Thursday's Therapy - A Grief Shared - Part I ~by Lynda Boucugnani-Whitehead, Ph.D.

Thursday's Therapy

A Grief Shared - Part I

~by Lynda Boucugnani-Whitehead, Ph.D.

(Psychologist and Grieving Mother)

This will not be the typical article you often see in a professional publication. There will be no references to scholarly works, no discussion of what has been gleaned from years of research, no statistics, no methodology. Rather, this will be a story from the heart, one that I hope may help psychologists first understand, and then do what they do best. I had the inspiration to write this article just a week or so before the tragedy in New York. In my frame of reference, following the horror at the World Trade Center and Pentagon and in Pennsylvania, perhaps this is divine inspiration - this is something I just have to do.

What is it like to live through such a profound grief, to have your whole life changed in an instant, to have much of your future taken away, and to find yourself in a world that you don't recognize?

We have all had at least a taste of this, as Americans, our lives have been changed by these events. There is a loss of a sense of security and for what we thought our future would be.

But what about those people who have sustained a more profound and excruciating loss - the loss of a loved one who was treasured and so much a part of the fabric of your very life.

What is it like to have that person taken away so abruptly, to one minute have that loved one beside you as a part of your dream, and the next to have that love ripped away from you?

What do psychologists and other helping professionals need to know in order to help those who have sustained such a loss?

This story is very personal for me and, therefore, somewhat difficult to tell. As many of you know, my daughter, Maria-Victoria, was killed in an automobile accident just three blocks from my home as her brother was driving her home from school. A speeding driver ran through a red light and smashed into their car killing Maria-Victoria instantly. She was 13 years old. It was a normal day, bright and sunshiny and my life was going along as normal. My daughter was a beautiful, intelligent and accomplished person known for her extraordinary kindness and compassion for others. She was innocence and pure love blossoming into a leader of others and she was building the confidence that could have taken her very, very far in this life. In one second she was here, in one second she was not. The fifth anniversary of her death was just 2 days after the New York tragedy.

Within a few months of her passing, I joined a group called Compassionate Friends, which is a self-help group for parents who have lost children. It was a very good move.

It is said that the most profound loss a person can have is the loss of a child - I can tell you that this is the truth.

However, for those who have not lost children, the most profound loss is the one they have

experienced or are experiencing at the present time. Those of us in this group frequently lament about how ill-equipped others who have not experienced such pain and grief are in dealing with it. Ministers are often the focus of such discussions for example and we have often discussed how we can let others, especially professionals, know how it really is - what helps and sometimes, more importantly, what doesn't help. This is the purpose of this story - this Dialogue - to let my fellow psychologists know some things that in the future will help them be able to help. It is based on my own personal experiences as well as the numerous Compassionate Friends who have come into my life.

You have all heard or read about the stages of grief. The work that was done in this area by pioneers such as Elizabeth Kubler-Ross is very valuable in understanding the emotions of grief. Some professionals may feel that they can help people with grief because they have studied these stages and know the sequence by heart.

Throw it all away.

People who have sustained profound loss do not want to hear about the stages of grief - it's almost an insult. They do want to know that what they are feeling is normal, that they are not "crazy", that others have felt or done the same things.

There is no sequence of grief - it is a constant, evolving journey with many diversions into emotional peaks and valleys along the way.

It is a journey and it is never over.

It is true that at the time of the event you are in a state of shock and numbness. In my case after a telephone call, I made my way to the accident site. It was eerily quiet with cars backed up in four different directions at the intersection, so that I had to drive on the wrong side of the road to get there. When I got to the scene I was no longer within myself, I must have dissociated. I felt like I was observing everything as if I was in a movie. The people in all the cars were watching me. I imagined they were saying "that's the mother". I was aware that I was playing this "role". I imagine that many of the relatives looking for loved ones in New York must have felt this way too. At the hospital I was placed in a special room - meant to be a comfort but cut off from others. It did allow me to get out of the movie.

What helped? Friends coming to be with me. You need to hold and touch people - you need them to hold you and just "be there" for you.

What didn't help? Waiting 1½ hours to be told whether my children were alive or dead. I already knew in my heart and soul that Maria-Victoria was gone from this life but to have a doctor finally come in and say in a cool and dispassionate manner that "your daughter is deceased" made me angry. A simple "I'm so sorry", a touch on the hand and some semblance of compassion would have endeared this doctor to me for life. Why is that so hard to do?

We are blessed with this state of shock that comes almost immediately after suffering a traumatic loss. It allows us to do the things we have to do. For many of us this is very, very important. I needed to make sure that Maria-Victoria had a wonderful, up-lifting funeral

service that told the world about the wonderfulness of my little girl. I needed to write an obituary that would touch the hearts of Atlanta. I needed to comfort her teachers and students at her school, thereby comforting myself. I needed to be there for the hundreds of people who came to show they cared. Some people criticized the news coverage in New York of friends and relatives showing flyers of their missing loved ones saying it was exploitation. I spoke to them through my TV set saying - "you just don't get it - they need to do this -they need to let

others know about the one they love - they need to feel like they are doing something to take care of them."

What helped me so much in the initial weeks after the accident were touches from the hearts of other people. I savored all the cards, the incredible amount of food from individuals and whole schools, letters and phone calls from people I had never met who were touched by my daughter's story and the physical presence of people I was close to.

Such heartfelt gestures give life when life has gone out of your existence.

There is a time when you have to go back to work and start to live this new life. I was fortunate to have such a wonderful, supportive staff that literally carried me through that first year. Others are not so fortunate. Some have to go back to work just days after the funeral and are expected to perform as if nothing has happened. When a traumatic loss has struck you, you are amazed and perhaps a little bit angry that the world has gone on. You say to yourself, "how

can these normal things still go on - how can people laugh - don't they know the world has ended?" You think to yourself that you will never laugh again, that you will never feel joy again - it's incomprehensible to think that you could.

During that first year (time will vary among folks) you are literally "out of your mind". Believe it or not, there is actually a "physical pain", usually in your heart and chest area and all over

your body at times, experienced by many that is excruciating and you think will never go away. Mine lasted about 2 months and then just floated away. It was a relief to say goodbye to that constant companion.

You are "out of your mind" because you think about your loved one constantly - probably a million times a day it certainly seems.

That doesn't leave much room for concentration and memory. Those who have experienced such loss need to know that this is perfectly normal.

It is perfectly normal to put the iron in the refrigerator.

At work if you don't have support, you will certainly not be able to function like you used to. You may be able to do some things on "automatic pilot" but this is not the time to be making major decisions and you - and the business you work for - need to give you leeway for your memory lapses and perhaps loss of drive.

Every day is a struggle just to get up and live. Every day you get up and live is an accomplishment.

So be supportive and tolerant.

Make it a point to know about these cognitive disturbances, help the person you are helping to understand them. And - if you can - help their employers to know what to expect and how to give support.

(to be continued)

{Highlights mine} Thank you to Lynda Boucugnani-Whitehead, Ph.D. for her insights both personally and professionally into our child-loss grief, "the most profound loss a person can have"...

from: Lynda's note is from The Compassionate Friends of Atlanta via Facebook message http://www.facebook.com/group.php?gid=43057397614

Thursday's Therapy - Ways We Grieve, Part Three: 5 Stages of Grief + Debunking the 5 Stages of Grief

Thursday's Therapy

Ways We Grieve

Part Three

5 Stages of Grief

+

Debunking Stages of Grief

The following are two articles, Article One describing Kubler-Ross' 5 stages of grief and Article Two describing debunking the stages of grief:

Article One:

Stage of Grief Models: Kubler-Ross

Mark Dombeck, Ph.D. Updated: Dec 15th 2006

Kubler-Ross's Stages

Probably the most famous formulation of the stages of grief was developed by Dr. Elizabeth Kubler-Ross in her book "On Death and Dying."

Dr. Kubler-Ross actually wrote about the stages that dying people tend to go through as they come to terms with the realization that they will soon be dead. However, her stages have since been borrowed by the larger grief community as a means of describing the grief process more generally.

Coming to terms with dying is certainly a loss experience and an occasion for grief, so there is merit to this borrowing and reason to become familiar with Dr. Kubler-Ross' stages.

Again, not everyone will experience all of these stages, or, if all are experienced, they won't necessarily occur in this particular order.

• Kubler-Ross' first stage is Denial. In this stage, grieving people are unable or unwilling to accept that the loss has taken (or will shortly take) place. It can feel as though they are experiencing a bad dream, that the loss is unreal, and they are waiting to "wake up" as though from a dream, expecting that things will be normal.

• After people have passed through denial and accepted that the loss has occurred (or will shortly occur), they may begin to feel Anger at the loss and the unfairness of it. They may become angry at the person who has been lost (or is dying). Feelings of abandonment may also occur.

• Next comes Bargaining. In this stage, people beg their "higher power" to undo the loss, saying things along the lines of, "I'll change if you bring her (or him) back to me". This phase usually involves promises of better behavior or significant life change which will be made in exchange for the reversal of the loss.

• Once it becomes clear that Anger and Bargaining are not going to reverse the loss, people may then sink into a Depression stage where they confront the inevitability and reality of the loss and their own helplessness to change it. During this period, grieving people may may cry, experience sleep or eating habit changes, or withdraw from other relationships and activities while they process the loss they have sustained. People may also blame themselves for having caused or in some way contributed to their loss, whether or not this is justified.

• Finally (if all goes according to Dr. Kubler-Ross's plan), people enter a stage of Acceptance where they have processed their initial grief emotions, are able to accept that the loss has occurred and cannot be undone, and are once again able to plan for their futures and re-engage in daily life.

******

From November 2008 Scientific American Magazine

Article Two:

Five Fallacies of Grief: Debunking Psychological Stages

From the stages of grief to the stages of moral development, stage theories have little evidentiary support

by Michael Shermer

Denial, anger, bargaining, depression, acceptance.

So annealed into pop culture are the five stages of grief—introduced in the 1960s by Swiss-born psychiatrist Elisabeth Kübler-Ross based on her studies of the emotional state of dying patients—that they are regularly referenced without explication.

There appears to be no evidence, however, that most people most of the time go through most of the stages in this or any other order.

According to Russell P. Friedman, executive director of the Grief Recovery Institute in Sherman Oaks, Calif. (www.grief-recovery.com), and co-author, with John W. James, of The Grief Recovery Handbook (HarperCollins, 1998),

“No study has ever established that stages of grief actually exist, and what are defined as such can’t be called stages. Grief is the normal and natural emotional response to loss.... No matter how much people want to create simple, bullet-point guidelines for the human emotions of grief, there are no stages of grief that fit any two people or relationships.”

Friedman’s assessment comes from daily encounters with people experiencing grief in his practice. University of Memphis psychologist Robert A. Neimeyer confirms this analysis. He concluded in his scholarly book Meaning Reconstruction and the Experience of Loss (American Psychological Association, 2001):

“At the most obvious level, scientific studies have failed to support any discernible sequence of emotional phases of adaptation to loss or to identify any clear end point to grieving that would designate a state of ‘recovery.’”

Nevertheless, the urge to compress the complexities of life into neat and tidy stages is irresistible. Psychoanalyst Sigmund Freud insisted that we moved through five stages of psychosexual development: oral, anal, phallic, latency and genital. Developmental psychologist Erik H. Erikson countered with eight stages: trust vs. mistrust (infant); autonomy vs. doubt (toddler); initiative vs. guilt (preschooler); industry vs. inferiority (school-age period); identity vs. role confusion (adolescent); intimacy vs. isolation (young adult); generativity vs. stagnation (middle age); and integrity vs. despair (older adult). Harvard University psychologist Lawrence Kohlberg postulated that our moral development progresses through six stages: parental punishment, selfish hedonism, peer pressure, law and order, social contract and principled conscience.

Why stages? We are pattern-seeking, storytelling primates trying to make sense of an often chaotic and unpredictable world. A stage theory works in a manner similar to a species-classification heuristic or an evolutionary-sequence schema. Stages also fit well into a chronological sequence where stories have set narrative patterns.

Stage theories “impose order on chaos, offer predictability over uncertainty, and optimism over despair,”

explained social psychologist Carol Tavris, author of The Mismeasure of Woman (Touchstone, 1993) and co-author, with Elliot Aronson, of Mistakes Were Made (But Not by Me) (Harcourt, 2007), in an interview with me. “One appeal of stage theories is that they tell a story—they give us a narrative to live by (‘you feel this now, but soon ...’). In cognitive psychology and also in ‘narrative psychotherapy,’ there has been a lot of work on the importance of storytelling. Some therapists now make this idea explicit, helping clients change a negative, self-defeating narrative (‘look at all I suffered’) into a positive one (‘I not only survived but triumphed’).”

What’s wrong with stages?

First, Tavris noted, “in developmental psychology, the notion of predictable life stages is toast."

"Those stage theories reflected a time when most people marched through life predictably: marrying at an early age; then having children when young; then work, work, work; then maybe a midlife crisis; then retirement; then death. Those ‘passages’ theories evaporated with changing social and economic conditions that blew the predictability of our lives to hell.”

Second, Tavris continued, “is the guilt and pressure the theories impose on people who are not feeling what they think they should. This is why consumers of any kind of psychotherapy or posttraumatic intervention that promulgates the notion of ‘inevitable’ stages should be skeptical and cautious.”

Stages are stories that may be true for the storyteller, but that does not make them valid for the narrative known as science.

Note: This story was originally printed with the title, "Stage Fright".

Five Stages article: http://bit.ly/7ki9ZZ

Debunking Stages article: http://www.scientificamerican.com/article.cfm?id=five-fallacies-of-grief