Grief

Grief is something that every single human being will go through at some point in their lives. Grief can be over a loss of a friend or family member, over a change in a life situation such as new house, new job, new car. There are many situations that can cause grief. Typically, once the grieving process begins there are 5 stages: Denial & Isolation, Anger, Bargaining, Depression and Acceptance. Originally, it was thought that we go through these stages in this order. However, every person's grief is different. We spend different amounts of time in different stages and we can go through the stages in any order.
But what happens when the person grieving already has a mental illness? How does that change things? Personally, I have thought so much about this recently as I have been starting the grieving process myself because of the death of my mom, and now a friend as well.
I believe having a mental illness changes grieving in the following ways:
1) People with mental illness can have more severe reactions when grieving. I say this, not to minimize other's grieving processes and experiences but rather to point out that those with mental illness already have an extra emotional struggle on their plate and thus aren't always equipped to handle emotional struggles that come their way. Many suicides attempts are fatal by people who have a mental illness. When having a mental illness, it means we have physical characteristics in our brain that make us react differently to the world around us. Those with depression are not simply sad or even really or super sad. It is something on a whole different level. Those with anxiety are not nervous or even really nervous. Those with addiction or alcoholism don't simply drink or use drugs, it's something that's an addiction to the point where they almost lose control to it. Those with borderline personality disorder are not just emotional and sensitive, they physically feel things to a completely different extent. This is what makes grief so difficult for those with mental illness. We are already prone to having over the top reactions to situations in life or even nothing at all. Add stress into the mix and things get kinda shaky. That's where I bring in the point that grief to those of us with mental illness is different. Personally, since the death of my mom, I have been more angry than I have been in a really long time. And not just angry but irritable too, like the littlest things send me over the edge. I've been dissociating more, isolating more, and suffering more severe symptoms of depression than I have in a long time. That is part of my mental illness but it is also in response to the grief. My grieving looks different because my brain acts different. Another part of the severe reactions is that there are many people who commit suicide because of grief. My grandmother did and that makes me even more at risk for doing something similar.
Relating this on a more personal level and to give a clear example, my mother passed away 2 1/2 weeks ago. Since her passing, there have been symptoms of my depression that are making their way back in. I'm not eating much, which isn't characteristic for me. I'm also going through periods of time where I don't sleep much at all during the nights and then my body gets so physically exhausted that I will sleep for 14, 15, 16 hours at a time. I'm not able to concentrate well and my motivation is out the window. I've either been extremely tearful or not able to shed a single tear. One extreme or the other. I lay in bed for hours staring at my iPad hoping that the time will pass. I'm fighting the urge to isolate more than anything right now but even still, I'm isolating when I should be reaching out. When it comes to anxiety, I'm having 2 or 3 anxiety attacks in a day, some so severe they make me feel like I'm going to throw up when they rarely reach this intensity. When it comes to my Borderline Personality Disorder, I'm showing more severe signs of anger and irritability (and I am not one to show that I'm angry or irritable, so it's an incredible struggle to fight). I'm engaging in destructive habits again. My obsessive like thoughts of suicide and self-harm are much more present than they were before. I'm severely dissociating, worse than I ever have in my life. I'm paranoid at work and home. All of this is in response to the passing of my mother. My personal grieving process looks like this and it only looks like this because I have a mental illness.
2) People with mental illness need different support when grieving. Many people with mental illness have a therapist and psychiatrist already because of their mental illness. The help they need from them continues as a person grieves. It may even become more necessary due to the more severe reactions described above. Yes, people who don't have a mental illness will often seek out counseling and therapy when dealing with grief, but it is usually not right away. It is only after a period of time of struggling with grief that people will seek out counseling to help with their grief. People with mental illness have that support often the moment the grieving starts, if they are in treatment already. Additionally, people with mental illness need friends and family just like those without mental illness. But the support looks different in many cases. Many times, it's a friend to just sit with a person so they are not alone and to help keep themselves safe, often from their own minds. Other times, it's a person to talk to about the grief. Other times, it's to talk to someone about something that has nothing to do with the grief. Personally, since the passing of my mom, I have been the one to choose who I open up to and who I tell how I'm doing. I shut out people who demand to know how I'm doing and even times people who just ask in general "how are you", I can't answer them. Because of my mental illness, I have been extremely selective in who I talk to about my mom and when I talk to them about it. It's all been my choice. And that's hard for people who want to know how I'm really doing all the time and I can't give them an answer because I can't spit out my thoughts and feelings at the moment. That's why there is the support of a therapist and a psychiatrist as well as friends and family. The support need is different.
3) People with mental illness have different physical needs when grieving. What's the most common thing people do for a family that's just lost someone? Bring them food. While that is great for many people who are grieving, for those with a mental illness that can be a difficult thing and even a triggering thing. Because of the severe reactions, there are times when they don't want to eat because the depression is so bad and other times where they want to eat everything in sight. Other times, when they only want to eat specific items. This also applies to those with eating disorders. Food can be a big trigger for those with eating disorders as they struggle on whether they should eat the food that was brought for them. The food can sometimes be eaten, sometimes not be eaten and sometimes go to waste which can lead to major guilt. People with mental illness don't always need meals brought to them. It can sometimes hurt more than help.

So what can you do to help those who have a mental illness who are grieving a loss?
1) Support them through their severe reactions. Some reactions don't make sense to them or to you and that's all part of grieving with a mental illness. Be aware that there may be severe reactions from the person and that it's not your fault that they are acting this way. Be aware that sometimes extreme anger directed towards you may not be meant for you. When a person is open for talking, ask them about their reactions and their emotions and anything you can do to help them through their severe emotions.
2) Support them as a friend/family. This includes so many things. This means being the person they need when they need it but maintaining a healthy relationship as well. Make sure you are well supported and kept healthy through the entire process. Recognize when you can't be what the person needs and help that person find someone who can. This means that you as a supporter can play many roles, You can be a shoulder to cry, an ear to talk off, or just someone to sit with. You can be someone to be normal with too. Ask the person what they need and if they don't know, that's okay too. Offer support but don't push. The biggest thing is you recognize them going downhill and beyond what you can do to help them, HELP THEM SEEK PROFESSIONAL HELP! This could mean going with them to the appointments and describing what you are witnessing. But make sure that if you can't do it, they get the support they need from someone who can. Set healthy boundaries with the person while making it clear that you are not leaving them or abandoning them in this difficult time. Remind them of their importance and your care for them.
3) Ask what they need. If they need food, bring food. If they need supplies and toiletries, a gift card is always an option. If they need a ride somewhere or help figuring out something, anything you can do to help is encouraging. Personal notes and cards are always encouraging as well, especially when it's past the usual 2 week mark of the loss and the cards have stopped coming.
4) The most important thing to do to help anyone who is grieving is just to be there and be there through the long haul. Through the dark and the light, through good days and bad days. That's what grieving people need, especially those with a mental illness.

Personally, I still need support through each day and still need people to understand the reactions I have. This is something that is just beginning and may go on for a long time as grief can be a long process. That's why it's so important to recognize that when a person is grieving, especially a person with a mental illness, that the grieving process looks different for everyone.