07 October 2011

The Early Phases of Grief: the First Days and Weeks

“Early Phases of Grief: The First Days and Weeks” by Tim Heller, MSW/LCSW



When my wife, Sandra, died 4 years ago, I was with her in our home with DCH Hospice. I told my young adult daughters and my wife’s family and then went about notifying extended family that lived away. Having worked in hospice for over 17 years I thought would have a pretty good handle on this process. I had myself convinced I was prepared for her death. After all, we knew it was going to happen for more than 3 years. However, there is something different about the death of a loved one, when it actually occurs. I soon discovered I needed to actually experience this death and the bereavement phases that followed, before I knew what it was really about. This is just one person’s experience into and now through the journey called grief.


I would have to say, I still found it difficult at times to actually follow through with the many tasks associated with her death as well as some of the tasks of everyday living. In speaking from my personal, as well as professional experience, it is so helpful to have at least 1 non-judgmental person who you can call to talk to and who will be present for whatever needs to be done. I remember Wendell driving me to the funeral home to implement the plans Sandra had made months earlier. Getting through those early days and weeks would have been more difficult without the help and support of our close friends Wendell and Roxanne. While I did most of the contacts myself, I was able to and did call them for support and was reassured that we would survive and live through it. They were at the house to help in whatever way I needed.


Getting through the first days and first weeks after the death of your loved one can be difficult for most people. You find yourself dealing with situations and people you never may never had to interact with before the death. You may think it is all a bad dream and soon realize it’s not. On day 3 the words, “THIS IS YOUR LIFE” somehow resonated almost like an audio voice when I woke up the morning after the visitation. You may just want it all to stop! I know I did. Some people report feeling like they are “…on a merry-go-round and can’t get off.” I never did like merry-go-rounds.


After hearing the news of the death of your loved one you may be in a state of shock. It is like the fog coming in from the bay and enveloping your space. The fog is filled with confusion and feelings of numbness and unreality, i.e., “This can’t be happening to me.” It is not uncommon to experience problems with organization, memory, processing information, to name a few.


During these initial days and weeks as you venture through your initial unknown journey of grief, it is essential to let at least one, clearing thinking friend or family member walk with you. You do not have to “be strong” and fight this out by yourself. No one is meant to be totally independent. As human beings we are “inter-dependent” on each other and on a higher power however you define it. Even a hermit on an island still needs others to bring him supplies.


In the United States the normal mourning process, within the workplace, becomes counter-cultural where the expectation exists for instant results, rapid resolution of any problem and “zero tolerance” policy toward emotional expressions of grief. There is no specified period of time for the grief/ mourning process. It is not unusual to take 2-3 years to resolve the death of a loved one. It is important to remember grief resolution is unique to each individual and to his or her set of life circumstances.


The grief and mourning process does not come with instructions. Nor is it a series of well defined “stages” or “steps” you graduate through after mastering the previous one. How you grieve and mourn is up to you. Everyone eventually discovers what works for him or her. In the language of grief support/ grief counseling, technically the word “grief” is the result of having experienced the death of a loved one. The word “mourning” is how you go about publicly acknowledging and working through the death. Grief without the mourning process can be destructive and is not a healthy way of becoming reconciled with the death of your loved one. The mourning process is something each grieving individual needs to experience so they can heal over time and become reconciled with their loss. Usually it is not good to think of grieving as in terms of “recovery”. You recover from a broken arm after surgery and you arm is about the same after a period of time. When a close loved one dies your life is forever changed, you become reconciled with the death so you can eventually move on in your “new normal.”


Guidelines for getting through the initial days:


1. Be aware you will be shaken. No matter how well you feel prepared to handle death, it is hard to deal with it when it actually happens. Death will shake the very core of your belief structure. If you are aware that this might happen, it will help you not to be so afraid when it happens.


2. Take care of yourself physically. If you have a health problem yourself, you may not think to take care of yourself. If you have been under a doctor's care recently, or have a history of heart problems, stroke, high blood pressure or any other serious health #2 continued problems, it is vital to contact your physician immediately. You have just experienced a traumatic shock. That will affect your body. You may forget to take your medication or it may need to be adjusted. Let your physician know what you are going through so he or she can be of help if needed.


3. Remember to eat. As, I mentioned above, you might not think to eat. You will need your energy for the days ahead, yet food may have no interest for you. Be careful to eat regularly. Don't allow long periods of time to elapse without your eating, and be alert to consume things with nutritional value. Pie may be the only thing that tastes good, but when the sugar boost is gone, you will crash physically and emotionally.


4. Avoid mind-altering substances. If you can, avoid caffeine at this time. This will only contribute to more difficulty sleeping and increased anxiety and agitation. Perhaps try herbal tea instead. Also, avoid alcohol. Alcohol will numb the pain but create many problems later. There are many people who allow themselves to drink initially to numb the grief. It helps, so they continue. Later, they not only still have the grief with which to deal but they also have a problem with alcohol.


5. Loss in concentration. Be aware that your concentration will be affected in those early days and perhaps even for months. If you must make decisions, take a trusted friend or advisor with you. A second pair of ears is always good. Things are thrown at you so quickly that later you may not even realize what you agreed to.


6. Don't drive unless you have no other choice. If you must drive, be very careful. In fact, if at all possible in those early days, have someone else drive you where you need to go. Since your mind will be focused on other things, it is important to keep yourself and others safe.


7. Talk about the person who has died. It is important as well as normal to talk about what has happened. You may find yourself telling the story over and over, but that's okay. Let yourself remember past good times and tell stories about the person who died. Talking is a vital part of the grief process. If you can, talk with others who have been through the process. However, if someone tries to push you into doing or feeling a certain way, it is important to say no. This is a time of great stress for you and not a time to allow anyone to tell you how to react. If you feel there is something you will have trouble answering, ask a family member to stand close to you to help out. I had a friend who felt that if one more person said that her husband wasn't suffering anymore, she felt she would scream. So, at the funeral her brother handled most of the comments made by people, and she was able to concentrate on receiving hugs. For her that worked well.


8. Allow yourself some time alone. At some point before the funeral, take at least an hour to be alone. During this time, say out loud the name of the person and that he or she is dead. Use the word, "dead"; you need to hear yourself say it. There will be emotions connected with this but don't be afraid of them. It is important to hear yourself actually say the words. Later you may change the terminology to transitioned or #8 continued whatever is comfortable for you. But right now you are coming to grips with the concept of death.


9. Sleep may be a problem. Try to go to sleep close to your normal bedtime. You may not feel like sleeping, but keeping your routine is critical. If you stay with your same nightly ritual, whatever that may be, normal sleep will return more easily. Avoid tranquilizing yourself with medication unless allowed by your doctor, and stay away from drugs and alcohol. It is normal to have difficulty sleeping in the beginning, and we will talk more in other articles about how to address this problem over the long run. Right now, just try to stick with a routine.


10. Fatigue will be a problem and, at first, you may not want to be alone. Fatigue is a very common complaint and it may last several weeks. In the initial days, you may want someone to stay with you for that reason as well as others. That person could make sure that you have a hot meal and run interference for you. However, it needs to be someone who will respect your need to talk and your need to be alone and contemplate.


11. Allow others to help. Whether it is your church, friends at work, synagogue, members of a lodge, the military if that is appropriate, a club or any other group outside your family, let them help, They may not know what to say but they will be willing to help with tasks.


12. Honor your emotions. Your emotions will feel like they are on a roller coaster. You will have many feelings. You might even feel anger. It may be anger at the world or anger at God. These are normal emotions. Also, for a long time you will be asking, "Why did this happen?" Eventually, the question will change to "How can I work through these feelings of grief?" However, for now, it is important to get through those early days. Again, there is no right or wrong way.


Life is very fragile. We tend to live it as if nothing bad will ever happen. When it does, we are not prepared for the emotions we will have. Those who have been through a major loss assure us that slowly but surely the good days eventually begin to outnumber the bad. Right now it won't seem that way. So, just file this insight away for the future. You are in the first few days, and nothing will seem like it will ever be right again. This is grief, and the only way to heal is to go through the grief. However, others who have walked the path ahead of you can help ease your journey through this grief.


References Deits, Bob. Life after Loss. Tucson, AZ: Fisher Books, 1988. Fitzgerald, Helen. The Mourning Handbook. New York: Simon and Schuster Inc., 1994. Lewis, C.S. A Grief Observed. San Francisco: Harper San Francisco, 1961. Levine, Stephen and Ondrea. Who Dies? New York: Anchor Books, 1982. Marshall, Fiona. Losing a Parent. Tucson, AZ: Fisher Books, 1993.


Cautionary Note: This article is not meant for self diagnosis and should not be seen as a substitute for professional grief support/counseling. This is just one person’s experience into and now through the journey called grief. All grief groups and limited grief counseling are available to the public and provided at no charge as a community service. If you want help with grief and/or you want information about our grief groups or grief counseling, please call: Dearborn Co. Hospital Hospice, Tim Heller, MSW/LCSW 800-676-5428. 9.26.2011

1 comments:

David Paine said...

Thankyou for taking the time to share your professional and very personal experience. Having lost my wife only 6 months ago, after 40 years together, I find much of what you say to be very wise advice and quite helpful in understanding this season of my life. In addition, though, I've found it personally helpful to journal my thoughts and experiences each day to help me process my journey and also in some small way to help others. I share this at http://allestreedave.blogspot.com/

The Road Less Traveled....

The Road Less Traveled....
the Necessary Road through Grief

Popular Posts

Article: "Fixing a Hole/Grieving With Other Men" by Tom Golden,LCSW



There I was dripping in sweat, the kind that rolls down the side of your head and innocently into your ear. The still summer evening was allowing me to hear my own breath and my own thoughts. I was determined to make this a great hole and I kept digging--probably farther than I really needed to, but on I went. What seemed like a great deal of sweat was swallowed effortlessly by the hole, absorbed as a matter of course by the dirt in the bottom. The hole and the dirt were equally unmoved by the tears I shed.

This hole was to be the home of a tree that was being given as a memorial to my father who died last November. I had known the hole needed digging, but had put off the task until now--now being being just about the last possible moment it could be dug. As I continued digging, I found myself flooded with memories of my father. My thoughts moved back and forth between recent events leading up to his death and childhood experiences. I remembered his engineering talents and nature and tried to dig the hole in a way that would please him.

As I dug the feelings flowed through me: the sadness of missing him, the gratefulness of having been his son, and the anger and frustration of my powerlessness. All of these feelings found their way into this hole. The act of digging became an avenue for the various thoughts and feelings to arise. Through the action I was opened to my own inner world.

I started wondering why I had put off this job, then realized that I hadn't and didn't want to do it. Actually digging the hole brought the death more into reality, and a part of me didn't want that. I've learned to accept this part that wants to deny things. Denial is not really such a bad thing, and it doesn't go away as quickly as some people seem to think. I've noticed it has a slow, zig-zag decay that can last a long time. In a way denial can be our friend, allowing us to slowly accept the reality at hand. I became aware of the battle going on between the denying part and the digging the hole part. As a friend of mine says, "We have wetware, not hardware."

The tree has since been planted in an emotional ritual attended by myself and the six men who donated the tree. It became an avenue for all of us to delve into our interiors and connect with a variety of issues from fathers to death. The activity of buying, digging, planting, and gathering together became a hub for a wide variety of spin-offs. As we stood around the tree we all had a chance to speak and to listen. Somehow having an activity made this process flow smoothly. It would have been much more difficult to simply sit in a circle and talk about our feelings. It was through the doing that we could connect.

The tree now stands in a park that is adjacent to my home. Not only was the activity surrounding the tree helpful, now the tree has moved from being an activity to being a place. Each time I come and go I see that tree sitting there being itself. When I see the tree I am reminded of my father, my grief, and the men who lovingly honored both my father and my pain.

I have found a wide variety of activities that, like planting the tree, help me in connecting to my inner spheres. Writing, gardening, and music are examples. All of these activities can take me into myself and my grief and joy. Another example is a ritual I learned about some time ago from the Cree Indians of northwest North America: the tree wounding ritual. The following story describes this simple ritual and its beauty.

When his brother died suddenly, Jaque was torn by sadness and anger. Following ancient custom, he went into the forest, selected a tree and, after uttering a prayer, stripped away a piece of the bark. Now the tree, like Jaque, had lost something whose loss caused deep pain. Many times over the following months he returned to visit the tree. As the seasons passed, the wound in the tree healed. So did the wound in Jaque's heart. With the tree as a visible reflection of his loss, Jaque was reminded that he, too, was healing. (Excerpted from "Different Paths Toward Healing,")

In this instance there is also an action and a place. Both action and place serve as "containers" or "hooks" for the inner state of the man. As the man performs the action or visits the place, he is afforded the opportunity to experience his pain, and as the above example points out, to have his healing reflected back to him. I have used this ritual a number of times and have found it extremely helpful. The trees I have chosen are mostly in my back yard and stand as reminders to me of my grief, pain, and healing.

Death professionals have long been confounded by the difference in men and women in visiting gravesites. The men tend to visit more often. The above ideas should give us a deeper understanding of why this takes place. Men tend towards linking their grief with a place, action, or thing. There are many examples: the man who wore his deceased daughter's ring as a remembrance of her, the man who carved a bust of his wife after her death, a man who built a pond in memory of his murdered brother, a man who wore his father's watch, and on and on. These activities are often quiet and unseen by most people. The casual observer might assume that the man is "not grieving," but that is many times not the case.

The use of activity as a means to connect with one's grief is not exclusive to men, women also find this approach helpful. The difference is that women have a strength in connecting their emotions to their words and then are inclined to "share" those words with the people in their life whom they love. This proclivity fits nicely with the keyword of "intimacy" that Deborah Tannen used to describe women in her book "You Just Don't Understand". According to Tannen a woman's world revolves around her intimacy and connection with others. We would expect that when a woman experiences the chaos of grief, a primary mode of healing will be connecting her pain with her intimacy to others. Tannen goes on to use the keyword of "independence" for men. When independence is your keyword, you are probably less likely to want to "share" your feelings with those around you. You will be more likely to seek out modes of healing that will be harmonious with your interest in maintaining independence. I know for myself, and for many men, the verbal connection is facilitated by linking it with some action, place, or thing. I am less inclined to simply "share" my feelings with those around me. I am grieving, but I do it in my own way, a way that is more quiet and less visible and harmonizes with my interest in independence. It is for this reason that it is unwise to judge a man's grief by how much he "shares" it with others. A man's pain cannot be judged by outer appearances or the abundance of tears.

It needs to be said that when we divide men and women into two distinct groups we are in dangerous territory. All people are unique in the ways they find to heal themselves. There are probably more individual differences in grief than there are gender differences, but the gender differences do exist and need to be honored.

These differences can often be clearly seen in a married couple who have experienced the death of a child. Frequently the man thinks the woman is "overdoing it" as she openly emotes and shares her feelings with those she loves. The woman, on the other hand, sometimes thinks the man "isn't grieving" due to his difference in chosen path toward healing. Both are immersed in the chaos of grief and have limited reserves to come to the aid of their partner. This is a tough situation.

This leads us to a number of possible topics. One is, what do you do for a grieving man? How can you be of help to a man in grief? Another might be to examine some of the healing rituals used in tribal cultures where the men and women work together, each with their own roles to play in a manner that heals both themselves and their partner and honors their differences in the process. If you have a preference for the next column let me know via email.



Tom Golden is a professional speaker, author, and psychotherapist whose area of specialization is healing from loss and trauma. You can find out more about Ton's private practice here. Tom gives workshops across the country and in Canada on many aspects of this topic. His workshops are known to be both entertaining and informative. Contact Tom at the addresses below (email or snail mail) for inquiries about speaking or training for your group. You can also order his book Swallowed by a Snake: The Gift of the Masculine Side of Healing on this site or through Amazon.com

Tom Golden LCSW
P.O. Box 83658
Gaithersburg, Maryland 20883
USA
301 670-1027

Article: "Stress and Grief" by Thomas Golden, LCSW

Stress and Grief

Tom Golden LCSW



Stress and Grief: Do you Fight or Befriend?

As I watched our local TV news the other day, I was saddened to see a brief clip about a little, seven-year-old boy who had been hit by a car and killed. The tragedy happened not far from the boys home. The news cameras focused on the bereaved mother, sitting in her living room, in tears and surrounded by other women who were consoling her. The next image was of the bereavedfather who was by himself, pacing next to the roadside near where the accident had happened. The news anchor explained that the father was trying to understand how this tragedy could have taken place.

This was not the first time I have seen this scenario. After a major loss the women often move towards a nurturing and intimate connection and the men move towards "doing" something. Why is this such a common scenario? Why would the women gather and nurture one another while the man engaged in some
sort of activity?

Shelley E. Taylor, lead researcher and UCLA psychologist, may help us understand these questions. Dr. Taylor has made the important observation that much of the previous research done on stress was done with male subjects. Women had been omitted from the studies due to the researchers' fears that the women's monthly hormonal cycles could skew the results. Those studied were almost all men, and this original research found that when stressed, the subjects were likely to do one of two things: either stand and fight, or to retreat. This became a well known and publicly accepted syndrome that was titled the "Fight or Flight" response.

Dr. Taylor has helped us see that this "fight or flight" syndrome we have heard so much about is true for men, but may not be true for women. Dr. Taylor conducted research on this question that included women and what do you think she found? She found that women, when stressed, rather than resorting to fight or flight do something entirely different, they "tend and befriend." By "tend and befriend" she means that under stress women will move to nurture those around them (tend) or will make social connections with those they feel safe (befriend).

"This difference in seeking social support during stressful periods is the principal way men and women differ in their response to stress, and it is one of the most basic differences in men's and women's behavior," Taylor said.

Dr. Taylor goes on to explain that there is a physiological component in these findings which seems to be centered around a hormone called oxytocin. "Oxytocin has been studied largely for its role in childbirth, but it is also secreted in both men and women as a response to stress," she said. "Animals and people with high levels of oxytocin are calmer, more relaxed, more social and less anxious. In several animal species, oxytocin leads to maternal behavior and to affiliation"

Oxytocin, sometimes called the "cuddle" hormone, has been found to be a "major facilitator of maternal behavior." Researchers are finding that woman's estrogen amplifies the effectiveness of the oxytocin while the man's testosterone hampers and limits the action of this "cuddle" hormone. This dramatically increases the difference in men and women following stress with men tending to fight or flight and women moving more towards the tend and befriend. We are just beginning to find that there are physical reasons for men and women to react differently to stress and to grief and oxytocin is a major component in facilitating these differences.

Is it nature or nurture? Of course it is both. Men and women get very different messages from our culture about how to act following a loss. Importantly, we are beginning to find that there are also significant physical differences.

This is an important finding on its own but it is especially important to help us understand the ways we choose to grieve following a painful loss. Dr. Taylor's research helps us to see that women will tend to seek out social contacts following a loss and find solace in being "tended." The men,
on the other hand, find themselves in the midst of "fight or flight" and this will obviously move them towards a stance of either running or fighting. "Fighting" moves men into a sphere where they take some action that helps them with the grief. "Flight" is a common reaction where men or women withdraw for a period of time. Pulling back into the cave is a common phrase that captures this potentially healthy maneuver.

Not all men rely solely on fight and flight and not all women rely solely on tend and befriend. We are all a mix of both. Each of us will use both these strategies. The point here is that men will more often seek out an active
mode to help them with their loss and women will more often seek out an interactive mode. Sometimes there may be women who choose the action oriented paths and sometimes there will be men who prefer the tend and
befriend responses. When we talk about these differences we want to keep in mind that we can't lump all men in one pile and all women in another. That just doesn't work. We are all unique in our path to deal with grief.

Let's think back to our opening story. The mother was surrounded by other women who supported her in this time of crisis. She was obviously being "tended" and "befriended." Her women friends stayed close to her and talked, stroked, and nurtured. All of this in harmony with the basic ideas of tend and befriend. The father, on the other hand, was out pacing near the street. Why? Could he have been trying to bring some understanding to this devastatingly stressful event by piecing together bits of data and watching
the traffic flow to give him some understanding about how this tragedy could have happened? Could it be that understanding the tragic event became his focus and his "fight" at that time?

Behaviors like this bereaved father's are often misunderstood and mislabeled as not really grieving. We are living in a culture that disdains grief. This makes grieving tough for men or women. The movement of men and women to an active path in dealing with their grief, like this fathers, has been termed the "Masculine side of Healing." In these columns we will be exploring many aspects of this masculine side of healing, not just the men but men, women and children.



Tom Golden is a professional speaker, author, and psychotherapist whose area of specialization is healing from loss and trauma. You can find out more about Ton's private practice here. Tom gives workshops across the country and in Canada on many aspects of this topic. His workshops are known to be both entertaining and informative. Contact Tom at the addresses below (email or snail mail) for inquiries about speaking or training for your group. You can also order his book Swallowed by a Snake: The Gift of the Masculine Side of Healing on this site or through Amazon.com

Tom Golden LCSW
P.O. Box 83658
Gaithersburg, Maryland 20883
USA
301 670-1027