Grief
Grief is a bitch. There is no way around it. People grieve for many different reasons, and the process is different for each person, but the thing to remember is that grieving is a process. It isn’t an act or an event. It is a process that can take from days to years in a healthy person, and in someone who isn’t healthy emotionally it can last indefinitely.
The best-known “authority” on grieving was Elisabeth Kubler-Ross. (I put authority in quotes because the true authority is the person who is grieving.) She is a minor deity in many circles, including hospice nursing. She was a psychiatrist who was one of the first modern researchers to really look at grieving, how it works, how it affects people, and how we treat the dying. The shocking thing is that while people have been dying as long as humans have existed, this research really only started in the late fifties.
Kubler-Ross came to the US from her native Switzerland and was stunned by how terribly the health care system treated the dying and their families. We are, in all honesty, still pretty bad at it overall. That is why I went to work in hospice, and why so many nurses are huge hospice advocates. It is all about doing the best we can to make every death “a good death” for the patient, family and friends.
Once again, I have wandered off track. Kubler-Ross posited five stages of grief, and this theory has been widely accepted. They make sense as long as you remember they aren’t rules, but general stages the grieving often go through, in no particular order:
1. Denial and Isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Grief doesn’t only happen with death. People grieve many losses. I went through a long, kind of terrible period of grieving when I was formally diagnosed with rheumatoid arthritis. I say terrible because I spent a long time in Anger and I’m sure I was just about the most awful person to be around for a couple of years. When I had to stop working, I went through it again. I wasn’t so angry this time, but I held depression close to my chest in my crooked hands.
You might grieve a job loss, a divorce, your sibling’s mental illness; you may go through a grief process related to any loss. The trigger is often the loss of what you thought would be. If your child is born with health issues, you may grieve the loss of that ideal healthy child. The loss is the death of what could have been along with the fear of figuring out how to deal with what is.
There are many books on death and dying, on grieving actual or perceived loss. There is a website containing some of the ideas and work of Kubler-Ross and her colleague, David Kessler. One of the pages is an excellent guide to helping someone who is grieving. So often we ignore the grieving person because we don’t know what to say or do, or we have our own fears of loss that make it easier to deny what is happening. The page is titled, “The 10 Best and Worst Things to Say to Someone in Grief.” For me, the best part of the page is at the bottom:
Traits of the worst ones
They want to fix the loss
They are about our discomfort
They are directive in nature
They rationalize or try to explain loss
They may be judgmental
Not about griever
May minimize the loss
Put a timeline on loss
Traits of the Best ones
Supportive, but not trying to fix it
About feelings
Non active, not telling anyone what to do
Admitting can’t make it better
Not asking for something or someone to change feelings
Recognize loss
Not time limited
We will all go through the grief process at some point in our lives. We will each have friends or relatives who go through it as we stand by, helplessly flailing in our attempts to be there for them. The most important things I have learned in my nursing career are to listen and validate.
Just listen. Don’t think about what you will say or when lunch is or how you wish she would stop crying or anything else. Quiet your mind down, engage with the grieving person, and just listen. You do not have to fix it. You cannot fix it. Just listen.
Then validate. Everyone needs validation. Validate that you heard the person, you understand what he said, or you don’t understand and ask him to explain. The point of validation is to be there to witness, and express that you are witnessing, and that you care about what another human is going through. You don’t have to understand everything or agree with anything. You are a human being saying, “I hear you. You matter.”
Listening and validating the feelings of someone who is grieving can be very uncomfortable, often agonizing. Most of us fear death or loss or even bad luck. If it can happen to someone else right in front of us, it can happen to us. That’s scary stuff. But however uncomfortable you feel, the person who is grieving feels worse, and it is our duty as human beings to be there for each other, even when we don’t like it. Nothing is more important than supporting your fellow human.
If you are struggling with grief, get professional help. Sometimes grief can be complicated by difficult relationships. Sometimes people feel very hopeless in the face of loss. Do not allow grief to shut down your life. Get help.
I recommend a few books on grief:
The Year of Magical Thinking by Joan Didion
On Death and Dying by Elisabeth Kubler-Ross
the farewell chronicles by Anneli Rufus
