By Mariann Young, Ph.D., CBIST
Rainbow Rehabilitation Centers
What is Grief?
There has been a great deal written about grief, but in general it is a complex emotion that may not be easily understood. It is the internal or personal response to loss and one of the most common experiences of everyday life.
To grieve means to acknowledge in your heart and to others that your loss meant something to you, and that you must honor the importance and pain of your loss.
There is a wide range of grief, from mild sadness to overwhelming suffering. Grief may lead to depression, anger or disruptive behaviors if it is not acknowledged and addressed. The sadness, the tears, the fatigue, the changes in how we feel physically and emotionally and how we relate to friends and family can all be confusing.1
American culture does not always make it easy to express grief. As a society, we tend to glorify youth, beauty and health. This does not lead us to be able to handle the reality of grief or death. We can be expected to hide our emotions or to handle them within a certain time frame.2 We discourage the direct expression of grief and at times feel so uncomfortable in allowing the grief to be expressed that we try to stop it. We describe people who are crying or expressing pain as “not doing well” and try to cheer those who are sad. We advise grieving individuals to be brave when it is better to allow them the ability to express their emotions.3
After a person has a traumatic brain injury, the family is overwhelmed by emotions. There is the initial fear, depression, anxiety and guilt—to name just a few. The immediate concern is: Will they survive? There is joy and relief once it is known that the person will live. However, if the person has had a severe or moderate brain injury, the realization sets in that the person who survived is not the same person that they were before the accident.
Emotions may be in turmoil because of the conflict experienced when you are grateful that the person has lived yet grieve the person who is no longer there. The relationship that you had with the injured person, whether parent/child, partner, family member or close friend, is forever altered.
There are situations in which the family becomes so involved in providing care that they do not recognize the effects the injury has on all members of the family. Even the strongest families grieve the loss. Furthermore, there is not any ritual to assist in this type of grief, because the loss is ambiguous.
Ambiguous loss is unresolved. There is no closure to it, and it becomes the new reality. Some features of ambiguous loss include:
- The loss is always about relationships.
- The loss is stressful.
- There is the frustration of not knowing a “final outcome” of the accident – how long therapy will last, how severe the deficits will be, when will the person be back to their pre-accident self, what will the new normal be like, and how can a person cope?
- Ambiguous loss is not depression but can contribute to depression, anxiety, conflict, illness or explosive emotions if not addressed.
- Ambiguous loss may not be easily resolved.4
Children Who Experience Loss
No child is too young to be affected by loss. An infant recognizes the change in feedings and care-giving routines after loss. They miss the presence of the family member who has been injured, and they are able to sense the powerful emotions expressed by others around them.
Young children grieve deeply but for shorter periods of time than adults. They are easily overwhelmed by strong emotions, and a shorter emoting of grief serves as a protection for them. This does not mean that they are not sad or that their emotions have been addressed—it just means that it is all they are able to handle at that particular time. Older children may focus their attention on school, friends, or helping out when they can.
No matter the age of the child, they will likely not react in the way an adult expects them to react. In fact, children may find it easier to express their feelings through play, art or journaling. Although you may get an indication of what a child is thinking, it is unrealistic to interpret their thoughts exactly.
A child may not be ready to deal with the loss they have experienced, and their lack of emotion may be their inability to grieve at that time. Also, when children are stressed they may behave like a much younger child. They may become whiny and clingy. Younger children could have bowel or bladder accidents or become demanding.
It is important to meet the needs of a child who has experienced loss so that they can care more about others.5
What is Hope?
Hope is an optimistic attitude based on an expectation of positive outcomes. People who possess hope and think optimistically have a greater sense of well-being in addition to improved health outcomes. The impact that hope can have on a patient’s recovery is strongly supported through empirical research and theoretical approaches. A person can live with ambiguous loss without becoming hopeless.
According to Janet Cromer, RN, MA, LMHC, these are some of the key points:
- Recognize what’s going on. Underneath the confusion is a list of losses, changes, thoughts and feelings. Write down your thoughts without censoring them. Talk to other family members about their observations and talk to the individual about what bothers him or her. Talking about an issue does not make it worse.
- Find a safe and supportive connection. Talk to a therapist, counselor or spiritual leader who is experienced in dealing with ambiguous loss. Inquire in advance if they understand the issue. Join a support group that can assist in your finding meaning and hope in the loss.
- Come to a shared understanding of the situation over time. Learn what has been lost for each family member and focus on where to build. Mourn whenever you feel the need and understand that this act is not disloyal to the person.
- Get to know the person for who they are after the accident. Rebuild roles, rituals, and rules to live by.
- Incorporate humor and fun whenever possible.
- Accept that all or nothing will likely not work. There will be many situations in which there can be anger and concern about a deficit (e.g., memory issues).
- Hope is in the knowledge that there are new strategies to try and new options for solving a problem. Explore these as your life moves in a new direction—one small step at a time.
How to Help Families who have Experienced Loss
One of the most important things you can do for families who are grieving is to offer help. Following are some suggestions:
Spend time with the family. Offer your company. Help out around the house if you can. Fix something that is broken. Do laundry or make a meal. Help the children with homework.
Don’t try to take away the grief. Let the family express powerful feelings. Trying to take away the grief or finding something positive in the situation is usually not helpful. Listen more and talk less.
Keep in touch. Grieving takes a long time. Offer support over the coming weeks and months, paying special attention to birthdays, holidays and anniversaries.
Family Support Group
Rainbow offers a Family Support Group at Rainbow’s NeuroRehab Campus® in Farmington Hills, MI. The group is free and open to the public. For more information, send an email to FamilySupport@rainbowrehab.com or call 734-482-1200 and speak with Dr. Mariann Young.
- The Essential Guide to Grief and Grieving. Holland, Debra, M.S. Ph.D. New York: Alpha Books, 2011.
- http://www.tneel.uic.edu/tneel-ss/demo/grief/outline1.asp (Accessed July 5, 2017)
- http://www.deathreference.com/Gi-Ho/Grief-and-Mourning-in-CrossCultural-Perspective (Accessed July 5, 2017)
- http://www.lapublishing.com/blog/2011/brain-injury-blog-ambiguousloss/ (Accessed Oct. 30, 2017)
- After a Loved One Dies-How Children Grieve. Schonfeld, David, MD & Quackenbush, Marcia, MS,MFT,CHES. New York: The New York Life Foundation, 2009.