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View from the Other Side of the Stethoscope

Patient Handout—Honoring Grief

Harpham, Wendy S. MD

doi: 10.1097/01.COT.0000453671.96155.fe
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WENDY S. HARPHAM, MD. WENDY S. HARPHAM, MD, is an internist, cancer survivor, and author. Her books include Diagnosis: Cancer, After Cancer, When a Parent has Cancer, and Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on “Healthy Survivorship,” and as she notes on her website ( and her blog (, her mission is to help others through the synergy of science and caring.

Oncology professionals play a vital role in helping patients who are suffering from obstructed grief. As mentioned in my prior column (OT 8/10/14 issue), all you may need to do is validate patients' sadness as the normal—justified—response to their loss and instruct them to honor their grief.

Here is a handout for patients who need encouragement to grieve their illness-related losses. Please feel free to edit it or use it as is.

Honoring Grief

Dear Patient,

Survivorship involves loss. You benefit from knowing when and how to grieve those losses. Your reading this handout will help you grieve in healthy ways and minimize a common problem called obstructed grief.

What is Grief?

Grief is the natural response to any loss in life. It is not a momentary feeling, but rather an emotional process marked by sorrowful thoughts and painful feelings. Over time, grief helps you accept the loss and adjust in healthy ways.

Sometimes patients don't adequately grieve a significant loss. This can cause a complication called obstructed grief, whereby sadness finds expression through negative thoughts and feelings. You don't want to hamper your grief, because that consumes energies you need for dealing with medical challenges. Also, it can weaken your hope and spoil otherwise good times.

What are Risk Factors for Obstructed Grief?

A variety of factors can increase the risk of obstructed grief, such as...

  • The loss is invisible, and so not recognized as a loss. Examples include loss of stamina or sense of taste, or loss related to changes in your roles, relationships, hopes, and expectations.
  • The sadness is not signaled by tearfulness. Instead patients may develop a change in appetite or unusual snippiness with loved ones, or they have difficulty sleeping—symptoms easily blamed on the illness or the stresses of treatment or recovery.
  • Patients believe that crying shows weakness or may hurt their chance of recovery.
  • Patients fear that once they start crying they won't be able to stop.
  • Patients assume that the explanation for their discomforting emotions must be something other than sadness over a loss, since they are feeling heightened gratitude for all that is good in life.
  • Patients sense that they have no right to feel sad about a treatment-related loss if they are doing well medically. This notion is often reinforced by people who remind them how lucky they are to be here to deal with their loss.

If feeling sad, keep in mind that...

  • Grief is healing, so you no longer feel sad about the loss.
  • Grief is temporary, even if the loss is permanent. Patients stop crying, often sooner than they expect.
  • Any loss causing ongoing sadness must be grieved. This holds true even if that loss is temporary, relatively minor, expected, or accepted as the price of recovery. It holds true even if the actual loss occurred long ago.
  • In general, focusing on “positive” feelings is good—but not if patients block out the pain and negative feelings that are tied to the healing power of grief.
  • Healthy grieving takes great courage and strength.
  • People can feel happy about some things in life while feeling sad about—and needing to grieve—losses.

Do I Have to Grieve Now?

If you are adjusting fairly well to the consequences of a loss then, no, you may not need to grieve now (or ever). But if thinking or talking about the loss stirs any unpleasant emotions, or if you find yourself suppressing an urge to cry, expressing your grief may be necessary to adjust and find some happiness.

Many patients believe they cannot afford to spend any time or energy grieving a painful loss while dealing with medical issues. Sometimes that's right. You may do best to postpone grief until things settle down. That said, at other times the best path to physical healing includes a brief spell of focusing on your loss and grieving freely. Thereafter, instead of wasting precious energy stifling grief, you can direct those energies toward managing the medical challenges optimally.

What makes grief so difficult?

Here's the problem: Grief hurts. Since human beings are wired to avoid pain—including emotional pain, it's natural to try to repress, ignore, or deny your sadness. Unfortunately, that instinct can keep you from benefitting from the bitter medicine called grief.

Other factors make grief difficult, too. The socially acceptable window for sorrow remains unreasonably short. Friends and loved ones may tell you “It's time to move on,” whether with subtle signals or blatant scolding. They may not really believe that, but their compassion for you and/or their own sadness about what's happening prompts them to blurt out such things.

What now?

Honor your grief.

First, take time to acknowledge your losses without judgment. Remind yourself that grief is justified and necessary. Then, find safe places to express your grief.

The centerpiece of healthy grief involves sharing your thoughts and feelings with people who care. So turn to trusted friends or loved ones with whom you can talk—and cry— freely, without their trying to fix anything.

In addition (or instead), consider a visit or two with a grief counselor. Professionals offer the advantages of their expertise and their lack of involvement in your past or future personal life.

You may find it healing to express your grief through art or journaling, or by wailing alone at home while watching a tear-jerker movie or listening to sappy songs on the radio. If so, that's great. Go for it. Just don't neglect to also express your grief with people, because the human connection is uniquely and powerfully healing.

Our ultimate goal is helping you live your best life. We are depending on you to tell us if sadness persists, just as we must know if you have fever or bleeding. Ongoing sadness is a symptom that needs proper attention.

As you honor your grief, take comfort in knowing that you are paving the way for getting good care and living as fully as possible today, tomorrow, and every day.

© 2014 by Lippincott Williams & Wilkins, Inc.
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