Tuesday, September 27, 2016

On The Other Side Of Grief (Stage 6)

Stage 6

            The final stage is called "In Memoriam."  This stage is not mentioned much in the literature but seems to belong because so much has been created out of significant losses. It is the need to do something creative, useful, and meaningful - to create some personal meaning out of an event that seems meaningless and often absurd.  There are many examples of this, such things as foundations, support groups, books, etc.  This kind of writing is mine.

Some final notes:  Grief cannot be denied; only delayed.  When people try to deny and suppress it grief shows up in physical symptoms, due to the stress of so much control.  The physical symptoms most closely related to grief are any number of chronic upper respiratory illnesses.  The hard part is that these are also very real diseases.  It is more an association then a one to one cause/effect.  But over the years I have noticed that people who have experienced loss, and not grieved, tend to catch cold more often and their colds last longer.    

Grief comes in waves that are relatively short in duration, and very intense.  This intense expression of deep feelings leaves one feeling dazed and stunned - briefly - then there is some relief, until the next wave.  Between the waves, life goes on as usual.  Eventually the waves of grief get further apart, less intense and less devastating - like a receding tide.  Grief and guilt go hand-in-hand. Guilt is woven throughout the process.  It is so profoundly a part of our humanness and is the result of being imperfect and often impotent.  As we face our limitations, the guilt gradually disappears.  There is so much in life that we have no control over and no say about.  We are stuck with what life deals us.  Our freedom is in how we choose to deal with that hand.

            Given all the possibilities of how the process can go awry, most people somehow manage to get through and recover.  Usually with grace and dignity.  It is a continual tribute to the human spirit, and I am always impressed.




Arleah K. Shechtman

Monday, September 26, 2016

On The Other Side Of Grief (Stage 5)





            The next stage is acceptance.  This is like a sunrise.  The grieving person begins to get on with life.  Energy and interests, pleasure and joy gradually return.  If the grief work has been done for the bereaved person and the helper, there is a new sense of strength and purpose, and the relationship is deeper and wider than before.   Both feel OK about the relationship and so are able to connect in new, nourishing, and more productive ways.  Both the bereaved person and the friend have to make a myriad of choices to achieve a stage of acceptance.  One of the hard lessons learned throughout the healing is that adults often have to learn how to pick the choice that sucks the least.

Saturday, September 24, 2016

On The Other Side Of Grief (Stage 4)

     The next stage is depression.  This is usually the longest, lasting up to a year or longer in duration.  This is often a very private time - the mourner is deeply internalized.  It looks like withdrawal- and it is.  This is where the major work is done.  Sadness, remorse, guilt, weeping, sighing and a lower level of activity characterize this time.  Life feels bleak, futile and sometimes meaningless.  Most people continue to work and do things as usual, but it is like going through the motions.  That is because most of the energy is being used to recover, much like recovering from major surgery.  There is not much lightness or joy during this time.  Depending on the nature and degree of the loss, this is an existential crisis, an identity crisis; one’s entire life view is being redone.  For example, in dealing with my own bereavement - the death of my 15-year-old daughter - the belief that I could protect my children was shattered.  I realized about eight months after her death that this loss was no guarantee or insurance that I would not lose again.  I realized that I had no exemptions from life, no special privileges.  And perhaps the hardest:  No restitution.  No one would or could make up or replace what I had lost.  I was faced with terrible fear and the choice of whether I wanted to risk loving again.  All those thoughts, feelings and decisions occurred during my very long depression.

            This is an equally difficult time for those around the grieving person.  Grief goes on longer than anyone wants it to, or thinks it should.  Everyone gets sick of it, including the bereft person - and still it goes on.  Hang in, is the message here.  It will end, time does heal.  As helpers, once again we feel our own helplessness and impotence and we want to withdraw.  That is a normal and natural response and to be trusted.  Some distance is necessary at this point because so much of the work is private and internal.  Just sitting together, walking, or a brief handclasp is the most required and the most effective way through this time.
 
            This is the rebuilding time after a shattering experience and all the little bits and pieces that take so long to accept need to be put back together, often in a different configuration.  Once again this is the continued evolution of a new history together.

     The last phase a person can be stuck in (chronic grief)  is depression.  This is really hard to call because depression is also the longest part of recovery.  We often get weary of the length of depression.  So much happens during this time; the most significant choice being made is whether or not to pick up and go on with life.  A person stuck in depression uses the loss as the reason to stay in place.  The loss is used as a sort of brake and break from moving too fast.  Sometimes the person just stops and never seems to get moving again.

            I will never forget how a friend of mine helped me move on.  About two years after my daughter's death, he commented that I used her death like a black ace, to hide behind.  I, of course, was very hurt and indignant at first, but as time passed I realized he was right.  Again, it was thre the kindest.  I am glad he and others cared enough for me to want me back.

            This is also another example of the new person and new relationship emerging from the old.  Because people pursued me, and because I chose to live, I have been able to recover.  My goal has become to turn around and give back to others who have just begun their journey.

            Being stuck in depression is probably related to an early loss of self.  More than any other stage, this may require some additional professional help.  It is broader and more pervasive than most other feelings and harder to define and get to the root.  It is amazing to me how many people sense that they are stuck and simply need support to follow through.  Perhaps some reassurance that they are not bad or crazy - just stuck for the moment.


            In many instances, professional counseling is the only help available.  This is due to not having families and communities easily available anymore.  It is also due to the strange lack of permission in our culture to grieve.  The further away from the event, the less it is OK to still feel sad or be mourning.  After 3-6 months the person is expected to be back to normal, and after the first year fewer and fewer people even remember the loss.  It takes a good three years to feel good after moving geographically from one home to another, let alone a death, divorce or a major illness.  The less tangible and concrete the issue, the more pressure to forget it, or the implication that it is only in our head, but not real pain


Counseling offers an understanding ear, supportive assurance, cognitive understanding, and simply a safe place to continue the process.  For a person to admit they need help, and then to actually go for help, takes enormous courage and strength - because the message is that we should be tough, handle our own problems, and after all, this is "only feelings.”

Friday, September 23, 2016

On The Other Side Of Grief (Stage 3)

Stage 3

            The next stage to be discussed is bargaining, which is a deep regression to an earlier, much younger state. We often see strange rituals, enshrinement or deification that seem puzzling or obscure.  This is primitive, magical thinking and also the attempt to regain some sense of control or "normalcy."  There is the need to feel safe, and there is no safety.  The work during this phase is to realize that nothing will bring back life as you have known it, no matter how many things are enshrined.  This is a very important time and is part of the redoing of the upset sense of reality.  It is an - "if this, then that" attitude.  For example, in bereavement we sometimes see a room or object enshrined; the thrust being, if I keep everything exactly as it was, then the person will not be so gone.

     In this stage the grieving person’s response is to bargain for impact.  To try and do something safe and familiar.  The most common form this takes is for us to join in the rituals.  It is such a relief to feel useful and see the grieving person interacting once more.  It seems like the person is finally getting on with life, and they are.  This joining together continues to strengthen the relationship and is part of our new history together.

     A person stuck (chronic grief) in bargaining continues with the rituals or enshrinement or deification in order to avoid further hurt.  I have known parents that haven’t touched anything in the child’s room since the death, as though that child would return and continue like always.  Others I have worked with simply won’t talk about the child, as though they never existed. These people also do not bother those around them.  It is as though everything were OK once again.  The problem is that further growth and intimacy is not possible in all other areas of life.  This is a very tricky type of stuckness  because it is usually not visible to others.  The person may appear to be peaceful - the key is the lack of growth because all energy is being used to stay in place.  Sometimes there are clues in unreal conversations about the loss.  This phase is probably related to significant earlier loss that is also unresolved and the person is simply overwhelmed.  As a youngster this person was probably required to be stoic or a good soldier.  The bargain is usually not spoken, but goes something like - "If I do not change anything, it will not be so true."  The way to help a person stuck in bargaining is a gentle, but firm confrontation that life must go on. This type of message may need to be expressed several times.  Otherwise the mourner may sink deeper into isolation and magical thinking.

Thursday, September 22, 2016

On The Other Side Of Grief (Stage 2)


      The second stage of grief is anger, which is related most closely to feelings of helplessness, and is the attempt to regain some sense of control.  Anger is often disguised or misplaced.  Often emerging in this stage is an upset sense of reality, characterized by obsessive reviewing.  The obsessive review is woven throughout recovery and is like talking the loss and the event, literally, to death.  The person may insist on talking about old times a thousand times and have little tolerance for other's problems and no interest in other's lives.  There is frequently a verbalized statement that "no one has suffered as much as me."

     This phase is also characterized by the need to place blame.  A great deal of time and energy is invested in trying to figure out why this loss happened and what or who “caused” it.  This is another attempt to reduce the pain.  It is also another way of trying to hold on to life, as they knew it. The time and energy is a distraction from reality for a little while.
    
It is so difficult to be angry directly - especially at the dead person.  It is hard to be angry with someone you cared for, who didn’t decide to die.  It is so difficult because anger exposes our needs and our fear of weakness with it. This makes us feel terribly vulnerable and exposed
 
            Our response is often feeling angry, fed up and even disgusted.  We feel angry at the person's passivity, inappropriateness, or self-absorption.  We are sick of hearing about it.  We feel angry that nothing we do seems to help, and we just want them to get on with life.  This is an important turning point in the process, and the most important thing we can do is to say exactly what we feel.  This truly helps the person move into the next stage and keeps the connection of the relationship alive and growing.  If we turn away because we do not want to add to the burden or upset them more, we begin to create distance.  The grieving person is then even more isolated and alone.

      Someone that is stuck (chronic grief) in anger is very easy to spot.  They are often bitter, blaming and sometimes cynical. A person stuck in the anger phase of grief is difficult to be around.  Though they often do not ask for much emotionally, they may be overly demanding in other ways.  The purpose, or attempt here is to feel safe and back in control.  The tasks for this phase is to break free of the attachments that no longer exist so healing can occur. Once again, chronicity creates distance.  Anger of this nature is probably related to early betrayal of the child.  As a youngster this person was most likely required to protect others from their own needs/pain.  So grief elicits enormous guilt and shame at one's impotence.  Helplessness is very hard to deal with, particularly for men.  A lifetime of being in charge and knowing how to "fix" life can be profoundly compromised when faced with loss.  This is very frightening and may cause internal panic, in the form of rage.  Few men have the understanding or emotional skills to deal with intense loss.  The way to help someone stuck in anger is to help articulate the bind they are in and how unfair it all is, that they have to change or retreat.  Otherwise the person is profoundly alone and isolated and believes they are different or strange.

Wednesday, September 21, 2016

On The Other Side Of Grief (continued 3)

            However, given all that, there are some behaviors that suggest when a person is in chronic grief.  Let me step back and say that what makes grief so mysterious and hard is that it cuts right through all the defenses and touches our core.  In cutting through it touches all other grief and unresolved issues and brings them to the surface with the current grief.  That is a lot of the sense of being out of control and feeling crazy.  If there are significant unresolved issues, the defensive system will go into overdrive and the result is that a person gets stuck.  Much like a record, just going round and round in the same phase.  This is also true for those around the grieving person.  If we have unresolved issues, we will have a difficult time being around any grief.  It is difficult to discern the difference, because "stuckness" is simply an extension of normal, acute grief.  The key is that it "feels off" to people around them.


Stage 1

The first stage of grief is shock and denial.  This stage is characterized by feeling and acting chaotic. Often a person will say that they feel crazy or disorganized.  Often it will be difficult for the person to concentrate and stay focused.  This is usually exacerbated by cultural norms that require life to go on and for the person to be "tough."  The internal experience just does not fit, so the person feels guilty or ashamed that they do not have better control.  No words can capture the full depth and intensity of grief, so the person has a great deal of trouble defending themselves from these messages.

            The people around often have similar reactions, wanting to minimize and make things OK.  There is often a sense of great helplessness.  This is often captured in the phrase - "I don't know what to say."  This is shock and denial on our part.  The mind freezes and we draw a blank.  It is the "Oh no, this can't be true."  And (in a secret place) “I don't want to deal with this.”  Denial is important and necessary in the beginning.  Often we know the truth before we totally accept it.   Shock and denial protects us from being totally overwhelmed, and then the dealing with it comes in small manageable pieces.  This is why it takes so long.
 
            It is difficult to give a time frame for stages, since each person is different and the shift from one stage to another is usually gradual, seldom sequential and not ever neat and tidy.  Often a person will experience all the stages in a whirl from time to time, but each stage has a specific set of tasks that has to do with healing and restructuring and a characteristic mood or "sense of."

            The shock and denial phase of the non-mourner is much shorter and usually passes quickly, and we do think of something comforting to do or say.

      A person who is stuck (chronic grief) in shock and denial is amazing to be around.  They seem strong and in control.  We seem to admire them and wish we were that tough.  Do not believe it.  This type of behavior is necessary and appropriate to get through the first few days or weeks after a loss, to simply accomplish all the practical tasks required.  But if there is no reaction, it is a danger sign.  This stuckness is characterized by lack of, or inappropriate, affect or feeling.  There is a strange incongruence in affect and behavior that does not fit the circumstances.  I have come to call this "chirpy."

            Chirpiness is probably the result of a lifetime of "being there" for everyone else and feeling too terrified of the vulnerability of "breaking down" and needing to ask for something from others.  Someone stuck in this phase is certainly no trouble to be around.  They do not bother anyone with their problems.  They are also impossible to get any closer to.  A safe distance from others is the rule here, so as not to risk grieving.  This is most likely related to early abandonment issues and as a youngster this person was required to perform far beyond their developmental abilities.  The way to help someone in this terrible dilemma is to gently insist on closeness.  In short, to offer the help this person is so terrified of asking for.


Tuesday, September 20, 2016

On The Other Side Of Grief (continued 2)

What seems important is to recognize some of the signs of mourning and to know we will have a parallel process.

     Having dealt with grief from the inside out as a bereaved parent and a bereaved child, and from the other side of grief as a professional, there are a few other things I have learned.

            Sudden, shocking loss is one of the most difficult aspects of our humanness.  I am talking about any loss, not only death.  There is divorce, loss of jobs, loss of health and youth, moving, etc.  And the biggest surprise: Wonderful events always embody loss.  The birth of a child, marriage, a promotion, a new house and any success means leaving something behind.

            Most people move through grief in the context of family, friends and community.  Many with the help of their faith and church.  It is only a problem when a person gets stuck in one of the stages.  This brings me to the two most common questions asked.  First is "Well, how long will this take?" or "How long should it take?" Second is, "Is this normal?"

            In the attempt to answer these questions I have defined grief as either acute or chronic.  Acute grief is the normal, natural process that people move through.  Chronic grief is when the grieving process is shut down and stuck in a particular phase of the grieving process.  It doesn’t matter how or when this happens, if the process is shut down it will never be finished.

The first year is the hardest.  It is the hardest because it is the anniversary year.  Each holiday or special time is the first without the lost person, lost job, lost community, or whatever the particular loss might be.  Around the first year anniversary a marked change is usually evident.  Not that grieving is done, but the acute submersion is less.  I am deliberately not being very specific, because grief is so individualized.  To set time frames would compromise the respect and dignity of a person's right to grieve in their own time and in their own way.  There simply is no logical sequence to all the feelings - they come when they come, and not on schedule.