Therese Rando, Ph.D., a clinical psychologist, traumatologist and thanatologist— someone who is educated in the study of death and grief—became involved in helping people cope with death after experiencing losses of her own. She is the clinical director of The Institute for the Study and Treatment of Loss, which provides mental health services through psychotherapy, training, supervision and consultation and specializes in loss and grief, traumatic stress and the psychosocial care of persons with chronic, life-threatening or terminal illness and their loved ones. Rando has penned numerous books on grief, including How to Go on Living When Someone You Love Dies, and recently completed Coping with the Sudden Death of a Loved One, which is expected to be released in 2008. Here, Rando discusses the first 30 days of grieving the death of a loved one.
The rituals around the death have the potential to be very therapeutic. If meaningful to the person, they can help provide structure and support at a time of chaos. One thing people don’t understand is that the individual differences in grief make a huge impact—there is not just one way to grieve. There’s a mistaken notion that everyone follows the same pattern. While we can share some common aspects, everyone’s grief is as individualistic as their fingerprint.
“How can I survive this?” and “Is what I am going through normal?” come up soon after a death. The person may not have any experience with grief and may not know what to expect. Grievers often question their reactions because they’re not a part of their usual experiences. Some reactions may even be shocking to them and can erode the image they have of themselves.
For people who have been involved in helping a sick loved one, they can experience some traumatic reactions that are similar to those seen in post-traumatic stress disorder. They often need to address the distress, helplessness and unpleasant experiences, while helping care for this person during a lengthy or debilitating illness. With a sudden death, there is an abrupt destruction of the world the person used to know and many consequences of losing someone without a chance to prepare or say goodbye. This violates their assumptions and beliefs about life and can be quite traumatizing to them. The circumstances of the death can be especially upsetting to them, particularly if they weren’t with their loved one.
Most people feel some amount of shock and denial. This is OK because it is typically how our minds initially deal with a significant loss. In both unanticipated and anticipated death, we might feel disoriented and have a great sense of having been yanked out of the world we knew. We sometimes say, “This can’t be happening.” We might feel out of control, disorganized, confused, lost, emotionally overwhelmed and physically ill.
Some people may get into the role of taking care of others and making arrangements, while others may withdraw or get hysterical. There may be changes in a person’s usual ways of behaving and patterns of eating, sleeping or relating to others. Particularly with a sudden death, there may be shock, a temporary absence of feeling, crying, anxiety, anger and guilt, as well as sadness. In an anticipated death, there can be trauma and exhaustion that comes after you’ve seen your loved one suffering, along with guilt, sadness and even relief.
People who are grieving often feel as if they’re watching themselves from the outside go through these emotions. There is an expectation that if we do the right thing, we won’t feel so bad, but this isn’t true. It is normal to have distress when dealing with the loss of someone you love. Grievers need to understand that the normal course of grief involves feeling worse before you can feel better again. The first 30 days can set the tone for your bereavement, but distress will fluctuate up and down for quite a while afterwards.
You don’t overcome your feelings; you work through them. There’s no one way to do this. Many people need to express their feelings of loss. In many societies there is an expression of pain in guttural ways—you will see footage of bereaved people wailing and screaming in some cultures—and there is often a lot of physical movement involved. This gives people an “out” from the incredible tension often brought about after major loss. In our society, we tend to tell people to “calm down.” While sometimes this is necessary, at other times it isn’t helpful. If you feel this tension, it needs to be released healthily; it could possibly cause more complications if it is kept inside. You need to identify what you’re feeling and discover ways to handle your emotions and thoughts in healthy fashions that work for you. You also need to learn how and when to take breaks from your grief. Diversions can be useful as long as they don’t cause problems or prevent you from ultimately doing the grieving that’s necessary for you.
Recognize that you can have a variety of reactions. Let yourself feel— or not to feel—as suits you right now. At the beginning, you need to give yourself permission to let your reactions come as they are. The one exception to this is if you consider hurting yourself or someone else or doing something to sabotage your life. Thoughts of dying are not uncommon, as some people may think, “If I could just be with him.” But if there is a real danger, a professional needs to be brought into the situation immediately. You’ll have to take care of yourself and make sure you eat and sleep properly and avoid abusing alcohol and drugs. Getting physical exercise is very important to channel distress.
People want to make their pain go away, but grief is a gradual unfolding process and cannot be over quickly. It involves slowly and painfully learning over time the reality that your loved one is no longer here in this world. Only then can you make the necessary changes to accommodate that reality. Early on after the death, many people find it helpful to reminisce or talk about their loved one and ask any questions they may have about the death. This is a time when you should treat yourself as if you are in “emotional intensive care.” In ways that are personally comfortable to you, take it easy, don’t overwhelm yourself, make sure you have realistic expectations of yourself as a mourner, and ask for and accept the support of others. Don’t make any major decisions or changes if you can avoid it.
You certainly don’t do it in the first 30 days. It takes much longer and involves learning, over time, how to make the necessary changes to cope with your loss. You have to figure out how to integrate it healthily into your life. People mistakenly feel that if they do the right thing, they won’t feel badly, but there’s no healthy way not to have some distress after you’ve lost a loved one. You can learn how to get through it and eventually harness it, but you can’t avoid it totally and still be healthy.
Although you can definitely regain your capacities, you don’t go back to “normal,” per se. You develop a new “normal” over time—one that takes into account all the changes in your life. Over time this means renegotiating your life, reconstructing meaning, and learning to live all over again. For many people this involves, “How can I go forward in a new world and still have a connection with my loved one?” It’s very important for people to know that when someone dies, you don’t have to cut all the ties—you transform them. You let go of the old interactions and ties you had with them while they were alive, and develop a new relationship based on more abstract connections. It’s about moving forward in the new world while not forgetting the old.
We all will have to deal with our feelings and make sense of our world. We have to expect that, at times, we may not be able to function as we normally would, which is when we can reach out to others. I feel like I’ve been to hell and back with some of my losses, but I have the fundamental belief that we can find a way to cope with such painful events.
…it gives you the opportunity to grow, helps you see the real importance in life and what your priorities should be.
For more information on Therese Rando, visit www.thereserando.com
In this book, Rando, Ph.D. leads you gently through the painful but necessary process of grieving and helps you find the best way for yourself....