over life or destiny.” He or she searches for answers
to why the trauma occurred. The goal of the search is
to give meaning and purpose to the loss. The nurse
might hear the following questions:
- “Why did this have to happen? He took such
good care of himself!” - “Why did such a young person have to die?”
- “He was such a good person! Why did this
happen to him?”
Questioning may help the person accept the re-
ality of why someone died. For example, perhaps the
death is related to the person’s health practices—
maybe he did not take good care of himself and have
regular check-ups. Or it may include realizing that
loss and death are realities that all must face one
day. Others may discover explanations and meaning
and even gain comfort from a religious or spiritual per-
spective such as believing that the dead person is with
God and at peace (Davis & Nolen-Hoeksema, 2001).
ATTEMPTING TO KEEP THE LOST
ONE PRESENT
Belief in an afterlife and the idea that the lost one has
become a personal guide are cognitive responses that
serve to keep the lost one present. Carrying on an
internal dialogue with the loved one while doing an
activity is an example: “John, I wonder what you
would do in this situation. I wish you were here to
show me. Let’s see, I think you would probably... .”
This method of keeping the lost one present helps
soften the effects of the loss while assimilating its
reality.
Emotional Responses to Grief
Anger, sadness, and anxiety are the predominant
emotional responses to loss. The grieving person may
direct anger and resentment toward the dead person
and his or her health practices, family members, or
health care providers or institutions. Common re-
actions the nurse might hear are as follows:
- “He should have stopped smoking years ago.”
- “If you had taken her to the doctor earlier,
this might not have happened.” - “It took you too long to diagnose his illness.”
Guilt over things not done or said in the lost
relationship is another painful emotion. Feelings of
hatred and revenge are common when death has re-
sulted from extreme circumstances such as suicide,
murder, or war (Zisook & Downs, 2000). In a study
to assess short-term grief responses after elective
abortion, Williams (2001) noted that some women
experience feelings of loss of control, death anxiety,
and dependency as well as feelings of despair and
anger.
Emotional responses are evident in all phases of
Bowlby’s grief process. During the phase of numb-
ing,the common first response to the news of a loss is
to be stunned, as though not perceiving reality. Emo-
tions vacillate in frequency and intensity. Contrasting
emotions are common such as experiencing an impul-
sive outburst of anger toward the deceased, oneself, or
others at one moment then feeling unexpected elation
at a sense of union with the deceased (Bowlby, 1980).
The person may function automatically in a state of
calm then suddenly become overwhelmed with panic.
In the Clinical Vignette, Margaret discusses having
felt “ a numbness” while going through routine func-
tions immediately after her husband’s death then
one day finding herself in a department store over-
whelmed with frustration and wanting to shout,
“Doesn’t anyone realize I’ve just lost my husband?”
In the second phase of yearning and search-
ing,reality begins to set in. The grieving person ex-
hibits anger, profound sorrow, and crying. He or she
often reverts to the attachment behaviors of child-
hood by acting similar to a child who loses his or her
mother in a store or park. The grieving person may
express irritability, bitterness, and hostility toward
clergy, medical providers, relatives, comforters, and
even the dead person. The hopeless yet intense desire
to restore the bond with the lost person compels the
bereaved to search for and recover him or her. The
grieving person interprets sounds, sights, and smells
associated with the lost one as signs of the deceased’s
presence, which may intermittently provide comfort
and ignite hope for a reunion. For example, the ring of
the telephone at a time in the day when the deceased
regularly called will trigger the excitement of hear-
ing his or her voice. Or the scent of the deceased’s
perfume will spur her late husband to scan the room
for her smiling face. As hopes for the lost one’s return
diminish, sadness and loneliness become constant.
In the vignette, Margaret became angry with her
husband for not having his physical examination
sooner and upset with friends who seemed to dis-
appear after James became critically ill. Such emo-
tional tumult may last several months and seems
necessary for the person to begin to acknowledge the
true permanence of the loss.
During the phase of disorganization and de-
spair,the bereaved person begins to understand the
loss’s permanence. He or she recognizes that pat-
terns of thinking, feeling, and acting attached to life
with the deceased must change. As the person relin-
quishes all hope of recovering the lost one, he or she
inevitably experiences moments of depression, apa-
thy, or despair. Night is a time of acute loneliness
during this phase.
In the final phase of reorganization,the be-
reaved person begins to re-establish a sense of per-244 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS