The Biology of Grief

Scientists know that the intense stress of grieving can affect the body in various ways, but much remains a mystery.

By Ann Finkbeiner

In 1987, when my 18-year-old son was killed in a train accident, a chaplain and two detectives came to my house to notify me. I didn’t cry then, but a wall came down in my mind and I could do nothing except be polite and make the necessary decisions. When friends and relatives showed up, I was still polite, but the wall had now become an infinite darkness and I was obviously in shock, so they took over, helping me to eat and notify people and write death notices.

I’ve been thinking a lot lately about the more than 565,000 people who have died from Covid-19 in the United States. Each of them has left, on average, nine people grieving. That’s more than five million people going through the long process of grief.

Manisha Patel, a senior business systems analyst in Bensalem, Pa., lost her father, Ramesh Patel, to Covid-19 in June. “I have been through the toughest time of my life,” she said. “I feel heavier, but I weigh no more and I eat less. And there’s a lot of gray hair I didn’t have. My heart aches for him, it longs for him, it looks for him.”

When someone you love dies, experts have a pretty good sense of the path that grief takes through the mind, but have only a general sense of how it progresses through the rest of the body. First is a shock in which you feel numb or intensely sad or angry or guilty or anxious or scatterbrained or not able to sleep or eat or any combination of the above. During those first weeks, people have increased heart rates, higher blood pressure and may be more likely to have heart attacks. Over their lifetimes, according to studies done mostly on bereaved spouses, they may have a higher risk for cardiovascular disease, infections, cancer and chronic diseases like diabetes. Within the first three months, research on bereaved parents and spouses shows that they are nearly two times more likely to die than those not bereaved, and after a year, they are 10 percent more likely to die.

With time, most people stabilize; they begin to learn — gradually and on their own timeline — how to more or less continue with their lives and function in society. But studies suggest that after six to 12 months, about 10 percent of bereaved people have not begun to function better. They get stuck in what’s called “complicated grief”: they stay completely preoccupied with loss and persistent yearning, and remain socially withdrawn.

Scientists know that grief is not only psychological, it’s also physical. They know that it causes the brain to send a cascade of stress hormones and other signals to the cardiovascular and immune systems that can ultimately change how those systems function. But nobody knows how those systems act together to create the risks of diseases and even death.

One reason scientists don’t know more about the biology of grief is that only a handful of researchers study it, and they are usually psychologists with biological interests. Mary-Frances O’Connor, a psychologist who researches grief at the University of Arizona, studies both the psychology of grief and its biological changes in the laboratory and is one of the few researchers who straddles both fields. Hybrid science is seldom funded well; grief is neither a disease nor is it classified as a mental disorder, and the main funding agency, the National Institutes of Health, has no single established channel for funding it.

Nevertheless, researchers have found enough people to take surveys and get blood tests and scans to note some patterns.

Chris Fagundes, a psychologist at Rice University, said that in his own lab, he and his team have found links between grief, depression and changes to the immune and cardiovascular systems. In one study published in 2019, he and his team performed psychological assessments on 99 bereaved people about three months after the deaths of their spouses, and then took blood samples. Those who experienced higher levels of grief and depression also had higher levels of the immune system’s markers for inflammation.

“Chronic inflammation can be dangerous,” Dr. Fagundes said. “It can contribute to cardiovascular disease, Type 2 diabetes, some cancers.” In another study of 65 people, published in 2018, Dr. Fagundes and his colleagues found that bereaved spouses who had higher levels of markers for inflammation also had what experts refer to as lower heart rate variability — a characteristic that can contribute to an elevated risk for cardiovascular disease.

Other studies have found effects on the cardiovascular system, too. In one, published in 2012, researchers measured the heart rates of 78 bereaved people twice — once for 24 hours within the first two weeks of a spouse or child’s death, and again for the same amount of time six months later. They found that their heart rates were initially faster, then returned to normal, suggesting that the bereaved may have been at least temporarily at higher risk for heart disease. Another study published in 2012 found that those with higher scores on grief assessment tests also had increased levels of cardiovascular clotting factors, possibly raising the risk of developing blood clots.

And in one review of 20 studies, published in 2020, people who scored higher on psychological measures of grief also had higher levels of certain stress hormones like cortisol and epinephrine. Over time, chronic stress can increase the risk of cardiovascular conditions as well as diabetes, cancer, autoimmune conditions and depression and anxiety.

Put the studies together and on the whole, Dr. Fagundes said, “everything starts with the brain.” It responds to the death (and to intense stress in general), by releasing certain hormones that fan out into the body, affecting the cardiovascular system and the cells of the immune system. Aside from that generality, however, the biology of grief has no clear chain of cause-and-effect that the biology of, say, diabetes, has. That’s because the goals of these studies are to better understand the griever’s risks for disease, not to understand the path of grief through the body.

The one exception is with the study of the brain. In 2001, Dr. O’Connor first began imaging the grieving brain, and a handful of similar studies have been done since. In these studies, a person lies immobile in a functional magnetic resonance imaging (or fMRI) scanner, looks at certain pictures and listens to certain words, and the machine maps the blood flow to parts of the brain. In one study published in 2003, Dr. O’Connor found three areas of the brain that were triggered by words related to grief (like “funeral” or “loss”) and a fourth triggered by pictures of the person who died. Some of the brain areas were involved in the experience of pain, others in having autobiographical memories. These findings were “not world-stopping,” Dr. O’Connor said, “like, sure, that’s what happens in grief.”

But the responses recorded in another area, called the nucleus accumbens, were more surprising. This region is part of the brain’s network for reward, the part that responds to, say, chocolate, and it was active only in people with complicated grief. Nobody knows why this is so, but Dr. O’Connor theorized that in the continuing yearning of complicated grief, being reminded of a loved one with pictures and words might have the same reward as seeing a living loved one. In regular, uncomplicated grieving, the reminder is no longer connected to a living reward but is understood as a memory of someone no longer here.

All of these studies, however, have limitations. Many of them are small and haven’t been replicated. The researchers also don’t have the resources to follow the participants over time to see whether those with higher risks for a disease eventually develop that disease. Many studies are also a snapshot of one point in time, and will miss the changes that occur in most people over months and years. Studies using fMRI have limits all their own, too: “A lot of things could make the same areas light up,” Dr. O’Connor said, “and the same thing might not make the same areas light up in everyone or in one person over time.”

Grief, biological and psychological, is of course the result of another hard-to-study state, human attachment or love. “Humans are predisposed to form loving bonds,” Dr. O’Connor said, “and as soon as you do, your body is loaded and cocked for what happens when that person is gone. So all systems that functioned well now must accommodate the person’s absence.” For most people, the systems adjust: “Our bodies are amazingly resilient,” she said.

In a recent issue of the research digest UpToDate, medical doctors outlined the most current scientific studies on bereavement. One way to think about grieving, they said, is that the feeling of connection to the person who died “gradually moves from preoccupying the mind to residing comfortably in the heart.” I’m unsure about that word, “comfortably,” but yes, I’m no longer preoccupied. Now, 34 years after my son’s death, I’m back in charge, and if pain never quite goes away, then neither does love.

Complete Article HERE!

Most End-of-Life Care Wishes Met in Older Population

by Roxanne Nelson, RN, BSN

Most older individuals received end-of-life care that was in keeping with their wishes, concludes a study of 1542 decedents who had received care through the Kaiser Permanente Southern California healthcare system.

“Our study of decedents paints a clear picture,” said lead author David Glass, PhD, a research scientist at the Kaiser Permanente Southern California Department of Research and Evaluation and lecturer in the Department of Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.

“Most older decedents are receiving end-of-life care that is in keeping with the care and treatments they prefer,” he told Medscape Medical News. “[B]oth those who wanted physicians to ‘do everything’ to save a life and those who wanted a less intrusive approach reported that their end-of-life wishes were being met,” Glass commented.

The study was published online in JAMA Network Open.

These results differ from those of other studies in that these results show a “generally positive picture of end-of-life care,” the authors point out.

Two factors many account for this. One is the age of the population, which included only individuals aged 65 years or older. The other factor is that many studies do not focus on patients who have died. Because the goal of end-of-life planning is to optimize care at the end of life, “studying patients who do not die is a biased approach,” the authors note. “It is intuitive that the various elements of advance care planning will have more relevance and be more readily adopted by older individuals who ultimately died.”

Details of the Results

The investigators set out to examine how well the end-of-life wishes of decedents aged 65 years or older had been met during their last year of life. The study involved three planned samples of family members or informants who were identified as the primary contact in the medical record of Kaiser Permanente Southern California decedents.

The first sample included 755 decedents who were 65 years or older, had had two or more visits in the last year of their life, and had died between April 1 and May 31, 2017.

The second included 332 decedents, also aged 65 years or older, whose costs of care in the last year of life were in the top 10% of the costs of care of the entire cohort.

The third sample included 655 decedents whose costs of care were less than those in the top 10%.

Most of the deceased patients had discussed their end-of-life wishes with close relatives or had completed an advance directive. The authors report that 82.6% had discussed end-of-life care, and the next of kin professed high levels of knowledge (79.7%) about preferences and familiarity with healthcare decisions (91.2%).

In addition, 84.1% of the decedants had completed an advance directive; 55.4% reported having had an in-depth discussion; and 9.7% had said they had had some discussion about end-of-life preferences.

Most decedents (88.9%) received treatment that was concordant with their end-of-life wishes, and most (82.5%) believed that the right amount of care had been given. Only 5.9% received treatment that they did not want.

Complete Article HERE!

A Daughter Grieves Her Mom, And Finds Herself, In ‘Crying In H Mart’

By Kristen Martin

By the time I came to know Michelle Zauner as a writer, when The New Yorker published her personal essay “Crying in H Mart” in August 2018, I had been following her as a musician for five years.

I first saw her perform in Philadelphia as the frontwoman of emo band Little Big League in 2013; when she emerged with her poppy shoegaze solo project Japanese Breakfast in 2016, I recognized Zauner only in her soaring, searching voice.

Psychopomp, the first record Zauner released as Japanese Breakfast, hinted at where she had been in between: escorting her mother from the world of the living to that of the dead. The first track “In Heaven” tells some of the story of the aftermath of her mother’s death of cancer in 2014: “The dog’s confused / She just paces around all day / sniffing at your empty room / I’m trying to believe / When I sleep it’s really you / Visiting my dreams / like they say that angels do.” Those lyrics break me a little each time I hear them, reminding me of my own grief, of my own sweet childhood dog who looked for my mother and father after they both died of cancer when I was a teenager.

But where Psychopomp and her 2017 record Soft Sounds from Another Planet explore death and grief in sparse lyrics over upbeat synths, in “Crying in H Mart” Zauner digs much deeper. The essay meditates on how shopping at the Korean American supermarket H Mart brought her mother back to her but still made her loss sting. At H Mart, Zauner writes, “you’ll likely find me crying by the banchan refrigerators, remembering the taste of my mom’s soy-sauce eggs.”

“Crying in H Mart,” stood out to me as a representation of grief that I could relate to — one that doesn’t reach for silver linings, but illuminates the unending nature of loss: “Every time I remember that my mother is dead, it feels like I’m colliding into a wall that won’t give…a reminder of the immutable reality that I will never see her again.”

That essay became the first chapter of Zauner’s new memoir, also titled Crying in H Mart, which powerfully maps a complicated mother-daughter relationship cut much too short. Stories of Korean food serve as the backbone of the book, as Zauner plumbs the connections between food and identity. That search takes on new urgency after her mother’s death — in losing her mother, she also lost her strongest tether to Korean culture.

Zauner was born in Seoul, the daughter of Chongmi, a native of the city, and Joel, a white American. When she was a year old, the family relocated to Eugene, Oregon, where her mother ruled with an exacting nature. Chongmi was a woman in pursuit of perfection in everything, and of course this prodding extended to her only child. At a young age, Zauner realized that one way she could get her mother’s approval was demonstrating an adventurous appetite. On trips to Seoul, they bonded over midnight snacks on jet-lagged nights, when they “ate ganjang gejang…sucking salty, rich, custardy raw crab from its shell.”

Zauner’s food descriptions transport us to the table alongside her. On a college break, when her mother prepares galbi ssam, the relief of being cared for with a meal attuned to one’s tastes radiates off the page: “Blissfully I laid my palm flat, blanketed it with a piece of lettuce, and dressed it just the way I liked — a piece of glistening short rib, a spoonful of warm rice, a dredge of ssamjang, and a thin slice of raw garlic…I closed my eyes and savored the first few chews, my taste buds and stomach having been deprived of a home-cooked meal.”

It is this kind of care that Zauner attempts to repay for her mother when she is diagnosed with stage IV squamous-cell carcinoma in her stomach at age 56. After her mother’s diagnosis in May 2014, Zauner, then 25, moves home, ready to bolster Chongmi through chemotherapy with Korean cooking.

But chemo wrecks the appetite — I recall my mother being plagued with everything tasting as though it were laced with metal. During the first round of chemo, her mother can’t keep food down; during the second round, she develops mouth sores that make eating painful. When the chemo fails to shrink her tumor, Chongmi decides to forgo further treatment, having learned a lesson from her younger sister Eunmi, who died of colon cancer following 24 chemo treatments. In this, Crying in H Mart is a rare acknowledgement of the ravages of cancer in a culture obsessed with seeing it as an enemy that can be battled with hope and strength.

Zauner carries the same clear-eyed frankness to writing about her mother’s death five months after her diagnosis. One chapter recounts her mother’s last days, unconscious at home, her breathing “a horrible sucking like the last sputtering of a coffeepot.” It is rare to read about a slow death in such detail, an odd gift in that it forces us to sit with mortality rather than turn away from it.

Also notable is that Chongmi’s death does not fall at the end of the book. It comes just past halfway through, allowing Zauner ample space to grapple with the immensity of her loss. One balm that emerges is reconnecting with her Korean identity through finally learning to cook the dishes she longed to make for her mother.

As a teen, Zauner drifted away from her Koreanness, effacing that side of her heritage for fear of being seen as other. In those same years, she shrunk from her mother’s need for control and constant wheedling. Just as they established their adult relationship — just as Zauner begun to embrace her mother’s culture — her mother died: “What would have been the most fruitful years of understanding were cut violently short, and I was left alone to decipher the secrets of inheritance without its key.”

Cooking becomes the key. Her teacher is Maangchi, described by The New York Times as “YouTube’s Korean Julia Child.” In cooking, Zauner conjures ghosts: her aunt Eunmi munching on Korean fried chicken, her mother ordering more kimchi to go with knife-cut noodle soup in Seoul, her grandmother slurping black-bean noodles.

Near the end of the book, Zauner meditates on the process of fermenting kimchi, and how it allows cabbage to “enjoy a new life altogether.” She realizes that she needs to tend to her memories and heritage in the same way: “The culture that we shared was active, effervescent in my gut and in my genes, and I had to seize it, foster it so it did not die in me…If I could not be with my mother, I would be her.”

What Crying in H Mart reveals, though, is that in losing her mother and cooking to bring her back to life, Zauner became herself.

Complete Article HERE!

Efforts to reduce opioid prescriptions may be hindering end-of-life pain management

By Jon Furuno

Policies designed to prevent the misuse of opioids may have the unintended side effect of limiting access to the pain-relieving drugs by terminally ill patients nearing the end of their life, new research led by the Oregon State University College of Pharmacy suggests.

A study of more than 2,500 hospital patients discharged to hospice care over a nine-year period showed a decreasing trend of opioid prescriptions as well as an increase in the prescribing of less powerful, non-opioid analgesics, meaning some of those patients might have been undertreated for their pain compared to similar patients in prior years.

The findings, published in the Journal of Pain and Symptom Management, are an important step toward optimizing pain management and minimizing the suffering of dying patients. Hospice care refers to treatments whose goal is to maximize comfort and quality of life as opposed to prolonging life.

Researchers at OSU, Oregon Health & Science University, the Dana Farber Cancer Institute and Ariadne Labs in Boston, the University of Massachusetts Medical School and the University of Maryland School of Pharmacy used electronic health record data to examine 2,648 discharges of adult patients to hospice care.

The discharges were from an acute care, academic hospital between Jan. 1, 2010, and Dec. 31, 2018. The average patient age was 65, more than half had cancer, and the study sought to determine the year by year frequency of patients receiving opioid prescriptions.

After adjusting for factors that could affect prescription frequency, including age, specific diagnosis and where the patient was to receive hospice care, the results showed a nearly 12% downward trend from the first year (91.2%) to the last (79.3%).

“Pain is a common end-of-life symptom and it’s often debilitating,” said the study’s lead author, Jon Furuno, an associate professor and the interim chair of the Oregon State Department of Pharmacy Practice, who notes that more than 60% of terminal cancer patients report “very distressing pain.”

Opioids, a class of drugs that block pain signals between the body and brain, are an effective pain management tool. But there are barriers, Furuno said, to the optimal prescribing of opioids.

Among the hurdles are timely and accurate pain assessments, patient and caregiver concerns regarding addiction, and caregiver concerns about making mistakes in administering the meds. Additional obstacles are policies and practices aimed at limiting opioid use in response to the opioid epidemic.

Traced to over-prescribing that began in the 1990s, the epidemic claims more than 40,000 American lives annually, according to the U.S. Department of Health and Human Services. Ten million people a year misuse prescription opioids and 2 million suffer from an opioid use disorder. Opioids can be highly addictive and they exist both as prescription painkillers like morphine, hydrocodone, fentanyl and oxycodone and street drugs such as heroin.

Five years ago, the Centers for Disease Control and Prevention produced a guideline for prescribing opioids for chronic pain, and there have been several other federal, state and local efforts over the last 10 years to curb opioid prescribing, Furuno said.

“There are some concerns, however, that indiscriminate adoption or misapplication of these initiatives may be having unintended consequences,” he said. “The CDC Prescribing Guideline and the other initiatives weren’t meant to negatively affect patients at the end of their lives, but few studies have really looked at whether that’s happening. Our results quantify a decrease in opioids among patients who are often in pain and for whom the main goal is comfort and quality of life.”

Furuno adds that the concurrent increase in non-opioid analgesic prescriptions suggests health care providers remained concerned about pain management even as they wrote fewer opioid prescriptions.

“Sometimes non-opioids alone are the best choice, or non-opioids in combination with opioids,” he said. “But it’s important to remember that non-opioids alone are also not without risk and that delaying the start of opioid therapy may be delaying relief from pain.

“Even among patients prescribed opioids during the last 24 hours of their inpatient hospital stay, opioid prescribing upon discharge decreased,” Furuno added. “It seems unlikely that patients would merit an opioid prescription on their last day in the hospital but not on their first day in hospice care, and it’s well documented that interruptions in the continuity of pain treatment on transition to hospice are associated with poor patient outcomes.”

Losing Both Parents During COVID

— A Physician’s ‘Unwitnessed Grief’

The author with her parents, Betty and Stanley Walton

How a Pandemic Stole the Comforts of Mourning

By Melissa Walton-Shirley, MD

On a recent walk with our labradoodle, a woman standing outside her door caught my attention. Despite the mask and cane, I recognized her as the mother of a high school friend. I stopped for a yard visit, staying at a safe distance. She gingerly came toward me, searching with her cane for places in the soft ground that would not betray her. “I miss your parents so much,” she said, tears welling. I swallowed hard. Her words and the comforting whispers of others forever suspended in the darkness and space that COVID-19 brings to grieving.

The conversations meant for funeral visits, memorials, and wakes must now occur on the occasional lawn, across the grocery aisle, or by text and social media. Despite these attempts to wrap us in kindness, the essence of unwitnessed grief feels like the south pole of a magnet that searches for, but cannot find, its north. Our planet’s deaths from COVID number over 3 million, but not everyone who died in 2020 succumbed to the viral infection. Those of us who lost loved ones to other causes share one thing with those who mourn COVID deaths: the absence of our traditional mourning rituals.

There are no lines at the funeral home or packed memorial services where mourners can feel the love and support of a sea of friends and acquaintances at our backs. There are no tables crowded with food where we can commune in honor of those we loved. We will never get that back; our grief cannot be postponed until the pandemic is over. But that’s not all. This era has also robbed many elderly people of a good death.

A Socially Distanced Death

My husband Tony and I flew back to the United States in March 2020 from a trip to Israel. We connected through JFK when New Rochelle, New York, was on fire with the viral outbreak and the country was starting toward the height of COVID uncertainty. We quarantined for 14 days and then visited my elderly mom and dad on their side porch—a door between us. Their aide and near-constant companion helped my parents get situated near enough to the door to see our faces, and we used our phones on speaker. For weeks the cool Kentucky spring did not gift us enough warmth to visit outside.

In early May, I would get the closest to my father that I would ever be again—6 feet away as he sat on the swing on their front porch. It was there that he told me what I already knew: he was dying. There was no hug to follow.

I offered to take Dad to the hospital, but he declined. He was 88 years old and afraid of contracting the virus. He survived this long because of the many magnificent devices that cardiology has to offer, but the ravages of neuropathy and congestive heart failure had taken his mobility and his will.

A week later, he was febrile and bedfast. His carer raised the bedroom window so that we could speak through the screen. Tony and I spent the day. Seeing how weak Dad was, we went home to pack a bag so I could sleep on the porch underneath his window. I needed him to know I was there just in case. As I threw my things into the back of our car, I received a text. It was a video of my father sent by the night sitter asking me if he was “okay.” He had obvious agonal respiration, an image that no amount of time will erase. He was gone by the time I arrived.

Complete Article HERE!

Why We Need More Shows Like HBO’s Six Feet Under

One of HBO’s most underrated shows, Six Feet Under deals with subject matter that affects everyone.

By Nicole Waxman

Notorious for its high-quality, mature and complex TV shows likeThe Sopranos andGame of Thrones,HBO is one of the reigning experts on excellent television content. Yet, one of their most underrated TV shows,Six Feet Under, still flies under the radar. Created by Alan Ball, the series follows the Fisher family as they run their family funeral home. While Six Feet Under a slow-burn drama series, it really explores the process of grieving and what it means to live with the knowledge of death. There aren’t many shows like it and none tackle the concept of death so realistically.

The human race lives each day knowing that there will be an end to the journey. However, there are so few projects that deal directly with death in a non-comedic way. Six Feet Under does use comedy, but it focuses on the entire process of death, from the moment it happens to what comes after. There are many scenes that feature David Fisher in his element, the morgue, as he embalms the corpses to be presented for viewing. The show spends a lot of time in this environment, often even having the members of the Fisher family conversing with the dead.

Six Feet Under also pays a lot of attention to the process of grieving and all of the dirty bits that come along with it. It highlights the effects of grieving on interpersonal relationships and the relationship with oneself, tackles some fairly existential questions as Nate is faced with death time and time again and shows how low people can get when faced with the concept of losing their life.

It’s surprising that there aren’t more shows like Six Feet Under, as it provides a safe environment for a dialogue to be started about death. The series shows the merits of religious beliefs when dealing with death, as well as more atheistic practices. It emphasizes that there is no right answer and that death is handled differently from person to person. Claire, the youngest of the Fisher family, struggles with her identity more than any of her siblings, having experienced the death of her father at a relatively young age.

Another key aspect that makes this show so great is its inclusion of mental health. Brenda, along with her brother Billy, struggles with mental health problems throughout the show, having been raised by two strict and judgemental psychologists. To be more specific, Billy suffers from Bipolar disorder throughout the show, which, when combined with dealing with death, becomes a turbulent machine that is hard to stop.

This focus on trauma, identity and mental health forms a well-rounded approach to tackling the subject of death, which can be pretty touchy. Every culture handles it differently and has different etiquette surrounding the experience. While Six Feet Under mainly covers the North American practice, it makes sure to include other cultures’ rituals involving death. But more than that, what the series does so well is it finds the common thread between cultural practices to get to the heart of the topic — death is a universal fact. We all know it’s going to happen, and we all feel similar feelings of pain, loss and heartbreak.

The world needs more shows and movies like Six Feet Under. We spend a lot of time distracting ourselves from the inevitable, and this show zones right in on what we don’t want to see. But it’s also incredibly therapeutic and helps with understanding the process from beginning to end. The nature of Six Feet Under is intensely emotional, but it’s worth every single minute. It uses creativity, ingenious characters and sharp wit to tackle a subject that inspires fear in every being on Earth, while still leaving viewers feeling comforted and grateful.

Complete Article HERE!

How to Help a Grieving Neighbor

Grief can be a lonely process, made lonelier by a pandemic that has kept us apart from the people we love.

By Ronda Kaysen

Q: I live in a close-knit Upper East Side rental building, where neighbors trade phone numbers and collect one another’s packages. The woman who lives below me lost her husband in August after an illness. Since then, I’ve heard her wailing, talking and cursing to herself, clearly in despair. The neighbor below her also can hear the noises, but we don’t know how to approach this. I have offered the widow help with errands when I see her, so she knows we’re here for her, but she declines, and I don’t think that would really help anyway. Any advice on how we can handle this?

A: Grief can be a long, lonely process, made lonelier by a pandemic that has denied us opportunities to spend time with the people we love. At another time, your neighbor may have had more sources of comfort than she does now. Or, she may have a strong support network now, and just needs the space to grieve alone at home.

But you don’t know if she’s OK, and as a concerned neighbor you could certainly offer your support. Even if she has support, she may need more.

You were kind to offer help with her errands, but as you suspected, that may not be what she needs. “People don’t need help, they need company,” said Dr. Katherine Shear, founder and director of the Center for Complicated Grief at the Columbia School of Social Work. “Offering to do some errands or get things, that’s a very reasonable thing to do, but it’s not quite the same.”

Stop by her apartment to let her know that she’s been in your thoughts. Ask if she is OK, and if she has friends and family nearby who spend time with her. Remind her that she is not alone in the building. Ask if she might want some company. The flowers are blooming, the days are getting warmer — suggest taking a walk or sitting outside together.

People who are grieving “are not good company themselves, but they just need the presence of someone” who is willing “to share this very human experience,” said Dr. Shear, a psychiatrist.

Your neighbor may rebuff your initial request, but you can keep trying. The other concerned neighbor could follow up with a similar offer. If you run into her in the lobby, remind her that the offer still stands. “Gentle persistence is what I would call it,” Dr. Shear said. “Let your compassion be your guide.”

Complete Article HERE!