When Elizabeth Kubler-Ross formulated five stages of reaction to dying she did not intend that they be taken as rigidly sequential steps that would follow one another. Her stages of denial, anger, depression,
bargaining and acceptance were formulated about the act of dying. Clearly this is a loss with grief from the awareness that one is dying. Ross acknowledged that her stages were not rigid and there are other emotions associated with dying.
But do the stages of reaction to dying translate to the grief and bereavement experienced by the relative and friends of the person dying?
In my own formulation based on work with the bereaved as well as on the academic work of Lindemann (1944) and Parkes (1972) I believe grief can be likened to a pot of soup. Initially there is probably for most people shock and disbelief. Following that however are numerous behaviors and feelings such as searching, pining, yearning, anger, guilt, anxiety, sadness, jealousy, loneliness, accommodation and many others. We are the pot and our own history determines the heat that will bring out certain feelings and behaviors much as cooking soup is determined by what is in the pot and the heat.
Depending on the connection to the bereaved and what roles they played in our lives as well as our own personal history of life experience and current circumstance various emotions and behaviors will show themselves in each individual. Probably for most people early on there will be shock or disbelief. At the end there will be some accommodation. Each individual is unique and the myriad of emotions described above will manifest themselves in many varied ways among the bereaved.
More recent work from studies done at Yale (2007) have led Parkes and Prigerson (2009) to posit that there may be some pattern of numbness, followed by pining, then disorganization and despair ending in acceptance. They note that people move back and forth and that there are considerable differences in duration and form from one person to another.
For those working with the bereaved the idea of stages can be used as a loose formulation of a process of adjustment that has common emotions and behaviors that occur in most people. However, they are not rigid, will not happen to everyone and will not happen in the same way depending on the person.
As helpers, counselors, family members we can understand that we are dealing with people who have their own reactions to loss. By paying attention to those individual reactions we can deal with the emotions and behaviors at hand. The stages, processes or pot of soup can be used as guidelines to reassure the bereaved they are not alone and to foster understanding without rigidity.
The death of a son or daughter is not easy for parents. Whether the child is a newborn, a fully grown adult or somewhere in between parents will suffer painful grief. The effect on parents is so painful because they have lost their child and all the hopes and dreams they had for their child. Children represent the future to parents. It has been accurately stated that "when a child dies a part of the parent's future dies also."
It may be easy to believe that parents whose child dies at birth, shortly after birth or even up to a year will not have intense feelings about the death. Nothing could he farther from the truth. For these parents there have been many hours of planning, great hopes built before and during pregnancy, many hours of care for the child that will not be easily forgotten or substituted for. There are expectations and dreams for the child and a desire to see hopes become real. The child becomes an important member of the family, even before birth.
You can help parents whose child has died by:
VISITING- Many parents feel isolated from family and friends when a son or daughter dies. Some of this isolation comes because friends avoid them out of uncertainty about what to say and do. If the child was older the family may lose contact with other families with whom their child participated in sporting, school, church or other club events. Another reason for isolation comes from grief itself. Grieving people generally show less interest in reaching out to others.
By calling on the phone or stopping by to visit you will be helping grieving parents. You may even bring dinner with you or offer to help with projects or shopping.
LISTEN- There are many things a parent might wish to say about their deceased child. They have many questions and concerns that they will wish to voice. They may wish to show you photos or to reminisce. You can help by giving them the opportunity to discuss these important matters. If you are a good listener you don't have to say a lot. Simply asking a person how he or she has been doing, or telling them you've been thinking about them or their child is enough. If they choose to discuss their child or their reaction to the death allow them to continue. They may choose not to talk about the death and wish to discuss other matters. A good listener will not try to steer the conversation.
Anger and guilt are only some of the many feelings that parents may experience. They also may cry easily. Don't let your own discomfort force you to attempt to divert they by changing the topic. Your acceptance of feelings should be non—judgmental. That is, do not pass judgement by telling the person they should or should not feel a certain way. The fact is they do feel a certain way and they need to express that feeling and receive support from you. Figuring out the reason for the feeling can be accomplished later.
Intense feelings of grief may last for several months or even for a year. After a reasonable time you may feel your friends are having excessive difficulties such as prolonged depression, excessive drinking, withdrawal from others or other behaviors not typical of them. You may wish to suggest that they seek professional counseling or find a group of other bereaved parents who can assist.
ATTEND SERVICES FOR THE CHILD— If a family holds a public service for their deceased child you can he a great help by attending. Public services such as funerals and visitations are consoling because they demonstrate to the bereaved that you care. Your attendance is often so important that few words have to be expressed. A genuine expression of sorrow, a hug or holding your friend's hand will often be most helpful.
WHAT TO AVOID
MAKING UNNECESSARY DECISIONS— A grieving parent is still an adult. As such decisions relating to their family and to themselves should be left up to them. Sometimes it is left to
relatives to make funeral arrangements or to dismantle a deceased child's room without the parents being present, this is usually a mistake. In fact although it is painful to do such things it is also therapeutic because it gives the parents some activity and helps them to feel some resolution of their grief.
CHANGING THE TOPIC OF CONVERSATION- Bereaved parents report that they resent having conversation about their child ignored or brushed aside. The child was a part of the family and most parents wish to remember that. Friends on the other hand are not usually certain what they should say when the conversation turns to the child so they change the topic. The best solution is to listen or recall something that you did with the child.
OFFERING PAT ANSWERS- A most resented form of conversation is the offering of pat answers such as:
"You have an angel in heaven.
"You can always have another child."
"Since he was so young you won't miss him."
These are rarely consoling since they deny the bereaved parent's feelings of loss and are seen as ways to tell the person that things aren't so bad when they clearly are quite had. These statements are almost always more consoling to the speaker than to the listener.
In a marriage two people come together to form a unit called a family. In the formation of that family and in the relationship with one another they are still individuals and will react to stress in their own individual way. Their individual grief will also vary according to how they were raised, previous losses that they experienced, and how they related to the child who has died. That relationship may be quite different for each partner.
John Smith may have been raised to take things in stride and get on with life. He may have had a stormy relationship with his now deceased son Tim. Because of that background he may feel very guilty about the loss but he is unable or unwilling to talk about it. His reaction may be to work harder and attempt to forget. At the same time he tries to forget he may deny any pain and in fact bury the pain and himself in his work. Nevertheless there may be a mood change, where he becomes sullen and quiet to the dismay of his wife and friends.
On the other hand Nancy Smith has had many losses in her life and the death of her son is more than she can take at this moment. Tim was very special for her and she also believed that her husband was too harsh on Tim. While she does not blame John for the death she does feel that life for Tim would have been better if John had not been so harsh. She needs to reach out, talk and be held by her husband.
In this example we can see on a small scale the different stresses that are placed on a couple just because of the feelings of grief. Each will face and manage the pain in their own manner. If their expectations of one another or their perceptions of the child are substantially different there is potential for strain on the marriage. John needs to be alone, Nancy needs to be reached out to, John feels guilty about his relationship with Tim, Nancy feels some resentment of him. These differences in the way this couple grieves can cause them to feel very isolated from one another as they grieve.
SOME DIRECTIONS FOR HELP
There is a need for married couples to understand that each will grieve in his or her own personal way. Prior to marriage they were individuals and their individual feelings will continue. With this understanding there can be a dispelling of any notion that their individual feelings are inappropriate. Feelings are always appropriate. All feelings need and deserve to be recognized and examined. Consequently the bereaved individuals in a couple must accept their individual feelings just as any other bereaved individuals do.
But that is not enough. Since this couple is also married it is important that each partner accept the other partner's feelings. Sometimes this is most difficult because the feelings may be a threat to the partner. In this example Nancy's feelings of resentment about the manner in which John treated Tim could be a raw nerve that could lead to great upset if brought up. But it must be brought up, examined, and dealt with. If it is not it will create more difficulty. Once accepted the feelings need to be worked out among the partners so that the feelings become a part of the past.
In summary it is important to realize that:
a. grief affects both partners individually.
b. grief affects the entire marriage.
c. each partner requires support from the other.
d. when we are grieving it is sometimes difficult to reach out, especially to someone who is also grieving.
There is more to come in this series, so please stay tuned. And, keep in mind that couples who are grieving can work through these feelings and can get help from qualified support groups, therapists or clergy.
When a sailing ship is caught in a storm on the ocean it is subject to many forces from the strong winds and waves tugging at it. The crew must work together to keep the sails and masts from being torn away. They have to prevent the ship from taking on too much water. They must secure the contents of the ship so the least damage is done to the contents or to the ship itself. When the storm subsides the ship is either completely destroyed, moderately damaged or it continues its journey unscathed. The crew who worked so hard together is often bonded closer than ever before -- if they survive -- as the result of their efforts. In the event of damage however the crew may not be so bonded but rather blame and fight among themselves.
Similarly the marriage that struggles with the terrible grief of the death of a child must wrestle with many enormous forces to survive. If the marriage is a strong one and if the partners work together they may survive and prosper, even stronger in their commitment to one another. If their marriage is not so strong they will have a great deal of work to do to repair the damage. If their marriage is in trouble from the start much of their effort will be wasted, though it is not impossible that strength will be gathered to repair the marriage.
It has been said that 75% of marriages where a death of a child has occurred terminate or at least have a period of separation as a result of the loss (*see author's note on statistics). It is hard to verify this particular statistic however, it can be said with some assurance that such marriages do have some serious and stormy weather ahead. In the next several articles we will look at the stresses the marriages face and discuss some ways that bereaved parents can work together to steer their marriage through the terrible forces that will be exerted on them.
The four areas that we will examine are:
a. Grief's individual and collective effect.
b. Communication between partners.
c. Disruption of the family system.
d. Death's uncovering of other serious problems.
AN IMPORTANT RULE
Before examining each of these areas it is important to say that the stresses on a marriage can be so great that I categorically recommend to each and every grieving family that they seek counseling for the twofold purpose of learning exactly how difficult things may be and to learn how to begin coping. Such counseling should be done by a trained person who understands loss in general and specifically how the death of a child can affect the marriage. We will develop this theme throughout this series.
* Author's Note: I would like to thank Glen Lord for his comment (see the comments section) which provides links to reputable studies with updated and far less dismal numbers.
Some sociologists suggest that older people may be more prepared for death because of their age. That may be so; but it really isn't much consolation when someone loved dies. In fact, many older people may be more lonely because they have fewer friends and they have limited ability to get out and around. They have fewer options for social life and activities. It may even be hard to get to church or other activities they have always done. Older people may not wish to ask for help because they are afraid of imposing.
Your offer of a ride to the store, a visit to a friend or church, help in straightening out paperwork or help with some household chores will often be happily accepted. While you are with them you can make it a point to listen if they wish to tell you about their loss. You can not make grief go away but you can help make it easier to bear.
A recent article in the New York Times http://www.nytimes.com/2013/07/10/nyregion/ready-for-less-tearful-future-newtown-is-declining-tributes.html?pagewanted=all reported that the residents of Newtown, CT wished to stop participating in offers of events and memorials from outside groups in the interest of moving “into a quiet period, of rest, recuperation, and healing.”
Public mourning and memorials are not new. They do appear to be more frequent and “in your face” as we sadly encounter more mass tragedy and as we face a 24 hour news cycle that reports not only the tragedy but the responses and memorials that come from it. The public, not directly affected by the deaths in a mass tragedy, is often traumatized, shocked and grieving. The public’s focus of grief may not be as intensely on the death of the individuals who lose their lives or are maimed. While there may be sadness at loss as we mourn individuals, for the public there is also mourning the loss of trust and sense of security.
Of course, the individuals, who have directly lost loved ones will have the grief work and mourning of the loss of loved family members, friends or colleagues.
Public expression of grief is important for a society as much as grieving by individuals is important or their own reckoning with loss. We have many examples of public mourning and memorials. We have holidays dedicated to veterans and soldiers from wars. In the past it seems these markings have been solemn and public but not forced on the bereaved by massive publicity from media. Those wishing to participate could and those needing more privacy could have it as well.
Some current public memorializing has a secondary purpose. Large events are designed and publicized to raise much needed monies for victims and families’ funeral and medical expenses. So, in addition to memorializing these losses there is an important charitable aspect. Politicians and others use such events to promote agendas for better or worse. If managed appropriately the potential for exploitation should be minimal but always watched for.
Yet it seems as though there needs to be great sensitivity to not overly prolonging and reminding the public or individual grieving people of the negative and tragic losses. Such can only set people back, prolong sadness, and interfere with letting go and moving forward.
A rule of thumb in helping in private mourning is to offer and organize help but then to allow the bereaved to accept or reject it while rechecking periodically. It is also generally accepted that public memorializing of private grief will shift to the families of the bereaved and become more personal as the public moves on.
What makes public mourning more painful over time is the difficulty for those who are ready to move on to get away from intense visualizations on television, at concerts, sporting events. One cannot always change the channel, leave the, stadium, etc. As I write this I do not propose a solution, but I believe we need to examine our public response and how long we continue to relive events beyond what is therapeutic and avoid what sells or is exploitative. A friend summarized his feelings succinctly. "I'm in the camp of respectfully recognizing the lives of those who died, pay attention and give recognition to those who were injured, and then move on. I think the Boston bombing was handled well. Clean the site up and open it right away. Don't let the terrorists have a reminder of what they tried to do."How do you feel about public memorials and their impact on private grief? Please share your thoughts.
This weekend I was pleased to hear from my old friend James Bradley
. James is the New York Times Best-Selling
author of Flags of Our Fathers
and The Imperial Cruise
. He is also the son of Wisconsin funeral director John Bradley. James wrote with a wonderful review for my eBook & pamphlet Helping Your Grieving Friend
. Thank you James!"Many know that my father helped raise the flag on Iwo Jima. After the war, John Bradley was a funeral director and an admirer of Dr. Donald Steele. My father always said, "Funerals are about the grieving survivors,” and he read books about the psychology of grief. Now Dr. Steele has written
Helping Your Grieving Friend, a smart and sensitive guide on how you can make a difference at a difficult time."
Helping Your Grieving Friend
is available in eBook form through Amazon and as a 16 page booklet directly from Steele Publishing
. You can order one copy for yourself or more for your funeral home, hospice, support group or other organization. Order today!
Maybe... Maybe not! Everyone grieves in their own way and it is most unfair to decide how another should or will grieve.
While psychologists do feel that many people who have had a long time to prepare for a loss may have an easier psychological adjustment than those dealing with a sudden loss.
But we are told also that people who have been through a long illness with a loved one are frequently physically and emotionally drained. They may even be more susceptible to illness themselves. Having been through weeks or months of stress they may have eaten and slept poorly. They may feel guilty for feeling relief from their heavy burden. Those desirous of helping the grieving in these circumstances should be willing to assist with feelings. They also could help the bereaved to reorganize their life without the deceased, to get needed rest and, when necessary, to become active again.
However, it is important not to push the bereaved to "get back to normal" too quickly. The death of someone we love can change our lives drastically. There are often major decisions to be made following a death. The house may be too large, we may have a sudden loss of income, we may have to raise the children alone. Adjustment to these changes may force us to make major decisions at a time when we are already distressed emotionally and least able to make good decisions. We may feel rushed to make decisions simply to avoid memories.
Good decision making requires that you take time, have all the facts before you and be rational not emotional. Anyone who is faced with major decisions because of a death in the family should take time, get rest and get good information and wait until your emotions have subsided.
Be sure to ask for help from qualified professionals before making any major decisions, especially while you are grieving. Your lawyer, accountant and therapist can all help you make good decisions, while you work towards "normal".
Children who have lost a parent may have a lot of questions about death. In addition they may feel insecure about life. They may wonder if death will strike again.
It is helpful to provide children with direct and honest answers. At the time of the funeral and visitation they should be allowed to participate in ceremonies if they wish. After the funeral children need to be given reassurance and love while the family adjusts to the loss.
It is not helpful to tell children that Daddy or Mommy went away or went to sleep. Such comments can be misinterpreted and the child might react by fearing sleep or being angry at the parent for leaving.
Often a child will ask something like, "Daddy, when will you get me a new Mommy?"
It is not unusual for a child to worry about a new mommy or daddy when his real concern is, "who will take care of me?" Security is vitally important to a child and the death of a parent shakes the core of that security. A child who loses a parent or other loved person needs lots of reassurance. They need to be told that they will receive love and care. A child may also need reassurance that others whom he counts on will not go away or die. There are, of course, other ways to reassure a child.
Dependability, a reasonably stable routine, spending time together and support during feelings of loss are important. Children may not always communicate exactly what they mean but you will rarely fail them by giving them security and reassurance.
One of the hardest losses of all is the death of one's child. We often think that it's unnatural, it's out of order, the parent is supposed to die first. No matter what the age of our child, when a child dies parents experience all of the usual feelings of grief such as anger, guilt, loneliness and sorrow. In addition, especially with younger children, many parents find themselves isolated from others. Their child may have been their social link to the community. Without their child they feel out of place and isolated.
Particular difficulties can arise for parents that may jeopardize their marriage. Communication breakdown over feelings about their deceased child is possible. This usually develops because each individual parent grieves in his or her own way. It can become difficult to show feelings without angering or distressing the other partner.
Extra effort needs to be taken at such a time. Working through each individual's grief and their feelings about one another or even about other surviving children are important. Patience with the grieving and with oneself is important, everyone works through their emotions at their own pace and in their own way. Seeking help from grieving parents' groups or from qualified professionals can be most helpful.