When Grief Gets Physical

Trail in Garner State Park 2016

Most people see grief as an emotional response to a loss.  We expect to see grieving people weeping or sitting in stunned silence.  Grief is an internal response to a significant loss, and, as such, it does involve a wide range of emotions.  However, it also includes thoughts and ideas that invade out inner conversation and has a profound effect on our body and physical health. While we are most often attentive to the effects of grief on our soul and our mind, we are less likely to appreciate the toll it takes on our physical well-being.

Grief is a form of stress.  It is the result of an unwelcome change to a significant relationship.   It forces us to deal with a big hole in our lives.  This causes us to either deal with it or avoid it. This the classic fight or flight response.  When this occurs, our body prepares itself to either fight off the threat or do out best to escape it. 

In the next few pages, I will explore how our physical lives respond to grief.  I will then explore ways to deal with the effects that flow out of the “Fight or Flight” response in our day to day living in the world.

What Is Physical Stress?

Stress is commonly understood as the preparations that our lives make when we experience a threat.  These physical preparations include getting the body ready to fight off the threat.  Blood is redistributed to our large muscles and heart to supply them with the oxygen and carry away any waste products like carbon dioxide.  This ensures that the heart and large muscles have what they need.  Our stomach and intestines slow down since they are not a priority at the moment. The brain becomes very sensitive to information from our senses as it probes the world around us for signs of the threat.  The immune system becomes less active.  Our heart rate goes up and our lungs take in more air to build up the oxygen in our blood.  The liver prepares to pump out glucose to power our brain and muscles.  The increased blood pressure puts a strain on our kidneys by forcing them to hold on to or replace fluid in the blood.

These preparations are very “expensive.”  They cause wear and tear on the organs and blood vessels.  They use up our body’s resources.  They are designed for a short-term response to an acute threat to our well-being.  Once the body is out of danger, the body will begin to repair the damage and replenish the resources.  But, if the threat level remains high, the body will have limited opportunities to repair and replenish.

Chronic stress has been linked to cancer due to depressed immunity.  It is also a major factor in cardiovascular disease.  It is suspected as a major cause of Type 2 Diabetes and non-alcoholic cirrhosis (fatty liver disease.)  Stress plays a major role in strokes and aneurysms due to high blood pressure.  It is also a factor in kidney disease and renal failure.  It can cause ulcers and a number of gastrointestinal disorders.  In short, chronic stress plays havoc with our physical well-being.  Complicated, or extended, grief will shorten our lives.  Grief can break not only your heart, but also your liver, kidneys, lungs, brain, and every other organ in your body.

How Do I Physically Experience My Grief?

Grief is most commonly felt as a deep weariness.  We feel physically tired.  This is the cost of simply coping with all the changes.  We are struggling to stay mentally alert and we become tired.  But it may also be a side-effect of poor eating or sleeping habits as well as not getting enough physical exercise.  Grief wears us down.  Unfortunately, rather than taking a break, we keep on going.  We may focus on taking care of others or dealing with the day to day details of mourning, like the funeral or estate.  In short, we become tired and stay that way until our body forces us to get rest through illness or exhaustion.

A second common way we are physically affected by grief is by self-medicating in order to cope with the rollercoaster of emotions.  We may take prescription drugs that we have around the house, or that we have received through a “helpful” medical professional.  More commonly, we will use alcohol or other more readily available drugs to try and numb the pain.  Some folks will turn to comfort food that is high in fat and carbs to cover up the pain.  A third and less common way is through extraordinary exercise, the Forrest Gump response, that releases the natural morphine produced in our body.  This adds the risk of strained and sore muscles to the mix.  Medicating for grief is not bad as long as it is done under the advice of a doctor.  The issue is not the “medicating” part of the phrase, but with the “self-“ part.

Another common physical effect of grief is the change that can occur in our body’s clock.  Our normal rhythms of activity and rest are disrupted.  Jet lag, rotating shift work, and “pulling an all-nighter” will have short-term effects on our physical well-being.  But grief can cause a sleeplessness that changes the way we spend our daylight hours.  Our body chemistry changes which may alter our food cravings.  Routines, like positive habits, help us get through our day so that we can focus on other things.  Once we lose our routines, we become lost in our everyday lives and find that we have to think about the simplest things like eating, paying bills. or taking medications.  We may let these daily chores slide because we are so tired.

Another aspect of physical grief may occur as tension induces aches and pains.  Exercising when under tension can make our leg and shoulder muscles very tired.  Clenching our jaw can cause headaches and possibly jaw pain, TMD.  Tension in our shoulders and chest can cause muscle pain that can mimic a heart attack.  It can exacerbate neuropathy in the hands and feet and Restless Leg Syndrome.  Tension can reduce the functioning of our stomach and intestines causing heartburn, ulcers, and diarrhea or constipation.  It can also reduce the effectiveness of the kidneys.

A more subtle way that grief changes the performance of our body is in our perception of the world.  It can literally change the way we “see” the world.  This is not simply our interpretation of what we see, though it can affect that as well.  It can change the way we perceive color and motion and even shape.  This effect is well known to people who interview witnesses after a traumatic even.  An eye witness is not usually very reliable.  They are known for filling in the details that they feel they should remember.  These gaps in detail are generally caused by the stress.  Stress causes us to focus on what matters most to us.  When we lose someone important to us, we focus on what we have lost and disregard a lot of other stuff.   It is not just our interpretation.  We did not see that “other stuff.”   Further, we may feel pain more profoundly.  We may be distracted by a favorite song on the radio and not even see the stop sign in front of us.  Food may no longer taste the same.  Our sense of smell may become more or less sensitive, especially when it is associated with our loved one.  We do not merely interpret the sensation of the world differently, we are likely perceiving it on a whole new way.

Another effect of grief, especially complicated grief, is a lowered immunity.  This is even more common in seniors.  The older we get the less we are able to keep our immunity up during times of stress.  Every hospice worker has seen the surviving spouse who, following the death of the patient, begins to decline.  The decline is often related to pneumonia or some other infection due to decreased immunity.  I have often worked with bereaved who had to battle their own round of infections after the initial shock of the loss begins to abate.  The changes in blood chemistry and the physical functioning of bone marrow and the liver and pancreas can change our bodies ability to ward off infections.  Long-term grief increases the likelihood that we will face a significant illness.

These are the major threats that grief can bring to our body.  But there are several others that are very common and can have a significant effect on our physical health. 

·      Change in diet – paying less attention to the quality and quantity of what we eat can lead to malnutrition, undernourishment, or obesity.

·      Change in hygiene – Many folks, especially those who have lost their spouse, become less concerned about the hygiene.  They may brush their teeth less often, ignore washing hands, or taking baths/showers.  They may become less attentive to changing their sheets, cleaning the house, or washing dishes.  Each of these carry risks to their physical health.

·      Change in willingness to seek medical or dental care – The bereaved person may no longer find it important to get check-ups, take flu shots, or go to the dentist for routine care.  They may lose any interest in self-care.

·      Change in interaction with family and friends – Some deeply grieving people withdraw from their family and friends.  They increase their isolation and lose the support that can help them move through their grief.

·      Interrupt our financial security – Many grieving people must also face financial insecurity.  They may lose the income from the deceased person.   They may be forced to pay off uninsured medical bills.  They may simply have no idea how to handle the financial details of their household.  This increases the stress and increases all of the risks listed above.

Grief is not simply an emotional response to an unwelcome loss.  It is also a mental and physical response.  The risks and consequences of complicated grief will have a deep and lasting effect on us, body-mind-soul.

What Can We Do?

Identifying the problem is important, we need to be able address it as well.  Each of these physical consequences of grief suggest things that the bereaved can do.  I have neither the space nor the expertise to describe all of these.  However, I will share a few ideas that may be helpful.

For the Grieving Person

Remember T. L. C.

Stay in-Touch with your Body

Listen to your Body

Take Care of your Body

Under normal circumstances, we each carry responsibility for our own well-being.  It is not the professional’s responsibility to keep us healthy.  It is our responsibility to do the things that maintain our health, relying on professionals for assistance and support, when necessary.  Therefore;

·      Stay in-Touch with your physical self.  Get to know and appreciate how your body feels, performs, and responds.  Once you have a baseline of understanding you can begin to see when things happen that may require a response.   Everyone is different.  No one can tell you how your body should feel.  This is something we have to discover on our own, in conjunction with the health professionals around us.  By staying in-Touch with our body, we will know when something needs attention.

·      Listen to your body.  We all have little aches and pains.  We have learned that many of them are just part of who we are.  However, the body has ways of telling us when something is awry.  Pain helps us know that something needs attention.   The loss of visual or aural acuity will also suggest that something is not right.  A new, unexplained bump or lesion on our skin is the body’s way of saying, “Pay attention!”  A change in toilet habits can be a signal that all is not right.  Shortness of breath without exertion or with minimal exertion may be a sign your body is saying, “Get this checked out!”  These signals only work, however, when we listen to them.  If we ignore them, we will pay the price whether we are grieving, or not.

·      Take Care of your body.  Once we have stayed in-Touch, and Listened, we need to take action and actually do something to Care for our body.  Your body is the only one you will get during this lifetime.  There are no body transplants.   See your doctor.  Get the tests done.  Go to the dentist.  Eat right.  Get your rest.  Pay attention to good hygiene.  If something feels wrong, get it checked out.  Take care of your body.  Your life depends on it!

For Those Companioning Someone in Grief

When we are companioning someone who is able to make their own decisions and take responsibility for themselves, our major job is to lovingly hold up a mirror for them and encourage them to be honest with themselves.   

We do them a great disservice when to try and take away their autonomy by telling them what they should do, especially if we have not really spent any time listening to them.  Too often we try and make decisions for them based on our needs rather than their desires.  An adult child has every right to help their parent see the consequence of their parent’s healthcare choices.  They need to have the courage to hold up that mirror so that the parent can see what is happening.  The adult child then needs to have the love that lets go of their desires when the parent has made an informed decision based on their needs and desires.  The same applies to a friend. 

The caregiver may believe that the grieving person may not be seeing clearly.  They may believe the grieving person’s judgment is warped by their pain.  But this does not necessarily mean that they are incapable of making an informed decision.  We each have our own reasons for making our self-care decisions.  The one in grief has the right to place comfort and quality of life over length of life.  As a companion who cares about them, we must give them emotional room and support to make their decision and then walk with them as they live out that decision in everyday life.

However, if we, as a loving companion, believe that our family or friend is not capable to making a decision in their best interest, then we have an obligation to explore this situation.  We may want to talk with other family of friends and check our perceptions.  We may want to raise the issue with the person in a gentle and tentative way.  If our suspicions grow, we may want to talk with the next of kin or people who hold a medical or durable power of attorney and share your suspicions.  As a friend or family member, your role ends when you report this concern.  You should continue supporting your friend, but you are not the one who is responsible for making any further decisions for them. 

If you are the next of kin or medical power of attorney, you may want to have a sit down with your family member and their doctor.  Mental capacity is a very difficult judgment call and must be left in the hands of the medical professionals.  They will be able to assess and declare whether the one in grief has legal capacity or not.  If they do not, then those with the power of attorney become the responsible parties.  It is their responsibility to make decisions for the grieving person in the best interest of the grieving person.

Grief will always have physical consequences.  As a companion to the one in grief, our task is to continue to love and respect them. We are there to walk with them through the shadowed valley.  We are at their side so that we can allay their fears of being abandoned and left alone in their suffering.  And, above all else, we are there to remind them that they continue to be a person worthy of your love and respect.  As you walk with them may you find the strength, the hope, and the love you need to make that journey at their side.

Blessings,

Bob

A Vacation from Grief

There is an old illustration that demonstrates the effects of long-term, unrelieved stress.  Take a full 12 oz. water bottle and hold it in your hand with your arm extended fully to the side.  Easy, right?  Just wait!  The longer you hold the bottle the weaker your arm and shoulders become.  Eventually your arm will shake and the muscle with give out.  You will have to put it down or let it fall. 

Our ability to carry a load in the short-term has very little to do with carrying even the lightest load for the long-term.  We will exhaust our strength and have to let go.  The good news is that if we set the bottle down for a little while, we will recover our strength and can pick it up again.

Many used to believe that this was caused by a build-up of lactic acid in the muscles.  But modern research has shown that this muscle fatigue is due to the muscle becoming more acidic which causes burning and the shakiness.  The acidic build up lessens the ability of the nerves to support the muscle contractions.  The body releases lactose to neutralize the change in pH but this is only temporary.   The only cure is to relax the muscles and let the chemistry return to normal.

This illustration serves as a good example of what happens when we walk through the shadowed valley of grief.  It takes a great deal of energy to cope with the myriad of details, situations, social expectations, and emotions that arise with a loss of someone important to us.  We may not feel the weight of the grief and mourning at first.  (Grief is the internal experience of our loss while mourning is the external expression of our grief.)  In fact, we may find comfort in “taking care of things.”  Staying busy and taking care of ourselves and others occupies a good part of our lives.  But, like the water bottle, this activity does cause us to use energy and we will grow tired.  At first, a nap or a good night’s sleep may be enough for us to get back to our mourning and grief work.  But these may become less and less effective as the days wear on.  We may find that a nap no longer helps as much as it did.  We may try and sleep later in the morning but still wake up and not feel very well rested. 

The grief will continue to cause stress on our body-mind-soul.  The coping will use up our energy and, as our energy supply gets lower, we will find it more difficult to cope with our physical fatigue, our thoughts, and our feelings.  We will either have to “set the bottle down” or risk dropping it all together.

Time for a Little Vacation from Your Grief

How do you set that “water bottle” of grief down?  How about a little vacation from your grief?

In the lingo of bereavement this is called a respite.  But I prefer the word vacation.  Respite means to take a break from.  It looks back at what we are leaving behind.  It feels like we are walking away from our grief and most folks are uncomfortable with that.  They feel that their grief is part of their love for the person they have lost.  By walking away from the grief, we feel that they are walking away from them.  But taking a break is not about our grief and the person we are grieving.  It is all about who we are as one in grief.  It is all about taking care of ourselves for the long-haul so that we can continue to love and cherish our memories of the person we are grieving.

A vacation is defined as a period when we vacate a part of our lives so that we can engage in recreation.  Vacation does not focus on what we are leaving.  Instead, it focuses on what we are recreating?  It is not about what we have lost, but about who we are and who we are becoming on this side of the loss.  Most folks who take a vacation know that they will be returning to their lives.  They will go back to work.  Likewise, we will return to our grief and mourning work.  However, we expect to return with more energy and an improved attitude in our daily lives.  Vacations are all about self-care and the future.  Respite feels a lot like escape from the past.  When the bottle gets too heavy to hold and our lives are feeling shaky, it is time for a vacation.  It is time to set the bottle down and recreate.

What sort of vacation should I take?  Vacations come in all shapes and sizes.  I have taken “staycations” of a few days and month-long trips with the family.  Your circumstances will help you discover the vacation that will best serve your needs.  Here are a few things to consider.

Length of time

There are certainly benefits and disadvantages to long and short vacations.  How long will you need?  It is really hard to say.  The strange thing about grief is that every instance is unique to our present situation.   It is hard to predict.  We learn from taking work vacations that two weeks may be too little or too much.  We may prefer several long weekends to one long week away.  It really depends of our circumstances.   

For a grief vacation, it is advisable to plan for a particular period of time but leave room for cutting or extending it.  It is also a good idea to keep you plans as flexible as possible.  The depth our weariness can make a longer period necessary, but it may also add to the stress you are already carrying.

One of my bereaved folks planned a 10-day cruise with her son and daughter-in-law.  It appeared, up front, to be a perfect trip.  They would be exploring a part of the world they had never seen.  They enjoyed each other’s company and allowed for free time apart from one another.  It was well-planned.  When she returned, I asked her about the trip.  She said it was okay.  But she was not able to enjoy it.  Every mealtime she saw couples her own age enjoying each other, and she could only think about the future that had been taken from her.  She enjoyed being with her son and his wife, but she felt like she was in the way and kept them from enjoying their cruise.  Most of all, she told me that after the fifth day at sea, she woke up and asked herself, “What am I doing here?”  She said that if she could, she would have jumped on a plane and come home.

A cruise may be just the thing for your vacation, but it does lock you in.  You may want to consider a more flexible schedule, especially within the first six months of the loss.  How long?  As long as you need, but not any more than that.  Remember, it is about you and your needs.

Companions

Another question that will arise is “Who should I take with me or should I go alone?” Again, there is no pat answer for this.  It depends on your needs, personality, and family/friends available.

Should I go alone or with someone else?  Most extroverts, folks who are energized by engagement with other people, may find a solo vacation rather difficult.  They will depend on finding people along the way to engage in conversation and share experiences.  Tours and other organized activities can offer this.  But they may be more comfortable having a close family member or trusted friend to share the adventure.

For introverts, folks who find energy in being by themselves, may want to limit the time they engage with others.  For them, a solo vacation may be more helpful.  If you take someone along, you need someone who understands your need for solitude, time to read or simply sit and enjoy the day.  Being solo can make travel more stressful dealing with the details.  A group tour can also be more stressful as you struggle to deal with the extroverts in the group who want to know all about you.  All of this should be considered.

What sort of companions should I choose?  These vacations may include trips or simple days spent exploring your interests close to home.  Regardless, you may want to choose someone to go with you.  Family can be an excellent resource, but they will bring their grief along as well.  This may be more than you can handle.  A close friend may be an excellent choice, especially if you share common interests that you will explore together.

You may want to take a trip with or to your family.  Many times, this offers the added benifit of a change of scenery along with support.  However, you may find it difficult focusing on the future or your present as you help your family deal with their grief.  You may also find yourself having to endure being the recipient of their help for you.

Should grandparents travel with young children, i.e. their grandchildren?  The great advantage of taking grandchildren is that they can give you permission to play.  As a grandparent, just the presence of the children can lift my spirits.  However, the younger the children, the more care they may need.  If this gives you energy, it can be a great experience.  If not, it may be best to give yourself an escape hatch if it does not serve your need for a break.  A final gift that children offer us is to keep us looking to the future, their future!

If you are considering your co-workers as companions for your vacation, you may want to consider these points.  Co-workers can be a great resource for companionship if you are still working.  However, you will want to consider a brief vacation in the break room over a cup of coffee.   Your level of trust must be exceedingly high if you are to invite someone along on a trip or a weekend away.  There are those who prey on the grieving.  They may see them as a source of financial gain, sexual exploitation, or leverage in the workplace.  I believe most workplace companions need to remain in the workplace.  They can be invaluable in that setting.

Activities

“What should I do on my vacation for recreation?”  To recreate suggests that we look at the present and the future and do things that appeal to both.  Travel is only one option and it tends to limit our ability to change our plans and respond to immediate needs.  It does offer a change of scenery and new experiences for the body-mind-soul.  But your vacations should not be limited to travel.

You may want to consider some short-term volunteer work.  This may mean a once-a-week trip to a children’s center, clinic, library, school, or nursing home.  Be careful to avoid placing yourself in the situation that will touch your grief and remind you of your recent loss.  If you took care of your spouse in a nursing home, you may want to avoid volunteering in one for your vacation.  You may do so for other reasons but plan on some other activities for your grief vacation.  Most hospices require a bereaved to go one year following the loss before they can volunteer with a hospice.  Short-term volunteer work can help you look ahead and discover interests and passions for your new life.

Some bereaved may invite their grandchildren to come and stay with them.  This offers the opportunity of being playful and looking ahead as noted above.  It has the added benefit of allowing you to be part of their lives and helping them grow through and understand grief and the importance of family. 

You may also consider having coffee with folks your age on a regular basis.  This is not the same as joining a support group.  This coffee of tea group is simply about companionship and engaging the world without focusing on your grief.  Remember, a vacation is about taking a break.  There are no “busman’s holidays” in grief.

As you ponder what sort of activity you should engage in while taking a break, consider balancing the stress of change in your schedule with the recreating that will be gained.  Length of time, your choice of companions, and the activities all need to be balanced against the cost of stress and the benefit from the relaxation that comes from setting the water bottle down for a while.

How Do I Know it is Time to Come back?

Before moving on to talking with those who are taking care of one who is grieving, I want address one other question.  “How do I know that it is time to come back?”  As with most vacations, we intend on returning to our jobs.  Likewise, with a grief vacation we realize that we will return to the grief work that still remains.  This vacation is temporary.  Further, we may not be able to forecast the optimum length, who, or what before we start our vacation.  We need to be flexible enough to change any of these elements along the way.  How can we know it is time to change the plan? 

Simply put, when we can feel the strength beginning to return to our body-mind-soul, we are ready to start planning our return to our grief.  I can remember when I did the bottle exercise, I was thinking to myself, “When do I pick the bottle back up?”  I discovered that when I no longer dreaded doing so, I could pick it up again. In grief, we will not likely look forward to returning to our grief work.  But we know it must be done. Therefore, we can return from our vacation when we no longer dread the thought.  We may not want to start again, but we are no longer afraid to do so.

Returning to the routine and familiar lives will offer you some comfort.  You will bring a renewed sense of self and the energy it offers.  Your path ahead may still be unpleasant, but you will likely have more energy for coping, an openness to accepting support from those around you, and a new perspective on the things that may be stressing your grief experience.  If, upon returning, none of these things are evident, take another vacation.  It is part of your self-care as you walk the shadowed valley.

A Word to Those Who Support others in Grief

How can the family and friends help those they care about take a vacation from their grief?

The first thing you can do is to give them permission to take a break.  Sometimes our friends and family want to “psychoanalyze” the needs and motives of their grieving family member.  They may label a need to take a break as an avoidance of their grief or responsibilities. They may resent the grieving person’s choice and feel that it is dishonoring the memory of the one who died.  They may simply not see the need for the break and demand that the grieving person keep at their griefwork so that they can get through it and get on with their lives.  None of these are helpful or caring responses.

As family and friends of the grieving, we can best encourage the grieving to set the bottle down for a brief time by reassuring them that it is okay if they feel it would help.

How can you do that?  You can print and give this article to them.  You can offer to help them to sort out the questions raised above.  You can offer to give them a lift to the airport and to take care of their pets while they are gone.  You may offer to take a class with them or help them find that volunteer position.  Offer to help pay for their class or a trip.  Most of all, you can sit and listen to them as they process their needs and possibilities without judgment or throwing in your 2 cents worth unless they insist that they need you input.  The bereaved have taught me over the years that they know what they need to find their way through the shadowed valley.  Most of what we can provide to them is to help them uncover their needs, identifying ways to address them, and permission to do what they realize is necessary and important.  Help them put the water bottle down and take a break from their grief.

Blessings,

Bob

Bob’s new book, Whispering Presence: Inviting Mystery to be Your Daily Companion, is now available from amazon.com in both print and kindle editions.  You can download a free excerpt from Amazon.  If you want a companion who can help you find something more in your life, get your copy today.