I recently spoke with D. Keith Cobb MD, an internal medicine physician in practice near Savannah, GA, author of the new book, The Grief Survival Handbook: A Guide from Heartache to Healing, which I recently reviewed for Blogcritics. Here’s some of our conversation.
Why did you write The Grief Survival Handbook?
Soon after I first started my practice, I met a couple who had hours before received a phone call that their 20-year-old son was killed in a car accident. Understandably, they were so distraught they were unable to think straight, much less attempt to go to the local funeral home to plan a funeral. As I sat in the exam room and grieved with them, I thought about my own grandparents who had experienced the same tragedy decades ago, and the struggle they went through when they lost their son. Although I was able to provide medication that day to somewhat soothe their pain and anxiety, I thought that my grandparents would be much better equipped to counsel and grieve with this couple. I subsequently asked my grandparents (as well as other patients over the next few months and years) for more details on how they survived their loss. I was eventually able to collect helpful stories and do more research into the grief process that led to the publishing of The Grief Survival Handbook. I use it as a resource for patients and their families.
You probably encounter death all too frequently, as an internal medicine physician. Are you more philosophical about death now, having been exposed to it so much? If so, how?
It makes me more appreciative of life and aware of the uncertainty of tomorrow. The death of a patient, family member, or friend is always a poignant reminder that we should make the most of each day to be the best we can be — both personally and professionally — in order to do the most good and have a positive effect on those in our sphere of influence.
One would expect a person grieving the loss of a partner or a close family member to feel depressed. What’s the difference between that kind of depression and clinical depression? Should they be treated the same way?
Depression is an expected part of grief. But grief involves much more, such as the intense yearning for the loved one and often anxiety, regrets, and sometimes anger that we are having to go through such a difficult time. Clinical depression, also known as Major Depressive Disorder, will often have no identifiable inciting factor. Those with clinical depression can’t usually name an event or situation that precipitated the cloud of their dark mood. As physicians and researchers, we still don’t fully comprehend all the physiologic and chemical changes that cause it, but we are making great advances in our understanding and treatment of depression.
The depression of grief is often called a reactive depression. However, more and more physicians and psychologists are recognizing grief as its own distinct entity with depressed mood as part of the overall process. Many of the same medications we use for clinical depression can be used to help with the burden of grief, if needed.
What other physical and emotional conditions are associated with grieving?
In addition to the depressed mood and anxiety, I find insomnia, moodiness, and difficulty concentrating to be common complaints. Existing medical conditions can worsen during the grief process, especially at the beginning. Diabetics will often see their blood glucose levels become difficult to control; asthmatics may notice they are wheezing more frequently. Stomach ulcers, acid reflux, or irritable bowel syndrome may flare up. Even angina attacks may occur in those with heart problems. Those are all conditions that should not be dismissed as simply part of the grief, but should be evaluated by a physician. As far as treating the anxiety and stress, I frequently offer my patients a mild sedative to help them rest at night for the first few weeks after a death in the family. Often a good night’s rest will help refresh our minds and bodies and give us a bit more strength to face the next day.
Is there a normal timetable for grief, a point at which the pain should be starting to lift?
On average, we can expect grief to last for about two years. During that time, it’s a gradual recovery consisting of bad days and good days, with eventually more good days than bad. But when someone loses a child, it takes much longer — and the pain never completely leaves us. Life will be good again, and we may find a day that seems normal along the way, but it’s a new normal. Granted, life is never quite the same, but life can be good again.
What are some practical strategies or insights you can offer to help grieving people in their healing process?
There seems to be a key to unlocking the door to recovery, but each person has their own key that they must discover. In retrospect, patients tell me they were able to look back and see various coping mechanisms they found that worked for them.
Getting back into the routine of life is helpful. Whether it is your job, your hobby, or your family activities, being physically and mentally active helps us to recover. We may need some time initially to regroup, but the sooner we can become active, the better. It not only takes our mind off the loss to some extent, but physical activity raises our natural endorphins, which improve our mood. Consider a grief support group. Such groups are available in most communities as part of hospice organizations and are a great asset to those who attend. And there are many online resources and books to help navigate the grief pathway.
What can grieving and the loss of a loved one teach us?
The loss of a loved one should be a reminder that life is fragile and must be handled with care. We must make the most of each day. Whether at work, home, or on vacation we must take advantage of the good opportunities life does offer us in order to build relationships and provide a positive influence on those we can while we can.
While many events in life seem beyond our control, our response to situations is one area that is in our hands. And the manner in which we respond not only affects our own outlook and moods, but it is an opportunity to inspire our family and friends to live through their trials with determination and courage.