Comfort For Those Who Mourn

Adding to a child's shock and confusion at the death of a brother, sister or parent is the unavailability of other family members, who may be so shaken by grief that they are notable to cope with the normal responsibility of child care.

Parents should be aware of normal childhood responses to a death in the family, as well as danger signals. According to child and adolescent psychiatrists, it is normal during the weeks following the death for some children to feel immediate grief or persist in the belief that the family member is still alive. But long-term denial of the death or avoidance of grief is unhealthy and can later surface in more severe problems.

A child who is frightened about attending a funeral should not be forced to go; however, some service or observance is recommended, such as lighting a candle, saying a prayer or visiting a grave site.

Once children accept the death, they are likely to display their feelings of sadness on and off over a long period of time, and often at unexpected moments. The surviving relatives should spend as much time as possible with the child, making it clear that the child has permission to show his or her feelings openly or freely.

The person who has died was essential to the stability of the child's world, and anger is a natural reaction. The anger may be revealed in boisterous play, nightmares, irritability or a variety of other behaviors. Often the child will show anger towards the surviving family members.

After a parent dies, many children will act younger than they are. The child may temporarily become more infantile, demanding food, attention and cuddling, and talking "baby talk."

Younger children believe they are the cause of what happens around them. A young child may believe a parent, grandparent, brother or sister died because he or she had once "wished" the person dead. The child feels guilty because the wish "came true." Some danger signals to watch for:

• An extended period of depression in which the child loses interest in daily activities and events.
• Inability to sleep, loss of appetite, prolonged fear of being alone.
• Acting much younger for an extended period.
• Excessively imitating the dead person; repeated statements of wanting to join the dead person.
• Withdrawal from friends.
• Sharp drop in school performance or refusal to attend school.

These warning signs indicate that professional help may be needed. A child and adolescent psychiatrist can help the child accept the death and assist the survivors in helping the child through the mourning process.

The American Academy of Child and Adolescent Psychiatry

Background

The experience of grief wears many faces for children and families whose lives are challenged by change, turmoil, illness, death and/or the loss of hopes and dreams. Grief is a process not easily acknowledged in our society, particularly the grief of experiences other than death. Yet grief is often an integral part of most life changes and experiences. Families who can acknowledge their grief and learn healthy ways to express their pain can then free their emotional energies to focus on life and the challenges ahead. Grief that is not allowed a healthy release frequently finds expression in anger, child abuse and/or neglect, substance abuse, illness and sometimes by the sabotaging of another's efforts to help.

It is a commonplace in the bereavement literature that unresolved grief can lead to difficulties coping with any losses throughout life. Families in need of crisis and respite care all struggle with feelings of loss. For example, a mother who seeks out crisis nursery services may also be in the process of divorce which brings its own unique grief to the situation. The family of a child considered medically fragile who is in need of respite care may experience a sense of loss over not having a "healthy" or "perfect" child. Knowledge of the process of grief and how to help individuals and families cope with their loss experiences can be an invaluable asset to crisis nurseries and respite care programs and their service providers. By offering individuals and families opportunities to grieve their losses and acknowledging the hurt that accompanies those losses, we offer them tools and strategies to cope with the ongoing losses that are a part of everyone's life.

What is Grief?

Grief is one's own personal experience of loss. Mourning, on the other hand is "grief gone public." It is the outward sharing and expression of the pain. Sometimes it is helpful to make a distinction between the two in order to understand that there are some individuals in our society who have "permission" to grieve but cannot mourn. Society does not easily acknowledge the grief of a parent whose child is born with a disability, parents who experience a miscarriage, families where a loved one is diagnosed with a life threatening illness, families affected by AIDS, etc. Caregivers can be helpful to such families by labeling their experience as one of grief and normalizing their pain and emotions. It is important to remember that all losses need to be grieved in some way.

The Emotions of Grief

People experience the pain of grief with a variety of emotional responses which include shock ("it can't be true"), denial ("the tests were wrong"), anger ("why did she get AIDS and not someone else?"), guilt ("why did I smoke [or drink alcohol] during my pregnancy"), fear ("will my other children die, too?"), exhaustion, depression, confusion, and bargaining("if only we could have a miracle"). These are just a few of the myriad of emotions people in grief experience. It is also important to understand that people experience these emotions in a roller-coaster fashion: sometimes feeling up and hopeful, other days feeling deeply depressed, other days coasting along and feeling virtually no emotion. All of these emotions are a normal part of the grief and mourning process.

Healing Strategies for Helping Families Grieve

It is important when working with anyone who is grieving to do the following:

• Become aware of your own personal issues around grief. This means becoming aware of your own fears, attitudes and beliefs about grief. For example, if an individual were raised to believe that "We don't air our dirty laundry in public," then that individual may have difficulty helping a family who needs to vent and share their pain openly and/or with great emotion.
  
• Acknowledge the family's grief. Label their experience as one of grief. Let them know they have a right to have their feelings.
  
• Be there. One's presence can be the greatest gift given to a grieving individual. Sometimes holding someone's hand, offering a hug, or just acknowledging, "This must be so hard for you," can be enough to support someone in their grief process.
  
• Listen. Grieving people need to share their pain with another person who will not judge them or give them advice and suggestions. Listening to someone tell their story over and over can often be an invaluable gift to them in helping them sort through their feelings and release their pain.
  
• Offer "permission to grieve." Teach grieving families that it is important to express the emotions of grief, but that there are ways to express pain that are more healing than others. For example, an angry parent can learn to express their anger through physical activity such as yard work, tearing up old phone books, writing letters, or screaming in a pillow. The key is to help grieving people find constructive ways to release their feelings of grief rather than to take it out on others or themselves.
  
• Help families create a memory book. This might include photos, drawings, funny things someone said or did, etc. This is especially helpful to families who have experienced a death.
  
• Develop and encourage support groups. Support groups give families a chance to share their pain with others experiencing loss.
  
• Children love, therefore they grieve. Encourage children to participate in all of the above suggestions. By teaching children how to deal with the pain of loss early in life, we can teach them how to grieve the losses that are an inevitable part of their future lives, losses such as moving, divorce, the break-up of a relationship, or the death of a friend, loved one, or pet. Children can draw pictures or write letters to an ill sibling as a way to express their love and concern.
  
• Encourage families to write letters to someone who has died or is ill. Frequently they can express many unresolved emotions in letters that need never be sent. Writing a letter or note to a child who is in a crisis nursery may offer a parent a healing release of feelings of frustration and despair.
  
• Every grieving individual or family can teach us about what they need from us at this painful time in their lives. Grieving individuals can also remind us about what truly is important and meaningful in our own lives.

Caring for Self

It is very important when working with individuals who are in pain to take good care of oneself, physically and emotionally. There are times when care providers can become too involved or attached to trying to "fix" the problems their families face. This can deplete the psychological energy needed to work effectively with families who are experiencing grief. It is helpful to realize that each of us have gifts to share with others, such as the gifts of one's presence, understanding, love, and concern. Becoming overly attached to how others receive these gifts, sets us up for pain and disappointment. It is also important to nurture oneself on a regular basis by setting limits, treating oneself in special ways, and taking moments each day to renew, relax and appreciate life.

When To Be Concerned

There are times when the grief experience can be overwhelming and individuals and/or families may need more extensive counseling and support. Clues to more complicated grief and mourning include:

• lack of basic self-care
• unusual and alarming behavior patterns
• suicidal threats or attempts
• multiple losses that can be overwhelming
• severe withdrawal and/or depression
• substance abuse
• radical lifestyle changes

Summary

All losses need to be grieved: obvious losses as well as symbolic losses, such as the loss of hopes and dreams, or the loss of what never will be. Since families who seek out crisis nursery and respite care services are also families experiencing some kind of loss, knowledge of the grief process, and how to assist someone in the process, can enhance one's effectiveness and sensitivity to families in need.

About the author:

Kathleen Braza, M.A., is a bereavement consultant and national speaker on issues of grief and loss in adults and children.

1. Be open, honest, and gentle in describing the death. Only offer details that the children can absorb. Don't overload.
   
2. Have family powwows on a weekly basis or more often. Give each child a chance to talk.
   
3. Give each child the opportunity to participate in devising meaningful family rituals.
   
4. Check with each child to see if he or she is feeling guilt. Offer reassurance.
   
5. Don't be afraid to let your child see you cry. They need to know that crying is a natural response.
   
6. Be there for your children. They will need your affection and security now more than ever.

Bodies of all human beings (and animals alike) react to stress in basically the same manner. In 1944 Hans Selye a neurophysiologist formulated the three phases of stress reactions but it is only recently that scientists can identify with considerable accuracy what actually takes place. According to Selye the reaction to stress happens in three phases but for our purpose we will only discuss phase one.

The first phase or the "alarm reaction" occurs immediately on contact with the stressor (grief at the death of our child). At the death the brain "translates" the stress of grief into a chemical reaction in the body. The pituitary gland located at the base of the brain is stimulated to produce a hormone called adrenocorticotrophin hormone (ACTH). This reaction is a "protective" one and in essence makes the body ready to do battle. The ACTH (from the pituitary gland) then travels to the adrenal gland, a gland at the top of the kidneys, which causes a chemical reaction which ultimately produces cortisone. As the cortisone level increases it causes the production of ACTH to level off. This circle of the building up of one chemical that stimulates the production of another chemical that "turns off " the original one is known as "biofeedback.".

What happens in the case of grief where the stress continues for many months' The biofeedback does not operate as it should. Because the stress is continuing, the production of ACTH is continuing thus causing the adrenal gland to produce more and more cortisone. The result is an abnormally high level of cortisone circulating in the blood sometimes exceeding ten to twenty times the normal levels.)

A high level of cortisone is one of the things that causes our immune system (the system that normally tights off disease carrying bacteria fungi and viruses) to falter. The high level of cortisone affects yet another gland the thalamus which manufactures the white cells of our blood. With the thalamus not functioning properly It cannot produce white cells that are effective. Those white cells normally locate and phagocytize (eat up) the invading germs. viral particles or even pre-cancerous cells. Thus with the white cells unable to function properly the individual is 100% more susceptible to the most common germs.

Of course this is an over simplified description of the chemistry of stress but knowing that there is a legitimate reason for susceptibility to illness during grief encourages us to take preventive measures. Knowledge that changes in eating habits; problems with sleeping: restlessness; lack of physical energy; and various other manifestations, are a normal part of the grieving process will lessen the stress to some extent. Another way to lessen the stress and probably the most helpful is to acknowledge and appropriately express the emotions that we feel during grief. These measures can considerably decrease the potential for illness to develop because it displaces and releases the tension brought on by the stress of grief. And certainly good nutrition exercise and proper rest are essential preventive measures.

Another point to consider too is that the stress of grief is rarefy the only stress we are experiencing at the time of our child's death. Problems in our marriage or with our surviving children are only two examples of the other stresses that may be added to the stress of grief. Put a number of stresses together and our bodies will surely suffer.

We must be very aware that our child's death and the resultant grief is a legitimate reason for physical illness. We must do whatever we can to lessen our susceptibility. Heading directly into our grief and allowing ourselves to face our painful emotions is the most helpful thing we can do. Talking about our child and the circumstances of the death crying when we need to and talking with someone who will listen non-judgmentally to our anger and guilt is the only way to successfully resolve our grief—and ultimately resolve the stress that is caused by the grief.

The majority of bereaved parents experience some kind of physical illness in the first four to six months after the death of their child. For most the illness can be directly tied into the extreme stress of their child's death. I know it is hard to be concerned about yourself physically when you hurt so badly emotionally. but remember you will not always be in this emotional pain. Remember too if you have damaged your body in the early months of grief you run the risk of never completely recovering from the physical illness—and recovery for bereaved parents means recovery in body as well as mind.

Even though no one can take away your pain or struggle, there are things to do that will make the holidays less stressful and more enjoyable. One of the most difficult aspects of traumatic change is loss of control which leads to feelings of instability and insecurity. By implementing the following, you can begin to regain control and take some very positive steps toward loss recovery.

Plan

Don't play ostrich and let the holidays ambush you. Divide tasks into essential and non-essential. Shop by catalog or when the stores are less crowded. Change the routine or location. Start a new tradition. And, consult with immediate family members so all voices are heard.

Let Your Needs be Known

If you need help in preparation of a meal, ask. If you have some bittersweet times and need a shoulder to lean on, ask. If you want to talk about your loved one or the difficulty of this holiday, ask. Your family and friends are not mind-readers.

Develop One or More Coping Techniques

There will be rough times and days. Decide on what your stress reducer will be - hot baths, long walks, deep breathing exercises, calling a friend, etc.

Watch Your Physical Health

Make sure you get extra rest and eat well. Overdoing (or dancing as fast as you can) is often a reaction to grief which can lead to total physical and mental exhaustion if carried to an extreme. You have enough to deal with; be kind to yourself and those that have to interact with you.

Resolve to Use Your Learning to Help Someone Else

Although you may have been through the most difficult year of your life, you have also grown in compassion and understanding for others. By using that knowledge to help someone else, you give meaning to your loss.

TLC Group grants anyone the right to use this information without compensation so long as the copy is not used for profit or as training materials in a profit making activity such as workshops, lectures, and seminars, and so long as this paragraph is retained in its entirety.

Rules of Grief Etiquette

by Joan Rudnicki
Evanston, Illinois

I am not a grief professional; I am a bereaved person, and I count myself the friend of scores of bereaved people. Most of these people have lost children, but some have lost spouses, parents or dear friends or other relatives.

In the four years since Ellen died, I have attended more than one hundred grief support group meetings, so I am confident that I speak for many bereaved people when I offer what I call the "Rules of Etiquette to Help Those in Grief." If you are like I was before my daughter died, you probably are familiar with some, but not all, of these "rules."

Before my daughter died, I wasn't sure how to help people who had suffered a loss. From somewhere - probably my mom I thought that writing a condolence letter was a good idea, so sometimes I did that. But if I couldn't think of the right words, I didn't write the letter at all. I didn't always avoid bereaved people. But if I thought they didn't see me (say, at the grocery store), I did avoid them. Usually I was relieved if I didn't have to interact with them too much until enough time had passed and it looked like they were "over it.,'

In my heart, I knew I wasn't helping them much. But on the other hand, I was sure I wasn't hurting them. I knew I never said the wrong thing, because I used our conversations to distract them from their grief. I never spoke about the person who died - after all, what would I do if the bereaved person started to cry? So I chatted about the weather, or redecorating the house or where we went on vacation, etc.

When Ellen died, I learned the hard way that even with the best intentions this way of dealing with bereaved people is unsupportive -perhaps even hurtful. Unless a person who is trying to be comforting has experienced a similar loss themselves, they generally need to be told what to do to give the help that is needed. Our culture often does not prepare us to interact in a supportive way with those who are struggling to cope with the death of a loved one. Therefore, I would like to share the following "rules of grief etiquette."

Rule #1:
Don’t be afraid to talk about the person who died. Have the courage to say the deceased person’s name.

Do this whether the death occurred ten days, ten months or ten years ago. People die, but our love never dies. Let me say it again, love never dies. That is what grief and mourning are all about. We have to find constructive ways to deal with all of that love for someone who is no longer here to receive it. I love Ellen today, four years after her death, as much as the day she was born. I fell in love with her that day and my love for her will never die.

If you knew the person who died, please share your memories. If you think a father would have loved to have seen his daughter make that great soccer play, tell his widow. If you didn't know the person who died, ask about him or her. What was his favorite color; what did she like to do on a beautiful, sunny fall afternoon?

If you don't talk about the person who died, it is as if he or she never lived at all, and that is even worse than the death. A bereaved father I know told me that when his family and friends refuse to talk about his absent son, it is as if his beloved child had been killed all over again.

A caveat to this rule is to ask the bereaved person if this is a good time to recount a memory. You might say, "You know, I just remembered something about (use the name of the loved one)." Or, "I would like to ask you something about your (wife! husband! dad! mom! child! sibling ...). Is this a good time for you to hear it?" If the answer is no, stop there. But ask them again a few days or weeks later. At some point, the bereaved persons will be not only ready, but very grateful for your gift of remembrance. Nothing brings me more joy than hearing a memory someone shares about Ellen.

Another caveat: When you talk about the person who died, your worst fears might come true and the bereaved person might cry, but those tears are good and very healing. You can look at those tears in a positive light. I once came across a list of about ten milestones for a bereaved person that lets that person know that he or she is making progress on the journey of grief. All of those milestones began with the phrase: You know you're feeling better when ..." One of the milestones is, "You know you're feeling better when you can say your loved one's name or tell a story about your loved one and not cry.

This milestone does not happen magically at some point in time. We no longer cry when we hear something that used to make us cry because we have finally told our story enough to take the raw, stinging pain out of it. How many times each of us has to tell the story before we can do it without crying is unique for each one. Some bereaved people seldom cry when talking about the person who died; some cry every time for years.

Rule #2:
Saying nothing to a bereaved person about his or her loss is wrong. Saying the "wrong thing" sincerely is actually better than saying nothing at all.

Say, "I'm sorry," or "I wish you didn't have to feel so much pain," or "I don't know what to say, but I really care."--you feel as if you've already said the wrong thing, acknowledge it, but don't change the subject to cover it up.

Rule #3:
Listen and do not give advice.

Allow the survivor to talk. Say, "I don't know what your loss is like, but if you want to tell me about it, I would like to listen." If the bereaved person doesn't want to talk, wait and ask again another day. Keep making it clear that you want to listen. Ask again and again even years later. Because love never dies, the pain from the loss never totally disappears. The deep, sharp pain of new grief does change. It becomes less intense, less overwhelming. With adequate support, the bereaved person will be able to manage the pain instead of being at the mercy of it.

Rule #4:
Remember significant days.

Some potentially difficult times are holidays, the change of seasons, the absent one's birthday, wedding anniversaries and, of course, the anniversary of the day the person died. Don't ignore these special and significant times. If you know the survivor(s) well, ask how you can help them on those days. If you don't know them well, send a card and/or write a note telling them you are thinking of them, as well as of the person who died. It is always appropriate to write down a memory and give it to the family. You don't have to wait for a holiday to do so.

Also, remind the family of memories they have shared with you. Many bereaved people are fearful that their memories will fade away, so writing them down is a marvelous gift. You could use a holiday as an occasion to send any family pictures of the loved one that you might have. Do something in memory of the deceased (such as donating money or time to charity, buying a book on a subject they care about and donating it to the library, or planting a tree or garden) and tell the family about it. Let the family know that their loved one has a place in your life, too, and that you will never forget them or their loved one.

Rule #5:
Include bereaved people in invitations.

If you always invited them before, keep doing it. In your invitation, make it clear that you are aware that it might be hard for them to accept. Ask if you can do anything to make it easier for them. Ask if lighting a candle at a dinner party to represent the beloved person would be comforting.

Reassure the bereaved that you will not be hurt if they decline, but don't pre-decide for them that an occasion would be too difficult for them. Let them decide for themselves. If they decline, respect their decision, but don't stop inviting them. What is too difficult to do at two months might become do-able at eight months.

Rule #6:
Apply all of the above rules to anyone who had ever had a loss, no matter how long ago. It is never too late to start applying these rules.

Remember that love never dies, and the residual pain will never totally disappear. Last spring, I was at a PTA meeting where some moms were casually chatting about how difficult it was to schedule parent-teacher conferences when you have children at two schools. No one there seemed aware of the fact that I would love to have had their troubles. I was sad, angry and totally distanced from everyone in the room. It isn't that I didn't want them to talk about their children I just wanted to tell them, "If you do think of my loss, don't change the subject or ignore me. Acknowledge that the conversation made you think of Ellen, and you were wondering if I was thinking of her, too. Acknowledging my pain always causes it to melt away.

I do not believe that those who knew about Al's death did not worry about me and my family. It is likely that many were concerned. But I know that most of my friends are young, and have not yet had a close family member die. Death is scary or unreal, and few can envision themselves in the position I have been in twice. In a word, they are ignorant about my feelings and how to react to them.

A few of the braver approached me with hearty, superficial greetings that suggested my absence but not its cause: "Well hello, nice to see you back" or "So school's about to start, are you ready?" This was, for all its well meaning, very painful for me. I felt these people were using trivialities as a way of saying, "These things are more important than his death, and I'm more concerned about today's weather than how terrible you feel." With uneasy smiles on their faces, these people made me feel like a fool.

To a few, I said, "Perhaps you didn't know my brother died." The response was a muffled, "Oh, yes... I'm sorry." I stopped volunteering this information: it was awful to realize that these people, through all the banality, knew about Albert, and said nothing. Some people undoubtedly kept silent in the hopes that I would approach them to talk and they could then be duly supportive. This was a gross error of judgment. I needed to have friends voluntarily open their hearts in sympathy, as I was feeling vulnerable and afraid that those I turned to might turn me away. To me, the silence said, "Leave me alone, I don't care."

Still others made efforts to engage me in conversation, as long as I was able to be cheerful and not talk about Albert. To these people, my casual comment like, "Oh, I remember when Albert and I visited that person" was nervously ignored and met by an embarrassed silence. I needed to be able to remember my brother reflectively, without self-consciousness or shame. And even close friends could not understand that waves of grief, anger and depression affected me in ways I myself could not understand. How I needed their patience and support, their faith that I was angry at Death, and not at them.

My grief is now settling into the long depression that is a necessary step to healing. But every week, people on campus - maybe your friend or roommate - also face the unthinkable tragedy in a place where youth can lead people to feel immortal. These people need your support, and it's not hard to give it to them. If someone you know, whether closely or just vaguely, is bereaved, please don't be shy or afraid. Take the initiative, walk up, look into his or her eyes and say, "I am so sorry to hear about the death." (Only one person did this to me. Though I was not particularly close to him, his generosity moved me to tears.)

You need not give your philosophy on tragedy in life or your favorite remedy for depression. The bereaved person does not expect or want this. And if you consider yourself to be a close friend of the bereaved person, now is your chance to prove it. Listening - not avoiding the bereaved's sadness or being afraid to have the friend cry to you - is essential. If your friend does cry, consider yourself lucky that he or she is comfortable enough to share these deep emotions with you.

And don't try to stop the tears - they are also a step to healing and must flow freely. If you feel anger or hostility directed at you, take comfort that anger and grief are interconnected. The friend is not angry at you, it is simply his desperate attempt to justify or focus the waves of anger and desolation that surge uncontrollably through him.

If the bereaved are surrounded by people who care, the grieving process is made less bitter and devastating. Yet caring and concern for your friend is meaningless unless you directly tell her that you do care. I understand that Dad and Albert had no intention of abandoning me, that they left me through no power of their own. The intentions of my silent friends are much less clear. Remember this: Just say, "I heard, and I'm sorry."

Cendra (ken'dra) Lynn, Ph.D.
Rivendell Resources griefnet@rivendell.org
PO Box 3272 griefnet@ic.net
Ann Arbor, MI, 48106-3272 313 / 761-1960
Grace happens

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