Good grief?

Is there a right way to grieve the loss of a loved one? The answer, I believe, is NO, but some ways seem less healthy than others.  For example, grieving in isolation may deny a person much needed social support.  Also, rigidly expecting certain “stages” to occur, or time-lines to be followed, can lead to crippling disappointment and guilt feelings.  For a good update on this topic, see “Good Grief, is there a better way to be bereaved?” in The New Yorker (here).  Also, you may want to check out my earlier posting on this topic (here).

Coping with loss

A close family member is dying. She is 87 years old, has inoperable cancer, is in hospice care at home, and is fully alert and aware. She made the decision to reject any active treatment that would prolong her life (such as IV fluids, transfusions) and has bravely provided her many friends and family members the opportunity to tell her “Goodbye” and whatever else is on their minds. The fist thing she said to me when I visited her a few weeks ago was, “I’ve accepted it; I don’t like it, but I have no choice.” Her accepting attitude, and calm and upbeat demeanor, has allowed me and many others to talk openly with her about her life, her death, and things we have put off saying.  Mostly, the conversations have been completely ordinary, including the usual amount of laughter and humor. Many tears have been shed, but I think all would agree that she has provided us with a rare and valuable experience.

The recent death of Randy Pausch (author of The Last Lecture) has sparked interest in talking about life and dreams with someone who is dying.  Here is a talk (10 minutes) he gave shortly before his death. This kind of openness is a welcome change from the days when terminal illness and death were taboo subjects. When my grandmother died of cancer 40 years ago, I remember how the family never mentioned cancer or death, and all of the conversations with my grandmother were stilted and superficial, because we didn’t want to “upset” her. I was a medical student at the time and begged my parents and aunts to talk openly with her, but they refused.

All of us, especially if we live long enough, experience loss — of friends, family, pets, dreams, situations, things. The loss may be from death, but may be from some other form of separation or change. It is my belief that how we cope with these losses determines to a great extent how we cope with life. I also believe that our grieving these losses is cumulative, and that how we “resolve” each one affects how we cope with the following ones. The overused metaphor that occurs to me is an onion, with its concentric layers.

There are many dimensions to coping with loss, and a huge variation within us and between us in how well each loss gets resolved before we experience the next one. Some of us are lucky, having fewer losses, or at least having them spaced out in manageable portions. Others are extremely unlucky, having major losses when we are least prepared, or having multiple losses at one time.

Here are some of the factors which determine the extent to which a loss gets “resolved:”

• We grieve the loss and, depending on the circumstances and culture, go through a period of formal or informal mourning.
• We acknowledge and think about our ambivalence about the person or thing which we lost. The more conflicted the relationship, and the more ambivalent we are towards the lost person or object, the harder it may be to get resolution. This may require years of introspective work and even the help of a therapist.
• We free ourselves from guilt and self-reproach surrounding the lost person. This, too, may require much effort and the help of a therapist.
• We forgive our self (and, if possible, the lost one).
• We retain a positive image of the lost person or at least of the lessons learned from our exposure to the person and how they were lost. Recent research shows that this is a double-edged sword; some people cannot let go of their attachment to the lost person enough to move on with their lives.
• For some, it helps to have faith in an afterlife, or a “better place” where we might even reunite with the lost person in the future (although, with some losses, we may wish to never see the person again).
• The most important “rule” for coping with loss is that there are no set rules or patterns and that each person and each loss is unique. For example, you may or may not feel like crying, and it does no good to berate yourself for crying too much or too little.
• In many situations involving loss there is an opportunity for anticipatory grieving, as there is in the personal example I opened this post with. When we have time and opportunity to cope with loss before the person actually leaves, we may do a lot of the “work” of grieving in advance.
• A loss may trigger, or activate, unresolved feelings of grief from one or more previous losses. This provides a challenge, but also an opportunity to “work through” psychological issues. Even if an earlier loss was appropriately grieved and resolved at the time, as we age and develop psychologically the earlier loss may acquire new meaning and significance, so re-grieving it is not a sign of illness or weakness.
• We experience loss and grief in conjunction with others (family, friends, co-workers, etc.) so there is a communal dimension to our grief. How one person in a connected group grieves affects the grief process of the others. Spouses, for example, may grieve the loss of a child in different ways and that can lead to marital stress. Siblings may grieve differently when they lose a parent, and should be aware that old rivalries and jealousies may get reactivated. Also, having emotional and material support from other people makes a huge difference in our own grieving and can be life-saving.
• Times of loss and grieving can increase any tendencies we have to “indulge” in unhealthy behaviors (e.g., overeating or over drinking). We may have to be especially careful to limit the long-term damage that would result.
• Ultimately, accepting the loss(es) and moving on with your life is considered a healthy outcome, though in many circumstances one never fully “gets over it.”

I have experienced a lot of personal loss in my 65 years (grandparents, parents, parents-in-law, sister, brothers-in-law, nephew, spouse, friends, pets, etc.) and for me there has been a learning process. I grieve differently now than I did when I was in my 20s, 30s, 40s and 50s. I am not sure I am any better at finding resolution, but I know what to expect of myself, and that is somewhat comforting.