KNOW THYSELF
Are you the life of the party, or are you more comfortable in a quiet corner with one or two friends?
Are you spontaneous or inclined to think things out before acting?
Do you weep at insurance commercials, or are you loath to show emotion, especially in public?
Are you a whiz at math but can’t stand English, or vice versa?
Are you a hugger, or do you prefer to maintain strong physical boundaries with other people?
Do you like classic rock or jazz?
We could go on and on. Fortunately, there is no right answer to any of these questions. We humans are all wired so differently, and those unique traits and ways of interacting with the world do not change when we have suffered a loss. This is another factor that the stages of grief and other popular theories fail to take into account. Our current psychological and cultural ideas of grief need an overhaul, in no small part because they continue to emphasize a one-size-fits-all approach, even as we recognize the extent to which our individuality shapes the way we deal with stress and pain.
Beginning with Freud and for decades hence, the dominant theories about how humans function were “deterministic”; they assumed that we were driven by unconscious dynamics or primitive, animal-like responses to external stimuli. That line of thinking greatly influenced one-size-fits-all grief theorists, from Freud to Kübler-Ross and beyond.
But roughly forty years ago, when I was in training, another way of looking at why we do what we do had found its place in psychological schools of thought. Humanistic theory and therapy emphasized the uniqueness, wholeness, and personal power of each individual. Humanistic therapy focuses on personal experience as a means of determining what a person needs in order to work through his or her problems. The idea seemed to offer the possibility of more flexibility in grief counseling.
Historically, extroverts and emotive people have been seen as the healthy ones. Woe to the quieter individuals who were cautious and shy around other people and who tended to internalize their feelings. In the past, these folks were said to be “repressing.” But more and more clinicians are now embracing the notion that differences in personality are — except in extreme cases — totally benign, totally okay. Although the old deterministic school still tends to prevail, it is more and more acceptable to be an introvert, or a person more prone to thinking than overtly feeling. Today hundreds of “type” tests help describe personality without labeling someone as healthy or unhealthy.
Knowing yourself and understanding your unique way of interacting with the world is very important as you seek to reduce the anxiety or shame that comes from feeling that you have to get grief right. Your personality, life experiences, and wiring will dictate, to a significant degree, how you experience loss and what you need from yourself and others as grieving unfolds. You will learn your unique “normal.”
Take a few minutes now to set this book aside and close your eyes. After a few deep breaths, focus on your feelings, particularly with regard to your loss. Notice what you feel and, if possible, where in your body your feelings seem to reside. Now think of how you would be most comfortable expressing those feelings. Maybe it’s by talking to a friend. Maybe it’s by going for a run, or writing in your journal, or listening to music, or screaming into a pillow, or praying, or meditating, or doing yoga, or attending a support group.
Think about how your basic personality type might influence how you grieve. Do you crave interaction with others, or do you prefer to be alone? Is it more important for you to understand or to feel? Do you feel compelled, as many these days do, to read everything you can find about grief? Do you feel the need to express and honor your grief by serving others — volunteering at a children’s hospital, food pantry, or nursing home? Some people need to write or to blog. Some need to sit in a special chair. Some need to arrange a photo album. Some need to donate money or become involved in a cause. Some need to ritualize their grief — light the same candle every night or visit the cemetery once a week. All of these can be healthy mourning behaviors according to a person’s sense of what they need and who they are.
When you’ve opened your eyes, it might be helpful to jot down your feelings and thoughts in your journal. And again, know this: no one else will feel the way you do or will seek to express those feelings in the same way. Write that sentence down. Claim it. Also know that if you repeat this exercise a year from now, the feelings and ways of expressing them will be different. You are dynamic and changing, and so is your experience of your loss.
In the majority of cases, what people feel or experience as they grieve is normal and healthy, but how they express it might not be. Avoiding behaviors that don’t serve you is another way to stay connected to your grief. The goal is to stay present to your grief story, as painful as it might be, and to try not to run from it. However you might try to escape, grief will be waiting for you, in one form or another.
As I said in chapter 1, immediately after Ryan’s death, I engaged in more than my share of escape behaviors. Even today, I know I tend to overeat and don’t get enough sleep when I’ve suffered a loss. I don’t need to gain ten pounds every time someone dies, but it’s a big struggle for me to manage my food intake and my sleep when I’m feeling the inevitable pain of grief.
Granted, for a person in the throes of mourning, some numbing out and distraction are necessary. That’s why God created crossword puzzles, golf, gardening, coffee shops, and movies (preferably comedies). What are your healthy distractions? The key is to distinguish healthy distractions — activities that allow you to pause your feelings for a moment, so that you are able to come back and be truly present with them later — from activities you are doing to suppress or avoid painful or uncomfortable feelings. And you are the only one who knows the difference.
I try to help my clients achieve a sense of balance. I would never say don’t go shopping or have a glass of wine or relax in front of the television. But mindlessly watching seven hours of football or ten straight episodes of Game of Thrones might be another story. As is having a third glass of wine or mindlessly maxing out your credit card in a shopping binge.
A client who had recently lost his spouse complained to me that he spent half of his workday lost in thought about his loss or surfing the Internet. He needed to get back to being more productive. So we worked out a program.
“Let’s not go for a hundred percent concentration,” I said. “What would eighty percent of the day look like?” It looked a lot more productive and satisfying, as it turned out.
I also suggest to clients that for every hour they spend watching TV, they spend a half hour journaling about their loss.
Don’t beat yourself up if you have that extra piece of cake or second glass of wine. Just try to turn back to the healthier ways of coping. If the compulsion to act in unhealthy ways gets to be overwhelming, find an “accountability partner.” The very act of reaching out to a trusted person often creates the comfort you seek and deflates the desire to act in a self-defeating way.
It’s equally important to remember that, just as you deserve to feel and express yourself according to your own desires and personality, those around you have the same need. It is indeed a challenge to honor your own feelings while making room in your heart for the unique coping styles of others, especially those closest to you. The inability to do so has been the source of much added stress for couples and families mourning the same loss.
My clients John and Liz are a good example of how our differences in this area can cause problems. Their marriage had been a long and happy one; as they sat in my office, holding hands, it was clear that they still adored each other. But it was also obvious that they occupied opposite ends of the personality spectrum. John was a successful real estate agent and looked and dressed the part. His charisma filled a room. Liz was pleasant, but very quiet, and chose her words carefully.
They had successfully negotiated their differences over the years. But their ability to do so had broken down after their son had died from complications of HIV. Both were devastated and concerned about the impact of the loss on their other children. But that was not why they sought me out. John and Liz felt increasingly distant from each other — so much so that they worried their marriage was at risk.
Arguments had gotten more frequent. She resented that he was rarely home. When he wasn’t working, he channeled his sorrow into volunteer work for HIV-related causes. He loved to tell stories about his son and wept openly when he did. Liz grieved privately and more analytically. She read several books on grief and poured her feelings into a journal, but she was far less outwardly emotional than her husband. That left her vulnerable to his judgment, which she resented. She was also lonely.
He felt he was dealing with his grief more authentically. In fact, John wondered whether Liz was grieving at all. He and his wife had expected to lean on each other after their son’s death, but tension and resentment often obscured their sorrow.
“I can’t stand the idea of losing her, too,” the tearful husband told me in our first session.
“I feel the same way,” Liz said.
I was quickly able to broaden their perspective.
“I’ve heard your story many times before,” I said.
“You have?” Liz said.
“This is tricky, and I won’t lie to you — a lot of marriages don’t survive because of the kinds of issues you’re facing now,” I said. “But I don’t see that here. You are two very different people, but you’ve made that work. Those differences have been a strength of your marriage, not a weakness. Am I right?”
John smiled.
“Yin and yang,” he said.
Liz laughed.
“We still haven’t figured out which is which,” she said.
“Now you’ve both suffered a loss so terrible that you assumed it would be different this time,” I said. “Yet as hard as this has been, you are both still who you are. That doesn’t mean one of you is grieving right, and the other is grieving wrong.”
The tension between them evaporated immediately. They were able to connect better in their mutual mourning by remembering and reaccepting their differences. I never saw them again.
The same dynamic plays out again and again for couples who have suffered loss. In the mid-1980s, for my doctoral dissertation, I interviewed ten couples who had recently experienced the loss of a baby to sudden infant death syndrome (SIDS). My research sought to evaluate the impact of such a tragedy on marriage.
I was amazed by the uniformity of what I heard. Every couple I interviewed had reached a crisis point in their relationship because they had either failed to acknowledge or had misinterpreted their partner’s unique way of grieving. He thought she didn’t need him because she spent so much time talking with friends. She thought he didn’t care because he was more withdrawn and showed less emotion. They weren’t naming their differences; instead, they were running with their unchecked narratives of what they thought the other was doing.
The remedy was communication.
“I know you need space, but there are times I need to be close to you.”
“I know you need to talk to your friends, but I need for you to talk to me, too. Can we find a middle ground so both of us can get our needs met better?”
Of course, the same challenges present themselves whenever people grieve in community. If I see a family of five grieving the death of a mother, I expect five different expressions of mourning, though there is typically some overlap. In such cases, it takes wisdom and compassion to make room for each person to grieve in their own way and to know that there are limits to how family members can support each other when everyone is doubled over from loss.
Several years ago, I was asked to help support members of a neonatal unit at a nearby hospital where the medical team had unexpectedly lost a patient. The nurses and technicians — men and women — were visibly distraught and eager to share their feelings. But as we sat together initially, the doctor who led the team never lifted his eyes from an open textbook. The tension was obvious. Tearful nurses spoke of the death and glanced at the doctor, who sat impassively, looking down. I addressed the tension in the room.
It’s important to explore both the medical reasons for this baby’s death and your feelings about it. And all of you need to process what has happened in your own way. Some folks are more emotional and need to talk. With something like this, others need to understand what happened medically. But wherever you are, let’s put the medicine aside for now. You all can meet again later to discuss that part of it. But I don’t think we can address that and your sadness and upset at the same time.
It was pretty clear to everyone who my comments were addressed to. The doctor closed his book and looked around at his staff.
“You’re right. I’m sorry,” he said. “We can talk the medicine later.”
“Thank you, Doctor,” a nurse said. “We know baby Brian’s death was hard on you, too.”
“It was,” he said. “I guess you never get used to it.”
The energy in the room shifted with those few words, with the tacit acknowledgment by that nurse that the loss was heartbreaking for the doctor, too, though he might show it differently.
The doctor’s behavior, which others felt was insensitive and off-putting, was, in reality, just different. To deal with his pain, the doctor most needed to explore whether a mistake had been made, whether he and his team had done all they could to save their young patient. What he wrestled with was a sense of responsibility and guilt. Other team members needed to examine those things, too, but their priority was to address the feelings of loss that had been brought on by their love for the baby and his family.
The group eventually got to a place of accepting that they were all struggling, just not about the same things at the same time. With that acknowledgment, the team came together. The staff felt safe to speak of their sorrows, or not speak of them, in their own ways.
Notice the subtle but important differences in the terms used to describe loss. Grief and mourning are often used interchangeably, but they actually speak to different parts of the experience. The definition of grief is “sorrow or mental anguish resulting from loss.” In other words, it is a noun that describes the feelings.1 Mourning is a verb that describes the act of expressing grief. As leading grief expert Alan Wolfelt put it, “Grief is what we think and feel inside after a loss. Mourning . . . is the expression of our thoughts and feelings outside of ourselves.”2
So is it possible to grieve and not mourn? To feel sorrow but not express it some way? Shakespeare had an opinion. “Give sorrow words,” the bard wrote. “[T]he grief that does not speak / Whispers the o’er-fraught heart and bids it break.”3 But speaking our sorrow is not the only way to mourn. There is also prayer, meditation, listening to music, singing, journaling, and the many other examples cited earlier in this chapter. You can add any number of your own. I know a woman who rarely spoke of her loss but visited her husband’s grave every day. She was certainly mourning.
Is there a wrong way to grieve? That question has been a preoccupation of my profession since Freud. By definition, pathological grief means the presence of physical or mental illness or deviation from the normal and healthy. The definition of pathological grief has been remarkably elastic, inconsistent, and flat out wrong in so many instances. I remind you of the newspaper article from chapter 2, in which experts decreed that anyone who has not marched through the stages in six months might need professional help.
I’m trained to diagnose psychological pathology and am always on the alert for signs of it in my grieving clients. It’s essential that things like major depression, suicidal thoughts, and panic disorders are diagnosed and get proper attention and treatment. It is my job to recognize those conditions when they exist and to take the necessary steps to keep my clients safe. But sometimes, distinctions between normal grieving and something more serious are blurry. For instance, there has been much debate in recent years about the similarities and differences between clinical depression and the situational sadness of loss.
The deep sorrow of grief and clinical depression do share similarities, such as changes in eating and sleeping habits, low energy, and difficulty concentrating and experiencing pleasure. But they differ in important ways. A grieving person will more likely seek to reach out and share the experience and will, at least in the best of circumstances, expect to receive some support. Depression is isolating. In grief, emotions like sadness and anger are magnified; depression numbs our feelings. Grief, as we have seen, can be life and soul affirming; depression is often accompanied by self-loathing and feelings of insignificance.
The stress of grief can indeed morph into depression, especially if a person lacks support or healthy ways to manage stress. All of us go through life with brains that are flawed and imperfect in some way. For example, if you have suffered from chronic depression or anxiety before your loss, those conditions could intensify after one.
I urge you to seek help if you have any doubts about your mental state. Err on the side of caution if you are concerned. As has been the case with so many of my clients, maybe all you need is reassurance that what you are feeling is normal. I know from long experience that this is often the case. We clinicians have historically overdiagnosed pathology relating to grief, to the detriment of patients and clients. Grief is not a medical condition. We professionals should learn how to better care for and support the bereaved and stop treating grief as an illness in such a knee-jerk way.
Embracing your uniqueness, accepting the uniqueness of others who share your loss, coming to terms with frailties and how you deal with stress — all these things will bring measures of peace and will deepen you as a person. Although grief is uninvited, be open to what it will teach you about yourself.