Bereavement process, when to see a specialist

Grief is a natural response of people to a major loss. The most common example is after the death of a loved one. But, we also talk about it when what is lost is a cherished object, a pet, a vital function such as the amputation of a hand, or simply a dream or life project.

All cultures recognize grief, but it manifests itself very differently in each individual even within the same culture or in the same case of loss. Much depends on the personality of the individual, his or her education, the tolerance of the family-cultural environment to emotional pain and the depth of internalization of the lost object. It also depends on the type of loss, i.e., if it is sudden it carries more risk of grief than if it is an expected death, such as after a long illness.

In spite of the peculiarity of each case, among specialists in Psychiatry there is a certain agreement to be able to differentiate a case of “normal” bereavement from a more complicated one or from a depression. It is estimated that 10% of cases may develop into severe depression with melancholic features. There are risk factors such as lack of social or family support to share it or when the person has a history of depression or anxiety. Not allowing oneself to go through a “normal” grieving process is also detrimental. Some patients flee into a protracted state of denial in which they engage in many work activities or begin to use toxic substances such as alcohol or drugs.

The grieving process

Mourning is a process of adaptation to the loss and, as such, goes through different stages.

  • State of emotional shock: The patient feels disbelief and discredit, in addition to denying what has happened.
  • Depressive state: It can last up to three months. The person enters a state of depression, sadness and longing for the loved one. This state is known as the mourning period and is characterized by recurrent thoughts of the lost ones, feelings of guilt of not having been able to do more or not having been in some way able to prevent the loss of the person. During this state there may be temporary disturbances of sleep, appetite or vital energy. Sometimes thoughts of suicide may appear, but not as a desire to destroy oneself, but as a desire to be united with the dead person.
  • State of acceptance of what has happened. The person resumes the activity of his or her usual life as it was before the loss. However, one can suffer small relapses when remembering the person missed, but these will be spaced out in time and intensity.
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When to see a specialist in Psychiatry

There are several symptoms and warning signs that indicate that you should contact a specialist in Psychiatry. These are:

  • The phase of sadness and depression is accompanied by a lack of functioning in the social and work environment. Also, if this phase is prolonged beyond three months.
  • The person only remembers the best of the person he/she has lost, without being able to be equanimous in the memory.
  • The neurovegetative symptoms of sleep, appetite and vital energy are distorted and prolonged for more than three months.
  • Self-esteem is affected and self-confidence is lost.
  • When mood swings occur in which the individual feels better at night than during the day.
  • If suicidal ideas persist and are accompanied by concrete gestures or plans.
  • The affected person enters a state of alienation or excessive guilt and reveals having delusional ideas.
  • If the person has recurrent obsessive thoughts about the loss suffered, his sadness and depression without being able to concentrate on anything else.

Psychiatric treatment of grief

When a complicated case occurs, a differential diagnosis must be made, assessing the existence or not of the consumption of toxic substances that may alter the picture.

Treatment includes addressing all the signs mentioned above. Support therapy, either individual or group, is essential. On the other hand, psychotropic drugs, mainly antidepressants and anxiolytics, should always be used under medical prescription and guaranteeing the patient’s safety.