The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

Chapter 16.26 picasGrief and BereavementElizabeth A Keene Reder, MA“Can it be in a world so full and busy that the loss of one creaturemakes a void in any heart so wide and deep that nothing but thewidth and depth of vast eternity can fill it up?”CHARLES DICKENS■ Most of us answer “yes” to Dickens’ question. The experience of a death of a loved one can beone of profound sadness and loss. The multidimensional responses to a loss are all part of thegrief process. This process is often complicated when the death is AIDS-related. If the death ofone individual can be as devastating as Dickens’ question presupposes, what happens whenpeople experience multiple significant deaths, as most bereaved in the HIV community do?There are unique challenges and needs in the bereavement process for people coping with AIDSrelateddeaths. This chapter will explore the nature and process of grief and identify interventionsfor use by the palliative care team in helping the bereaved cope with their losses, adjust toa changed life, and be open to personal growth and transformation.THE LANGUAGE OF GRIEFGrief is the normal, dynamic process that occurs in response to any type of loss. This processencompasses physical, emotional, cognitive, spiritual, and social responses to the loss. It ishighly individualized, depending on the person’s perception of the loss and influenced by itscontext and concurrent stressors. 1Mourning is often used interchangeably with grief, but mourning more specifically refers to thepublic expression of grief. This public expression (perhaps crying or wailing) does not necessarilyrelate to the significance of the loss; it is usually related to cultural and religious values andencourages social support for the mourner. 2Bereavement is the state of having suffered a loss. This incorporates the period of adjustment inwhich the bereaved learns to live with the loss. The root of the word “bereaved” means to berobbed of something valuable. 2Complicated mourning arises from an interrupted or obstructed grief process. Rando 2 usesthis term to refer to potentially harmful outcomes, from somatic discomfort to chronic emotionaldistress, and even the possibility of death, when grief is unaccommodated. There are risk factorsthat can lead to complicated mourning; many of these factors apply to AIDS-related deaths.XVIU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 329