Whatever it is that I have lost (or must give up) I must grieve. If I do not do my grieving about the old hurts and insults, then, when I am faced with a here and now grief experience, I will end up having to dredge up all that old energy along with the current experience.
Elaine Childs-Gowell

On a daily basis, medical students, residents, physicians and other healthcare providers care for patients who are experiencing a life challenge or have experienced various losses; yet we may be completely unaware that our patient has been significantly impacted by a loss and is grieving. These include the loss of body image, loss of body function, loss of mental function, loss of health through various illnesses or disease, loss of sexual function, loss of plans, hopes and dreams for the future and loss of independence. Physicians and healthcare providers may also inflict loss on patients with medications, treatments and surgical procedures. Many of the losses faced in medicine evoke a grief response. Therefore it is important that we learn to recognize the signs and symptoms of the normal grief response to distinguish grief from medical disorders and enable the proper diagnosis. Treating those suffering from loss, without being aware of the grief response can have detrimental affects on medical diagnoses, treatment plans and therapeutic responses.

Understanding Loss & Grief

Loss--the disappearance of something cherished by an individual i.e. person or property--is a byproduct of living. Most people have experienced some type of personal or professional loss at some point in their life. There are also many losses that occur during "routine" medical diagnoses or procedures resulting in a patient grieving in addition to his or her medical diagnosis. This is particularly true if the patient is adjusting to being diagnosed with a life-threatening or terminal illness, a chronic medical condition, the loss of a limb or a breast, the loss of a child, the loss of mobility, hearing, sight etc. Many times these losses are never publicly announced or acknowledged such as the case of a miscarriage or abortion, death of a relative by suicide or various types of physical or emotional abuse. Instead the person endures very private sorrows that can impact his/her health and well being.

Grief is the normal reaction to a loss. During this process the grieving person may experience significant and subtle changes that can impact his/her physical, emotional, mental, behavioral and spiritual health thereby compromising overall well being. Experiencing a loss or a life challenging upsets the normal balance and reduces a person's energy. Therefore, grieving is the highly energy requiring process a person goes through while restoring the balance and energy in his or her life. Grieving losses is an important step for restoring balance, because, according to Elaine Childs-Gowell, if we don't grieve the old losses, when faced with a new loss, we will have to use our energy to face the past as well as the current loss.

The Impact of Grief on a Person's Well Being Health

is the optimal state of well being--being well physically, emotionally, spiritually and mentally. Wellness is considered to be the state in which the physical, emotional, mental, and spiritual dimensions are balanced so that energy is used effectively. Although grief and wellness seem unrelated, unrecognized acute loss or unresolved grief can mimic various medical conditions, lead to illness and a decline in wellness. A grieving person may experience a variety of somatic complaints: fatigue, insomnia, pain, gastro-intestinal symptoms, chest pressure, palpitations, stomach pains, backaches, panic attacks, increased anxiety or a generalized feeling of not being quite right. These symptoms may be due to a medical disorder or a grief response following a loss. Potentially serious medical complaints require a through evaluation to exclude serious medical disorders before a grief response or depression can be diagnosed.

Loss and the resulting grief response can impact a person’s mental and behavioral wellness. Repressed, unrecognized or unresolved grief can cause personal anguish, increased anxiety, multiple physical complaints, functional impairment, strained relationships, marital discord, disrupted sleep, impaired childhood, increased substance abuse—tobacco, alcohol, drugs, tranquilizers; clinical depression, and an increased mortality from heart disease and suicide. The death of a spouse has been shown to negatively impact the health of the surviving bereaved spouse, including increasing the risk of death. Studies have shown that bereavement—grief following a death--can also lead to an increased mortality from ischemic heart disease, the development of high blood pressure, depression of the immune system, and increased depressive and anxiety disorders including post traumatic stress disorder.

In order to enhance our patients' well being, we need to recognize the role that loss and grief may play in a current medical diagnoses or conditions. We also should determine the patient's past losses, life challenges or experiences, which can still impact the person's health and affecting his or her overall wellness.

Distinguishing between Grief and Depression

During a normal grief response, a person may experience symptoms of distress or depression. This overlap between grief and depression makes it challenging for practitioners to determine if a person is experiencing a grief response or true clinical depression. The accompanying table summarizes the key characteristics of grief and depression to help you distinguish between these two related but distinctive conditions.

Conclusion

Failing to identify a grief response to loss may result in a poor response to therapy because the correct diagnosis (grief) was not make and underlying etiology for the patient's symptoms was never identified. If the grief response is not identified, the patient may not receive the support needed to help him or her cope with the life changing events. Taking a loss history may help the practitioner to identify and correctly diagnosing a grief response. This in turn can help the practitioner to educate the patient that their symptoms may be related to the life challenge, which then helps the patient to process the change, integrate the loss, begin living again and restore balance, energy and well being.

Resource available on request.

Kirsti A. Dyer, MD, MS, FAAETS, FACW, NCBF, CWS Internal Medicine Physician - on Hiatus for Childcare Adult Medicine, Life Change and Wellness Specialist Nationally Certified Bereavement Facilitator Certified Wellness Specialist Journey of Hearts, The Violet Heart. Dr. Dyer can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it