Healthy Living

Grief: We've Got It All Wrong

11/18/2016 02:28pm ET | Updated November 22, 2016

It was snowing lightly when I heard the news. It was the kind of snow that melts as soon as it touches your clothing, and that forms brown slush on the ground, making the landscape look dirty and slimy rather than like a winter wonderland. I was fighting my way through the slush with two toddlers in a double stroller when I got the text message:

“Something bad happened at work. I have to stay late.”

A few minutes later, another one:

“I’m OK.”

I called my husband to see what had happened. That’s when he told me. His friend and co-worker had been in a car accident the night before. I was startled, and asked if our friend was OK. My husband’s choked back voice broke the news: “he died.”

******

I barely knew my husband’s friend. I had brief conversations with him at the gym and at company parties, but I knew very little about his personal life. Yet, news of his passing left a hole inside me that I had a very hard time dealing with.

I had a good cry in the car, and I was depressed for some time. Soon after we heard the news, I had a brief encounter with a friend. I looked at her, broke down crying, and went in for a hug. Her response to my grief: “Well, you didn’t know him that well, did you?”

As unhelpful and even harmful as that comment was, I don’t blame her. Her comment is simply a reflection of our attitude towards grief in North America. We don’t know what do with grief. We have strange ideas about how long it should last, who should grieve and how, and when it’s appropriate to share memories and even some tears together. We don’t know how to deal with grief. And we’re hurting the bereaved with our unhelpful attitudes.

North America has forgotten how grief works

After hearing the news about our friend, I had to deal with a double-whammy of pain: the grief I felt, and the guilt about feeling grief for someone I barely knew. Whereas I knew about support groups for the bereaved in my town, I felt inadequate reaching out to them. After all, I wasn’t related to the deceased, and wasn’t even that close with him. According to the belief system around me, I wasn’t allowed to grieve.

In addition to this odd invisible rule about who is allowed to grieve, there also seems to be an arbitrary time limit on grief in North America. We are so used to the busyness of our lives that “moving on” after a tragedy seems to be the natural and expected step. However, those who work with the bereaved know something that we as a culture have failed to grasp: grief has no time limit, and it is not a linear process.

Community support and counselling can help the bereaved

Zaneta Gileno understands that grief has no time limit. So much so, that the program she directs offers support for the bereaved for a long as they want that support. Tragedy Assistance Program for Survivors (TAPS) has been providing support to family and friends of America’s fallen military for 22 years. Some of their clients have received support since day 1, and have found a family that understands that grief comes in waves, and that those waves can come decades after the initial news of their loved one’s passing.

TAPS provides unlimited support because the organizers and health professionals within the program understand that whereas grief changes, it never completely goes away. People adjust to a new normal. They integrate the loss into their lives, rather than “move on.” The reality of grief for the bereaved is that sadness will come and go, and that it can come anytime – even years after the loss has taken place.

For people with loved ones in hospice care, preparing to say goodbye is difficult, but knowing that a loss is coming can help prepare them to embrace their grief. Some hospices, like Providence TrinityCare Hospice, provide organized community programs for the bereaved. These community programs are in addition to their state-mandated 13-month bereavement program for hospice patients’ families. The hospice fills a need for bereavement support in the community-at-large in parts of California. They too understand that grief is a process, but that it is not linear, and it does not follow a clear timeline.

When it’s more than just grief

Whereas it’s perfectly normal to feel sadness and grief in “waves,” even years after a loss, for some people, the grief will become paralyzing. At that point, the feelings of the bereaved have become more complicated than grief. Sadness, “waves” of grief, and remembering a loved one because of certain triggers are all perfectly normal responses to loss, no matter how long ago the loss took place. And whereas there is no time limit on grief, the bereaved will eventually integrate that loss into their lives and “adjust to a new normal,” as Gileno puts it. Returning to work and social activities when they are ready to do so is a step all bereaved persons will need to take.

This step can prove too painful for some. That is when psychiatric help may be needed. Not because they have waves of grief (this is normal), but because the waves have turned into an ocean, and it’s drowning the bereaved, who now can’t function in daily life.

Dr. Dion Metzger sees patients who need help adjusting to their new normal. Metzger counsels bereaved persons immediately after a loss, but she also sees patients whose loss occurred some time ago, and who have difficulty re-adjusting. She explains that the DSM (the Diagnostic and Statistical Manual of Mental Disorders) looks at grief of this kind as a major depressive episode, and it is treated the same way as depression.

Metzger explains that even for those who are able adjust to their new normal, grief is not something that really ends. One patient* who lost her mother 10 years ago feels like a part of her is missing. She’s “able to function, but the sense of loss is persistent,” says Dr. Metzger.

Don’t ignore people’s loss

After an immediate loss, most people say their condolences, say how sorry they are, overwhelm the bereaved with more food than they know what to do with, and ask what they can do to help. But after some time passes, we seem to forget people’s pain. And sometimes, we even tell them they’re feeling too much pain, or that they’ve been hurting for too long. Even when we’re not this blunt, we just avoid or ignore the topic, which can hurt the bereaved just as much.

Laura S. knows this well. After losing her twin girls at 19 weeks of pregnancy, she received amazing support from counsellors, friends, and family. A year and a half have passed, but the sense of loss is still there. She has had another child since then, and many things have happened, but she loves the children she lost, and she loves to talk about them. Yet, very few people ask her about the subject. She believes people avoid it because they’re afraid to bring her more pain, but she wants to talk about her girls: “It’s weird that we assume that you wouldn’t want to talk about a person you loved who isn’t here anymore,” she says.

Here’s how to talk to the bereaved

Many of us simply don’t know what to do after someone dies. We help the bereaved for a few weeks, attend ceremonies, and then move on with our lives – and expect the bereaved to do the same. We put memories of the deceased on the back burner and stifle memories, instead of sharing them with the surviving. But those who work with the bereaved say we’re doing it all wrong.

Here’s what we actually should be doing about grief: firstly, do away with expectations of what grief looks like, or of how long it should last. Many bereaved persons use the expression “grief comes in waves – sometimes when you’re least expecting it.” And it doesn’t matter how long ago the loss took place, because loss is permanent, and therefore, so is the empty space it leaves inside you. Once you’ve accepted that the sense of loss is permanent for the bereaved, make a commitment to help your loved ones through hard times.

Dr. Metzger says that anniversaries of the death or special dates (anniversaries for couples, birthdays of the deceased) can be particularly difficult, long after the initial loss. She advises friends and families to keep an eye on the calendar and offer to spend time with the bereaved – whether it’s to distract them with an activity, or to share memories and photographs – whatever the bereaved person wants. Just be there. “Sometimes, during these special dates, the feeling of loneliness can be so intense that just being present can be therapeutic for [the bereaved],” she says.

Kelie Anderson, Bereavement Coordinator for TrinityCare Hospice, advises friends and family of the bereaved to ask open-ended questions. She emphasizes the importance of allowing the bereaved to grieve and speak about their loved one in the way that’s most comfortable to them.

Barbara Roberts, Administrator of Providence TrinityCare Hospice, says that sharing happy memories of the loved one with the bereaved person can bring them joy: “In my personal experience, being reminded of not only just the sadness, but when somebody says ‘I remember this funny story’ or remembering or helping prompt those sort of shared, happy memories… bringing the memories forward that are positive too, but it’s [still] acknowledging that the person is gone.”

Resources to help you help the bereaved

After you’ve accepted the fact that our current expectations about grief are entirely inaccurate and even harmful to the bereaved, you may still be uncomfortable speaking with those who have suffered a loss – especially after some time has passed since their loved one’s death. The good news is that there are many resources to help you.

For family and friends of the bereaved who have lost someone in the military, Gileno recommends the book Healing Your Grieving Heart After a Military Death, by Bonnie Carroll and Alan Wolfelt. This book provides “100 practical ideas for family and friends” of the grieving person. Gileno also mentions that Alan Wolfelt and Bonnie Carroll have written several books about grief for different populations.

Providence Trinity Hospice provides a flyer entitled “What to Say… What Not to say,” a brief list of helpful and hurtful comments that people make to grieving persons. For example, you can say, “I’m here and I want to listen.” But saying “It all happened for the best” can cause the grieving person even more pain.

Local support groups for bereaved persons also often provide helpful flyers for those who would like to understand and become more compassionate towards a grieving person.

Make a commitment to embrace death as a part of life

We are uncomfortable with bereavement in North America because we are uncomfortable with death. But embracing death as a part of life and celebrating the life of the deceased helps us to honour their legacy and to keep it alive for many years to come.

Make a commitment today to hug someone who has lost a loved one and to ask them, “How are you doing?” or to share a happy memory of their loved one.

The bereaved will be comforted by your actions, and you’ll have contributed to a healthier view of grief in North America.

*details have been changed to protect patient’s identity.

Sources:

Kelie Anderson, Bereavement Coordinator and Barbara Roberts, Administrator, Providence Trinity Care Hospice

Zaneta Gileno, Director of Community Based Care, Tragedy Assistance Program for Survivors

Dr. Dion Metzger, psychiatrist and author, www.dionmetzgermd.com, www.themoderntrophywife.com