Podcast: The Impact of Grief & Loss on Your Mental Health
Jenn talks to Dr. Ipsit Vahia about how grief and loss can impact your mental well-being. Ipsit discusses the healthy components of the grieving process and shares ways for us and our loved ones to strike a balance of coping and grieving.
Ipsit Vahia, MD, is a geriatric psychiatrist, clinician, and researcher. He is the associate chief of the Division of Geriatric Psychiatry and director of Digital Psychiatry Translation at McLean Hospital. He is also director of the Technology and Aging Laboratory. His research focuses on the use of technology in the assessment and management of older adults.
Jenn: Welcome to Mindful Things.
The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.
Hi, folks. Good morning, good afternoon, or good evening to you. Wherever you’re joining us from, whatever time you’re joining us, thank you for taking the time to join our conversation about grief, loss, and mental health.
I’m Jenn Kearney, and I’m joined today by Dr. Ipsit Vahia. And I wanted to start by just saying a little bit of the obvious: Loss is expected, yet it’s always unwelcome whenever it comes into our lives. Some of us deal with it better than others, and that’s totally normal to have a hard time with loss, grief, mourning, or a combination of the three.
We all have different thresholds for pain, different outlets of coping, as well as different ways to express sadness. And as we’ve continued to navigate a pandemic, many of us have had really unimaginable loss, and we were unable to process and grieve in ways that may have brought us comfort before.
It’s been a really difficult road for a lot of us, and while some of our moments of loss have passed, oftentimes the pain still lingers. So over the next about an hour, Ipsit and I will discuss how grief and loss can impact your mental wellbeing.
We’ll talk about the healthy components of the grieving process, ways for us and our loved ones to strike a balance of coping and grieving, and when someone should actually seek help for grief and mourning.
So if you are unfamiliar with him, Ipsit Vahia, MD is a geriatric psychiatrist, clinician, and researcher. He is the associate chief of the Division of Geriatric Psychiatry, and the director of Digital Psychiatry Translation at McLean Hospital.
As if he didn’t do enough in a day, he’s also the director of the Technology and Aging Laboratory, and his research focuses on the use of technology in the assessment and management of older adults.
So, Ipsit, thank you so much for joining. And I wanted to just start by laying the groundwork and asking, what are some of the hallmark symptoms of grief and mourning?
Ipsit: A great place to start. Before I get into that, I think it’s important to make some distinctions straight at the outset, because a lot of this language is used interchangeably, but they do have relatively specific meanings.
Bereavement, grief, and mourning are the three that get used interchangeably most often. Just to set a little baseline for the folks joining us, bereavement is the fact of the loss. When someone dies, or if someone that you know has passed away, then you have experienced a bereavement.
Grief is different. Grief is the emotional response to the loss. So we experience grief as a result of a bereavement. Though, increasingly, I think research is showing that grief can happen in the context of any loss, it does not have to be bereavement specifically.
Mourning is less well-defined, but mourning typically refers to the more acute part of grief shortly after the bereavement, and it’s often used to describe the rituals associated with bereavement, be it funerals, memorials.
Some faiths have defined periods of mourning of two weeks, or a month, et cetera. So I think it’s important to make these distinctions because it helps us think more objectively or more scientifically about this process, and how we’re having this at a time when there have been 750,000 deaths from COVID alone in the United States over the past 18 plus months.
The global death toll is five million. It’s not a stretch to say that there may be virtually nobody on the planet at this point, that has not been touched by loss or bereavement, even if it’s a couple of steps removed.
So, if anything, I think we’re grossly underestimating just how much grief there is in the world. And that doesn’t even include other losses: income, way of life, opportunities, employment, et cetera.
This may be the only time I find myself speaking to the audience where I think that, if you look at grief as the lens through which we’re approaching this session, then I think it’s an experience that everyone can relate with somehow or the other. That would not be true if we were talking about bipolar disorder, or schizophrenia, or even really depression. But grief, yes.
Jenn: Yeah, it is truly something that impacts everybody. I can’t think of one person who hasn’t experienced some sort of grief or loss ever. You know?
Ipsit: Yeah, yeah. The other point I want to make early is that grief is not a state, it is a process. And it’s a process that’s not linear, it happens in fits and starts.
So it’s not uncommon to meet someone that has had a recent bereavement, and in the moment appears okay, but that does not mean that they’re not in grief, it just means that they’re in a better moment that could, and likely will change.
So, I think we as human beings need to recognize that this is not linear, it happens in fits and starts, and it happens over time. How much time varies also? In the research literature, six months is kind of how we think about it.
But that’s a somewhat arbitrary number, can be a lot shorter, can be a lot longer. And the final point I want to make, to start with, is grief is not pathological, it is normal, it is essential, it is healthy.
Jenn: So when I was doing some research before our conversation, one of the things I stumbled across pretty often was a description of normal, air quote, “normal” grief, and complicated grief. What are the differences between those two, if there are any?
Ipsit: There are very significant differences between the two. Normal grief is a process of recovery or healing. It starts right after the bereavement.
There’s usually an acute phase of two to four weeks where you will see things and behaviors, that without the bereavement, would be considered unusual: sudden crying, intense cravings and longings, guilt, shame, even things like imagining seeing a loved one or having complex fantasies about the loved one that has passed away.
That then goes into a more consolidated phase where there are moments of normalcy, or happiness, or joy. And then, over time, grief can be re-triggered at the anniversary of the loss, say, or if there’s some other reminder. But for the most part, people have lives like they used to before the bereavement. That is the normal, or the expected trajectory of grief.
For some people, approximately 10% is the number that research suggests, grief does not proceed in that way, and that beyond six months, up to a year or more, there’s a sense of intense longing, intense yearning, to the point where it can be disabling, an extreme preoccupation with the loss.
There can be a decline in functioning. So there’s regret trying to, trouble moving on, trouble, say, parting with the loved one’s possessions, trouble thinking about anything but the loss that has been experienced. It does not heal. And it’s not depression.
Depression is a more nebulous sadness, loss of motivation, loss of energy, even tearfulness, sometimes thoughts of suicide, changes in sleep, et cetera. Complicated grief may sometimes look similar, but it’s far more focused on the bereavement itself.
Jenn: I know that one of the things that I’ve mentioned, you’ve lately mentioned, is that people process grief, and loss, and bereavement in different ways. But is there such a thing as a typical healing process after a major loss? What does that process commonly entail?
Ipsit: It varies because the process differs from person to person and from loss to loss. Even for the same person, who they lose and how matters.
Classic literature says that among immediate family, the loss of a grandparent is the least traumatic, the loss of a grandchild is the most traumatic. Because there are some people who you expect that you will lose, people that typically are much older.
So the loss of a grandparent is less traumatic than the loss of a parent, which is less traumatic than the loss of an older sibling, spouse, or younger sibling.
The loss of a child is much harder. And the loss of a grandchild... Because I work in geriatrics, I have crossed paths with people that have lost grandchildren, and I don’t think people ever really recover from that.
Jenn: And I cannot fathom how heartbreaking that must be.
Ipsit: It’s devastating, it’s devastating. And even in the context of a loss like that, is there grief, is there recovery? Typically, yes. But as you might expect, it’s slower, there’s more disability as a result.
People do... Moving on is not a great term because how can you move on from something like that? But some sense of day-to-day normalcy does return. Joy is possible, pleasure is possible.
And those are the hallmarks of the grief process, that in the initial intense phase, I think there can be disability, but what you want to see is little bits of everyday pre-bereavement life coming back.
Returning to work, going out, doing things they enjoy, being able to talk about the person they’ve lost in a positive way, so, happy memories rather than just the fact of the loss, gratitude for having shared that time.
One expects to see these phenomena come into play. In complicated grief, for which the technical term is now prolonged grief disorder, complicated grief is pathological, and you don’t see these things come into play.
So there is distinctions. They can be subtle, and they vary from person to person. But the idea of normal grief is that over time, it resolves, and prolonged grief does not. Grief-related depression, some think of it as a third entity where the grief resolves, but there are these lingering depressive symptoms.
Why do these distinctions matter? It actually has to do with the treatment. Many would say that normal grief requires no treatment, that support and processes is sufficient. Depressive disorder as a result of grief requires treatment, and it responds well to antidepressant treatment, or a more regular cognitive behavioral or other therapy for depression.
Prolonged grief disorder does not respond well to antidepressant treatments, it does not even respond well to general therapeutic approaches. There are very specific targeted therapies for prolonged grief disorder that do work.
Jenn: So when should someone talk to a doctor about how they’re feeling after a major loss? Is there some sort of timeframe that they should be on the lookout for?
Ipsit: There isn’t an absolute guideline. There are people that will reach out a day after a loss because of how they’re feeling. There are some that make the assumption that, “I lost a loved one, and of course I’m going to be devastated, so this is as it should be,” and they may not seek care for months or even years.
I think if it is distressing, talk to somebody. Talk to a therapist, talk to a doctor. Let them guide you, and let them work with you on what sort of intervention is needed. If it’s early and if it’s devastating, a concrete example would be if someone experiences a loss and they find themselves not sleeping.
Now loss of sleep in the context of acute grief is an expected thing. On the other hand, if someone has not slept for a week, then that’s its own challenge, and that’s the sort of thing that maybe an intervention is needed for.
Jenn: Gotcha. Can you expand on what kind of disabilities you were alluding to that may be associated with complicated grief?
Ipsit: Yes, it can be very traumatic. People withdraw, they cut themselves off from friends and family, they become isolated. There is this constant reliving of the loss itself. It’s more common in cases where the loss was sudden, unexpected, and it was a traumatic event.
The typical example is after a suicide. Complicated grief in people that are survivors of suicide is significantly more common than other types of losses. A car crash or an accident, any situation where someone was not supposed to but did pass away is a higher risk for complicated grief. The nature of the relationship matters, too.
When I’ve worked with complicated grief, it’s often been in the context of the loss of someone with whom they were not getting along, an estranged family member, but there was unfinished business that will never now be completed.
That sense of regret that remains, of guilt that remains, that’s a risk for complicated grief. And we haven’t seen studies, but we have seen case examples that in the context of the pandemic, especially in the early days, there were a lot of instances where people were not able to communicate with their loved ones.
There was no funeral, they were not able to attend funerals, they were not able to have the closure. That sense of not being able to say goodbye has been devastating.
Jenn: I know you’ve mentioned suicide, and we have received a couple questions about it. Do you have advice on how to support somebody who has lost a loved one to suicide?
Ipsit: That’s a difficult one because there isn’t a one-size-fits-all recommendation. I think the most general advice I could give is be there. They may not need you, they may push you away, but be there. And don’t be afraid of opening a conversation, because it’s likely that the person that’s experienced the loss may not feel ready.
They may not know what to say, they may not know where to start. If you can just open a conversation and give them a safe space to talk about it, that’s a good place to start, because what that does is it makes them feel safe, it makes them feel comfortable, it makes them feel heard.
I think people, in a very well-meaning way, often fall into that urge to offer solace, to offer advice, to offer guidance. People that have experienced loss will tell you that that’s not always welcome. In fact, it can be counterproductive.
Jenn: I imagine that that would. It takes the focus away from the person who’s grieving and shifts it toward the person who’s trying to be helpful, but is really making themselves a little bit more focused, that center of attention.
Ipsit: And a couple of practical tips: These are small things, but they’re things I’ve learned over time. They’re things that are often being taught by people that have experienced bereavement.
Again, I work with geriatrics, so a lot of the folks I work with deal with the loss of friends, spouses, family members, quite regularly. And they will teach me. And I am grateful for it, even when they’re telling me I screwed up.
One is, instead of asking, “How are you,” consider asking, “Are you okay?” Or, instead of saying, “Hope all is well,” because how can all be well? Instead of saying, “Hope all’s well” or “How are you,” say, “Are you okay? How are you coping?”
Asking it that way, it relieves the person who you’re talking to from the pressure of presenting as okay. When you say, “Hope all’s well,” the answer is typically, “Yeah, things are fine” or, “Yeah, things are okay.” Whereas you asked, “All’s well,” and they said, “I’m okay.”
They’ve already told you that all is not well, but things are okay. But you may have missed the opportunity to intervene or give them a safe space to talk. Assume that they are not okay. Also, understand that, especially right after a loss, grief is an up-and-down process.
So, when you ask them, are they okay, or are they doing okay, really all they can tell you is how are they doing in that moment. So why not ask about it? “How are you doing today? Are you coping okay today? Are you okay today?”
Because yesterday they may have been, today they’re not, or today they may be okay, tomorrow they may not be. Either way, by realizing that you’re focused on them in the here and now, that can be very comforting.
Jenn: Its’ really fascinating, too, how just a couple words can change exactly what moment that person’s talking about.
I’ve found that a lot of times when, excuse me, with mental health screenings, if a doctor asks, “How are you today,” that ends up being a list of missed symptoms, because if the person feels okay in that moment, they’re going to say, “You know, not bad. Things are fine.” But that erases the last two weeks of the depressive state that they’ve been in.
Ipsit: Yeah. It... When you’re screening, you want more longitudinal perspective as a clinician. If you’re supporting someone that has had a recent loss, then the here and now is what really matters.
Jenn: That’s a really important distinction, too, because I’m sure that there are several clinicians that are listening in, and sometimes it’s very hard to take one hat off and put another on.
I did want to ask you, I know that grief, loss, mourning are all really heavy topics, but what are some signs and symptoms that you might be either closer to acceptance or that your grief may actually be resolving?
Ipsit: This was something that was taught to me by one of my mentors when I was training. I’ll share his name, Dr. Sid Zisook at UC San Diego. He happened to be a supervisor and a mentor, and is one of the world’s experts of grief.
His tip, which has stayed with me, is a good sign of whether you’re going to be okay and make it through the process of grief is if you attend a memorial, are you able to laugh, or are you able to smile?
It’s a very simple thing, but it carries over an answer to your question, Jenn, that as one goes through the process of grief, if fond memories make you smile, it’s always poignant, but it can be happy. We know that a lot of people use humor and positivity as a way of enabling the moving on from grief.
Another thing he taught me, which has stayed with me, is that a lot of people will confess that the funniest that they have ever been is when they were delivering a eulogy. And it’s true, it’s a comforting thing that you can say something at a memorial or while delivery a eulogy that makes people laugh, and that makes people smile.
So I think understanding that devastating as a loss might be, but with time, the loss kind of slots into a broader narrative about that person’s life, and that, sure there is sadness, but there’s also joy, there are things to celebrate: mourning, of course, but also celebration.
If that is seen, or if that is experienced by someone, then that’s an early sign that they will move through the process of grieving as one might expect, and that that feeling will happen.
Jenn: Is there anything that you are aware of that would be considered a risk factor for someone to be more susceptible to extreme grief or mourning. Maybe if somebody is prone to depressive states, would that be considered a risk factor?
Ipsit: It’s not clear. It may be. I think preexisting propensity to depression is a risk factor for complex grief, but it’s not a clear one-to-one association.
Because grief, by definition, happens in the context of a loss, it’s more the nature of the loss, the circumstances surrounding it, and the nature of the relationship with the person that they’ve lost, that are the more strong determinants of whether someone has normal or complex grief.
Jenn: We had someone write in, asking how can they help a family member that seems stuck in their grief, and also is not interested in seeking mental health treatment.
Ipsit: Oh, that’s a complicated one. Again, I don’t know the circumstances or the specifics, so it’s hard to get too precise. My non-clinical recommendation would be stick with the process. See if you can make this person aware of how they may have changed, how they may be stuck.
Make them aware of the fact that they’re not being able to move on in ways that they should be. Time matters. If it’s two months, three months since the loss, then they may actually be within the bracket of normal.
If it’s been six, eight months, a year, then yes, maybe there is a problem. Also, pay attention. It’s not unusual for people to be stuck or preoccupied with the loss while returning to normal life, they’re just not able to engage or behave in the same way.
So there’s very little that’s black and white, and a lot that’s gray, and understanding those shades of gray and where someone is, it matters.
I would say, looking and trying to place where this person is within the broader context of their life, their loss, and the process that they’re going through, may be more productive than trying to push them towards mental healthcare.
Jenn: Would you have any suggestions for treatment for a person that’s experiencing grief from the death of a loved one that was their sole support, even though the death occurred over a year ago?
Ipsit: Extraordinarily difficult. Again, without getting clinical here, I would want to know what stuck means. Even for someone that has the expected grief and recovers from their grief, if they have lost a sole support, there is just a total disruption of life.
So you cannot, by definition, refer to normal because normal included that person. And I’m not talking about the support piece, I’m talking about, is sole support in the sense that it was the only family member nearby, or is sole support something more significant, like managing their money, managing their medications, paying the bills, effectively running their life?
The former scenario is easier to cope with. The second one is hard, but it’s for practical reasons rather than emotional reasons.
I would say in a situation like that, they probably should seek assistance either from a psychiatrist or even from someone that’s a case manager that can provide therapy or support, but may also be able to help get some of those instrumental pieces of day-to-day life back on track.
Jenn: You know, we’re recording this at the beginning of the holiday season, and holidays can be incredibly tough for folks who have a lot of memories with loved ones that are no longer with them.
Do you have any advice around possibly changing traditions around holidays if you’ve experienced multiple losses of those people that you once celebrated with?
Ipsit: These are such poignant questions, Jenn, right, inevitable, given the topic that we’re discussing. Yes, I think... Think of the fact that the traditions you had, represented a very different reality from the one you’re in now.
The reality you’re in now does not include the person you lost. And that is difficult, it’s also a fact. Because you lost a loved one, life has changed irrevocably, but the future is not yet written.
The future is in your control. And it’s not at all unusual, even for people that lose a spouse after 50 plus years of marriage, to write a new chapter. As you said, Jenn, create a new tradition, find a new way of celebrating. And if you choose to continue a previous tradition, let it not be from a place of sadness, let it be from a place of gratitude and celebration.
How you go to the same restaurant can be very different if you go there and are devastated because of how it’s different, or it could be very positive because you’re doing it from a place of celebrating what happened and what is to come.
Again, I am grateful for the lessons I learn from my patients who have sometimes twice the life experience that I do, and have been through things that I cannot fathom. What must it be like to lose a spouse of 50 years?
If you ask them, they will tell you. And they will tell you that they are grateful. That is a part of their life, the largest part of their life, but there may be a little epilogue. That epilogue may include a different partner for company.
It’s a very different type of relationship; it’s not unusual for people in their 70s and 80s. I’ve heard, I’ve never seen this, but on matchmaking websites, that’s been one of the more fast-growing areas: matchmaking for people in their late 70s and early 80s. And they’re looking for a very different thing.
They’re looking for companionship. It’s different at different ages, of course. I think the point I’m trying to make with the stories of my older folks is because it illustrates that at any point in life, starting a new chapter at the point of loss is possible.
Jenn: I almost wish that we could end the session now, because I’m like, that’s such an impactful and uplifting way. But no, we still have time, so don’t worry.
I did want to ask, a lot of folks have been inquiring about discussing loss in the context of an estranged relationship. Can you elaborate any further on that?
Ipsit: Yes, I think estranged relationships can be in many forms. I guess what I was referring to is, in all relationships have ups and downs, and for the most part, you get along with your loved ones, but there are moments where you don’t.
And in more significant situations, it could be a family member: parent, child, sibling, spouse, that you haven’t talked to in a while, that communication for whatever reason came to a halt, and then that person passed away, and there was no closure.
So the relationship ends on this note of negative emotion, and perhaps unfinished businesses, that, again, will never be completed. It’s the whole idea of I never got to say goodbye, I never got to say, “I’m sorry.” I never got to say, “I love you.”
It can be a terrible thing to live with. We are drifting out of the realm of psychiatry and more into the realm of being an empathic human being, which some would argue is psychiatry, and others would say is completely different. But one must learn to forgive oneself in those situations. A good therapist or a good clinician can help.
It’s this broad... What needs to happen is the processing of the emotion that such a loss may have triggered. Some people can do that by themselves, others may need a clinician or a therapist.
Some turn to a priest or spirituality. Some turn to friends or family. There is no wrong answer. But the process needs to happen. An unfinished process is a risk factor for things like depression, or even prolonged grief.
Jenn: Have you found that spirituality or religiosity, especially in the work that you’ve been doing with geriatric populations, does it impact grief? And if so, how?
Ipsit: Absolutely it impacts grief. I mean, it is, you know... If we pause for a second and think about how just about every faith or spiritual tradition has actually quite a complex and well-developed set of rituals around loss and death, people have turned to spirituality or religion to help with loss, since time immemorial.
Some might even argue that that is among the more fundamental roles of spirituality and/or religion, and I make the distinction between the two, that yes, I think belief in a higher power, for some people, belief in an afterlife, it brings comfort, it helps process, it helps process the loss, it helps sometimes makes sense of loss.
There has been some evidence that people that are more spiritual cope with death better than those who are not. This is not, it’s not an absolute finding. I’m absolutely not recommending that everyone become religious and spiritual, but if you already are, there’s some assumptions there, right?
There’s assumptions that you believe in a higher power, that you believe in whatever the doctrines of the spiritual system you’re engaged with. And if that is true, then it’s inevitable that that faith or that doctrine will give you some concrete steps for coping with grief and loss. So, it’s sort of built in.
It’s not a surprising finding, should not be a surprising finding. It’s certainly not absolute; there are plenty of people that are both religious and highly spiritual that descend into complicated grief. So if that was a cure-all, you would assume that no one would get depressed. That is absolutely not true. So there’s a lot of nuance there, but many find it comforting.
Jenn: Have you found that support groups for grief can be helpful for people?
Ipsit: Yes. Again, it’s not absolute, but if one chooses to enter a support group for grief, it’s likely that they’re okay with being in a support group, and they’re okay with sharing, and they see value in it, so they come in, wanting benefit.
And with all of those things being true, yes, it will be helpful. Like any treatment that’s psychotherapeutic, it starts with a belief in the truism of the treatment, otherwise it’s not going to work.
Jenn: Do you have any advice for how to support kids between the ages of six and eight, through the loss of a parent?
Ipsit: Wow. I have kids in that age range, so that’s a very personal question without it being intended, so...
Jenn: Yeah, sorry, didn’t think that was going to hit as home for you as it did.
Ipsit: But I will speak in my capacity, not as a psychiatrist, but as a human being. I think... So again, I work with older adults, so I will disclose that this is a... There are clinicians that specialize in precisely this age group, and in coping with this precise situation.
So this is general expertise, not domain expertise, and it’s common sense, as an individual that has encountered this in my personal life. I think what happens when a child of that age loses a parent, it’s, well, the nature of the relationship with the parent matters.
Assuming that this was a normal, healthy, loving relationship, it is devastating. It is life-changing, and there is, simply put, not really a way around that. That child will never be the person they would have been had that loss not happened.
Again, this is truth. That being said, there are ways to mitigate that sense of abandonment. It’s important to understand what the child is thinking. It’s important to talk about it. I think we constantly underestimate the emotional intelligence of children, especially younger children.
If I had to make one recommendation, it would be talk to the child about the loss, and what they’re thinking, and what’s going through their head. Are they feeling guilty? It’s not uncommon for children to feel that somehow it’s their fault. Know that it’s happening. Understand what their fears are, what insecurities this has triggered.
Don’t try and reassure them that everything is going to be okay, because even if it does end up being okay, they don’t know that, and you don’t know that in the moment. But this is one where I cannot recommend strongly enough the importance of connecting with a professional that can help, because children know, I think, the...
They’re able to detect when someone is being genuine or when someone is saying things because they’re supposed to say them. I actually think children in the age of six and eight are exquisitely good at it, and we don’t give them enough credit for it. But openness, sincerity, honesty, a safe place to talk, and professional support would be my recommendations.
Jenn: All very good ones. And I have to say, kids in that age range, and even maybe a couple years younger, know exactly when you’re blowing smoke, because they just look at you, and they’re like, “Mm-hm, okay.” So very good advice there.
We had a clinician write in, saying, “As a provider, how can I best support widows and widowers, in my practice?”
Ipsit: As someone that deals with widows and widowers regularly, I think the first thing is to not make that... You want to know, but you don’t want that to be the focus, unless the loss has been recent, obviously, in which case, you do.
That being said, I think it is meaningful to understand the nature of how that person became a widow or a widower. What was the loss? Is it a factor? Understand the circumstances of it, understand the disruption of it. If it was a remote loss, understand how they have coped, how they have adapted.
I think... So this touches on a theme that we haven’t gotten to so far, Jenn, which is loneliness and isolation. That is... We could have a whole webinar about that alone. But I think with people that are older, or even younger and widowed, that’s really what you want to get at.
Now loneliness and isolation, like grief and bereavement, are terms that are used interchangeably, but they are different. Isolation is the physical act of not having contacts, not having supports.
Loneliness is an emotional experience of isolation. So you could be isolated and not lonely, or you could be not isolated and very lonely. So you want to know who that person’s support system is, who they talk to, who their friends are, who their family are, how often they see them, et cetera. That’s an assessment of isolation.
Loneliness is asking them, the simplest question to ask someone if they are lonely is, “Are you lonely,” or, “Do you feel lonely?” And they will tell you, because it’s highly subjective. And this could be someone that goes to three parties every weekend and still feels lonely because their relationships may not have a certain meaning or a certain quality they want.
In working with widows and widowers, that’s really important to assess. So you want to know about the loss, you want to know about the circumstances, but what you really want to understand is are they experiencing isolation or loneliness.
You said it was a clinician that asked this. Doesn’t matter what kind of clinician you are: mental health, primary care doctor, orthopedic surgeon, if you have a patient experiencing loneliness, they will do worse than someone that is not, doesn’t matter what you’re treating.
Jenn: Do you have any advice for dealing with continuous grief over the loss of your child?
Ipsit: That sounds like prolonged grief disorder. And there are prolonged grief therapies. There’s not a lot of people that are formally certified, though that number is growing.
A resource for folks interested, is most of the research that’s come out of this has been done by a consortium of investigators, but this work sort of is, it’s based out of the Center for Complicated Grief Research at Columbia University.
And the world’s expert on this is a psychiatrist by the name of Dr. Katherine Shear, or Kathy Shear, S-H-E-A-R. If you wanted to learn more, you just need to Google her name, and their website offers resources.
If you happen to be a therapist that wants to get trained in this, because the work was supported by the NIH, their training manuals are free in the public domain. I believe you can just download it straight up.
So someone preoccupied with the loss of a child, that circumstance just without knowing any specifics, would seem to fit the risk factor, it would hit all of the risk factor notes for developing prolonged grief disorder, or complicated grief.
Those terms are actually fair to use interchangeably, unlike some of the others. But that needs to be treated in a specific way.
Jenn: What should you do if somebody becomes angry or upset when you try to discuss their loss with them?
Ipsit: Depends on when you’re asking. If you’re asking a week after the loss, then that’s just the anger that’s tied to the acute grief process, and I would back off. If it’s a year or two later and they’re still reacting that way, then maybe something is there.
I would still back off. But that’s different. Is that avoidance that’s masking a more pathological process? Is there depression in play? Depending on what you’re asking, who this person is to you, how you’re connected, all of that...
So it’s hard to give a very general answer to this, except to say, process or give some thought to where that anger may be coming from. It has less to do with your intent and more to do with what that person is experiencing. And for someone that is experiencing grief or loss, whether acute or not, whether pathological or not, your intent doesn’t really matter.
Jenn: It’s very good to know. Do you have any recommendations for books or resources for learning about grief?
Ipsit: I mentioned the Complicated Grief Center at Columbia University. I would say that’s a very substantial resource. Some of the names affiliated with this work, there’s many, but Dr. Katherine Shear is kind of the world’s expert on it.
Sid Zisook, who was one of my mentors, is another. Dr. Naomi Simon, who’s part of our very own system, is another. If you’re looking at the scientific literature, that’s where I would start. I believe they’ve also written some books for the lay audience.
Jenn: We had someone write in, asking about, they lost their parents in the spring, one day after another, and they’re curious about whether or not their grief and loss trajectory is expected to be twice as long because they’ve experienced double the loss in such a short amount of time.
Ipsit: If they’re still listening, first of all, my condolences on their loss. I can’t even imagine what that must have been like. It’s hard to generalize whether two losses mean double the trajectory. That’s not what you would expect.
Would it be a little bit longer? Perhaps. So there have been scenarios where sometimes a mass loss like that is processed as one entity. Other times, it’s longer and more complicated. But, I think the pandemic rules may or may not... I say, “rules,” loosely.
It was a figure of speech, there are no rules. I think the way grief plays out over the course of the pandemic may be a little less typical because it’s happening on an overlay of so much disruption, even otherwise.
Things are getting better now, but realize that a lot of the mechanisms or things we rely on for support, for moving through grief, for overcoming it, may not be available. Your friends and family may not be able to see you.
There may or may not have been a funeral or a memorial. Zoom is great, but sometimes not enough. And again, to the person that asked this question, and it’s a brave question, so I am humbled by being asked it, I don’t know what other losses may be in play.
So I think these are all factors. It’s hard for me to give a general answer except there should be a process of recovery. If this happened in March, then I would pay attention to how you’re doing now.
It may take longer to get back to baseline, whatever that might look like, but that you should be in a better, more different place now. There should be joy, there should be some normal things, there should be basic functioning. But thank you for that question, and they have my best wishes.
Jenn: I know one of the things that we’ve talked about previously is when you’re dealing with losing somebody, you might be oversleeping, you might not be sleeping at all, you just have general lethargy or loss of interest.
What advice do you have with dealing with that fatigue and loss of interest in activities, that comes along with losing someone? Is there a certain point of time that we should accept it, or should we start doing things that are good for us, right away? Are there guidelines for this?
Ipsit: So fatigue, loss of sleep, disruption of sleep, that’s all to be expected. It may linger for six-ish months. I would expect that at the six-month mark, it would be still there, but better than it was a month before, and that month would have been better than the month before that, and so on.
So as a clinician, when I get asked about these things, I’m less concerned about timeframe, and more concerned about process. What you want to see is not that things are okay by six months, but you absolutely want to see that things have improved over six months.
So everyone’s different, and everyone’s process is different, but there needs to be a process. If at six months you were the way you were two days after the loss, then that’s probably not normal, and merits clinical attention.
Jenn: How can a person encourage their family members to help them process their grief if the family chooses not to talk about the loss at all?
Ipsit: Oh, that’s a great one.
Jenn: I’m sure you’ve received types of questions like this before.
Ipsit: Yes, yes. It’s so subjective, Jenn. I would have a much more concrete answer if you were one of my patients, but that’s the point. Maybe if it’s not working out, maybe if you’re struggling, then consider speaking to someone that’s not part of that family system.
That someone could, but need not be a therapist. It could be a trusted friend, at least in the initial stages. It could be a priest, it could be...
It could be anyone with whom you think you’re comfortable talking about this. But you may need an outside sounding board, whether a mental health professional, or otherwise.
Jenn: Yeah, one of the things that I’ve found most valuable is that, as I have lived away from some of my family at times, that sometimes who you identify as your family isn’t necessarily a bloodline.
So that means you could reach out to other folks that you consider to be family members, that might be able to help you more with that grief.
Ipsit: Yeah. A lot of priests and chaplains that I’ve crossed paths with over the years, of, at this point, just about every major faith, will tell you that much of their work, not the work of conducting services, but their day-to-day work with their congregants or people, involves helping them cope with grief and loss, an extraordinary amount of it falls in that domain.
Jenn: I know we have time for just about one more question, and it’s my own personal question. Because you work with such a unique population that has so much wisdom, what are some of the most valuable things that you’ve learned from your patients, when dealing with grief or loss, that have really stuck with you or impacted you?
Ipsit: There are so many, but I’ll stick with the one that has stayed with me most firmly, that even though you may not see it, even though you doubt it, even though you don’t believe it, life after is possible.
Jenn: That’s a great, honestly, that’s a great way to end the session. That’s such a simplistic but concrete statement, that, yes, it’s possible. Wow, that was incredibly profound.
Ipsit: You asked about profound wisdom from people I work with, that’s about as good as I ever got.
Jenn: You’ve really nailed it! Yeah, I can’t think of a better way to end this session. Ipsit, this has been phenomenal.
I know this is not an easy topic to discuss, but you have handled this just so beautifully, so thank you so much for spending an hour with me to talk about something so heavy, and giving a lightness and hopefulness to it.
Ipsit: Thank you.
Jenn: And everybody’s-
Ipsit: I can’t see or directly interact with those listening, but I imagine that they relate to the idea of grief or loss, if they are here at all. And to each one of you, my very best wishes.
Jenn: And we hope that you found this webinar today as insightful as I did. So, Ipsit, thank you again from the bottom of my heart for this. And thank you to everybody who joined.
This actually concludes the session. But until next time, be nice to one another, and most importantly, be nice to yourself. Thank you again. Take care.
Ipsit: Thank you.
Jenn: Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.
Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.
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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.
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