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Saying Goodbye

Saying Goodbye

We’ve all been through a time when the world seemed dull and hopeless after experiencing a loss – regardless of whether they’re family, friends or simply an individual of great significance to us. People experience loss in a multitude of ways beyond the passing of a loved one; we grieve at the end of a relationship, a permanent change in appearance, a passing life stage, or simply anything that we can never again regain or revisit. Due to the cyclic nature of life, we deal with grief constantly. Some of them are more gradual and less noticeable like ageing, while others may be more unexpected and sudden like the death of a loved one.

Grief affects us in ways beyond both physical and emotional pain. The five stages of grief modelled by Elisabeth Kübler-Ross concluded that the five major emotions experienced during grief were denial, anger, bargaining, depression and acceptance (Kübler-Ross & Kessler, 2014). This model was based on her work on patients with terminal illnesses, suggesting that these five stages were more applicable to people facing their own existential crises rather than those who were grieving. But in practice, we find that the five stages were also shown in grief clients despite the lack of linearity of graphical evidence. Most of the time these emotions are interwoven with many others, including guilt and fear. Beyond emotional responses, the process of grief also includes natural physical responses like sleeplessness, appetite loss, and a weakened immune system. But with proper coping mechanisms, these responses can be alleviated with time, allowing you to feel more prepared to make peace with it. 

Grief is a personal and subjective process, and coping mechanisms vary amongst people, so there is no norm or timetable to abide by. In most cases, people can process and resume their day-to-day functions after a certain period of time. However, in more severe cases (i.e., the loss of a romantic partner, the loss of a parent, the loss of a grandparent) we find it overwhelming. Especially if such grief was complex or unresolved (for example through sudden life changes, traumatic events, or unresolved issues with the deceased). During Covid-19, these situations were more prevalent than ever before. One of my friends was unable to complete quarantine in time to see his beloved family member in the hospital for the last time. Another one was unable to enter Hong Kong due to Covid-19 restrictions and had missed the last call from his father before he passed in the ICU. 

In sessions, we sometimes find people still struggling with loss even after many years due to the build-up of pain over time in addition to mental challenges stemming from grief, including difficulties in emotion regulation or disassociation. Such challenges can become debilitating as individuals often do not even realise that grief is still affecting them. Clinically, the prevalence of prolonged grief disorder (PGD) was found in approximately 9.8% of bereaved adults in the population. Of the adults suffering from PGD, the symptoms they experienced consisted of intense preoccupation with the deceased, persistent distress, detached or numbed emotion, inability to trust others, and avoidance of the reality of loss (Rosner et al, 2018). 

However, there are many ways to make it easier to cope with grief. If you are currently grieving, there are a multitude of things that may help you navigate this time:

  • Know That You Are Not Alone

Because there was love, there will be pain. Whenever there is a start, there will be an end. As the pain of loss is natural and inevitable, no one can live without going through it. But rather than fearing it, try to remember that it is possible to have an easier relationship with the pain of the loss by allowing ourselves to feel it.

  • Talk About Your Feelings

If you feel that you are struggling with grief, resistance or avoidance will not lift the burden. Instead it may cause unnecessary frustration. Try to express and share your feelings though they are difficult. It will aid your grieving progress. Begin to share these thoughts with your support system, address them in a journal, and find your emotional outlet. 

  • Share Your Memories

Share your memories to alleviate fear of forgetting them. Recalling and sharing the memories with those you surround yourself with can bring you a sense of peace amidst this painful time. The most memorable moment during the funeral of a loved one is the sharing of cherished memories with the people who share our pain. These moments may remind us of the fragility of life and how despite the fact that we are mortal, the love we have is eternal. 

  • Find Ways to Remain Connected With Your Loved One 

You can still connect with those who are no longer with us. I have seen many post-it memos placed along the surface of a tombstone by a wife or a grandchild, each inscribed with a message yearning for their beloved husband or grandfather’s embrace one last time. While others may play songs they used to listen to together, or plant a tree to symbolise their everlasting life. These things serve as a reminder to us that despite our loved one not being physically with us, they are here with us in spirit. 

  • Prioritise Yourself

Everyone grieves at their own pace. To find the best way to heal you have to take care and prioritise yourself. If you feel like crying, cry it out. If you need space, ask for space. It is not selfish nor insensitive to take time for yourself to heal. Please do not be hard on yourself for not being ‘strong enough’ in such circumstances, instead, we learn how to be strong enough through grief. Only through pure transparency with ourselves and our emotions can we make peace with them.

  • Remember That Your Life is Valuable

There are a lot of changes that follow loss, sometimes the change is so drastic that you begin to feel lost in the world. Just as how precious the deceased are to you, your life is just as precious to your family, your friends, and most importantly, your own self. With this mindset you will learn to find purposefulness in continuing on with the future and finding back your sense of self that was lost amidst the grief. 

  • Seek Help When You Need It

If you ever feel overwhelmed in the madness, reaching out to your support system is a wonderful method. You can also read self-help books pertaining to grief, seek help from your religion, your support group, or perhaps by paying a visit to a professional psychotherapist as a source of help for navigating past these mental challenges.

If you are accompanying someone who is grieving, here are some helpful ways you can engage:

  • Keep Them Company

Yes, you just need to stay with them. Remember that they do not need advice or positive talk at the moment, they simply need your presence. Having someone alongside you who is listening with all of their heart is one of the best forms of support. Even if you cannot be there in person, texting or calling them is another viable way of showing support. The feeling of being cared for will aid them through this difficult time.

  • Distractions

Whether it is house renovation, work, or travel planning, it can help people temporarily disconnect from reality and focus on the world around them. Exercise is always a good idea to help them feel uplifted naturally, so asking them for a walk if they are willing to do so is another effective form of distraction. If they do not want to engage in anything physically, providing them with a list of TV show recommendations may help occupy part of their mind.

  • Be of Help

There are a multitude of things you can do to help provide an extent of aid towards a grieving individual. For instance, you can help them with their chores, take their kids to the park, order food for them, etc., Simply by doing this you are offering substantial help and providing time and energy for the individual to deal with the chaos surrounding their loss.

  • Respect, Empathy, and Understanding

There are times when grieving individuals may have some irrational thoughts like bargaining with fate or impulsive, emotion-centred reactions such as blaming the hospital or the doctor. Try to give them space to sort things out and accommodate them with understanding. Everyone heals at their own pace, so your respect is an important buffer for them to feel supported and loved to learn to make peace with their bereavement. 

 “The reality is that you will grieve forever. You will not get over the loss of the loved one; you’ll learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.” – On Grief & Grieving, Kübler-Ross and Kessler

It is a heartbreaking part of the journey. But aren’t we blessed to ever have someone or something that was so hard to let go of in this life?

References

Kübler-Ross, E., & Kessler, David. (2014). On grief & grieving : finding the meaning of grief through the five stages of loss (Scribner trade pbk. ed.). Scribner.

Rosner, Rita, Rimane, Eline, Vogel, Anna, Rau, Jörn, & Hagl, Maria. (2018). Treating prolonged grief disorder with prolonged grief-specific cognitive behavioral therapy: Study protocol for a randomized controlled trial. Trials19(1), 241–241. https://doi.org/10.1186/s13063-018-2618-3

Megan Chang

MC

If you would like to speak with a counsellor about how we can support you, please contact us.

Find out more about Megan here.

Other Articles:

Talking About Eating Disorders

Talking About Eating Disorders

Talking About Eating Disorders

 

What is an Eating Disorder? 

Eating disorders (ED) can be expressed in a myriad of ways including extreme restrictions on one’s food intake, binge eating, purging attempts, mental distortions of body image, and extreme exercise. An excessive obsession with food, weight, and body shape are potentially all alarming signs of an eating disorder. Despite this, not everyone with such thoughts and behaviours may be suffering from such a disorder. A professional diagnosis utilising the criteria from the newly updated 5th edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5), is required to conclusively identify whether an individual may have an eating disorder. 

The DSM-5’s criteria have been deemed highly reputable in its encapsulation of what constitutes a certain mental disorder. For example, in Anorexia Nervosa (AN), the DSM included the following as its criteria: reduction in energy intake, low body weight, intense fear of weight gain, denial of current low body weight, and mental distortions of body image. 

There are various types of ED, as follows: 

  1. Anorexia Nervosa (AN) 
  2. Bulimia Nervosa (BN) 
  3. Binge Eating 
  4. Pica 
  5. Rumination Disorder 
  6. Avoidance/restrictive food intake disorder (ARFID). 
  7. Other Specified Feeding or eating disorders (OSFED). 

Among various types of EDs, AN and BN are the most common ones treated as an outpatient. AN was addressed in abundant research due to its increasing prevalence in adolescents throughout the decade. It has since become the third most common chronic disease in adolescents, next to asthma and obesity. 

Furthermore, in contrast to males, females have higher prevalence rates in most types of eating disorders. For AN, the research concluded that around 0.9~2.0% of females had developed this disorder, a percentage that is approximately sevenfold that of a male. Here we will discuss this mental health condition through research findings regarding ED among female adolescents, and young adults. 

Risk Factors 

There are several etiological and risk factors that contribute to the development of ED: 

  1. Genetic factors 

Among various studies, evidence indicated that females are significantly more likely to develop ED if a biological family member had ED prior. Both the inherited traits of personality and temperament may explain the influence. In addition, the environment in which one grew up is associated with genetic factors that may result in the development of an ED. 

  1. Neurobiological factors 

Neuropsychological functioning plays the role of mediating between underlying neurobiological abnormalities and psychological functioning in eating disorders. Nonetheless, the relationship is bidirectional. While neurobiological abnormalities can contribute to the development of ED, consequences following ED, such as constant low weight and underconsumption of nutrition, also lead to the poor neurobiological wellbeing of the individual. Emphasising the severity of an ED due to such a cycle. 

  1. Psychological factors 

EDs are highly related to underlying psychological distress. Grief, low self-esteem, trauma, or other mental disorders can be associated with its development. Family, especially parents, were often found to be responsible for such conditions. Literature indicated that restrictiveness of the authoritarian parenting style is highly at fault for lower self-esteem and higher levels of depression in their children, two main psychological distresses identified in an early ED pathology. 

According to the research of the risk factors contributing to EDs, mothers who are highly critical and overbearing were found to have caused the development of an eating disorder attitude towards their daughters. The study “Family Interactions and Disordered Eating Attitudes: The Mediating Roles of Social Competence and Psychological Distress” conducted an investigation with a sample group of 286 families in the University of Arizona. Dr. Analisa concluded that young females tend to have poorer social and relationship skills if the individual’s mother frequently communicates with overt criticism, which is a rather unhealthy pattern to be subjected to at such a young age. In these emotional obstacles, the individual experiences are known to cause higher levels of psychological distress and a disordered eating attitude in their daughters. 

The research revealed that the negative form of family communication between mother and daughter impacted the sense of self and social skills of the young female significantly in this developmental stage. This was linked to their struggles over control and self-enhancement. Consequently, disordered eating is developed to deal with negative emotions or compensate for their incompetence in social life. 

These risk factors, along with the developmental changes of young females, are not only associated with the development of an ED but also the maintenance of thoughts and behaviours with such conditions. Clinically, we need a holistic assessment of these aspects of a client’s life to deduce and proceed with the most effective strategy for support. 

Protective factors 

ED can manifest at any age, but the most common age of onset is adolescence. As a result, families are at the front line in preventing, identifying, and supporting their young family members with ED. Adolescents are experiencing tremendous changes in their psychosocial development, including an increased sense of autonomy, a shift in focus from family to peers, and the emergence of abstract thinking. Therefore, self-image awareness and confusion in identity evolving in this stage deeply affects the young adolescent’s social life and overall well-being. 

According to the attachment theory, a secure attachment can create a crucial buffer for young adolescents when facing psychological challenges. In the present, families must have open and transparent communication with the younger generation. By conveying messages clearly and listening carefully, parents can help enforce an environment in which proper guidance is provided in terms of well-respecting the children’s volition. 

In essence, parents are role models to children, emphasising the importance of demonstrating how grown-ups maintain a healthy relationship with food, appearance, identity, and social interactions. In addition to the family, the community, like schools and peers are also vital in the prevention and recovery of young people with ED. 

Early treatment is the key 

ED, especially AN is highly related to risks of potential morbidity and mortality. Despite such statistics, nearly 45% of people with ED do not receive professional treatment for their eating disorders. It is beyond crucial to seek help earlier before it further affects the health of both the client and the family. 

Eating disorders can indeed be treated, but preparations for adverse situations like negative reactions and relapses, are quintessential. It is an emotional and delicate journey for not only the individual who succumbed to it but the family who also walks alongside the young adolescent through such disorder. If you are aware of someone undergoing these conditions, please reach out to your GP or qualified healthcare provider for a professional assessment and support as soon as possible.

Megan Chang

Find out more about Megan: HERE

If you would like to speak with a counsellor about how Megan or AMindset can support you, please contact us.

References:

1. Common Types of Eating Disorders (and Their Symptoms)

https://www.healthline.com/nutrition/common-eating-disorders

2. Over-bearing mothers can produce daughters with poor social skills and disordered eating attitudes

https://www.sciencedaily.com/releases/2013/09/130918090208.htm

3. Bryant-Waugh R. and Lask, B. (2013) Overview of eating disorders in childhood and adolescence.

In: Bryant-Waugh, R. and Lask, B. (eds) Eating Disorders in Childhood and Adolescence, 4th edn. Hove: Routledge, pp. 33-49.

4. Teens Visiting ER for Eating Disorders Doubled During Pandemic

https://www.google.com.hk/url?sa=t&rct=j&q=&esrc=s&source=newssearch&cd=&ved=2ahUKEwjgkPfx-oL6AhWMp1YBHWy-Ar0QxfQBKAB6BAgSEAE&url=https%3A%2F%2Fwww.healthline.com%2Fhealth-news%2Fnumber-teen-girls-in-the-er-for-eating-disorders-doubled-in-pandemic&usg=AOvVaw2eUiRaYrDLJHweAGt31jvV

5. Stice E & Bohon C. (2012). Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition, Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.

6. Analisa Arroyo, Chris Segrin. Family Interactions and Disordered Eating Attitudes: The Mediating Roles of Social Competence and Psychological DistressCommunication Monographs, 2013; 1 DOI: 10.1080/03637751.2013.828158

7. Bohrer BK, Carroll IA, Forbush KT, Chen PY. Treatment seeking for eating disorders:

Results from a nationally representative study. Int J Eat Disord. 2017 Dec;50(12):1341-1349. doi: 10.1002/eat.22785. Epub 2017 Sep 30. PMID: 28963793.

8. Nicholls, D. (2013). Aetiology. In B. Lask & R. Bryant-Waugh (Eds.), Eating disorders in childhood and adolescence (p. 50–76). Routledge/Taylor & Francis Group.

9. Fonagy, P., Gergely, G., Jurist, E.L. and Target, M. (2004) Affect Regulation, Mentalization, and the Development of the Self. London: Karnac Books.

10. Enten R.S., Golan, M. (2009) Parenting styles and eating disorder pathology, Appetite,Volume 52, Issue 3, Pages 784-787, ISSN 0195-6663,

https://doi.org/10.1016/j.appet.2009.02.013.