Surviving Spouse Financial Checklist

— Preparing For The Road Ahead

The death of a spouse is devastating. There is the obvious sadness experienced due to the loss of a loved one. However, there is also the challenge of losing a life partner who helped you make various important decisions. For years, or perhaps decades, a couple likely worked together to tackle important decisions about their kids, home, health, vacations, and of course finances. After a spouse’s death there are still many important money choices that need to be made to prepare the surviving spouse for their future. Navigating through those responsibilities may seem overwhelming. Working through a financial checklist may make the process a bit more manageable. Below are ten steps to consider.

1) Obtain copies of the death certificate: Having a death certificate is essential to winding down the affairs of a deceased person. You will need to submit it under many situations, including each time you claim benefits like Social Security, life insurance proceeds, payable on death accounts, or veterans’ benefits.

The easiest way to obtain a death certificate is through the funeral home or mortuary at the time of the death. It’s advisable to ask for multiple official copies, usually at least 10, since many requests will require an original. For deaths that occurred within the past few months, you can also get a death certificate from your state’s Department of Health or Office of Vital Statistics.

2) Contact Your Advisors: If you work with a team of trusted advisors, such as an attorney, accountant, and financial advisor, you should reach out to them relatively early in the process. These professionals may have all the pertinent files regarding your family’s finances, so you don’t have to go searching for them.

Your attorney should have a copy of the original will in their office and can review it with you and discuss next steps. If probate is necessary, an attorney can guide you through the process and any necessary court filings. Finally, they can also help with determining if the deceased’s estate will cover existing debts in their name or what your liability may be.

Your accountant can address the various tax implications. Taxes for a deceased spouse should be filed and paid in the year of death. This includes filing Estate Tax Form 706 and any other forms that may need to be filed with federal, state, and local tax authorities.

Immediately following a spouse’s death, your financial advisor can help process the transfer and consolidation of certain accounts. For example, the funds from a deceased spouse’s IRA can rollover to the IRA of the surviving spouse. Additionally, accounts that were titled Transferred on Death or Joint Tenant With the Right of Survivorship will be transferred into the surviving spouse’s name. If the financial advisor also handled your insurance, they could work with you to get the death benefit from a life insurance policy in a timely manner.

The financial advisor can also coordinate with the attorney and CPA on various estate and planning matters. They may set up a designated estate account with funds for the executor of the estate to settle the deceased person’s unfinished affairs. If any trusts were established for estate planning purposes, the advisor can address how these fit into the broader estate plan and ensure they are funded and implemented correctly.

Looking forward, you should set up a planning meeting with your team of advisors to assess your new financial reality and share your goals for the future. Together, they will be able to put together a customized plan to reach those objectives. They may also be able to serve as a sounding board, helping to facilitate prudent decisions, and shouldering some of the responsibility your spouse shared while they were alive.

3) Contact The Social Security Administration: Be sure to reach out to the Social Security Administration (800-772-1213). You may be entitled to Social Security survivor benefits and you should also put the deceased person on the Social Security Master Death Index to prevent potential fraud. Additionally, you may want to speak to your financial advisor about coordinating social security benefits with your other financial and income goals.

4) Reach Out To Your Spouse’s Employer: In addition to informing the employer of your spouse’s death, it’s worth speaking with their human resources department about any potential benefits such as life and medical coverage and retirement or pension plans. There may also be compensation due, such as stock options or bonuses that were already earned. If your family was covered through your spouse’s medical insurance, you will need to ask how long you can continue that coverage. There is typically extended healthcare coverage through COBRA for 18 months. If your spouse belonged to a labor union, you should also contact the union to see if they offer any assistance.

If your spouse worked at several companies over their career, it may make sense to reach out to each to see if there are old retirement accounts or pensions that were never rolled over to an IRA. These funds may add up and should not be overlooked.

5) Update All Property Titles: It’s important to update all ownership documents to remove your spouse’s name, including your auto and homeowner’s insurance policies. When retitling your home, determine if the mortgage has insurance that would pay it off in the event of a death. To update the title of a property that is held jointly you must inform the Land Registry of the death and send them a completed “deceased joint proprietor” form (available on the government’s website) with an official copy of the death certificate.

6) Identify Your Spouse’s Debts: Make time to call each of your spouse’s creditors to determine its policies. Common debts may include a mortgage, credit cards, business loans, and student loans. You should cancel all credit cards in your spouse’s name and update any cards you held jointly.

7) Child Support or Alimony: If your spouse was previously married, their death likely terminates any existing spousal support order unless the parties had otherwise agreed in writing. Discussing the matter with your attorney is advisable to ensure it is handled correctly and all loose ends are tied.

8) Update Your Own Documents: After the death of your spouse, much of your previous financial planning will need to be updated or revised. This includes updating your beneficiaries across retirement accounts, insurance policies and revisiting your power of attorney and healthcare proxy to ensure the correct people are listed in case a need arises. You should also update your tax withholding status and medical coverage through your employer.

9) Keep An Eye On Your Mail: After such a traumatic experience, there will likely be some items that fell through the cracks. A good way to stay on top of closing out your spouse’s affairs is to pay close attention to the stream of letters you receive. Over time you will receive utility bills, charitable solicitations, account statements, subscriptions, and other pertinent items. You can deal with each item as it comes in. This will help alleviate the stress of trying to update everything all at once and will hopefully result in having everything updated within a few months’ time.

10) Consider Postponing Major Financial Decisions: On occasion, drastic changes need to take place immediately after the death of a spouse. For example, if the living arrangement of the surviving spouse is no longer sustainable then selling the family home may be required. However, if a matter is not pressing, then you should wait to act. Unfortunately, widows are preyed upon by unscrupulous salespeople in all lines of work. It’s important to get comfortable telling people that you are putting all major decisions on hold for a year while you get your bearings and heal emotionally. It may also be wise to enlist the help of a trusted family member or friend to serve as a sounding board when making choices about your financial future.

During the initial stages of the grieving process, you may feel like your life has been turned upside down. Your emotional, mental and physical condition has undoubtedly changed. However, over time, with the support of friends and family and the guidance of trusted advisors, you will be able to move forward from this difficult period in your life and prepare for what lies ahead.

Complete Article ↪HERE↩!

October 23, 2021October 22, 2021

Prolonged grief disorder recognized as official diagnosis.

Here’s what to know about chronic mourning.

By Jelena Kecmanovic

With the United States surpassing 727,000 deaths from covid-19, the disease caused by the coronavirus, millions have been left grieving the losses of their loved ones. As a psychologist, I bear witness to the emotional and physical pain, sadness, anger, fear, isolation and struggle of those who mourn. They often feel like there is a wall between them and the rest of the world, like our accelerated, progress- and positivity-centered society does not allow for grieving and honoring the deceased.

The pandemic has made things worse, with relatives barred from supporting the dying, and religious and cultural mourning rituals disrupted or impossible. “In the current environment, we are likely to see more people whose grief doesn’t lessen with time, and whose intense suffering disrupts their ability to function,” said Holly G. Prigerson, professor of sociology in medicine at Weill Cornell Medical College in New York City, and a co-author of “Bereavement: Studies of Grief in Adult Life.”

Prigerson’s studies over the past three decades, along with other research from the United States, the United Kingdom, the Netherlands and Australia, among others, have led to the inclusion of a new disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — the main guide for diagnosing mental health problems. The American Psychiatric Association recently announced that prolonged grief disorder (PGD) will be added to the newest version of the manual, DSM-5-TR.

What is prolonged grief disorder?

Grief is a natural human reaction to the death of a loved one. It tends to come in waves, often triggered by internal or external reminders of the loss — that’s why anniversaries or holidays can be particularly difficult. It is also idiosyncratic, hence the maxim that there is no one right way to grieve. For some people, talking a lot about the deceased is healing, while others benefit from more interior mourning.

While most people have a hard time after a death, over time they are able to accept the loss, find meaning in life without the deceased and reintegrate into society. They find new ways to love and work.

“But for a small but significant group of people, grief doesn’t resolve. It is ongoing, pervasive, intense and debilitating,” said Katherine Shear, professor of psychiatry at the School of Social Work and founding director of the Center for Complicated Grief at Columbia University. “This is what we call prolonged grief disorder.”

PGD can be diagnosed no sooner than one year after the death of a loved one, and it is defined by a daily, intense yearning for the deceased or a preoccupation with thoughts or memories of them. Additional symptoms — three of which are required for a diagnosis — are identity confusion, disbelief, avoidance of reminders of the loss, intense emotional pain, difficulty engaging with others and with life, emotional numbness, feeling that life is meaningless, and intense loneliness.

Although PGD is newly designated as a disorder, similar conditions have been documented and investigated for many years, usually called “complicated grief.”

Why is it important to recognize prolonged grief disorder?

About 1 in 10 people who have lost someone struggle with PGD. Until now, many of them might have wondered what was wrong with them and whether they could get better. “People ask us, ‘Am I going crazy?’ all the time, and having PGD recognized will validate their suffering and show them there are others suffering in a similar way,” said Natalia Skritskaya, a clinical psychologist and associate research scientist at Columbia’s Center for Complicated Grief.

Although PGD shares some symptoms with depression and post-traumatic stress disorder (PTSD), it is “neurobiologically and epidemiologically different,” Prigerson said. “It has a distinct pattern of symptoms and different treatments.”

PGD puts people at higher risk for medical problems (cancer, high blood pressure, heart or immunological issues), other mental health disorders, disability, hospitalization and suicide. The DSM classification will help health-care professionals identify those who suffer from PGD so that they can properly help them.

All the while, we need to be careful not to pathologize grief. “We run a risk of stigmatizing the grieving, reducing their dignity and medicalizing the natural process,” said Allen Frances, a professor and chairman emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine and the author of “Saving Normal.” “Some practitioners, especially in primary care after a 10-minute visit, might overuse the new label, over-diagnose and overprescribe

So, always ask questions and advocate for yourself or your loved ones if you feel like medical providers are not taking time to listen and understand.

What makes people more susceptible to PGD?

Research has identified several factors that complicate grief. If you were very dependent on the deceased for practical or emotional needs, or if your world revolved around them, the loss can be hard to process. On the other hand, difficulty remembering positive traits of the deceased can also prolong grief.

“Sudden and traumatic deaths, and deaths by suicide, are more likely to lead to complicated grief,” Skritskaya said. “If the grieving person is dealing with multiple losses, poor social support, has a lot of stress in their life, or a history of psychological disorders or prior trauma — those are risk factors, too.”

Also likely to worsen grief: chronically avoiding thinking about the loss; or getting stuck in a ruminative cycle asking why this has happened to you, or wondering whether you could have done something different. Judging oneself for experiencing negative emotions related to grief is not helpful either

What are the treatments?

Treatments for complicated grief have been investigated since the late 1990s and practiced for much longer. “Research showed that neither antidepressants nor standard depression-focused therapy are very effective for complicated grief,” Shear said. “That’s why we developed complicated grief treatment.”

Shear’s integrative treatment helps patients understand and accept grief, manage emotions, strengthen relationships, create a coherent story of the death, live with reminders and feel connected with people who died, and begin to see a promise in the future. It was shown to help a majority of people with PGD.

Robert Neimeyer, professor emeritus of psychology at the University of Memphis, director of the Portland Institute for Loss and Transition and co-editor of “Grief and Bereavement in Contemporary Society,” finds that the most important goals of complicated grief therapy are to develop a narrative of what happened, to revise and re-create one’s relationship with the loved one, and to reinvent oneself. “After loss, we need to reconstruct life meaning and find a way to reinvest in living,” he said.

A 2014 Australian study found that grief-focused cognitive behavior therapy helped those with PGD. The therapy included noticing thinking traps that get us mired deeper in grief, gradually approaching previously avoided situations that had reminders of loss, and scheduling social and other enjoyable activities. A version of this treatment that also focused on recurrent vivid recounting of how the loved one died was particularly effective.

And I have found that, in situations in which PGD is related to guilt, regret or a sense of unfinished business with the deceased, writing a letter or having an imagined conversation with the lost loved one can be a powerful aspect of treatment.

While psychotherapy is a first-line treatment for PGD, antidepressants can be helpful with the depression that often accompanies complicated grief. Grief support groups are also recommended, especially when they involve mourners with similar grief stories.

Complete Article ↪HERE↩!

October 22, 2021October 21, 2021

What the death rattle and capital punishment have in common

By Joel B. Zivot and Ira Bedzow

Death rattle. That’s the sound some dying people make, caused by a buildup of mucus and other secretions in the throat as the body begins to slowly lose its life force. It can sound wet and crackling, or like a soft moan or snoring or gargling.

No one knows if a dying person finds the death rattle disturbing or distressing, as no one can pretend to know with certainty the inner subjective experience of anyone too ill to express it. The common medical assumption, though, is that they are not distressed by it. But the death rattle is disturbing to family members and loved ones who are with their loved ones as they are dying. They typically interpret the sounds as indicative of pain and the absence of a “good death.”

A team of researchers in the Netherlands conducted what they call the SILENCE clinical trial to see if an injection of scopolamine butylbromide, an antispasmodic drug, could stop, or at least reduce, the death rattle. It did.

In an accompanying editorial, two U.S. physicians make the case that administering a drug to reduce the death rattle is justified, even when one cannot know the inner experience of a dying patient. They claim that “when in doubt regarding comfort, it is best to try treatment.” They also write that it can relieve the distress not of the patient but of those bearing witness to the death.

The first reason reveals a technological imperative that is permeating health care delivery. The technological imperative says, “If it’s possible, it should be done.” While moral philosophers since Immanuel Kant have held that “ought implies can” — meaning that having a moral duty entails that one is able to fulfill it — the premise doesn’t work both ways. Shooting first (in this case a subcutaneous injection of scopolamine butylbromide) and asking questions later is not the best approach. Of course, it may become best practice to reduce the death rattle, but the medical profession should at least consider why before deeming it so.

The second reason — to alleviate the discomfort of those bearing witness — speaks to the current debate over the legality and morality of capital punishment, especially now when the Biden administration wants to reinstate the death penalty for Boston Marathon bomber Dzhokhar Tsarnaev, even though earlier this year the U.S. attorney general ordered a moratorium on federal executions.

Death by execution and death in the setting of end-of-life care have something in common. Both involve the presence and witness of interested parties. And what is witnessed — rather than what is occurring to the dying individual — matters a great deal.

The law stipulates that punishment cannot be cruel and unusual. The experience of execution also confronts society’s aversion to see itself as inhumane. But the absence of cruelty does not create humaneness. Punishment must not be tortuous or deliberately degrading and should not exceed the severity of the crime committed.

The Biden administration may see execution fitting for the crime of the Boston Marathon bombing. That decision will rest with the court. Whether or not execution on its face is inhumane, it is certainly extreme and should be used judiciously — not politically.

The idea that execution may be a form of torture is one of the primary reasons for its medicalization. The American Society of Anesthesiologists strongly discourages anesthesiologists from participating in executions, and says that legal execution “should not necessitate participation by an anesthesiologist or any other physician.”

Execution wrongly impersonates a medical act and the impersonation is so convincing that even doctors and the public are fooled. In the United States, no method of execution has ever been set aside as unconstitutional, though methods of execution have come and gone — think hanging, firing squad, and electric chair (though this last one may be coming back) — based on public perception of the outward appearance of death by execution.

Administering paralytics and other drugs may make lethal injection look more humane, even peaceful. Yet autopsies performed on individuals executed by lethal injection have shown that they suffered from pulmonary edema — their lungs were drenched with body fluids. In a self-aware person, such lung congestion would be akin to death by drowning.

Society’s opinion about what it finds to be cruel continues to evolve. But it should primarily take into account the sufferer, not those who are watching.

At the bedside of someone who is dying, families and friends are increasingly welcomed to be present, to accompany a loved one in their last moments. This is a good thing, as it returns death and dying to the realm of the home and community so people do not have to die alone. It also helps drive home that death is part of life and not something to hide away or ignore.

The danger that the SILENCE trial presents is the risk that hospitals will curate the dying experience for the sake of loved ones, just as lethal injection curates a medicalized execution for the sake of the witnesses.

If the death rattle is not painful, instead of muting it — and instead of simply paralyzing the executed — it may be better to recognize the bright line that separates the living from the dead. Mollification of observers’ experiences in both instances may anesthetize feelings regarding natural death or killing. It may also lower the bar for what constitutes facilitating death or moral killing.

As a society, we must be sure to uphold our collective humanity and alleviate suffering. But we should be focused on the suffering of the dying and not those who are watching.

Complete Article ↪HERE↩!

October 21, 2021October 20, 2021

Sexual Bereavement

— A Challenge That Few Talk About

By Cecilia M. Ford, Ph.D.

When Sarah’s husband died of cancer at the age of 50, they had been married 25 years. An accomplished man, active in their community, he was deeply missed and Sarah’s circle of friends joined forces to help her through her mourning. Support and succor were offered, but after eight years, when one friend suggested she try to help her create an online dating ad, she remarked that no one had even brought up the subject in all that time. “I know everyone accepted that I deeply loved my husband, and that was part of it,” Sarah says. “But it was as if my life as a woman died along with him in my 50s.” But she had been lonely for the intimacy she had shared with her husband, and was very relieved when someone finally brought it up.

This problem is one that Dr. Alice Radosh, a neurobiologist who lost her husband, terms:

” ‘Sexual bereavement,’ which she defines as grief associated with losing sexual intimacy with a long-term partner. The result, she and her co-author Linda Simkin wrote in a recently published report, is ‘disenfranchised grief, a grief that is not openly acknowledged, socially sanctioned and publicly shared. … It’s a grief that no one talks about. … But if you can’t get past it, it can have negative effects on your physical and emotional health, and you won’t be prepared for the next relationship,’ should an opportunity for one come along.’ ”

Most adults retain sexual feelings as they age and statistics show that they are sexually active, despite popular misconceptions. The New York Times reports: “In a study of a representative national sample of 3,005 older American adults, Dr. Stacy Tessler Lindau and co-authors found that 73 percent of those ages 57 to 64, 53 percent of those 65 to 74 and 26 percent of those 75 to 85 were still sexually active.”

Older adults are often embarrassed to make their interest known, fearing ridicule or disapproval. Even health care professionals routinely fail to inquire about their older patients’ sexual health. Widows have the added burden of feeling, in some cases, that finding a new partner is disloyal to their lost loved one. Some, interested in intimacy but not necessarily remarriage, are ashamed to be associated with what they see as negative social stereotypes of sexually active older women. Despite considerable progress in our attitudes about sexuality, there is still a great deal of discomfort surrounding this topic.

The Times wrote about a recent survey that found:

“Even women who said they were comfortable talking about sex reported that it would not occur to them to initiate a discussion about sex if a friend’s partner died.” The older the widowed person, the less likely a friend would be willing to raise the subject of sex. While half of respondents thought they would bring it up with a widowed friend age 40 to 49, only 26 percent would think to discuss it with someone 70 to 79 and only 14 percent if the friend was 80 or older.”

Younger widows also feel the “disloyalty” factor when experiencing sexual longings. But older women face another common obstacle to re-entering the romance arena: the older they are the longer they are likely to have been out of “circulation.” There are a few common issues that tend to worry these women. One is that they feel intimidated about starting up a new romance with an unknown person after so many years of marital intimacy. Another major factor is worry about the “baggage” that they bring to a new relationship, usually in the form of children and their problems. No matter how grown-up, our children tend to be central to our lives, and worry that a stranger may not accept them or vice versa is common.

Complete Article ↪HERE↩!

October 20, 2021October 19, 2021

How Anticipatory Grief Differs From Grief After Death

by Lynne Eldridge, MD

Anticipatory grief, or grief that occurs before death, is common among people who are facing the eventual death of a loved one or their own death. Yet, while most people are familiar with the grief that occurs after a death (conventional grief), anticipatory grief is not often discussed.

Because of this, some people find it socially unacceptable to express the deep pain they are experiencing and fail to receive the support they need. What is anticipatory grief, what symptoms might you expect, and how can you best cope at this difficult time?

As a quick note, this article is directed more to someone who is grieving the impending loss of a loved one, but preparatory grief is also experienced by the person who is dying.

Hopefully, this article (as well as another on how to cope with anticipatory grief later on), will be helpful to both those who are dying and those who are grieving a loved one’s imminent death.

What Is Anticipatory Grief?

Anticipatory grief is defined as grief that occurs before death (or another great loss) in contrast to grief after death (conventional grief). Rather than death alone, this type of grief includes many losses, such as the loss of a companion, changing roles in the family, fear of financial changes, and the loss of dreams of what could be.

Grief doesn’t occur in isolation. Often the experience of grief can bring to light memories of other episodes of grief in the past.

Differences From Grief After Death

Anticipatory grief can be similar to grief after death but is also unique in many ways. Grief before death often involves more anger, more loss of emotional control, and atypical grief responses.

This may be related to the difficult place—the “in-between place” people find themselves in when a loved one is dying. One woman remarked that she felt so mixed up inside because she felt she kept failing in her attempt to find that tender balance between holding on to hope and letting go.

Not everyone experiences anticipatory grief, and it is not good or bad to do so. Some people experience very little grief while a loved one is dying, and in fact, find they don’t allow themselves to grieve because it might be construed as giving up hope. Yet for some people, the grief before the actual loss is even more severe.

A study of Swedish women who had lost a husband found that 40% of the women found the pre-loss stage more stressful than the post-loss stage.1

For those who are dying, anticipatory grief provides an opportunity for personal growth at the end of life, a way to find meaning and closure. For families, this period is also an opportunity to find closure, to reconcile differences, and to give and grant forgiveness. For both, it is a chance to say goodbye.

One person related that the night their grandmother died they were lying in bed with her. She turned to them and said, “We’ll miss each other,” and hugged them. It was her goodbye gift.

Family members will sometimes avoid visiting a dying loved one. The comments they make include, “I want to remember my loved one the way they were before cancer,” or “I don’t think I can handle the grief of visiting.” But anticipatory grief in this setting can be healing.

One study found that anticipatory grief in women whose husbands were dying from cancer helped them find meaning in their situation prior to their husband’s deaths.1

Though anticipatory grief doesn’t necessarily make the grieving process easier, in some cases it can make death seem more natural. It’s hard to let our loved ones go. Seeing them when they are weak and failing and tired makes it maybe just a tiny bit easier to say, “it’s OK for you to move on to the next place.”

Does It Help Grieving Later On?

Grief before death isn’t a substitute for grief later on, and won’t necessarily shorten the grieving process after death occurs. There is not a fixed amount of grief that a person experiences with the loss of a loved one. And even if your loved one’s health has been declining for a long time, nothing can really prepare you for the actual death.

Yet, while anticipatory grieving isn’t a substitute or even a head-start for later grieving, grieving before death does provide opportunities for closure that people who lose loved ones suddenly never have.

Symptoms

The emotions that accompany anticipatory grief are similar to those which occur after a loss but can be even more like a roller coaster at times. Some days may be really hard. Other days you may not experience grief at all.

Listed are some of the typical emotions associated with anticipatory grief. That said, keep in mind that everyone grieves differently:

Sadness and tearfulness: Sadness and tears tend to rise rapidly and often when you least expect. Even small things, such as a television commercial may be a sudden and painful reminder your loved one is dying; almost as if it is again the first time you are aware of your impending loss.
Fear: Feelings of fear are common and include not only the fear of death but fear about all of the changes that will be associated with losing your loved one.
Irritability and anger: You may experience anger yourself, but it can also be difficult coping with a dying loved one’s anger.
Loneliness: A sense of intense loneliness is often experienced by the close family caregivers of someone dying from cancer. Unlike grief after a loss, the feeling that it’s not socially acceptable to express anticipatory grief can add to feelings of isolation.
A desire to talk: Loneliness can result in a strong desire to talk to someone—anyone—who might understand how you feel and listen without judgment. If you don’t have a safe place to express your grief, these emotions can lead to social withdrawal or emotional numbness to protect the pain in your heart.
Anxiety: When you are caring for a loved one who is dying, it’s like living in a state of heightened anxiety all of the time. Anxiety, in turn, can cause physical symptoms such as tremulousness, palpitations, and shaking.
Guilt: The time prior to a loved one’s death can be a time of great guilt—especially if they are suffering. While you long for your loved one to be free of pain, you fear the moment that death will actually happen. You may also experience survivor guilt because you will continue with your life while they will not.
Intense concern for the person dying: You may find yourself extremely concerned about your loved one, and this concern can revolve around emotional, physical, or spiritual issues.
Rehearsal of the death: You may find yourself visualizing what it will be like to have your loved one gone. Or if you are dying, visualizing how your loved ones will carry on after your death. Many people feel guilty about these thoughts, but they are very normal and are part of accepting the inevitability of death.
Physical problems: Physical problems such as sleep difficulty and memory problems. Learn more about the physical toll of grief.
Fears of loss, compassion, and concern for children: One study found that fears about what was going to happen and how they would be cared for were very strong in children who are facing the death of a parent or grandparent.2

While you may have heard of the stages of grief and the four tasks of grieving, it’s important to note that most people do not neatly follow these steps one by one and find that they wake up one morning feeling they have accepted what has happened and have recovered.

Instead, any of these stages may be present at any one time and you may find yourself re-experiencing the same feelings of shock, questioning, or despair many times over. As noted above, there is no right way to feel or grieve.

Treatment and Counseling

Anticipatory grief is a normal process in the continuum of grief. But in some cases, this grief can be so intense that it interferes with your ability to cope. It’s also common for people to develop depression when faced with all of the losses surrounding grief and it can be difficult to distinguish grief from depression.

Coping With Anticipatory Grief

It’s important to express your pain and let yourself grieve. Finding a friend or another loved one you can share your feelings openly with is extremely helpful, just as maintaining hope and preparing for death at the same time is difficult.

It can be even harder as people may wonder why you are grieving—even become angry that you are grieving—before the actual death.

Keep in mind that letting go doesn’t mean you have to stop loving your loved one—even after they die. During this stage, some people begin to find a safe place in their heart to hold memories of their loved one that will never die.

Frequently Asked Questions

What is anticipatory grief?
Anticipatory grief is a sense of deep sorrow that occurs before someone’s death, as you’re anticipating what will happen.3 Your feelings can be very confusing and may leave you lonely and anxious on top of feeling great sadness.
Why do I feel guilty about my friend dying?
Guilt can be related to many emotions. You may have a sense of relief that a person who’s been ill is at the end of their suffering, but that feeling comes with guilt that you’re “happy” they’ll die soon. Sometimes, guilt comes from unresolved issues you may have had with the person who is dying.

Complete Article ↪HERE↩!

October 19, 2021October 18, 2021

The 11 qualities of a good death

Opening up about death can make it easier for ourselves and our loved ones.

By Jordan Rosenfeld

Nearly nine years ago, I received a call from my stepmother summoning me to my grandmother’s house. At 92 years old, my Oma had lost most of her sight and hearing, and with it the joy she took in reading and listening to music. She spent most of her time in a wheelchair because small strokes had left her prone to falling, and she was never comfortable in bed. Now she had told her caregiver that she was “ready to die,” and our family believed she meant it.

I made it to my grandmother in time to spend an entire day at her bedside, along with other members of our family. We told her she was free to go, and she quietly slipped away that night. It was, I thought, a good death. But beyond that experience, I haven’t had much insight into what it would look like to make peace with the end of one’s life.

A recent study published in the American Journal of Geriatric Psychiatry, which gathered data from terminal patients, family members and health care providers, aims to clarify what a good death looks like. The literature review identifies 11 core themes associated with dying well, culled from 36 studies:

Having control over the specific dying process
Pain-free status
Engagement with religion or spirituality
Experiencing emotional well-being
Having a sense of life completion or legacy
Having a choice in treatment preferences
Experiencing dignity in the dying process
Having family present and saying goodbye
Quality of life during the dying process
A good relationship with health care providers
A miscellaneous “other” category (cultural specifics, having pets nearby, health care costs, etc.)

In laying out the factors that tend to be associated with a peaceful dying process, this research has the potential to help us better prepare for the deaths of our loved ones—and for our own.

Choosing the way we die

Americans don’t like to talk about death. But having tough conversations about end-of-life care well in advance can help dying people cope later on, according to Emily Meier, lead author of the study and a psychologist who worked in palliative care at the University of California San Diego’s Morres Cancer Center. Her research suggests that people who put their wishes in writing and talk to their loved ones about how they want to die can retain some sense of agency in the face of the inevitable, and even find meaning in the dying process.

Natasha Billawala, a writer in Los Angeles, had many conversations with her mother before she passed away from complications of the neurodegenerative disease ALS (amytropic lateral sclerosis) in December 2015. Both of her parents had put their advanced directives into writing years before their deaths, noting procedures they did and didn’t want and what kinds of decisions their children could make on their behalf. “When the end came it was immensely helpful to know what she wanted,” Billawala says.

When asked if her mother had a “good death,” according to the UCSD study’s criteria, Billawalla says, “Yes and no. It’s complicated because she didn’t want to go. Because she lost the ability to swallow, the opportunity to make the last decision was taken from her.” Her mother might have been able to make more choices about how she died if her loss of functions had not hastened her demise. And yet Billawalla calls witnessing her mother’s death “a gift,” because “there was so much love and a focus on her that was beautiful, that I can carry with me forever.”

Pain-free status

Dying can take a long time—which sometimes means that patients opt for pain medication or removing life-support systems in order to ease suffering. Billawala’s mother spent her final days on morphine to keep her comfortable. My Oma, too, had opiate pain relief for chronic pain.

Her death wasn’t exactly easy. At the end of her life, her lungs were working hard, her limbs twitching, her eyes rolling behind lids like an active dreamer. But I do think it’s safe to say that she was as comfortable as she could possibly be—far more so than if she’d been rushed to the hospital and hooked up to machines. It’s no surprise that many people, at the end, eschew interventions and simply wish to go in peace.

Emotional well-being

Author and physician Atul Gwande summarizes well-being as “the reasons one wishes to be alive” in his recent book Being Mortal. This may involve simple pleasures like going to the symphony, taking vigorous hikes or reading books He adds: “Whenever serious sickness or injury strikes and your body or mind breaks down … What are the trade-offs you are willing to make and not willing to make?”

Kriss Kevorkian, an expert in grief, death and dying, encourages those she educates to write advance directives with the following question in mind: “What do you want your quality of life to be?”

The hospital setting alone can create anxiety or negative feelings in an ill or dying person, so Kevorkian suggests family members try to create a familiar ambience through music, favorite scents, or conversation, among other options, or consider whether it’s better to bring the dying person home instead. Billawalla says that the most important thing to her mother was to have her children with her at the end. For many dying people, having family around can provide a sense of peace.

Opening up about death and dying

People who openly talk about death when they are in good health have a greater chance of facing their own deaths with equanimity. To that end, Meier is a fan of death cafés, which have sprung up around the nation. These informal discussion groups aim to help people get more comfortable talking about dying, normalizing such discussions over tea or cake. It’s a platform where people can chat about everything from the afterlife (or lack thereof) to cremation to mourning rituals.

Doctors and nurses must also confront their own resistance to openly discussing death, according to Dilip Jeste, a coauthor of the study and geriatric psychiatrist with the University of California San Diego Stein Institute for Research on Aging. “As physicians we are taught to think about how to prolong life,” he says. That’s why death becomes [seen as] a failure on our part.” While doctors overwhelmingly believe in the importance of end-of-life conversations, a recent US poll found that nearly half (46%) of doctors and specialists feel unsure about how to broach the subject with their own patients. Perhaps, in coming to a better understanding of what a good death looks like, both doctors and laypeople will be better prepared to help people through this final, natural transition.

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October 18, 2021

Grief-induced anxiety

— Calming the fears that follow loss

By Jessica DuLong

Millions of Americans are grieving loved ones taken by Covid-19. Yet even outside of a pandemic — with its staggering losses of lives, homes, economic security and normalcy — grief is hard work.

“The funny thing about grief is that no one ever feels like they’re doing it the right way,” said therapist Claire Bidwell Smith, author of “Anxiety: The Missing Stage of Grief.” But there is no right way, she insisted. The only “wrong” way is to not do it.

What often trips people up is misattributing the sensations of grief-related anxiety to some unrelated cause. “Probably 70% of my clients have gone into the hospital for a panic attack following a big loss,” Smith said.

After doctors rule out physical illness, clients come to her for counseling, frequently struggling to understand the link between their physical symptoms and bereavement.

This becomes especially problematic in grief-averse places like the United States, Smith explained.

With over 4 million reported Covid-19 deaths reported worldwide since December 2019, grief and loss have touched an untold number of hearts and minds. Smith recommends connecting the dots between loss and anxiety as a critical first step toward healing.

This conversation has been edited and condensed for clarity.

CNN: How are grief and anxiety related?

Claire Bidwell Smith: When some big change comes seemingly out of nowhere and disrupts life, we realize we’re not safe, things aren’t certain, we’re not in control.

All of that is true all of the time, but loss is a huge reminder. The life changes and emotional upheaval are so much bigger than most people understand. Grief, which is the series of emotions that accompany a significant loss, can drop you to your knees. That feeds anxiety.

Grieving people can begin feeling anxious about their own health or the safety of other loved ones. Sometimes, they don’t even realize what they are experiencing is anxiety or is in any way related to their grief.

Anxiety, a psychological condition that causes fear and worry, can present with many physical symptoms. These can be misleading, making you think you have heart palpitations, a stomach issue, a new sweating problem, headaches, insomnia. Many people think they have a medical problem and not an emotional one.

CNN: How do you help people ease their grief-related anxiety?

Smith: My first job is to help people connect the dots between their loss and their fears by tracing their anxiety on a time line: When was I last anxious? How were things before my loved one died?

If the loved one had a long illness, the anxiety might begin before the death. After a sudden death, the anxiety might start right away. Usually if someone’s going to veer into anxious territory, it’s something that happens quickly following loss.

Some people I see, who have never had anxiety in their lives, suddenly begin to have panic attacks right after the death of a loved one. Others, long familiar with anxiety, see symptoms really ratchet up after a loss, or maybe take on new manifestations.

CNN: What coping strategies can people use?

Smith: Seeking out support is really vital. There are so many more support groups and grief therapists available right now. And because of the pandemic, many are available virtually. You can often find support online and start tomorrow. If the therapists or groups you find are booked, get on a wait list. It’s never too late to work through your grief.

If people don’t seek out help to untangle their emotions, they get stuck in anger or guilt. Those play out in substance abuse, depression and anxiety, in relationship issues and in trouble at work and school. So, the domino effect of trying to muscle through and not seeking out support isn’t good.

CNN: What advice do you have for those resistant to formal mental health treatment?

Smith: Self-guided online courses are one option that many therapists provide. Even reading articles or books or listening to a podcast about grief can normalize your experience and help you give you more permission to mourn. You can feel like you’re going crazy, like something else is wrong with you, when really, it’s grief.

Social media offers so many grief resources. A simple search on Instagram for #grief can help you find solidarity with others. Even just reading about other people’s experiences through their posts and comments is valuable because it can help you realize you’re not alone.

CNN: Because of the pandemic, so many people have been unable to be with their dying loved ones. What impact might that have?

Smith: We will see more complicated grief, with extended periods of grieving where people may get stuck in a loop of guilt or regret or anger. That comes, in part, from the feeling that a lot of the losses were preventable, and because people were forced to say goodbye to loved ones over Zoom and FaceTime with nurses wearing masks and face shields. Those kinds of endings can lend themselves to complicated grief.

Clients I’m working with who have lost a loved one to Covid-19 are feeling anger as they watch people get vaccinated — or choose not to get vaccinated. Everyone’s posting reunion pictures. Someone who lost a parent to Covid a month ago is painfully aware of just how close they were to not having to go through this loss.

Initially, they have to work through shock, anger and guilt. Then we can begin to find new ways to say goodbye. That can look like doing self-compassion exercises or speaking with a pastor, minister or rabbi to work on absolution of guilt. It can involve finding spiritual connections to someone they have lost by writing them letters. I urge people to embrace their own sense of ritual and perhaps even hold memorials.

CNN: What role do meditation and mindfulness play in healing?

Smith: When we are grieving, and when we are anxious, we spend a lot of time dwelling in the past and fretting about the future. Meditation and mindfulness help bring our awareness to the present moment.

Meditation also helps us to understand our own thoughts, and how we can learn to detach from negative ideas and irrational fears.

CNN: You write that imagination can be another powerful tool. How?

Smith: I wasn’t there the night my mother died. Even today, I imagine myself crawling into her hospital bed and holding her and saying the goodbye that I didn’t get to. I’ve found catharsis in envisioning what I would have done, had I been able. But it took me years — definitely more than five — to get to that point.

Just like when athletes envision a course the night before, imagination can almost give your body a sense memory, which can be soothing. But it’s not something that people are ready to do right away.

CNN: What role does story play in coping with grief and loss?

Smith: People carry around stories of loss and death, but they often feel like they are suppressing them because they haven’t found good places to share them. How we hold a story is very indicative of how we feel emotionally. When we are holding a scary story, an uncomfortable story, a story of regret for a long time, it plays out in our day-to-day life.

Healing comes from finding outlets to explore a story and possibly find ways to reframe it. We can do that in therapy, counseling, support groups, online grief forums and grief writing classes, among other places.

CNN: You’ve come to believe that staying connected with our lost loved ones can be more healing than letting go. What does that look like?

Smith: That looks different for everyone, and it isn’t something most of us can do right away — we often just want our person back in front of us. But once they are ready, I encourage my clients to call upon their loved ones, continuing to be in conversation with them internally. There used to be this emphasis on letting go and moving on. Now, I feel it’s more important to move forward with the person you have lost.

For example, pondering: What advice would my dad give me about this job offer? What would my mom think of my new boyfriend?

Developing and fostering a relationship with our person can include sharing stories about them, taking on certain aspects of work they did or doing things in remembrance.

CNN: You quote Hope Edelman, author of “The AfterGrief,” who has said the crux of grief work is making meaning out of loss. Is there a way to foster the meaning-making that can have such lasting value?

Smith: In some ways, that stage comes naturally. However, we can’t get there until we work through guilt, regret and anger that stand in the way of our ability to make meaning. If we’re angry with our loved one or a situation that happened, a lot of people will hold onto that anger because it’s a very powerful emotion.

But I’ve never seen a grieving client who hasn’t questioned life in a new way. Where’s my person? Can they see me? Will I ever see them again? Why am I still here?

It’s really hard to go through huge loss and not have those questions. Those inquiries lead to finding meaning and transformation.

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