Facing Loss

When one loses something or someone that is valuable or important, one may experience a period of grief. People who live with cancer may grieve for many reasons, such as the inability to take care of a child, the loss of control of the health or the loss of a body part. Grieving can be a long and painful process after the death of a loved one. Everyone’s experience of grief is unique as each person goes through the process on their own way and in their own time.

The nature, intensity and duration of grief may be influenced by the following factors:

• The age, gender, personality and the coping style of the grieving person.
• Their relationship with the person who died.
• The cause of death.
• The support systems of the grieving person, including the family, friends, social communities and religious or spiritual beliefs.
• How the life of the grieving person changed after the loved one died.

In general, there are 5 stages of grief.

1. Denial

• One may be shocked or numbed when they hear about the death of someone. They may feel that something is unfinished and unsaid.
• Denial is a normal reaction to loss. This is a temporary way to deal with the rush of overwhelming emotion.

2. Anger

• After the shock and numb, one needs to face the reality. One may feel frustrated and hopeless. These feelings may turn to anger towards other people, oneself or even their God.
• One may feel relieved after the death of someone whom they have been taking care for a long time. However, at the same time, they may feel guilty for that.

3. Bargaining

• Bargaining is the thought of changing the circumstances (loss of the loved ones) with another situation. Common thoughts are “If only…” and “What if…”
• One may wish to undo something that has already occurred. For example, “I would go for lunch every week with my grandma if only I could have her back”, or “If my wife was here, I would tell her how much I loved her”.
• One may also ask for a higher power or God. By asking a higher power to bring someone back, They are acknowledging that their loved one is gone.

4. Depression

• Depression after loss is different from clinical depression. Feeling sad is a normal reaction.
• One may feel depressed and experience loneliness, lack of energy, change of sleep pattern, loss of appetite, lack of interest in daily activities, withdrawal from social life and fear about future.

5. Acceptance

• In this final stage of grief, one accepts the reality of your loss. This may take months to years.
• The intensity of grief lessens with time although the sadness may come again especially on special days (birthdays, anniversary, holidays) or places or things that arouse memories of the loved one. One will return to life gradually. Readjustment of life brings hope and a desire to dream.
• People accept the loss and try to start a new page of life. Life is more joyful. Good days are gradually increasing.
• One may also find ways to get connected with the person they lost. For example, recalling their words, seeing their photographs, reading the letters sent from him/her andreading the online page to share memories.

• Grief means sadness.
  • Grief is not just sadness. It can affect one’s emotions, behaviour, beliefs, relationships and physical wellbeing. People with grief usually have both emotional and physical manifestations.
• The stages of grief are in order.
  • People may encounter different emotions which may not appear in order. The process of grieving just likes a roller coaster, full of ups and downs, with unpredictable feelings and behaviours.
• The timing of each stage of grief is similar for every people.
  • Different people go through the stages of grief differently. Some may recover quickly while some need more time.
• After the last stage of acceptance, grief is over.
  • Waves of grief may come and go over months or years. Even years after the loss, grief may still exist in one.
  • Although the grief may never completely disappear, one can find relief in support and understanding.

Signs

• Emotional manifestation: shock, numbness, anger, guilt, anxiety, sense of helplessness, disorganisation and sadness.
• Physical manifestation: a hollow feeling in the stomach, dyspepsia, tightness in the chest or throat, chest pain, oversensitivity to noise, shortness of breath, muscle weakness, dizziness, headache, lack of energy, dry mouth, as well as aches and pain
• Cognitive manifestation: disbelief, sense of unreality, confusion, difficult to concentrate, poor short-term memory, preoccupied with thoughts of the deceased, as well as a sense of presence of the deceased.
• Behavioural manifestation: loss of appetite, sleep changes, nightmare, dreams about the deceased, withdraw socially, engagement in restless overactivity and behaviour to remind oneself about the deceased or to avoid oneself from thinking of the loss, as well as a sudden and radical change in lifestyle to avoid the pain and bereavement.

• Allow oneself to feel all emotions
• Share struggles and feelings with trusted friends
• Attend the funeral even in states of withdrawal, seeing the deceased body and saying goodbye to your loved ones. You may feel regret in the future if you do not do these.
• Have healthy and balanced diets
• Limit caffeine and alcohol
• Exercising regularly during the day for better sleep
• Do not force one into sleep. Get up for relaxing activities in case of insomnia.
• Avoid making any significant decisions or changes soon after the bereavement
• Seek help from families and friends. Discuss with them about new arrangements or routines.
• Engage in relaxing and grief relieving activities, e.g. writing a journal, drawing, painting or writing a letter to the deceased.
• Consider spiritual or religious practices
• Join grief support groups
• Talk to a clinical psychologist

Complicated grief is the grief that does not lessen while worsening as time passes. If one finds themselves dwelling in depression or even being suicidal, it is important to seek help. One may receive professional advice from a doctor, a psychologist, a psychiatrist or a social worker if one is:

• unable to function well on daily activities,
• unable to sleep well for a long time,
• unable to take care of themselves,
• has feelings of worthlessness,
• begins to rely on alcohol or drugs,
• suicidal,
• may hurt someone because their anger cannot be handled well,
• unable to eat regularly over a long time.

Joining support groups may offer one a chance to talk to others who share their experiences and feelings for encouragement, comfort and practical advice, and to be reassured that their emotions are normal. The support groups may be in person, on the phone or online.

One may also practice their own religious beliefs. Talking to a religious leader may relieve one’s emotions.

For details, please visit Support Groups for Grieving under Community Resources

Helping others in grieving can be very hard. You do not know what to say and what to do to comfort the grieving person. Words become difficult in this moment. Being with the grieving person and listening to him/her are, somehow, enough for him/her. Let the grieving person know that they are not alone. Here are some points that you should notice when you come across to someone who is grieving:

It is common not to tell the truth of death of the loved one to the children. We believe that knowing the truth of death will hurt the children. However, children may have lots of imagination about the “missing person”. They may think that the death is due to their misbehaviors. The imagination can be more frightening to the children. Without appropriate sharing and explanation, the guilty, anxiety, insecurity and fear cannot be handled well. Grieving is a process of expressing feelings that leads to healing.

Depending on the ages of the children, they show their grief in different ways. They may show their sadness for a short period and then have joyful time later. If the child had a very close relationship to the person who died, he/ she undergoes an intense loss. The child may not show you how pain he/she is verbally but surely, the pain exists. Especially when they grow up, they will re-experience the pain again. This is commonly observed during certain milestones in life, such as graduation from college or getting married.

It is important to help children understand death and let them express their feeling in their way. The understanding, emotion expression and the behavior vary according to their age, personality, previous experiences and support from family members.  Remember the characteristic of children from each stage may overlap.

Institute of Mental Health Castle Peak Hospital: Overcoming grief and bereavement

Videos

▶️ HK Life and Death Studies Association: The pain of bereavement and comfort techniques | Arnold Leung |What about life and death education (Chinese version only)

▶️ Jockey Club End-of-Life Community Care Project: It’s not too late to cherish your life when 'Heart-to-heart and Death' (Chinese version only)