As a minister, I mostly deal with grief among parishioners as a process that follows the death of a friend or loved one. When a friend or loved one dies, a bereavement process begins, a journey that allows those left behind to proceed through a variety of stages of grief.

Many years ago, Dr. Elizabeth Kubler-Ross identified the five stages of grief:  Denial, Anger, Bargaining, Depression, Acceptance.  When I took a course on Death and Dying at the university, I was taught that different individuals pass through the stages at different speeds and perhaps even in different orders.

But I was also taught that grief is not limited to the experience of loss through death. Grief could occur over the loss of a job, the loss of income, the loss of one’s freedom, or the loss of one’s faculties.

Since my first visit to the funeral home at the age of six I have been aware of the kind of grief that accompanies death. Only in recent years have I come to understand the grief one can experience for those who are still alive. As I have dealt with those experiencing diminishment and dementia, I have gained a new appreciation for how we grieve for the living.

First, in 2004, my father was diagnosed with small cell lung cancer. Although he responded well to the initial treatments, a heart condition caused the suspension of therapy, and during the ensuing months I grieved for his loss of weight, his loss of independence, his loss of mobility, his loss of modesty, and ultimately his loss of breath. By the time he died, he was barely recognizable to his friends, and I seemed to have made multiple stops at every one of the five stages. I grieved more during his deterioration from cancer than I did after his death.

The second saga began almost one year after my father’s funeral when my wife’s mother was diagnosed with ovarian cancer. For my wife and me, the same grief cycle began all over again. Although there were many good days and fun visits with my mother-in-law who demonstrated extraordinary hope and perseverance, we grieved over her loss of hair, her loss of dexterity and balance due to neuropathy, her loss of ability to hold her grandchildren, her loss of appetite, her loss of youthfulness, her loss of vitality, and her loss of ability to serve in her many volunteer positions. When she died three years after her diagnosis, we believe death came as a blessing, an act of deliverance from the terrorism this disease can inflict upon a body.

Finally, just before the death of my mother-in-law, my grandmother was diagnosed with Alzheimer’s. And our family began to experience grief over a different kind of loss. This severe expression of dementia manifests itself in a variety of ways. Although many of the symptoms seem to come and go, and some days are better than others, during her journey we grieved her loss of memory, the loss of her familiar personality, the loss of her awareness of her surroundings, the loss of her freedom, the loss of her driving, the loss of her home, and because she had been relocated to a care facility, the loss of her church, the loss of her community, and the loss of her network of friends.

We believed that when she passed in 2011, she experienced the ultimate healing. We miss her, but her passing was a welcomed relief for her, and under no circumstances would we wish her to have lingered and sunk deeper into the chaos and confusion of dementia.

Now we are telling stories about our aunt, one of my father’s two remaining siblings, who is near the end of her life on earth. She has been in a care facility for almost 10 years and has experienced memory loss to the point that she hasn’t recognized many of her family members for quite some time. Thankfully, she has continued to have a kind personality and positive attitude despite her loss of memory.

On the occasions I have had the opportunity to visit her, I have both treasured her positive influence in our family across the years, and I have grieved that she can no longer remember many of those treasured experiences and relationships. When she closes her eyes for the final time here, I will continue to grieve, even though I am aware that a peaceful homegoing will be an answer to her prayers.

I am still thinking about how grieving for the living differs from grieving for the deceased. As a pastor I am more aware now of how many in my community are grieving a loss related to those who are still here…the grandmother who is grieving over the grandson who is in prison, the father-in-law who is grieving over the loss of his daughter-in-law because of a divorce, the former manager who is grieving over the loss of his colleagues after his job was terminated, the school teacher who is grieving over the loss of contact with students following her retirement, and the family who is grieving the gradual dementia in their mom or dad.

In reflecting on my own experience, I would contend that grieving for the living can be more complex, more long-term, and more exhausting in many circumstances than the grief associated with a death. 

To those grieving someone who is still here, let me pass along a few suggestions that friends and counselors offered to me:

• Try to practice good self-care.
• Find ways to stay connected to your faith community.
• Strive to maintain a good regimen of exercise, rest, and healthy nutrition.
• Maximize your time with your loved one.
• Maintain at least one hobby, project, or activity that is replenishing for you.
• Allow and encourage friends and family members to grieve at their own pace in their own space as the journey unfolds.
• Ask God to renew and replenish your strength.

Grief lasts for a season and each season is unique in context, scope, and duration. And sometimes grief doesn’t involve a funeral home. Grief doesn’t always emanate from a sudden loss or a final loss. It may involve the gradual loss of someone who is still here.

(Barry Howard currently serves as the pastor of the Church at Wieuca in North Atlanta. He also serves as a leadership coach and columnist for the Center for Healthy Churches. He and his wife, Amanda, live in Brookhaven, Georgia.)