I was six when my grandmother died. She was my best friend, my hero, and my protector in an alcoholic home. Her death was sudden and violent, and it led to my entry into the foster care system and separation from my disabled mother very soon thereafter. Years later, I would still cry whenever my grandmother was mentioned, and at each anniversary of her death, my behavior would become sad, withdrawn, and angry.
What I was experiencing, which did not have a name at the time, was a mental health condition called prolonged grief. Not only can grief and loss exacerbate existing mental health conditions, but prolonged grief is now considered a mental health condition in its own right.
Prolonged Grief as a Diagnosis
When a person loses a friend or family member, it is expected that they will experience a variety of difficult emotions as they cope with life without the person they love. It is also expected that they will find a way to move forward without continuously feeling intense sadness. According to the American Psychological Association (APA), grief rises to the level of being considered a mental health condition when:
- Feelings of loss remain intense more than 6-12 months after the person passed
- The person has symptoms including:
- Difficulty accepting the death
- Inability to experience happiness
- Difficulty in social settings
- Intense anger, sadness, or guilt around the death
- Feeling like part of themselves is missing
Prolonged Grief is Not Depression
The intense sadness of prolonged grief (sometimes also referred to as persistent grief) is different from depression, in that it is specifically related to missing the person who has passed on. Depression often does not have a specific cause, or the cause will be unrelated to a death. Grief also does not tend to respond to antidepressant medications.
Risk Factors for Persistent Grief
According to the Centers for Disease Control and Prevention (CDC), prolonged grief is more likely to occur when:
- The person who passed was especially close, such as a child or romantic partner
- The death was especially sudden or violent, as with:
- The deceased was a minor
- The aggrieved person is isolated or does not have a strong support system
- The person is experiencing other hardships or stressors
- The surviving party already had a mental illness, such as depression, PTSD, or separation anxiety
The Dangers of Prolonged Grief
If prolonged grief goes untreated, the person is at heightened risk for:
- Substance abuse
- Suicidal thoughts
- Sleep difficulties
- Compromised immune system
Mental Health America (MHA) recommends a number of ways that any person experiencing grief can seek out help to get through the difficulty of losing a loved one:
- Seek out people who will show compassion
- Ask other friends and family members to share their memories with you via email, letters, or text
- Express the feelings you’re experiencing
- Pay attention to your physical health needs
- Recognize that the person who passed would not want you to let life pass you by
- Put off big life changes until you have had a chance to process the loss
- Seek out professional help if needed
Helping Someone Manage Their Grief
It can be very difficult to know what to say or do when someone is suffering from the loss of someone they held dear. MHA recommends the following ideas:
- Share in their pain – Encourage them to talk about their friend or family member who passed. Ask about the things that made that person unique and loveable.
- Don’t offer words of comfort that aren’t comforting– Saying that the person is in a better place, that the death was for the best, or that the grieving person will move on in time are often not particularly comforting or even accurate.
- Be practical about helping – Cooking a meal, dropping off some groceries, driving a child to activities, or helping to write thank-you notes can mean a lot.
- Give the person time – Everyone is different in how long they need to process the loss. Don’t get impatient and expect the person to get over their pain quickly.
- Help them get professional help – If the person’s symptoms meet the criteria listed above, they may need help connecting with a mental health professional.
Grief in Children and Adolescents
It is important to understand that children and adolescents may grieve differently because:
- They may be more confused by deaths and not truly understand what is happening
- It can impact their sense of security more deeply
- They may have limited ability to express their grief
Grief may trigger behaviors in children that can seem off-putting to adults who do not understand the situation. Some children may, for example, revert to bed-wetting or other regressive behaviors. Some may bring scenes of death and dying into their play. And some children or teens may ask questions that seem insensitive or may pretend the death never happened.
If you are concerned that someone you know is having an especially hard time coping with the death of a loved one, it is better to reach out for professional support now instead of waiting to see if they will get through it on their own. Highland Hospital can help you and your loved one determine the best course of action to move toward healing.