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

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 16: Grief and BereavementTASK III:ADJUST TO THE LOSSThe third task refers to the work of developing the skills and filling the roles necessary tomove forward without the deceased being physically present. 8 Usually this task can only beginafter several months of dealing with the loss. It may include adjusting to living alone, being asingle parent, getting a job, learning to manage finances, or taking on household tasks. Forthose dealing with HIV, it can also mean needing to find other caregivers.Some bereavement support groups use the image of Janus, the Roman god of departures andreturns, beginnings and endings, as a symbol for their group. This two-faced god, who looks bothforward and backward, is an appropriate symbol for this task as the bereaved struggle withlooking back to acknowledge what has been lost and beginning to look ahead to see what ispossible in their lives.Part of adjusting to the loss is facing all the significant “firsts” that occur in the first year ofbereavement. Coping with the first holiday, birthday, or anniversary without the loved one cantrigger a temporary upsurge of grief. 2 Grief responses can be triggered by cyclic precipitantssuch as holidays or anniversaries, linear precipitants that are one-time occurrences related toexperiences or age (i.e., not being present at an important function), and stimulus-cued precipitants,including reminder-inspired reactions (“we always used to…”) and music-elicited reactions.2 An upsurge of grief may include a return of physical symptoms, various emotional responses,changes in social behavior, and spiritual distress. These temporary reactions must bedistinguished from complicated grief, and should not be misdiagnosed as pathological responses.TASK IV:REINVESTING ENERGY FROM THE DECEASED INTO NEW LIFEThe fourth task of mourning refers to the ability to transfer the emotional energy invested inthe relationship with the deceased into new, healthy approaches to life. 8 This does not meanthat the deceased is now “forgotten” or that the bereaved has “obtained closure.” Rather thistask refers to the bereaved’s ability to establish a new connection with the deceased, one thatcan transform their new life. Browning explains this concept as “saying good-bye to grief, withoutsaying good-bye to the loved one.” 28Reinvesting the emotional energy into new life may include a variety of methods. Simple gesturessuch as considering the deceased’s perspective in a difficult situation or wearing a locketwith a picture of the deceased are examples of this reinvestment. Others reinvest the energyoutward in sociopolitical actions such as working for justice, fundraising, or creating a memorialfor the deceased.Signs that a person is learning to accommodate their grief include:• A return to good health (or their health status before the death of their loved one)• Acknowledgment of the reality of the loss• Redefined identity• Emergence of new skills or roles338U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau