Tuesday, October 27, 2015

Two Follow up Blogs on Grief, As Promised

The Process of Grief

As I mentioned in my previous blog, in the realm of counseling, there is a commonly understood process of grief.  Elizabeth Kubler-Ross was a woman who spent much time researching those in hospice care who were in the process of dying, so that she could learn how we as humans approach death.  She identified 5 stages of dying which described those with terminal illness, who know about their impending deaths, and how they integrate that knowledge in their last days.  These stages have also been applied to those who are grieving a loss—with understanding the differences from those experiencing death.  It is worth reviewing these stages to gain some recognition that grief is a process—not one point in time but a process of accepting a change you do not want to embrace. 

Generally speaking, these stages are similar with all kinds of losses.  With sudden loss, however, there may be unique tweaking to these stages.  Sudden loss brings with it the potential for anxiety and trauma at a more powerful level than an expected loss.  Sudden loss enhances the feelings of the loss of perceived control.  I will discuss that in more detail later.

The stage of DENIAL is the first stage.  When you are confronted with something you do not want, your first response is to ‘push-back’.  Think about it.  If you are told something negative about someone you know and trust, your first response is likely to be something like: “Oh no, not him.  He’s a committed Christian and a good person!” That’s a push-back response.  The most common push-back to death is to deny the diagnosis, deny the loss, deny that your world has the potential to completely change at a moment’s notice.  We are creatures who like stability, homeostasis, and predictability.  When someone gets a diagnosis of terminal cancer, for example, those who love that person can insist on a second opinion in order to eliminate any doubt.  Of course, that is a reasonable request, but often this demand for another opinion is a push-back against the unsavory truth.  There can be a lot of ‘drama’ from family around these situations, because no one wants to hear a diagnosis of terminal cancer.  Finding the ‘right’ hospital, the ‘right’ doctor, the ‘right’ treatment, etc.—these can be ways of denying the diagnosis and ultimate fate of the one you are losing.  (I am not suggesting that it is unreasonable to consider alternative treatments; rather I am saying that often the pursuit of the ‘miraculous treatment’ is a push-back response.)

Another aspect to consider about denial is timing.  That is, you can act like you have accepted something, from an intellectual stance, but emotionally be in denial about the immense loss and how it impacts you, until after the death, after the funeral, at the point when life is supposed to get ‘back to normal’.  Often, loved ones manage through a funeral and all the preparations in a ‘zombie’ state, distanced from emotions.  It is often after the ceremony that the emotional denial lets go, and you ‘fall apart’ as the reality of the loss, and all its implications, hits you. 

The next stage is ANGER.  Anger is a powerful emotion, and at times, a very useful one.  When dealing with a situation you don’t want, anger is a terrifically useful push-back.  When you discover you really do not have control over the loss of someone—either through illness or sudden tragedy—the emotion of anger can give you a sense of power.  This powerful feeling helps you stand up against the loss of perceived control.  Very often when a family loses a loved one to cancer or some health issue, the family will try to bring suit against the doctor, the hospital, people who are perceived as responsible for the death.  Many challenge even God in anger.  His love gets called into question for many when faced with a loss.  And He is gracious enough to know that sometimes you will stomp your ‘spiritual foot’ and complain while in this process of grief.  Anger can also be funneled into a useful benefit: MADD (Mothers Against Drunk Driving) was formed by Marie Tursi when her 20 year old son was killed by a drunk driver.  She became ‘outraged’ when she learned the drunk driver who killed her son received a sentence of 4 years of probation and a nominal fine for reckless driving.  The anger she had was the impetus to this successful national program which supports and advocates for families of those killed by drunk drivers.

The next stage is BARTERING.  This stage makes a lot of sense when applied to the one who is dying from terminal cancer, but can also be applied to those loved ones who are losing someone.  Bartering describes a tentative acceptance of death, but also a last hope against hope for a different outcome.  At this stage, people often ask God for a miracle.  As Christians we know that God is capable of miracles.  I am aware of a recent miracle in which someone’s tumor, which was clearly evident from scans, was not there when the doctors opened him up—a miracle indeed!  In the bartering stage, you look for this miracle to avoid embracing the diagnostic truth.  You often hear people promising God things at this point, like a total life-change for God—becoming a missionary, doing something specific and huge for God, etc.  Bartering suggests that the one experiencing loss is beginning to recognize he does not have control, and yet still might have enough control to tip God’s plan in another direction. 

The stage of DEPRESSION is all about giving up any pretense of having control.  This can feel incredibly defeating to both the one dying and those around him.  You can feel very deflated if you give up the push-back and realize you cannot change what is happening.  In your emotional and even spiritual frailty, you can swing to the opposite end when letting go of control, to a place of despair and defeat.  Most of us live with the ‘delusion’ that we have a lot of control over our lives.  Certainly you have volition and the ability to make choices; but the majority of factors in your life are way beyond your control.  You can work to be healthy by eating right, exercising, and taking care of yourself, but you cannot make a cancerous tumor go away no matter how many miles you run.  For many, this confrontation with limitation of control can reach a crisis level.

When you come to the end of yourself and your false sense of control, then you are ready to receive God’s strength in facing whatever you must face.  Now you are in the stage of ACCEPTANCE.  Acceptance comes with feeling ‘okay’ with what you cannot control.  Facing death, or the loss of a loved one, is not easy—grief is normal in these circumstances.  But once you accept what you cannot change, you can engage in ‘real time’ with the love you have with family and friends in the time you have left together.  In a way, it can even feel more intensely sad, yet rich in love.

It is important to know that these stages are predictable, but how they express themselves in your experience is unique to you, your family, and your situation.  Grieving takes time.  Even within your own family, people grieve differently, and it is important to allow differences in how you grieve.  Our culture presents some taboos about grief, which are gender specific—men are not ‘supposed’ to cry, so men feel compelled to suck it up and ‘be strong’.  In other cultures, crying and great displays of angst are the protocol, which in my opinion, allows a healthier response to the loss of a loved one.  What is important is to allow for each other in this difficult process, and give permission for the differences in expression of grief, and at the same time, receive support from each other. 

In my next blog about grief, I will address sudden loss and the trauma around it, and rituals you can develop to help process grief. 




How to Grieve

We all grieve in unique ways—even among loved ones, there can be differences in expressions of grief.  Our personalities have much to do with that, as do some cultural influences, including ‘family culture’.  This blog is not a detailed 1-2-3 step process of ‘how to grieve’; rather, I would like to suggest ways of marking your grief, as you move forward—even unsteadily.  Grieving well is important to the integration of your loss into your life.

When you start on the road of grief, one of the first reminders of loss you bump up against is facing the first holiday, birthday, or anniversary, without your loved one.  During the first year of your loss, these significant markers—times which you usually shared with your loved one—will confront your feelings in a profound way.  One of our human temptations (to manage feelings) is to minimize the importance of these feelings.  We tend to force ourselves to ‘buck up’ and face forward—as though allowing yourself to feel the sorrow will set you back, show signs of weakness, or whatever the taboo de jour.  Well, no.  If this is your first Thanksgiving holiday without your loved one, then it is not only acceptable but important for you to talk about how much you miss your loved one, and reminisce about previous Thanksgivings with him or her.  Some people fear that doing this will hold them back, make them feel worse, and prolong the grieving process.  The truth is, without doing these things, you are more likely to not only prolong the grieving process, but even short-circuit it, so that every holiday, birthday, anniversary, will confront you with fear for how you will be impacted.  The irony is, the more you ‘give in’ to the grief, the healthier the process.  But you want to ‘give in’ in appropriate and healthy ways.  Marking the special day is one way. 

Another way to process your grief is one of practicality: going through the articles which belonged to your loved one.  This is a highly emotional process, and it is reasonable to do it in small doses, if possible.  Those who lock away a room of a loved one, as a memorial of sorts without changing it, not only ‘freeze’ time, but stunt their grieving process.  Holding up the beloved stuffed toy, or worn sweater, and crying through the memories it elicits, is helpful to your grief process.  It brings intense feelings, but you are only expressing what is already there!  This is good.

Photographs are always a wonderful part of grieving.  We use them at funerals, but we can also use them to help the grief process.  One way you can do this is to make a special photo album—or, if you are technically savvy, make a thumb drive or electronic photo frame of pictures of your loved one.  You will find yourself viewing these regularly during your initial stages of grief.  As time moves forward, your need to process with these photos will diminish little by little.

If it is possible, spend time together as a family processing your loss.  This is important to do with young children, with say, the loss of a parent or significant family member.  You can make a special ‘book’, with photos and written memories of the lost loved one.  I have often suggested a special box—there are so many beautiful storage boxes you can get today—in which you can place drawings, photos, written stories or memories, etc.  Young children can easily access these articles to use as talking points in recalling their loved one.  It is especially important for kids to have opportunity to do this.  Children can shut down their feelings if they intuit it is too painful for grown-ups to do so.  And sadly, then their own grief process becomes stunted.

Some people choose to make a permanent marker to remember someone, like planting a tree or a garden bed of roses, for example.  What you choose to do can be a special way to honor your loved one.  You can also start a tradition on a particular day (his or her birthday) for anyone to participate in—like going to a park, or somewhere particularly memorable for your loved one.

These are some suggestions for creatively walking the path of grief.  I surely have not exhausted all possibilities, but I hope this has stimulated your creative juices, and has given you ‘permission’ to step into your sad feelings and not run from them.  Finally, there are some things I’d like to cover as possible complications for grief.  These include sudden loss, family disagreements, and ‘complicated’ bereavement. 

Sudden loss brings with it a jolt of the fragility of life we typically do not acknowledge in our day to day existence.  When you lose someone precious to a horrible accident or sudden heart attack, you are not only faced with the loss, but with the intrusion of a major change in your life and your expectations.  You then have to face two major shifts you had no plan to face: the loss, and the confrontation of the fact that life can change so quickly in ways you never planned.  For some, the suddenness of loss can bring with it anxious feelings: sleeplessness, fear, and emotionality not previously encountered.  This can feel terribly frightening, and can interfere with the grieving process.  Almost like dealing with a traumatic event, symptoms can become severe, and impede the normal progression of grief.  Sometimes people around you may not comprehend your reactions, and you may feel unsupported.  Counseling may bring some perspective to feelings of trauma and fear, and offers techniques to deal with it.

At times, the loss of a loved one can bring conflict in a family system because people deal with loss in different ways.  If someone is more internal, and tends to cry alone rather than in front of others, or even tends not to cry, this person may have low tolerance for another family member who is more expressive with grief.  The one grieving more openly may want comfort from the other, but not get it because her tears make the other uncomfortable.  The consequences of these differences can bring great struggle, from frustration and anger to hurt with each other.  This is part of the reason why some couples eventually break up after losing a child, whether newborn or older.  Loss can also bring any underlying conflicts within the family, to the surface in an ugly way.  If there were disgruntled feelings between the loved one who died and others in the family, these will resurrect even unwittingly as the family struggles with the loss.  Without bringing these conflicts to an acceptable resolution, your grief can be suspended, or, you may need to ‘protect’ yourself from others’ ‘issues’ while you grieve on your own.

Finally, there are times that the loss you experience is so devastating that the normal sadness you feel can grow into a depression.  If you have depressive tendencies anyway, or have a history of major depression, a loss may cause a severe reaction of withdrawal and disengagement from life, making your experience that of depression rather than actual grief.  This is called complicated bereavement, and needs to be treated in counseling, with possible psychiatric intervention (medication). 

This has been a quick ‘guide’ to grieving, which I hope has been helpful.  I welcome your stories or questions, if you are so inclined! 



Priscilla Ortlip, MSW, LCSW
Founder & Executive Director
The Christian Counselors Collaborative

Disclaimer:  I am a professional, licensed clinical therapist in the state of PA, but this blog is not a therapeutic venue—anything I state here is not for treatment or to address anyone’s specific emotional or mental health need.  If you are experiencing immediate distress, call 911.  If you would like to consider counseling with the CCC, please call CCC Intake at 1.855.222.2575.









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