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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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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.
 


 
 
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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. 

 
 
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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.

 
 
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Some death and illness can leave us shattered and seeking meaning and purpose. The existential question of "why" which many ponder can become quite personal and be framed in personal terms as "why me".
 
We may never get a completely satisfactory answer to either the "why" of life or the universe or to the "why" of what happens in our own lives.
 
Victor Frankl was a psychiatrist imprisoned in Hitler's death camps. He survived and wrote a book entitled "Man's Search For Meaning". For those of us surviving losses of all kinds Dr Frankl's work is inspiring and not patronizing. I often recommend it as it helps those struggling with loss, illness and tragedy.
 
 
http://www.goodreads.com/work/quotes/3389674-trotzdem-ja-zum-leben-sagen-ein-psychologe-erlebt-das-konzentrations

 

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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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    Copyright 2013, Dr. Donald Steele, Ph.D.
    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.