Grief

Although the death toll from AIDS in our community has been less staggering in the last few years, it remains a sad reality. Possibly, because of the drug cocktail and the focus of "living with AIDS, we tend to forget that people are still dying from the disease.

In addition to AIDS, Gay people and our loved ones die of all the same causes that afflict all people. When we do, we leave behind mourners, just like straight folks do. Unlike straight people, however, we often lack the support systems they have and are too often left to grieve alone. Our friends have become weary of grief and sometimes seem to be disinterested in our plight. I think it is important to remind ourselves about what the loss of a loved one means and how we may feel and cope when we are confronted with that reality.

Regardless of who we lose (lover, friend, parent or sibling) or the cause of death, certain truths are universal. In this short essay I have attempted to outline the stages of grief. They may vary in duration and intensity but from personal experience and observation I am confident that the mourner will experience them all. I present this in the hope that it may help those who are suffering and those who love them.

STAGES OF GRIEF

GRIEF AND MOURNING
The death of someone close to us throws us into a sea of chaotic feelings. Sometimes the waves of emotions seem powerful enough to threaten our very survival; sometimes they feel relentless and never ending. Sometimes they quiet down, only to arise months or even years later when we least expect them.

Grief is not something we ever really "get over" - our loss remains a fact for a lifetime. Nothing about grief's journey is simple; there is no tidy progression of stages and its course is long and circular.

While there is no clear road map, there are some features common to almost everyone's experience. Some of the dimensions presented below may be dealt with in a matter of hours or days. Others take weeks or months to work through. Grief is a natural healing process, requiring time, attention, hard work and lots of loving care.

SHOCK AND SURPRISE
Even if death is expected, you may feel numb or anesthetized. Your actions may be mechanical and you may get things done. For example: Handle all the funeral details but you are not "all there". People around you may be saying "isn't he strong?" or "She's handling this so well." The impact of reality of the death has not fully reached you. This period of shock is a way your psyche has of protecting you, allowing reality in slowly. If the loss is sudden, unexpected or violent, the period of numbness may be longer.

EMOTIONAL RELEASE
The period of shock has worn off and without this cushion, reality can be acutely painful. As the impact gradually dawns on you, conflict may arise about whether to show grief or not to show it. How much and for how long? You might try to keep up a good front or remain strong, even though you may feel like crying or screaming. If people are praising you for being so brave and not "falling apart", do you dare show them how you really feel? This is a time when emotional release is important and should be encouraged. Concealing painful feelings may prolong the grief process and increase physical and emotional distress. At this point, other measures can help support your expression of grief.

LONELINESS
Sometimes even before the funeral, the third stage of loneliness,isolation and depression begins. The funeral is the focus for realizing that your loved one is really gone. Family and friends can be helpful and consoling, but after the funeral the prevailing attitude is "it's all over." The supportive people in your life may disappear. After the funeral, you may suffer a second major loss - everyday contact with your loved one. This might mean no home cooked meals, coming home to an empty house, no welcome home greeting, or going to the grocery store alone. Even if your loved one has been sick for a long time, you no longer have hospital visits to make. Your entire routine of daily living has been shattered. You are alone, suddenly overcome by an utter sense of depression and despair. It is important at this point to have people in your life who can validate the magnitude of your loss.

PHYSICAL DISTRESS WITH ANXIETY
Questions that may come up for you at this time include: What am I going to do? What's going to happen to me? How can I get along without him? Will I lose my friends? If you, too, are HIV+ you may develop the same type of physical symptoms your loved one had. Anxiety and stress may bring with it such physical symptoms as muscle weakness, shortness of breath, insomnia, headaches, backaches or an upset stomach. During the entire grief process, you need to take especially good care of your body. You are vulnerable and may need a lot more rest and you may want to see your physician for a physical examination.

PANIC AND DISORGANIZATION
You may have trouble concentrating on anything but the loss. You may feel something is wrong with you if you wonder: I can't get these thoughts out of my mind. Won't they ever stop? Sometimes I think I see him. Sometimes I feel his touch. Sometimes I hear his voice. I've got to do something. I can't sleep. I can't eat. All I do is think about him. Will it ever stop hurting? Will I ever stop dreaming about him? As a bereaved person, you need to know this does not mean you are going crazy. This is a normal part of the grieving process.

GUILT
When faced with real or imagined guilt, you may begin asking questions like: What did I do wrong? What if I stayed awake, hadn't gone to work, showed I loved him? These questions indicate guilt, which needs to be brought to the surface and hopefully shared with a non-judgmental listener (or in a diary). Partial or complete interruption of the grieving process at this time can cause severe depression and/or suicide.

HOSTILITY, PROJECTION AND ANGER
In conjunction with or emerging from the feelings of guilt, you may experience hostility. Maybe you are hostile to people whom you perceived contributed to your problem. For example; (To the physician) Why didn't he do something? Why didn't he get there in time? Did he do everything he could? You may be experiencing anger at friends who draw away from you or seem to belittle your loss with well meaning but clumsy remarks. You may be furious with God or fate for taking away your loved one.

SUFFERING IN SILENCE AND DEPRESSION
This is a time when you may suffer in silence. You might feel fatigued, worn out and unable to get started with any activity. Your thought processes are involved with the loss - emptiness and loneliness- but you may no longer want to talk about it. You recognize that others expect you to stop grieving. Tears, anger, frustrations or depression are poorly tolerated by others several weeks after the funeral. Except for the initial loss, this stage is the hardest. YOU, THE BEREAVED PERSON, FEEL ALONE. You may have feelings of "not wanting to go on" and then shock or guilt for having such thoughts. This is a period when you are recreating meaning in your life - and it takes time. Anger is a very normal human emotion and it is important to uncork your bottle and find appropriate ways to release these feelings of "What I'm going through is so unfair!" "Why did it have to happen to him, he was a good person." Talking about it and physical activity both help keep anger from burning inside.

GRADUAL OVERCOMING OF GRIEF
Your adjustment to a new status in life gradually occurs with working through this grief period. There can be noticeable change as early as four weeks to three months, but often it is longer. By the end of this phase, there is considerable brightening of mood, more activity and the beginning of reestablishment with people.

READJUSTMENT TO REALITY
The acute phase is normally completed in three months, but it does vary. Readjustment continues for at least two or three years. Because traditional symbols of grief, such as the black veil or clothing or arm band, are out of style, it is easy for others to forget that you are grieving. You are beginning to restructure your life without your loved one. You may want to take a vacation or get involved with a new activity - or take up old activities you used to like. Occasionally you may feel twinges of guilt as you begin to enjoy yourself or laugh freely again, as though you are somehow betraying the memory of your lost loved one. It is helpful to be aware of guilt feelings that get in the way of readjustment. It is also helpful to recognize that wedding anniversaries, birthdays or the anniversary of the date of death may cause a temporary flood of feelings or may bring back a very short version of the grief process. This is normal and does not mean that you will be in acute pain forever.

RELIEF
Don't be surprised if you feel a sense of relief at some point. This is natural, especially when a disease has been lingering and painful. You aren't a monster, you're a human and much of this emotion is relief that a painful thing is over.

CONCLUSION
Grief is a natural, human experience we all go through. Each grief journey is unique. Reaching out to others for support and being kind to ourselves can help us survive the pain.

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