Monday, November 30, 2009

On Grief, Healing and Resilience

[Note: Originally published in November, 2009, this post was updated on March 17, 2013]

Billed as “the largest and most dynamic gathering of women in the nation,” the California Women’s Conference launched its website in July 2009, as a way to extend the power and reach of the conference.  The 2009 conference included very moving talks by Katie Couric on Resilience and Maria Shriver on Grieving, as well as a Panel on Grief, Healing and Resilience.

Katie Couric's husband died in 1997 after a 9-month battle with colon cancer; her sister died four years after that. In her presentation, she described how she managed to find meaning after both these devastating losses, along with her struggles to "make it" in a man's world of broadcast journalism, all the while relying on her father's advice simply to "do your best."

When this conference was held in 2009, Maria Shriver was California's First Lady, wife of Governor Arnold Schwartzenager, and producer of the conference. She presented herself a bereaved daughter and niece, as both her mother (Eunice Shriver) and her uncle (Teddy Kennedy) had died within a few months of this event. She spoke vividly and movingly about her grief ("Every moment of every day I can feel my broken heart") and the pain of losing her mother ("My mother's death has brought me to my knees. Life without my mother is unimaginable to me.")

Moderated by Maria Shriver, the panel featured bereaved parents Elizabeth Edwards (now deceased ex-wife of Senator John Edwards), Susan St. James (actress and wife of NBC Sports chairman Dick Ebersol) and Lisa Niemi (widow of Patrick Swazye). Topics ranged from coping with anticipatory grief, letting go, feelings of disloyalty and guilt, grief triggers, and dealing with the insensitivity of others, to finding hope and making meaning out of loss. Their stories were powerful, compelling, uplifting and filled with hope. Watch Good Morning America’s brief overview of the panel presentation on YouTube: Women Dealing with Grief.

Tuesday, November 24, 2009

Engage With Grace, 2009

Some conversations are easier than others.

Last Thanksgiving weekend, many bloggers participated in the first documented blog rally to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:


Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality, and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways.


(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )

Advance Directives

[Reviewed and updated October 29, 2017]

In a segment entitled The Cost of Dying, 60 Minutes featured Ira Byock, MD, palliative care physician and author of the acclaimed books Dying Well and The Four Things That Matter Most. In this New Health Dialogue Blog post, Dr. Byock offers his thoughts on advance directives, arguing that physicians should be discussing these matters with all their adult patients, “whether these conversations are reimbursable or not.” See Health Care: Time for a Serious Discussion.

Your feedback is welcome! Please feel free to leave a comment or a question, or share a tip, a related article or a resource of your own in the Comments section below.
If you’d like Grief Healing Blog updates delivered right to your inbox, you’re cordially invited to subscribe to our weekly Grief Healing NewsletterSign up here

Saturday, November 21, 2009

An Invitation to Widowed Persons, from Soaring Spirits Loss Foundation

"Kick off the holiday season with hope by spending some time with Soaring Spirits Loss Foundation! We are planning parties in four different states to celebrate YOU! Widowed? Not looking forward to the holidays? Love someone who is widowed? Not sure how to help? Want to be inspired by the power of hope, and support a worthwhile cause at the same time? Join us at one of four uniquely fabulous locations, for great food, festive drinks, live music, silent auctions to get a jump on some gifts, support the programs of SSLF, and start the season off with a festive good time! Events will be held in: Los Angeles, CA 12/2 at 8:00PM. Austin, TX, 12/2 at 6:00PM, Seattle, WA 12/3 at 6:00PM, and Tribeca, NY 12/5 at 6:00PM. Send inquiry to [email protected] for event details in your area!"

Friday, November 20, 2009

Research Report: An Internet Tool to Normalize Grief

Researchers have studied the usefulness of an Internet-based self-help tool, Making Sense of Grief, which they designed to inform, educate and support recently bereaved individuals experiencing normal grief. Results suggest that the intervention had a measurable positive impact on the participants, with no ill effects noted during follow-up interviews. The study points to “the positive potential of the Internet to assist the bereaved in normalizing their grief and enhancing adaptive adjustment to life without the deceased.” [Dominick S, Irvine A, Beauchamp N , Seeley J, Nolen-Hoeksema S, Doka K and Bonanno G. An internet tool to normalize grief. OMEGA – Journal of Death and Dying. Vol. 60(1), 71-87, 2009-2010.]

Tuesday, November 17, 2009

Web Site: The Eldercare Support Group

Caring for her aging father is what inspired Shelley Webb to develop The Eldercare Support Group,  along with her blog and bi-weekly newsletter, Taking Care of the Folks.  Using her own experience as a care giver as well as her education and training as a registered nurse, Shelley offers encouragement, empathy, education and effective strategies to enrich the lives of others caring for elder loved ones.  Included are helpful articles addressing various aspects of care-giving for the elderly, including self-care, money and legal issues as well as activities and health.  Visitors are welcome to subscribe to her (free) bi-weekly e-zine and download her special report, 12 Things You MUST Do To Stay Healthy and Sane While Caring for Your Aging Parents.   “You and I are on the same journey,” Shelley tells her visitors, “and together we can find the joy in caring for our loved one.”

Monday, November 16, 2009

Web Site: The Heartlight Tree

Carla Blowey, bereaved mother and author of Dreaming Kevin: The Path to Healing, invites you to send an ornament in memory of a child who has died, to be placed on The Heartlight Tree this holiday season. This is an opportunity to let your lovelight shine, for your own child or for any child who has died and blessed your life. To learn how you can share your lovelight, visit The Heartlight Tree.

Article about Abandonment and Grief

Having recently learned of the death of the mother who abandoned her in early childhood, a woman asks, “Where is a grief support group for me?” Mother Loss And The Grief of Abandonment

Sunday, November 15, 2009

Interview, Are We Medicating Normal Grief?

Source
[Reviewed and updated November 6, 2017]

In this informative interview with Open to Hope founders Drs. Heidi and Gloria Horsley, Dr. Richard Dew discusses the potential overuse of antidepressant and anti-anxiety medication in grief. Speaking from his own experience not only as a physician but also as a bereaved parent himself, Dr. Dew notes that

• While the sorrow of grief is normal and to be expected, studies indicate that clinical depression is likely to occur in only 30-35% of bereaved parents; the other 70% will not experience the type of depression that calls for prescribed medication.

• Doctors should avoid prescribing antidepressants and anti-anxiety agents for newly bereaved parents, at least for the first 2-3 months following the death of a child. After that, if symptoms warrant it, a trial may be indicated – with the understanding that medication will not remove the grief; it only makes it more bearable.

• Studies show that 13% of those with a prior history of clinical depression will develop depression following the death of a child.

• Indications for antidepressant medication include inability to function and / or a history of depression prior to the death of a child.

• The newer antidepressant medications are far safer than their predecessors; they are neither addictive, nor lethal if taken as an overdose.

• Bereaved parents are wise to look for a counselor or therapist who is knowledgeable about and experienced in working with normal grief.

Listen to the entire interview here: Where Sadness Ends and Depression Begins

Your feedback is welcome! Please feel free to leave a comment or a question, or share a tip, a related article or a resource of your own in the Comments section below.
If you’d like Grief Healing Blog updates delivered right to your inbox, you’re cordially invited to subscribe to our weekly Grief Healing Newsletter. Sign up here.

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Friday, November 13, 2009

Web Site: Custom Crafted Songs

Psychologist and award-winning singer/songwriter Anna Huckabee Tull enables mourners to give voice to their grief through beautiful custom-crafted songs of love and loss. Following an in-person or telephone interview during which she captures the essence of the person’s message and story, Anna reviews with her client the lyrics and rough-cut recording. Upon completion of the process (which takes from 3 to 6 weeks), the client receives a studio-recorded CD of the song, a lyric sheet, an originally designed and signed CD cover with lyrics, and coaching “on making your most successful ‘presentation’ of the song.” Anna's Web site, Custom Crafted Songs also features the Song of the Month, where you can listen to her songs, view the lyrics, and read the stories behind the songs.

Tuesday, November 10, 2009

Articles on Caring for Wounded Soldiers

The Armed Forces Services Corporation is asking for help in gathering information for their Wounded Warrier Caregiver Project. In response to their request for information on compassion fatigue for the soldier's caregiver, Executive Director of Gift from Within Joyce Boaz put together two articles she thought would be useful for loved ones caring for their wounded soldiers. They are written by Gift from Within Board Member Dr. Angie Panos, who asks that her articles be shared with all of us:

Preventing Compassion Fatigue: What Veteran Spouse/Partner Caregivers Need To Know

Keeping Your Relationship Healthy When Your Veteran Spouse/Partner Is Injured

Additional Articles On Compassion Fatigue:

Charles Figley, Ph.D., The Art and Science of Caring for Others without Forgetting Self-Care

Janice Harris Lord, ACSW How to Provide Spiritually Sensitive Trauma Care

Angie Panos, Ph.D., Supporting Our Soldiers-PTSD Info For Chaplains

Angie Panos, Ph.D., Understanding and Preventing Compassion Fatigue - A Handout - For Professionals

Supporting Grieving Families after Fort Hood Tragedy

Through her work in the Public Affairs Office of TAPS, the Tragedy Assistance Program for Survivors, and through her own experience as the sister of a fallen soldier, Ami Neiberger Miller is well qualified to offer practical suggestions for expressing sympathy and support to the families affected by the horrific shootings at Fort Hood last week: How to Support Families Grieving after Fort Hood Tragedy. See also Fort Hood Tragedy: How You Can Help Right Now

Saturday, November 7, 2009

Anticipatory Grief and Mourning

[Reviewed and updated November 2, 2017.]

Grief does not wait for death to happen; it occurs both in anticipation of and following a loss. Extended illness, disability, severe accidental injury, a terminal diagnosis or the aging and decline of an elderly family member can produce what is known as anticipatory grief and mourning. We find ourselves reacting and continually adapting not only to an expected loss, but to all the losses – past, present, and future – that are encountered in that experience.

Anticipatory mourning begins as soon as we become aware that death may happen. It begins when a life-threatening illness is diagnosed or a terminal prognosis is given, we understand that there is no cure, and we realize that death is likely or inevitable.

Issues of grief and loss are inherent in the care-giving process, and grief is experienced by everyone involved – whether we are the patient grappling with the illness or disability, or the family member, partner, close friend or care giver who is intimately connected with and looking after our loved one. We are coping not only with our own feelings of grief and loss, but also with physical and mental fatigue, and we may feel overwhelmed with all the financial, legal, medical and personal responsibilities associated with care-giving.

In some ways, anticipatory mourning can be harder than the grief we experience after the death, because when we are waiting for the death to happen, we are on constant alert, living in a state of emergency over an extended period of time.

On the other hand, this period offers the benefit of preparation time, as we and those close to us begin to think about our life without the one who is dying, and how we and our loved one can use the time remaining to reflect, to prepare for the future, and to finish unfinished business.

Suggestions for coping:

•Recognize that, in the beginning, it is normal to feel shocked, dismayed, helpless and numb, especially if the onset of the illness is sudden or unexpected. You need time to take in this most unwelcome news, at a pace that is tolerable for you.

•If you have the time and the skills, use the Internet to research the latest developments concerning the illness. List medical specialists conducting studies or research on the disease or condition. Locate local support groups related to the illness.

Investigate and reach out for available help and community support. Assemble a team of family, friends, clergy, neighbors, colleagues, health professionals, home health care and housekeeping services, church and other volunteer organizations. Explore care-giving resources on the Web, such as those listed on the Caregiving Links page of my Grief Healing website.

Contact your local hospice at any time to inquire about hospice services; it is not necessary to wait until treatment aimed at cure is replaced with the goal of comfort and symptom relief. The best time to learn about end-of-life care is well in advance, when educated decisions can be made based on the input of everyone involved. The hospice staff will contact your doctor to determine if and when a referral to hospice is appropriate. Alternatively, you can talk with your loved one’s doctor directly, and he or she can make a referral to hospice. (To locate a hospice near you, see Find a Hospice or Palliative Care Program.)

Have emergency phone numbers and important resources readily available (legal, insurance, medical, financial, home repair).

Identify what needs to be done, and find help to do it (errands, grocery shopping, household repairs and maintenance, transportation, housecleaning, prescription pick-ups).

Follow the lead of the person who is dying, as a unique individual experiencing illness in a personal way, and choosing whether to openly discuss the illness and impending death.

Encourage – but do not force – open, honest communication among care givers, family members, friends, and the one who is dying. Recognize and respect the fact that some individuals may not be able or willing to talk about the reality of the illness and its probable course, either at the present time or with certain other persons or family members. Know that it is natural to take in the reality of a terminal diagnosis gradually, as facing it all at once is overwhelming. Listen without judging, giving others permission to express their thoughts and feelings about the illness without fear of criticism. Let others know how you are feeling and what you need.

Remember that this time for warmth, sharing and togetherness will not come again. Although communication may be frustrating and painful, now is the time to contemplate and clear up unresolved issues – to say, do and share what is especially intimate and meaningful, in a positive, affirming and encouraging manner.

Allow for the expression of difficult feelings by using alternative communication tools, such as letters, video- or audiotapes.

Anticipate the family’s new reality after the death, and do what you can to help the dying person complete end-of-life tasks (last will and testament, distribution of possessions, funeral preparation, gathering and safeguarding important documents such as medical, legal, and family papers).

Expect changes in the ways family members interact with one another. As the illness progresses, roles will shift. Responsibilities formerly held by the dying person will be reassigned, and everyone must adjust to those changes. Maintaining some of the normal family routines will help to provide security in the midst of all the chaos.

Let some details slide. Slow down, and focus on what is most important. Remember that the emotions that seem to have taken over your life right now will not last forever, and the rest of your life will not seem so sad and overwhelming.

Practice good self-care. Pay attention to your family’s needs for adequate rest, nutrition, exercise, recreation, respite, and fun. In your efforts to remain strong and care for the dying person, don’t let your own physical, emotional and spiritual needs, or the needs of other family members (especially children), get lost or neglected. Keep a journal or a diary; seek individual counseling; find and participate in an in-person or online support group for care givers.

Embrace and express your spiritual beliefs, if faith is important to you and your family. Turn to those spiritual practices that bring comfort, peace, and hope: prayer, meditation, listening to your inner voice, reading, attending religious services. Recognize that, under these circumstances, it is not at all unusual to feel angry at the doctors, at the one who is dying, or at God for the injustice of it all. If there are some things you prefer to discuss with someone outside the family, talk with a pastoral counselor or spiritual advisor. Find someone you trust who will not judge you, and who will listen to whatever thoughts and feelings you may need to explore.

What if the one who is dying is a child?

Give yourself time to confront the harsh reality that, as unfair and unnatural as it seems, the child is terminally ill and will not recover. Parents do not expect to outlive their children – it goes against the natural order of things. It is extremely difficult to process and accept the fact that a beloved, innocent child is dying.

Follow the child’s lead. Listen first, and do what you can to support and encourage open and honest communication with the child and among family members. Answer only what is asked, but be meticulously honest, using language at the child’s level of development and understanding. Lying to children in an effort to protect them from the truth of their condition is neither respectful nor loving, and can lead to confusion, frustration, mistrust and anger.

Pay attention to questions, statements or behaviors that may suggest a child’s trying indirectly to communicate other needs, questions or concerns.

Help the dying child live, laugh and play as happily and as normally as possible. Spend as much time together as you can. Help to maintain relationships and contact with peers through play dates, visits, phone calls, letters, cards and e-mail.

Remember the needs of the dying child’s siblings.

Do what you can to support and nurture other family members and close friends.

Find and utilize all available sources of support (Make-a-Wish Foundation, Candlelighters Childhood Cancer Foundation, and others).

Your feedback is welcome! Please feel free to leave a comment or a question, or share a tip, a related article or a resource of your own in the Comments section below.
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Tuesday, November 3, 2009

November Is National Hospice Month

November is National Hospice Month: an opportunity to educate ourselves about the benefits of hospice, to better understand end-of-life issues, and to recognize the invaluable contributions of caregivers. Learn more here: Hospice Foundation of America

Monday, November 2, 2009

Losing a Cherished Pet: Myths and Misconceptions

[Reviewed and updated October 23, 2017]

Unfortunately, since the normal life span of most animals is so much shorter than our own, sooner or later most animal lovers will experience the loss of a beloved pet. Whether struggling with an animal’s chronic illness, facing a decision about euthanasia, or mourning the loss of a pet, our reactions may be so intense that we feel shocked and overwhelmed by them.

Yet grief at the loss of a beloved companion animal is no different from that of losing a cherished friend or special member of the family. Grief is a natural, spontaneous response to the loss of a significant relationship.

Even so, in my work with bereaved animal lovers and in conversations with family, friends and colleagues, I've still encountered a number of myths and misconceptions surrounding this different sort of grief. Here are just a few of them:

There is nothing special about the relationship between animals and humans. Your relationship with a companion animal can be just as special and loving as those you have with any other family member or close friend. Loving an animal is different from loving a human being, because a pet loves you in a way that people cannot: profoundly, boundlessly and unconditionally.

Losing an animal is less painful and less significant than losing a human loved one. Pain over the loss of a beloved companion animal is as natural as the pain you would feel over the loss of any significant relationship. Since cherished pets weave their way into every aspect of your daily life, in some ways it may be even more difficult to cope with losing them. Once they're gone, you're repeatedly encountering evidence of their absence and constantly reminded of your grief.

Having close relationships with animals (and grieving at their loss) is abnormal and unnatural. You need not let anyone influence you to believe that your relationships with animals are somehow wrong or less important than those you have with humans. Loving animals well and responsibly teaches all of us to better love all living beings, including humans. Grief is the normal response to losing someone you love, and grief is indifferent to the species of the one who is lost. Love is love, loss is loss, and pain is pain.

Relationships we have with animals are not as important as those we have with humans. Having deeply meaningful, spiritual and healthy relationships with animals is not abnormal, and in some cases may be more emotionally healthy, spiritually healing and personally rewarding than those we have with humans. Pets offer us a kind of loyalty, devotion and unconditional love that cannot be found in the more complicated relationships we have with relatives, friends and neighbors.

Death of a pet can be a useful “dress rehearsal” for the real thing, especially for children. Death of a pet is often a child's first real encounter with a major loss. Suddenly friendship, companionship, loyalty, support and unconditional love are replaced with overwhelming and unfamiliar feelings of loss, confusion, emptiness, fear and grief. Far from being a so-called dress rehearsal, for most children pet loss is a profoundly painful experience.

Most people think of euthanasia as a quick and easy way to get rid of their sick, dying, old or unwanted animals. Deciding when and whether to euthanize a beloved pet is probably one of the most difficult choices an animal lover ever has to make. On the one hand, you know that choosing to end your animal's life will intensify your own emotional pain, yet postponing the decision may prolong your animal's pain and suffering needlessly. At such times it is very important to explore all aspects of the euthanasia decision with your veterinarian and with others whom you trust, to listen to what your animal may be trying to tell you, and to trust your own intuition.

Conducting rituals, funerals or memorial services for dead animals is a frivolous waste of time and money, and those who engage in such practices are eccentric and strange. Whether for animals or for humans, death ceremonies and rituals help meet our needs to support one another in grief, acknowledge the important role our loved ones played in our lives, honor the memory of our departed companions, and bring meaning to our loss.

Your feedback is welcome! Please feel free to leave a comment or a question, or share a tip, a related article or a resource of your own in the Comments section below.
If you’d like Grief Healing Blog updates delivered right to your inbox, you’re cordially invited to subscribe to our weekly Grief Healing NewsletterSign up here


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