Grief Support

After the unexpected death of his wife, Irish author C.S. Lewis wrote in A Grief Observed, "No one ever told me that grief felt so like fear. The death of a beloved is an amputation."

While dealing with grief is not easy, we believe the resources within this section of our website can help. Should you need additional support in grieving your loss, please call us at (412) 793-3000. We will do everything we can to assist you.

Dealing with Death

In today's society, we tend to ignore death. We avoid discussing it, thinking about it, and planning for it. While we all know that death is inevitable, we are unwilling to think it will ever happen to us.

"Death can be terrifying." Dr. Todd Kashdan opened his article, "Confronting Death with an Open, Mindful Attitude", with those four painfully-honest words. He goes on to explain why death is such a scary thing for most of us. "Recognizing that death is inescapable and unpredictable makes us incredibly vulnerable. This disrupts our instinct to remain a living, breathing organism."

Our fear of dying has kept us alive (as individuals and communities) for centuries. It's natural. Yet, the fear of dying does not serve our personal need for safety and if we are to live our lives, we need to release the fear altogether. Dr. Kashdan argues that a mindful approach to living may be what's needed.

What is Mindfulness?

Mindfulness has been defined as, "The state of active, open attention on the present. When you're mindful, you observe your thoughts and feelings from a distance, without judging them good or bad. Instead of letting your life pass you by, mindfulness means living in the moment and awakening to experience."

Awakening to the inevitability of your own death is liberating. You are no longer forced to manage the fear; you are able to include death into your life experience.

Preparing for Your Death

Death is a natural part of life. When you live with intention, which involves looking toward death and preparing for it, you crush its power to keep you from living fully. The following task list will, when done mindfully, help you to not only confront your own death but to take control of it. While you'll never actually know how your life will end until the time of your death, your preparations will help you become comfortable with it.

• Write a will, notarize it, and provide a copy to your executor as well as any other individuals who are important in the settlement of your estate.
• Designate a Power of Attorney and Living Will, two essential documents if you are ever unable to care for your financial, medical, or legal needs due to an accident or illness.
• Make a detailed plan of your funeral or memorial service, which will help your survivors acknowledge and celebrate your accomplishments.
• Organize all financial papers including insurance policies, bills, mortgage papers, vehicle titles, and loan documents. It may be useful to consider adding a trusted family member to your bank accounts.
• Secure your digital life for your survivors. Make sure to list all account passwords and usernames and let your survivors know how you would like your digital real estate (email and social media accounts) handled after your death.

If you don't work to really get in touch with the reality of your death, you will never be fully satisfied with your life. When endlessly trying to become victorious over death, you stop living fully.

Dealing with Grief

If you Google the word "grief," the search engine will deliver well over 100 million results! That's an unbelievable amount of information about dealing with grief at a time when you may already feel overwhelmed by the smallest of tasks. We are here to help.

You Aren't Alone

While the experience of grief can be very isolating, we would like to help you take steps to counter the feelings of loneliness and disconnection. While the articles in our grief library can make a difference in your day-to-day life, please don't hesitate to call us should you need additional support. We will do our best to ease your bereavement and, if requested, provide a referral to a local grief counsellor or therapist.

Grieving with Purpose

No one is prepared for grief. The rush of feelings, the thoughts, anxieties, and heartache can take us by surprise and drive us to our knees. Yet, when we choose to harness that power for self-growth, amazing things can happen. Good can come from pain.

Sigmund Freud first brought up the concept of grief work in 1917, and today the idea that bereavement is purpose-driven continues.

Dr. James Worden chose to see the work of bereavement as task-oriented:

• To accept the reality of the loss
• To process the pain of grief
• To adjust to a world without the deceased
• To find an enduring connection with the deceased in the midst of embarking on a new life

Your current job is to focus your attention on achieving each of those goals. It will not occur in any logical order; each of us is different and the path we walk in the bereavement journey is not a straight one.

Dealing with grief is hard work. It takes both courage and hard work to successfully adapt to the loss of a significant person in your life.

Six Signposts Along Your Journey

Dr. Stephen Joseph identifies what he calls six signposts to facilitate posttraumatic growth. He reminds readers too that "posttraumatic growth does not imply the absence of emotional distress and difficulties in living. It does imply that it is possible through the struggle to come out on the other side, stronger and more philosophical about life."

Before identifying these six signposts, Dr. Joseph reminds his readers of three very important things:

• You are not on your own
• Trauma is a normal and natural process
• Growth is a journey

He also provides a fundamental rule: don't do anything you might not be able to handle now. "If you experience intense emotions, become physically upset, or begin to panic...stop." He gently reminds readers that "having a sense of personal control over your recovery is important. There might be some things you do not feel ready to handle now, but in time, as you discover new strength and develop new coping skills, this will likely change."

Sign Post #1: Taking Stock

Are you physically well? Are you getting enough sleep and eating the right foods for optimum health? Have you received the kind of medical, legal, or psychological help you need? What is your current condition: physically, spiritually, and emotionally?

Sign Post #2: Harvesting Hope

People traumatized by loss often feel hopeless. It's hard to get up in the mourning and thinking about the future sparks pessimism and negativity. Find inspiration in the stories of personal growth written by others; set goals and practice hope as you set out to achieve them.

Sign Post #3: Re-Authoring

Learn to tell your story differently. Take the victim mentality out of the story of loss you tell yourself and others and replace it with the word survivor to return to a sense of control over your life.

Sign Post #4: Identifying Change

Keeping a daily diary can help you to see the small changes within more easily. You can also track those moments when you feel at your best and identify the conditions that brought them about. Identify and nurture the positive changes in your life throughout your bereavement journey.

Sign Post #5: Valuing Change

Review these changes, identifying the ones that you'd like to continue to nurture. Personal transformation requires it. Growth is encouraged when we take time to think about what we have gained from loved ones and when we find a way to use what we have learned to give to others.

Sign Post #6: Expressing Change in Action

Express your growth in new behaviors or, more simply, put your growth into action. When you think in terms of concrete actions, it helps make the growth experienced within your bereavement real to you.

"By focusing on these six signposts," writes Dr. Joseph, "you will find that your posttraumatic growth is beginning to take root."

Ending Denial and Finding Acceptance

Acceptance is the very first task in your bereavement. Dr. James Worden writes that we must "come full face with the reality that the person is dead, that the person is gone and will not return."

This is where a funeral can be very important. Traditionally, the casketed body of the deceased is at the front of the room and guests are invited to step up to personally say their goodbyes. Part of stepping up means seeing with our own eyes that death has actually occurred and that actualizing is an essential part of coming to accept the death. Yet, the tradition of viewing has eroded over time with many families today choosing cremation and opting to hold a memorial service after the cremation has taken place. The focal point of the ceremony becomes the cremation urn, holding the cremated remains or ashes out-of-sight and making the reality of the death less evident and the road to acceptance less clearly marked.

Acceptance May Seem Out-of-Reach

For many, acceptance means agreeing to reality. Most of us, when we lose someone dear to us, simply don't want to agree to it; we actually have an aversion to agreeing and accepting. So, let's use a different word - try adjustment, or integration. Both words focus on the purposeful release of disbelief. Someone who has integrated the death of a loved one into their life has cleared the path to creating a new life; a pro-active life where a loved one's memory is held dear, perhaps as a motivating force for change.

It does take time. In Coping with the Loss of a Loved One, the American Cancer Society cautions readers that "acceptance does not happen overnight. It’s common for it to take a year or longer to resolve the emotional and life changes that come with the death of a loved one. The pain may become less intense, but it’s normal to feel emotionally involved with the deceased for many years after their death. In time, the person should be able to reclaim the emotional energy that was invested in the relationship with the deceased, and use it in other relationships."

Whatever you call it, this essential part of mourning is what allows us to live fully again. It allows us to step out of the darkness of mere existence and back into the sunshine where life is sweet again. Of course, it's a very different life than the one you had before your loved one died.

When Grief Doesn't Ease

Sometimes it feels as if your bereavement will never end. You feel as if you’d give anything to have the pain go away; to have the long lonely hours between nightfall and dawn pass without heartache. You are not the only grieving person who has longed for some measure of relief.

In the novel, My Sister’s Keeper, author Jodi Picoult wrote, “There should be a statute of limitations on grief. A rule book that says it is all right to wake up crying, but only for a month. That after 42 days you will no longer turn with your heart racing, certain you have heard her call out your name.”

No such rule book exists. Grief counselors and therapists tell us that the length of time it takes anyone to grieve the loss of someone they held dear to them is dependent on the situation, how attached you were to the deceased, how they died, your age and gender. So many variables exist and there’s absolutely no way to predict how long it will take for you to adapt to your loss.

The Difference Between Normal and Complicated Grief

Research findings have led experts to come up with many differing categories of grief experience ranging from normal to complicated. Normal (or uncomplicated) grief has no timeline and encompasses a range of feelings and behaviors common after loss such as bodily distress, guilt, hostility, preoccupation with the image of the deceased, and the inability to function as one had before the loss. All are normal and present us with profound, and seemingly endless, challenges. Yet, Katherine Walsh says, “Over the course of time, with average social support…most individuals will gradually experience a diminishment of these feelings, behaviors, and sensations.”

So, how can you know if your bereavement is no longer within the range of normal? Ms. Walsh goes on to say, “While there is no definitive time period by which this happens, if an individual or members of a family continue to experience distress intensely or for a prolonged period—or even unexpectedly years after a loss—they may benefit from treatment for complicated grief.”

A Useful Model for Assessment: Worden’s Four Tasks of Mourning

There are certain tasks that, when achieved during your bereavement, can successfully allow you to emerge on the other side of loss as a better, stronger, and more resilient individual. James Worden proposed these four tasks:

1. To accept the reality of the loss
2. To process the pain of grief
3. To adjust to a world without the deceased
4. To find an enduring connection with the deceased in the midst of embarking on a new life

Instead of focusing on your bodily discomforts, feelings, and common behaviors, this model allows you to better see where you may be stuck or stalled in the adaptive process. Fortunately, Worden also gives us a list of indicators advising that "any one of these clues in and of itself may not be sufficient" for a diagnosis of complicated grief. "However," he continues, "any of these…should be taken seriously, and the diagnosis of complicated grief should be considered when they appear."

12 Clues... 12 Insights

While grief educators and theorists tell us that a diagnosis of complicated grief should not even be attempted until after the first anniversary of the death, if any one of the following symptomatic clues exists for longer than six months, you may want to consider grief counseling or grief therapy:

1. You cannot speak of the deceased without experiencing intense and fresh grief long after the loss.
2. A relatively minor event triggers an intense grief reaction.
3. Your conversations with others are littered with references to loss. In other words, loss is an ever-present motif in your world view.
4. You have issues related to your loved one's possessions. Keeping everything the same as before their death could indicate trouble just as tossing out everything right away can also be a clue to disordered mourning. (You also need to factor in your cultural and religious background)
5. You have developed physical symptoms similar to those of the deceased before their death. Sometimes these symptoms recur annually, on the anniversary of the death, or on holidays. An increased susceptibility to illness or the development of a chronic physical complaint can also be an indicator.
6. If you have made radical changes to your lifestyle, or excluded friends, family members, or even activities associated with the deceased, it may indicate unresolved grief.
7. A long history of depression, often marked by guilt or low self-esteem, can reveal disordered mourning. The opposite is also true: a person experiencing a false sense of happiness or elation could be experiencing unresolved grief.
8. A compulsion to imitate the deceased, in personality or behavior, can be a sign of complicated mourning.
9. Having self-destructive impulses or exhibiting self-destructive behaviors can be significant. These can range from substance abuse, engaging in self-harm, developing eating disorders and suicidal tendencies.
10. A sense of unexplained sadness occurring at a certain time each year (holidays, anniversaries, or birthdays) can also be a clue to unresolved grief.
11. Developing a strong fear about dying, especially when it relates to the illness that took the life of your loved one, is an important clue.
12. If you have avoided visiting your loved one's grave or if you are still unwilling to discuss the circumstances of their death, this could indicate complications in your bereavement.

There are many types of complicated grief; it can be delayed, masked, exaggerated, or chronic. Self-diagnosis is without purpose. A year after the death, if you feel your grief symptoms worsening, we advise that you seek a referral from your family physician for professional grief counseling or therapy.

When Grief is Unacknowledged

In Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice, Kenneth Doka offered a very simple definition of disenfranchised grief as an experience when "survivors are not accorded a right to grieve". Can others really deny us our right to feel sorrow and pain? Can they set limits on our bereavement? The answer is, at least in some cases, yes. It happens all the time.

In Disenfranchised Grief Revisited: Discounting Hope and Love, Dr. Thomas Attig claimed this right entitles a bereaved person to grieve when he or she needs or chooses to, and in the manner in which they choose. In response, others are obligated to honor the right and refrain from interfering in the experiences and efforts of grieving.

It's more than "a matter of indifference to the experiences and efforts of the bereaved. It is more actively negative and destructive as it involves denial of entitlement, interference, and even imposition of sanction. Disenfranchising messages actively discount, dismiss, disapprove, discourage, invalidate, and delegitimize the experiences and efforts of grieving. In this way, the people around the bereaved withhold permission, disallowing, constraining, hindering, and even prohibiting the survivor's mourning.”

When Can Disenfranchised Grief Occur?

Author Jonathan Vatner shares examples of situations where disenfranchised grief can result:

• Your ex-husband passes away, for example, and your friends don't see why it matters.
• An executive is having a serious affair with her married co-worker. When he dies unexpectedly, the expression of her grief is limited by the covert nature of the relationship.
• A spouse, brother, or son is missing in military action.
• When death has occurred due to socially unacceptable causes such as AIDS or suicide.
• A beloved dog, cat or other pet has died.

What Does Disenfranchised Grief Sound Like?

When you are mourning an unrecognized or undervalued loss, you may hear statements like this:

• "When things like this happen, all you can do is give it time and wait it out."
• "Eventually, you’ll get over this."
• "The best thing is to try to put what happened behind you and get back to normal as soon as possible. Try to go on as if nothing has changed."
• "There’s no point in looking for meaning in something like this. Suffering brings us face to face with absurdity. The best thing is to try to forget."
• "Face reality. She is dead. You will have to fill her place with something else."

Sometimes those dealing with grief disenfranchise their own grief with inner talk that sounds like this:

• "Somehow it feels disloyal to laugh or try to be happy. I sometimes feel that I owe it to him to live in sorrow."
• "What can I possibly have to look forward to?"
• "I’m kind of embarrassed to admit that in some ways I seem to have grown from the death of my child."
• "How can I ever let myself love again if it all comes to this?"

Suffer in Silence No More

The stress of grieving in isolation can be unbearable. If we listen to Dr. Lani Leary, even if you endure the ups-and-downs of bereavement on your own, the grief work you do will still be compromised. She tells us that it is not time that heals. Instead, healing comes with validation: "All grief needs to be blessed. In order to be blessed, it must be heard. Someone must be present, someone who is willing to hold it by listening without judgment or comparison."

In the article "Mourning Becomes Neglected: 4 Healthy Ways to Grieve", author Jonathan Vatner shares these four ways you can reclaim your right to grieve and get much-needed support:

1. Recognize that there is nothing wrong with you. Whatever your feelings are, they're legitimate.
2. Find people who will understand. Search online—there are bereavement support groups for just about any type of loss.
3. Be honest about how you feel. If a well-meaning friend cracks a joke about your deceased ex-husband, explain that this loss is painful for you.
4. Develop a ritual or ceremony to commemorate the person's passing. Visit the grave after the funeral or hold a private one when you can take as much time as you need to express your anguish.

Speak Up and Speak Out

In the book Invisible Monsters, author Chuck Palahniuk wrote, “Most times, it's just a lot easier not to let the world know what's wrong.” Whatever you do, if you feel those around you are not supportive of your bereavement, do not follow his words. Let others know how you feel and what you're thinking. In doing so, you're educating them on the essential truth of bereavement: all losses are worthy of recognition and acknowledgement, and all those in mourning have the right to grieve.

For Friends of the Bereaved

People can be very supportive in the initial days after a death. There are lots of things for them to do: help to make funeral arrangements, notify other friends and family of the death, and take care of day-to-day chores. It's a matter of being friends: taking on the necessary tasks so survivors have the time and energy to actively mourn their loss.

Unfortunately, once the funeral is over, things can change dramatically. This support system can dissolve quickly as people return to their normal routines. The phone stops ringing and the bereaved may find their days and nights to be long and lonely.

How to Really Help Someone in Mourning

It's about not walking away. Granted, you may part company after the funeral but a true ally doesn't stay away long; a better-than-good ally keeps checking in with the bereaved. Being a friend in need during this time can feel very difficult.

Rachael Naomi Remen, M.D, wrote what she considers to be the focus of this grief work: "Grieving allows us to heal, to remember with love rather than pain. It is a sorting process. One by one you let go of things that are gone and you mourn for them. One by one you take hold of the things that have become a part of who you are and build again." You do that with a model of task-oriented bereavement.

The Four Tasks of Mourning

James Worden writes that the four things that must be completed in order to adjust to the death of a significant other are:

• To accept the reality of the loss
• To process the pain of grief
• To adjust to a world without the deceased
• To find an enduring connection with the deceased in the midst of embarking on a new life

Those four tasks define the work of grieving. When you choose to become an ally to someone in mourning, it becomes your responsibility to support them in achieving those things within their time frame—not yours.

In no way should you impose a limit on the amount of time their bereavement takes; the only limitations you can set have to do with any negative behaviors you witness. Is your friend using alcohol or drugs to manage their emotions? Are their eating habits becoming destructive? Are they choosing to isolate themselves from the wider world? All those things should raise red flags. If you think their grief has overwhelmed them and set them upon a self-destructive course, it may be time to suggest they see a certified grief counselor or therapist.

Other meaningful things you can do to help them successfully adapt to their loss—again using Worden's four tasks as our guide—include:

• Attending their loved one's funeral is just the first step in accepting the reality of the loss. Taking them to visit their loved one's grave or other place of interment to leave flowers or simply to spend time in conversation and contemplation continues this process. Never force them to go; only suggest and then support them when they agree to your suggestion.
• Empathetic listening—listening not just with your ears but with your heart. This goes a very long way in helping them to process the pain of grief. Be willing.
• They will have to learn to be functional in this new world without their loved one. That can involve practical assistance from you: help to pay the bills, assist with grocery shopping, or offer your support while they learn or relearn how to do something.
• The bereaved must reintegrate their sense of self while at the same time process any changes in their beliefs, values, and assumptions about the world. Again, empathetic listening without judgment gives them a safe space to work out these significant changes in their world view.
• Help them to find a suitable place in their emotional life for the deceased: "a place that is important but that leaves room for others" and "a place that will enable them to go on living effectively in the world". It is suggested that they envision what they would want for themselves if their grief were magically removed.

Popular writer Barbara Kingsolver penned these wise words about friendship: “The friend who holds your hand and says the wrong thing is made of dearer stuff than the one who stays away.” She's so right—never stay away because you're frightened of saying something inappropriate. In "Coping with the Loss of a Loved One", the American Cancer Society said it best: "Be there. Even if you don't know what to say, just having someone near can be very comforting."

Other simple tips include these:

• Ask how the bereaved person feels and listen to the answer. Don’t assume you know how they will feel on any given day.
• Listen and give support but don’t try to force someone if they’re not ready to talk.
• Accept whatever feelings the person expresses. Even if you can’t imagine feeling like they do, never tell them how they should or shouldn’t feel.
• Give reassurance without minimizing the loss. Try to have empathy with the person without assuming you know how they feel.

Author Sarah Dessen captured the nature of good listening in this passage from her book, Just Listen: “This is the problem with dealing with someone who is actually a good listener. They don’t jump in on your sentences, saving you from actually finishing them, or talk over you; allowing what you do manage to get out to be lost or altered in transit. Instead, they wait, so you have to keep going.”

So, as an ally to your bereaved friend or family member, you need to cultivate patience and the willingness to wait. You need to be watchful for signs of depression, which may include continuing thoughts of worthlessness or hopelessness, being unable to perform day-to-day activities, feelings of intense guilt, extreme weight loss, and thoughts of death or suicide. The American Cancer Society cautions that "if symptoms like these last more than 2 months after the loss, the bereaved person is likely to benefit from professional help. If the person tries to hurt him- or herself, or has a plan to do so, they need help right away."