (lingering) grief reaction is a condition where symptoms do not improve or worsen over time and depression lasts for years. A person loses himself and the ability to take care of himself. Clinical depression sets in.
3. Exaggerated grief reactions are pathological conditions even for grieving. For example, instead of fear or anxiety, a person develops a phobia or develops panic attacks, instead of anger, attacks of rage appear and attempts to physically harm oneself or others.
4. Disguised grief - a person suffers and grieves, but denies any involvement in this grievous situation. This often manifests itself in the form of acute psychosomatics (exacerbation or manifestation of diseases).

Help for the grieving

It is very important to understand that any emotional states for a grieving person are indeed variants of the norm. It can be incredibly difficult to endure and stay close in the difficult emotional experiences of a person who has lost a loved one. But rehabilitation after the death of a loved one implies support and participation, not ignoring or depreciating the significance of the loss.

What to do for family members to help the grieving person cope and not harm

It all depends on the stage of the loss experience. At the stage of denial, it is very important to respect the grieving person's right to shock and disbelief. There is no need to convince him, no need to prove death. A person will come to understanding, but at this moment his psyche is protected from injury. Otherwise, the reaction from normal to pathological, since the psyche will not cope with the amount of loss in a short time. You need to be there and allow you to experience mistrust, denial and shock. The illusion should not be maintained, and neither should it be denied. The anger stage is a normal process. A person has something to be angry about and it is necessary to allow this anger to be. Yes, it is hard and unpleasant to be the object of aggression. But help after the death of a loved one should consist in accepting any of his normal emotional states. Let it be better accusations, shouts and broken dishes than attempts to harm yourself. The bargaining stage also seems "strange" to the relatives of the grieving person, but one must allow the person to bargain and find comfort in faith. If his activity in this direction does not entail leaving for a sect, dangerous rituals or suicide, it is worth allowing a person to be a believer and bargain with God. Depression is a period when loved ones should be especially attentive. This stage is the longest and most difficult.

In no case should you stop tears, devalue the loss (everything will be fine, do not cry, everything is fine). It is important to talk about loss, talk about its severity and pain, empathize and, in fact, work as an emotional mirror. If loved ones are not able to be around this way, it is worth contacting a psychologist and allowing the person to safely experience grief. At the stage of adoption, it is very important to support any new beginnings, plans and positive motives. Both the memories of the deceased and the emphasis on positive experiences are important. If the experience of grief turns into a pathological one, you need to immediately contact a psychotherapist, and if necessary, a psychiatrist.

Natalia Kaptsova

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The death of a person is always an unexpected event, especially when this happens to people close and dear to us. This loss is a profound shock for all of us. At the moment of loss, a person begins to feel the loss of an emotional connection, a deep sense of guilt and an unfulfilled duty to the deceased. All these sensations are very oppressive, and can cause severe depression. Therefore, today we will tell you how to survive the death of a loved one.

Death of a loved one: 7 stages of grief

Psychologists identify 7 stages of grief that all people who grieve for a deceased loved one experience. Moreover, these stages do not alternate in any specific sequence - for everyone, this process takes place individually ... And since understanding what is happening to you can help you cope with grief, we want to tell you about these stages.
7 stages of grief:

1. Negation.
   "It is not true. Impossible. This could not happen to me. " Fear is the main reason for denial. You are afraid of what has happened, you are afraid of what will happen next. Your mind is trying to deny reality, you are trying to convince yourself that nothing has happened in your life and nothing has changed. Outwardly, a person in such a situation may look simply numb, or, on the contrary, fuss, actively engage in organizing a funeral, call relatives. But this does not mean that he easily experiences the loss, he just has not yet fully realized it.
   However, it should be remembered that a person who has fallen into a daze should not be protected from the hassle of a funeral. Order of funeral services and registration of all required documents make you move, communicate with people, and thus help to get out of stupor.
   There are times when, in the stage of denial, a person generally ceases to perceive the world adequately. And although this reaction is short-lived, help to get out of this state is still necessary about. To do this, you need to talk to a person, while constantly calling him by name, do not leave alone and try to distract a little ... But you shouldn't console and calm down, it still won't help.
   The denial phase is not very long. During this period, a person prepares himself, as it were, for the departure of a loved one, realizes what happened to him. And as soon as a person consciously accepts what happened, he begins to move from this stage to the next.
2. Anger, resentment, rage.
   These feelings of a person capture completely, and are projected onto the entire surrounding world. During this period, there are enough good people for him and everyone does everything wrong. Such a storm of emotions is caused by the feeling that everything that is happening around is a great injustice. The strength of this emotional storm depends on the person himself, and how often he spills them out.
3. Guilt.
   A person more and more often recalls moments of communication with the deceased, and the realization comes that he paid little attention here, he spoke very sharply there. The thought more and more often comes to mind: “Have I done everything to prevent this death”. There are times when the feeling of guilt remains with a person even after he has gone through all the stages of grief.
4. Depression.
   This stage is most difficult for those people who keep all their emotions to themselves, not showing their feelings to others. And in the meantime, they exhaust a person from the inside, he begins to lose hope that someday life will return to a normal owl. Being in deep sadness, the grieving person does not want to be sympathized with. He is in a gloomy state and does not contact other people. By trying to suppress their feelings, a person does not release his negative energy, thus becoming even more unhappy. After losing a loved one, depression can be a rather difficult life experience that will leave an imprint on all aspects of a person's life.
5. Acceptance and pain relief.
   Over time, the person will go through all the previous stages of grief and finally come to terms with what happened. Now he can already take his life in hand and direct it in the right direction. His condition will improve every day, and his anger and depression will subside.
6. Revival.
   Although the world without a loved one is difficult to accept, it is simply necessary to do it. During this period, a person becomes uncommunicative and silent, often mentally withdraws into himself. This stage is quite lengthy, it can last from several weeks to several years.
7. Creation of a new life.
   After going through all the stages of grief, a lot changes in a person's life, including himself. Very often in a similar situation, people try to find new friends, change the environment. Someone changes jobs, and someone a place of residence.

How to survive the death of a loved one? This worries anyone who has experienced dire feelings of loss. When grief begins at the very loss and does not last long, it does not drag on too much - it is natural, as if a piece of the body was cut off from us. However, if grieving is long-term, lasts for months, years, strongly - this happens under the influence of negative mental programs that are fueled by negative emotions. The loss of a loved one gives rise to a whole complex of oppressive emotions, experiences that rise from the bottom of the unconscious, often direct thinking again and again at the moment of loss, hurt and develop into neurotic states.

Grief, when it visits a person, gives a strange, often very individual reaction. What does psychology say about this, how to survive the death of a loved one? Almost all people go through all the stages of mourning. Strong, strong-willed people with the habit of controlling everything, often occupied by high positions - at first they clearly concentrate, complete all the necessary things, give orders, and then fall into. Individuals with strong somatization, on the contrary, may not even find the strength to move, they will feel completely crushed, absent, as if this is not happening to them. A frequent reaction is not to believe, not even imagine how to survive the death of a loved one, dear person.

Unbelief, which replaced grief, is followed by the search for those responsible for death, the thought of what should be done in order to avoid it. Psychologists say that those who are practically not guilty blame themselves more. Then comes the stage of relaxation and rejection. Then a year passes, and again quickly shock, disbelief, the search for someone to blame, guilt for oneself, numbness, and then the worries pass. Normally, after a couple of years, the feeling of grief should leave a person.

How is it easier to survive the death of a loved one, leaving only a bright memory of him? Having recovered from the first shock of loss, you will begin to remember the good things that the one who left after himself leaves behind, how many good deeds he did, what funny cases there were. Such a bright memory makes it possible to speak to us about the departed in the present moment.

Burying a loved one, we go through great stages of our inner difficulties. Correct reaction is very important. Trying to restrain feelings or taking sedatives is not worth it - they will only disrupt the natural course of the mourning process, for which relief will eventually come. Cry, if you want, you can, you need to, even express your complaints, accusations to the departed, how could he leave. It is easier for women to do, while men often hold back, because the losses are harder to live, they are in longer.

How to survive the death of a loved one, dear person, if it seems that there is no strength for this? If your feelings are extremely painful, it seems that you are not able to cope with them, a long time has passed already - you simply have to get rid of destructive experiences, because in this way you are doing badly not only to yourself, but also deceased person... Think that the departed loved one wanted you not to worry and cry, but to rejoice, remembering your best moments. Do it for him, consider the good in life, enjoy his memory. The worst thing you will choose to do is worry and harass yourself. You should work on your experiences by defeating personal negative programs, learn to be happy, accepting death as a natural, natural phenomenon.

When you are in difficult long-term experiences, you cannot stop their flow - it may be time for you to see a therapist who specializes in dealing with trauma, working with grief. By yourself or with help, but you need to let go of the departed, remember him only from the positive side, with a bright memory and light emotions.

How is it easier to survive the death of a loved one? Remember him lightly, continue his work. What our loved ones created - they did to make us happier. And rightly so are those parents who, having burned out for the baby, give birth to the next one. Children who live for a month or two with their mother if their father died, or support their father if their mother died, do the right thing, help, preserving their way of life for a while, but then continue to live life to the fullest, pushing the remaining parent to her.

How to help survive the death of a loved one?

If a friend or coworker is going through this trauma now, you will most likely face an aggressive or absent response. Now he is not what he always is, does not want to spend time with you, to perform duties at work, the state of insanity can last for six months. He needs a pause now, a certain distance to be with himself - then take a step back, give him that opportunity. Indicate that you will be ready to help, but you will not tolerate him. The death of close relatives does not justify the boorish behavior of people with loss.

When your friend is not himself, cannot cope with the situation - do not try to help him only yourself, sitting on the phone at night. The best help will be if you find a specialist for him who can return to society. There is no need to calm him down - let him grieve. If a person repays everything in the initial part of his grief, he will shorten the entire period of getting out of a stressful situation.

Here the proverb is true - words cannot help grief. When loss visits a person, the main thing is to remember that no one is to blame. A person often begins to analyze why the catastrophe happened, the tragedy broke through into life.

The main task for you, if you are with someone living in grief, is to enable him to live his loss and, if necessary, be there to support him. Of course, everyone reacts differently to the loss of a close relative. It often seems that the response is inadequate. However, this is a normal reaction to abnormal circumstances. And the task of those nearby is to support, to help pass the grief, to learn to live without the departed.

Often in such situations, people get lost, not knowing how they will behave correctly, so as not to make things worse, not to say too much. This is your own fear of error, because it is easier to help adults who have already experienced the loss themselves. It is worth saying in simple words that you condole. This is necessary for the grieving person, because condolence means I am sick, I experience your pain, like you do. The grieving then feels that he is not alone in a difficult situation.

Is it important to express feelings or try to distract a person, switch him to a practical channel? Here we are dealing with feelings, with the inner reality of a person. If conversation helps, it's worth talking. If silence is silent. If you just sit down and show your compassion, the person will often begin to speak on their own, pouring out their pain. It can even often come to tears that cannot be tried to stop, because with the help of them a person gets relief.

How can a child cope with the death of a loved one?

Death goes hand in hand with life, fathers die, incomplete families remain, mothers die of illness, and then the fathers are forced to raise the child themselves. How to tell a child about death that he will not see his father again, mother, grandmother, grandfather, brother or sister? It is especially difficult to find what to say to a child if dad or mom died, with what words, with the help of whom? Most often, close people deceive children, informing that dad, for example, will leave and will not arrive soon. The child is waiting, can wait for years. Then wine appears, it seems to him - he himself did something wrong, because dad does not come. He continues to hope, to make some plans. Then hope is lost, anger at the one who deceived appears. Most often this is the remaining parent. This is where trust goes.

It is advisable to tell the truth, the truth in the context of the family, in what grief happened. If the idea is acceptable for adults that the soul is in heaven, sees you, helps you and accompanies you now - tell the child about this. But if an adult has a feeling that the departed will not return, will never hug - so it is worth saying to the child, to put it mildly.

To report death without traumatizing the child's psyche, psychologists suggest such steps. The first is to share the child's emotional experiences, saying that you clearly understand how the child dreams that dad, for example, would come to the kindergarten for him, play, help, and then explain to the child, in a childish way, where dad really is, what happened ... A frequent explanation is to say that dad is now in heaven, he cares, watches, next to him. And also show father's photos different ageswhere are you together, talk to dad's pictures. You can start talking about your day, where you were, what you did with your child. You will allow your child to form a positive father image that will help him later in life.

It is indecent to cry in society now. Adults, children hide tears in themselves, then we see a number of diseases: enuresis, sinusitis, bronchitis, asthma,. It turns out that the child first encounters his very vivid experiences, does not find an explanation for them, does not find support. Adults tend to push feelings, because they are often not ready now to face the child's experiences. An adult is often afraid for a personal reaction that he will not cope with his feelings and will not be able to help the child.

Let's remember how our grandmothers in the old custom used to say "some kind of woe, cry." And indeed, the child on the shoulder of the grandmother will immediately cry out a huge part of the pain, it becomes easier for him, because tears cleanse. The body is freed from the clamps, an understanding of what is happening comes, a humility that will never be like before. This is a certain period of maturity, the road to maturity.

When does the understanding of what death is? Between about five and seven years. Until the age of five, a child does not yet understand that the disappearance of a loved one from life can be a departure forever. The child does not have a need to immediately return, to insist that this person be near, there are so many things around that distract the child's attention. Until five, this period passes without a heavy feeling of loss.

Around the age of three, a child experiences loss, and when a significant adult disappears from his life, he experiences a loss as a loss of stability in his life. It is traumatic for him, but he cannot yet realize that a loved one has died. Therefore, until about one and a half years, psychologists insist not to try to explain to the child what happened, it is enough to give a feeling of stability thanks to another adult. Even if the kid asks, calls the parent - explain that he is far away. The child cannot yet sympathize with the loss.

By the age of five, the child begins to realize the loss of a loved one as his departure. However, it is still very difficult to understand that this departure is permanent. The feeling of stability is lost, it is clear that adults are nervous, often cry, worried - the child adapts to this feeling of adults involuntarily. A common mistake that adults make when trying to protect a child is referring to relatives or hiring a nanny who leaves with him, which cannot be done, since the anxiety that the child naturally experiences when being around should be calmed by you. If a child leaves for another place, remains in the dark about what is happening - later this anxiety can often develop into a fear of losing a loved one. A close relative must be with the child at such a moment, who will support him, in case of questions he can simply explain what happened.

From the age of six, the child already fully understands the existence of death, that the departure of a loved one is forever. Here, the fear of losing someone else can arise. It is then important to show attention, to give the child a symbolic image of the departed - for example, to make a memorable beautiful album together.