The experience of grief is a normal, albeit painful healing process which forces us to examine our lives and our priorities after a loss. There are no tidy and predictable "stages" but there are numerous intense feelings and thoughts which we need to address.

Early in our grief we try to protect ourselves from feeling the full impact of our loss. We tend to "numb out". We function mechanically and look pretty good on the "outside". This may last for weeks or months and at this point we need people to assist with concrete tasks to lighten our daily load.

Once the numbness wears off we begin to ride a roller coaster of intense emotions. This phase lasts for many months. Our task during this phase is to acknowledge the impact of our loss. We may feel incredible pain, anger, anxiety, loneliness and exhaustion. We need opportunities to vent our feelings and problem-solve with people who are able and willing to accept our pain. For most people self-care is very difficult during this time yet essential. If we negotiate these feelings and find new ways of making sense of our world "as it is now" we begin to feel a better balance.

Our sadness is still very much there but the intensity of our feelings ease and we get "glimpses" of peacefulness and real hope again. Our tasks at this point include re-entering the mainstream of life and redirecting our energy toward the future while retaining our memories of the past. Social support and connectedness with others is important to our healing.

The following list highlights a few important matters to consider during bereavement:

• Grief is not pathological or a sign of weakness. It is a sign that you are a normal caring person.
• Everyone deserves some support - don't be afraid to accept it.
• While you may feel pressured to put on a brave front, it is important to make your needs known by expressing your feelings to those you trust.
• Often numbness sees us through the first few days, weeks or months. Don't be afraid when more intense emotions arise later - this is normal. Special anniversary dates may also unleash more intense sadness.
• Many people are more emotionally upset during bereavement than any other time in their lives and are frightened by this. Be aware that intense emotion is not unusual. If you are alarmed, seek a professional opinion.
• Whether you feel you need to be alone or with others, let people know. Needing company is common and does not mean you will always be dependent on it.
• There is no set time limit for grieving. It varies from person to person, depending on the individual circumstances.
• Guilt, anger and feelings of being out of control are common. Identify your feelings and the tools that help you cope with them.
• It is easy to neglect yourself in every way because your energy levels are low. Try to keep a routine.
• You are under great stress and may be more susceptible to disease, so try to get regular exercise and eat reasonably even if you have to 'force' yourself at first.
• Although sleep may be disturbed, try to get adequate rest.
• If you have physical symptoms that concern you, get a doctor to check them out.
• Medication rarely helps normal grief and only tends to mask or prolong it. There are situations where it may be temporarily helpful such as if you have a history of depression, long-term sleep deprivation or another disorder. Always ask your doctor or therapist how they believe the medication suggested will help you heal.
• If people urge you to see your doctor, do so even if it doesn't make sense to you at the time. They may see what you can't.
• Alcohol is a depressant so it should be used minimally if at all.
• Friends and family are often most available early in bereavement and less so later on. Don't wait for them to guess what your needs are. They will often guess incorrectly and too late.
• Someone who is not too close to you but is willing to listen may be particularly helpful. It is often the people we least expect who know how to be available.
• No one will substitute for your loss. Try to enjoy people as they are. Don't avoid social contacts because of the imperfections in those you meet.
• Sometimes, in an effort to stop the pain of grief, people turn towards replacing the lost person (e.g., adoption of a child, remarriage) too soon. Give yourself time to heal.
• It is normal for many people to doubt their faith when a tragedy occurs. Try to not feel guilty. Grief forces us to re-examine everything in our lives including our spiritual beliefs.
• If your spirituality is a source of great strength seek out your spiritual counselor to help you talk out your philosophy.
• Remember we are all in the same boat and grief is a universal process. We will all have to deal with these feelings sooner of later.

Mary Raymer, M.S.W.

Mary is a psychiatric social worker and licensed marriage and family therapist who has served the terminally ill and their families for 25 years. An early hospice leader, she has held a wide range of clinical and adminstrative positions in hospice and palliative care. She has served two terms as President of the Michigan Hospice Organization. She presently has her own private practice where she specializes in complicated grief reactions, stress and terminal illness. She lectures and consults nationally and internationally on end of life issues. She has published articles on a variety of topics in end of life.

Mary was awarded both the Lifetime Achievement Award and the Outstanding Hospice Leadership Award by the Michigan Hospice and Palliative Care Organization and has also received a Project on Death in America Social Work Leadership Award from the Soros Foundation in New York. Most recently, she was awarded the National Hospice and Palliative Care Organization's highest honor, the Heart of Hospice Award.