Thursday's Therapy - "The Death of Grief, the Birth of Mental Illness" ~Joanne Cacciatore, PhD, LMSW, FT

Thursday's Therapy

"The Death of Grief, the Birth of Mental Illness"

~Joanne Cacciatore, PhD, LMSW, FT

Grief is not disease.

MONDAY, DECEMBER 3, 2012

The Death of Grief, the Birth of Mental Illness

For immediate release December 4, 2012

Dear MISS Foundation families, providers, and supporters,

We are saddened and disappointed by the recent announcement that the DSM-5 task force has finalized the decision to eliminate the bereavement exclusion from the Major Depressive Disorder diagnosis in the upcoming edition of the manual. This move will allow clinicians, including counselors, general physicians, social workers, and psychiatrists, to diagnose a major mental disorder in bereaved parents and other grieving individuals as early as two weeks following the death of a loved one should they meet the DSM-5’s criteria for depression. Importantly, many of you will recognize these criteria which include sadness, feelings of emptiness, crying, sleep and weight changes, guilt and regrets, and loss of interest or energy. Yet, all of these symptoms are quite common in grief, and particularly after the death of a baby or child which evokes enduring and intense reactions in parents.

This move has personal implications for the MISS Foundation. The DSM-5 change increases the likelihood that grief will be misdiagnosed as Major Depressive Disorder in the most vulnerable of all populations.¹ The possibility exists that bereaved parents and other grievers will be mistakenly treated for a misdiagnosed mental disorder. Recent trends suggest that the most common form of treatment offered for this disorder is psychotropic medication.^2-3 While some medications may be effective for some forms of depression,⁴ there is no sound evidence that they are effective for grief. Research shows that bereaved parents are already medicated earlier than can be justified by current evidence.^5-6 We fear the DSM-5 change will exacerbate this trend and cause even more grieving individuals to be prescribed medication for symptoms which are actually a normative response, despite the lack of evidence to support this practice and a lack of information on how such medications may interfere with the grieving process.

The MISS Foundation has actively opposed this proposed change in DSM-5 and will continue to do so. You can read Dr. Joanne Cacciatore’s initial blog post which went viral in March of 2012 on this topic here.  The first open letter outlining our concerns sent to the American Psychiatric Association in March can be read here and another letter sent in April can be found here. Finally, in October the MISS Foundation issued a formal letter on behalf of the organization and can be viewed here. Finally, many links to research and articles about this issue can be found in this blog entry at the end.

We issue a caution to our families: We urge bereaved individuals to be informed about what this change could mean when seeking help from medical and mental health providers using DSM-5, scheduled to be published next year. Should you have concerns about the quality of medical/mental/emotional care you are being provided, please speak with experts who can help guide you. Get help somewhere, indeed.

Please be assured that many other parents are experiencing the same immense suffering and that you are not alone. Seek solace through skilled and highly trained providers who truly care for you and are willing to walk with you through your darkest times: providers who understand the death of a child as life’s worst tragedy and who will be truly present with and available to you. Seek solace through like others in support groups, online support, and through your community.  Seek solace in spirituality and nature and books that help you to cope as you travel this overwhelming road. Seek solace through self-care and compassion. Seek solace through others who are unconditionally loving whether that be your partner, family, children, animals, or your faith based community. Seek solace through contemplative practice such as prayer, meditation, and quiet time and also through action in service and kindnesstoward others.

We issue an ardent appeal to providers: The bereaved are a vulnerable population. Please, be mindful and conservative in the issuance of diagnoses and medication, and educate yourselves in evidence-based practices as well as culturally influenced interventions. Take personal responsibility to learn what is truly normal, not pathological, after a traumatic death. The DSM-5 gives you much power and influence over the life of another. Please do not take this responsibility to “do no harm” lightly.

Dr. Joanne Cacciatore, Founder                                           Kara Thieleman, MSW, PhD Student         

Karla Helbert, LPC, Facilitator                                              Dr. Melissa Flint, Clinical Psychologist                    

Jennifer Soos, MFT, Facilitator                                             Dr. Trish Wonch Hill, Policy Analyst

Barry Kluger, CEO                                                                 Kelli Montgomery, Executive Director

Yasaman Parsi, Grief Counselor                                          Rebecca Ong, MSW, Grief Counselor

References

1. Wakefield, J. C., & First, M. B. (2012). Validity of the bereavement exclusion to major depression: Does the empirical evidence support the proposal to eliminate the exclusion in DSM-5? World Psychiatry, 11(1), 3-10. doi:10.1016/j.wpsyc.2012.01.002

2. Mojtabai, R., & Olfson, M. (2008). National trends in psychotherapy by office-based psychiatrists. Archives of General Psychiatry, 65(8), 962-970. doi:10.1001/archpsyc.65.8.962

3. Olfson, M., & Marcus, S. C. (2010). National trends in outpatient psychotherapy. American Journal of Psychiatry, 167(2), 1456-1463. doi:10.1176/appi.ajp.2010.10040570

4. Kirsch I., Moore, T. J., Scoboria, A., & Nicholls, S. S. (2002). The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment, 5(1), 23a. doi:10.1037/1522-3736.5.1.523a

5. Cacciatore, J., Lacasse, J. R., Lietz, C., & McPherson, J. (In press). A parent’s TEARS: Primary results from the Traumatic Experiences and Resiliency Study. OMEGA.

6. Cacciatore, J., & Thieleman, K. (2012). Pharmacological treatment following traumatic bereavement: A case series. Journal of Loss and Trauma, 17(6), 557-579. doi:10.1080/15325024.2012.688699

Link to this article here. Please share far and wide with others.

Article: http://drjoanne.blogspot.com/2012/12/the-death-of-sadness-birth-of-mental.html
Also, please note the comments and responses underneath Dr. Joanne's article, as these are also enlightening.

Thursday's Thursday - Is Grief an Illness?

Thursday's Thursday

Is Grief an Illness?

HealthDay News

Is Grief an Illness? The Debate Heats Up

Psychiatric experts torn on whether bereavement should be included in new diagnostic manual.

By Alan Mozes, HealthDay Reporter

THURSDAY, Feb. 16, 2012 (HealthDay News) — The loss of a loved one can trigger deep emotional turmoil, but is the grief that follows a normal part of being human or is it a form of mental illness in need of diagnosis and treatment?

That's the gist of a "major debate" now unfolding in the world of psychiatry, as the American Psychiatric Association (APA) prepares to issue the fifth edition of its seminal reference guide to mental disease, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The issue: For the first time, the manual — a touchstone for mental health professionals across the United States — may not exclude the concept of " bereavement" from the constellation of behaviors and experiences that it deems worthy of consideration when clinicians set out to diagnose a major depressive disorder.

What does this mean? That feelings or outbursts accompanying the passing of a family member or close friend — such as crying, insomnia, fatigue, confusion and profound sadness — may now be viewed as a treatable illness rather than as a normal reaction to life's most shattering moments.

Needless to say, not everyone agrees with this shift in thinking.

"To me, grief is a normal condition, not to be tagged with a diagnostic code and to be treated," stressed Dr. T. Byram Karasu, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine and psychiatrist-in-chief at Montefiore Medical Center in New York City. "Everyone loses someone in their lives at some point. So, this would be classifying everyone at some point. No one would be immune to this."

"And that does not make sense, because grief is a normal and very healthy behavior," 

said Karasu, who also chairs the APA's National Task Force on the treatment of depression. 

"One has to feel joy as well as pain and depression, otherwise life is not worth living. And one should not interrupt the grieving by medication or psychotherapy. You have to feel the loss, and only by feeling the loss and recovering from it will the person become a better person. Interrupted grief will remain unfinished business."

Karasu's stance is in line with those expressed by the editorial board of the British medical journal The Lancet, which lays out its opposition to the new clinical approach in its Feb. 18 issue.

"Grief is not an illness," 

the journal's editors argue, noting that a diagnostic change in the APA's forthcoming manual would empower clinicians to interpret any post-loss despair that endures beyond a two-week window as a troubling sign of sickness rather than a standard sign of coping.

The Lancet team suggests that, instead, an intense but normal bout of grief can last six months to a year, depending on the very individualized nature of the particular relationship that has been severed by death. 

{Or as we Child-Loss Grievers know, our grief will normally last a life-time!}

"Medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed," the authors noted.

They acknowledged, however, that sometimes grief can morph into something much more complicated, longer lasting and "pathological." In such instances, true clinical depression may ensue along the lines of a so-called "prolonged grief disorder," a potentially new designation now under consideration by the World Health Organization. And such patients, the board agreed, might stand to benefit from some form of mental health intervention.

The concern over exactly when normal grief becomes a condition that perhaps requires treatment is what's driving the notion of inclusion in the DSM, said University of California, San Diego, psychiatry professor Dr. Sidney Zisook.

"It is well recognized that the death of a loved one, just like any other serious stressor, [such as the] loss of a job, diagnosis of a fatal illness, divorce can trigger a clinical depression,” he said. "The ensuing depressive syndromes are no less severe or debilitating when brought on by bereavement as they are after any other life event or, indeed, when the depression seems to occur out of the blue." {Well, now, that concept is debatable! Child-Loss Grief does feel quite severe and debilitating, but it does allow us breathers between the grief-bursts which clinical depression is not as likely to do.}

"Acknowledging that bereavement can be a severe stressor that may trigger a clinical depression in a vulnerable person does not medicalize or pathologize grief," he suggested. "Rather, it prevents clinical depression from being overlooked or ignored, and facilitates the possibility of appropriate treatment."

"This acknowledgment," Zisook cautioned, "does not mean that we think acute grief should end in days, weeks or even months. For some, it may last for years, {or in Child-Loss Grief, a life-time,} whether or not there is also a clinical depression. But, acknowledging that clinical depression may also be present in some bereaved individuals may go a long way towards helping those individuals get on with their lives."

For University of Michigan Medical School psychiatry professor Dr. Randolph M. Nesse, the debate boils down to a tug-of-war between basic common sense on the one hand and science's search for diagnostic consistency on the other.

"Everyone knows that grief is something that happens to everybody," he noted. "And just because an emotion feels bad doesn't mean it's wrong or unhealthy. Most often it's a common-sense response to a real problem."

"So, my take is that it would be senseless to eliminate the grief exclusion [from the DSM]," said Nesse, who is also a professor of psychology at UM's College of Literature, Science and the Arts. "But, because it can be so damn hard to figure out when an emotion is normal or not normal without really knowing what is going on in a person's life, there are undeniable advantages to having a neat, clean, simple check-box kind of classification system for diagnosing depression. It makes it easier. So, you include grief as a box to tick, whether or not there is a real problem to be diagnosed."

"But that is what is so troubling," 

he added. 

"Because when someone gets a diagnosis of depression it then encourages giving that person treatment. And the getting of that treatment then pushes the person being treated into believing they do indeed have a problem that needs treatment to begin with. And that can be very unhelpful in many, many cases in which grief is really a normal and healthy response to a life event."

{Add to that, that many times, so-called Grief "Treatment" has been known to do more harm than good under psychotherapists who do not understand the multi-dimensional, long-term, and enduring aspects of Child-Loss Grief!}

Last Updated: 02/17/2012

Highlights, mine, and {Comments, mine}

~~~~~~~~~~

Moral of the Story when Grieving your Child:

{Also, pictures/graphics, mine}








Pictures/Graphics, thanks to ~ihaveaspecialangel My Special Angel: For Loved Ones Lost, and Grieving Mother, Jill Compton

Article: http://www.everydayhealth.com/emotional-health/0217/is-grief-an-illness-the-debate-heats-up.aspx?xid=tw_heartdiseases_20120222_grief

Saturday's Sayings - With Child-Loss Grief and Trauma...Some "Tools" to Help

"May God bless and comfort all this New Year's 2012. May we continue to trudge down this road of pain and sorrow and may it "soften" a little."

~A lovely New Year's wish (and picture) from a grieving mother, "KLJ"

on The Compassionate Friends of Atlanta site,

one of the several child-loss grief groups on Facebook to which I belong

https://www.facebook.com/groups/43057397614/

Saturday's Sayings

With Child-Loss Grief and Trauma...

Some "Tools" to Help Us

A grieving mother sent me an email this week, asking what are some of the child-loss grief groups available, as I have mentioned in our blog some to which I belong, so today I will share a few of them with you in this post. One is quoted from above, The Compassionate Friends of Atlanta. It is one of the many branches of The Compassionate Friends, USA (TCF) which has a webpage which can be followed on Facebook. TCF also has many local groups, not just "virtual" groups to which you can belong (for free!) It is designed for grieving parents, grandparents, and siblings of a deceased child to come together to give and receive support during this devastating loss of a child.

TCF's main "virtual" site is https://www.facebook.com/TCFUSA

Its main webpage can be found at http://www.compassionatefriends.org/home.aspx

And its local chapter locator site can be found at

http://www.compassionatefriends.org/Find_Support/Chapters/Chapter_Locator.aspx ~

Tommy and I joined our local TCF group here in Knoxville, Tennessee, "The Compassionate Friends, Knoxville" (we have no worldwide-web exposure yet!) about two years ago, and it has been such a great help for us.

General Helping Tools:

Ten Ways of Giving

The way of celebration: gratitude

The way of generativity: helping others grow

The way of forgiveness: set yourself free

The way of courage: speak up, speak out

The way of humour: connect with joy

The way of respect: look deeper and find value

The way of compassion: feel for others

The way of loyalty: love across time

The way of listening: offer deep presence

The way of creativity: invent and innovate

~ STEPHEN POST & JILL NEIMARK,

in "Why Good Things Happen to Good People"

*****

Spiritually-Supporting Helping Tools:

A Sharpened Focus

Day 200

"When you know that this life is not all there is," says Anne Graham Lotz, "and you know that one day you are going to be standing before God giving an account of your life, and you know that there is a great big eternity out there when we are going to worship the Lamb and forever glorify Him, it gives you a seriousness about life now. It sharpens your focus and motivates you to live every moment of your life fully to the glory of God."

Train yourself to focus on eternity. Focus on the big picture, not on your own limited life on earth.

In some ways you probably feel more unfocused than you have ever felt in your life, as if you are walking around in a constant fog of grief. In other ways you may feel more alert than ever because you are observing life from a completely different perspective. Many things—from the simple to the complex—take on a different meaning or level of importance to you. Sharpen your focus on the God of eternity by reading His Word daily. Stop trying to handle your tumultuous life alone.

"If the axe is dull and he does not sharpen its edge, then he must exert more strength. Wisdom has the advantage of giving success" (Ecclesiastes 10:10 nasb).

Eternal God, grant me the wisdom and the focus to recommit my days to You. Help me to understand the seriousness of following Your eternal plan as written in the Bible. Amen.

~by Anne Graham Lotz, thanks to Grieving Mom, "JW-T" for sharing

*****

Emotionally Supportive Helping Tools ~ Child-Loss Grief Groups:

Celebrating earlier this morning on the One-Year anniversary with Barbara, the founder of "Grieving Mothers," https://www.facebook.com/groups/Grievingmothers/ another of the several child-loss grief groups to which I belong:

~~~"Happy Birthday" to "Grieving Mothers"~~~

Dearest Barbara,

You are so amazing to be able to share so much of yourself with us. Your endurance / perseverance through grief gives us hope and direction. I know your responsiveness to all of us on this site has to require an incredible devotion of heart and spirit. I just wanted you to know I so appreciate you, and all of your giftings to us. I quote you so often on my blog ~( I hope you're not sick of my borrowing from you so often for my "Saturday's Sayings," on my blog, not to mention using the many wonderful pics you share with us)!!!

It has been amazing to me to watch this group grow by leaps and bounds in just one year! Thank you for inviting me in a year ago; I lost my 19-yr-old "forever teen angel" just 5 years ago, and I have found group support with other grieving moms and dads has been a tremendous help for me in my own coping and healing. I am a Christian psychotherapist, and a grieving mother; healing through this grief and trauma has been quite a challenge for me; my body is still reeling from all the trauma it has been through in these few short years, and finding helps for my woundedness is so greatly appreciated. I cannot imagine 25 years of compiled pain; may we all season as gracefully as you seem to.

Thank you so much for your servant's heart for all of us. May God bless you and keep you oh so close to His heart. I will be honored to light a candle for your precious little Jeremy today. Today, I am sharing this picture with you that I found at Dr. Athena Staik's fb page, but I want you to imagine that this is a giant heart of love formed in Heaven today as all our precious angels surround your Jeremy with all their hearts of love, holding him close in heart until you get there to hold him not only close to your heart as you do now, but also, finally, close within your own mothering arms.♥

*****

Some Mentally- and Physically-Supportive Tools to Help...

Newsweek shares tips for helping your brain in this week's edition!

Clues from a January 1, 2012 Newsweek Magazine article on how to

from "Buff Your Brain"

(Sharing just a few tips with you that editor Sharon Begley presents)

Although most of us think of motor skills and cognitive skills as like oil and water, in fact a number of studies have found that refining your sensory-motor skills can bolster cognitive ones. No one knows exactly why, but it may be that the two brain systems are more interconnected than we realize. So learn to knit, or listen to classical music, or master juggling, and you might be raising your IQ.

While improving your brain takes work, the good news is there are some accessible ways to go about it. Aerobic exercise buffs the brain as well as the quads. Walking 30 minutes a day five times a week stimulates production of BDNF (brain-derived neurotrophic factor), a molecule that nurtures the creation of the new neurons and synapses that underlie learning. In neuroimaging studies, scientists led by Arthur Kramer of the University of Illinois at Urbana-Champaign have shown that exercise increases gray matter in the region of the hippocampus that processes new knowledge and dispatches it to permanent storage in the frontal cortex.

If a half-hour walk leaves you tired, good: a midday nap not only can restore brain power to its fully awake best but can also raise it beyond what it would have been without some shut-eye. In a 2010 study, psychology professor Matthew Walker and colleagues at the University of California, Berkeley, found that a nap may not merely restore brain power but also raise it. Students who took a 90-minute nap at 2 p.m. after a task that taxes the hippo-campus—learning the names of some 120 faces they had never seen—retained more than their non-napping peers. Even more surprising, they also learned new face-name pairs better at 6 p.m. than they had before the nap, and better than the non-nappers. “In people who stayed awake, there was a deterioration in their memory capacity, but a nap restored that capacity to levels even higher than before the nap,” says Walker. So kudos to Nike and the host of Silicon Valley companies like Google that provide nap rooms for employees.

EEGs, electrodes that record brain activity, suggest how that happened. The number of bursts of electrical activity called sleep spindles—Walker calls them “champagne pops in the brain”—that people experienced during their naps predicted how much their ability to learn would improve once they awoke. Sleep spindles, he suspects, indicate activity in the hippocampus that moves information from that region into the cortex for permanent storage. It’s like moving data from a USB stick onto a hard drive, which “both consolidates into long-term storage the information you offload and leaves you a renewed capacity for absorbing new information—learning,” says Walker. The better we move information from the hippocampus (working memory) into the cortex, the more information we can access when we need it.

Even without the midday nap, the brain has a way of carving out its own downtime, characterized by what’s called the “default-mode network”—basically, brain activity that takes place when you’re daydreaming or keeping your mind blank. Using functional MRI, scientists at Japan’s Tohoku University measured cerebral blood flow in 63 volunteers asked to keep their minds blank. Those with the greatest blood flow in the white matter that connects one neuron to another scored highest on a task requiring them to quickly generate novel ideas, the researchers reported in the journal PLoS One in November. Creativity arises from seeing connections others miss, so it makes sense that increasing the activity in white matter by letting the brain rest in default mode supports creativity. So put away the BlackBerry and let your brain idle.

Too hyper to do that? Then go all in with a jolt of caffeine. It might not make you more creative, but coffee can make your mind sharper, as zillions of java addicts will swear. A 2011 study in Nature Neuroscience backs them up: in lab rodents, caffeine strengthens brain connections. Rats given shots of joe comparable to two cups of coffee had stronger electrical activity between neurons in the part of the hippocampus called CA2 than they did otherwise, found Serena Dudek of the National Institute of Environmental Health Sciences and colleagues. Stronger connectivity means better learning and memory.

Here's a brain-buffing trifecta:

• Memory training +
• Fueled by caffeine +
• Interspersed with good sleep +
• Aerobic conditioning, +
• Computer-based brain exercises to hone attention, +
• A regimen of reading, +
• Watching, +
• Doing +
• Broken up by ample mental downtime:

It promises to add up to a smarter you in 2012 and beyond. (!!!)

~Sharon Begley, the science columnist and science editor of Newsweek*

*****

Best Wishes in the New Year as you lovingly nurture yourself through your great grief.

Feel free to let us know what kinds of "tools" have been the most helpful to you!

*Sharon Bagley is also the coauthor of the 2002 book The Mind and the Brain and the author of the 2007 book Train Your Mind, Change Your Brain.Sharon Begley is the science columnist and science editor of Newsweek.She is the coauthor of the 2002 book The Mind and the Brain and the author of the 2007 book Train Your Mind, Change Your Brain.

Thursday's Therapy - Why Going to a Grief Counselor May Not Help... Part Three ~by Angie and Tommy Prince

Thursday's Therapy

Why Going to a Grief Counselor

May Not Help... Part Three

~by Angie and Tommy Prince

In the last two weeks in Thursday's Therapy, we discussed some of the important findings of the study reported in an article on Medscape called,

"Loss of a Baby Linked to Increased Mortality in Parents"

From the results of a study reported in September of this year, it seems it is a huge revelation to mental health experts that the likelihood for a parent grieving the loss of a child is 4 to 5 times more likely to die or become widowed within the following decade than parents who do not experience this type of bereavement. (And in this study, the researchers, mind you, restricted their research to only those parents who had lost a child in the first year of life.)

The study was an important one that should help to sensitize the professional helping field of the distinction to this type of grief, and the distinction is that

Child-Loss Grief is like NO other grief known to mankind.

Too often when a child-loss griever goes to counseling, we are treated as if we were just like any other griever out there, and we all know that's just NOT the case. Our grief is more profound than any other loss out there, so to be met with expectations to "get over it" in ANY certain time-frame could be absolutely devastating to our war-torn hearts and souls. So while we want to take nothing away from an important mile marker that this study provides to help professionals better understand our child-loss grief, it is incumbent upon Tommy and me who are in that same helping field to point out the still-prevalent cluelessness among the professionals you (and we) may be subjecting ourselves to in our deep grief. Even the professionals quoted in this article jump to some pretty biased and/or ignorant conclusions about our child-loss! Tonight we will cover just one of the professionals mentioned in the article, to expose to you some of the ignorance that was exposed even after concluding a brilliant study! (We hope to cover the other professional mentioned in the article next week.)

For instance, in the following quote, look how the conductor of the research contradicts her own study's findings from one paragraph to the next!

"Other research by Dr. Harper and her colleagues seemed to confirm that the child’s age at time of death is not a significant predictor of grief or depressive symptoms. Cause of death, whether illness or accident, also didn’t make a difference, said Dr. Harper.

"It may be even more devastating to lose a child early in life rather than, say, when he or she is a teenager. 'You could argue that when you lose a child very early on, you’ve lost a whole lifetime of experience,' said Dr. Harper. 'You’ve lost a part of yourself and the future.'"

Her conclusion may sound heretical to those of us who have lost a teenager or a young adult, as she had no grounds from her clinical study to even make such a startling extrapolation, just pulling ideas from thin air that have nothing at all to do with any of the results in her study! In contrast to her shocking words, lets look at other experts in the death and dying field, and see what they have to say.

*****

Jane Bissler, PhD, writes about identity change in “My Child has Died and so Have I!: Grieving the Loss of an Adolescent Child.” Her article is published in the January 2009 issue of “The Forum,” the printed newsletter of the Association for Death Education and Counseling. In another article entitled, "Coping with the Death of a Chidl" the mental health expert for CNNhealth.com, Dr. Charles Raison, was writing regarding the devastation that John Travolta and his wife Preston were facing with having just lost their 16-year-old son, Jett:

The loss of a child is "the most painful loss that humans can sustain," said Dr. Charles Raison, CNNhealth.com's mental health expert.

It's a sentiment to which many parents can relate.

"Parents are particularly devastated when their children die in their late teens or 20s; they've raised the child who is growing into maturity and just beginning to blossom into his or her own life.

"'Part of the tragedy of Travolta is that it's right in that time period, right when the grieving is horrible,' said Raison, an assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta, Georgia.

"It's also the unfulfilled possibilities that the child could've brought to the world -- the child was going to carry the family name, write a book, contribute to mankind -- and all that is torn away.

"'When an adolescent dies, we're in the stage of launching them,' said Bissler, a member of the board of directors for the Association of Death Education and Counseling. 'When they're adolescents, we start looking to schools, colleges, their first apartment. When they're about to be out on their own, we're looking forward to that. When we're not able to take child-rearing to fruition, we're left with a hole. The child is gone and I can't finish my job as parent. I can't launch this child to adulthood.'

"Sometimes the parental grief is compounded, because teenagers are often at odds with their parents and their death could have occurred during a difficult time in the relationship.

"Grieving parents can fall into blaming themselves for their child's death although it may have been completely out of their control.

"'That recrimination is especially painful when there are what ifs,' Raison said.

'What if we had been there?

'What if I had taken keys away from the kid? Those are the worst types of incidents that drive people crazy.'

"These recriminations can make people anxious and depressed. If the grieving parent begins to feel hopeless, useless, lose weight or have trouble concentrating, these could be symptoms of depression.

"When people are really distraught and it goes on for a number of weeks, get professional help," Raison said. "There's nothing that would take away (the grief) from the loss of (their) child. You don't want to do that. You also don't want to get into a process where it leads to full depression and people can't function in their lives and their other children suffer.'"

*****

As you can see, these are quite different perspectives within the same mental health helping field. It can be quite confusing to those of us who want to go into therapy and trust that any given professional knows what he or she is doing only to find such wide discrepancies in the understanding of the very real aftermath of child-loss with which we are trying so hard to contend.

However, Dr. Harper, the conductor of the child-loss parent research did come up with this conclusion that should present a new message to those professionals who want to treat ALL GRIEF as the same:

"It’s possible that the type of bereavement experienced by parents who lose a child might be different than, say, losing a spouse or a parent. 'Perhaps losing a child needs a special level of consideration and I’m not sure that’s the case at the moment.'"

And, yes, Dr. Harper, we would agree, child-loss does need "a special level of consideration" that you recognize you're not sure is currently out there in the field! And we urge you on in your research, possibly even to broaden your study to many other ages of children lost to parents so that we could all broaden our understanding of

the vast devastation with which, it is our contention, ALL child-loss parents are now grappling.

For we believe,

No Matter Who You Are Nor How Old Your Child Is, If You Are A Child-Loss Parent, Your Heart Is Going To Be Broken In Two, And Your Life Will Never, Ever, Be The Same.

Picture, thanks to a grieving mother

Reactions to the following article: http://www.medscape.com/viewarticle/750262?src=emailthis ~This study was published online September 1, 2011 in the British Medical Journal of Supportive and Palliative Care.