Take this quiz:
- Name the five wealthiest people in the world.
- Name the last five Heisman trophy winners.
- Name the last five winners of the Miss America contest.
- Name ten people who have won the Nobel or Pulitzer prize.
- Name the last half dozen Academy Award winners for best actor and actress.
- Name the last decade’s worth of World Series winners.
How did you do?
The point is, none of us remember the headliners of yesterday. These are not second-rate achievers. They are the best in their fields. But the applause dies. Awards tarnish. Achievements are forgotten. Accolades and certificates are buried with their owners.
Here’s another quiz. See how you do on this one:
- List a few teachers who aided your journey through school.
- Name three friends who have helped you through a difficult time.
- Name five people who have taught you something worthwhile.
- Think of a few people who have made you feel appreciated and special.
- Think of five people you enjoy spending time with.
- Name half a dozen heroes whose stories have inspired you.
The lesson? The people who make a difference in your life are not the ones with the most credentials, the most money, or the most awards. They are the ones that care.Read Full Post | Make a Comment ( None so far )
In a bitter skirmish over the definition of depression, a new report contends that a proposed change to the diagnosis would characterize grieving as a disorder and greatly increase the number of people treated for it.
The criteria for depression are being reviewed by the American Psychiatric Association, which is finishing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., the first since 1994. The manual is the standard reference for the field, shaping treatment and insurance decisions, and its revisions will affect the lives of millions of people for years to come.
In coming months, as the manual is finalized, outside experts will intensify scrutiny of its finer points, many of which are deeply contentious in the field. A controversy erupted last week over the proposed tightening of the definition of autism, possibly sharply reducing the number of people who receive the diagnosis. Psychiatrists say current efforts to revise the manual are shaping up as the most contentious ever.
The new report, by psychiatric researchers from Columbia and New York Universities, argues that the current definition of depression — which excludes bereavement, the usual grieving after the loss of a loved one — is far more accurate. If the “bereavement exclusion” is eliminated, they say, “there is the potential for considerable false-positive diagnosis and unnecessary treatment of grief-stricken persons.” Drugs for depression can have side effects, including low sex drive and sleeping problems.
But experts who support the new definition say sometimes grieving people need help. “Depression can and does occur in the wake of bereavement, it can be severe and debilitating, and calling it by any other name is doing a disservice to people who may require more careful attention,” said Dr. Sidney Zisook, a psychiatrist at the University of California, San Diego.
In blogs, letters, and editorials, experts and advocates have been busy dissecting the implications of this and scores of other proposed revisions, now available online, including new diagnoses that include “binge eating disorder,” “premenstrual dysphoric disorder” and “attenuated psychosis syndrome.” The clashes typically revolve around subtle distinctions that are often not readily apparent to those unfamiliar with the revision process. If a person does not meet precise criteria, then the diagnosis does not apply and treatment is not covered, so the stakes are high.
“The world has changed” since the last revision, in 1993, said Dr. James H. Scully Jr., chief executive of the psychiatric association. “We’ve got electronic media around the clock, and we’ve made drafts of the proposed changes public online, for one thing. So anybody and everybody can comment on them, at any time, without any editors.”
Many doctors and therapists approve of efforts to eliminate vague, catch-all diagnostic labels like “eating disorder-not otherwise specified” and “pervasive development disorder-not otherwise specified,” which is related to autism. But a swarm of critics, including two psychiatrists who oversaw revisions of earlier editions, has descended on many other proposals.
“What I worry about most is that the revisions will medicalize normality and that millions of people will get psychiatric labels unnecessarily,” said Dr. Allen Frances, who was chairman of the task force that revised the last edition.
Dr. Frances, now an emeritus professor at Duke University, has been criticizing the current process relentlessly in blog posts and e-mails. Dr. Robert L. Spitzer, who oversaw revision of the third manual in 1980, has also voiced concerns, as have the American Counseling Association, the British Psychological Society and a division of the American Psychological Association. Some of the concerns have to do with important technical matters, like the statistical reliability of diagnostic questionnaires. Others are focused on proposed changes to the most familiar diagnoses.
Under the current criteria, a depression diagnosis requires that a person have five of nine symptoms — which include sleeping problems, a feeling of worthlessness and a loss of concentration — for two weeks or more. The criteria make an explicit exception for normal grieving, which can look like depression.
But the proposed diagnosis of depression has no such exclusion, and in the new study, Jerome C. Wakefield of New York University and Dr. Michael First of Columbia concluded that the evidence was not strong enough to support the change. “An estimated 8 to 10 million people lose a loved one every year, and something like a third to a half of them suffer depressive symptoms for up to month afterward,” said Dr. Wakefield, author of “The Loss of Sadness.” “This would pathologize them for behavior previously thought to be normal.”
But Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh School of Medicine and the chairman of the task force making revisions, disagreed, saying, “If someone is suffering from severe depression symptoms one or two months after a loss or a death, and I can’t make a diagnosis of depression — well, that is not being clinically proactive. That person may then not get the treatment they need.”
Another point of growing contention is a proposed new diagnosis, “attenuated psychosis syndrome,” which would be given to people who experience delusional thinking and hallucinations and sometimes say things that do not make sense. Psychosis is the signature symptom of schizophrenia, typically a lifelong, disabling mental disorder. Psychiatrists have long hoped for a way to catch it early, before it turns into full-blown schizophrenia.
But critics say these symptoms are poor predictors of the disorder. In studies, 70 percent to 80 percent of young people who report these strange experiences do not ever qualify for a full-blown schizophrenia diagnosis, yet the label increases the risk of being “treated” with powerful anti-psychosis drugs.
“There’s already overuse of these drugs in children and adolescents, and having this vague diagnosis, regardless of its intent, will only increase misuse in this vulnerable population,” said Dr. Peter J. Weiden, director of the psychosis treatment program at the University of Illinois at Chicago.
Some outside experts say the same is true of other proposed additions, like premenstrual dysphoric disorder (lethargy and other depressive symptoms in the week before menses, among other things) and binge-eating disorder (out-of-control bingeing, complete with self-loathing). Getting the diagnosis increases the likelihood of being treated for what is normal behavior, or close enough.
Task force members argue differently: if a person is in distress and seeking help, then treatment ought to be offered — and covered by insurance. For now, these revisions are still in play; the completed manuscript is due to the printer in December. In the longer term, the politicking is likely to have a corrosive effect on the process, some experts said. Recent findings in genetics show that nature does not respect psychiatric categories — many different disorders seem linked to some of the same genetic glitches.
Already a federal agency, the National Institute of Mental Health, has set up its own independent effort to classify mental disorders, called Research Domain Criteria, which will not be based on existing categories.
In time, said Dr. Steven E. Hyman, a resident scholar at the Broad Institute of M.I.T. and Harvard, this kind of approach should ground the field more in nature and less in expert opinion. Until then, there is and will be the diagnostic manual.Read Full Post | Make a Comment ( None so far )
Debbie called to talk about a problem she was having. She had come a long way in her therapy, but she felt the need for a touch up. She just wanted to talk it out for a few minutes. Her friend, Robin, had died ten months ago, but she was still depressed. Her other friends were falling away from her, too. They were all busy with their own lives. They don’t take the initiative the way Robin used to. She was having ups and downs with her teenage son, her ex-husband, and she was neglecting her gardening. She didn’t have the energy she used to have.
This is the way depressed people talk when they are down. Life is flat, stale and unprofitable. There is no joy or even the hope of joy in the future. After fifteen minutes of rambling, Debbie burst out in tears, “I’m angry at Robin for leaving me! That’s what I am, angry. I didn’t even know it.” We heard her out, we validated her legitimate anger at this loss, this grievance. The wound hadn’t healed yet. It would take a few more months for it to close. As a lifelong pleaser, Debbie had not allowed herself the luxury of experiencing her legitimate anger at this grievance. She had sealed it over, or rather, her attitudes had sealed it over for her. We agreed that sending an anger letter to Robin for dying so young and for abandoning her so unfairly would be an appropriate Homework under the circumstances and said goodbye.
This phenomenon is called Bubbling Up. When we talk about, and relieve the overlay of attitudes and daily concerns that are in the way, we create an atmosphere in which it is possible for a concealed pain to bubble to the surface. We are encouraging it to happen by having real intentions, not good intentions. We are creating a context of mutual respect in which trust and cooperation can flourish. We are being patient. We are enabling Debbie to let go instead of hanging on. We are creating an atmosphere of respect in which it is possible for our client to heal and grow.
Debbie’s relief was palpable. She felt joy in finding the root of her grief. It had gotten away from her. Her anger at this undeserved loss had sunk below the level of conscious awareness. It had to be retrieved and it was. Debbie experienced feelings of relief, accomplishment, control, being alive in the present, identity, maturity, independence and all the other facets of self-respect. She had been taking this loss personally as she had taken similar losses in her childhood. She was a grown up now. She was able to remind herself that she was not an out of control victim of this loss. It was regrettable and unfortunate for Robin and for herself, but she had the power of choice now that she didn’t have as a child. She could finish her grieving now as a worthwhile human being in spite of what happened. The wound will heal cleaner than it would have otherwise.Read Full Post | Make a Comment ( None so far )
Russia is hard on its children, and Yelizaveta Petsylya and Anastasia Korolyova finally decided, at the age of 14, to do what thousands of other Russian teenagers have done. There was one way to assert control over their lives, and that was to end them.
Russia has the third-highest teenage suicide rate in the world, just behind its neighbors Belarus and Kazakhstan and more than three times that of the United States. On an average day, about five Russians under age 20 take their own lives.
Psychiatrists and health experts here know why it happens. Alcohol abuse, domestic violence and rigid parenting all play a role. Too many parents expect unquestioning obedience. Social conformity is strictly enforced, especially outside the big cities. Isolation is a huge problem in such a large country. There’s rarely anywhere to turn for help — but even if there were, families would be unlikely to admit their failings to outsiders.
Suicide is an attempt to seek relief from all that, by taking charge. The two teens, called Liza and Nastya by their families and friends, left letters behind: They wanted to wear white dresses and be buried in white coffins, and in death their wishes were honored.
In the Soviet era, suicide was considered an affront to the state, the failure of a citizen to fulfill his responsibility. Psychiatry was more often associated with punishment than with therapy, and that left a stigma and mistrust of mental health care that persists. And, while championing the collective, the Soviets destroyed the old Russian sense of community. Bullying is everywhere. And so is loneliness.
“At home, you order, you enforce, you punish your kids instead of trying to understand them,” said Anatoly Severny, one of Russia’s very few child psychiatrists. “Schools use what I call repressive pedagogics. Kids are forced to do everything.”
When Liza and Nastya leaped on Feb. 7 from the roof of a high-rise on the north side of Lobnya, a mid-size suburb about 40 minutes by train from Moscow, the press took notice because UNICEF had just released a report on teenage suicide in Russia. Almost every day since then, there have been more reports of adolescents killing themselves — in Barnaul and Krasnoyarsk and Moscow and Yakutsk and Rostov-on-Don.
It seems like an epidemic, but in fact it’s the usual state of affairs. (The official statistics may undercount the suicide death toll by as much as 25 percent.) The media attention, unfortunately, lends a certain glamour to the act, said Sergei Belorusov, a psychotherapist and volunteer for a church-run Web site called Choose Life, which counsels those seeking help.
“At this age they don’t have a concept of death,” he said. “A teenage suicide is a message. They often think there’s something heroic about it. But they also think there’s a start-over button somewhere.”
Nastya was outgoing, open and frank. Liza, more complicated, wouldn’t let anyone get too close. Last May they began singing with a glee club at the Chaika cultural center. Nastya enjoyed it so much that she decided to take private singing lessons from Dmitry Konovalov, at about $8 an hour. Liza had a stronger voice, and more musical talent, but her mother wouldn’t pay for lessons. In disappointment, or anger, she withdrew from the glee club.
In January the two girls, friends since first grade, began cutting classes at School No. 8. But Nastya still came by for her twice-a-week lessons with Konovalov. He last saw her on Feb. 6, when they discussed what she would be working on at their next session, three days later. But the next day, she was dead.
“When you’re 14, you don’t clearly understand what suicide is,” Konovalov said. “ ‘How pretty I’ll be at my funeral!’ They don’t understand they can’t watch the reaction. It’s the end.”
Nastya, he said, never showed any signs of depression. But a month before the girls died, Liza posted a message on a Russian social Web site saying she would “respect to the end the person who stayed with her to the end.”
Nastya posted this message: “What would I do without my friends?”
Anton Baranov, who is a year ahead of Nastya and Liza at School No. 8, said they would all sometimes go out together in a group of five or six kids. The school is small — each grade has only about 25 students — so of course everyone knew everyone else. Anton said the school set up a small memorial to the girls, which came down after a week. The teachers talked to their classes about the suicides, but none had noticed ahead of time that there were any problems — despite the recent truancy.
“Nobody teaches teachers how to pick up on these cases,” Severny said. An attempt to introduce mental health services at schools has been “absolutely ineffective,” he said.
“The level of trust among students toward their schools, their teachers, even psychologists in schools, is very low,” said Alla Ivanova, a researcher at the Ministry of Health. “The culture is, you don’t discuss your problems with anybody.”
The suicide rate is highest in the Far East and in parts of northwestern Russia, said Bertrand Bainvel, head of the UNICEF office in Moscow. It is much higher in small towns than in cities. More boys kill themselves than girls. There is not a big seasonal variation, despite the long hours of darkness in a northern winter.
A teenager beset by problems at home, or breaking up with a boyfriend or girlfriend, or trying to deal with sexual identity, goes into a tunnel, Belorusov said. His job is to try to expand the dimensions of that tunnel. He gets four or five referrals a week from Choose Life. It’s crisis intervention — e-mail exchanges that attempt to convince the adolescent on the other end that someone understands, and cares.
“So then we try to solve the problem together.”
Suicide is not impulsive, he said. First comes the idea, then a weighing of pros and cons. This, he said, is when an alert parent or teacher or friend should pick up the hints. “But people put up a fence. They don’t want to listen.”
So, like Liza and Nastya, the teenager withdraws further. The tunnel narrows. “And then the only self-realization is in the romance of the flight down,” Belorusov said. “And that’s when you go to the roof.”Read Full Post | Make a Comment ( None so far )
Q. I always knew I’d feel sad when my father died, but I wasn’t expecting to feel so angry. I snap at everyone. What’s wrong with me?
A. It may give you some comfort to know that anger is one of the most common emotions people feel while grieving.
This anger often gets misdirected. That may be what is happening to you when you are overreacting to, or snapping at, the people around you. Here’s a familiar pattern to consider — people who are angry at the deceased often feel guilty about it. You may find it helpful to acknowledge the real, human feelings, positive and negative, about the person you lost.
Unfortunately, snapping at loved ones tends to push them away at a time when you could use their support. So be mindful about letting your anger isolate you.
It may help you to reflect on what may be causing your anger. Is it easier for you to get angry than sad or anxious? You may be able to ward off snapping at people if you clue them in about how you are feeling. That may help them be more tolerant of your irritability. Stress-relief techniques like meditation or yoga may also take the edge off.
If simple techniques don’t work, you could talk to a professional. Irritability is sometimes a symptom of depression, and that can be treated. A psychotherapist may be able to help you understand better the source of your anger and help you develop more constructive ways of managing the anger when it comes up.Read Full Post | Make a Comment ( None so far )
Q. I lost my brother several months ago, and there are days when I still feel overpowered by sadness. Is it normal to grieve this long?
A. I’m sorry to learn of your loss. The brief answer to your question is that everyone grieves differently. Rarely does grief have a clear beginning, middle, and end, like hiking up a mountain and back down along a defined trail. And popular culture promotes the misconception that there is an orderly progression of emotions that will lead to “closure.” This is also probably wrong for most people.
The truth is that grief doesn’t neatly conclude at the six-month or one-year mark. Depending on the strength of the bond that was broken, grief can be lifelong. Parents whose children die often say they never get over the loss. The loss of a spouse is also devastating. But the loss of other loved ones, including a sibling, can take a long time to get over as well.
Although it may persist, grief does usually soften and change over time. How this goes will be influenced by your emotional style, the nature of your support system, and the culture you are a part of.
The loss of a sibling is not talked or written about as much as other losses, but it has a unique quality. Siblings share an upbringing and history. The more integral someone was to your life, the more opportunities there are for happy and sad reminders that underscore the massive loss. Alongside warm or warring memories, you may always feel the absence. Sadness, abandonment, disorientation, and even anger may arise around birthdays, weddings, the anniversary of the death, and holidays or other occasions you might have shared. A familiar scent, song, or likeness can trigger feelings of grief, too. All of this is entirely normal. And siblings are contemporaries, part of your generation, which may raise concerns about your own mortality.
Usually the raw, all-consuming shock of early grief will ebb slowly within weeks or months. Gradually, at their own pace, most people do find themselves adjusting to the loss and slipping back into the routines of daily life.
So give yourself time. In the midst of loss, many people find opportunities for growth. In many cases, people emerge from the depths of their grief with greater confidence in their ability to manage life’s sorrows and difficulties.
Holidays, anniversaries, birthdays, and events that would otherwise be joyful can be especially hard on people who are grieving. If the grief is fresh, holiday cheer can seem like an affront. Celebrations may underscore how alone people feel. Likewise, it’s hard to accept that others may not mark the days that you do — the first time you met your loved one, a birthday, or the anniversary of an illness or death. The following strategies may help people ease pain around holidays and other difficult times.
Start a new tradition. People can remember the deceased on special occasions by placing a lighted candle on the table, leaving an empty chair, or saying a few words of remembrance. If the person who died always played a special role in festivities, another family member may be able to carry on the tradition.
Change the celebration. Sometimes people opt for a simpler celebration. They go out to dinner instead of planning an elaborate meal at home. Or they schedule a trip or an outing with family members or friends.
Ask for advice. It may help some people to talk to others who have lost people close to them to find out how they have managed holidays.
Express personal needs. People who are grieving may find it hard to participate in all the festivities or may need to let go of overwhelming or unsatisfying traditions. It’s all right to tell people you’re just not up to it right now or to change plans at the last minute. Don’t feel pressured to do more than you want to do. Leave an event when you wish to go.
Plan to mark the day. Others find it helpful to make special plans for an anniversary, birthday, or other special day. This can include walking through a nature preserve, visiting the cemetery or the place where ashes were scattered, or enjoying an activity the deceased would also have loved. Think of a ritual to help you connect. Light a candle and say a prayer. Release balloons. Carry a memento from your loved one.
Help someone else. It may also help to volunteer through a charitable or religious organization. Make a donation to a favorite cause in memory of the person who died.Read Full Post | Make a Comment ( 1 so far )
Grief can be so intense and long-lasting that it sometimes resembles a psychiatric disorder. As many as 50% of widows and widowers, for example, develop symptoms typical of major depression in the first few months after a spouse dies. They may also have hallucinatory experiences — imagining that the dead are still alive, feeling their presence, hearing them call out.
These symptoms, upsetting as they may be, are usually normal responses to a profound loss. In most people, the symptoms ease over time. One review noted that 15% of people who are grieving are depressed one year after a loss. By two years, the proportion falls to 7%.
But if the symptoms are intense enough to interfere with relationships, work, school, and other areas of life, the problem may be complicated grief — a term that describes a grieving process that is particularly difficult. Also known as protracted or chronic grief, it combines features of depression and post-traumatic stress disorder (PTSD) — which is why some professionals call it traumatic grief. One study estimated that nearly 5% of all older adults were experiencing complicated grief.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) does not describe complicated grief as a psychiatric disorder, but a group of experts are reviewing a proposal to include this condition in the manual’s next edition.
Complicated grief is more likely to occur after a death that is traumatic — premature, violent, or unexpected. But in some people, even normal bereavement can produce complicated grief.
Whether that happens depends on how a person copes, not just with trauma, but with loss. Everyone experiences unfulfilled hopes, broken romances, illness, and injury. For anyone who could not respond to earlier losses without losing emotional equilibrium, complicated grief becomes a greater danger. So a person with a history of depression, anxiety disorders, or a personality disorder is more likely to suffer complicated grief after bereavement, as well as PTSD if the loss was traumatic.
While it is hardly necessary for everyone who is grieving to seek professional help, people who develop complicated grief may need treatment. Other reasons to seek professional help include drug abuse, increased use of alcohol or tobacco, gaining or losing a significant amount of weight, experiencing uncontrollable anxiety, and failing to feel somewhat better after a year has passed.
Psychotherapy can help people to identify incompletely mourned losses of the past and draw connections to the present loss. Several options exist, and a review concluded that all were effective — to varying degrees — at improving symptoms and diminishing the level of complicated grief.
Interpersonal therapy, for example, explores the patient’s relationship with the deceased person, emphasizing disputes, role transitions, and grief. Cognitive behavioral therapy can provide people with tools to work through aspects of grief and help people learn to think differently about the loss.
A hybrid therapy known as complicated grief treatment (also called traumatic grief therapy) includes both interpersonal and cognitive behavioral approaches to mitigate the effects of trauma and relieve stress. The therapist provides information about the grieving process, along with an explanation of a “dual process” in which patients concentrate on both mourning (adjusting to the loss) and improved functioning (restoring a satisfying life).
The therapy includes exercises that push mourners to confront situations and people they have been avoiding. They are also asked to retell the story of the death, to relate memories of the deceased, and to hold imaginary conversations with him or her. (The therapist asks the bereaved to take both sides in these conversations.) To help restore some joy to their lives, mourners are encouraged to think about what they would want for themselves if their grief were not so overpowering.
This technique can be overly taxing, causing some patients to leave prematurely. But for those who can tolerate it, it may have advantages. In one study, 51% of people who underwent complicated grief treatment improved afterward, compared with 28% for standard interpersonal therapy. The results also showed that complicated grief treatment was especially effective for people who were mourning a violent death.
These successes are promising, but it’s not clear that the treatment would yield the same results if performed by the average clinician rather than inside a specialized research setting. Nonetheless, the research suggests that there are a variety of helpful options.Read Full Post | Make a Comment ( None so far )
Losing a close friend or family member can be devastating. All the small details of daily life — getting out of bed, making meals, going to appointments, taking care of children, handling responsibilities at work — may seem monumentally hard or inconsequential. It is important for people to let the nonessentials slide and focus on ways to get through this difficult time.
Dr. Michael Hirsch, a psychiatrist at Massachusetts General Hospital and medical editor of Harvard Medical School’s Special Health Report Coping with Grief and Loss: A Guide to Healing, offers the following advice. Although some tips may seem basic, they are vital for enabling people who are grieving to work through the process.
People who are grieving a loved one’s loss may neglect their own health and well-being. In spite of the emotional pain, it’s important that you attend to the basics — making the literal, eat-your-vegetables choices — to maintain your physical health.
Eat well. A well-balanced diet is essential as you withstand the stress of grieving. That means eating plenty of vegetables, fruits, and lean proteins, and drinking plenty of water and other healthy liquids. If your appetite is diminished, try eating small portions more frequently. A daily multivitamin can cover any missing nutrients.
Take necessary medications. Grief makes people more vulnerable to illness, so it’s important that you keep taking your regular medications.
Get enough sleep. Grief is exhausting. If you feel tired, nap to make up for a sleep deficit. Paradoxically, doing more exercise is likely to improve your energy. Watch your caffeine and alcohol intake, as these substances can interfere with sleep.
Exercise every day. A simple walk, a bike ride, yoga, or a harder workout can ease agitation, anger, and depression. Depending on your needs, exercise can provide you with a distraction when you need a break from grieving, or offer you some quiet time to focus on your loss.
Avoid risky behavior. In the wake of a profound loss, people often justify using dangerous coping strategies — such as drinking too much alcohol (more than one drink a day for women or two for men), using drugs, or engaging in impulsive or self-destructive behavior. The short-term relief of pain is likely not to be worth it if the pattern of dangerous behavior persists or intensifies, leading to further losses.
Delay big decisions. Grief can cloud thought processes, and people who make abrupt decisions may regret them later. Many experts suggest that you wait a year, if possible, before moving, changing jobs, clearing out keepsakes, and making other momentous decisions.
Practice self-care. People who are grieving should regularly ask, “What would help me most today?” The answer may vary from day to day and even from hour to hour. Sometimes you need to cry, or talk to a friend, or just take a break from grieving.
Dr. Alan D. Wolfelt, a grief counselor and author of Healing Your Grieving Heart, suggests that people who are grieving identify three friends or family members who can provide support on a regular basis in the first weeks and months after a loss. Perhaps they have practical help to offer (such as cooking meals), or are not judgmental and willing to listen. The following tips may also be helpful.
Tell people what helps. People who are grieving may need to say, “I just need to cry right now,” or “There’s nothing you can do to fix this. It would help if you just stay with me for an hour.” If you want to talk about the person you’ve lost, you may need to let others know. For example, it might help if you say, “I miss her so much. I just want to talk about her, but I feel like everyone is afraid to say her name.”
Embrace mixed feelings. It is entirely normal to have mixed emotions about the loss and about your loved one. It helps to express these so that other people understand what you are going through. Some of the things you can say:
- “I feel so angry about his death. It seems so useless.”
- “I’m relieved that Mom isn’t suffering anymore, but I miss her terribly.”
- “My relationship with my dad was really difficult. I’m feeling a lot of things right now — not just sadness.”
- “I know you think I should be over this, but I’m not.”
Take away uncertainty. Often, people aren’t sure how to act around you when you are grieving. Although it may be difficult for you to express what you need while you are grieving a loss, the following directions might help others understand how they can support you:
- “If you really want to help, clearing up the kitchen or vacuuming would be great.”
- “Hugs just make me feel worse right now. What I need is a little time alone.”
- “I can’t bear to be alone tonight, but I don’t want to talk. Could you stay and just watch TV with me?”
- “I feel so mad about everything. I’m irritated with people all the time.”
Find others who understand. People who have also lost a loved one may be more understanding. Ask them outright: “What helped you? How did you get through this awful time?” When friends and family can’t help in these ways, support groups often can.
Leave the door open. People who are grieving sometimes may wish that everyone else would just go away and leave them alone to sort through their feelings. If you express this need too forcefully, though, you may drive people so far away that they are not going to be there when you do need them. Here are some ways of expressing the need for solitude while leaving the door open to future support:
- “I just want to go home and go to bed right now. Would you call me tomorrow, though?”
- “I feel so upset these days, I can’t settle on anything. Please don’t take it personally.”
- “I’m just not up to that right now. Maybe in a few weeks. Will you try me again?”
Realize that everyone grieves differently. People who experience the same loss often grieve in different ways. For example, one parent who loses a child may need to cry and talk frequently, while the other might work incessantly and act increasingly distant. Both are trying desperately to deal with their pain and loss. Professional insight from a grief counselor can be valuable when grieving drives a wedge between you and your spouse, family members, or other loved ones.
Remembering and honoring the person who died helps people keep memories alive. Sometimes it helps shape meaning from loss. You can commemorate a loved one in various ways.
Artwork. Creating art can help you explore your feelings, chronicle the life of the person who died, or express your ideas of an afterlife. For example, you can create a memory quilt incorporating meaningful scenes and fabrics. Children struggling with grief may find creating art — whether it’s with clay, colored pens, paints, or collage supplies — particularly helpful.
Journal. Some people create a journal to memorialize a loved one’s life. You can also develop a timeline of important dates and events. The journal can include pictures, stories, sayings, and well-loved recipes. Friends and family may want to contribute as well.
Memory box. You can use pictures, objects, and art supplies to make a memory box for display or keepsakes. When you are ready to go through your loved one’s belongings, you can set aside items for the memory box.
Slide show. You can use favorite pictures, songs, and sayings to create a poignant multimedia remembrance of your loved one’s life. Or splice old videos together and copy them onto DVDs for others to enjoy.
Photo wall. You can create a collage or remembrance wall from photos taken at different times and events.
Good cause. Sometimes people leave instructions about how they want to be remembered through memorial gifts to various causes, such as medical research, peace efforts, and scholarship funds. If not, you can think about how best to honor your loved one.
Peaceful spot. A peaceful nook with a comfortable chair, lighting, photos, inspirational books, or other important objects can serve as a spot to honor your loved one. Some people create serene outdoor spots, such as a fountain in a garden. Or you could walk regularly through a nature preserve, or visit a spot your loved one enjoyed.
Garden. Planting a garden or a tree can be a wonderful way to remember someone.
Gravesite. In many cultures, the gravesite is a focal point for commemorating the loved one, particularly on special days such as birthdays, anniversaries, or holy days. You can plant flowers there, say a prayer, or simply visit for a few moments of contemplation.
Prayer. Spirituality is of great comfort to many people. Depending on your own views, spiritual practices can include saying prayers, lighting incense or a candle, creating a shrine, or meditating.
Echo. You can create an “echo” of your loved one, by doing something silly, pleasurable, or solemn that they once did. This might involve giving a holiday toast, traveling, playing well-loved music, cracking a bad joke, or performing acts of kindness.
601 E St. NW
Washington, DC 20049
AARP is a nonprofit membership organization for people ages 50 and older. Its Web site offers many helpful publications on grief.
The Compassionate Friends
900 Jorie Blvd., Suite 78
Oak Brook, IL 60523
This national nonprofit organization offers bereaved parents, grandparents, and siblings friendship and understanding delivered by others who have stood in their shoes. The Web site has a chat room and offers many supportive brochures for family members, friends, teachers, and various professionals.
P.O. Box 3272
Ann Arbor, MI 48106
This online community offers e-mail support groups for children and adults. The Web site also includes links to other helpful organizations.
Healing Your Grieving Heart: 100 Practical Ideas
Alan D. Wolfelt, Ph.D. (Companion Press, 2001)
This simple book is packed with thoughtful coping strategies described briefly and compassionately. The author, a psychologist and grief counselor, has written many more titles in this series, including Healing Your Grieving Heart for Kids, Healing Your Grieving Heart for Teens, and Healing a Parent’s Grieving Heart.
Saying Goodbye: How Families Can Find Renewal Through Loss
Barbara Okun, Ph.D., and Joseph Nowinski, Ph.D. (Berkley Books, 2011)
While death used to be a swift act — an event — the act of dying is now a process that family members may have to live with for a protracted time, as modern medicine is increasingly able to keep very sick people alive. Two psychologists guide readers through the complex journey of “living with death” in this reassuring and hopeful book. Real-life stories illustrate lessons about practical matters, such as taking care of finances, and emotional ones, such as talking with children about death.
Seven Choices: Finding Daylight after Loss Shatters Your World
Elizabeth Harper Neeld, Ph.D. (Warner Books, 2003)
This book chronicles the author’s experience of losing her young husband and the experiences of more than 60 other grieving women and men. Neeld describes seven turns in the road and the opportunities she believes each one presents as those who’ve been bereaved seek to honor the past while building a future.Read Full Post | Make a Comment ( 1 so far )
Dr. Elisabeth Kübler-Ross developed a frequently cited model of bereavement, the “stages of grief,” in her landmark book On Death and Dying. She described a linear five-step process — consisting of denial, anger, bargaining, depression, and acceptance — as terminally ill patients became aware of impending death. Dr. Kübler-Ross’ work helped legitimize the wide variety of emotions in people who are dying. The five-stage theory was later altered and adapted to cover the reaction to other losses, such as divorce or the death of a loved one.
Today, however, many experts no longer embrace the concept of sequential stages of grief and have proposed a number of alternatives.
For example, Dr. Colin Murray Parkes, who has written extensively on bereavement, proposed that people who have experienced a loss undergo several prolonged and overlapping phases — numb disbelief, yearning for the deceased, disorganization and despair, and finally reorganization — during which they carve out a new life. The road to this new life may be long. According to Dr. Parkes, people must go through a painful period of searching for what has been lost before they can release their attachment to the person who died and move forward. When enmeshed in disorganization and despair, people find themselves repeatedly going over the events preceding the death as if to set them right.
Dr. J. William Worden suggested a model of grieving that includes certain tasks. The first three tasks are to accept the loss, to experience the resulting pain, and to put the loss in some perspective and adjust to a changed world without the person who has died. The fourth and final task is for people to alter ties with the deceased enough that they are able to invest their love and energy in others. People may shuttle back and forth among these tasks. However, Dr. Worden suggests that leaving some of the tasks undone is like healing only partially from a wound.
Some experts combine elements of several grief models. Dr. Margaret Stroebe and Dr. Henk Schut note that early in grieving, the emphasis is on “loss-oriented coping,” such as focusing on the person who died, the circumstances of the death, and painful feelings like yearning and despair. Later, people invest more in “restoration-oriented coping,” focusing on managing practical issues that arise, such as loneliness or challenging new circumstances. Rather than grieving continually, people seek occasional periods of respite. Time away from grief might take the form of a weekend with friends or a day of social activities.
A new way of grieving
Most recently, two psychologists make the case that advances in diagnosis and treatment — which have enabled people to live longer with life-threatening illnesses, such as cancers and heart disease — have significantly changed the grieving process.
In their book Saying Goodbye: How Families Can Find Renewal Through Loss, Dr. Barbara Okun and Dr. Joseph Nowinski identify a pattern of grief commonly encountered by families who face the loss of a loved one to protracted illness. The book includes the following stages, which begin long before a person actually dies.
Crisis. Family life is disrupted by the diagnosis. People are upset, saddened, and anxious. Other, unexpected feelings — resentment, anger, or guilt — may also emerge but often go unexpressed in the interest of rallying around the patient.
Unity. The patient’s needs are paramount. Activities include managing medical treatment, lining up social and support services, gathering insurance and other information, and attending to legal matters such as wills.
Upheaval. The patient may be in remission or doing relatively well. But for others, unity and patience may have worn thin as protracted illness buffets their lives, relationships, and routines. At this stage, it’s important — though often difficult — for family members to communicate honestly about the upheaval they’re experiencing.
Resolution. As the patient’s health deteriorates, everyone comes to accept that the end is near. Decisions about hospice and other end-of-life matters have been made. Now is the chance for resolving old issues, healing wounds, and addressing resentments and jealousies — factors that can undermine family members’ ability to come together and support one another.
Renewal. This final stage begins with the funeral and continues for a long time, as individuals adjust to the loss and to their changed roles.
Navigating the process
Every person — and every family — grieves differently. Some people may feel anxious, or others worry on their behalf, if they don’t follow a particular path. However, grief is not a tidy, orderly process, and there is no single “right” way to grieve. It’s normal for emotions to collide and overlap. Each person grieves uniquely, taking as much time as necessary, finding a meaningful way to come to terms with a loss.Read Full Post | Make a Comment ( None so far )
When people talk about grieving, they often describe an experience akin to being at sea. Wave after wave of emotion envelops them, and just when they think they’re recovering, a new wave hits them. Yet with time, most people manage to reach equilibrium. While significant losses are never forgotten, the feelings of grief become less intense and more manageable.
The following experiences are all part of the normal spectrum of grieving and can last from six to 12 months.
Yearning. Survivors repeatedly want to reunite with the person who died in some way, and may even want to die themselves in order to be with their loved one.
Deep sadness. People often experience waves of deep sadness and regret about the loved one. Crying and even sobbing jags are also normal.
Other negative emotions. Anger, remorse, and guilt are all common negative emotions as well.
Vivid memories. It’s common to think of the deceased often and recall vivid memories of times together. Images of the deceased — or even the sound of a loved one’s voice — may emerge without warning.
Somatic disturbances. Grief affects people physically as well as mentally. It’s normal for people to have sleep problems, changes in appetite, digestive difficulties, dry mouth, or fatigue after a loss. Occasional bouts of restlessness and agitation are also common.
Disbelief. It takes people a long time to truly accept that a loved one has died. People often forget at times that a loved one is gone — until some reminder brings the reality searing back.
Apathy. It’s typical for people to withdraw or disengage at times while grieving. They may become irritable toward others.
Emotional surges . Although some of the worst emotions and disturbances ebb with time, the grieving process also involves surges of emotions. Holidays, anniversaries, birthdays, and other significant events can trigger bouts of raw grief.
As if the normal process of grief were not challenging enough, the following events or factors may make it even harder. In some people, these factors can cause grief to become complicated and prolonged.
Conflict in relationships. People who had an ambivalent, angry, conflicted, or highly dependent relationship with the deceased may find it hard to grieve.
Multiple deaths. If the loss occurs in conjunction with deaths of other loved ones, the grieving process can become magnified.
Mental illness. People who already have depression, anxiety, or another mental illness may have an amplified response to a loss and experience a more intense bereavement.
Traumatic death. A death that was unexpected, untimely, traumatic, or violent sets the stage for a more difficult grieving process.
Caregiving. People who provided care to their loved ones before they died are likely to feel the loss more acutely than others, in part because they structured so much of their time to be with their loved ones. They may be haunted by images from the final days. In other cases, they may be at a loss to know how to spend their time.
Social isolation. People who have few friends, family members, or other sources of social support may feel abandoned as they navigate the grieving process. Elderly people who outlive their spouses and friends, for example, may suffer more because they are suffering relatively alone.
Hirsch M, ed. Coping with Grief and Loss: A Guide to Healing (Harvard Health Publications, 2010).Read Full Post | Make a Comment ( None so far )
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