Showing posts with label grief. Show all posts
Showing posts with label grief. Show all posts

Wednesday, July 6, 2011

Mid-Week Balance: 6 July 2011



I realized, as I went back through my starred post, I noticed a pattern. As I reviewed the posts, the dominant theme of giving yourself space emerged--giving yourself permission to be human, to have bad days, to grieve, to accept that sometimes we all need some grace. I hope you feel the permission when you need it.

Jen Gresham at Everyday Bright asks what happens when Wonder Woman doesn't feel so wonderful. It's such a thoughtful reminder that we all have periods of struggle.

It's not unusual for us to try to hold back difficult feelings or deny their existence. Elisha Goldstein of the Mindfulness & Psychotherapy blog offers this thoughtful reflection on why feeling our grief can be good for our health.

Mara of Medicinal Marzipan offers a compassionate, self-loving challenge to the idea that we must always be "consistent." When we focus on each moment, we're freed from the effort to seek consistency.

I was absolutely floored with the concept that Melissa (Dr. Snit) of Living With Lupus--But Dying of Everything Else explored in her latest post. She talked about serious illness as being a time when we are in a "state of grace." Read more to understand what this means to her (what it means to me might be a blog post of the future).

Okay, bear with me, this last one may see like a stretch at first. But actually, since we are talking about allowing ourselves to be real and imperfect, it's a pretty good fit. I was thrilled to see this piece at the Ms. Magazine blog about how the AMA is taking a stand against digital retouching of photographs--which is all about hiding "imperfection."

I hope this brings some self-acceptance to your week. Got another great resource? Pass it along!

Wednesday, March 9, 2011

When "Helpful" Isn't--Part Two



In a response to the original "When 'Helpful' Isn't" post, Twitter user @BookMD said something that made me take notice. In fact, her response absolutely nailed something that I tried to articulate in the original post, but I feel like it is important enough to merit a "Part Two."

Before I launch into that, let me review my list of sample un-"helpful" responses:

* Everything happens for a reason.
* This is part of a bigger plan.
* You can have another baby (get married again, apply for another job, etc).
* You just need to think positive.
* It will feel better tomorrow.

Here is the concept that @BookMD pointed out. While there is power to thinking positive, to looking at the bigger picture, to having hope . . . it is very hard to access that intellectual power when you are FEELING intense pain or loss. And when someone offers an intellectual response when you are in the midst of feeling pain, that creates a disconnect.

In the original post, I described this disconnect as "feeling dismissed." As I have reflected further, I think that the emotional experience of these unhelpful responses can be more insidious and damaging than "feeling dismissed" implies. The disconnect that is created when an intellectual response is offered to emotional pain can create a sense of being judged.

The sense of being judged can arise because these unhelpful responses, which I have also heard described as "stock," "cliche" or "pat," do not actually acknowledge the feelings and experiences of the person in pain. There is not a space in these responses where the pain can be seen and validated. Worse, there can be an implication that the person in pain is somehow responsible for their pain. Clients describing moments of "unhelpful" help report that they often ended up feeling as though it was their fault that they are hurting. My clients say that they walk away from those kind of responses feeling that if they were more positive, hopeful, tough, etc, they would just be able to banish their pain.

The reality is that our feelings exist. They exist even if they are uncomfortable to us or others. They exist even when there are logical reasons for them to dissipate. They exist on their own terms, regardless of the needs or expectations of those around us. So offering someone who is feeling pain an intellectual response is generally not helpful. Sometimes, it can even cause additional hurt.

In the first post on this topic, I explored some of the reasons that people might respond in unhelpful ways, as a well as a short list of suggestions for more validating responses.

I want to reiterate that the most helpful response when someone in pain is often taking the time to listen to their experience. Most folks in pain do not need someone else to help them interpret their feelings, or to try to make meaning out of their struggle. The most healing gift is the permission to feel and express those feelings honestly.

What barriers have prevented you from offering "helpful" help in the past? How have you overcome them? What was the most helpful response you received while in pain?

Wednesday, February 9, 2011

A Response to "Rethinking Grief"



In this recent article, the author explores a new book by Ruth Davis Konisberg, "The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss."

There are several points made in the article that I absolutely agree with. Elisabeth Kubler-Ross's five stages of grieving (denial, anger, bargaining, depression, acceptance) are now widely embedded in our cultural understanding discussion of grief. Even folks who have never heard of Kubler-Ross use those terms and the idea of "grief stages" to discuss grief and loss. And I agree with both Ms Konisberg and the article's author that there is very little empirical support for the idea of discrete "grief stages" that are moved through in a clear, easily identifiable manner.

Like Ms Konisberg, I believe that the concept of clearly defined "grief stages" can actually make grieving feel more challenging for those whose grief doesn't follow the Kubler-Ross model. When I work with clients, we talk about the common emotional components of grief (sadness, anger, confusion, loss, loneliness, etc). We discuss the fact that many people experience grief emotions more than once in their grief process. And finally, we talk about the fact that each person's experience of grief is distinct and unique.

Finally, I agree with Ms Konisberg's premise that grief is a natural human experience. I believe that most people experience and process grief without the need of additional support and intervention. I think that identifying and supporting our strength and capability for resilience is critical to our emotional health.

I did have one significant reservation as I read the article and explored Ms Konisberg's book. There is a mention of complicated grief, such as might be experienced after suicide, loss of a child, compound losses, etc. However, I was concerned that individuals with complicated grief may feel disempowered by the suggestion that grief is a relatively quick process.

I think that the central tenet that grief is deeply individual, not responding to any prescribed formula is an important take-away. I hope that readers whose grief is not "quick", are able to hear that their grief is valid and not necessarily unhealthy.

What have your grief experiences been? What was the best support you received? What support felt least helpful? Is there a resource that you wish had been available during your grieving?

Friday, July 30, 2010

Complicated Grief: Surviving Suicide



This is the second in a series on complicated grief. The first post in this series explored the challenges of surviving perinatal loss. Today, I'll be exploring how the suicide of a loved one can also lead to complications in the grieving process.

Defining Complicated Grief
Complicated grief is grief that is triggered by a loss that is out of context with normal, developmental losses. For example, the death of a parent when you are in your 60s is a painful event, and it is developmentally appropriate. The death of a parent when you are in your 20s is unexpected and out of context, so your experience of grief may be more traumatic. Another indicator of complicated grief is that the normal emotions of grieving (e.g. sadness, denial, anger) may be felt with greater intensity or may last longer than expected. Finally, complicated grief can occur in situations where the loss has a negative effect on your social support system.

Surviving Suicide
The term "suicide survivors" is often used to describe the immediate family and close friends of those who have committed suicide. This term may also include care-givers or others who are connected to someone who completes a suicide. Sometimes, the family and friends of a person who attempts suicide, but does not complete it, may have parallel experiences. Suicide survivors often experience all the components of complicated grief.

Loss Out of Developmental Context

Everyone knows that they will lose loved ones to death. These losses can occur in multiple ways. A loved one can die of cancer, heart attack or other illness. They might die in a car wreck or other accident. They may even die of old age. However, with all of these types of death, people who are left behind are able to understand that their loved ones did not choose their deaths.

The primary feature that sets deaths by suicide apart is that suicide is ultimately seen as a choice. Even the language used to describe suicide (e.g. "committed suicide") implies the element of choice or control exercised by the person who died. The sense that "they chose to leave" is a primary feature that places loss by suicide outside of the normal developmental context of loss.

Emotions of Greater Intensity

The same feature that sets suicide loss outside of the normal loss context is a primary reason that many suicide survivors experience their grief emotions at higher intensity. When it feels as though a loved one has chosen to die, to leave, that can strengthen the intensity of emotional reaction.

Some survivors of suicide deal with very strong denial. They cannot bring themselves to accept that a loved one's decision was a choice. You may feel the need to find an external source of blame. They may also cope with the loss by focusing only on the good memories or the strengths of their loved one. When asked about feeling angry or abandoned, they may react strongly in defense of the person who committed suicide.

Many suicide survivors also struggle with guilt and unanswered questions. They may feel as though they should have "known" or "done more." Even if their loved one left a note, most survivors of suicide have additional questions about the motivation behind that decision. The guilt can be nearly paralyzing, as they struggle to understand a decision that makes no sense to them.

One of the most challenging emotional experiences for suicide survivors is anger. While anger is a normal part of our grief emotions, anger after suicide is often more complicated. Anger after a suicide may be directed at ourselves for "not knowing." Self-directed anger may be complicated by guilt. It may be directed at a third party (case manager, school, etc.) because they did not prevent the suicide. But the most difficult level of anger is the anger survivors may feel is anger at the loved one who committed suicide. For many suicide survivors, this anger is so intense that it can feel like it entirely wipes out the memories of positive parts of the relationship (at least in the short term).

Challenges with Social Support
Surviving suicide can be also be difficult because survivors may not feel able to utilize their normal social support network. This can happen for several reasons.

When one member of a family has committed suicide, the rest of the family may struggle with openly sharing their pain within the family. Family members may be dealing with different emotions at different times. Survivors may be sensitive to "upsetting" one another by talking about their pain.

Because suicide is viewed as a choice, there is a lot of social stigma around discussing death by suicide. This stigma can impact social support in several ways. Some friends or family may not know how to address the suicide, and so may appear to be unaware of survivors' pain. They may choose not to discuss their loss because they are protecting the memory of their loved one--survivors do not want them to be remembered or judged by that single choice.

Finally, the intense emotions that many suicide survivors face may make it difficult for them to get support from their normal social support network. Survivors may be concerned about overwhelming those around them. They may be worried about how feelings of guilt, anger, or loss may reflect on their loved one. Survivors may simply not have the words to describe what they are experiencing.

Getting Support

Losing a loved one to suicide can create complicated grief. It is important for survivors to find the right type of support as they navigate the challenges of being a suicide survivor. Whether seeking individual therapy, family therapy, or a survivor support group, many suicide survivors benefit from being able to explore all the components of their grief in a safe, supportive environment.

Resources
If you have survived the suicide of a loved one, or are concerned that someone you care for may be at risk of suicide, here are some resources:
Suicide Awareness Survivor Support
International Association for Suicide Prevention
Books by and for Suicide Survivors

Please reach out for any support you need!

Wednesday, April 7, 2010

Complicated Grief: Perinatal Loss



This is the first in a periodic series about dealing with complicated grief. Today, I'm exploring the complicated grief that can accompany perinatal loss.

Defining Complicated Grief
Complicated grief is grief that is triggered by a loss that is out of context with normal, developmental losses. For example, the death of a parent when you are in your 60s is a painful event, and it is developmentally appropriate. The death of a parent when you are in your 20s is unexpected and out of context, so your experience of grief may be more traumatic. Another indicator of complicated grief is that the normal emotions of grieving (e.g. sadness, denial, anger) may be felt with greater intensity or may last longer than expected. Finally, complicated grief can occur in situations where the loss has a negative effect on your social support system.

Defining Perinatal Loss
Perinatal loss is the loss of a child either during pregnancy or delivery. Perinatal loss can include miscarriage, stillbirth, death from birth defect, or loss at delivery (e.g. cord death).

Loss Out of Context
A perinatal loss is out of the developmental context of loss. Children expect to outlive their parents. Parents do not expect to outlive their children. Living through the loss of a child can be intensely traumatic for couples, as evidenced by recent research. This developmental mis-match can also contribute to the difficult emotions that parents may face.

Intense & Challenging Emotions
Parents who experience the loss of a child or an expected child might expect to feel sadness, confusion, or uncertainty. What can take them by surprise is both the intensity of the emotions they experience after perinatal loss and their experience of the challenging emotions of anger, anxiety, and jealousy.

Sadness might seem like an inadequate description the pain parents feel. Intense grieving, including tearfulness, depressed feelings, and difficulty interacting with others, can last for months after the experience of a perinatal loss. Many clients who have experienced perinatal loss report feeling worried that they will never stop feeling sad.

Many parents are unprepared for the experiences of anger, anxiety, and jealousy they may have following a perinatal loss. Parents have talked to me about feeling angry when they see parents who do not seem to appreciate or properly care for their children. Parents can experience anxiety about whether or not they will have the same losses if they attempt future pregnancies. They also describe feelings of jealousy when they see other pregnant women or parents with very young infants.

Challenges to Social Support
The final way in which perinatal loss is a complicated grief is the potential it has to isolate parents from their natural support systems. This isolation can happen for several reasons.

First, particularly for very early miscarriages, it is possible that many people in parents' support systems either may not know about the loss, or may not characterize it as a source of grief. Parents may hear such statements as, "Don't worry, you'll get pregnant right away," or "Miscarriage is pretty common." These statements are often meant to be helpful, but many parents report feeling that their own sadness was dismissed by such statements.

Because pregnancy losses are out of developmental context, many members of parents' support systems do not have a comparable loss to draw upon. This can cause people in the support system to pull back because they are unsure of how to be helpful.

The intensity of emotion experienced by parents can also impact social support. It can be challenging to explain that you aren't able yet to attend your cousin's baby shower, or to hold another infant in the family. Parents report judging themselves (and fearing judgment from their support systems), for their feelings of jealousy or anger.

Finally, some social support systems simply aren't prepared for the duration of grief after a perinatal loss. Parents express feeling that their grief has outlasted the "grace period" that was allotted for it.

What to Do?
If you, or someone you know, has experienced perinatal loss, there are good resources for you. In the Kansas City area, Alexandra's House is a resource for parents who have learned that they may be facing loss during or shortly after pregnancy. For parents who have already suffered a loss, Shawnee Mission Medical Center offers a Perinatal Bereavement Group that meets bi-monthly.

It is important for parents to continue talking to one another, to give one another permission to grieve differently, and to seek as much support as needed.