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I'm afraid my sister-in-law's grieving process isn't healthy

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The question:

My sister-in-law lost her 24 year old daughter to a tragic accident two years ago. She and her husband have had some professional help in coping but she seems unable to resume her life. I know this must be the most unimaginable loss and there is no getting over it. She sent out Christmas cards this year and, along with her son and husband's name, she also included her daughter's name on the cards and gifts as one of the senders.

She stopped watching any TV and only knits - a new activity. She says she feel guilty anytime she finds she's enjoying herself. Is this somewhat normal behaviour and she just needs more time? Or should we be gently trying to encourage her to get more help?

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The answer

The death of a child is perhaps the most traumatizing and unnatural loss that any parent can experience. The death of a loved one is something that is so difficult for us to comprehend in the best of circumstances, but when a loss is tragic, untimely or unexpected the impact on us can be particularly tremendous.

The stages that individuals go through in dealing with grief really are variable, and depend on the circumstances of the death, the individual's coping resources, and the types of supports around them. Many parents who have lost a child will deal with some or all of the following:

- denial (difficulty accepting the loss or in some cases denying the emotional impact of the loss);

- anger (at the situation, or toward others who they feel may not be able to understand the loss); and,

- depression (sadness, loss of interest in activities that one used to enjoy, excessive guilt, and in some cases suicidal thinking).

It is not at all uncommon for parents to demonstrate behaviours that seem to look to others as though they have not accepted their child's death (e.g., keeping their child's bedroom intact, not moving any of their child's possessions). This is often a way to hold onto the memory of their child, as parents will often worry that they or others may otherwise forget their child. Your sister-in-law may be feeling a deep sense of betrayal to her daughter if she were to exclude her name from something that is sent out on behalf of the family (i.e., the cards/gifts).

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People will often ask what a natural time period is to recover from the death of a loved one.

You are accurate that a parent - or anyone who has lost a loved one for that matter - never really "gets over" the loss, they simply learn to cope better over time. There is no set timeline in which people recover from a traumatic death. Some people find they are able to cope with the loss and start to reintegrate back into their usual life within a few months; many find that it takes much longer.

The first year in particular is often very difficult, as there are a number of "firsts" that are experienced without the loved one (birthdays, anniversaries, holidays).

Given that it has been two years and your sister-in-law seems to be continuing to struggle quite significantly, it may be helpful to gently encourage her to think about getting some additional assistance.

Approaching her very gently and sensitively is key. Let her know that it is not your intent to at all overstep any boundaries and that you cannot even begin to appreciate how she must be feeling, but that you are worried about her. You could ask her if there are things that you could do that would be helpful. You could offer to help her with perhaps finding a community support group for parents that have lost children, or going to speak to a professional about her feelings and emotions.

For a number of people, the very natural and expected grief following a death can turn into a more pervasive clinical depression and it would be important for her to know that there are supports and effective treatments that could help with that.

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Often it can take years for a parent to find a "new normal" in their life, where they try to reconcile how to continue living a joyful life while still honouring and respecting their child's memory. Although it sounds simplistic, time and the gentle, unconditional support of loved ones such as yourself will make your sister-in-law's pain lessen over time.

Send psychologist Joti Samra your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Samra.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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