That
Response
to
Loss that
We
Call 'Grief'
by
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Kathleen R.
Buntin, B.S.
Presented at
the
AMCAP Convention
5 April, 1985 |
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A few weeks ago, a dear friend
telephoned. "Will you talk
to my neighbor?" she inquired, after a few hasty
preliminaries. She described
the neighbor, of whom she had spoken briefly in
the past, and
the problem. I agreed
to listen and suggested some times when I would be
available. |
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Since
the publication of
The Living Half (1984), a book describing my
experiences following
the death of my husband, such requests no longer surprise
me. This woman whose husband had filed for divorce was not
the first
to
call for help, nor was she likely
to be
the last. There was
the young man who had turned
to alcohol following
the untimely death of his brother;
the teacher whose husband had become sexually involved
with another woman;
the man severely depressed following a major career
change;
the professional woman facing disfigurement following
facial cancer;
the father of a stillborn infant; a young woman whose
father remarried only weeks after her mother's death;
the divorcee who deeply desired remarriage but who
flitted from relationship
to relationship each beginning a new hope, each ending a
painful reminder of her father's emotional desertion of her as a
child. |
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There is a common thread that
leads these
to seek for someone who they feel would understand. That
thread is
grief. In one way or another, they have all experienced a
loss and are grieving for that thing which was and is no
more. |
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I cannot remember
the first time I grieved; I can remember vividly
the first time I labeled it as such. It hit me like a
bludgeon right between my emotional eyes and sent me reeling in
pain and confusion. It was months before I could speak its name,
before I could begin
to understand it, and months more before I could see it
as a process of going through and not staying in, a healing and
not a dying, a road
to growth and not insanity. |
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Elizabeth Kubler-Ross (1969), a
pioneer in
grief work, first began
to notice
the predictability of
grief when she worked with
the terminally ill. She observed that each patient,
regardless of length or type of illness, age, gender, economic
status, or religious persuasion, seemed
to go through a certain process in coming
to terms with
the reality of impending death. As Kubler-Ross chronicled
those
grief stages she found that while all patients went
through
the stages at different rates and intensity, they did
go through all of them. |
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Grieving, then, is a predictable
psychological process; it is letting go of a loved or cathected
thing; it is making real within oneself a fact that, though hard
to accept, already exists. In that context,
the process may be observable in psychotherapeutic work
involving
the acceptance of any reality when such reality involves
the giving up of a familiar, though dysfunctional,
cognition or behavior. It is certainly observable in those
obviously
loss-related life crises such as death, divorce, severe
financial reversals, serious illness, surgery, and physical
handicaps. |
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The first stage of
the
grief process is
the initial shock. It can last from a few hours
to several weeks. Physical symptoms can include
light-headedness, nausea, shaking, crying, hyperventilation,
fainting, weakness of limbs, inability
to focus thought, numbed affect, blurred vision, ear
ringing, and a sense of being outside
[p.53] of oneself watching
the occurrence in a dispassionate manner. |
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The mourner may need
to be sedated at this point, but care should be taken not
to give
the message that
the drug will take all
the suffering away.
Grief is an extremely painful process, and there is no
easy or fast way
to speed through it.
The mourner must feel
the pain, not avoid or deny it, in order
to heal.
The therapist should facilitate
the process by helping
the client get in touch with his feelings
to understand where he is in
the process. For
the therapist
to listen and reflect with empathy and honesty is also
comforting
to
the client. Because
we are such a death and pain-denying sodety, significant
others tend
to pull away from a mourner's suffering.
The therapist may be
the only person who really hears and allows
the client
to own his pain. |
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Denial is often present in this
early shock stage and may continue for many months. If this is
the case,
the therapist needs
to help
the client see
the reality of
the situation before
the
grief work can truly begin. Denial is recognizable in
that
the client appears "stuck" and is not moving through
the
grief process. There may be a sense of emotional tension,
nervous energy, physical symptoms such as extreme weight
loss, and irrational behaviors and cognitions. Examples
of denial include
the widow who slept, fully clothed on her couch for 18
months before she would return
to her bed,
the mother who wrote a weekly letter
to her son for over a year following his death, and
the child who included a stillborn sibling in his family
drawings five years after
the fact. |
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Some therapists have found it
necessary
to take a strong reality-based approach with clients who
are too long in denial.
The rationale is that if
the client can be prodded into anger (another stage of
the process
to be discussed later) he can begin
to move again. |
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Latter-day Saints may prolong
the stage of denial by allowing their knowledge of a life
after death
to forestall their acceptance of
the mortal death. It is this "I know I'm going
to see her again" testimony that outsiders see at
the funeral which causes them
to assume
the mourner has strength which, indeed, he may not have.
Later, when
the shock dissipates and
the reality that "she is not coming back
to this life" hits, it may look and feel like a
regression.
The mourner and his significant others may doubt his
testimony and/or his sanity. Professionals often have clients
referred
to them at this point by friends and family who say, "He
was taking it so well, but now he has fallen apart."
The therapist should reassure
the client that this is progression and not regression,
and that he now will be able
to begin
the real
grief work that will allow him
to heal and
to grow. LDS clients who haven't made that transition may
be helped
to see within
the context of
the gospel
the reality that death is as much a part of mortality as
is birth and that
the change it brings must be accepted and dealt with. |
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The next three stages—guilt, angel and depression—are not
on a clearly defined continuum. They tend
to overlap, fluctuate and flow into one another;
the guilt may produce depression which may turn into
anger which may be turned inward
to guilt and depression again, and so on. Some mourners
feel all three in fairly equal amounts; others may be especially
hard hit by one stage while only slightly aware of another. It
does appear, however, that all grievers experience all
the stages
to a lesser or greater degree, and for
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grief process
to be truly therapeutic, stages cannot be rushed or
skipped. |
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The guilt stage is all those "if only's" or "I should
have's" or "Why didn't I's."
The therapist can facilitate
the process of passing through this stage by first
helping
the client look at
the rationality or irra-tionality of
the guilt. By having
the client reexperience
the event about which he feels guilty,
the therapist can ask
the client if
the choice made was a logical choice given
the knowledge
the client had at that moment in time. (We
all have 20-20 hindsight). If it was a proper choice and
the client still feels guilty about it,
the therapist may help by challenging
the irrationalities. |
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[p.54]
But what if
the choice was not proper, even given
the more limited knowledge of
the past? Some therapists regard all "shoulds" and "oughts"
as irrational, but that is a difficult stance
to take with an LDS population. Even
the position that
the past is over and unchangeable and should be forgiven
and forgotten is difficult unless
the client is given
the opportunity
to own and
to work through his guilty feelings.
The five steps of repentance—recognize, remorse, confess,
recompense, and forsake—are as applicable here as in any other
situation involving guilt.
The therapist can facilitate
the process with techniques such as
the Gestalt "empty-chair"
to allow
the client
to confess and ask forgivenesss of
the deceased and by helping
the client find opportunities for recompense here and now
(like Ebeneezer Scrooge's repaying Feziwig by being more
generous with Bob Cratchet). |
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One therapist, working with a
divorced client in
the throes of guilt, asked her how long a "sentence" she
would need
to serve for
the "crime" of being
the only divorced person in her family! After pointing
out that even criminals sent
to prison have a set sentence, he helped her work out an
appropriate "term"
to serve after which time she gladly "pardoned" herself. |
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It may be helpful
to remind
the client that, as with all repentance,
the process and
the growth are for
the client, not
the deceased. |
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Anger is typically a difficult
stage for Latter-day Saints
to handle. Because
we are culturally taught that anger is "bad,"
we are practiced in denying anger rather than owning and
constructively releasing it.
The therapist's first job may be
to help
the client become aware of his anger. Anger may be masked
under guilt and depression or under physical symptoms such as
ulcers or migraine headaches. As mentioned earlier, it may take
"stirring up
the hornet's nest"
to get
the client moving out of denial or depression and into
the anger stage. |
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Once released, anger can be
frighten-ing
to
the client and his significant others.
The therapist's role includes allowing
the client
to express anger in his/her presence without judging or
reacting personally, as others in
the client's life will likely do; teaching
the client that anger is a normal and acceptable part of
the
grief process, thus assuring him that he is not "bad"
nor "going crazy" and helping
the client develop some acceptable ways
to release
the anger, such as vigorous physical exercise,
the use of batakas in therapy, creative expression, etc. |
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As
the anger becomes more controllable,
the therapist may want
to deal with
the client's "Why me?" sense of injustice from an
existential prospective, if that seems appropriate, or he may
want
to teach Ellis' A-B-C relationship of event, perception,
and emotion.
We cannot always control what happens
to us;
we can control how
we perceive and react
to what happens. |
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Depression in
the
grief process is symptomatically similar
to other depressions. There is a stated sense of
helplessness and hopelessness.
The tendency is
to live in an idealized past and
to seek "to
be normal" or "the
same" again. There is great anxiety about
the future and therefore a wish not
to think about it, even a feeling of wanting no future
and of having thoughts of suicide. |
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Because of
the very real possibility of suicide, depression is
perhaps
the most dangerous stage of
the
grief process. Statistically speaking, people do
die of
grief as Victorian novelists once claimed. Widowed and
divorced people die from every major cause of death at a faster
rate than their married counterparts. Suicide rates for widowed
males are higher than for any other group in
the country (Lynch, 1977). Widowers are most at risk
the first six months; widows, during their second year
alone. |
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Depression unchecked can become
a vicious cycle with an emotionally depressed state leading
to lack of concern for physical well-being, which, in
turn, [p.55]
leaves
the mourner run-down and therefore more susceptible
to emotional depression.
The therapist needs
to break
the cycle, and a good place
to start is with
the physical aspect. "Homework" assignments, for example,
of keeping a food diary
to insure proper nutrition, getting prescribed amounts of
fresh air and exercise, or making a visit
to
the medical doctor should help. Vitamin supplements,
special diets, or anti-depressants may be prescribed by
the M. D. |
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Clients may need
to be taught that recovery comes in small bites, not big
gulps, and that life always goes forward, not backward.
The client can be "normal" again if he or she is willing
to redefine "normal" under new circumstances. Therapists
may also help
the client reach small goals by setting up simple,
achievable, and easily recognized behaviors and having
the client act "as if" he or she is already achieving
that goal. "One day at a time" (or "one hour at a time," if
necessary) is a good place
to start. In
the beginning
the goal may be, not happiness, but less unhappiness. As
progress is made and growth perceived, most
grief-induced depressives will ultimately move toward
happiness. |
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Grief psychologists tell us that one hour of emotional
stress is as draining as three hours of physical labor (Theos
magazine). During
the grieving process intense amounts of energy are
invested in going over
the past with
the only reality
the mourner knows being that world of pain inside of
himself. As he gradually works through that pain and begins
to tentatively look away from
the past and toward
the future, he is approaching resolution. |
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The role of
the therapist during this final stage is
to help
the client accept that progress has come "line upon line"
and will continue
to do so. As
the client experiences a perceived "relapse" into
depression or anger after having resolved those issues,
the therapist can help him see that what he feels is not
truly a relapse or '"a going backward," but still '"a going
forward" and |
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learning and growing. It is
helpful
to illustrate
the process not so much as an emotional roller coaster
(although that's what it feels like) but as a spiral, looping
back on itself, with ever-decreasing loops,
the "highs" lasting longer and
the "lows" coming less frequently. As
the client continues
to develop his own strengths,
the therapist can begin terminating
the relationship, taking care
to prepare
the client for this new
loss and subsequent
grief. |
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In addition
to personal therapy,
the LDS professional can serve a valuable role as a
resource consultant
to ecclesiastical leaders such as bishops and Relief
Society presidents who, although they deal with
grief in
the front lines, may not understand
the process. Loving, caring people can innocently
increase
the pain of
grief by saying or doing counterproductive things. |
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Because of
the LDS understanding of
the Plan of Salvation,
we often think that as Latter-day Saints
we should be immune
to
the doubts, fears, and pains of life. As LDS therapists,
we know this is not
the case.
We react
to
loss in
the same predict-able way all do who are in
the mortal condition.
The scriptures are full of testimonies
to that effect. |
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Job, who is remembered for his
great patience in tribulation, knew
grief. Observe
the recognizable depression, guilt, and anger as Job
said: |
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Let
the day perish wherein I was born, and
the night in which it was said, There is a man child
conceived. |
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Why died I not from
the womb? Why did I not give up
the ghost when I came out of
the belly? (Job 3:3, 11) |
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Oh that my
grief were thoroughly weighed, and my calamity laid in
the balances together! |
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For now it would be heavier than
the sand of
the sea: What is my strength, that I should hope?…is
wisdom driven quite from me? (Job 6:2-3, 11, 13) |
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When I lie down, I say, When
shall I arise, and
the night be gone?…My days are swifter than a weaver's
shuttle, and are spent without hope. |
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Therefore I will not refrain my
mouth; I will speak in
the anguish of my spirit; I will complain in
the bitterness of my soul. |
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[p.56]
…thou scarest me with dreams and terrifiest me through visions:
So that my soul chooseth…death rather than my life. |
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I have sinned: what shall I do
unto thee, O thou preserver of men?… |
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And why dost thou not pardon my
transgression, and take away mine iniquity?…(Job 7:4, 6, 11,
14-15, 20-21) |
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…how should man be just with
God? Behold, he taketh away, who can hinder him? |
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If I had called, and he had
answered me, yet would I not believe that he had hearkened unto
my voice. |
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For he breaketh me with a
tempest, and multiplieth my wounds without cause. (Job 9:2, 12,
16-17) |
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My soul is weary of my life; I
will leave my complaint upon myself; I will speak in
the bitterness of my soul. |
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I will say unto God, Do not
condemn me; shew me wherefore thou contendest with me. |
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Is it good unto thee that thou
shouldest oppress, that thou shouldest despise
the work of thine hands…? |
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Thine hands have made me and
fashioned me round about; yet thou dost destroy me. |
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If I be wicked, woe unto me; and
if I be righteous, yet will I not lift up my head.
I am full of confusion, therefore see thou mine affliction: |
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For it increaseth…(Job 10:1-3,
8, 15-16) |
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It is often difficult
to be worshipful in
the throes of
grief or, as Paul said,
to "glory in tribulations" (Rom. 5:3). But
we do know and accept that tribulation can bring, not
only healing, but growth. |
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As
the Savior told Joseph Smith: |
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If thou art called
to pass through tribulation;…know thou, my son, that all
these things shall give thee experience, and shall be for thy
good. |
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The Son of Man hath descended below them all. Art thou
greater than he? (D&C 122:5, 7-8) |
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Buntin, Kathleen R. (1984).
The living half. Salt Lake City, UT: Deseret Books. |
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Kubler-Ross, E. (1969). On
death and dying. London: Macmillan Co. |
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Lynch, J. J. (1977).
The broken heart. New York: Basic Books. Theos
Magazine (January 1983 through June 1984). |
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The Holy Bible. King James Version. Salt Lake City, UT:
Published by
The Church of Jesus Christ of Latter-day Saints, 1979. |
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The Doctrine and Covenants of
The Church of Jesus Christ of Latter-day Saints. Salt
Lake City, UT: Published by
The Church of Jesus Christ of Latter-day Saints, 1981. |
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Source: AMCAP Journal, Vol.11,
No. 2 (1985 Issue), pp.52-56 |
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