Grieving and Bereavement: Thoughts from Clinicians, Psychologists, and Experts
I’m convening public discourse about grieving and bereavement and would like to hear from a cross section of experts, clinicians, and community members about their lessons learned or thoughts on grieving. #grieving #bereavement #grief
Here are my initial thoughts:
Coping with loss is the essence of moving forward with a productive life. The finality of loss through death forces us to have to survive the loss of a loved one, while also to face our own mortality.
Of course, the value of personal psychotherapy provides the environment to work through this process and move forward. Most are familiar with Kubler Ross and her stages of grief including denial, anger, bargaining, depression, and acceptance. These were clinical phases observed by Kubler Ross in her breakthrough work with patients who were dying and their families. Her clinical process really seems to fit, but it never was research based. In particular, while widely accepted, it is not a linear process and people go through these phases in different ways and different rates.
Recently a neurological and biological understanding of grief focuses on studying the brain. A book by psychologist Mary Frances O’Connor (The Grieving brain: The Surprising Science of How We learn from love and science) takes this science based approach.
She addresses the important distinction between grief and grieving. While grief is a natural response to loss, grieving as noted by O’Connor is a form of learning. It is complex and continues as we have to meet attachment needs with the loss of our loved one. O’Connor notes how complex grieving is as our brain needs to also learn we can’t control the outcome of how things will turn out.
The science of specific neurons in the brain have to do with attachment as the brain encodes relationships. Yet I do not believe there will be a science of bereavement. While the pursuit of this science of the brain is always important, grieving is so complex and individualized that it always becomes psychological. People often ask me how long one grieves, possibly asking “how long am I going to feel this way,” or trying to understand how they can emerge into feeling unburdened. I have often responded from my own experience that the first year is the hardest, as you go through all the holidays and family gatherings without them. By the second year, you are more acclimated to them not being there.
Yet, even that is generic. So many other factors are involved: What was the age of the deceased? What was your relationship with them? Was it a sudden death or did you have time to prepare? Did you have closure on any conflicts with the loved one?
Some cases of loss of a loved one are even described as complicated bereavement. How do you grieve and resolve issues when you lose someone through an accident, suicide or homicide? Today’s dramatic increase in suicides and of shooting/homicides has created a traumatic society in which the stress of complicated grieving endures to the point of psychological breakdown. The psychological breakdown includes us as individuals and our communities and society as a whole.
One assignment for training workers in hospice care is to write their own obituary. I would be interested in a study that measures brain activity when a person performs this exercise. Maybe the results might convince me there is a science of bereavement.
What do you think? What are your lessons learned or thoughts? – Jay
Written by
Commentators
- Aleta Edwards
- Andrea Sugar
- Barry Aaronson, Ph.D.
- Behrooz Bernous, Ph.D., J.D.
- Beth A. M.
- Christine Shoemaker
- Colleen Cherry MS Child Life Specialist
- Danielle Slupesky
- David Shapiro
- Diana Griebell
- Dr. Rosa Thomas PhD
- Dr. Jay Slosar, Psychologist
- Froma Walsh
- Jennifer Maldonado, LCSW
- Jill Lloyd
- Julie Nierenberg
- Kathryn Daignault, M.A., C.A.S.
- Kathy Clair-Hayes, MA, MSW, LICSW
- Kimberly Thompson
- Lisa Larsen
- Mae Quigley
- Maria Montenegro
- Marsha Somers, PhD
- Michal Baghlani
- Misa Tsuruta, PhD
- Nikki Smith
- Paul M. Martin
- Stan Goldberg, Ph.D.
- Stephanie Smith
- Suzanne Lachmann
- Tara Hayes
- W. Larry Dandridge
I tend to see bereavement through the lens of attachment theory. There is a breadth of scientific literature that demonstrates how individuals with differing attachment styles experience loss in unique ways and are vulnerable to different forms of complicated bereavement. This research certainly aligns with my own clinical observations, which I ended up writing about in my recently published book called Personal Grief Rituals: Creating Unique Expressions of Loss and Meaningful Acts of Mourning https://www.routledge.com/Personal-Grief-Rituals-Creating-Unique-Expressions-of-Loss-and-Meaningful/Martin/p/book/9780815384120?gclid=CjwKCAjwv8qkBhAnEiwAkY-ahnfGqanaZA1sD9VbgAlyYtfgnbSlHwB07a3GkZFifhVWZdhXUULcexoC1UgQAvD_BwE
I'm glad to see this needed conversation --my work, from a systemic perspective, expands an individual/ dyadic lens to attend to the reverberations of a tragic death in family and social networks and how therapists can address relational complications to foster healing and resilience https://www.guilford.com/books/Complex-and-Traumatic-Loss/Froma-Walsh/9781462553020/summary
https://youtube.com/watch?v=rKAGb8XutJQ&feature=share I have shared some of my thoughts of grieving in the speech I gave on Memorial Day to veterans, veterans' family members, citizens, Gold Star family members, and others. See https://youtube.com/watch?v=rKAGb8XutJQ&feature=share
This is a difficult subject to study due to the great number of individual variables...age of survivor, age of decedent, death history, personal temperament, family culture.... I support 2-24 year old survivors of a death. This population has the added need of additional support after initial sessions, due to development and changes in understanding of death and its impact on their life and major life events creating re-grief. Despite all the variables, there are many constants in grief that can be tracked and studied, as well as the interventions used and their affect on emotions and somatic responses.
My " knowledge" on grief does not come from textbooks or scientific studies, rather through life itself and in the the work I do. I am upfront and personal with families, loved ones etc. on the grief "journey" as a grief support facilitator, as well as a 40 year hospice volunteer, a death doula, a celebrant, and end of life care guide . I've also experienced numerous deaths of loved ones from an early age, starting with my mom when I was 5 years old, and it has been a continuum ever since.... We all come from different faiths, cultures and backgrounds, there isn't a one size fits all approach to grief. I had someone in my grief support meeting ask " why do we have to grieve?" And that's a really good question... we may all have different answers. But to me grief is a necessary part of the human experience. After all, death is the inevitable truth for all of us. And like anything it depends on how you choose to see it. Some will never see anything positive through the experience, and then others will. To me it is necessary just as darkness is in order to appreciate/recognize light. The best thing we can do as a society is talk, share and be more open to accepting of each other's journey without judgment or labels.
For me, grief is a matter of integration. It will always be a part of who I am. I have "lost" both parents and my late husband in the span of a few years. While each of these deaths had its own unfolding, none was a sudden incident. I particularly resonate with David Kesler's next stage of grief, the making of meaning. I have done this and continue to do this in a variety of ways: I wrote and published a memoir about being with my dad in his dying time, I collected others' stories about death and dying and published those as an anthology, and now I work to train facilitators in the process of preparing for the end of life. Each of these tasks has served a great purpose in my own acceptance of and integration of grief as one ongoing aspect of my life story. Everyone will experience loss and grief, and we all benefit from the willingness to be in conversation about that. I dedicate my work to creating a shift in how our society perceives death, dying, grief and bereavement.
I always say that grief is the cost of love, and loving well, we grieve deeply. To go through grief is to go through a transition, a graduation into a new type of relationship with yourself and with the deceased. It requires a shift in identity. It requires lessons to be learned. As we challenge previously held identities and ideas, we shift neural pathways and I do think that would be expressed in neurological scanning. Neuroplasticity is very much a thing. I think a scientific approach and the psychological approach can be married into a transformative helping experience with a guide. As a death doula this is one of my goals; to be that guide.
As a psychotherapist, I see grief as a significant part of each and every person's life. I do not see grief in phases, however, I do see it as a wilderness that must be navigated through and is a concept that Dr. Alan Wolfelt identified. Grieving is a personal and tender experience that is so exquisitely unique to each individual, based on culture, ethnicity, beliefs, values, worldview, as well as physiological and psychological characteristics. We have also seen the impact of grief on animals when losing their own - it is clear they are in distress and often demonstrate their grief just as humans do. I see grief as a landscape that cannot be ignored or denied, but one that has to be gently and compassionately faced, without trying to go around it, above it, below it or underneath it - one must take the journey for themselves, WHILE creating meaning. Initially making meaning from a loss can be extremely difficult as it often takes unpredictable time and emotions. I believe that finding meaning through grief is what brings hope. This hope can also found through demonstrations of rituals, being a part of a group or community, honoring a loss in a special way, or in whatever capacity makes sense for each person, INCLUDING children.
As a secondary note of consideration: You state "People often ask me how long one grieves, possibly asking "how long am I going to feel this way," - this is a gap in the literature that my colleagues and I have identified. As a suggestion, it is a gap in need of filling and would be an excellent topic to pursue. 🙂
Hello, I have read your article and I am confused by a few points. First, you state, "Yet I do not believe there will be a science of bereavement" and then give your reason why "grieving is so complex and individualized that it always becomes psychological" However, at the end of your post, you state: "One assignment for training workers in hospice care is to write their own obituary. I would be interested in a study that measures brain activity when a person performs this exercise. Maybe the results might convince me there is a science of bereavement." There seem to be two different thoughts here - one is that you do not think there will ever be a science of bereavement but you would like to try and find it. If that is the case you may want to revise the "never" part of your first statement. Further, I am confused as to how measuring brain activity (assuming an fMRI-type study) of a person thinking about their own death connects to someone who is grieving. Can you give me your thoughts on this?
In my practice as a Hospice Social Worker, I have found educating people (SOs, family, caregivers) about grief as well as anticipatory grief helps people put a name to what they are feeling. There is comfort in knowing the difference between grieving what was and what will change in the future. Also, when I am lucky enough to attend death visits, I make each task as predictable as possible by informing loved ones what will happen. I assisted a wife in utter disbelief that hee husband has passed by encouraging her to hold his hands, his his face, hug him, tell him about favorite memories and things she was going to miss about him. I also invited her to take deep breaths as I pointed out all the signs that her husband had died. I invited her to give herself permission to acknowledge that he had died. She spent about 20 minutes talking to him and laying on top of him wailing and back to talking to him and kissing his face. Through this process, she was able to move from disbelief to acceptance by the time the mortuary transportation arrived. Before each new hurdle happened (informing her the transportation had arrived, inviting those gathered to say a prayer, etc), we talked and she wailed. But she had movement.
In my over 20 years of working with people living with grief, I have learned that each person’s process is unique. The grief phases noted by Kubler Ross add a structure, they are not experienced as linear. I often tell my clients, “If there was one way to grieve, it would have been on Oprah and we would all know how to do it.” I find that people do not have the basic understanding of how grief impacts their body. So I normalize the fatigue and exhaustion, the brain fog. I encourage people to rest, to take a break from work, to have better nutrition, to move their bodies, to allow their feelings to be what they are. COVID radically changed how people grieve. Many people could not have their traditional rituals and felt more alone and isolated. Those are the ways that we feel supported. I work with people to create their own ritual for saying goodbye. I encourage clients to write down their stories, the things they don’t want to forget about their loved one. And then, to share those stories. For it is in sharing the stories and our love of the person that died, that we allow their spirit to continue to be part of our lives.
A well written article by Dr. Slosar and I agree with his opinion that grieving is mostly a psychological work and a process that takes time and patience. However, seeing a therapist or grief counselor does help. In my opinion what complicates bereavement and grieving is that the loss triggers not only previous losses but also causes anxiety and fear of future losses. It is the combined and cumulative effects that complicate and prolong grieving in some cases. A well trained and experienced clinician, preferably with personal experience with grieving can not only help the process but can also help further emotional development in the grieving person.
wonderful article, thank you; I don't feel that measuring brain activity alone in the grieving will provide the answers in relation to the process of grieving, except with respect to grief or grieving's impacts on body. Content in relation to experience is another matter, far subtler, more nuanced and complex.
I am an End-of-Life Guide and an advocate of the Death Positive movement. I believe there are things we can do while we are still living that will result in a slightly smoother path of grief for our loved ones. Our society makes it taboo to freely talk about death. Talking about sex used to be frowned up and had a negative stigma and it only created harm in our society. Talking about death is healthy and through this, we can more easily fulfill a person’s wishes at their end of life and after death, which creates less stress on loved ones and makes the grieving process more manageable. I agree with you that bereavement and grief are very complicated and individualized. Healing is not a straight line; is is more of a chaotic, curvy, twisty path. I don’t think grief really ends, but rather we have to build are lives around it and lay the groundwork to move ahead through support and methods of healing. (ran out of space- I will chime in on writing own obituary in another comment- this was a homework assignment in one of my death doula training courses and it was enlightening!)
This was a wonderful article, and there are different kinds of grief and different circumstances. It is our price for loving and needing others. One aspect of complicated grief I see a lot is that of shame and perfectionistic based people. They feel that they failed somehow, should have been able to do something, and are so self-critical they cannot even reach the real grief issue. These people have an extra step in this extremely painful process. I have learned that helping people overcome the self-blame and shame is very powerful in that it enables people to go forward with the grieving process. So much anxiety I see is rooted in unacknowledged grief from the past, and so much in the present is complicated by self-blaming and judging. Psychotherapy can help tremendously in helping people through the stages of grief and help them find a way to accept and live and move forward even with the grief.
A repeated refrain in my work as a psychologist is "it's not what happens to you, it's what you believe about it." This is particularly evident in the grieving process surrounding pregnancy/neonatal loss. In these cases, there was little to no interaction between the grief-stricken person and the deceased ... the grief is over the loss of hopes, dreams, and plans. It is the loss of the anticipated future. This may sound as if grief is a purely selfish process (e.g., "I'm not grieving that my baby died, I'm grieving for myself") but we are not given the ability to step out of our own framework and view life in a purely objective manner. Religious communities have long acknowledged the selfish nature of grief, in that believers grieve despite firmly held beliefs that the beloved is in a "better place." Perhaps the most helpful thing we can do is to acknowledge that loss is an emotional, spiritual, and social wound, and that it is natural and inevitable that woundedness causes intense pain. I'm doubtful that identifying what stage of grief we're in ultimately matters to the healing process.
As a Hospice Social Worker and End-of-Life Doula I have learned that many variables effect how we humans grieve. It is holistic for both the patient and the loved ones and it depends greatly on where we are at physically, mentally, emotionally and spiritually also on important details such as sudden death or prolonged death, our relationship to the dying, how we deal with anticipatory grief, how we are able to communicate with the dying is also vey important. Most Americans say death is a subject people generally avoid according to research done by the Kaiser Family Foundation, 2016. Western society is so used to repressing our feelings and communications around grief and death and dying. Humans can anticipate their own death and the death of their loved ones. This anticipatory grief increases the intensity of the desire to bond between the dying and the loved one and creates a strong need to stay close to one another and need for communication we are taught Grief is all about intimacy and the loss of a very intimate relationship. Over the years I have learned how important it is to engage and encourage communication and memorable moments between loved ones and the dying. And more importantly to process it.
I see grief as an invitation to dive deeply into all that it means to be alive and human. Human nature pushes us to label, categorize, study and even pathologize that which makes us uncomfortable. Those intellectual pursuits are also handy distractions from really feeling the depth of the emotions that grief encompasses. Life and death are like the opposite sides of the same beautiful, perfectly rusted, ancient, messy, raw, divine coin. I invite people to develop a relationship with their grief and sorrow in the same way we aim to cultivate joy and gratitude in our daily lives. Holding gratitude in one hand and grief in the other, we can learn to balance ourselves in the present moment. For one cannot be in the light without casting a shadow.
Some other noteworthy facts about grieving and what promotes vs. hinders grieving are the other members in the family/friendship circle; what support will you have after the death, as in the case of a spouse and the loss of roles that person played/how they will be filled as well as other current life stressors - I'm sure most realize and agree with these. As for Kubler-Ross - even in terms of her work with terminal or dying patients, the process is not linear. I would argue that there's a cycling in and out of phases. Maybe more important for psychologists would be where you are in your own aging and health. That will have a big impact when considering whether on not to take on grieving clients. In terms of research, it could be productive to talk to those who have been given a terminal diagnosis (eg metastasized cancer) and measure brain activity while talking about it. Compare those who are proactive, hopeful , active in treatment/advocate for themselves and decline procedures and/or medications vs those who just accept whatever the "experts" tell them is next. Writing your own obituary, while anxiety provoking, for many is still a reality somewhere off in the future vs. someone w/ a terminal condition.
I tend to see grief/bereavement as central in psychopathology, whether the person is directly affected by it or not (like in depression). Loss seems to contribute to other psychological phenomena, such as anxiety or abuse, and can extend intergenerationally. And it is not only about loss of a loved one but also other kinds of losses - hope, status, expectations, etc. I often see people get stuck when they are not able to mourn their losses. Increasingly, people don`t take time to process losses, which is not a very good thing to happen. Like in my country (Japan), people used to take "kibiki," that is being absent from school/work for a few days when a relative passes away. Nowadays a lot of people don`t do it because they don`t want to (or can`t) miss work/school days. I wonder which is priority.
I feel my ability to assist my clients through the grieving process has been strengthened by my own personal experience with the sudden and unexpected loss of my mother. Kubler Ross' final book 'On Grief and Grieving' brought me comfort throughout this time, however I also leaned heavily on therapeutical approaches that I use with my clients. More specifically, ACT and Mindfulness. Although I initially struggled with the acceptance of her passing and got caught in the thought processes of what I could have done to prevent it, it was not until I moved into complete acceptance and mindful emotional regulation that I found I was able to transition through the grief process and focus on what she provided that I was thankful for. Thankful for the values she instilled in me that I am able to pass onto my children, therefore keeping her legacy alive. Additionally, reflecting on her ability to live through the loss of my twin sister at the age of 6 weeks while continuing to care for myself and my older sister gave me strength. I knew that if she was able to survive the loss of a child that I too would be able to survive the loss of her. Kubler Ross in my opinion was on point when she said that grief is about learning to live with loss.
I’ve come to understand grief in the adolescents with whom I’ve worked…and in my personal experiences recently…as a profound loss of safety and belonging. The safety of believing at some level that the other person will always be here is suddenly gone, and with it, the safety inherent in keeping oneself from truly knowing those we love are mortals all, as we ourselves are. A certain loss of belonging is particular to the relationship we no longer have and what it meant to us. Practices meaningful to us can restore a sense of safety and connection over time, perhaps a deeper sense for having done the honorable work of grief.
ERK never suggested these were linear stages. (Not phases) She also stated up front that her experiences were with the dying. Not the loved ones of the dying. Grief and bereavement are indeed messy and complicated. No two griefs are the same for anyone, each one shapes you for the next. The hardest hurdle for most clients I’ve worked with is learning that grief will never go away, you don’t “get over it.” But you learn to walk with it and allow it to become part of your heart. (After all, grief is love) Only once that can be accepted and we allow ourselves to walk with it instead of away from it, can we begin to heal.
Excellent article. Very helpful. Grieving many losses is a natural part of life, but a process many of us are not trained to cope with. Being raised in a Jewish culture, I found " sitting shiva" for 3 or 7 days for the death of a loved one or friend was very helpful. Guarded against isolating or denying the pain of losing someone important. I think of the healing process in Gestalt terms of figure/ ground. That is,I will never totally get over losing someone dear to me, but over time the sadness changes from the foreground of my thoughts to the background.As Jay so eloquently pointed out, that process is different for each individual.
In eight years as a bedside hospice volunteer, I served patients/families who were in Kubler-Ross’s various stages of grief. However, NONE--patients nor family members (400+)--followed the exact order and most had “missing” stages. In conversations with people who had a more intimate relationship with Elizabeth than me (A workshop with her for parents of disabled children) most doubted she intended the stages to be sequential. While I rely on neurology to explain how we remember, interpret, and react, I agree, that current neurological epistemology on grieving is too simplistic. As critical as I am of neurological theories, I don’t believe most psychotherapeutic approaches are much better. The underlaying approach I have always taken in my counseling of people who were dying and their families is that grief isn’t about the loss of a specific person, item, ability, etc., but rather the loss of the emotion that entity generated. https://bit.ly/3IAS7gw Focus on finding something that can regenerate the emotion (i.e., an activity that can create the calm felt by the actions of a caring partner) rather than the direct substitution (e.g., another partner) and you or your client is on the way to reducing the effects of the loss.
This article aims to do the impossible: help people anticipate how they might grieve, and it does so, valiantly. To me, the way you explain the grieving process gives it a kind of structure. In here, grieving is understood through different lenses depending on the way the death happened, and how you might be able to gauge your process based on yearly family traditions, for example. Yet you also acknowledge - and I wholeheartedly agree - that Kubler-Ross’ stages of grief gave us a way to look at and work with grief, and to reassure those we work with that these stages do not necessarily happen in order; not at all. I can’t help but think of an article I wrote for Psych Today where I use Kubler-Ross’ work as a springboard for my stages of grief, during a traumatic breakup. I’m going to post it here (if this site permits) because so much of what I describe about the stages of grief during breakup very much mirror the stages of grief during death (with just a few exceptions, like the person your grieving is still walking around in the world). This article offers a different way of viewing grief that complements the way grief is described here: https://www.psychologytoday.com/intl/blog/me-we/201406/the-7-stages-grieving-breakup?amp
The idea of studying grief is fraught with the perennial issue in psychological research of how to operationalize the concept. One of my clients connected me to the work of Hope Edelman, a qualitative researcher after my own heart. Her book, The After Grief, is anchored in 88 interviews, extensive review of the literature, and conversations with professionals. It yields a rich picture of grief, its forms, and the places it takes its keepers. How else do we glean what happens unless we explore it with those to whom it presents and are willing to take the journey of putting it into words? Edelman's work highlights the complexity of grief in myriad ways: its phases, its ties to joy and despair, its course and subtle presence. She helps reframe grief from a linear concept to one more like a spiral staircase. Operational definitions to study complex experiences must be anchored in qualitative work like Edelman's. By exploring grief through case studies, Edelman provides an opportunity to see the many pieces of the puzzle — how grief exists as a shared collective experience and a personal response. Through her work, we can better appreciate how it evolves and study it in productive ways to be meaningfully applied to our patients.
Thank you for the invitation to join in the discussion. Though we have not been in contact directly for many years, you remain an esteemed colleague, When we first interacted I saw you as a mature and established clinician while I was just beginning my career. Now I am probably older than you were then. When I thought to myself that it is wonderful you are still engaged professionally, something I actually also now say about myself, I am acknowledging that our time on the earth is finite. Things change. Careers finish. Marriages end. Sickness, old age, and death are inescapable. In Buddhism this is discussed in terms of emptiness (https://tricycle.org/magazine/what-do-buddhists-mean-when-they-talk-about-emptiness/) and given the term Śūnyatā. For me this philosophical contribution of Buddhism has been central to my own capacity to accept change and loss. Teaching and promoting Non-Attachment (https://www.originalbuddhas.com/blog/the-buddhas-philosophy-of-non-attachment-and-the-middle-way) has also become inextricably integrated in my work helping others overcome misery - both as Psychologist and as a Buddhist Practitioner. Along with that is another central Buddhist teaching - Compassion for Self and Others.
This is so poignant. Integration is my instrumental word for therapeutic change. I came across a quote that I use in my book but it was by Frank Lloyd Wright which I saw at an exhibit. He stated: Integration is the first essential. So he went on that before you design something you have to start with integration. Well, in order to move forward you have to integrate loss and all of life's changes. Congrats and kudos for your work !
Thank you, Dr. Jay.
I am attempting to have open discourse on these types of issues as I am not an expert. Hopefully experts can respond and add to the discourse. You note also a literature gap in how long one grieves. I would love to hear about this. All the best Jay Slosar
To your last point, perhaps explaining what's happening in the brain as a person grieves will help them understand why they are having certain feelings or cognitions. Some people relate to that through psychoeducation, and others find it irrelevant to their experience. Generally, though, we like to have explanations and answers to why we suffer. I suppose it would help if we explained it in ways that the person receiving the information could understand.
Stephanie Thank you for this feedback. Your dissection does provide me insight into my presentation and even conflict as I so want to (and with academic perspective) adhere to science and brain research. Yet I know from personal and professional experience how grief and grieving are so personal and unique. From this I want a deep human response of empathy and attachment. I don’t see the word “never” in my statement but rather “I do not believe”. I am currently reading The Body Keeps the Score which is about the brain and trauma but also about healing. I think this is a model that is in my thoughts---factual info about the brain with response and healing. But the example at the end does as you note provide a contradictory statement from my initial premise and reveals what I stated above. So as to brain research and activity, is the response in the brain the same for all persons whether it be thoughts of one’s own death or actual loss and grief? Or even the distinction between grief from a loss/death that has closure or a death that fits the categories of deaths of despair and is therefore much more traumatic for survivors? see 2nd post All the best Jay Slosar
Have you read Mary-Frances O'Connor's book "The Grieving Brain?" It is one of the best books I have read on the subject and she addresses some of the questions you are raising. Her thoughts revolve around visual maps and patterns created in the brain and how the patterns themselves (whatever they may be) are broken and cause trauma to the brain when a tragedy such as the death of a loved one occurs. "You note also a literature gap in how long one grieves. I would love to hear about this" - This could be related to O'Connor's thoughts...how long one takes to grieve could be based on how long it takes for the brain to re-pattern itself.
What a powerful case example, Thanks.
Ha! Yes Oprah. The impact on the body is an important point. Would love to hear more thoughts about that.
Thanks for sharing the process of carrying out this assignment. It reminds me of morbid humor we all use when there can be so much death around us. But what you describe is the existential reality of dying.
Re: Writing your own obituary. This was a real eye-opener! During my death doula training, we had an assignment to write our own obituaries and it was an amazing exercise. I first wrote a “typical one” listing my education, jobs, achievements, list of family members, etc. When I read it afterwards, I hated it. It felt like reading a resume and I thought, “Who really cares about awards and what I might have accomplished?”It made me think more about the people I will leave behind and how I would like act and treat others going forward during my lifetime. I then preceded to write a funny, low-key obituary that captured the essence of who I really am…”
Aleta the article is dated. I have updated research on perfectionism and made a 1 hour video that was gonna be a CE submission but haven't followed through on that. Look forward to hearing back form you. Jay Slosar https://www.ojp.gov/ncjrs/virtual-library/abstracts/importance-perfectionism-law-enforcement-suicide-suicide-and-law https://slosarconsulting.com/wp-content/uploads/2020/01/jay_slosar_role_of_perfectionism.pdf
Dr. Jay Slosar, PsychologistThank you!
Aleta. Your response is very interesting to me as you provide a clinical association with shame and perfectionism. I am quite aware and have written about perfectionism and its relationship to suicide. Its relationship to shame and then self blame is something I want to further consider. For my experience shame is often related to cultural background and the distinct differences about how different cultures respond to death and grieving. That said, every case is different and closure is an important factor to me in relation to shame. However, you present that shame may be related to self blame or self-critical response that they failed to do something that they feel may have prevented the outcome. Thus, I wonder if that is guilt. There is a notable difference in guilt and shame-- as shame is a deeper feeling and often called the hidden emotion. Still, you indicate the perfectionistic person is more susceptible to shame and this seems clinically a very important point. Thanks. I have an old article about Perfectionism and Law Enforcement suicide presented many years ago at Quantico/FBI symposium I can send you if you like. All the best, Jay Slosar
While shame has often been pathologized as categorically unhealthy, sometimes a sense of shame is healthy, such as feeling ashamed for causing harm to others. That from a Buddhist perspective is a healthy and adaptive form of shame, and can keep one on track in cultivating or reinforcing non-harming and empathic behaviors within the interdependent/interconnect matrix in which we naturally exist... ie golden rule.
Dr. Jay Slosar, PsychologistJay, please send the article. Yes, shame and guilt are different, but shame is about the self feeling unacceptable, not good enough or adequate, rather than a moral grief. I work with many who experience so much of life through the painful self lens. Sometimes even with divorce, shame is so strong the grief of loss cannot even be felt. It is so painful and sad. Shame based suicide is so very tragic maybe because it could be prevented. I think of shame as a terrible self-image problem that is very deep. By its nature it makes people not want to go there. It enters into so many emotional states. It's such a terrible feeling manifesting in different ways.
So true. There certainly can be tremendous growth in feeling more "alive and human."
Adolescents pose a real challenge/specialty. Thanks.
Hi Barry, great to hear from you. The support of culture and religion is so instrumental in coping with loss and allows one to avoid the isolation.
I think there are many variables. This includes closure, events surrounding the death, family dynamics and religious and cultural factors. There is a lot of listening to do for a clinician and many factors to consider to address grief and grieving.
EKR never suggested that they were linear stages. That's been misconstrued for decades now.
Sorry for the misunderstanding. My comments were directed toward the misinterpretations of her work in various sources, not your article.
Stan Goldberg, Ph.D. Are you referring to my article?’I go to great pains to emphasize that there is no “order.”
Thanks Suzanne and for sharing your personal example.
Thanks for this! This book and research sounds awesome.
David Great to hear from you. Your growth and wisdom are valuable contributions to grief ad grieving and coping to become a better person.
Awe...Thank you for your kind words Jay. The intersection is very interesting of our own personal growth journey with what we have to then share with those we serve. The first Buddha launched on his own spiritual journey when confronted by the inescapables of sicknoess, old age, and death. Following Enlightenment he then taught about the 4 Noble Truths - beginning with the realization that Life Is Suffering. There is no way around it, and actually it is the avoidance of suffering that leads to misery. The good news, though, is that we can wake up. In fact, I have come to realize that one awakens not despite confusion but actually the confusion is essential for Enlightenment. In the same way, one has to go through denial, anger, bargaining, and depression to come to acceptance. It isn't pleasant - but coming to acceptance (i.e. overcoming defensiveness and facing things as they are) creates opportunities for growth and positive change. This is our task as humans and helpers of other humans.
