BEREAVEMENT AND GRIEF

BEREAVEMENT AND GRIEF

What is grief? Grief is a natural response to loss. It’s the emotional suffering you feel when someone you love or to whom you are attached, or when something you love or to which you are attached, is taken away.

“Grief management” is a misnomer Grief is a natural process and happens gradually; Many people go through the grief process with no help from anyone in a caretaking; We grieve differently—there are no “steps”; Grieving a significant loss is among the most difficult experiences we will face.

A Few Myths About Grief: • MYTH: The pain will go away faster if you ignore it. MYTH: It’s important to be “be strong” in the face of loss. MYTH: If you don’t cry, it means you aren’t sorry about the loss. MYTH: Grief should last about a year.

PART ONE: FIVE IMPORTANT CONSIDERATIONS FOR THOSE WHO ARE WITH OR WHO ARE SUPPORTING THOSE WHO ARE GRIEVING

(1) LISTENING (2) LISTENING AND TALKING (3) THE REFUGE OF THE MOMENT (4) SUPPORTING THE BEREAVED IN SELF-CARE (5) SUPPORTING THE BEREAVED TO BE ACTIVE

(1) Listening:Listen with our whole beings to whatever the bereaved are saying. This is perhaps the greatest support we can give to someone who is grieving.

(2) Listening and Talking There is no problem you need to solve or advice you have to give. Listening is often enough. Three specific reflections about talking: • There are ways of talking which are helpful; • There are comments which are extremely unhelpful; • There are also a few overall pointers.

Ways of talking that are helpful • Acknowledge that someone died—using the word ‘died’ can show you are open to talk about how the person really feels if they want to. • Be genuine and don’t hide feelings. • Ask how the bereaved person feels—never assume since these feelings change. Asking is a good way to invite talking and a release of energy. • There is no reason to talk in hushed tones. • Offer support—”Tell me what I can do for you.”

Comments to Avoid • "I know how you feel." • "It's part of God's plan." • "He's in a better place now.” • "This is behind you now; it's time to get on with your life”

Overall Pointers • Accept and acknowledge all feelings. • Be willing to be silent and in silence. • Let the bereaved talk about how their loved one died. • Offer comfort and reassurance without minimizing the loss.

(3) The importance of refuge in the moment • The future is just too painful to think about and the past is equally too painful. In the case of those in intense grief, “now” is also the only refuge. • not denial • Allows the theloss to sink in at a rate the bereaved can handle. • living the “here and now”

(4) Supporting the bereaved in self-careencouraging the bereaved to take care of himself or herself physically. Eating, sleeping, exercising, going for walks are important for a healthy body. important for healthy grieving process. Ways of being in the moment.

(5) Supporting the bereaved to be active Example: my own grief, surprise I could do it, passing time which felt frozen, was in the moment

Part One SUMMARY: Five Important Considerations • (1) Listening • (2) Listening and Talking • (3) The Importance of Refuge in the Moment • (4) Supporting the Bereaved in Self-Care • (5) Supporting the Bereaved to be Active

PART TWO: REFLECTIONS TO HELP UNDERSTAND THE GRIEF PROCESS

REFLECTIONS TO HELP UNDERSTAND THE GRIEF PROCESS Most, even including Kubler-Ross, say there are no steps. Rather what follows are two items: (1) A Roadmap of the Grieving Process (2) The Tasks Involved in Grieving

(1) A Roadmap of the Grieving Process • Reaction to the First Awareness of the Loss • The Loss sinks in • The Bottom—”this will never end” “I’m always going to feel this way” • Glimpses of Change—just glimpses • Coming Back into the World • Adaption

a) Reaction to the first awareness of the loss. This varies from person to person: numbness, shock, breaking heart, disbelief, denial are typical.

b) The loss sinks in. Yearning for the deceased, anger, sadness, broken heart, despair, whatever the person feels is legitimate. There is no “condition” that will tell you what another person might go through. And unless you have been mindful of your own losses, you may not even know what happens to you. • As the loss sinks in, our view of the world changes and we may question if life has a purpose or even any meaning. We may be angered that the magnitude of our own loss doesn’t make a ripple in the greater world.

c) The bottom. What happens here also varies but this is where the sense that “this will never end” or “I’ll always feel this way” can become dominant. Other typical responses: despair, listlessness, and disorganization.

d) Glimpses of change. These are brief moments that indicate a change is happening, however slowly. They often catch a person by surprise. They may generate guilt: how can I enjoy this when so-and-so has died? They may generate an unrealistic hope for a quick recovery. They are just what they are—indications of a change beginning.

e) Coming back into the world. There are good days and an ability to reconnect to old friends and old engagements.

f) Adaptation. The person has completed what can be completed. It does not mean that there will not always be moments of sadness or that the bereaved is content or happy with the loss. It’s just that the bereaved can re-engage in life and has many more good days than bad.

(2) THE FOUR TASKS INVOLVED IN GRIEVING • (1) To Accept the Fact of the Loss • (2)To Process the Pain of Grief • (3) To Adjust to a World without the Deceased • (4) To find an Enduring Connection with the Deceased in the Midst of Embarking on a New Life

Task One: Making Real the Fact of Loss • Those about to suffer a death loss • Making real the fact of loss after a death

Making real the fact of loss for those about to suffer a death loss How to tell patients about their condition and discover if they want to know. The great advantage of people openly knowing they are dying when they are dying: • dying and family members can be present, complete major unfinished business and say goodbye; • those at a distance can return to be with dying; • ends dance of pretence and irrelevant conversation; • in any culture of not telling, very sick patients with positive prognosis may be unnecessarily stressed.

Making real the fact of loss after a death Intellectual and emotional components Helpful actions: • Viewing the body (unless disfigured by explosion, etc) • Engagement in process between death and completion (personal examples) More difficult losses: • The lack of a corpse (war, drowning) • Disenfranchised grieving (miscarriage, abortion, secret lover)

TASK TWO: PROCESSING THE PAIN OF GRIEF • Completing unfinished business—one important reason to tell condition to dying if he or she wants to know • Taking time off for grief • Journal, memorial book, painting the colours of loss • Joining a group for those who are grieving • Mindfulness • Difficulties: • guilt—rational guilt, irrational guilt, irrational guilt with staying power • loss through suicide

Irrational guilt and rational guilt.

TASK THREE: ADJUSTING TO A WORLD WITHOUT THE DECEASED • External Adjustments—loss of a companion, sexual partner, accountant, baby-sitter, gardener, audience, bed warmer and/or many more. • Internal Adjustments—the internal task is to ask “Who am I now?” Over time negative images tend to give way to more positive ones. • Spiritual Adjustments—the bereaved may initially lose all direction in life and may consider himself/herself without value. The world may seem to make no sense.

Eitherthe bereaved person makes progress toward a recognition of changed circumstances—aims, goals, perception of self without deceased--— Or else remains in a state of suspended growth in which she or he is held prisoner by a dilemma that cannot be solved.

TASK FOUR: FINDING AN ENDURING CONNECTION WITH THE DECEASED IN THE MIDST OF EMBARKING ON A NEW LIFE • Love continues and may appear as sadness; • Continue work of deceased, completing a project, volunteer work, helping with a condition the death brought to ones attention (diet, smoking, suicide prevention, alcoholism, becoming a hospice pioneer).

PART THREE: THE COMPLEXITY AND INPUT FROM UNRESOLVED LOSSES

Changes that may be significant losses for many or some people • Divorce or relationship breakup • Loss of health • Losing a job • Graduation • Loss of financial security • Leaving home (for college, marriage) • Loss of a friendship • Sexual abuse • A miscarriage • Loss of a cherished dream

More Changes that may be significant losses for someone • Losing money (including bad investments) • Loss of mobility/capability • Being robbed or mugged • Retirement • Children leave home • Loss of faith or religious belief • A loved one’s serious illness • An abortion • Loss of virginity • Loss of a pet • Leaving a familiar hated work environment

Exploring and working with past unresolved losses Grief history • All recent deaths or significant losses • All significant losses beginning with first death loss or first remembered significant loss • This takes an hour or so and the person may add to the list later as other losses are recalled • The list above may help a person recall losses that were not death losses

Exploring and working with past unresolved losses (continued) Take three of these losses and describe the experiences of how you went through the phases of grieving: • a) reaction to the first awareness of the loss; • b) the loss sinks in; • c) the bottom; • d) glimpses of change; • e) coming back into the world; • f) adaptation

Exploring and working with past unresolved losses (concluded) • By reviewing three significant losses, a pattern or profile of how a person grieves may arise. The person can then assess what was helpful, what was not, and any changes that might helpcomplete the four tasks of grieving • The work here is the same as the work in going through the four tasks of grieving: making real the fact of loss, processing the pain of grief, adjusting to a world without the deceased, and finding an enduring relationship with the deceased in the midst of embarking on a new life. • The practice of mindfulness meditation is a useful way of staying in the moment and allowing memories, images, pain and joy to arise and cease.

The form of meditation here is often called vipassana. The aim is simply to be in the moment and to experience the pain and grief and anger and torment, not to become it. These are all natural human conditions—the “mistake,” which most of us make, is to take them personally. Rather than “I am angry” the ancient Irish language said “the anger is on me.”

The Guest House– by RumiThis being human is a guest house.Every morning a new arrival.A joy, a depression, a meanness,some momentary awareness comesas an unexpected visitor.Welcome and entertain them all!Even if they are a crowd of sorrows,who violently sweep your houseempty of its furniture,still, treat each guest honorably.He may be clearing you outfor some new delight.The dark thought, the shame, the malice.meet them at the door laughing and invite them in.Be grateful for whatever comes.because each has been sentas a guide from beyond.

In closing… Two deeply mistaken myths: • MYTH: The pain will go away faster if you ignore it • MYTH: It is far better to avoid uncomfortable events and tasks than to acknowledge that a family member or friend is dying or has died. • Rather, take time off to grieve, allow the energy of the loss to express itself and flow through, TAKE TIME OFF TO GRIEVE.

One way of bringing this home the importance of these “tasks” : looking ahead five years and asking what would I prefer to look back upon in five years?Would I prefer to remember that I said goodbye to my dying parent? Would I prefer to remember that I thanked the person for all that they had given me? That I asked forgiveness for mistakes I had made? Would I prefer to help prepare the body of a loved one?The five-year tool is a useful one and someone who is bereaved will recognize it being useful such as soon as they are asked.

Some important lessons….Keeping relationships current (for example, telling people you love that you love them); Keeping what is important current.

In my first grief lecture in Thailand, I was asked only one question: what can we do to prepare ourselves for loss and grieving? In addition to keeping our lives current, there is another practical answer:

By practicing meditation that quiets the mind and brings us into the “here and now” moment, including being mindful of touches and tastes and sights. This has nothing to do with religion but everything to do practical concerns.That is an indispensable important way of preparing ourselves for loss, grief and our own deaths.

1) It helps us to process the pain of grief;2) By practicing daily, we develop an important tool that will be ready when we need it;3) Meditation actually changes our brain to abide with physical andpsychological pain

Grieving for significant losses is one of the most difficult things we human beings experience.I wish all of us well.

BEREAVEMENT AND GRIEF