Book Review: Mindfulness for Prolonged Grief; a guide to healing after loss when depression, anxiety, and anger won't go away

Mindfulness for prolonged grief

What was called Complicated Grief, has now been termed Prolonged Grief. For when you are still grieving, months after a loss, incapable of living your best life, it is time to get some help. It makes so much sense to me. While my mother died 6 weeks after I moved to care for her, the trauma I experienced caring for my late father led to many symptoms of PTSD. Seriously. I've seen many families speaking to this on Canadian Virtual Hospice. They cannot forgive themselves, or cannot get over their grief. For me, I spent hours wondering if I did enough, made the right decisions.

This is an excellent book! It incorporates a lot of the techniques I've come across during my own recovery process, as well as those I've used in my teaching practice, in order to relax my students, and focus their minds (Meditation, relaxation, belly breathing, etc.).

How do you know what treatments you need? 

See you healthcare professional. Try treatments. If they do not work, stop. I've found that long-term antidepressants work for me. I've also found that therapists help, too. It is my belief that we need to know what is normal, and what is not and, therefore, when to get help. If we are in the depths of mental health issues, reaching out may be impossible, and it is up to family and/or friends to be able to determine when to intervene.

We all experience loss

This is an excellent self-help book for those who seek to improve their mental health, as well as their physical health. It came at just the right time for me. The loss of my ex-husband brought back a lot of old issues. My 2nd husband's surgery, and my work as caregiver, brought back issues and some of my anxiety symptoms, as well as new ones, while fretting over hubby's care. I was having chest pains, triggered by anxiety, and talk of wills, legal issues, and my divorce decree. Directly related! (But I did go to hospital to have it checked out.)

We know that bereavement (the state of having lost a loved one), grief (your feelings)  and mourning (the rituals of bereavement) are separate things. There is a complex grief and grieving process. I must say that after my father died, I experienced a number of these symptoms. I mentally revisited the sights, sounds, smells of his long-term care room with horror, triggered by other smells. I now realize that I needed to give myself permission to heal after caring for my mother and father. It wasn't just one event, but months of worrying about what I needed to do, being afraid of not doing enough, or doing the wrong thing. I was unable to concentrate at work, to make decisions about curriculum, or interact with my principal. She didn't understand my issues, and I ended up taking leave. Then, the bank decided my father was dead, he wasn't, mom was, and closed his bank account. It was a difficult time.

Excellent charts

Kumar says, One of the most consistent experiences people share in grief are the “supernatural” ones. This is very different from depression criteria. People do very often have visions, sensations, and experiences they struggle to explain, and often attribute them to their deceased loved one or loved ones. 

I can identify with this. You need to know that this is normal and can be comforting, rather than frightening.

We know that a combination of CBT and drugs work best (Cuijpers et al. 2009). It takes discipline, and mindfulness. The book is truly a way of doing your own Cognitive Behavioural Therapy, if you cannot afford, or do not have access to professionals. I used my Employee Assistance Program (EAP) each time and found that talking to professionals helped.

Your healthcare professional is the person to talk to, but if you can ameliorate some symptoms using CBT, Mindfulness meditation, traditional or Complimentary Therapies (i.e., massage, Reiki) , this book is for you. These solutions (Mindfulness) work well in conjunction with medication. Sometimes it is about immediate Mental Pain relief, rather than Physical Pain Assessment and management.

The well of grief

Excellent chapters:

1. Identifying your grief - important noting your symptoms (create a medical journal)
2. Mindfulness meditation – I've tried meditation and it didn't take! Deep breathing exercises may be for you. (Meditation, relaxation, belly breathing, living in the present moment.)
3. Mindfulness of the body – (Grief is stressful; fight or flight leads to hormonal responses)
4. Sleeping mindfully – good points on sleep hygiene; Sleep Induction, Sleep Hygiene, Dreaming, Journalling.
5. Mindfulness in motion – I prefer walking meditations, but included are Body Scan Techniques and Progressive Muscle Relaxation. 
6. Mindful sustenance – Eat well, eat mindfully, healthy food choices.
7. Mindful cleaning and decluttering – Sweeping, vacuuming, decluttering mindfully.
8. Transforming pain – Compassion, Random Acts of Kindness, reaching out, forgiving. 
9. Creative action – Spiral Staircase of Grief (essentially around death dates, some call it being in the well of grief. Celebrate their day of birth, not mourning on the day of their death.
10. Mindful resilience – Take charge, set goals, track your progress, draw, listen to music, celebrate your life.

The book fixates on the US healthcare model, whereby people only get insurance plan funding if their mental or physical issues can be properly labelled according to the DSM ( DSM-V –Medicalisation of Grief).  In Canada know that we can access healthcare no matter what. We need not pay up front, then fight to have our insurance reimburse us. (You can read more by Dr. Kumar here: removal of the bereavement exclusion). Or in a blog post following the release of the updated DSM-V, “Grief Over New Depression Diagnosis.”  Others worry that physicians will refuse to prescribe medication, even if it is perhaps necessary.

The DSM, since they are looking for labels and a diagnosis, may frighten those with the symptoms of Prolonged Grief (see Identifying Your Grief). Illumination, shedding light on mental health issues, helps us all. (Cancer in your family). It is crucial to get the right help.

Sameet Kumar, PhD, is a psychologist at the Memorial Healthcare System Cancer Institute in south Broward Florida, who specializes in working with end-of-life care and bereavement. He is a skilled writer who blogs regularly about his work applying mindfulness with the dying, and the author of the best-selling Grieving Mindfully: A Compassionate and Spiritual Guide to Coping with Loss, and the newly released Mindfulness for Prolonged Grief: A Guide for Healing After Loss when Depression, Anxiety, and Anger Won’t Go Away.

My late mother's celebration

Lots of good research out there:

Cuijpers P, van Straten A, Warmerdam L, Andersson G. (2009). Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depression and Anxiety 26(3):279-88. (Full record)

Cuijpers P, Donker T, van Straten A, Li J, et al. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies.Psychological Medicine 40(12):1943-57. (Full record)