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Wednesday, February 27, 2013

I Didn't Tell My Son Goodbye and I'm Glad

The last time I spoke to my son was the morning before the plane crash that took his life.  He was in a hurry, as usual, so we talked briefly, we both exchanged “I love yous” and  he told me he would call me later.  He never did. 

Ever since that day I have trouble with any type of goodbye.  I sometimes wonder if that is a result of the loss of my only child or if it was the result of an experience I had early in my grieving journey.

Site of Plane Crash; Bloomington, Indiana

Shortly after my son’s death I went to see a grief counselor and she insisted that I write a letter to my son telling him goodbye.  She felt that this would be helpful. She believed that because of his sudden, violent death I hadn’t been able to say goodbye before he died like parents of ill children.  This was supposed to be an exercise to help me to come to terms with the loss and finality of his death.  It proved to be an awful experience for both the counselor and myself.  I was infuriated that I was told I had to tell him goodbye.  Although I realized he was gone and not coming back I refused to say goodbye, I wasn’t ready and I didn’t know if I would ever be ready—and that’s what I wrote.  This wasn’t well received by the counselor because I didn’t follow the “textbook” response to the exercise.  She and I argued over this issue as I tried to defend my position.  It was exhausting for me at a time when grief was already taking my energy—but I felt strongly about it and would not back down.  He was my son, my only child, and no one would tell me to say goodbye to him.
This experience and several other unfortunate experiences with other experts and first-responders was what convinced me that I wanted to become a counselor and to specialize in grief counseling. No one can tell you how to grieve; no one can take on the work of grieving for you.  You have to find your own path on your personal grief journey.   In writing this post I found online a story about a woman whose only son was killed by a train in 2003.  Maria Malin wrote a book about her journey, called “When You Just Can’t Say Goodbye, Don’t.”  Maybe I should send a copy to that grief counselor.

Thursday, February 21, 2013

Stop the Presses--The Misuse of the terms Grief & Bereavement

In last couple of days I have noticed the words grief and bereavement used in headlines of stories on the internet that had nothing to do with death.  I understand that with many major losses such as job loss, dissolution of a relationship, or a traumatic event there are similar feelings related to grief symptoms.  However the use of grief and bereavement in these two instances bothered me. 

The first instance was titled, “Church is in Bereavement over Pope.”  In the author’s defense the title was taken from a quote from Auxiliary Bishop Charles Sicicluna who said, “The church is in bereavement, coming to terms with bidding Benedict XVI farewell and waiting for his successor.”  I understand this historical significance of the Pope deciding to step down but I can’t see the choice of the word “bereavement” to explain how people are feeling about this change.  There is no death, no loss, only a change in the head of the church made by the Pope’s own choice.
The second instance was titled “Grief and Organizational Change” and uses the five stages of grief to discuss changes that happen in business and how to deal effectively with them.   This one was particularly disturbing to me.  I then did a Google search on Grief and Organizational Change and found over 175,000 results including a book published in 2009.  I find it interesting that people writing about business would want to use the bereavement comparison when business is so unsympathetic to employees who are bereaved.
The reason for pointing out these two instances is to say that in our culture where grief and bereavement are so misunderstood and sometimes swept under the carpet the use of these terms for other purposes tends to dilute the definition and does a disservice to the people who are suffering through their own grief journey. 

Tuesday, February 19, 2013

Grieving My Son...It is a Lifetime Endeavor

Last night I had a personal reminder that the grief wound may heal but the scar is always there.  I am in the process of “downsizing” my possessions in order to make a move to another apartment.  In an attempt to consolidate my boxes of memories of my son I decided that it was time to dispose of his middle-school yearbooks.  I don’t look at them and there isn’t anyone who wants them so I felt it was time to let them go along with many other things I had been storing.  I picked up one of the yearbooks and was putting it into the trash pile when two photographs fell out.  These photos were taken in 2003, about a year before my son died and I had never seen them before.  I can only guess that he put them in the yearbook to get them out of the way but I’ll never know.  The photo’s showed him looking happy and joking around with whoever was taking the pictures.  The one photo was of him standing at the stove of his apartment cooking up something.  Robert loved to cook for his friends and considered himself something of a gourmet.  The other picture was of him and his girlfriend at the time and they both were making goofy faces. 

It was a surprise that after 7 years I found pictures I had never seen before.  It was also a moment where I felt the pangs of grief for the life that was taken from him at age 24 and the future we would have had together.  However I also was able to appreciate the journey I have traveled through my grief. In spite of the sadness I felt I was able to smile at the young man in the picture and the memories of a time when he was so happy and creative and living life to the fullest.  I am so proud to be his mother.  I love you, Robert.

Sunday, February 17, 2013

Two fathers started an initiative, the Farley-Kluger Initiative, in 2010 determined to amend the current Department of Labor FamilyMedical Leave Act (FMLA) to include bereavement leave for parents when their child, up to age 26, dies. 

At the present time the FMLA is a federal law that requires companies with 50 or more employees to afford their employees 12 weeks a year of unpaid time off for their serious health condition or that of their children up to age 18, spouse, and parents.  It also covers the employee after birth of a child or adoption placement. There is also a section related to military leave.  
The two men who began this initiative are both authors of books about their own grief journey after the loss of their children.  Barry Kluger’s only child, his 18-year-old daughter, Erica was killed in a car accident in 2001.  Kelly Farley’s daughter, Katie, and son, Noah, both died in infancy within 18 months of each other.  Kluger’s the author of A Life Undone: AFather’s Journey Through Loss.  Farley’s book is called Grieving Dads: To the Brink and Back.
After both Farley and Kluger’s lobbying attempts in Washington D.C. there has been legislature introduced in the Senate and the House to make this amendment happen. Currently there is a bill before the Senate.  However Farley stated that he was informed that only about 10% of the bills introduced are ever approved.  The two men have started a petition campaign online in order to get the word back to the legislature that people want this change.
I have mixed feelings about this amendment.  As a parent who was in this position almost 7 years ago my first reaction is that this is a wonderful change and is something that every parent needs.  The early stages of grief after the death of a child are so chaotic and life-altering that an individual’s focus is all-encompassed on dealing with the symptoms of the grief.  As I discussed in my previous post about grief in the workplace there are problems with concentration and memory that affect the worker’s performance and the probability of triggers that cause crying is always there.  This 12-week leave would give the grieving parent time to get past the most critical and intense grief period. 
However I am concerned about the employee whose spouse or parent dies.  These employees may have already been on an FMLA leave caring for the ill spouse or parent and once the death occurs the employee is no longer eligible for FLMA, has only the company’s bereavement time available (usually 1-3 days) and then must return to work.  This can be an awful predicament for an employee who is exhausted from being the caregiver for their loved one for weeks, has been experiencing anticipatory grief (I will discuss this in detail in a future blog) and is now in the full throes of early grief symptoms. 

Then there is the employee whose spouse dies unexpectedly leaving them with young children who are themselves grieving or the employee whose spouse had handled all of the household business and now the employee has to take over all of these responsibilities.  Both of these scenarios require concentrated time for the employee to be able to bring his or her life to a new normal and FMLA bereavement leave would be appropriated in these cases too.  Just as no one grieves the same, no loss is the same.  There is a general consensus that the death of a child is one of the most devastating losses and having experienced it personally I would have to agree.  However I also appreciate the fact that the initial grief after the death of a spouse or beloved parent can be a devastating blow. 
So, should this amendment be only for parental bereavement leave or be opened up to include the same criteria that the original FMLA covers and include spouses and parents?  In my opinion it should include these loved ones.  Most employees can not afford to take time off without pay therefore I do not believe that this will be an overused leave option which is the fear of opening it up to more reasons.

I would be interested to hear other people's opinions of this change in the FMLA.  What do you think? 

Friday, February 15, 2013

10 Things You Should Never Say to a Grieving Person

Most people don’t have a clue what to say to a person who is grieving.  They find it awkward and uncomfortable because they are dealing with their own emotions related to death and immortality.  What they say can have a profound effect on the grieving person and can be remembered by that person for years.  The best advice is to just say, “I’m sorry” and leave it at that.  It is better at this time to allow the griever to do the talking and be a good listener.  They will appreciate you so much for that!  A hug can say much more than words and is harder to misinterpret.

Below are ten examples of things that were either said to me or have been said to other grieving people who have shared them with me.  The comments below the examples are there just to get you thinking and start a conversation.  Some of the comments may seem trite, or tongue-in-cheek, or a little rude, but sometimes that is how a grieving person may feel at the moment.  I hope this helps you think before you speak the next time you are in front of a grieving person.  If you are the grieving person who is confronted by one of these statements perhaps you will reflect on the fact that the person is reacting and not thinking and this might help to soften the blow a bit.
I’d love to have you join in the discussion and send me other examples that you have experienced first-hand.
1. I know just how you feel.
No you don’t.  We are different people.  Everyone grieves differently and every relationship with the deceased loved one is unique.  You can’t know how I feel, but you can ask me how I feel.
2. You are so strong.  I could never live without my ___________. (insert--child, spouse, partner, mother, father, etc.).
No I’m not strong.  In fact I have never felt more weak or confused.  I don’t know what else to do but move through this nightmare.  I didn’t have a choice.  Telling me I’m strong makes me feel more confused.
3. God only takes the best.  He must have really needed him/her.
I really needed him/her more.  I wish he/she wasn’t the best and was still here with me.
4.  It’s been… 2 days, 2 weeks, 2 months, 2 years.  It’s time for you to get over it and move on.
There’s a timeline?  No one told me there’s a timeline.  I don’t feel ready, so I’m not ready. 
5.  Don’t cry. He/She wouldn’t want you to be sad.
Really?  I don’t think we ever had that conversation about how to act after one of us died.  I think not crying would be worse.  I have to be able to express my feelings and I think he/she would be proud of me for doing that.
6.  It’s time to give away his/her stuff.  You can’t keep it forever.
Again with a timeline?  Why can’t I keep it forever?  As long as I am making strides forward in my life there’s nothing wrong with keeping my memories of this person who was so important in my life.
7.  You ought to…move out of your house, go on vacation, start dating, get out more.
If my loved one hadn’t died would you be giving me this same advice?  Why do you think it’s ok now?  I can’t make these kinds of decisions right now.  Give me room to breathe.
8.  You should get a goldfish, kitten, puppy.  You should have another child.
I am having trouble taking care of myself right now.  I can’t remember to water the plants and you want me to take on another responsibility?  Oh, and by the way, another child isn’t a replacement.  It’s not like buying a new car.
9.  Can I have his/her car, clothes, sports equipment, books, music collection…?
Um, no. 
10.  Everything happens for a reason.

There was no reason for this.  I can’t believe this.  My loss may eventually have meaning in my life but it didn’t happen for a reason.  Death happens, just like life happens.

Tuesday, February 12, 2013

Walking the Grief Maze

Grief is probably one of the oddest and unsettling experiences that the average person goes through in their lifetime.  There is nothing logical about the symptoms or the length of time each person requires to adequately grieve the loss.  The griever worries that something is wrong with them. The people around the griever encourage this attitude by benchmarking grief and measuring the experience.  Too often a grieving individual is told that it’s time to get over it.  When the greiver internalizes this and isn’t able to meet the mark he or she may feel ashamed and guilty.  These feelings on top of the grief are a lot for anyone to handle. You can not try to think your way out of the grief, or place blame on yourself for not progressing. 

The term grief journey is used often and for a good reason.  It’s not a single episode or a few days of public mourning.  This is a journey on a path that hasn’t been traveled before.
I think grief is more like traveling through a maze.  You begin to walk the maze and come to a block, you may have to turn around and go back over your steps and start again, you walk around and around the maze confused and anxious.  Sometimes you think there is no way out of the maze.  Occassionally you meet a fellow wanderer and the two of you can work together because you are experiencing a similar maze.  However in the end the maze is yours to explore and walk through until eventually you find your way out.  You never forget the maze and the changes walking it has made in your being, but you move on putting one foot in front of the other.

Monday, February 11, 2013

When Grief and Work Collide

In the United States the average bereavement leave is from 1 to 4 days.  What happens when the grieving employee returns to work?  People who are grieving often want to get back to their normal routine and going back to work offers them that chance.  However while grieving the individual may be having trouble sleeping, have changes in eating habits, have decreased energy levels, and be subject to crying spells.  Add these issues to the stress of a work day and this can be a recipe for an emotional roller coaster for the employee and confusing for co-workers.

When my son was unexpectedly killed in a plane crash nearly 7 years ago I was fortunate enough to have an extremely understanding boss who allowed me to take extra time beyond the 3 bereavement days provided. When I returned to work I was surprised by the different reactions I received from my co-workers.  Some of my co-workers would see me, quickly turn around and walk away, unable to face me and their own feelings about death and grief.  Other co-workers regaled me—on my first day back—with their tales of loss and grief, or those of someone else they knew, as a way to bond with me in some strange way.  Then there were the co-workers who saw me and broke down in tears.  The co-workers who helped the most were the ones who just told me they were glad I was back and went on about their day.

As the weeks went on my co-workers went back to their normal routine, but I was still experiencing grief and having difficulty concentrating and trouble with my memory which made working more difficult.  Worse yet were the unexpected triggers during the day that could start tears running down my face.  It could be something as simple as hearing a song in the hall that reminded me of my son or someone on the phone might have the same name or date of birth as my son.  Through it all I thought I was moving ahead, wiping the tears away, and still doing my work to the best of my ability.  I didn’t know that my co-workers were judging me.  Most of them felt like I should be “over it” by now and that there was something more ominous and serious wrong with me.  The biggest lesson that business and workers need to understand is that grief is not a predictable, neat process.  Everyone will experience grief differently and react differently.  Grief and the symptoms of grief do not stop after the 3-day bereavement leave from work!
With approximately one in four employees grieving at any one time there needs to be more understanding of the effects in the workplace.  I think that there needs to be education provided by the employer in order for the griever and those working with the griever to know what to expect—or more importantly, what not to expect.  Someone in who is already in an emotionally fragile state should not have to be concerned about how they are perceived at his or her workplace.  I’d like to hear from others about their experiences when grief and work collide.

Saturday, February 9, 2013

Grief and Mindfulness-Part Two

As I discussed in Part One of Grief and Mindfulness, there are lessons that can be taken from the Buddhist’s mindfulness meditation practices that can help a grieving person.  Sameet Kuhmar,Ph.D., author of Grieving Mindfully reminds the reader that mindfulness is a practice.  It is not learned all at once and each session is different because you are different at each session.  For the purposes of this post I am going to explain three very simple techniques that can be used at any time during the grief journey and even after during distressing times.

First, is the use of diaphragmatic breathing, sometimes called belly breathing.  There are lots of different ways you can sit for this technique but it is important that you feel grounded.  Another words your feet should touch the floor or ground and your hands should be in your lap, on your legs, or on your belly.  This breathing technique requires you to breathe in while expanding your stomach instead of your chest.  This may take a bit of practice to begin with since it’s not the usual way of breathing.  On the inhale expand your belly while counting  to 5 or 7.  You will find what is a comfortable count for you.  Then on the exhale bring the belly in towards your spine while counting to 5 or 7.  Then repeat.  Try to concentrate on your breath, your counting, and the feelings in the various parts of your body.  If you lose concentration and your mind wanders, just notice and acknowledge that and start again.  In grief and anxiety we tend to not take deep breaths.  Early in grief many people sigh often, probably because they are not breathing deeply or properly.  This exercise will help to calm the breathing and focus the mind.
The second technique is a muscle tension and relaxation technique.  The tension in the body when you are grieving or anxious can cause you to feel sore and experience muscle pain.  This exercise should help to relieve some of that.  This exercise can be done any time of the day but it is especially useful to relax prior to going to sleep.  For this technique you need to lie down on your back with your hands by your side and legs extended.  Starting at your toes and feet you will tense up the muscles and then relax moving up the body until you  reach the top of your head.  So, to begin you tense and curl your toes, hold for a count of 3-5 and then release, pause and then tense your entire foot for a count of 3-5 and then release, etc.  Remember to keep your breathing natural and constant throughout.  Don’t hold your breath when you tense up.  The end result should make you feel less tension throughout your body.  As you are doing this you may also recognize certain parts of your body where the tension is more centered.  This is an important part of the mindfulness process in order to become aware of your body and how you are feeling.
The third technique may seem very simple, but if practiced correctly it can be very meditative.  This is called walking meditation.  The best way to practice walking meditation is to find a path in nature where you can walk and concentrate on your pace and on the beauty and serenity around you.  You begin walking and try to concentrate on your steps, on the sound your feet make on the ground.  Try to keep your mind centered on the task of walking and listening.  If your mind wanders to other thoughts it’s ok, just acknowledge it and let it go and begin again to concentrate on your steps.  While you are walking you can listen for the sounds of nature, the wind through the trees or the birds singing.  The purpose of this exercise is to calm your mind and body and to practice staying in the moment and allowing yourself time to soothe.  This is a time to let go of the sorrow of the past and the worry of the future and to be in the now.
I hope these techniques can help you as much as they have helped me.  I used these in the early, tumultuous days of my grief and I still use them often.  If you want to read more about mindfulness I recommend that you look at the books written by Jon Kabat-Zinn, Ph.D., one of the pioneers of mindfulness in the U.S.  If you would like to read more about mindfulness and grieving the book by Kumar is a good resource.

Friday, February 8, 2013

Grief and Mindfulness--Part One

I was able to use mindfulness techniques in order to help me through with my grief.   I am so grateful that I was exposed to these easy to use techniques early in my grief journey.  What I learned about mindfulness meditation helped in those early months and continues to be something I use during times of stress and difficulty.  In this first part I will introduce you to one of the pioneers of mindfulness and medicine in the United States and then I will begin to explain why mindfulness can help the grieving person.  In the second part, I will explain some of the techniques that can easily be employed and used wherever you are.  I have added links to the author’s books for those who want to learn more about the subject.

Jon Kabat-Zinn, Ph.D. is the founder of the Mindfulness in Medicine, Health Care, and Society Center at the University of Massachusetts School of Medicine.  He has written numerous books on the subject of mindfulness.  One of the books that he wrote with a group of co-authors is called “TheMindful Way Through Depression” and has been highly successful and well received.

Kabat-Zinn is a scientist, with a degree in molecular biology from M.I.T. so he is not someone who is what you would consider a “New Ager” or into pseudoscience.  This guy has a brain and has studied the impact of mindfulness on the brain and the immune system.  He is considered one of the top experts on the subject.

Kabat-Zinn has been practicing mindfulness meditation since the mid-sixties.  In the late 70’s he started the Stress Reduction Clinic.  He reason for beginning this clinic was to bring Buddhist meditation into mainstream medicine sans the Buddhism.  Kabat-Zinn explains mindfulness as an act of self-compassion by paying attention to yourself in the moment.  Kabat-Zinn stated that he considers healing as “coming to terms with things as they are.” 

One of the few books that I found that combines mindfulness and grieving is “Grieving Mindfully” by Sameet Kumar, Ph.D.  Dr. Kumar is a Buddhist and a psychologist who works a cancer center in Miami, Florida.  Unlike Kabat-Zinn who takes the Buddhism out of mindfulness meditation, Kumar as a Buddhist comes from the Buddhist origin but he also states that as a psychologist he believes that the ideas of mindfulness can be successfully translated into the psychotherapeutic world.

Unlike some grief therapy methods that suggest that the grieving individual try to do everything they can to not think about the pain and sorrow they are feeling and to re-direct their energy, mindfulness asks that the griever tune into the pain of what Kumar calls the “intense pain of love after loss.”  Instead of denying the grief, mindfulness requires you to come to full awareness of the grief in order to really feel and experience the pain in order to soften the pain by living only in the moment.  Mindfulness allows the griever to mourn and experience the grief and learn from it in order to grow and be able to move away from the misery and make meaning of the pain.

Kumar notes that grief can be more difficult when we try to numb ourselves of the feeling and try to rush the grieving journey.  He states that often people around the griever will encourage the individual to move forward, get over it.  Kumar says that gives the griever the message that they are doing something wrong.  Kumar says that when we look at grief as an extension of our love than we can understand that there is nothing wrong with grieving.
Next--Part Two- Easy Mindfulness Techniques for the Grieving Heart

Thursday, February 7, 2013

Where is My Valentine? Grief and Holidays

I read a brief, interesting article online today about Valentine’s Day related to grief and loss.  Most people think about those who have experienced the loss of a loved one having to deal with the first major holidays such as Thanksgiving or Christmas or commemorating the first birthday following the death.  However for the grieving individual even the small holidays may bring back memories that cause a tsunami of emotions that are unexpected. 
I know that for me, personally, the first Halloween was difficult because it had always been an especially fun holiday in our house and my son had enjoyed it so much.  Five months after his death I walked into a craft store, saw the Halloween display and had feelings of gut-wrenching, unexpected grief.  I had to immediately leave the store and sat in my car in tears.  Now almost seven years later I can remember the holidays with my son with happy memories.  I still will remember him on Valentine's Day and think about previous Valentine's Days we spent together but there will be more smiles and less tears.
Grief is not a nice linear progression.  I have heard  grief explained like a walk along a beach. Sometimes the waves of grief merely come up and lap across your feet, at other times the waves swell up and almost carry you away.  Then there are times when the wave is so big and engulfing that it surprises you with its intensity and knocks you down and takes your breath away.  The longer you walk along the beach…or the more time into your grief journey the more you are able to expect the waves and ride them out.  It does get easier to ride the waves.

Wednesday, February 6, 2013

7 Signs of Complicated Grief

Part 2 of Could It Be Complicated Grief?

Now to the 7 signs of Complicated Grief.  This is just a brief list of what I consider the most serious signs that should warrant at least a consult with a professional.  There are more signs (symptoms) that you can read about on the Mayo Clinic site.

1) Suicidal thoughts or actions
One of the most alarming signs of complicated grief can be suicidal thoughts or actions.  This is different from the thoughts in uncomplicated grief of wanting to join the deceased love one or wishing to change places with the deceased in order for them to live.  This is not a sign that should be taken lightly. If there are ANY concerns regarding suicide ideas, plans, or attempts—DO NOT WAIT—contact someone immediately.  Suicide is one of the top causes of death in the U.S. and most people will tell someone about his or her plans within days of the event.  It is better to err on the side of caution and save a life.  NationalSuicide Prevention Lifeline 1-800-273-TALK (8255)

2) Depression or unrelenting sadness
This is not the initial sadness when thinking about the deceased loved one.  This is a deep sadness that you can’t shake after many months that affects every part of your life and isn’t getting better.  Depression is often a complication of complicated grief and may require professional support and treatment.  Often in our society we say we are “depressed” when what we mean is that we are sad or upset about a singular event—this is not the same thing as a true depressive disorder.  If you aren’t sure what you are feeling is depression you can consult a professional who can do an assessment with you to help you to understand what you are feeling.  Depression is treatable with either talk therapy or behavioral therapy to change the negative or faulty thinking that lead you to be depressed and keeps you there.  In addition there are medications that have been found to be effective in treating some forms of depression.  The National Institute of Mental Health has a website with a great deal of helpful information about depression and where to seek help.

3) Life is No Longer Enjoyable
This sign is often associated with depression as many of the signs/symptoms of complicated grief do overlap with depression symptoms.  For this sign the person suffering from complicated grief may feel like they will never feel like they did before and are merely putting one foot in front of the other as they trod through each day.  Activities and people that they use to enjoy no longer have that same feeling.  If asked, the individual would find it practically impossible to name anything they would want to do that would bring them joy.

4) Withdrawing from Social Activities
As the time goes by after the death of the loved one and other people continue on with their lives, the person with complicated grief may feel like they are alone in their grief and that they are the only one who still cares about the loved one.  This also makes the person feel like the world around them is foreign to them because they no longer no how to act/react in public situations.  These feelings along with the feelings of depression will keep the person from wanting to participate in social activities and lead to isolation.  This becomes a dangerous loop because isolation makes it more difficult to move beyond the constant thoughts about the loss and therefore keep the person from venturing out into the world.

5) Bitterness, Anger, Irritability, Agitation
There is often guilt and anger surrounding the death of the loved one, especially if this was a violent death.  These negative feelings are not assuaged by positive feelings and just feed upon each other and this leads to the irritability and agitation that the person with complicated grief experiences. 

6) No Hope in the Future
The person with complicated grief cannot imagine a future without the loved one in it.  Trying to think about a future like that can bring on feelings of guilt and anger.  This can further exacerbate the depressive feelings and make the individual feel hopeless and helpless.  Without meaning or purpose for life the individual can see no future and is incapable of hoping for a different future without the loved one.

7) Difficulty handling normal activities and routines
When there is no hope or meaning, the individual has trouble accomplishing even the most routine activity.  It can be rough for the person with complicated grief to take care of their needs, to handle daily chores, or to concentrate enough to hold down a job.  Some people will look from the outside as if they are coping and handling their responsibilities adequately but enternally the person is struggling to just keep up.

Once again I would like to mention how important it is to know the signs of complicated grief in order to seek out treatment to prevent more serious psychological or physical disorders.  In addition I want to reiterate this post and the previous post were strictly informational and that I am neither a psychiatrist nor a medical doctor.  I have provided links to well-known and respected sites if you would like more information on the subject. Whenever there is any question about an individual’s well-being a trusted member of the medical community should be consulted.

Tuesday, February 5, 2013

Could It Be Complicated Grief? Part One

This is Part One of a two-part post about complicated grief.  This part will define uncomplicated grief and complicated grief and discuss the risk factors that may make someone more likely to experience complicated grief.

It is important to know the signs of complicated grief in order to seek out treatment to prevent more serious psychological or physical disorders.  However before discussing these signs it is important to note that I am neither a psychiatrist nor a medical doctor.  Whenever there is any question about an individual’s well-being a trusted member of the medical community should be consulted.
The Psalm tells us that there is “…a time to weep, and a time to laugh; a time to mourn, and a time to dance.” (Ecclesiastes 3:4, King James Version).  If we live long enough most of us will experience the feelings of grief when we lose a loved one.  It is socially accepted that after the death of a loved one that those left behind will participate in a short period of public mourning. It is pretty evident by the typical business policy for funeral leave of between 1 to 3 days off no matter the relationship of the deceased loved one that our culture expects people to “get over it” and “move on.”  However that isn’t the reality and private grief is veiled in mystery because it is different for each individual and the type of relationship that individual had with the deceased loved one. 
There has been research into “normal” grieving or better termed uncomplicated grief and the similarities in experiences among those grieving.  From this research and reports from the grieving individuals themselves there have been a loosely agreed-upon definition of grieving and the experiences of grieving (Bolen, P. A. & van den Bout, J., 2008, January 15).  With uncomplicated grief the grieving person begins to adjust to life without the deceased love one.  It isn’t a recovery but a process of changes and adjustment that now allows the individual to live a different life.  It can dramatically alter the person however they are able to find meaning and purpose and allow themselves to have hope for the future.
Some of the study results have shown that treatment or intervention for uncomplicated grief is not helpful and there are professionals who believe it is not only unnecessary but harmful to the natural progression.  My personal opinion is that grief is different for each individual and therefore options for support and treatment are individual and should be decided by the grieving individual. 
There are some people who may find grass-roots support groups, run by those who have also experienced loss, most helpful; others may find more formally-run bereavement educational groups, usually held at funeral homes, hospitals, and hospices, a good fit; and others may find talking to a grief counselor or mental health counselor something that is helpful and fits their needs.  There are other individuals who have family and friends’ support that don’t feel the need for other support but many people don’t have this type of support and may need to reach out to these other avenues of support.
Approximately 10% to 20% of all bereaved individuals will develop complicated grief (Lobb et al., 2010).  Complicated grief is sometimes called abnormal grief, chronic grief, or prolonged grief. Complications that can co-occur or happen during complicated grief are depression, anxiety, post-traumatic stress disorder, risks of heart disease, high blood pressure, and cancer.  In addition the individual may continue to struggle with coping with daily life functions and may also begin to abuse drugs, alcohol, and nicotine.
There may be some risk factors that can cause someone to be more susceptible to moving into chronic grief.  Some of these risk factors include when the death is unexpected, violent, or due to suicide; when there is a minimal support system of family and friends, when the individual had a close or dependent relationship with the deceased person.  In addition there are some characteristics that the individual possess that may predispose them to complicated grief, some of these characteristics include, trauma at a child including abuse or neglect, history of separation anxiety in childhood, difficulty adapting to life’s changes and lack of resiliency, and prior psychological problems.
Lobb, E. A., Kristjanson, L. J., Aoun, S. M., Monterosso, L., Halkett, G. B., & Davies, A. (2010). Predictors of complicated grief: A systematic review of empirical studies. Death Studies, 34(8), 673-698. doi:10.1080/07481187.2010.496686
Next –Part Two--7 Signs of Complicated Grief

Monday, February 4, 2013

Through A Child's Eyes-2 Grief Books for Children

Tear Soup: A Recipe for Healing After a Loss by PatSchwiebert and Chuck DeKlylen; Illustrated byTayler Bills.  The story follows Grandy, an old, wise woman and how she copes with grief.  In the book Grandy makes a giant pot of tear soup--an analogy to the size of her grief.  The book is beautifully illustrated and that will draw in the younger family members, but the story told is more sophisticated and palatable for adults.  

I have given it to families to share with their children to help them understand death and grieving and the adults have gained much from reading it to their children. In additon, bBecause of its ease of reading it is good for someone in the early stages of grief who is having trouble concentrating and reading anything lengthy.
Saying Good-bye to Grandma, by Jane Resh Thomas.  This book tells the story of seven-year old Susie and her first experience with death, grief, and the traditional mourning process.  It is a good, straight-forward explanation for the child who is asking what's going to happen.  This is a good book to read with your child to encourage questions and start a conversation.  Throughout the book the love of the family is evident and this in itself is comforting.

Sunday, February 3, 2013

Elephants Never Forget and Neither Do Grieving Parents

An excellent book that explores life after the loss of an adult child is Our Walk With Elephants by Peggy Boon, Ph.D. and Bonnie Headington, Ph.D.  These authors have the distinction of not only being mental health professionals but also bereaved mothers.  One of their most salient points is the fact that bereaved parents continue to grieve over the years.  Once the acute grief is over there are reminders that happen daily, monthly, yearly, that awaken the pain of the loss. A reminder may be as simple as another child's college graduation, a wedding, or a birth.  All of these things will remind the parent of the events they will never experience with their child. The authors approached their need for answers as a research project.  They obtained participants and decided on questions they wanted to examine.  They then conducted structured interviews with the participants and the result is this book.  Although they took a scientific approach to the subject the book is a sensitive, narrative of personal stories of loss and common themes experienced by bereaved parents.

Saturday, February 2, 2013

Grieving on Mars--Do Men Experience Grief Differently?

When Men Grieve: Why Men Grieve Differently and How You CanHelp by Elizabeth Levang, Ph.D.  Dr. Levang, a psychologist and consultant on grief and bereavement, explained the unique way men grieve and in addition she included men’s personal accounts of their experiences with grief.  Dr. Levang discussed the different languages of grief that men and women have.  While women will talk about their feelings men are more likely to try to think their way through the grief.  Dr. Levang stated that the differences in coping style can cause a division between the two genders.  She explained that at a time when we are most in need of compassion and understanding these differences can isolate husband and wife and make communication even more difficult.
It is so important for grievers to understand how individual grief is.  How we process the grief can be affected by our gender, culture, social status, and family background.  Understanding and allowing others to grieve in their own way, time, and space is paramount to allowing ourselves the freedom to grieve as we need.  This book can help the man who is grieving to be able to honor his way of grieving and for the women in his life to understand him better.

Friday, February 1, 2013

Bereavement or Depression--The Great Debate Continues

Lately the mainstream media has picked up on the discussion that has been raised regarding the changes in how depression and bereavement are going to be designated in the revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  This manual and its revisions, have been published since 1994 by the American Psychiatric Association and is used by all mental health professional in the United States to categorize and diagnose mental health disorders in adults and children.

What has caught the attention of professionals and lay-people alike is the changes that are being made in the categorization of depression.  In the current edition of the DSM, bereavement has been carved out as a separate category from a Major Depressive Episode. The guideline states that diagnosis of Major depressive Disorder would not be given until the symptoms had been experienced for at least 2 months after the loss.  Symptoms include: feelings of sadness, insomnia, poor appetite, and weight loss. The DSM differentiates between normal grief and a Major Depressive Episode by advising the professional to look for subtle differences in symptom presentation.

The removal of the bereavement category was explained by the American Psychiatric Association in a news release of 12/1/12 that stated:

Removal of bereavement exclusion: the exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one. 

"Grief is an equal opportunity human reaction; grief affects everyone." explained J. Shep Jeffreys in his book   "Helping Grieving People: When Tears Are Not Enough."  This is an accurate statement.  Everyone will eventually experience bereavement if they live long enough.  However each person reacts differently to the stressors of grief and just as with physical illness some people will be resilient and able to bounce back while others may have a more difficult time and may need support and treatment.  The thing is to not spend so much time debating whether this change is "pathologizing" grief but to spend the time helping those who need it.