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The Dance of Trauma and Grief: Day 30 of #31DaysWithGrief

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January 30, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 30—The Dance of Trauma and Grief

This is a month-long series to support persons grieving and those who love them. It includes content from “Sharing Our Stories: A Hospice Whispers Grief Support Workbook” available through Amazon and wherever books are sold.

On Day 6 of this series, I wrote about The Many Faces of Grief. As this 31 Day series draws to a close, I want to say a bit more about the intersection between Trauma and Grief.

Grief related to loss is an expected part of our lives. We know that we and others age and that changes will come, including the death of others and even our own. We don’t like to think about it and, though on some level we know to expect it, it still stinks and causes sadness, distraction, and other symptoms that usually pass within weeks or months to a couple of years.

Trauma is not something we naturally expect. Traumatic experiences or events that cause physical or emotional harm can overwhelm our capacity to cope and the effects can be lasting, leaving us terrified and feeling vulnerable, powerless, and unavoidably distracted.

When speaking of the interaction between trauma and grief, we’re still working out the details.

Some grief experts believe that all loss results not only in grief but also trauma, as the loss is traumatic in and of itself. Others disagree and believe loss may involve and/or lead to trauma, such as a death in a car accident, but not all loss meets the criteria of traumatic loss. Therefore, not all grief will contain trauma but some grief could be traumatic.

More agreement exists that the experience of trauma will naturally result in grief in addition to traumatic distress. Trauma often involves a lack of trust, safety, feelings of normalcy, and it challenges our existential beliefs about how the world should be. Those losses contribute to grief that must be mourned in addition to the trauma from which the person must recover. Therefore, most agree that all trauma involves some form of grief.

Teasing out the relationship between trauma and grief is important because the treatment interventions differ between the two.

Grief support typically involves reminiscence and other means of helping the person accept the absence of the deceased while creating a new way of connecting to the person’s memory and moving on with life in a new way.

Trauma is most often treated using cognitive behavioral and/or physiological interventions designed to help the person feel safe once again and cease the intrusive replays of the traumatic event.

When both are present, the key is determining how to treat both and in what order. In some cases, treating the severe distress of trauma must come first so the person can feel safe enough to do any further work. There seems to come a point, however, when the person must grieve the losses resulting from the trauma before they can let go and continue healing.

I spent a great deal of time healing from a traumatic event and was doing pretty well, but then deep grief arose to which I had to attend. Once I did, I achieved an even deeper healing and freedom than ever before. It profoundly impacted my professional work by giving me a greater perspective and more profound respect for the importance of the role of grief in trauma.

In the Day 26 post in this series about the Myth of Moving On, I shared William Worden’s Tasks of Mourning. There is a general agreement amongst grief experts that a combination of factors influence the depth and severity of our grief and Worden’s model is one those most frequently used.

There are many ways these factors may combine, or collide, to result in traumatic grief. If the death was the result of an accident, natural disaster, crime, or sudden and unexpected illness, for example, the seemingly capricious nature of the death can significantly complicate our grief. A grandparent’s death from a long-term illness can be much easier to wrap our heads around than a drunk driver crossing the yellow line and killing a child.

Losing support from someone on whom we depend financially, physically, and/or emotionally can pull the rug out from under us and can be experienced as traumatic as it threatens our security. The death of someone similar to us in some way can also hit too close to home, leaving us feeling unsafe in the world and experiencing the loss as traumatic.

I once performed the crisis debrief for student medics who were the first responders after a significant tragedy at a campus. These students performed beyond admirably, earning the respect of the “professional” responders who showed up to relieve them as rescue efforts continued.

Many were already fairly seasoned as paramedics and EMTs, but seeing their classmates who looked and dressed like them, whom they even recognized from campus and classes, was just way too much. It blasted past their natural defenses, the mechanisms that protect us from being constantly afraid of something happening to us, and made them come face-to-face with the uncertainty of life.

That, as much as anything, was what they struggled with as they mourned their classmates and dealt with the trauma of the tragedy.

Whatever our story, whatever loss we’ve faced, it is important to recognize any trauma that may be involved, complicating our grief. I, like others, resist the use of the word “abnormal” grief, because we do not wish to pathologize an understandable response to inordinate circumstances. If trauma has been a part of your experience, it is worth seeking support for the grief related to the losses that accompanied the trauma.

Getting the proper type and amount of support is important, and certainly understandable and well-deserved. I hope you find what works best for you and your unique situation.

Peace,

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

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Living with the Misunderstanding of Suicide: Day 29 of #31DaysWithGrief

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January 29, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Much of the poetry in Sharing Our Stories was written and graciously offered to the workbook by my friend, Janie Cook. I thank her for agreeing to open her tender heart, once again, and share it with us. You can learn more about Janie and her story at the end of this post.

Day 29—Living with the Misunderstanding of Suicide

by Guest-author, Janie Cook

To lose a loved one to suicide creates a uniquely complicated grief – one that is often deeply misunderstood, because to take in why someone would die this way requires opening up to their immense psychic pain. Society wants to avoid facing that pain, that fear, and in so doing creates a stigma around suicide that shrouds it in secrecy and isolates those who grieve in silence.

Stigma reveals itself in the language society has adopted to describe a death by suicide. The common phrase we hear is that someone “commits suicide “– similar to the way we talk about “committing” a crime or a sin – instantly labeling that person and negatively characterizing their death. Add to that, the judgmental facial expressions, the shame cast upon your loved one and the walls that go up around you as you try to live with this loss and you see the obstructive and destructive impact stigma can have.

Our family has tried to be patient with these comments and see them as a misunderstanding. We try to remember and have compassion for the fear behind them and then, with as much kindness as possible, offer our words of love in describing who our son was and the lethal impact of his acute, untreatable depression.

There is a Hebrew word that has helped me immensely to deal with this part of my mother’s grief. Part of the Jewish Passover Seder ritual ,called the Haggadah, is the word “dayenu” (which means “it is enough” or “it is sufficient”). “Dayenu” is repeated as the refrain in a Passover song that celebrates each one of God’s liberating acts as though it alone would have been enough to bring peace. This song strikes me as a powerful celebration of any one of the moments in our lives when we recognize Love’s gifts as whole and complete.

So, when the stigma of suicide announced to me that Matt’s death was inappropriate to talk about, not worthy of being grieved and therefore woefully misunderstood, I heard healing in this word, “dayenu”, and wrote my own verse to the song:

Matt lived his life in love,

Dayenu.

He gave himself away for those he loved,

Dayenu.

He is remembered with deep-hearted kindness and gratitude,

Dayenu.

He left this life loving us,

Dayenu.

And if we are the only ones who understand,

Dayenu.

More About Janie’s Story, from the Introduction to Sharing Our Stories:

Many of the poems were contributed by friend and colleague, Janie Cook, and are shared with her gracious permission. Janie and her husband have two children—a son and a daughter—and live in Austin, Texas.

Their son, Matt, died of depression through suicide that claimed his life in 2007. They experienced the sudden death of a child and the complicated grief that persons experience when society heaps stigmas born of ignorance and fear on the families of those who make this choice.

It broke their hearts, but also broke their souls open to greater compassion, love, and understanding. It led Janie to begin working as a facilitator of grief groups and to share her experience with others who are mourning, especially after the death of a child, through her blog at livingwiththelossofachild.blogspot.com.

Again, many thanks to Janie, and others, whose words are shared throughout this text.

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Is There Space for Gallows Humor: Day 28 of #31DaysWithSuffering

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January 28, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 28—Is there Space for Gallows Humor?

In the midst of our discomfort with death, we may deflect away strong feelings of grief through the use of humor. This can be a challenge for us if it leads us to avoid either our feelings or those of another.

Other times, however, humor can be a very effective tool for coping as it provides some distance from the pain and reminds us that more still exists to live for beyond our grief. It can be hard for some to feel free to engage in or express humor, fearing doing so in a way that is offensive or hurtful to others.

We’re wise to be mindful, yet it is also important to not rob ourselves of the fullness of life, even as we life in the face of death and other loss.

I’ve shared elsewhere, through Hospice Times, an excerpt from Hospice Whispers: Stories of Life that speaks to this through a story called, “I’m Trying to Die Here”. After reading this story, you may explore the related reflection questions that are published in Sharing Our Stories: A Hospice Whispers Grief Support Workbook, and which I have also shared here for you, below:

I’m Trying to Die Here

Reflection Questions from Sharing Our Stories: A Hospice Whispers Grief Support Workbook

1) Where did you or your loved ones find humor in the midst of your sadness or grief? What was that like for you? For them? Is it helpful or disturbing for you?

2) When and why might humor not feel good to someone who is hurting?

3) What is your reaction to my shock at the dark humor of the therapy team I worked with in my younger years, as described in the beginning of the story?

4) Where do you believe the line is between irreverence and humor? Does that line change for you at times?

5) I mentioned in this story that most often we healthcare staﬀ get to answer the same questions multiple times. When we experience grief, our thoughts and feelings can be quite disorganized as much of our inner physical and emotional resources are going toward coping with the stress.

What types of forgetfulness or fuzzy-headedness did/do you experience? How do you find gentleness for yourself during these times?

6) What diﬀerences are/were there between the ways you and other family members grieved and dealt with the stress of facing the death of a loved one? How do/did you navigate those diﬀerent ways of grieving and handling stress?

ACTION PLAN:
Memories or thoughts arising from this story to hold onto…

Memories or thoughts arising from this story to let go of…

What action steps might I take to encourage my journeys of grief further along?

What might I need to take time to simply sit with?

What lessons or insights did I gain through remembering my own, or hearing of others’ journeys?

——————————-

My hope is that this excerpt and the entire series will lend a little insight to let you know that you are not crazy, you are not alone, and that you will find your way, perhaps even with the tool of humor at your disposal.

I’m glad you’re with me on the journey.

Peace,

Carla

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Tags : #31DaysWithGrief, bereavement, caregiver support, carla cheatham, counsel, Death of a loved one, end of life, grief, grief counsel, Grief Workbook, Hospice, hospice whispers, humor, Loss of a loved one, palliative care, series, sharing our stories, support

Am I Stuck? Depression and Grief: Day 27 of #31DaysWithGrief

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January 27, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 27—Am I Stuck?

We’re not sure we know how to do this…

“Am I stuck?” This is one of the most common questions I hear from those who are bereaved. Having never done this before, and living in a society that is still struggling to catch back up in our willingness to discuss death and grief, we’re often lost at sea and wonder whether we’re doing it right.

We are bombarded by others’ ideas about what our grief should look like, how we should handle it, and how long it should last. The good news is that, statistically speaking, you’re probably doing it just right! Only about 10-15% of cases turn into what is known as Complicated Grief that requires more professional intervention and support.

Other times, a piece of grief can linger, popping up from time to time, but in a way that is only uncomfortable for a moment and does not truly hold us back from working, sleeping and eating, having relationships, and mostly enjoying life. In those latter and more severe cases, clinical help is a must. But even those periodic and momentary gut punches deserve a space to be processed and healed.

A loved one died years ago. It was complicated for me by the fact that we held a difference of belief that was significant enough for her to choose to distance herself from me. That piece was already a source of huge sadness and grief, but it became even more so when any chance for reconciliation and repair died along with her.

It comes up for me from time to time, and I’ve been working with it to find even more healing. Though it has not been severe enough to interfere with my daily life, I attend to it because any rocks on my path can slow me down, hold me back, and cause an unnecessary ache in the toe I keep stubbing on it.

An excerpt from Sharing Our Stories…

Sometimes, grief can be even more complicated, like the story from this section of Sharing Our Stories: A Hospice Whispers Grief Support Workbook:

One woman contacted me after reading Hospice Whispers, asking for my help. She said she didn’t know what was wrong with her, but that everyone was telling her she “should be over it.” When I asked her what SHE thought, she replied,

“Well, I should be, shouldn’t I? But I’m just not, and I can’t make it happen. Then I feel guilty and ashamed and even more alone and angry and misunderstood, which pisses me oﬀ even more!”

“Find places where people can let you just be. When you find that, and don’t feel rushed, I’m pretty certain you’ll notice something loosen inside of you over time. ‘Wallow’ as long as you need to. In fact, roll around and nest in those feelings as much as you need. When you’re done with them, you’ll know. Life usually doesn’t allow us to stagnate too long, and if we’re stuck, we’ll eventually know it instinctively from within, not because others are rushing us to move on their timetable.

Feelings need room to move and breathe. When they feel pushed back against, they tighten. When they are given space, they can relax and shift as they need. It will happen naturally, without pushing, from you or anyone else.”

Certainly, there are cases in which people do get stuck and the natural grief process stalls. In others, the naturally intense feelings of grief can become so magnified that it leads to dysfunction. The body can get caught in a pain loop and need outside assistance, and there is no shame in getting support from a counseling professional when such complicated grief arises.

Places like The Center for Complicated Grief through the Columbia School of Social Work (https://complicatedgrief.columbia.edu/) and others can provide more guidance and resources on this topic.

I heard back a few months later from this woman who struggled with her grieving process. She had joined a special yoga class for those who had experienced grief. She laughed, “I thought it was ironic that you encouraged me to find a place to let my feelings move and breathe, and then I stumbled into this yoga class completely by accident. I didn’t have to explain myself to others in the class because they were there for the same reasons. I could just go in and, well, be!”

I could hear in her voice the very relief she described. It was beautiful. And according to her, it worked to help move her to a new place. And THAT is exactly what I hope this workbook will provide you—a safe space for your feelings to just be.

(Sharing Our Stories: A Hospice Whispers Grief Support Workbook, pp 8-9)

What I did not take the time to share in the workbook is that I did assess her level of functional impairment—questioning to see if she was eating, sleeping, grooming, paying bills, working, engaging in relationships, etc. She was. But she was still angry with God and could not bring herself to attend religious services or celebrate religious holidays with her family, and they were concerned it was time for her to move on.

She wanted to do so, but pushing and forcing was not the answer. Also, as I wrote in yesterday’s post about the factors that can mediate the mourning process, some circumstances can make it more or less complicated and hard to endure. In this case, there were some circumstances I’ll not share in order to protect her identity, but that significantly complicated her grief, and would have for ANY human being.

Given the complicated circumstances, her grief was completely understandable and just needed more time than would most, but it also needed support! As she found safe spaces to give her that time and freedom to move, it did.

Is it grief or depression…or complicated grief?

Now, for those cases that are complicated in severity and/or duration, it is important to seek professional support because the natural grief process is either overwhelmed by the severity of the circumstances of grief and/or the natural process has stalled. Normal grief can mimic depression but is not considered to meet the clinical definition until it has lasted longer than 6 months.

Freud is often quoted for his distinction between grief and depression, “…after a loss, the world looks poor and empty; while in depression, the person feels poor and empty.”

When any 3 of the following last for at least 6 months, we consider the person to be experiencing Complicated Grief: thoughts and feelings of grief that are intrusive, leave a person feeling numb and/or in disbelief about the death, empty and purposeless, meaningless, irritable, and poorly functioning in their work, relationships, etc. If that is the case, then there is a need for an intervention.

There is no shame in this. Usually, there is a reason the grief is complicated that can be tended to with support. When an infection invades our bodies, our natural immune response kicks in to help us heal and recover. Sometimes, that infection is more than our system can take on and we need antibiotics to support our immunity. That is not weakness. That is not “crazy”. That is life and it happens, especially when complicating factors super-size the germs or hinder our immune response.

To be clear, grief doesn’t need to be complicated to seek support! Grief counselors and groups are always ready to walk the potentially scary and overwhelming road with someone who is in mourning and deserves an extra dose of support.

Whatever your circumstance, continue to be patient, be gentle, avoid shame at all costs, and find the support that your grief deserves.

Peace,

Carla

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The Myth of Moving On: Day 26 of #31DaysWithGrief

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January 26, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 26—The Struggle of Moving On

I love lists and formulas. I’m a good student. Tell me what to do and I’ll do my homework and check off the list and be done!

If only life, and grief, was quite so neat and tidy.

Having patience with our grief is often hard, and of course we want to hurry up and not feel sad, angry, lost, scared, overwhelmed, distracted, and exhausted anymore. I think this lack of patience with our own mourning is part of the reason we struggle to be present with others in theirs.

So, for everyone’s sake, let’s look at this concept of moving on.

The “it takes a year” thing is a myth…

One of the great, enduring, and completely erroneous myths about grief is that it takes about a year. Some research shows the acute stage of grieving can be over for many in 3-6 months while for others it can last much, much longer. Many factors can contribute to this variable timeframe.

Grief expert, William Worden (2002), proposed 7 Mediators of Mourning, including:

relationship to the deceased (spouse, co-worker, etc.)
nature of the relationship (secure, dependent, ambivalent, etc.)
cause of death (natural, traumatic, unknown, etc.)
history of other loss (unresolved family dynamics, personal and familial struggles, etc.)
other stressors (financial, familial, work, etc.)
individual factors (age, gender, culture, personality, esteem, coping, etc.)
social factors (support, engagement in activities, other relationships, etc.)

Each person’s unique circumstance can strongly influence how hard and deep and long their acute stage of grief may be. There is no shame in any of this. It is meant only to help understand and even predict what a mourner might expect and the type and amount of support they may need.

It is not a set formula, but an invitation to see each loss as unique. One might ordinarily expect the acute stage of grief, which is a period of distraction and likely disturbance of sleep, activity, work, etc., to be resolving around 6 months (though that does NOT mean that the grieving is over!) However, if there are other factors that come into play, this resolution of acute grief may take longer.

For instance, if a death involved an autopsy that left loved ones in uncertainty for months about the cause of death, this may delay the grieving process and open it anew when answers are finally received. The circumstances are complicated, but this does not mean that the grief process being a bit longer is in any way inappropriate, given those circumstances.

“I was surprised to find the second year was actually, in some ways, harder…”

Some persons are often caught off guard when they experience the grief of the first year and feel ready to begin moving on with life, just to find that the second year is actually harder, in some ways. No matter how much we understand about grief, that blasted year time-line gets stuck somewhere in our expectations, and sets some up for a shock.

But it’s more than that. Past the anniversaries, we move into “firsts” without our loved one there. The pockets of grief that arise with this are often not anticipated or even noticed by persons around us, so we have even less support than we did in the first year.

One woman shared:

“I thought I was good! I passed the one-year anniversary, which was hard as I remembered the sights and sounds and smells of the season and in some ways relived what I had been doing the 365 days before and how painful it was. But I was mostly okay! And then…

It was the first year of my adult life that he wasn’t a part of. I went to my first party without him by my side, received my first holiday cards addressed only to me, had persons asking me if I was ready to date which was something I hadn’t even considered in over 20 years. Triggers were everywhere that second year, and I wasn’t prepared for it.

I started moving even further into a life without him. As much as I wanted and thought I was ready for moving on, it was like I had to grieve letting go of my grief, which was one of my few connections left and another way of having to let go of him, if that makes sense.”

Another friend, during the recent holidays, commented on January 1^st about how stunningly hard it was to move out of 2016, the last year in which he had his husband with him. By going forward into 2017 alone, he said it was just as painful as if he had moved out of the home they had shared for their 48 year relationship. It was the first year in his adult life without the love of his life by his side, and it was surprisingly hard to make that one more step away from him.

There’s nothing wrong with you…

You may not experience this. But if you do find that each new step forward also has its own moments of grief, please know that there is nothing wrong with you. It is an understandable part of the process. If you’re stuck in your grief, which only happens about 10-15% of the time, you’ll usually know it. I’ll write more about that in a future post in this series.

For now, please hear this as a gentle reminder to be gentler with yourself and each other than you think you might need to be as you move into a fresh new start. As sweet as the new often feels, it is a new that is coming without the one you still wish was available to see and touch and hear, and the bitterness of that can easily dampen the moment.

When others do not understand this, it can send this part of your grief underground, leaving it disenfranchised. That which goes underground and is borne in solitude, can sometimes gather a sense of shame around it, even if cognitively we know that shame is not warranted.

Find safe places, other people who will understand or at least try, to share these bittersweet moments with. Just as your loved one is worthy of being remembered by you, still, your pain is worthy of being supported and cared for.

Peace,

Carla

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Is “Masculine Grief” a Thing?: Day 25 of #31DaysWithGrief

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January 25, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 25—Is “Masculine Grief” a Thing?

Stigmas around death and grief…

With our technological advances, we’ve come to be pretty disconnected with death in the last century. Compared to our previous lives on farms and ranches, when we spent more time in nature with the ebb and flow of fields, livestock, and even the elderly members of the family who lived with us, we rarely touch it, now. We’ve come to see death as a failure to be prevented rather than a natural and expected part of daily living.

Our stigma around death extends to our discomfort with grief. Studies show we have a very set, prescribed view of what is and is not acceptable, even attractive, in our grief responses (Kubitz, Thornton, and Robertson, 1989). We have a very narrow window of tolerance for the ways in which those mourning are allowed to express or cope with their grief before they face our judgment.

Women who openly emote immediately following a death are seen with compassion, understanding, and support, so long as their response isn’t considered “too much”. As time passes, if women continue to openly show their grief through tears, they’re judged, “Isn’t she over it, yet?”

Men face even more…

Men, on the other hand, are in even more of a bind. If they show no emotion right after a death, they can be judged as cold and disconnected but, if they show emotion, we write them off as weak and overly sensitive. If they show grief after time has passed? Forget about it. We can’t handle that, and it’s not just men who judge other men; they face it from the women in their lives, as well.

This very insightful piece from Mark Mercer points out some of the differences in the ways that men may grieve that are often misunderstood and not recognized for what it is.

We may think that men are not grieving, but it’s because we tend to think of the stereotypically feminine style of grief as being the only way.

In my family, I watched the men work for 2 days to design and build a wheelchair ramp that would withstand a tornado, even though it was pretty clear our loved-one’s decline was so rapid he would never actually be able to use it.

Working side-by-side in silence, they sweated and pounded and solved a practical problem for the man whom they loved who could no longer carry 4x4s and cement for himself. It was what they had to give and how they processed the circumstance. But I also know they later cried in private.

Being physically engaged, working out the energy of powerful emotions through movement and physical labor, taking time alone and in silence to solve problems and consider practical matters are some of the ways many men may be more likely to grieve.

Research is still teasing out whether that has to do more with genetics, the way we’ve taught men to grieve, and/or whether those are the only options we allow them to engage in. In reading the Mercer piece above and remembering my own family’s story, I have to wonder, if our society could allow it, if more men would more easily demonstrate an emotive style of coping.

A healthier view for us all…

Researchers once joined in with this dualistic view of masculine vs. feminine grief—men work logically and in silence while women cry, talk, and seek support. Now, we realize that these two styles are opposite extremes of a continuum with variations everywhere in between that both men and women can effectively use to cope based on their cognitive styles, culture, responsibilities, nature of the relationship with the deceased, etc.

These two styles are more commonly being called Instrumental (the more stereotypically masculine means of coping) and Intuitive (what we generally label feminine grief). An excellent interview with grief expert, Ken Doka, contains even more information about these styles.

We now know that whatever works for a person in coping with their grief is what we must support and that we do everyone a huge disservice when we pigeon-hole men and women into one particular style. The Instrumental and Intuitive terms promoted by Doka and others is a good place to start with getting over our narrow thinking and stigmatizing views.

Some research even demonstrates that if men and women are feeling stuck in acute grief later in their grieving process, problem solving (Instrumental) interventions are most successful with women and affect-stimulating (Intuitive) interventions are more helpful for men. It’s as if their preferred (or assigned!) style didn’t work for them in the first year, and they needed another coping style to help them come further through their grief.

Regardless, there are three points to make here:

We must not miss that men are grieving just because it doesn’t look like the stereotypically feminine/emotive style of grief.
We must not pigeon-hole men into only one coping style, but allow them the full range of options on that spectrum between Instrumental and Intuitive styles mentioned above.
Women can clearly find some relief from exercising the styles more often attributed to men, and should feel free to explore those ways of coping, as well.

Taking off the labels that can confine us, opening our eyes to see grief in all its many forms, and allowing everyone to access whatever tools work best for them in their circumstances is one of the important tasks ahead of us as we mature in our understanding of bereavement.

Perhaps Randall Horton said it best at the end of his beautiful piece in the Huffington Post,

“I dream of a world where grief is not gendered and where masculinity is not marked by solitary sorrow.”

And so may it be, for the sake of us all.

Peace,

Carla

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Sibling Grief: Day 24 of #31DaysWithGrief

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January 24, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 24—Sibling Grief

A friend said to me last year, “When you write your next book, PLEASE include what it’s like for us siblings. We always get left out!” So many dynamics come up around the death of a child that it can be impossible to address them all. The experience of the other children in the family often gets missed.

What it can be like…

Some siblings are close and loving. Others argue and fight. Most are a mixture of the two. If the child was a confidant or companion, that loss could be deeply felt. Losing a roommate or having your own bathroom may seem like a dream, until it comes by way of death and you’re sleeping alone in a way too quiet room. If the children weren’t close, guilt, which is already common for children to feel about a death of someone around them, may arise.

Regardless of how close they were, the sibling’s whole life has been thrown into turmoil. Parents and grandparents are distraught and often distracted, the comfort of routines and visiting with friends can disappear, new grownups are in and out of the home at all hours and the phone rings off the hook, things are happening that they just can’t understand.

Perhaps the child who died had an illness that already took time and attention away from the sibling and they resented it, or even felt relief that the turmoil around the illness and trips to the hospital and constant disruption were finally over. Either of these can prompt guilt in a sibling.

As life tries to move forward into a new normal, the child is having to adapt, as well. Sometimes, children adapt quite well. They grieve as much as they are able to in the moment and then can continue to grieve over the years as they cognitively develop and can handle more.

It can also be very hard for them to feel invisible while everyone around them grieves, and supports the parents’ grief while forgetting about the needs of the children. Siblings can feel pressure to grow up faster than usual to be more self-sufficient, emotionally and physically. They may try to make their parents feel better, and struggle when they can’t.

The vacuum left behind…

They may even try to make up for the vacuum left by their brother or sister, working to fill their shoes or fill the role they played in the family dynamic. Some parents may inadvertently put pressure on the child to do so. Feeling the incapable of being like their sibling, or even the pressure to try, can lead the child to feel incompetent, inferior, and never good enough.

One man, whose older brother died when the man was 6 years old, struggled for years with the magical thinking children can engage in to try to cope that told him if he was just good and loving and easy enough as a child, his mother would be happy again. Of course, that wasn’t rational. Of course, he couldn’t make that happen. And of course, his young mind felt responsible, and that small part remained with him for decades, until he finally dealt with it.

Siblings have has also come face to face with death in a way that most of us do not until we are much older. Being exposed to the existentially expected death of an elder is one thing. Facing the death of someone closer to our own age can leave us feeling even more threatened and insecure.

It’s jarring to realize that we aren’t immune and it really can happen to us. Blissful ignorance of threat can be adaptive, and having that illusion of safety lifted can be traumatizing in and of itself, leading to a sense of impending doom.

It never ends…

As the child ages toward adulthood, there can be a feeling that life is never allowed to be “normal” again. The cloud that comes with the death of a child in the family follows them through every meal, every trip, every holiday and gathering; their absence can’t help but be felt.

Then there are all the anniversaries of the death, when the child would have graduated, going to the weddings of the child’s friends, and on and on. The potential for triggers are constant. It is a heavy burden under which to grow up. And then to be an adult caring for aging parents without the added help the sibling may have been, yet another reason to feel put upon or abandoned.

Some do not see it that way. They find meaning in all of it that gives them hope and even a life purpose. They find comfort in the deeper perspective, wisdom, and compassion that can come from being around death and suffering.

Whatever your experience, I’m certain I’ve not comprehensively captured it here. The hope is to prompt persons to have a deeper understanding of what the experience of sibling grief might be like so we will all be less likely to ignore or miss supporting a grief that often remains faceless and hidden.

How to be present for a grieving child…

If you are around a child who’s sibling has died, here are a few quick tips to remember:

As always, avoid cliché’s or imposing theology or meaning on a child.

Do NOT use euphemisms like, “They went to sleep” or “on a trip” lest they freak out the next time they or a loved one gets sick or travels. Use the real words.

Don’t force or push them to talk. Leave blank paper and colors or colored pencils around for them to draw or write. Perhaps ask them to draw a picture for their loved one or of what they think it is like for their sibling now. Invite them to write their sibling a letter. Allow them to place the picture, letter, or other tokens in the casket with their loved one if they wish.

Children learn and process their feelings through play. They may even play “coffin” or “death”. Don’t be alarmed. This is normal as they try on what it might be like for their sibling. So long as they aren’t scaring themselves, its usually helpful.

Don’t force anything. If the child is 5 years or older, we typically suggest allowing them to decide what they want to do about the funeral or memorial service. If they are under 5 years, parents are encouraged to make the decision they feel is best, knowing what they know about the child.

If a child insists on being present but is denied, they can feel left out or like there is a secret happening that can be far scarier in their imagination than in reality. If they don’t want to go and they are forced, it can be traumatizing. If they do go, have a safe adult prepared to focus on them, while other grownups are grieving and distracted.

If you know the death is coming, have a special box of toys and coloring books prepared that are new to the child. Have a grownup with whom the child feels safe prepared to focus their energy on being present with the child somewhere nearby, but out of earshot while other grownups may need space to grieve openly in a strong way that may scare the child.

Refer questions to the parents. You’ve no idea what the parents wish to teach the child about why bad things happen or what happens after we die. Confusing the child with multiple messages is not helpful.

Get comfortable saying, “I don’t know”. You don’t have to have all the answers.

Don’t tell a child G-d did this, lest they learn to resent or feel afraid of a deity.

Don’t tell the child, “You have to be extra good/strong/brave/etc.” No, the child has to be a child and grieve exactly as they need to without grownup expectations being put upon them.

Be present, be open, don’t over-share horrific or graphic details, stay calm, and give them room to talk or be quiet or play or vent whatever emotions come up for them.

Again, this is far from a comprehensive list. Being with a sibling of a child who has died or is dying can be challenging, but the gift of simple presence can remain with that child for a lifetime, because someone refused to let them be invisible.

Trust yourself. You’ll do better than you think.

Peace,

Carla

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Parental Grief: Day 23 of #31DaysWithGrief

Posted by Carla Cheatham on

January 23, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 23—Parental Grief

As close as I can understand…

I tread gently when speaking of any grief I have not personally experienced. I did learn how amazing it is to love a child as a step-parent over a period of years.

I will never regret a single 2:00 a.m. wake up because of a nightmare. I’ll never begrudge even a moment of gently holding back her long hair with one hand as she puked up her toenails while worriedly calling the doctor for an appointment with my other. Every second was worth loving her.

I got a small taste of what it is like to lose a child when my relationship ended and I had no legal right to see this small, funny, brilliant, kind, beautiful human whom I absolutely adored. I did not give birth to her, but I felt the umbilical cord cut, grieved deeply, and miss her still.

As much as it hurt, and it did hurt too much to breathe for a very long time and I still get misty-eyed and choked up when I speak of her, I took comfort in knowing she was still alive. I imagined the others who would come into her life to love her. I prayed for her daily, and do still. I smile when I remember moments and antics. I wondered about her learning to drive, what high school was like for her, where she’s chosen to go to college and what she’s finally (for now) decided she wants to study and do and be for her career.

For me, knowing she was and is still in this world, and trusting the universe to care for her made it all easier to accept, because I trusted she was happy, had a future, and that perhaps I may even get the chance to see her again someday.

I can barely imagine that pain being even an ounce bigger by having to live with the death of a child.

We don’t compare pain, but acknowledge each grief’s unique features…

In Sharing Our Stories: A Hospice Whispers Grief Support Workbook, I wrote the following:

“We don’t compare grief, lest a person minimize their own pain if they believe it to be somehow less challenging than another’s experience. For example, some may say, ‘Oh, they’ve had it much worse than I have.’ This can lead a person to not feel as if they have a right to grieve as deeply or as long as they may need to. It can also leave them feeling guilty or ashamed about how they feel….

While we do not compare, there are forms of grief that have unique characteristics that challenge us in diﬀerent ways, such as grief related to a trauma or a sudden death. The death of a child or other young person can pose such a challenge for us…

It is natural for humans to think that parents will not outlive their children. When it does occur, it poses an existential challenge—something that ﬂies in the face of how we believe the world should be, how we make sense of things, and how we understand questions of existence and meaning and suﬀering. We may hear, or find ourselves saying, ‘Parents should never have to bury a child,’ or ‘Children should be able to grow up and live out their whole lives.’”

(from Sharing Our Stories, pg. 99-100)

Because the death of a child can so challenge our sense of the way the world should be, our defense mechanisms may come up even more strongly to try to make sense out of it all or to decrease the impact we feel about it. But we must guard against our discomfort causing them even more damage and trauma.

What to avoid when speaking to a parent who is grieving…

Here are a few things to remember when interacting with parents of children who have died, whether before or after birth:

Children who are stillborn or miscarried are no less valued and no less loved by their parents. Do not minimize this loss. Honor the death and find ways to show up well for these parents, as this form of grief commonly falls in the category of Disenfranchised Grief.

Ask, “What is their name?” The child is still very much present in their parents’ hearts and minds, so referring to them in the past tense can feel harsh or disrespectful.

If you do ask about the child’s age, be sure to NOT make it appear in any way that a younger age makes it somehow less traumatic to the parent. This is minimizing and dismissive. It can be tempting to use this information to feel like, “Oh, well they were only 2 months old, so that mustn’t have been that bad. I mean, it’s not like they…(insert excuse to make the pain not that bad, here).” Don’t injure them further by saying such insensitive things to decrease your discomfort. As I wrote in Sharing Our Stories, “Grieving parents often state their child’s life cannot be measured in hours, days, or years, but by the love their presence generated in the world—however long they were physically with us.”

Do not tell the parent in any way how they should feel, what they should think, what they should believe, or how they should act or respond. There are no right or wrong answers here, or with any grief. Each person must do whatever they need to find peace and meaning and should never have meaning imposed upon them,

Examples of imposing meaning, as well as cliché’s and theologizing to avoid, are:

“God needed another angel.”
“God was saving them from some worse experience later.”
“They were too good for this earth.”
“Well, at least you have (or can have) other children.”

There are more, but any parent whose child has died is probably ready to scream right now being reminded of or hearing these, so I hope this gives you an idea.

As always, if a parent’s form of coping is to believe any of these, it’s okay to affirm their feelings and beliefs that are getting them through, but make certain such words come from THEM. If it’s not helpful for them, the opposite of not helpful isn’t benign, it’s traumatic and damaging. Don’t risk it.

It is always safe to say, “I wish I knew what to say. I’m so sorry I don’t. But I care and I’m here, however and whenever you need.” Then follow that statement up.

Offer to run an errand. Offer to care for the house/kids/animals/yard. Invite them to lunch and be prepared to listen the whole time if they need to talk, without needing to jump in and speak over them. Let it be their space.

When you leave messages, make it clear that there is no pressure for them to respond, but to do so only if it is good and helpful for them; that you won’t take it personally, at all, if they do not do so. Let them know it is a simply given offer with no expectation on them in any way. And mean it!

So much more to say…

There’s so much more that could be said. Whole books and blog series and websites are devoted to this topic. For now, I will leave you with one of the many poems contributed to the Sharing Our Stories grief workbook by Janie Cook.

Janie’s own son, Matt, died of depression through suicide that claimed his life in 2007. She graciously offered her work to me from her blog, LivingWithTheLossOfaChild.blogspot.com:

First you try to take in all that is lost . . .
the dreams that will never be,
the deafening absence,
the precious reminders of the presence of this child
that literally rip a hole in your heart each time you see them
and, at the same time, you try to take in all the amazing gratitude you feel . . . ,
for the unforgettable moments you have been given,
for the vivid memories that replay like a beloved movie in your mind, and
for the amazing gift of a love as immense as this ?

Janie continues:

Grief is so confusing! It is packed with both of these heavy opposites. So, we careen from one to the other like a marble in a pinball machine – bouncing first one way then another. It is enough to make you crazy! It does make you crazy.

I carry an image in my mind of what healing looks like. It is standing with both feet planted firmly on the earth, arms outstretched, palms up . . . holding the son I have lost in one hand and the son I have been so graciously given to love in the other.

In my better moments, I am balanced between these two truths. And, I believe that healing is learning to keep this balance until it becomes so familiar to us that we do it without thinking. . . . gently holding one reality and then the other . . . . accepting the truth of both.

~Janie Cook

May those who love someone whose child has died find support to help you support them. May those of you who know what it is to face the death of a child find comfort and peace as you find your way in your own time.

Blessings,

Carla

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Loss After Crises and During Chronic Grief: Day 22 of #31DaysWithGrief

Posted by Carla Cheatham on

January 22, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 22—Sense of Loss After Crisis & During Chronic Illness

In my last post, I wrote of the impact of not just the primary losses we experience, but also the secondary losses of safety and security, connection and identity, future hopes and dreams, etc.

I’ve also written about Disenfranchised Grief, that which is not known about or understood by others, leaving the one grieving a loss even more alone, and even feeling judged.

Both dynamics come into play after a person has gone through a crisis that has seemingly resolved well and when persons go through chronic illness.

In the former, folks wonder, “It’s all ok now! Why are you still so freaked out?” In the latter, persons don’t understand what chronic illness does to a person’s physical self, emotional and mental health, relationships, income, and so on. Failing to understand fully what it’s like, they get impatient and/or judgmental with the person who is already suffering.

More of my story…

In 2012, as I’ve written before, I was preparing to compete in an Olympic distance triathlon. I began having shoulder pain my doctor feared was coming from a neck injury when I was rear ended in my car a few years before. She ordered and MRI that came back with some incidental findings—one kidney was dead, the other was inexplicably enlarged, and I had solid (read: possibly cancerous) masses on my uterus and ovaries.

I’ve always been fairly healthy. I was running 20-25 miles a week, biking 90, and swimming 5. I was about to do a century (100 mile) ride. I had a race to run. I did not have time for this. It wasn’t on the agenda! I told them to close the hood and stop looking.

But my life changed overnight as we tried to decide where to start. I gained 6 new specialists overnight and had 20 hours’ worth of doctors’ appointments a week as we did scans and tests and tried to figure out what was going on and what to do. In the meantime, my shoulder/neck injury worsened and became almost debilitating.

Yeah, it was a rough few months.

The end result was that I was mostly ok. There was no cancer and almost everything was treatable. That which wasn’t was mostly live-with-able. I didn’t have cancer! I should have been jubilant and relieved. My kidney was dead not because of some scary disease, but because a doctor made a mistake during a surgery over a decade before. The other was only enlarged because it was doing double duty, giving me 100% kidney function.

When it was “over”, it wasn’t really over…

I couldn’t understand why I still felt like, pardon the term, total shit. I wasn’t relieved. A doctor, who was supposed to treat me, damaged me irreparably, and either lied about it or missed it. Another surgeon tried to hide it from me. I felt betrayed, but had no legal recourse due to tort reform. What if my remaining kidney fails? What if I have to go on dialysis?

So what if it wasn’t cancer this time? The fact that I had sat in an oncologist’s office not as a healthcare professional but as a patient, a particularly sobering moment for me, had me worrying about tumors growing quietly inside me until it was too late. Sitting with the worry for almost 5 months before surgery revealed it was not cancer took a toll on my psyche.

The surgery that took care of the solid masses, that weren’t cancerous, required a partial hysterectomy. I had not yet give birth to children and, at 42 years old, had still been considering it. That option was now gone for me.

I was behind at work. I was behind on everything at home. Despite having insurance, that many co-pays decimated my savings. I was emotionally and physically and mentally exhausted. My adrenals crashed, as they tend to do AFTER a crisis is over as I’ve written previously, and the partial hysterectomy threw me into menopause, causing 30 pounds weight gain and lots of muscle loss almost overnight.

Did I mention already I was 42? Did I mention I was about to run a mid-distance triathlon and do a 100 mile bike race? I missed both of those. It was even more loss of my identity as an athlete and someone who was physically and emotionally strong.

The inner recovery took longer than the outward…

I could not get my confidence and sense of safety back for a long time. I had lots to grieve. I had come face to face with most people’s worst fears. I had dealt with loved ones not knowing how to respond and so disappearing in response.

I had dealt with the well-intentioned but totally unhelpful things people said such as, “But people live with one kidney all the time!” My response became, “Since you think it’s such a good idea, when are you going to donate one of yours?” That usually helped them do some perspective-taking and get a bit of an idea about how I felt, and they realized how thoughtless and dismissive that statement was.

So when a friend of mine, another hospice chaplain, recently went through her own medical scare and the result of the surgery was, “We got it all”, I understood her when she said, “Folks don’t get it why I’m still feeling skittish and am not rejoicing that it’s all over. It’s not over! Cancer was inside my body, and no one seems to get what that does to a person.”

The dynamics of chronic illness can be similar…

Persons who live with a chronic illness were probably nodding their heads in understanding during much of what I wrote above. The dynamics can be similar—the impact on work, relationships, dreams and plans, finances, mental and physical and emotional energy and clarity, dealing with persons’ impatience and lack of understanding and even judgment and blame—should I keep going?

Others’ suffering doesn’t end on our timetable, when we need it to be all nice and neatly over and resolved and tied up with a pretty bow of celebration saying, “Whew!! Glad that’s over!!” so we can feel better. When our patience or ability to sit with suffering ends, that isn’t the time to tell them to hurry up and get over it because we have become uncomfortable with their discomfort.

If we don’t have any more to give, we can make our excuses and step back to regroup. We can find ways to be supportive that we can handle so we don’t abandon those around us who are hurting. Certainly, we can’t carry all of the world’s hurts or even all the pain of all those around us. But we also can’t abandon everyone all the time. We must find some ways to show up and be of support, even by just saying, “I care. I’m here.”

Do what you can, but never rush, never judge, never condemn, never blame the victim, and never condescend to those who are hurting. When we want to accuse them of making too big of a deal out of something or attention-seeking or faking it, that’s our issue, that’s our shame, not theirs. Check our own motives for needing to cast someone off that way.

Certainly, we should not allow others to guilt us or manipulate us into care-taking or doing more than we feel is appropriate, but we must always check our motives and be mindful of our words.

Taking care of ourselves, and each other…

If we are the one struggling during or after a medical or other crisis, as always we must discern carefully whom we can trust with our vulnerability. Avoid or say little to those who have not earned that precious right. Set boundaries where you feel you can and need, and focus instead on those safe spaces you can turn with folks who get it and will affirm and encourage and never judge you.

I am SO grateful that I did have those to whom I could turn. They were lovely. But I learned a great deal about how important it is to be intentional about building that kind of community, and I got even better at it during that time. So start now building those safe spaces if you do not have them, and see if any part of you feels called to be a better part of such safe space for others.

We, and those around us, deserve it.

Peace,

Carla

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Primary and Secondary Losses: Day 21 of #31DaysWithGrief

Posted by Carla Cheatham on

January 21, 2017

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31 Days of Walking with Grief: Others’ and Our Own

Day 21—Primary and Secondary Losses

“So much of my time, energy, and identity has been wrapped up in being an architect. After my injury, I’m legally blind and can’t see to do the work that’s been my life’s calling, and I was GOOD at it. Who am I, now? How do I adjust to suddenly not going into work every day with my colleagues who are also my friends? Who am I now that I’m not the breadwinner and provider? How do I feel like I’m taking care of my family, now?”

“So much of my time, energy, and identity has been wrapped up in being Evelyn’s son. Caring for her after dad died and after her stroke has consumed our lives. Though we were tired, the family of folks here at this facility are now part of our everyday routine. My wife comes on the way to work to say hello and bring her laundry. I come and help her eat lunch and visit with the staff and her friends, and we come 3 nights a week to watch television and listen to music with her and the other residents and even their families. This is our second living room. We all supported each other. I don’t know how to say goodbye to not just her, but this whole community of people we’ve come to love. Where am I supposed to eat lunch during my break? It’s just so weird to lose it all at once.”

“So much of my time, energy, and identity was wrapped up in being Scotty’s mother. Now that he’s dead, I don’t know who I am any more. My nest isn’t supposed to be empty, yet and, when he did leave, it was supposed to be to go excitedly to college and figure out who he wanted to be, to fall in love and find his life’s passion in his work. Then I could watch proudly from the sidelines and cheer him on. He was supposed to have children and I was supposed to get to see him be the fabulous father and spouse I knew he would be, and I would adore the person he loved and their babies were supposed to come and fill the empty space on my lap. Now ALL of that’s gone.

When we experience a loss of any sort, it usually involves not just the primary loss of the thing, ability, relationship, or person we’re grieving but also the secondary losses of identity, routine, security, provision, and so much more.

We often do not recognize these secondary losses and realize their impact until they are already sorely felt. Others around us also fail to notice them and therefore forget to care for that part of our grief, as well. Because they don’t quite get it, they may not be as sensitive to these secondary losses as is deserved, so we can feel even more isolation and shame.

Caring professionals are, or should be, trained to predict and notice these secondary losses and help persons prepare for and cope with them. When I ask the questions, “What are you going to miss the most about your dad when the time comes that he does die?”, I’m not just inviting them to process their grief, but listening for cues as to the secondary losses they are going to experience.

So often, loved ones respond that they are going to miss just being able to pick up the phone and call them. Those grieving often tell me how many times they pick up the phone or think, “Oh, I need to tell mom about that, she’ll love it!” just to realize she’s not there to call anymore.

Many of us have a routine; we call her every Sunday afternoon and Thursday evening to check in and visit every other Tuesday when we take a half day off work. Or we have an empty seat at the table we aren’t sure what to do with. And what about their things?

One woman woke up, made coffee, and cooked eggs. “I was fixing two plates before I realized, he’s not coming downstairs to join me for breakfast anymore.”

We help persons think through what routine they want to adopt next. What have they wished they had time for but did not? What’s on THEIR bucket list? How could they perhaps honor the memory of their loved one by picking up something that would carry on their legacy?

Who is that loving friend who will agree to take a phone call every Sunday afternoon, Thursday evening, and have lunch every other Tuesday to listen to you tell stories about mom until you find a new normal in your life?

Who is willing to be your new “go to” person to call for a while to feel connected and share good news or when you’ve had a bad day or just need to pick up the phone and call?

Without skipping over your grief with busyness, how about taking that art class or joining the choir or signing up to be a reading mentor at a local school?

The goal isn’t to replace or forget about the person or relationship or ability or thing you’ve lost, but to find some sense of meaning for yourself, perhaps even in a way that helps you remain connected to what’s been lost.

“Mom was a teacher. She would like that I’m helping kids read.”

“My son loved nature. Volunteering at the community garden helps me help others enjoy what he most loved.”

“We used to dance wherever and whenever, just for the heck of it, before I found out about the affair and we divorced. I signed up for dance lessons. He’s taken enough. He doesn’t get to take that away from me, too.”

And the man who was an accomplished architect? His colleagues dragged him kicking and screaming into teaching, and he wound up loving every second of it for two more decades!

You’re not filling up a hole, you’re filling up your life. You’re not replacing them, you’re finding a way to find meaning in the midst of your loss and maybe even connect with them, or yourself, in a new and different way.

Whatever you choose to do, find ways to acknowledge what else has been lost and find others to be sensitive to these secondary losses. Grieve them, care for them, and find ways to heal them in time. As overwhelming and impossible as it may seem, there is still hope for finding a new normal, perhaps one you never wanted, but maybe one that contains joy in ways you never could have imagined.

Peace,

Carla

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