Thursday, May 06, 2010

What a Chaplain Has Learned About Grief, Part 1

I wrote this several years ago to present to an adult Sunday School class.  I have used it since to share with a parish visitation group and a parish that lost its church to arson.  I have recently revised it and thought I would share it here.  This is the first installment.

I'm going to share with you my thoughts out of almost thirty years as a chaplain.  Much of what I tell you will seem trivially true: you've heard it before. However, it is also my experience that these things are worth hearing again. When the times come that we need them, it's worthwhile to have these things well reinforced.

1.  You are going to grieve.

It's not a matter of "if" but of "when." Grief is the natural emotional and intellectual response to loss, and all of us will lose something or someone some time.

This also means that there is no escaping the process: once the loss occurs you are going to grieve, whether you want to or not. Not all losses will be equal, and so grief will not be the same every time. But in some way appropriate to each loss you will grieve.

2.  Every person has to grieve in his or her own way.

This is important for us to remember. When we're grieving it's very freeing that we can do what we need to do, whether it suits anyone else or not. 

Of course, even this blanket permission has its limits. It is very important not to deliberately injure yourself or another when you grieve. It is also possible for grief to make you dysfunctional, emotionally and intellectually "stuck." 

I will say more about that. However, in general you have permission grieve as you need to.

This is also important to us as we care for someone who is grieving. We can't expect a person to somehow "grieve right," to meet our set of expectations of how that grief should be. 

Folks in health care are as bad about this as anyone. We've read the articles, we know the studies, and we think we know what "normal" or "healthy" or "appropriate" grief is.  In fact, "normal' is a pretty broad range. As long as the person isn't doing harm to self or to another, or isn't so stuck they can't function, things are probably all right.

3.  Important grief will not happen fast.
More than a decade ago I was in conversation with a medical resident about a patient. The patient, according to the resident, was demonstrating unhealthy grief. The patient was still grieving a death after six months! I had to teach the resident what we knew then: that for an important loss it was within the range of normal to still be grieving actively a year later. 

I say "what we knew then," because in fact we know now that for a significant loss - death of a spouse or a child –active grieving may continue for three years.  And some losses – divorce when there are children is the best example - can raise feelings of grief for much longer, as new losses resurface old losses.  As I’ve said, the time and process of grieving will be appropriate for each person, and appropriate for the loss suffered.  Time is not the best measure. 

A better measure is some sense of "healthy," and the best measure of healthy is "functional." And this is the best guide to "functional:” as time passes, is the person becoming more able to do, first, what he or she has to do, and then what he or she wants to do? Again, this is not what we think the person needs or wants to do, but what that person needs and chooses to do.

4.  Forget stages.
Years ago now Dr. Elizabeth Kubler-Ross published her famous book, On Death and Dying.  Over the years it's become something of a standard, and it's easy to see why. Its five stages of grieving are clear, handy, and easy to remember. It's something all of us have learned.

Sadly, it's wrong; or if not wrong, it's usefulness is not nearly as universal as has been portrayed. It's wrong in large part because it only considered one group of grieving people and one sort of loss. For most people in most circumstances her scheme is too cut and dry.

Now, to her credit let me say that she does say some things helpful in what we call "anticipatory grief." That is, the grieving we can do when we know a loss is coming, but it hasn't happened yet. She was working with patients who had a terminal diagnosis. Knowing they were going to die, they did grieve, and they did experience the feelings she describe: shock and denial, anger, bargaining, depression, and, at least in most cases, acceptance.

However, I think there's a lot more to be said.  First, while they all felt those feelings, the list too limited. In fact persons in grief, whether it's ahead of the loss or after the loss, feel a wide range of emotions that includes those, but also includes sadness and frustration and fear and sometimes even happiness and relief. I would suggest a better book is Good Grief by the late Granger Westberg, in which he describes a wider variety of feelings and experiences for the grieving person.

Second, it's too pat to think of these as stages.  Grief is not a clean, step-by-step process in which one experience is left behind when you enter the next stage. Rather, on any given day when you're grieving you may experience any of these feelings. The process of grieving doesn't fit into a pattern, and you may well feel some acceptance or stability one day, and raging anger the next. 

What I think one can say is that early on there will be more bad days than good, when there are good days at all.  But over time the balance will shift, and good days will come to outnumber bad.

Let me say one other thing about anticipatory grief.  There is only so much grief work you can do ahead of time.  You will certainly begin grieving once you know the loss is coming, and you may well reach some level of stability.  You will still feel again the shock, if not the denial, and a lot of sadness when the loss actually arrives.

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