How to Cope with a Major Loss—Yours, or a Friend’s

Grief is a normal reaction to loss, but if it goes on too long it can be unhealthy. Dr. Saltz tells how to accept the loss and move on with your life. Plus advice on how to help a friend who is struggling with grief.

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Episode Transcript

Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,

(00:27):
hopefully with understanding, insight and advice. Sooner or later in life,
we all have to deal with a loss, So today
I'm answering a question I got from a listener about
a terrible loss. Brief is a normal reaction to a

(00:47):
significant loss. It can be the loss of an important
person in your life or a loss of something else
important to you, like your home or your health. Even
though it is painful, it is also healthy to grieve
in order to accept the loss and move on with

(01:09):
your life. Generally, people go through stages of grieving, but
because the process is so individual, not everyone goes through
all stages or in the same order. The five stages
are denial or disbelief, anger at the loss, bargaining about

(01:35):
the loss like if I am cured of cancer, then
I will stop smoking, intense sadness, and ultimately acceptance of
the loss. The length of time people grieve is extremely variable,
but most people have intense symptoms for at least two

(01:59):
months and gradually lessening symptoms for a year or more.
In the beginning, brief looks a lot like clinical depression.
In fact, you can't always tell the difference, and the
support you need may be very much the same. Talk

(02:23):
to others about how you feel. Distractions at times from
loved ones, taking care of yourself, and staying away from
alcohol and drugs as a means of coping are all
important tools to think about when dealing with grief. But

(02:43):
for some people, grief becomes so unbearably painful and debilitating,
or last so long that they develop what we call
complicated grief. There are no exact heart and fac best rules,
but basically, while normal grief starts to fade and improve,

(03:07):
complicated grief stays the same for more than several months
or even gets worse. The person is debilitated by sadness,
unable to move on with life at all. Either the
intensity of longing for the lost one or thing is overwhelming,

(03:30):
or a numbness is so pervasive that they cannot really
function in their lives. They may socially withdraw from others.
They may feel life isn't worth living and remain profoundly
sad or bitter or angry. Sometimes complicated grief causes the

(03:53):
person to feel guilty, as though they in some way
blame themselves for the loss. That is not a part
of typical, regular grief, but it can be a part
of complicated grief. What we don't know why some people
really get complicated grief. We do know that some situations

(04:16):
put you at greater risk for developing it. An unexpected
loss that is really shocking, a lack of social supports
in your life to help you, a history in your
childhood of trauma or of terrible separation, anxiety, a dependent

(04:37):
relationship with the lost person, an inability to adapt to
life's changes as part of your character of personality, or
a loss of a person to suicide. Complicated grief needs treatment,

(04:59):
the goal to be able to accept the loss, adjust
to the new situation, and become involved in new relationships.
Depending on your specific symptoms, different kinds of treatments can
be useful. Psychotherapy can help with processing the loss and

(05:20):
accepting it, building coping skills to move forward in life
and reach out to others for comfort. Support groups based
on similar losses amongst the group members can help by
being with others who truly feel as you do and
do understand your situation. Sometimes medications are prescribed for symptoms,

(05:46):
such as antidepressants for mood while the loss is real
and the grief is understandable. Medication can still help if
the mood is destructively low. So with this in mind,
let's turn to our listener question and see how can

(06:07):
I help? How can I help? With Doctor Gale Salts
will be back after this short break. Dear doctor Saltz,
A family member recently lost custody of her teenage child.

(06:31):
Since then, she does not want to leave her house
and does not want to interact with the family. Could
the child custody loss have triggered agoraphobia? How should I
talk to her and help her get better? Losing custody
of your child is a traumatic loss or a parent.

(06:55):
Even if medically, practically, and or legally it is deemed
better for the child, it can still be totally devastating
for the parent and sometimes also for the child, which
only adds to the parents grief at the loss. A

(07:16):
loss of custody is not only no longer having your
child with you, it is also an indictment of your parenting,
and it can rob a mother, for example, of her
own identity as mother, and this loss of identity can
be a terrible loss in and of itself. In addition

(07:39):
to actually losing the presence of your child. It is
therefore expectable that your family member would be grieving the
loss of this child. As I mentioned, grief can look
like and present like a clinical depression, and one of
the symptoms of a clinical major depression is a withdrawal

(08:03):
from the world, not wanting to engage socially with others, friends,
or family. Other symptoms of depression can include loss of
energy and overall fatigue, making the affected person feel like
lying in bed all day. Part of this may also

(08:29):
be something called and hardonia, a loss of the ability
to take pleasure in anything at all, including things you
used to find pleasurable. Grief can even present with a
good amount of anxiety, increased fears about all kinds of things,

(08:51):
and a desire therefore to just stay inside, close to home,
be in bed. Unfortunately, as you're alluding to, none of
this is healthy, nor does it help the person to
get better to improve their mood. Agoraphobia, however, is literally

(09:16):
an irrational fear of open spaces, and it most often
presents after struggling for some time with panic attacks. The
fear becomes that I might have a panic attack when
I am away from home, and what will I do then,
And the terror of that propels the person to stay home,

(09:37):
and over time it becomes a fear of leaving home
at all. It's true that a trauma, even a trauma
like this, can cause various mental health problems to erupt,
even something like panic disorder and agoraphobia, but this would
be a much more unusual situation. It is much more

(10:01):
likely that the desire to not leave home following a
traumatic loss is the various symptoms of grief and depression
that cause the person to feel so sad, hopeless, helpless,
low energy that they don't want to interact with anyone
or leave home. A person who is extremely depressed with

(10:26):
grief needs to be listened to, to be understood, to
have their feelings validated, and to not be left alone
all the time, to just ebb away and disappear. That
can be hard to do when this person doesn't want
to come out, but sometimes it means you coming to them.

(10:50):
It is also important to voice understanding that you do
understand it is difficult for them to engage, that perhaps
they need help and you do want to help, trying
to get them to at least just sit outside with
you for thirty minutes, or take a walk in the woods,

(11:12):
or meet up with a few of you for a
brief dinner. You might need to call up, you might
need to go over and walk them out. Literally go
over there, pick her up, and expect that sometimes she
may just do some canceling, particularly if she's in a

(11:32):
bad place that day. Have patience and know that it
does take time to grieve a loss, but that you
aren't going to leave her. Part of the grief can
be a fear that others will leave you too, so
reach out and let her know you're not going anywhere.

(11:53):
It's more important to listen and be understanding then to
try to convince a person and that they'll get over it,
or that it's not that big a loss. It is,
on the other hand, very tempting to do this, really
because you care about them and you just want them
to feel better, but this usually just makes them feel

(12:19):
that no one understands and makes them feel more isolated
and alone, which makes them withdraw further and feel worse.
So you don't have to solve their sadness or grief.
Just listening, being empathic and understanding, while still encouraging them

(12:40):
to talk to you, to get out a little bit,
to do anything is helpful. Just as important is that
if you hear they are voicing that their life doesn't
feel worth living, that they wish they were gone, or
if their inability to function causing them to lose more

(13:01):
things such as their job, other important relationships, their health,
then help this person to make an appointment with a
psychiatrist or a psychologist for an evaluation and treatment. As
I said, complicated grief where the person is very symptomatic

(13:22):
and can't function, really does require treatment. It may not
resolve on its own, and the affected person usually needs
help securing someone to treat them. They may not be
able to even manage that themselves, so help them make calls,
maybe even drive them to an appointment. I hope that

(13:46):
was helpful in the meantime. For all grieving, there are
steps you can take to help yourself. Exercise, particularly aerobic exercise,
helps really eve depression. Getting good sleep and avoiding alcohol
and drugs is very important towards fighting depression, as well

(14:08):
as avoiding a future problem of substance abuse, which sadly
many people fall into while struggling with grief. They're trying
to numb their problem and they start drinking more and more,
and now they have grief and they have alcohol abuse.
So it's important to try to not overdo it. Staying

(14:31):
connected to family, friends, and religious supports can make one
of the biggest differences in the dealing with grief. The
first year is the most important, and this is especially
true for each holiday or special day that reminds you
of the one you lost or the thing you lost.

(14:55):
So plan ahead for these days to acknowledge the relationship
up in a way that feels comfortable, but also to
be with others for support. Do you have a problem
I can help with? If so, email me yet how
can I help? At Seneca women dot Com. All centers

(15:18):
remain anonymous and listen every Friday to how can I
help with me? Dr Gail's Salts