Grief has been a big theme in my professional life. When I worked in hospice, one part of my job was to provide supportive counseling to the bereaved for 13 months after their loved one passed away. This was one of those "baptism by fire" situations. I didn't have much personal experience with loss prior to this position, and although I was given tools and training in school, that can't prepare you to comfort a 90 year old woman after she loses her husband of 72 years. That's bigger than you and me, or all of us. Big monster pain. I would sit with with the tears, offering kleenex and an empathetic ear. Over time, I was able to see that their biggest comfort was the opportunity for my client to participate in what we call "life review." This is essentially story telling, within which grief can be processed. I have heard the most beautiful stories about how couples met at the bus stop at 14 years old, and here she is at at 90, one person. One piece missing.
(We relate "Glee" to everything in our home.)
I see pain...
There is a big difference between the expected grief of an elderly person who has had a long and robust life, and an unexpected loss. These appear to be the most challenging. I will hear about people who went in for a routine procedure and throw a clot, dying without any way for the family to process, except utter shock. Then there are random accidents, criminal cases and one of the most unfortunate, suicide. I've worked with survivors of suicide in my career. The family is always left shaken, with real trauma in it's wake. While many think suicide is a selfish act, as a mental health practitioner, I see pain. There must have been an overwhelming amount of suffering in that person's life, to have found no other way to escape it.
The loss of a child is almost unbearable to think about. As a mother, I cannot begin to even fathom the loss. There must be an unmeasurable strength within the surviving family to go on after a miscarriage, still born, SID's death, terminal condition, or sudden accident that takes a child's life. How do you even begin again?
Most people have heard of the term "the five stages of grief" per Elisabeth Kubler-Ross. I'm going to give you a run-through, in case this is a new concept for you.
- Denial- This isn't possible. This can't be happening.
- Anger- Who is at fault here? Who can I blame? It's not fair!
- Bargaining- I will go to church every Sunday for the rest of my life, please bring them back!
- Depression- This can be a very dark place for people. At times, it seems like it will last forever.
- Acceptance- This is often after 13 months or so. Every holiday, anniversary and birthday has passed, and life has been reinvented without the loved one in it. Although the pain still exists, acceptance begins to put down roots.
Nerd Alert: The stages of grief from the OC...
When I'm working with the bereaved, they will check in with me to see if they are doing it right, or if they are just broken for good. The truth is, grief brings with it a slew of complex emotions that are hard to process. People will often use the metaphor of being hit with a wave of grief that is too intense to handle. People will think they have gone crazy and may never know "normal" again. There is no wrong way to grieve. If you aren't hurting yourself or others, you're doing just fine.
A deep emptiness in a survivor's chest...
There are those that believe the five stages of grief aren't adequate. Two more stages of grief have been added to the list by some professionals.
- Longing: This is the deep emptiness in a survivor's chest that physically hurts. People will say they just want to hug this person one more time. They need them on a core level and it simply can't be quenched.
- Continuing a relationship with the deceased loved one: While this sounds a little odd, there are many ways to continue a relationship with someone you can no longer see.
- Talk to them. They may be out of our vision, but there are a lot of faiths that believe the loved one continues to exist in another dimension, like heaven.
- Memory box. Gather mementos in a hat box. Take time (as frequently as you need) to sit with your grief and these items (pictures, movie tickets, letters, cards etc...) and feel your feelings. People often benefit from setting a time to cry, as tears often find their way out during work hours or in social gatherings if not attended to.
- Plant a tree that you can visit. This can be more comforting than going to a cemetery because it represents life.
- Journal your memories. This can be a cathartic and extremely therapeutic experience. I encourage people to set a time to process these feeling (both good and bad) in a journal. This also allows the bereaved to look back on their grief and see how much progress has been made over time.
The deep dark cement lake of depression...
While this blog is primarily focused on grief as it relates to death, grief can be associated with any major loss in life. This could be going off to college, the change of career, or even a marriage as you grieve the loss of your single life. Grief takes many forms throughout our lifespan. Honor yourself and the grief you feel. If you're hurting, take care of yourself. They call it self-care. This is vital for continued wellness and the ability to fend off the deep dark cement lake of depression that may come knocking on your door. Then there is complicated grief. Complicated grief may be caused for multiple reasons, but it's often due to the individual's inability to process grief within normal and somewhat predictable means. I have met patients that express acute grief from a loss that has happened almost a decade ago, but you could swear it was yesterday for the severity that sits in a puddle before you. I would also add, these complications are often seen after a period of 13 months, as most people have processed the stages by this time. Here are a few things to look out for as defined by The National Library of Medicine.
- Strong yearning for the person who died.
- Frequent thoughts or images of the deceased person.
- Feelings of intense loneliness or emptiness.
- The feeling that life without this person has no purpose or meaning.
- Dysfunctional thoughts.
- Troubling ruminations (over thinking) about circumstances or consequences of the death.
- Persistent feelings of shock, disbelief or anger about the death.
- Feelings of estrangement from other people.
- Changes in behavior focused on excessive avoidance of reminders of the loss.
- Or the opposite, excessive proximity seeking to try to feel closer to the deceased.
- Sometimes focused on wishes to die or suicidal behavior.
Don't feel guilty the first time you laugh...
The fact of the matter is that there is nothing that is going to make everything ok again. Nothing can replace this loss. I used to tell my bereavement patients, "It doesn't go away, it's just different." In other words, it won't always be this excruciating, but it will always be there. Life can go on, even if it feels that it's impossible. Don't feel guilty the first time you laugh, or the first day you forget to cry. It doesn't make them forgotten. It means you honor their life by continuing to live yours. If you need extra help as you learn to heal, please reach out to a counselor. It's always better to share your feelings, so they don't ooze out during staff meetings or grocery store greetings with a neighbor. Know you are never alone and ask for help when you need it. Gather your tribe to love you back to wellness. Your loved one will always live in your memories, dreams, and your heartbeat. Be well.