Tag: Grief and Grieving

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There Are 5 Stages of Grief

— Here’s What to Expect From Each One

Everyone who grieves experiences them, but we do it in our own way on our own timetable.

By Madeleine Burry

Whether it’s the death of a loved one, the loss of a job, the end of a relationship, or any of life’s small and large tragedies, we all grieve at some point. While you shouldn’t anticipate that your grief will resemble another person’s, there are certain common stages of grief we all experience.

Where the stages of grief originated

These stages of grief have typically been classified as denial, bargaining, anger, depression, and acceptance. The five stages originate from a 1969 book, On Death and Dying, written by psychiatrist Elizabeth Kübler-Ross. Though there’s some dissent about these five stages and not everyone goes through them at the same time or the same way, they’ve been accepted by psychology experts for decades and remain the model that is applied to all forms of loss.

“Coping with a loss is a very singular and unique experience to each person,” Holly Schiff, PsyD, a licensed clinical psychologist in Connecticut with Jewish Family Services of Greenwich, tells Health. Nor is the grieving process accompanied by a timetable, although often the worst symptoms peak at the six-month mark, she notes.

The grieving process is a “messy jumble of highs and lows, ebbs and flows, steps forward and backwards,” Schiff says.

Here, a look at what happens during each of these five stages, along with coping strategies for grieving.

Grief stage 1: denial

This initial stage of grief helps us to cope and survive a loss, Schiff says. “You are living in a ‘preferable’ reality, rather than actual reality,” she says. You might refuse to acknowledge the loss by keeping it to yourself and going about your life. When emotions start to overwhelm you and urge to to face the loss, you fight back and focus your mind elsewhere.

You may experience shock or disbelief while navigating denial, Arianna Galligher, LISW-S, associate director of the STAR Trauma Recovery Center at Ohio State University’s Wexner Medical Center, tells Health. “Many people describe feeling numb,” Galligher says, or struggle to connect with their emotions.

Grief stage 2: anger

Grief-related anger may lead you to ask “Why me?” or wonder why life is unfair, Schiff says.

“This response may be directed outward, inward, or both,” Galligher says. That is, it’s not unusual to blame yourself or to feel anger toward friends, family members, and others. In the case of a bad medical diagnosis, for instance, the target might be a doctor who didn’t catch the disease early on-or, someone who is fired may feel fury at their boss.

If it’s a loved one’s death you’re grieving, you could also be angry at the person-furious that they didn’t seek help sooner for a health symptom or mental anguish. If you’re grieving the end of a relationship or job, you might feel anger toward your ex or boss, blaming them for things ending.

Anger may feel unfamiliar, or maybe immature. But don’t avoid this necessary stage of grief, Schiff says. “The more you allow yourself to feel it, the more quickly it will dissipate.”

Grief stage 3: bargaining

During the bargaining phase of grief, people seek to resume their pre-loss life. Essentially, it becomes an attempt to negotiate out of the grief, Schiff says.

Many people experience guilt during this phase, too. “This response is often punctuated by ‘what if’ or ‘if only’ thoughts that seek to regain some sense of control when a person is feeling helpless or powerless over the outcome of a situation,” Galligher notes.

These thoughts may circle around and around: What if we’d skipped that errand-then we would have avoided the car accident. Or if only I’d made time for weekly date nights, we’d still be together.

Grief stage 4: depression

Facing the new, post-loss reality can lead to sadness and despair, Schiff says. “This is a natural and appropriate response to grief,” she explains.

During this phase, you may feel lonely, cry frequently, or feel disengaged from your regular activities and relationships. Depression can affect your sleep and appetite. People in this stage might find themselves losing or gaining weight, or they could feeling fatigued during the day because they’re waking up throughout the night.

Depression isn’t always displayed with a lot of emotion, however; sometimes it mean simply feel uninterested in day-to-day life and not feeling strongly about anything. If you don’t cry, it’s doesn’t mean you aren’t in the depression stage of grief. Think of “depression” as more of a stage where your emotions are muted, with grief preventing you from finding pleasure or contentment in things.

Grief stage 5: acceptance

Reaching the acceptance stage of loss doesn’t imply that you feel happiness-it simply indicates that you’ve acclimated to the loss and your new reality, Galligher says.

That means that while your emotions may stabilize, during the acceptance stage you may still feel sorrowful. During this phase, you’re learning to live with your loss, Schiff says.

While your emotions may stabilize, and you may no longer have the extremes of other stages, sadness may still occur.

Other ways of looking at grief

The Kübler-Ross theory can make grieving seem like an orderly, step-by-step process.

But in reality, mourning a loss isn’t a math equation: You may find yourself going from one stage to another and then again, Schiff says. Or, you may “even feel like you are in multiple stages at once as you cycle through a variety of emotions,” she says.

This rigidity is one of a few reasons for critiques of the Kübler-Ross model, Galligher says. This approach also assumes that all cultures conceptualize-and therefore, cope-with grief in the same way, she notes, which is not necessarily accurate. Other modern theories of grief focus less on stages and more on grief-related tasks (think: accepting the loss), Galligher says.

When to seek help

The grieving process can feel isolating and overwhelming. “It is important for people to seek help when they are grieving, and lean on family and friends for support,” Schiff says.

Grief can understandably affect your mental health, so consider reaching out for professional help if grieving-and feelings associated with the process-are making it hard for you to handle day-to-day functions or maintain relationships, Galligher says. Attending support groups or seeing a therapist can help you navigate life after loss, she says.

“If you feel like grief is taking over your life, speak to someone,” Schiff says.

Grief coping tactics

Navigating grief is innately challenging, but here are some therapist-recommended strategies to potentially ease the process:

Let your support system go work

While your grief is personal, there’s no need for it to be a solo operation. Seek support from friends, family, therapists, and support groups, Schiff recommends. She also recommends informing people in your workplace as needed. That way, “your job doesn’t expect the same ‘you’ to show up every day.”

Feel your feelings

“Give yourself permission to feel a range of emotions without judgement,” Galligher recommends. Expect challenging days and weeks to occur. It can be helpful to allocate a certain amount of time each day to grieving, Schiff says. But give yourself the grace of grieving without a deadline-again, there’s no set end-date for the process.

Prioritize self-care

Make sure you’re taking care of your physical and emotional needs: Don’t neglect sleep, exercise, and eating, Galligher says. And, avoid self-medicating with alcohol or drugs, she adds.

Plan ahead

Anniversaries, holidays, and other milestones can trigger feelings of grief, Galligher notes. “Engage in intentional self-care in anticipation” of these moments, she recommends. That might mean, for instance, deleting social media in the lead-up, taking time off of work, or reaching out to loved ones for support.

Complete Article ↪HERE↩!

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Coping with death through letters to the dead

The Magenta Horse Last Words altar at Siletz Bay Park awaits letters and offerings from visitors to help them cope with losing a loved one.

By Mathew Brock

Some people may regret not being able to say something to a loved one before they passed, but for the next month, residents and visitors to Lincoln City will have the chance to put those words into one final letter, even if it’s only symbolically.

The Golden Chachkie Last Words altar at sits slightly off the beaten path at Nesika Park.

At parks around Lincoln City, several altars appeared last month as part of the Last Word’s Mailbox Altars Public Art Installation, which gives people who have experienced the death of a loved one a place to grieve and cope by writing them letters.

The project serves another purpose however, as the letters left at the alters will be taken and turned into songs that will be performed at a virtual concert in August and sold as an album to help raise money in support of houseless veterans facing terminal illness through the Do Good Multnomah nonprofit group.

“These art installations are part of an interdisciplinary project that’s really a fundraiser,” said Crystal Akins, founder of Activate Arts and the artist responsible for the project. “I knew I could have done a regular fundraiser, like an event where you get wine and do the whole thing, but instead I wanted to do something that would bring the community together around death using their own grief and loss to transform that into a way to support a person in dying a good death.”

The project has been years in the making and was inspired by Akins’ work as a death doula, someone who helps the dying and their friends and family cope with death.

“It’s a long-term project, and I’ve been working on it for about five years so far,” Akins said. “I’ve been researching houseless death and am a death doula. I’ve been working with a lot of people who live in poverty and seeing how they die. I decided now it’s time to help build a community around death and to help veterans in poverty get access to a good death.”

Akins said the project was also inspired by the Telephone in the Wind art project, which first started in Japan with similar installations popping up in the U.S. and other countries since it debuted in 2011. At these installations, visitors can use a secluded phone booth to symbolically have one final conversation with a deceased loved one as a way to help cope with the loss.

“I saw that and the ways people were connecting with it and wanted to bring something similar here to try that would help bring community together,” Akins said. “Some of the letters I’ve been getting so far have taken the time to thank me for providing this space, and that was the purpose of this, to provide a space for people to experience grief and loss, which is especially important during this pandemic with people facing loss every day.”

The alters themselves were made by Akins using a “found art” art style, which takes discarded and recycled items and repurposes them as a medium for artwork. They’re currently located at Josephine Young Memorial Park, Siletz Bay Park and Nesika Park in Lincoln City until July 1, when Akins will collect and store them.

Those wishing to participate in the project can visit any of the altars and leave a letter, and if they like, a small offering as well, such as a flower, photo or rock. Those writing letters are asked to keep their own privacy in mind and to address letters without specific names, such as “Dear Dad,” “Dear Grandmother,” “Dear sister,” or “Dear Pet Companion.”

Complete Article ↪HERE↩!

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What Is Anticipatory Grief And How Does It Work?

By Judy Ho, PH.D., A.B.P.P., A.B.P.d.N.

Anticipatory grief, also referred to as anticipatory loss or preparatory grief, is the distress a person may feel in the days, months or even years before the death of a loved one or other impending loss. “It’s the experience of knowing that a change is coming, and starting to experience bereavement in the face of that,” says Allison Werner-Lin, Ph.D., a licensed clinical social worker and associate professor at the University of Pennsylvania’s School of Social Policy and Practice in Philadelphia. Many of us have experienced anticipatory grief without realizing there’s a name for it, she adds.

Some experts say anticipatory grief, when managed with coping techniques, can lessen the pain of post-loss grief. Others argue grief before loss has no effect on grief after loss.

Who Has Anticipatory Grief, and When?

Patients with a terminal illness, as well as their family members, friends and caregivers, often experience anticipatory grief. However, any kind of looming change can bring on anticipatory grief. This is true “even if the change is exciting and anticipated and chosen,” says Werner-Lin. For example, a person who puts in notice at her job may grieve the loss of friendship she expects will happen when she no longer sees her current co-workers every day.

Scenarios that may provoke anticipatory grief include, but are not limited to:

  • Diagnosis or progression of a degenerative disease, such as Alzheimer’s disease, other forms of dementia or Parkinson’s disease
    In one study conducted in Cork, Ireland, 29 people caring for a family member with Parkinson’s filled out questionnaires to assess their levels of anticipatory grief. Caregivers “were preoccupied with thoughts about…what life could have been if they were never diagnosed,” researchers found.
  • End-of-life care
    Anticipatory grief may affect the caregiver, the patient or both. In one study of family caregivers in Japan, a woman taking care of her husband, a cancer patient who was expected to die within six months, said, “I become anxious thinking about the future even when I am asleep. What should I do? My husband is the firstborn son. His 92-year-old mother is still doing well. He is genuinely firstborn. Everyone in the household relies on the firstborn son, and everything important is left to him. If he dies, everyone will be troubled.”

    • Caring for children with chronic disease
    • Hereditary cancer risk
      Anticipatory grief often surfaces in people who have genetic conditions that elevate their cancer risk, says Werner-Lin, who is also a senior advisor to the National Cancer Institute’s Clinical Genetics Branch and studies patients who have Li-Fraumeni Syndrome and BRCA mutations. In these cases, the patient imagines when a cancer diagnosis may come and how it will change their quality of life.
    • Awaiting an organ transplant
      Besides grieving the possible scenarios of their own death, patients on a heart transplant list “were also grieving in this way for their potential heart donor and the death that would have to happen to extend their own lives,” according to a study published in the Journal of Heart and Lung Transplantation.
    • Amputation
      A review of 134 studies of the social and psychological challenges that face amputees found that the time before the operation can be the most upsetting. Patients express grief over the unknowns surrounding their future, including “pain, financial difficulties, general health and future functional capabilities at home or on the job.”
    • Impending loss of a pet
    • A new job, a new relationship, a geographic move or a teen leaving home for college
      Even planned, desired life changes can prompt anticipatory grief related to the prospective loss of identity, friends or routine.

    Anticipatory grief can also surface around pregnancy and childbirth, including:

    • In-utero complications
      Parents who learn that their unborn baby may not survive can experience anticipatory grief around the potential loss.
    • Premature birth
      “Anticipatory grief may set in as parents mourn the loss of their ‘imagined’ or ‘wished for baby,’ as they struggle to develop a bond with their ‘real baby,’” write researchers in Primary Care of the Premature Infant. In some mothers, these feelings “may be rooted in her belief that her inability to bring her baby to term is a personal failure.”

    Anticipatory Grief and Age

    The younger a person is, the more severely they may experience anticipatory grief, particularly as it relates to death. In a review of 15 studies exploring anticipatory grief and illness, doctors at the University of Illinois at Chicago found that “younger caregivers and younger patients tended to report higher ratings of anticipatory grief.” In one study of adults with terminal cancer, patients under age 25 experienced more anticipatory grief than patients age 26 to 55. The younger group “viewed death as extinction,” influencing their grief, researchers found.

    Anticipatory Grief vs. Conventional Grief: What’s the Difference?

    Think of conventional grief as “grieving backward,” says Werner-Lin—mourning a loss that has already happened. Anticipatory grief is forward-looking. We’re grieving “what we still believe we might lose,” she says.

    This leaves space for hope, however unrealistic, that the loss may not occur. Anticipatory grievers might find themselves “hanging on to possibilities” in ways that may not be helpful, Werner-Lin says. Conversely, in a situation like a pandemic, it can be helpful to step back and remember that the worst might not happen.

    What You Might Feel When Experiencing Anticipatory Grief

    People undergoing anticipatory grief report a range of feelings that may include:

    • Anger or irritability
    • Anxiety
    • Denial
    • The desire to withdraw from social situations
    • Desperation
    • Dread
    • Guilt
    • An intense preoccupation with the dying person
    • Lethargy or lack of motivation
    • Loneliness
    • Loss of control over one’s emotions
    • Sadness
    • Tearfulness

    The Stages of Anticipatory Grief

    There’s no set order to what you might feel as you undergo anticipatory grief, and there’s no “finishing” one feeling before you move to the next. You may experience many emotions one day and none the next. You may think you’re done feeling certain emotions only for them to return days or weeks later.

    With that in mind, here are four phases a person with anticipatory grief may experience, separately or simultaneously, in any order, according to the University of Rochester Medical Center, a nonprofit research university in Rochester, New York:

    • Accepting that death is inevitable. This phase often co-occurs with feelings of sadness and depression.
    • Feeling concern for the dying person. For family and friends, this phase may express itself in regret—for example, feeling regret over past arguments or disagreements with the person they are about to lose. For the dying person, this concern may translate to fear of what it’s like to die.
    • Rehearsing the death. A person may become focused on funeral arrangements, saying goodbyes and other concerns related directly to what will happen in the time immediately surrounding the impending death.
    • Imagining the future. Family and friends may envision what life will be like without their loved one. This phase may include visualizing holidays and other special occasions without the person or thinking about objects that will be left behind. The person dying may think about similar scenarios, wondering what it will be like for their loved ones to experience life without them. The dying person may also imagine what their own experience may be like after death—what, if anything, comes next.

    Potential Benefits of Anticipatory Grief

    Anticipatory grief doesn’t necessarily reduce pain after loss. Any potential benefits have largely been studied in the context of anticipatory grief before death.

    Some early research suggested the preemptive processing of a loss could help a person better cope once the loss occurred. “Within this paradigm, the bereaved are able to deal with any unfinished business, say their good-byes, clarify any misunderstandings, and prepare for social adjustments to come, thereby having a less distressful and disabling period of bereavement when the death does occur,” according to a research review published in the journal Counselling, Psychotherapy, and Health.

    However, some more recent studies argue that anticipatory grief has no effect on post-death bereavement. Others find that pre-loss anticipatory grief may be a factor in predicting prolonged grief disorder.

    At best, research is contradictory. However, keep in mind that one doesn’t choose to feel anticipatory grief. More important than considering its benefits is making sure you get the proper help to work through it.

    How to Deal With Anticipatory Grief

    If you’re experiencing anticipatory grief, it’s important to talk about it with someone. “Grief is a universal human experience,” says Dr. Werner-Lin, and discussing it with others is how you begin to work through it.

    She gives the example of a group of rare disease patients and caregivers her research team worked with. Prior to talking about their anticipatory grief, “they all really independently felt like they were just plain struggling and not holding up their end of the bargain of humanity,” she says. “When really what was happening is something we could explain and work through. Talk about the dimensions of it. Talk about where it moved into their lives and filled in cracks and crevices, or was taking over their day-to-day lives and their relationships.”

    Dr. Werner-Lin recommends using the American Psychological Association’s Psychologist Locator Program to find a mental health provider who specializes in grief, whether that be a psychologist, psychiatrist, psychiatric nurse practitioner, social worker or counselor.

    Common counseling interventions include narrative therapy, which can help the grieving person reframe loss, and active listening, which allows the grieving person ample time and space to talk out their feelings, prompted by insightful questions from the counselor. This type of out-loud musing can help a person process their grief.

    Another form of evidence-based intervention is cognitive behavioral therapy. In this type of therapy, grief-related thoughts are identified and processed, and the grieving person is taught to reframe their evaluations about themselves, the world and their future. It focuses on managing distressing emotions and encouraging actions to help a person experience pleasure, joy, and a sense of community.

    If you don’t have the financial resources to hire a counselor, it’s still beneficial to talk to family and friends, who can engage in active listening and offer other support that’s important for processing grief, such as empathy and validation.

    For an end-of-life patient, anticipatory grief therapy may improve quality of life before death and may alleviate depression.

    Many insurance plans cover a percentage of therapy costs retroactively via claims forms. Call the number on your insurance card to ask about policies.

    Complete Article ↪HERE↩!

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What the Pandemic Taught Us About the End of Life and Grief

Hospice workers, ethicists and therapists say grief is a pathway toward healing

By Vicky Diaz-Camacho

Grief felt “closer” this year for Meagan Howard. It’s the only way she could describe it.

On May 16, her good friend died in a car accident. There was something different about this death. As a Black woman in the mental health field, Howard said she has personally felt the compounding trauma of the pandemic with racial tensions.

That’s why it hit harder.

But as she sat in silence and cried with another friend to mourn their loss, she felt the release.

“That was more healing than someone saying, ‘It’s going to be OK’,” she said.

Meagan Howard
Meagan Howard is transparent about her own difficulty to grapple with grief and now encourages others to find ways to navigate sometimes complex emotions.

Years ago, Howard personally struggled to acknowledge the grieving process when her grandmother died. Now, she works against that to help her own clients who are navigating complex feelings of anger, avoidance and sadness — symptoms of grief — and in her personal life.

She specifically counsels folks with substance use disorders at Midwest Recovery Centers, which can often stem from unresolved trauma and loss.

The pandemic sparked a new kind of uncertainty, ranging from housing and job security to health security. This is why it’s more important now than ever to take a moment to pause and feel, she added.

A paper for the National Institutes of Health (NIH) on preparing palliative care providers explained that “anticipatory grief is the normal mourning that occurs for a patient/family when death is expected.”

That anticipation evaporated in the wake of the public health crisis. Back in March 2020, the number of people infected and dying from complications skyrocketed. This, mental health experts say, caused a mental health whiplash.

“As a society, we’re just kind of told lock it down, keep it moving,” she said.

However, she witnessed a shift this year that ranges between communal trauma to communal grief.

Howard said grieving as a society has been an essential step toward collective healing.

“One of the most powerful things that I saw from the pandemic is this sense of community,” she said. “There is power in being able to share your grief in a community setting with someone else. (It) gives us power when we feel like we don’t have any.”

From a mental health perspective, grief is healthy.

“It’s needed, it’s necessary, it’s essential,” Howard said.

“If we’re not allowing ourselves that grieving process, then almost in a sense we almost start to die internally. And I know that sounds kind of morbid, but that’s what it feels like is happening if we’re not allowing that to come out.”

Researchers at the NIH outlined what they call “context of grief” during the pandemic, which underscored how the public health crisis complicated an already sensitive process.

The study identified three specific changes during COVID-19: spread of the disease; social distancing and the increase of deaths; and hospitalizations and overburdened hospital systems. It outlined the financial, emotional, social and mental toll this would take on society at large.

Among the recommendations was to address grief head-on:

“Approach difficult conversations directly and do not shy away from discussing emotions, grief, and overall patient and family distress during advance care planning conversations.”

Trauma and loss experts have long advised families to begin conversations early about advance care planning. The idea is to ease ourselves into more comfortable conversations about what to do when someone we love dies. More importantly, these conversations serve as an emotional buffer.

Caring Conversations

Life unexpectedly changed, leaving communities unsure how to grapple with uncertainty and at the same time inciting communal trauma of seeing folks die from COVID-19.

This brought to the surface ethical considerations that impact the grieving process. How do families broach the subject of advance care planning or Do Not Resuscitate (DNR) orders?

That’s where Terry Rosell comes in. Rosell is an ethics consultant at the Center for Practical Bioethics — one of the only three centers of its kind in the United States.

(Disclosure: the author’s spouse recently accepted a job at the center. The interview was arranged and conducted without their involvement.)

Rosell, who is also a faith leader, works closely with medical professionals and has seen firsthand how COVID-19 changed the way in which families and their doctors approach life and death discussions.

Terry Rosell
Terry Rosell is an ethics consultant and educator for the Kansas City University of Medicine and Biosciences and the University of Kansas Medical Center. He also was a theology professor.

“It’s hard enough to die. It’s hard enough to deal with our loved ones dying. So we ought to make it better,” he said.

End-of-life care is also known as hospice and palliative care, which emphasizes keeping the person comfortable while they’re dying. This is part of what Rosell teaches when he presents to physicians and hospital staff.

“The first ethics matter around end-of-life care is taking care of these patients. Just because they’re no longer curative, just because they’re no longer receiving aggressive care, we still have a duty to care for them,” he said. “We ought not to abandon dying patients, right?”

Another part of his job is educating on advance care planning, which ensures a person’s wishes are fulfilled. To some extent, this practice can curb the anxieties that come with anticipating loss.

But not everyone may know what hospice care or advanced care planning entails, which brings to the forefront the lack of visibility of end-of-life services. What the pandemic revealed was the need to address these conversations earlier on.

This helps with the processing part of loss, Rosell explained. Death is a part of life and grief follows suit.

“Any kind of significant loss has a grief response. It’s just part of being human,” he said.

Part of being human is finding comfort in some sort of routine, whether that be spiritual or a ritual. To that end, Rosell added: “Don’t give up on the grief rituals during COVID times. It helps us”

‘I don’t know who I am anymore’

For Oscar Orozco, being vulnerable is part of his job.

Orozco was a former medical social worker for Children’s Mercy, where he helped at-risk children. Today, he works as a grief counselor at Kansas City Hospice and Palliative Care. He echoes Rosell’s points on advance care directives to reduce the added stressors of planning while someone is on the decline.

Oscar Orozco
Oscar Orozco, a grief counselor at Kansas City Hospice and Palliative Care, sees grief as an unpredictable wave.

Even though he’s been in his new role for a short few months, the need for counseling folks through the process has never been more clear.

This year hardly anyone has been able to catch their breath. Orozco said he has talked to health care workers who are friends or clients and they said: “I can’t do this. It’s too much.”

Why?

“(There’s) death and traumatic death, and it’s different. This is not death that people could see coming,” Orozco explained.

Another piece of complex trauma is identity and how folks have struggled to come to terms with the absence of their loved ones.

“In our grief work, what I hear almost often is, ‘I don’t know who I am anymore’,” he said. “People don’t realize that it’s much more than just the death of that person, but it’s the death of … routines, of day-to-day activities and memories and parts of our lives really that died with that person.”

He sees grief like an ocean. It’s unpredictable but sooner or later it’s easy to know when the waves are coming. Managing grief is like swimming, he explained, and sooner or later, we learn how to stay afloat.

Oscar Orozco with his grandparents
Oscar Orozco (middle) lost his grandfather a few months ago. He’s since learned how to process the loss by channeling his grandfather’s love of food into his own life.

That’s how he feels about the recent death of his grandfather. He channels his emotions into cooking, which is how his grandfather expressed his love for the family. This physical act helps him emotionally recover and process.

Processing is key, he said, but that’s been on the back burner for so many during the pandemic. So he advises folks who have experienced loss to be active and deliberate in the grief journey. That could mean going to their burial site for a visit, or it could be to buy their favorite meal from their favorite restaurant.

Grief is an individual process. Orozco advises people to embrace the emotion whether it be by crying, journaling, hiking or traveling.

“You know, whatever it is that comes out naturally to express, but never cast it aside because we’re afraid of where it might lead,” he added.

“We need to talk about this. We need to have those conversations because as uncomfortable as they might be, they could be lifesavers for (us) to continue to live our lives in a meaningful way.”

5 Tips on Navigating Grief

  1. Grief can be complicated and hard to pinpoint. That’s OK. Acknowledge the feeling or sensation (it could be a stomach ache, fatigue, lack of focus or emotions such as profound sadness or anger) as a first step. Experts say there are several kinds of grief:
    1. Complicated grief: When loved ones ruminate about the cause of death, worry about the consequences, feel guilty and display avoidant behaviors, such as denial. Around 7% of bereaved people will experience this kind of grief.
    2. Disenfranchised grief: When a loved one loses a person or child. It “can occur when families are unable to grieve with normal practices of social support and rituals in burial and funeral services,” according to the NIH.
  2. Asking for help to begin the grieving process is OK. “Grief counseling can help,” said Terry Rosell at the Center for Practical Bioethics. “Ministers, clergy, rabbis, priests, there are a lot of people who can help with grief counseling (for free).” You can find grief counselors at your local hospice organizations and mental health professionals who specialize in loss — for good reason. One example is the Solace House Center for Grief and Healing.
  3. Communication is powerful. Talk openly with family members, chosen family or biological relatives, or friends about their wishes before death — sick or not. Studies on the psychological impact of meaningful conversations — or saying “goodbye” — among family members of cancer patients show it helps with depression and complicated grief.
  4. Engage in activities that remind you of your loved one. This can also be characterized as play therapy if your loved one was an artist, which eases the transition from grief to acceptance. “I very much believe that spiritual practices or just rituals is how we get in tune with what our body is telling us about the loss we experienced,” said therapist Meagan Howard.
  5. Cry. Therapists advise sitting in a safe, quiet place or with a support network to embrace the feeling and release. This is good both physically and psychologically. Crying is the body’s “release valve,” according to Dr. Judith Orloff, who wrote: “After crying, our breathing, and heart rate decrease, and we enter into a calmer biological and emotional state.”

Complete Article ↪HERE↩!

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How The Pandemic Has Exposed The Gap In Bereavement Support

By Katie Lynch

Workplace well-being and employer benefit packages have been expanded and highlighted in recent months in light of current events and as companies look to attract talent and build loyalty within their organizations. While vacation time, remote and flexible working, paid parental leave and other wellness perks are often touted as part of a progressive company culture, bereavement leave and grief support still remain a gaping hole in the employee value proposition, leaving people scared to share or ask for help during difficult life events at work.

Even in the wake of Covid-19, I find the conversation around grief and loss in the workplace lacking. Few companies have truly publicly acknowledged the devastating loss of this past year and its impact on employees. As of this writing, the death rate from Covid-19 in the U.S. has surpassed 580,000 Americans, leaving an estimated5.2 million Americans grieving (according to a recent calculation that for every person lost to Covid-19, nine close family members are left to grieve). It is undeniable that this pandemic has affected each one of us, so suffice it to say that all Americans have experienced grief and loss this past year. Why then are companies not talking about its impact on their employees and offering more support?

Companies that strive for empathetic and inclusive cultures need to acknowledge these issues and remove the stigma associated with grief and death in the workplace. According to the Society of Human Resource Management’s (SHRM) 2019 survey, 89% of employers were providing some form of bereavement leave to their employees. However, traditional bereavement leave lasts just one to four days, depending on the employee’s relationship to the deceased. Not only are some companies still not providing leave, but those that do provide it often fail to provide an adequate amount of time away and lack ongoing support for employees dealing with a grief event. When a company only provides employees with one day off following the loss of a loved one, it signals a lack of empathy and support from leadership.

Something that may be contributing to the lack of discussion about grief in the workplace is the lack of any federal or state legislation requiring companies to provide paid leave to their employees. Currently, there is no federal requirement to provide paid leave even for a funeral, let alone time to grieve one’s loss. The fact that the U.S. Department of Labor calls this “funeral leave” and not even bereavement leave shows how antiquated our view of bereavement remains. In an encouraging turn of events, President Biden recently announced the American Families Plan, which would immediately guarantee three days of paid bereavement leave if passed. As of today, though, Oregon is the only state to sanction the overarching need to support grieving employees with a law requiring bereavement leave for employees, with California hoping to follow suit as legislators consider a similar bill.

While some companies are investing in programs to help employees in need, there is room for further support. Having spent years working with people through challenging life transitions, I know firsthand that dealing with grief and loss is not just a single moment in time, and it almost always requires ongoing guidance, education and specialized support.

In 2017, two years after the tragic death of her husband, Facebook COO Sheryl Sandberg famously placed the company at the forefront of the bereavement discussion by championing the need for expanded bereavement leave policies for employees and recognizing that employers need to support their people throughout these situations. Yet, little has changed outside of a select few companies, including Facebook and SurveyMonkey, both supplying bereavement leave of 20 days for immediate family members and 10 days for extended family members. Mastercard, Zillow and New York Life Insurance Company have all in recent years adopted bereavement leave policies of 10 to 20 paid days, depending on who passed away.

While there were great hopes that 2020 would usher in a new era of discussing grief and loss in the workplace and providing employees with adequate leave and support, either internally or with the help of a third party, many companies have failed to take this crucial step. What is so shocking is that even before Covid-19 wreaked havoc on our world, it was reported that grief costs employers an estimated $75 billion each year in lost productivity alone. This number has most certainly skyrocketed in the past 14 months. What we are experiencing now is not new, but it has been worsened. If the risks and costs to businesses are so severe, why do companies not invest more heavily in supporting these employees?

Moving Forward

We need to use the momentum from Covid-19 to do better for our employees. With this mission helping to drive my company and me, we are having these difficult conversations with clients and are providing their employees with proper support in this area. We are hopeful that moving forward, more companies will recognize their responsibility to promote conversations in the workplace on dealing with grief and loss as well as training managers and employees on how to support colleagues following a grief event.

Companies that want to lead with empathy and be at the forefront of this movement will need to model their programs after progressive examples and invest in programs offering robust and ongoing support to employees following a loss. They will also need to create policies that are more inclusive, ensuring that bereavement leave is not just given for the death of a parent, spouse or child, but any family member to whom the person was close. This should also include miscarriage. In addition to leave, companies should also provide employees with ongoing and more robust emotional, administrative and logistical support.

Lastly, the topics of death and grief must become part of the conversation in the office, and managers and leaders need to get comfortable with the uncomfortable. The results will be seen in both better business outcomes and profits as well as a happier and healthier workforce overall.

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The Grief Crisis Is Coming

For each person who dies of Covid-19, experts say there are at least nine newly bereaved. We must begin to address the toll.

By Allison Gilbert

The end of the Covid-19 crisis in the United States is in sight, thanks to effective vaccines being deployed on a massive scale. But the still growing death toll will leave behind millions of bereaved people, wracked by the suffering that the loss of a loved one can bring. This is a public health crisis with consequences that may last generations, which we do not currently have the policy tools or resources to address.

We first need to get a sense of the scope of our national grief. Researchers are just beginning to count the bereaved, and while current estimates suggest five million Americans have lost a loved one to Covid-19, the final tally is likely to be much larger.

Ashton Verdery, an associate professor of sociology and demography at Pennsylvania State University, recently led a study that introduced the Covid-19 Bereavement Multiplier. By his team’s calculus, for every person who dies of Covid-19, nine loved ones are left behind.

To arrive at that number, the researchers included the losses of spouses, siblings, parents, children and grandparents. If other relatives — like nieces, nephews, aunts, uncles, stepparents — and friends are taken into account, “you may get 10 times or more” people in grief, Mr. Verdery said.

I know, from losing my parents at a young age, that grief plays out in waves across one’s life and has no clear ending. We should be prepared for another health catastrophe; while the Covid-19 vaccines can put a cap on the burden, they can’t halt or alleviate the pain. A recent study found that at least 37,000 children in the United States have lost a parent to Covid-19 so far.

Experts and grief organizations are asking American leaders to address this growing crisis. Evermore, one of the nonprofits that I have collaborated with in the past, is calling for the Biden administration to establish the first White House office of bereavement care to respond to the emotional and financial needs of grieving people after tragedy.

Another coalition of national bereavement organizations and grief researchers recently wrote to President Biden urging him to fund grief intervention services, including training to educate the public and professionals such as social workers, psychologists, teachers and clergy on how to assist the grieving.

Grass-roots groups like Covid Survivors for Change and Marked by Covid have lobbied at the state and federal levels for accountability to relatives of victims, including public and online spaces for mourning and remembrance, and compensation for families of people lost to Covid-19.

The effects of grief can be as physical as the symptoms of any disease. The short- and long-term impacts are well studied and include trouble sleeping, higher blood pressure, depression and anxiety. Studies have found that people who lose a spouse die earlier than their married peers. Children who experience loss of a parent may suffer lasting consequences, including lower grades and failing in school, as well as increased experimentation with drugs and alcohol.

The social effects can be drastic as well. Nearly 90 percent of young people in the juvenile justice system report having experienced the death of at least one loved one. And although grief is a universal experience, it can contribute to lifelong racial inequality, as Black Americans experience the loss of loved ones far more frequently and earlier in life than white Americans, contributing to differences in mental and physical health outcomes.

“Grief should be investigated the same way we examine other public health indicators like obesity, smoking and drinking,” said Dr. Toni Miles, a professor of epidemiology and biostatistics at the College of Public Health at the University of Georgia.

After conducting a statewide health survey three years ago, Dr. Miles discovered that 45 percent of Georgia residents over 18 indicated they were newly bereaved. The findings suggested that grief was far more prevalent than the other three risk factors, she said.

Viewing grief as a threat to overall health could pave the way for prevention efforts — including financial assistance — that help individuals navigate life-altering changes, such as shifts in family income and housing. “We need systemic change to protect those who are left behind,” Dr. Miles told me.

A White House office of bereavement care is a necessary start, and could benefit families who have lost loved ones to other causes, such as gun violence. There are early signs that this administration could be the one to embrace bereavement care. Starting on Monday, people who paid for the funeral and burial expenses of someone who died from Covid-19 can apply for up to $9,000 in reimbursement, the Federal Emergency Management Agency recently announced.

Mr. Biden has spoken frequently from experience about the scars that grief can leave, and what it’s like to face the “empty chair around the kitchen table.” He has the chance to reduce the toll that loss takes on its victims and on all of us.

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Complicated Grief

— What It Is, How to Process It, and Why It’s Different Than Typical Grieving

Complicated grief is more difficult to cope with, experts say. Here’s why.

By Claire Gillespie

It’s fair to say that grief is a complicated state in all its forms. People deal with it in different ways, and there’s no “right” way to grieve. But one type of grief is actually called “complicated grief,” and it’s primarily seen in people who enjoyed a very rewarding and loving relationship with the deceased.

For these people, working through the sadness and loss may be even more difficult than grieving over someone they were not as close to, says Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California.

“Extended grieving that does not lessen in intensity and continues beyond six months in a manner that significantly impairs functioning, thinking, social engagement, and self-care is termed complicated grief,” Mendez tells Health.

Complicated grief vs. common grief: how to tell the difference

When someone experiences complicated grief, thoughts of the lost loved one are overwhelming, Mendez says.

“The natural process of grief allows for the loss to be understood and accepted,” she explains. “The grieving process grows less intense, the pain of the loss decreases (but may not extinguish), and the time spent grieving reduces such that it is not all-consuming.”

Mendez stresses that grief has no “normal” timeline. However, there is a natural process of working through the grief. As part of this process, the grieving person becomes less likely to react emotionally to reminders of their lost loved one, and sadness is gradually replaced by fond memories. “A healthy grief process results in mindful discovery of ways to use the memories of the relationship to promote continued psychological growth,” she says. “In grief, pain for the loss is accompanied by positive emotions about the loved one and includes experiences of humor, relief, warmth, pleasure in closeness to others, responsiveness to being consoled, and preservation of self-esteem.”

Complicated grief interferes with the positive coping processes that are part of normal grief, which can affect a person’s day-to-day functioning and their ability to care for themselves, Leela R. Magavi, MD, a psychiatrist and regional medical director for Community Psychiatry in California. “Normal or common grief can be illustrated by a working woman taking care of her children and finishing her work for the day, but simultaneously grieving under the ‘normal’ exterior and day-to-day activities,” Dr. Magavi says. “On the other hand, complicated grief may lead to withdrawal from social interactions and lack of interest in once loved activities, including exercise and wellness.”

Are some people more prone to complicated grief?

If you have a history of depression, you may be more likely to experience longer-term grief when you have to cope with loss, Mendez says. Grief is frequently a trigger for a bout of major depression, she adds.

People who struggle with trauma are also vulnerable to experiencing complicated grief. “When grief intensity doesn’t decrease, stress prevails, and the loss is experienced as a traumatic life event—one that ultimately triggers major depression that is more serious than you would typically experience with a normal grief response,” Mendez says.

Other people who may develop complicated grief are those who have lost loved ones to suicide, experience multiple losses, or had a problematic relationship with the person who died, Dr. Magavi adds.

Signs of complicated grief

Someone experiencing complicated grief may engage in avoidant behavior, use alcohol or substances to numb their pain, or show little interest in spending time with family members and friends.

Some people may experience psychotic symptoms (such as hearing voices) or experience suicidal thoughts due to the severity of their depressive or anxiety symptoms, Dr. Magavi says.

Other signs of complicated grief include anxiety about the meaning of the loss, fear that the pain will continue indefinitely, worry that happiness is lost and will never be realized, feeling cheated, blaming others for the loss, and feeling anger toward the person who died.

Survivor’s guilt—a common reaction to traumatic events and a symptom of post-traumatic stress disorder (PTSD)—may also be tied into complicated grief, Mendez says.

While it’s common for people with complicated grief to experience relentless longing, yearning, sorrow, and overwhelming deep sadness, sometimes there’s nothing but a sense of numbness.

Dealing with complicated grief

The best way to deal with complicated grief depends on each individual’s circumstances, and it may be best to work it out with the help of a therapist or psychiatrist. Mendez advises seeking treatment from a professional who specializes in issues of death, dying, and coping with depression that stems from unresolved grief issues.

“Therapy techniques that follow a cognitive behavioral approach can help someone struggling with complicated grief to change faulty cognitive processes that reinforce depression and negativity,” she says.

Dr. Magavi recommends scheduling your days in advance to keep yourself busy and divert your attention from your pain in a healthy way. “Composing a gratitude list could also prove beneficial,” she says. “If you have lost someone, you could celebrate their life by recounting memorable moments, looking through photographs, partaking in their favorite activity, or perhaps even writing a letter.”

While spending time with other loved ones can provide comfort and support, it’s also important to pinpoint your own emotions and thoughts in the midst of collective grief. Sometimes you need time alone to process your own emotional response, voice, and needs in order to reduce stress and gain clarity, Dr. Magavi says. If you’re an empath, you’ll naturally absorb other people’s emotions—which could lead to an emotional breakdown during a tumultuous time.

Small, daily efforts can make a big difference in your journey out of complicated grief. Dr. Magavi advises all her patients to simply name their feelings out loud, then describe what they are feeling, both emotionally and throughout their body. “They make a log of their emotions and identify any triggering factors (those that exacerbated their condition), as well as alleviating factors (those that helped them feel better),” she explains. “This activity helps us learn more about what we feel, why we feel, and what we can do to combat helplessness and take control during times of uncertainty.”

It’s also important to own your grief, Dr. Magavi advises. That means resisting the temptation to alter your grieving process to match other people’s (or society’s) expectations. “Embrace your feelings, which may shift on a day-to-day basis,” she says.

Whatever you do, remember the things that are always true about grief. First of all, it’s a normal response to loss. “It’s expected, and generally an adaptive response to loss from various perspectives,” Mendez says.” Also, grief is not a permanent state—even if it takes longer to process.

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