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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.

 
 
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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.

 
 
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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".


 
 
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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.


 
 
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Some people think grief ought to be over quickly. They'll tell you to get on with your life. Others say it's over after the funeral. Many psychologists and sociologists say that acute grief can last for a year or more, maybe even two years.

It takes time to put one's life back together again. There are feelings of anger, depression or loneliness. There are new tasks to be mastered. Cooking for one less, raising the children alone, cutting the lawn, managing finances, probating the estate -all can be difficult tasks. Death of a loved one is usually a major life change. Reorganizing life, managing our feelings and finding ourselves does not happen immediately. You may need support of friends and others who understand. If you feel overwhelmed do not hesitate to ask for competent help.

Where can you get help with your grief?

Sometimes grief does not go away in a reasonable period of time. When that is the case the bereaved should contact a social worker, counselor or clergy person. In addition on the resources page of this blog you will find several books and pamphlets that may be helpful to read.

There are many people willing to help and no good reason that anyone should be without help. Still, psychologists have noted that some people are depressed and simply do not have the get up and go to seek help. Others may feel embarrassment.

If you or a friend needs assistance make an extra effort, pick up the phone and call your clergy or mental health center. The extra effort will be a good beginning to help you help yourself!


 
 
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Sudden death is shocking! We don't believe it, it will take time for the impact to fully sink in. Our lives are severely disrupted and often we don't have any idea of what to do next. Our grief will, of course, be most intense in the first days. Often those grieving a sudden death experience additional bewilderment and anxiety as they try to process and accept the sudden death of a loved one.

Grieving a sudden death is often different from an expected death, because there was no preparation, no chance to process the situation beforehand. All of the emotions of grief arrive very suddenly as well. Sudden death also poses challenges to our sense of control, it reminds us that our world is unstable and that we are never fully in command.

Later, reality will present itself in small doses as we process the loss. We have to learn how to do things the deceased once did for us and that we now must do for ourselves. We may need help learning to manage the house, take care of the children, and locating a job.

Avoiding excessive use of alcohol or sedatives is wise. Eating well and taking good physical care of yourself is also important. Seek help from friends or professionals when you need to talk or when you need advice on matters that cause you concern. 


 
 
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When one of your parents dies, in spite of your grief, one of your first concerns will be to care for your surviving parent. The loss of a partner can be devastating to many people. Widowhood will require adjustment and you can be most helpful. While you will, of course, want to be helpful at the time of the funeral, there are many concerns and decisions to consider the memorial. 

A primary consideration will be the age and competence of your parent. If a parent is capable of making decisions they should be allowed and encouraged as much as possible. They need your support. Of course parents who are unable to make decisions will need you to make the decisions for them.

DECISIONS

Sometimes with the best of intentions we rush in to help by making decisions for the survivor. Many parents will resent this infringement on their freedom, others may give in but become dependent or resentful. As a rule it is useful to offer advice and assistance while letting them know that the final decision is up to them. You may wish to offer to arrange funeral and memorial services, attend legal meetings, sorting and disposing of personal effects and helping with other practical matters. But it is not desirable to make funeral arrangements, legal decisions, sell property or dispose of personal effects without the full cooperation of a competent parent. While you have lost a parent, you need to remember that they have lost their life partner.

The death of a spouse will bring major life changes to your parent. Some decisions will have to be made immediately, but it is wise to advise your parent to avoid major life change decisions until time has been taken to permit reasonable decisions without regret. Grief can do strange things to our perspectives and decisions. In particular it is never wise to sell a house or move from an apartment when the pain of grief is intense. If a person thinks it would help them to grieve better or escape memories to be out of the home they shared with the deceased it might be wise to move to an apartment for several months first. After a reasonable trial a good decision can be made that will not cause unneeded financial hardship.

Your surviving parent was undoubtedly dependent on the deceased for many things. There will be a transition period where you can help the individual to learn many things needed for living without the deceased, such as cooking, taking care of finances, shopping and other practical matters.


COPING

It is important to remember that every person grieves differently. Recent studies have shown that the death of a spouse has profound, but very different effects on men and women. The New York Times has an excellent article which sums up the differences between how men and women grieve as well as more information on the subject. The same research has shown that men benefit greatly from men only support groups. The National Widowers Organization has a listing of resources specifically for men who have lost spouses. 

There are many resources available online and within your community (and many online resources can connect you with local grief support groups). Both Widowed Village and WidowNet are good places to start your search for information on bereavement support for your parent. 

Please share some ways you have found to help a parent cope with the death of a spouse.

 
 
That is a common statement. There is a problem with it, however, when someone we love dies survivors react with strong emotions. A funeral, while technically honoring the dead, is really more about the living. We've lost a very important part of our life and we feel sad, we are upset and we cry. We find it hard to believe that death has come. 

Often we need the formal ceremony, to begin the process of recognition as well as to realize and recognize that we do have support from friends and loved ones. By not seeing the deceased we lose the chance to confront the reality of death. Often seeing the body is an important first step to acceptance.  Many people ask why at funerals and visitations we view the body of the deceased. Psychologists tell us that viewing is usually helpful because our natural tendency is to deny death. Visitation acknowledges that a death has occurred. Seeing is believing, where simple telling is not always helpful. Visitation and viewing also play a social role. The deceased usually has many friends who would like to express their sympathy. Seeing the deceased in the presence of friends eliminates shock and disbelief. Friends are given a chance to say their goodbyes and to provide a family with some needed support.

The lack of a funeral can cause loved ones to have trouble accepting and beginning the process of moving on. While choosing not to have some type of memorial will have no effect on the deceased, it can have serious consequences to the survivors. 


I have a friend whose father was living overseas for 4 years before his death. He died overseas and, because they had a very contentious and difficult relationship she made the decision to not repatriate his body, and specifically requested that no one talk to her more about it or send any of his personal effects. After some difficulty involving embassies and language and cultural differences his friends overseas managed to put together a small but fitting funeral for him. Nothing formal, just some friends at the cemetery speaking about someone they loved, followed by a bonfire on the beach in front of his favorite bar. 5 months later, his daughter called one of his good friends to ask more about her father, and admitted that she was having trouble accepting his death. She had trouble believing he was really gone and not just "away", and she asked for some of his personal effects. His friend, having anticipated this reaction, sent his most treasured belongings (a ring, a hat, and pictures of his daughter and grandchildren), as well as pictures of him and a short video of people speaking about the man they loved, her father. This video exposed his daughter to a side of her father she had not known, the part that other people saw. It also helped her to see that he was really gone and begin the healing process, both grieving his death and making peace with a father who was not ideal, but, as it turned out, wasn't the worst.



 
 
That is a complicated question. The purpose of all ceremonies is to mark events in the lives of people and communities. Weddings mark new families; baptisms and bar mitzvahs welcome children and adolescents into society. Death marks the end of life. Students of human behavior tell us that ceremonies for saying goodbye have existed as long as man. The funeral acknowledges that a life has been lived. People express their feelings about life through ceremony. 

Funerals today come in all shapes and sizes, and that is OK. Many people have chosen to move away from the traditional funeral in favor of something that more accurately reflects the nature of the person who has passed away. Often people choose to use the opportunity to celebrate the life of the person who has died. he point of a funeral is to remember the person for who they were, and what is important is that the living have a chance to say goodbye and to grieve. 

Funerals are important to the survivors because they provide a socially accepted way for people to come together at a central point to show support for the grieving family. Many people welcome social support and going to a visitation or funeral is an important way to show someone that you care, both for them and for their loved one.


 
 
My name is Dr. Donald Steele, I have studied grief and bereavement for over 30 years. My interest in grief counselling began with a conversation with a good friend who went to mortuary school. At the time there were only a few people dealing with grief and bereavement. Little research had been done. He told me his professors taught about grief and encouraged them as funeral directors to do grief counseling but gave few strategies. It seemed like a reasonable pursuit for me to attempt to create strategies and better understand grief to help not only funeral directors but the grieving themselves as well as ancillary professionals such as nurses and even speech or physical therapists.

My friend noted that he heard two things at almost every wake. 1) What can I do to help? and 2)  some variant of "If there is ever anything they need let me know"  He noted how he thought this odd that the visitors would speak to him about this, as he was unlikely to be very involved in people's lives after the funeral. He decided he would keep a calendar book handy at wakes. When people indicated they didn't know what to do but that they were willing he would take out the book and say, "there is something you can do. How about setting a date and time with me when you will go visit the bereaved family "  That was it.  It was simple and powerful because all it required was a visit and no special skill or obligation. 

Later in my own conceptualization I used the mantra" Be there and listen". People need people and company and they often need to talk and relive their loss and the emotions that come from it. It is incredible how effective it can be to simply allow a person to talk it out.
 

 

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    As part of my doctoral studies at the University of Wisconsin, Madison, when information on grief, bereavement, death and dying was scarce, some colleagues and I began group work with the bereaved. Out of that work grew interviews with widowers, training with funeral workers, clergy, social workers, hospice and medical personnel. 

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    NOTICE: All content within this blog is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The author is not responsible or liable for any diagnosis made by a user based on the content of this site. The author is not liable for the contents of any external internet sites listed. Always consult your own GP if you're in any way concerned about your health.