What does healthy grieving look like?

Society has changed over the generations, including how long we live and how we experience death and dying. Health care has advanced. Maternal and childhood mortality rates have decreased.

At the same time, the dying process is often moved into hospitals and nursing facilities. This means that most of us have less experience with death and dying than our ancestors had. But eventually, we will all lose loved ones, and it can be difficult to find our bearings and navigate that unfamiliar territory of death and grief.

As a physician, I observe this process from a unique vantage point. I try to keep all my patients healthy, but no one will live forever, and when the inevitable is near, my role is to help patients and their families prepare for the end of life. Each situation is always unique. Some people are able to move through loss and bereavement more readily and fully than others. Some get stuck in a cycle of sadness and anguish.

Grief is traumatic. We never want to lose a loved one. The stress and mental anguish can be overwhelming. Most people eventually find their way through the stages of grief, but sometimes they need help navigating, understanding and expressing those feelings. Grief can take a huge toll on our mental health and even bleed into our physical health. Grief can cause depression, disrupt sleep, and affect cognition. It can weaken the immune system, spike blood pressure and skyrocket blood sugar. It can even trigger bad habits, like excessive alcohol consumption.

Fortunately, we have insights into how people process bereavement and how to move through the stages of grief in a healthy way. Psychiatrist Elisabeth Kubler-Ross studied the grieving process and found five common stages: denial, anger, bargaining, depression and acceptance.

Denial can be a way to shield oneself from overwhelming emotions by ignoring a health prognosis or avoiding thoughts of a loved one’s passing. Anger can be a way to release emotion by directing it outward toward a disease or a fatal accident. Bargaining comes when we realize we are powerless to change the reality of a situation and plead with a higher power to intervene. Depression comes when we dwell on what has been lost and struggle to see how life can be good again. Finally, acceptance is not about moving on but about accepting the reality of our changed situation and making a way forward while still cherishing the memory of one who has passed.

People may enter these stages of the grieving process before losing a loved one, such as in the case of a terminal disease. They may enter the phases out of order or spend long periods of time in one phase and relatively short times in another, but many people will experience these stages to one degree or another. Recognizing the stages of grief can help us navigate the grieving process, but talking through these feelings can help us to more fully process the myriad emotions they entail.

Talking is critical to healthy grieving because it puts into words our thoughts and feelings on a subject. Sometimes we don’t fully realize how we have been feeling or what we have been thinking until we begin to put it into words.

I remember in college, a teammate died after being struck by a bus on the way home from practice. When the team and other students gathered that evening, it was impossible to know what to say. We simply could not wrap our minds around what had happened. Our coach invited us all to share memories and stories of the man who had passed, and he started by reading an old email. Our teammate’s roommate shared about his poor taste in action heroes. Sharing stories is more than a way to keep memories alive. It can be a way to take stock of a chapter in our lives that has closed.

Many people turn to a trusted friend or family member in whom they can confide. This can be a good first step. Others find it easier to talk with someone who is separated from that part of their life. In these cases, a facilitated bereavement group can be a good option. Still, others find it difficult to have a conversation about something so painful, no matter with whom they are speaking, and prefer to write their thoughts and emotions in a journal before they are ready to speak them out loud.

Talking with a credentialed grief counselor is a wise next step after losing a loved one. Seeking medical help seems obvious after a physical injury. After breaking a bone, you might see an orthopedic surgeon and then work with a physical therapist. Losing a loved one is a less tangible kind of injury, but in many ways, it can be more painful, and healing after this kind of injury is just as important. Grief counseling helps us to better understand the grieving process. It helps us express and understand our feelings. It can help us to build a new relationship with the memory of the person who has passed. It can also help us to rebuild our sense of identity when much of that identity was tied to someone who is no longer with us. Grief counseling doesn’t mean we won’t have an emotional scar, but it can help us to heal more fully.

When I talk with my patients about the end of life, the most common thing I hear is concern for those they will leave behind. They want their friends and family to remember them, of course, but they also want their loved ones to continue leading rich and rewarding lives. Putting our thoughts and emotions into words is a way to bring those thoughts and emotions to the surface and do the difficult work of processing them to move forward.

Grieving isn’t about getting over or moving past a loss. Even if we could, we wouldn’t want to forget those we have lost. Healthy grieving is about carrying forward the memories of our loved ones and acknowledging how they have shaped us into the people we are today while leading the lives they wanted for us.

Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale. He lives in Bremerton.