At what point does bereavement begin in chronic illness?
In chronic illness, bereavement begins when the person begins to come into contact with his or her pain and as a result of ‘something that has been lost’. It begins, on the one hand, when the circumstances offer the person with chronic illness the possibility of beginning this process and, on the other hand, when he/she is able to recognize and come into contact with the losses generated by the illness.
The process can present quite peculiar nuances. Mourning is a natural process that the human being experiences as a consequence of a loss, whether it is a material or immaterial loss, the death of a loved one, a change in lifestyle, the loss of a job and other types of losses.
In the case of chronic disease, and more so if it is a degenerative disease, the person suffering from such a disease, even before being diagnosed, may have symptoms that alert him to a change in his state of health and thus he may become aware of his progressive losses. When this is the case, you realize that you can no longer do something that you could do before, but you do not yet know why.
This is an inexplicable suffering that does not make it possible to process the loss because in fact everything is still incomprehensible and rather gives rise to a series of questions that do not end up having answers, activating emotional processes that can influence the psychological well-being of the person him/herself and his/her family and friends.
Another moment in which the grieving process can be activated is when a diagnosis of an illness is received. In fact, both before and after the diagnosis, a person may not start the mourning process, consciously or unconsciously, because he/she may deny what he/she is experiencing, as a mechanism to protect him/herself or other loved ones. How many times have we heard people say “no, this is not possible…” or “this cannot be”? This is a natural response that tends to deny what has just happened, to protect ourselves from pain.
It can occur when a loved one dies, when we perceive a great injustice that deprives us of something or someone. It can be a recurrent thought for a long time during the mourning process and can end up having consequences for our health.
In the case of chronic illness something similar can occur. The diagnosed person often asks for a second opinion from another professional, gets information through social networks, or from other people they know. In other words, they are going through a state of shock and the first thing they end up thinking is “it can’t be that this is happening to me”.
Who suffers from bereavement?
Every person who suffers from a chronic disease ends up activating a mourning process for what he or she loses, not only in terms of health but also in terms of changes in lifestyle, of course, more or less shocking depending on the type of disease diagnosed. In people diagnosed with chronic and degenerative diseases, grief assumes peculiar aspects due to progressive losses that imply a continuous reactivation of the process. These processes have an impact not only on the sick person but also on family members and friends who have to deal with a new situation. In some cases also in co-workers when a person can continue to work, but with the need for some kind of adaptation in the workplace.
How can one have a positive attitude in a situation of grief?
In the situation of a loss and grief it is advisable and useful for the physical, emotional and psychological health of the person, to have a type of attitude that takes into account the reality and at the same time the emotional state in which we find ourselves.
We often hear words like “you have to fight… you have to win this battle”, all advice and wishes that are lovingly given to us by the people who love us the most. It is natural for our loved ones to worry about us, what is sometimes overlooked is that it is not always about doing something. Following a diagnosis, as a consequence of the progression of the disease, it is also important to get in touch with one’s own emotions, to recognize and accept them as they are, without judging them, without judging ourselves for the fact that we feel this way.
A useful attitude is to feel what is happening to us, to recognize it, and little by little we are able to take action and then take those steps to accept reality and adapt to new situations. It is very important to remember something that we often misinterpret, the process of acceptance of “what is” has nothing to do with resignation.
This concept is fundamental to have, each person in his or her own time and in his or her own way, a proactive attitude that allows us to perceive ourselves as living human beings, beyond the disease.
It is an attitude that provides us with a much broader vision through which we can realize how many resources we have and how many we still have to discover, to add a certain quality of life always compatible with the reality that we have to live. That is to say, to accept is not to be a loser, it is not to resign oneself, rather it is a process that can lead us to have a useful and constructive attitude, that can offer us a series of opportunities to live as better as possible with ourselves and with the people with whom we want to continue sharing time and a quality life.
Can grief cause depression and can it be prevented?
Every grief process involves more or less complex emotional work depending on the type of loss we have suffered. The process can be more or less bearable depending on personal resources, the support network we have, our capacity for resilience and the possibility of taking the appropriate steps to carry out the tasks involved in each grief process. To all this, we must add many external factors, economic, relational, life experiences. When these resources do not exist then it is possible that from a depressed state of mind a mood disorder can develop, that which we call depression.
It is true that there are people who are more predisposed to develop depression and others less so. As we have said, it depends on different factors, and of course in some circumstances it will be necessary to go to a professional to accompany us during a process that allows us to improve our mental and emotional health condition and avoid depressive states that would lead to situations that no one wants.
In the case of people with chronic disease, and even more so if it is a degenerative disease, research confirms that the rate of people who end up suffering from depression is higher than in people without such a diagnosis.
What advice would you give to a person with a chronic illness, and to their family/friends?
It is very important that the person with a chronic illness does not let his or her days be conditioned by the illness. It is useful to remember that before being people ‘with’ a chronic or degenerative disease we are people with an identity, with our past history, with a present, with desires, interests and projects. The disease, in spite of conditioning our life, health or activities, is only one element among many others and does not define who we are, but rather reminds us of what is happening to us.
Keeping this in mind is also a help for the people who take care of us, whether they are family members or not, and for our friends. In some situations these people are so concerned about our well-being that they sometimes go overboard in their care, unwittingly forgetting the importance of the autonomy of the person being cared for, their will, their needs, their freedom to feel happy, sad and to experience emotions and experiences as they wish. It is necessary to let the person feel entitled to ask for help when he/she wants it. In this way we will achieve two objectives. On the one hand, the person with the disease will feel freer and more autonomous, and on the other hand, the family member or caregiver will reduce his or her burden and will be able to better regulate the stress generated by the burden of caregiving.
How can a psychologist help to overcome grief?
Those who suffer from a chronic illness can cope resiliently with the difficulties that arise daily in their personal, relational and professional lives. I would like to remind you that resilience is the ability to know how to respond with one’s own resources to the adversities that arise in certain circumstances. It is an ability that is developed from a very young age and can be acquired gradually throughout life. When the person feels overwhelmed by the difficulties and therefore ends up suffering a high emotional load with a high level of stress or they realize that they begin to have negative thoughts or conflicts with loved ones, friends and people, then it can be very useful to ask for help from a specialized professional who can accompany them in the search for solutions and in the development of skills that allow them to make their daily situation more bearable or even deal with possible disorders. It is advisable to be very aware of one’s own difficulties and limitations and to prevent problems of any kind that could have been avoided (emotional or even behavioral). Prevention is better than cure.
Family members can deal efficiently with the difficulties that arise on a daily basis, but they may also need resources to manage problematic and conflictive relationships, which is why it is advisable to ask for help from a psychology professional specialized in these issues. In the case of requesting help, this can be provided individually or jointly, intervening in the relational dynamics and in the whole family nucleus.
In conclusion, in the chronic disease and more in that degenerative one there are some factors that can add certain individual and collective discomfort to the one already provided by the same disease. Being able to process grief by managing all the emotional aspects that the process entails, dealing with perceived or real loneliness, recognizing and accepting the losses that this new reality presents, is undoubtedly a necessary condition to be able to build a present and a future with better quality and more satisfactory and enriching human relationships. Both the person diagnosed with a chronic disease and his or her family, as a result of the diagnosis, need resources to begin to ‘write a new script’ and to start assembling a new movie for their future life. It is therefore very important to make this movie the one we really want and that it can once again have the colors and frames that allow us to live intensely and with the maximum possible wellbeing.