It's been three months since Haiti was violently shaken by an earthquake that left 250,000 people dead and hundreds of thousands more injured and homeless. The damage was not only physical, but psychological and emotional. Dr. Joseph P. Merlino [pictured right] is Deputy Executive Director at Kings County Hospital and Director of Psychiatry at the Brooklyn facility, which serves a large Haitian population affected by the quake. Dr. Merlino is co-editor of the book, Hidden Impact: What You Need to Know for the Next Disaster, A Practical Mental Health Guide for Clinicians, and a contributing author of the upcoming Clinical Manual of Disaster Mental Health. Here, Dr. Merlino discusses the normal stages of grief.
Q: What are the stages of grief?
A. In general, the first few days to weeks is a period when people feel shock and disbelief. They may feel numb, even denying what actually happened. They may search longingly for those lost. The next weeks to months is a period when anguish is felt; one may be preoccupied with those lost; feelings of restlessness and agitation are common as is the feeling of guilt. The next period, lasting months to years, is a period of resolution. Having grieved, individuals return to their former roles and begin once again to experience pleasure as they seek companionship and love from others.
Q. Is grief really necessary?
A. Absolutely. Grief is critical to one's health and to the return of a sense of normalcy. During grief we allow ourselves to be comforted and cared for. We are permitted to give up some of our responsibilities for a short while to care for ourselves and to be cared for. In the process of grief we re-establish our relationship with the deceased and come to accept the reality of their death. The common religious or civil rituals where family and friends gather to support the bereaved and to mark the occasion of the death -- through church service, public mourning and burial or cremation -- are also a helpful part of the process.
Q. Can someone grieve too much?
With normal grief, individuals regain their emotional balance within a few months and are capable of making new relationships within six months to a year. This does not mean that the person stops missing or thinking about the deceased, which is of course normal, especially around anniversaries and holidays. But, there is a condition we refer to as "pathological grief" which implies that disabling grief continues far in excess of what is typical. If someone remains seriously depressed with impairment in their usual functioning for longer than two months, it is important to seek the help of a healthcare professional.
Q. Do people of different cultures grieve differently?
A. Yes. The grieving process I have described is generally typical for our culture in the U.S. Individual customs and cultures vary and should always be taken into account when assessing normal and illness behavior.
Q. How can I help someone who is grieving?
A. Support during grief is typically provided by family, friends, and through religious affiliations. Listening is one of the most important things you can do. You may hear a similar recollection again and again. Assisting with chores like shopping and cooking and sharing in a meal can be very meaningful and comforting. Visits and calls to check in are also helpful.