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Posts Tagged ‘
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Note: Ms. Dina Ortiz, LCSW, is social worker specializing in outpatient mental health care. She is a California resident and has traveled to the Gulf Coast to help Hurricane Katrina survivors. This is her firsthand account.
Introduction
During the first week of September 2005, the National Association of Social Workers (NASW) sent a request for social workers via email asking them to volunteer with the American Red Cross to provide mental health services. I responded to their request with a yes. The primary assignment for mental health workers would be to support Red Cross Staff.
I soon received a telephone call from the Red Cross in Washington, DC. They wanted me to leave that day. After some discussion, it was agreed that I would leave the 10th of September (two weeks after Katrina had hit the Gulf Coast) to go to Montgomery, Alabama.
There were approximately 13 mental health workers who arrived in Montgomery on the same day. We received a Red Cross orientation and were “processed in” as disaster volunteers. The following day I was deployed to the Coast of Mississippi.
A “tourist bus” transported me with other volunteer health workers to our final destination. On the way, I began to see the devastation of Hurricane Katrina up close and personal. There were some awful sights. We saw ships that were settled on land. We saw bridges that had been ripped in half. We saw houses that had been lifted from their foundations and lodged on other sites. Sometimes these homes were on their sides or turned completely upside down.
During my first day on the Gulf Coast, I passed out bottles of water and dinners in containers to people who were cleaning up and working on their homes. I went through the debris with one woman who was attempting to find anything from her home worth keeping.
The debris created by Katrina was like sawdust. This rubble used to be homes. The sawdust was mixed with clothing, stuffed animals, and what appeared to be garbage. The smell was a mixture of death, rotten garbage, and mold. I was overwhelmed.
After about four hours of serving on the Coast, the mental health supervisor assigned me to a shelter. I would be based there for the next couple of weeks. I slept on a cot, showered in the shared bathroom, and did not leave the shelter for the first 10 days. (There was no such thing as privacy.)
I was available to help everyone in the shelter, including hurricane survivors and other shelter volunteers. The shelter was St. Paul's Methodist Church in Oceanside, MS. The church's structure had suffered minor damage but was still functional. There were approximately 150 displaced individuals (clients), 100 volunteers from churches throughout the United States, and 10 Red Cross staff staying at the shelter.
The clients were very busy each day. For example, they would sign up for resources, including FEMA and Red Cross financial services. They would search for clothing looking through piles of clothes at several different sites, and they would travel to the places their homes used to be and try to salvage some of their belongings.
The church volunteers were also very busy. They cooked meals for everyone and they degutted houses. They provided clothing, bedding, baby formula, baby diapers, cleaning supplies, and personal hygiene items to people in the shelter and the surrounding area.
The Red Cross staff consisted of nurses, case managers, and emergency service workers. I was assigned to the mental health support staff that helped the clients. The clients’ needs were great, and the term "mental health services" was used in a very broad sense: case management services, crisis intervention, mediation with staff and clients, locating love ones (dead and alive), unloading supplies, going through the debris with clients, and doing whatever needed to be done.
The hurricane victims' stories were the hardest to bear witness to. When they told their stories, they would stare straight ahead. Some had no emotions when they talked.
One woman, her husband, and their adult son were trapped in their home. She said the water rose from the floor to the ceiling almost instantly. When the water was up to her chin, she called 911. The 911 operator suggested that they stand on their furniture until the water receded. The operator said they had no one to send to help them.
The woman explained to the operator that she and her family could not stand on the furniture, because the furniture was floating on the water. She told me that she, her husband, and her son were finally able to open the front door of their home. This was a struggle because there was water pressure from both inside and outside their home. When they did finally open the door, they swam to dry land, which was a little island.
The water they swam in contained sewage and dead bodies, household items, furniture, cars, etc. That evening after the water had receded, the woman stated that she and her husband went back to their home and slept on their soaking wet bed. This lady, while staying in the shelter, was suffering from nightmares of drowning in this water.
Another survivor account came from a man who looked and acted like the Country & Western singer Willie Nelson. This man had been walking the streets of Biloxi, MS, until one of his friends transported him to the shelter. He stated that he had been looking for his wife for the past two weeks. He did not know if she was dead or alive. After I spent a couple of days of going to funeral homes and police departments trying to locate the man’s wife, I received a phone call stating that her body had been found in the ocean. When the man learned his wife's fate, he seemed to accept her death. He laughed and stated that his wife had wanted her body to be cremated and the ashes to be thrown in the ocean. Was this shock or acceptance?
The survivors in the Gulf have spirit and resilience. Their culture is rich and vibrant. They were thankful even in the time of destruction. When they told their stories, they often gave lots of details and included the humor. Staying at the shelter twenty-four hours a day, seven days a week, I came to appreciate the survivors and their strength. I will never forget them and I hope we will never forget the tragedy of Hurricane Katrina.
And yes, I would help again.
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Tags: Dina Ortiz, disaster, firsthand, grief, hurricane, katrina, loss, make a difference, real life story, social workers, witness
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In the wake of Hurricane Katrina, many Americans, especially those affected first hand, are trying to cope with the horrendous aftermath and others want to respond in some way to help survivors. This tip sheet offers practical advice for dealing with this high profile natural disaster, whether you are on the frontlines or helplessly watching from your home.
Most of us, at some time or another, have witnessed traumatic events, either in person or vicariously through television, newspapers, and other media outlets.
Here are some general tips on how to begin the healing process:
- Turn Off the Television. Constant repetition of traumatic events and reactions can increase the experience of trauma. Tune in enough to know what is happening in the world, but release yourself from the grip of repetitive traumatic presentations. Make sure children have limited and supervised exposure to the media coverage, as the repetitive pictures and stories can easily overwhelm and traumatize children.
- Talk to Others. Trauma can affect us more deeply when we isolate ourselves. We may do best if we keep share our feelings and thoughts with one another.
- Let Your Feelings Out. There is no shame in having grief, fear, rage, and sorrow. We have reason to feel these feelings. It may be best to let ourselves feel them and to reveal them to people we trust.
- Take Care of Yourself. Be kind to yourself during a traumatic time when rage is the rule of the day. Allow time for rest, for calm, and for comfort to re-enter your life. This may be a challenge at first, but deliberate attention to self-care will help you have the energy to help others.
- Allow Yourself to Find a Peaceful Core Within Yourself. Take time to slow down, rest, and let your emotional reactions settle. Let your attention go within. We each have a place within from which we derive strength and where we know what is true, what is right, and what we need to do. Find that place of strength within yourself.
- Here Is the Challenge: The Atmosphere of Rage and Fear. After traumas occur, many people experience the "fight or flight" instinct. On a collective level, these forces can unleash more trauma if not held in check by compassion, reason, caution, and understanding. Do not unintentionally take out your hurt and rage on others who happen to be in the wrong place at the wrong time.
Here is how we may change the traumatic responses of fear and rage to support our lives:
- Let your fear tell you what you treasure. We fear for ourselves and our loved ones, for all of what we love, and the lives we live everyday. Give support and love to the people and things that matters most to you.
- Let your anger fuel your support of what you care about. Anger is a force that we can use to support action toward what we love.
- Let your anger, pain, and fear bring us together as a world. We may allow our pain and fear and rage to continue to tear us apart, or we may recognize that we are all in pain, in rage, and in fear, and we all want what is precious to us to survive.
- Persistent reexperiencing of the traumatic event - for example, flashbacks, nightmares, or recurring and constant images;
- Persistent avoidance of stimulation associated with the trauma - such as avoiding people or places or images associated with the trauma;
- Numbing of general responsiveness – such as loss of feelings of love, connection, or any feelings at all; and
- Persistent symptoms of increased arousal – such as hyper-alertness, easily startled, and/or irritability.
These symptoms or stress reactions may arise just from exposure to this catastrophe, or they may arise from the triggering of previous public or personal traumas you may have experienced. If the symptoms persist, you may wish to see a mental health professional, especially one trained in treating trauma. The American Red Cross is just one national organization coordinating emergency mental health as well as a national disaster response to Hurricane Katrina. For more information, please log onto www.redcross.org or www.socialworkers.org to find mental health and disaster response services.
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Tags: behaviors, fear, grief, hurricane Katrina, loss, Lynn Hagan, post-traumatic, ptsd, rage, recovery, symptoms, tips
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Introduction
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Here are some of the young people who attended Camp Jonathan this year as they squeeze into a limousine to pose for a photo. |
Jonathan was a six-year old boy who died in 1988. Social worker Mary Lee Carroll, LCSW, served as his hospice volunteer. Her work with him and his spirit inspired Ms. Carroll to develop a pediatric bereavement program for a local hospice in Connecticut. In 1994, the organization received a grant from the Junior League of Waterbury, Connecticut, to sponsor Camp Jonathan. In 1999, Camp Jonathan was incorporated and now stands alone, and serves the needs of the breaved in the Watertown area of Connecticut. Every summer, Camp Jonathan sponsors a week-long summer day camp for bereaved children who have suffered the death of a significant person in their lives. The comments below on the nature of grief were made by children who attended a one-week support program in July 2005.
Grief is . . .
Hard and rough.
Sadness.
Mad and madness.
Unique.
Empty.
Lonely.
No fun – yukky.
Confused.
Hurtful.
Difficult.
Bad.
Unable to focus.
Like your heart is in a million pieces.
Difficult.
Very sad and depressing.
No fun.
Time consuming.
Rough around the edges.
Nerve wracking.
Like wearing clothes that are too small.
Draining.
Like you're in a different dimension.
Bitter.
Cruel, mean, nasty.
A bad thing. |
Something that makes you stronger.
Something you'll never forget.
A black hole.
Something everyone has.
Very sad and scary.
Losing something that you cared for.
Like trying to run when your shoes are too big.
Facing your fears.
A weight that starts off heavy and keeps getting lighter and lighter.
Like a forest fire.
First it wipes out everything. But then everything starts to grow back smooth and steadily, with a few speed bumps.
BUT: Some lives are just over.
You may never get to the light again, but it depends how well you see in the dark.
Wearing sneakers that are too tight all day long.
When it is very hot and you are uncomfortable.
Wearing shorts and it's really cold outside.
Darkness, when you don't have a night light and you're afraid of the dark.
Dismal.
The pits.
Tired and frustrating.
Depressing. |
In addition to helping children through the one-week summer experience, group support programs are offered at Camp Jonathan throughout the year for children with their parents and for children alone. The organization also sponsors an overnight retreat for bereaved women in November of each year.
Led by trained pediatric grief counselors, therapists, and assisted by trained volunteers, Camp Jonathan offers support for bereaved children and adults through group and individual counseling. The counselors use creative therapies to access feelings, such as movement, art, poetry, and psychodrama to help the bereaved successfully navigate the grieving process.
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Camp Jonathan kids. |
More kids. |
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Kids, the pet therapy dog, and his handler. |
Even more kids. |
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Tags: bereaved, camp jonathan, children, death, grief, kids, loss, Mary Lee Carroll, social worker
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Introduction
Grief is a process that takes time and in which movement is progressive and regressive. In order to clarify its progressive nature, grief is separated into different phases.
There is a sense of shock and disbelief. You feel numb. This can last from a few hours to a week.
This phase includes physical, emotional, psychological, mental, intellectual, and behavioral expressions.
- Physical: There can be a relentless aching and a feeling that your heart has been pulled out of your chest without an anesthetic. Symptoms may include: headaches, fatigue, backaches, tightness in the chest, changes in sleep patterns, changes in appetite with accompanying changes in weight, and experiencing symptoms that mirror those of the deceased.
- Emotional: There are feelings of depression, anxiety, guilt, and anger. With depression comes a feeling of despair and doubt about the ability to go. Suicidal thoughts may arise. Overwhelming feelings of anxiety may be experienced while contemplating life without the deceased. Guilt arises as responsibility (realistic or not) for the loss is assessed.
- Psychological: The deceased may be idealized as a way to compensate for the guilt and anger.
- Mental: Forgetfulness, confusion, and difficulty concentrating frequently develop.
- Intellectual and Philosophical: There is an attempt to understand and find meaning in the loss. Statements like, "He's with God now," and "At least she's not suffering anymore," abound.
- Behavioral: Crying, pacing, physical and/or verbal outbursts may occur. Searching is also evident, in which there is restlessness and wandering. There may be constant thoughts of the deceased and the events surrounding the loss. The bereaved may smell and or sleep with their loved one's clothing, listen to their old voice messages, and hold onto their belongings in an attempt to remember and be close to them. Searching may also involve the expectation that the deceased will return home at their usual time.
The reality of the loss is accepted. Crying diminishes. Physical and psychological well being are restored. The focus is on the present and the future. A new identity is established. Life can be enjoyed again. The period of time necessary to achieve acceptance is dependent on the individual's ability to succeed in doing their "grief work." It is influenced by past experiences, the extent the loss affects everyday life, the individual's personality, and the support available. This process can take up to two years to complete.
- Familiarize yourself with the normal reactions of grief.
- Identify your thoughts, feelings and behaviors as you experience them.
- Embrace the pain. Alternate experiencing the pain with respite, work, and exercising. A healthy balance will energize you and give you the strength to go on.
- Surround yourself with people sensitive to you and your loss.
- Share your story through journaling or talking with others.
- Join a bereavement support group.
- Know that a current loss sets off reminders of past losses and ushers in fears of future losses.
- Sensitize yourself to the many types of loss that may initiate a grief response.
- Avoid alcohol and drugs that will anesthetize you and impede your ability to progress in your grief work.
- Be aware that you may temporarily regress in your grief work on birthdays, anniversaries, and holidays.
- Wait a year, if possible, before making any major decisions.
- Monitor yourself. Are you having more "good days" or "bad days"? Consider seeing a professional if you are "stuck."
- Use your journey to become the best possible you. Working through your grief will strengthen your character, promote positive self-esteem, and provide a general feeling of emotional well being.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Tags: articles, denial, grief, loss, shock, Simona A. Seiderman
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Introduction
When the dying process moved from the home into hospitals and other institutions, Americans may have lost much of what earlier generations knew about the care of the dying and how to deal with loss and the process of grief.
These days many of us take two or three days off from work after a loved one dies and then are expected to become productive. Thanks can be very confusing who is still in the early stages of grief and loss. A grieving person may feel guilty for taking the time needed to grief and feel like a failure for not being stronger.
How Social Workers Help
Social workers can help the grieving person understand grief as the process of healing after a loss has occurred and to value it as useful, natural, healthy, and unavoidable. Even if others expect the grieving person to heal after only a few days, grief like any other healing process takes its own time.
Social workers can help the grieving person to set limits on their time, energy, and involvement so that the process of grief can go well and so that others can respect their need and right to grieve.
Social workers can provide explanations that grief feelings are normal and reassurances that like all processes, grief ends when its healing work is allowed to be done. If the grieving process seems to be very complicated, a social worker can refer the person to a grief counselor for additional help.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Tags: dying, grief, healing, help, loss, social workers, Sue E. Shealy, understand
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Introduction
If you are grieving the loss of a loved one, no one needs to remind you just how devastated you may be feeling. It is perhaps one of the darkest, most stressful periods in your life. As painful as it is to be in this state, it is a normal, healthy reaction to a loss. Thankfully, it does not last forever.
Although some people who are grieving become physically ill and are unable to eat or sleep, others report feeling numb; still others may isolate themselves, preferring to be left completely alone to their sadness. Everyone experiences grief differently.
Regardless of exactly how grief manifests itself, trust that the upheaval you are feeling is normal and universal. Most people experience a range of emotions, which can include the following:
- Anger
- Denial
- Disbelief
- Shock
- Confusion
- Sadness
- Guilt
- Yearning
Likewise, many people who are grieving speak of very real physical symptoms, such as:
- Loss of appetite
- Low energy level
- Stomach upset
- Headaches
- Sleep disturbances
Mourning can seriously deplete your body's natural defenses, leaving you vulnerable to infection and illness. Existing conditions can worsen or new symptoms may develop. Sadness can give way to major depression, which necessitates professional treatment.
Many people are surprised by the intensity and duration of their feelings and how quickly their emotions may swing from despair to anger and then back again to shock. This too is normal. Often, the feelings come in waves and can be quite overwhelming.
Grief is a process that takes time. Trust that, while you will never stop yearning for or missing your loved one, the pain will ease eventually.
Also keep in mind that grieving isn't always the result of a death. People grieve after other major losses such as a divorce or a move away from a familiar, comfortable place.
Immediately after the death of a loved one, people experience bereavement, which is defined as "to be deprived by death." This is a period of deep grieving.
Mourning is the actual process you go through to help you to accept a major loss. This may include religious rituals honoring the person or getting together with friends and family to share the loss. Like grief, mourning is highly personal and can last for months, even years, depending upon your background and traditions. In some Mediterranean cultures, for example, widows were once expected to dress in black for the rest of their lives. In other societies, those in mourning forgo special events or celebrations out of "respect" for the dead.
Losing a loved one is always difficult, but how you react will depend much upon the circumstances of the death. A shocking, unexpected death will unleash different feelings than a death that followed a long, drawn-out illness. Likewise, your relationship to the person is a factor in how you react.
- Death of a spouse can be very traumatic. In addition to the actual loss of a loved one, you may face potential financial woes, especially if that person was the family's main breadwinner. In addition, a surviving spouse may suddenly have to assume all parenting and household responsibilities solo, which calls for a major readjustment.
- Death of a child can evoke an overwhelming sense of injustice and guilt. No matter what the circumstances were, a parent may feel completely responsible for the death, as irrational as it may seem.
- Death via suicide may leave the survivors feeling angry, ashamed, guilty, and even responsible for the death. Suicide is one of the most difficult, disturbing deaths to mourn.
Suppressing your feelings does not work. Allowing yourself to grieve is perhaps the healthiest, most effective way to deal with the loss. You can do this in a number of ways, including these:
- Express your feelings – Whether you write them down in your personal journal, or confide them to a trusted friend, it's important to vent your feelings.
- Look for caring people – Join a support group with others who're experiencing the kind of loss you face. Spend time with relatives and friends who understand your situation and are willing to listen to you. Not everyone has this gift.
- Avoid making major life changes – Changing jobs, moving, or deciding to have another baby is not advisable just now. It's better to wait a while and gradually adjust to the loss.
- Look after your own health – The hard work of grieving is stressful and depletes you. Don't ignore regular check ups with your physician. Be mindful of how easy it is to become dependent upon alcohol or medication to ease your pain. Hard as it may be, it pays to eat well, exercise, and get adequate rest.
- Be patient. It can take months, even years to fully process and accept the loss. Ignore those who urge you to "snap out of it," or those who question why you're not "getting over it." Grief is experienced very personally on an individual time-line.
- Seek professional help – If your grief is unbearable, or if you are simply unable to function, it's a good idea to speak to a professional to help work through your grief.
From linking you with an appropriate support group to helping you make sense of the barrage of official paperwork you must fill out (death certificate, insurance forms, medical bills), social workers can help in a big way. They can point you in the direction of services to which you may be entitled, such as local organizations that can assist you or federal agencies such as the Veterans Administration, which also offer death benefits to families.
A social worker can also help you to determine whether you would benefit from a few sessions with a skilled therapist who can help you sift through the overwhelming, even conflicting feelings you may be experiencing.
Remember, help starts here.
While some social workers work in a hospital, school, or other institutional setting, others in private practice may be self-employed. Social workers make up the largest number of mental health practitioners in the country, and are located in every community.
When a friend, neighbor, or relative has lost someone close, you can help them to grieve through their loss.
- Listen. Allow or even encourage them to talk about their feelings and to share their stories and memories of the deceased.
- Avoid offering false comfort. Telling someone, "you'll get over it," or "don't worry, it was all for the best," is not helpful. A direct expression of sympathy, "I'm sorry," is far more effective, as is lending an ear.
- Think practically. Offer to prepare a meal, baby-sit a child, or run errands. A grieving person is overwhelmed and may simply need an extra pair of hands to tend to the practical realities of living.
If you find yourself using alcohol or drugs (and that includes prescription drugs) excessively following the loss of a love one, do seek out professional help.
Likewise, if you are deeply depressed to the point of feeling suicidal, or simply unable to cope with even the simplest tasks of daily living, contact a mental health professional. Remember, it's not a sign of weakness to admit that you need help. It's a sign of strength.
It's also important to know that you will get through this stage. People the world over endure the losses of loved ones, and do survive. You will, too.
For additional information, contact these organizations:
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Tags: child, grief, grieving, healing, help, loss, mayo, organizations, social workers, spouse, stages, suicide
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The Myth
- We only grieve death.
- People should leave grief at home.
- We grieve in slow predictable pattern.
- Grieving means letting go of the person who died.
- Grief finally ends.
The Reality
- We grieve all losses.
- We cannot control where we grieve or what will trigger our grief.
- Grief is an uneven process with no timeline.
- Grieving means going on with our life; while mainting memories, connections, and feelings of grief and loss.
- Over time, most people learn to live with loss.
Normal Reactions to Loss
Grief is a highly individualized experience that varies depending on who we are, whom we have lost, and how the loss affects our daily life. Grief is not only an emotional response to death or other loss. Typically, we also experience physical, psychological, spiritual, and behavioral reactions. Some of the immediate reactions may include, but are not limited to:
- Emotional: Feelings of shock and relief
- Physical: Shortness of breath, numbness, listlessness, feeling empty, chest pain, loss of energy, confusion
- Cognitive and Behavioral: Denial, disorientation
After the immediate shock, some later reactions may include:
- Emotional: Anger, fear, guilt, panic, loneliness, depression
- Physical: Lack of energy, chest pains, fatigue, tension
- Behavioral: sleeplessness and withdrawal or sleeping too much, overeating, substance use such as sleep aids, drugs, alcohol
Reactions to Sudden or Traumatic Loss
When a death is sudden, unexpected, or violent, and may have been caused by an accident, suicide, or homicide, the grieving process becomes more complicated. The family struggles with trying to make sense of the death and often searches for answers. The grieving process may take longer as family members experience fear and anxiety, guilt over what was done or not done, and anger due to feeling helpless and powerless.
Individuals may feel worse pain months or a year following the loss as the numbness that helped to protect them immediately following the death is gone and the loss is fully realized.
Anticipatory Grief
Grief can begin long before the death of a loved one when life-threatening symptoms first appear, particularly in cases involving cancer, AIDS, or other long-term illness. Anticipatory grief does not replace the grief that loved ones experience after the death. Grief reactions may include feelings of sadness, depression, and anxiety as family members consider questions such as, "What will I do?" and "How will I live?", or “How can I go on?”
Conflicting studies research the question of whether the opportunity to grieve before the death lessens the length of bereavement after death or eases the pain of grief. Since grief is so complex and an individualized to the person experiencing grief, it is difficult to provide a definitive answer. Many factors affect the grieving process, including the nature of the relationship, the manner of death, and other factors.
Unresolved Grief
People who experience intense grief for an extended length of time or depression, substance abuse, or post-traumatic stress disorder in reaction to the death have unresolved or complicated grief. Grief counseling or support groups are often helpful in these cases. Counseling or group support is used to help the mourner experience, express, and adjust to painful grief-related changes and emotionally separate from the loved one and go on with life. Many times talking to others who have experienced a deep, personal loss such as the death of a loved one can help someone cope with grief.
Grief in the Workplace
Most employers provide two or three days of bereavement leave to allow time for family members to make funeral arrangements and attend services. Grief does not end with the funeral, however. In fact, it is often just beginning. Some companies are now offering grief counseling for bereaved employees and sensitivity training for their co-workers. Counseling helps the bereaved to work through their grief and training helps co-workers to understand what the bereaved are experiencing. These services will be particularly valuable as the Baby Boomers age and cope with the loss of their parents or spouses.
Sources:
- AARP
- Hospice Foundation of America
- National Cancer Institute
- National Hospice and Palliative Care Organization
- U.S. Department of Health and Human Services, Human Resources and Services Administration
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Aging With Dignity
Aging with Dignity publishes Five Wishes, an easy-to-use legal document that helps adults of all ages plan for the care they want in case they become seriously ill.
www.agingwithdignity.org
Caring Connections
Caring Connections is a program of the National Hospice and Palliative Care Organization. It is a national consumer engagement to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. Caring Connections provides a variety of free resources on end-of life issues.
www.caringinfo.org
The Dougy Center for Grieving Children & Families
The Dougy Center was the first center in the United States to provide peer support groups
for grieving children. The organization has served more than 14,000 children, teens and families since 1982. Through its National Center for Grieving Children and Families, the organization provides support and training locally, nationally and internationally to individuals and organizations seeking to assist children in grief. The Dougy Center is supported solely through private support from individuals, foundations and companies, and receives no state or federal funding. The Dougy Center does not charge a fee for its services.
www.grievingchild.org
Growthhouse.org
Growth House, Inc., provides an award-winning Internet portal as a international gateway to resources for life-threatening illness and end of life care. The organization’s primary mission is to improve the quality of compassionate care for people who are dying through public education and global professional collaboration. Growthhouse.org’s search engine gives you access to the Internet’s most comprehensive collection of reviewed resources for end-of-life care.
www.growthhouse.org
Hospice Foundation of America
The Hospice Foundation of America exists to help those who cope personally or professionally with terminal illness, death, and the process of grief and bereavement.
www.hospicefoundation.org
National Hospice and Palliative Care Organization
The National Hospice and Palliative Care Organization (NHPCO) is the largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end of life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America and their loved ones.
www.nhpco.org
VOICES of September 11th
VOICES of September 11th (VOICES) advocates and provides services for those affected by the events of September 11, 2001. The organization promotes public policy reform on prevention, preparedness and response to terrorism. Through its work, VOCIES of September 11 strives to build bridges between international communities changed forever by terrorism. VOICES provides information, outreach and programs to more than 7,000 members. In 2006, VOICES launched the 9/11 Living Memorial digital archive, to commemorate the lives and stories of September 11, 2001 and the February 26, 1993 World Trade Center bombing.
www.voicesofsept11.org
Tags: death, foundation, grief, loss, organization, program, resouces, websites
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Introduction |
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Explaining Suicide to a Child – John’s Story |
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Child and Adult Grieving Differences |
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How Children Grieve at Different Ages |
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Should Children Attend the Funeral or Memorial Service? |
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Explaining Cremation |
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What to Say and Do |
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What Not to Say and Do |
Introduction
Children today have a familiarity with death, at least as an abstraction. They witness deaths on television, in movies, and in music. While death today is not often present in the home (as it was when it was more common for elders to die at home), children are aware of death in hospitals and of pets dying.
Discussing death with children is important, although doing so may be uncomfortable for adults. Children need to be told the truth in a straightforward manner and in a way that is age-appropriate for the child.
John’s father committed suicide when John was ten years old. His mother quietly said to him, “You know that Dad has been feeling very sad lately. This morning he took his life. He committed suicide.” By knowing the real situation, John could work through his feelings about his dad’s death. He felt free to ask questions and receive answers he could understand. Answer children’s questions directly, without a great deal of detail. Children who receive accurate information do not have to imagine the worst.
You must be careful with the language you use when discussing death with children. Terms such as asleep, passed on, passed over and gone on a journey are potentially dangerous for children who take such words literally. Imagine a child being afraid to go to sleep because sleep is synonymous with death.
Children grieve differently than adults. While children share the same grief emotions as adults, they often express them differently. For example, an adult may be able to express anger verbally, while a child may do so through drawing pictures. Children also grieve in spurts. One minute a child can be sad and crying in his room, and the next he’s outside happily playing baseball. Children at each age grieve differently from other ages. Outlined below is how children in different age ranges view death; however, keep in mind that factors other than age influence how a child grieves: intelligence, previous experience with death, family environment, religion, and culture also determine grief behaviors in children.
- Three to Five Years Old. Children at this age often think death is reversible. Magical thinking is common. If the princess can awaken from a long sleep, so can grandfather awaken from death. It is important to tell children that death is permanent, and that their loved one will not come back.
- Six to Ten Years Old. By this age, children understand that death is final. They begin to realize that they, too, can die. They need to be told that just because a loved one died, they are not necessarily going to die. Children in this age range are media-savvy and are aware of murders and kidnappings committed against children. They need to be made to feel safe and protected. They need simple, honest information.
- Eleven to Thirteen Years Old. Children in this age range have a realistic view of death, but refuse to believe death can happen to them. They share adult grief emotions, but often are overwhelmed by these feelings. They tend to move in and out of grief.
- Teenagers. Teenagers may either internalize grief or act out grief emotions in inappropriate or dangerous ways. Those who internalize grief may lead adults around them to think they are handling grief well. Look for grief emotions to sneak out, expressed in poetry, art, and music. Some teenagers act out their grief in destructive ways, such as driving recklessly, fighting in school, experimenting with drugs and alcohol, and engaging in sexual behaviors. Regardless of how a teenager grieves, help from an adult is needed. If grief becomes pathological, seek counseling with a trained mental health professional.
If a child is old enough to express his desire to attend, let him do so. Attending the service may help the child understand the finality of death, and may assist him in celebrating and mourning the death of a loved one. Explain to the child in advance of the service what he can expect to see and hear. Tell him you will be there to hold his hand.
If a child states that he does not want to attend, do not force him. Be sure, however, that the child has all the facts about the service, and pay attention to any fears the child may express. You can offer to visit the cemetery with the child later.
Cremation is often more difficult to explain to a child than burial. Keep your explanation simple. Do not use words such as fire and burn, which may frighten the child. Explain that the body was taken to a crematory where it went through a special process so that it was reduced to something that looks like sand. Mention that the ashes were put in a container called an urn, and then explain what the family plans to do with the urn.
If you are a friend to a child who is grieving, there are many ways in which you can help the child process emotions. Listed below are some things to do or not do.
- Keep routines as normal as possible.
- Say the deceased person’s name.
- Talk about the person who died. Keep memories alive by looking at photos, recognizing holidays and anniversaries, and commemorating the person.
- Provide the child with opportunities to express feelings. These feelings may include guilt, anger, sadness, confusion, or anxiety. Listen and give your support to the idea that it is acceptable to express emotions.
- Be patient and adjust your behaviors to fit the child’s needs.
- If a child becomes aggressive, try to channel his behaviors so that he understands what behaviors are acceptable, what behavioral limits are, and that he is cared for and safe.
- Share your feelings with the child. If you cry, explain your sadness to the child.
- Model appropriate grief behavior. Express your own emotions in a healthy way.
- Avoid euphemisms such as passed away, gone on a journey, and asleep. Children may take these terms literally. Be honest.
- Do not say, “God loved your mother so much that God sent her to heaven.” A child may feel that he, too, may die if he is good.
- Do not say, “It was God’s will.” Regardless of what you as an adult believe about spirituality and death, such a statement may negatively shape a child’s view of God and spirituality.
- Do not say, “It was best your mother died because she is no longer suffering.” Perhaps a child would rather have a suffering mother than none at all.
- Do not say, “You’re the man of the house now.” The child is still a child, and should not be saddled with adult responsibilities. Also, the child cannot take the place of someone who has died.
- Do not say, “You must be brave” Children do not have to be brave. They should be allowed to express emotions, and to know that such expression is acceptable. Do not say, “You’re doing so well” (if the child is not expressing emotion). Saying this may tell a child expression of emotions is not acceptable.
- Do not say, “You should be better by now.” There is no timetable for grief.
- If a child’s behavior becomes regressive, do not criticize the child. Regressive behaviors such as bed-wetting, and thumb-sucking are common after death.
The book A Good Friend for Bad Times: Helping Others Through Grief, by Deborah E. Bowen, MSW and Susan L. Strickler is published by Augsburg Books and is available at www.augsburgbooks.com. It is also available at other Internet book retailers and at local bookstores.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Tags: age range, children, cremation, Deborah E. Bowen, grief, loss, memorial service, suicide, what not to do
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Introduction
Certain illnesses and circumstances surrounding death require special considerations by friends and coworkers of those grieving. While the stages of grief are the same, particular issues may need to be addressed and unique comforts given with different circumstances.
Alzheimer’s disease is the most common form of dementia, affecting people of all ages, races, religions, economic status, and ethnicity. Its course is unpredictable.
Sue's Story
The patient has days of mental clarity when a plateau is reached, and days of total confusion. Sue’s mother began her descent into Alzheimer’s disease slowly. At first, she got lost going to familiar places. She wrote notes to herself constantly, including listing her sisters’ names. She became suspicious of people, was less spontaneous, and progressively lost interest in former activities. She began to hide possessions, particularly dinner forks and shoes. Later, she could no longer recognize friends and family. Near the end of her life she stopped eating and remained in bed in a fetal position.
As the illness progresses, caregivers of Alzheimer's disease patients find their experience also to be progressively difficult. They have most (if not all) of the anticipatory grieving emotions during the process of the illness. They may feel angry, sad, guilty (“I want my life back, and I feel guilty about wanting it when she’s so sick.”), discouraged, irritable, or exhausted (“I can’t get any sleep. She wanders all night.”). Folks who have not experienced caring for a person with Alzheimer's disease cannot understand how overwhelming this caregiving job is. Caregivers often feel alone and isolated in their roles.
Unfortunately, one of the by-products of caregiving for an Alzheimer's disease patient is that the caregiver loses contact with friends and outside activities. Both friends and other family members may withdraw from the caregiver. Sometimes this withdrawal initiates from respect for the caregiver’s time and energy. Sometimes it stems from a lack of understanding: “She must be so busy; she doesn’t want to talk to me.” The caregiver may initiate the withdrawal because she simply does not have time to focus on anyone except the patient.
Because Alzheimer's disease is such a slow, progressive illness, anticipatory grieving can last for years. Also, the grieving needs of the caregiver may be stronger before death than afterward, and support from friends is vital during this time. Be aware, also, that after losing a patient to death from Alzheimer's disease, the caregiver may experience a tremendous void in her life, as well as a loss of direction and meaning. She still must deal with grief after death. Those same grieving stages that occurred before death will reappear. They may be couched in a different framework, but they still must be addressed. Your friend needs you during both phases of her grief.
- Offer to stay with the person with Alzheimer's disease so your friend can get out and do something for herself. If she cannot think of any activities, suggest a walk, a movie, or a religious ceremony.
- Prepare a meal. Try to organize a group of supporters so that a meal or two can be delivered each week. Make large portions so some can be frozen for another meal. Offer to feed the person with Alzheimer's disease.
- Clean the house, do laundry, change linens, wash windows. Ask your friend if there is a particular task that needs addressing.
- Run errands.
- Pay for occasional respite stays in an adult care center. Transport the patient to appointments or to an adult care center (if used).
- Help install special locks on doors.
- Order identification bracelets.
- Provide gift certificates to encourage self-care for your friend. Suggestions include certificates for a massage, manicure, pedicure, or hairdresser. Then be willing to sit with the person with Alzheimer's disease while your friend is out.
- Call if you cannot visit regularly.
- When you do visit, do not overextend your time, particularly if the patient is having a difficult day. Send inspirational cards or notes saying “I’m thinking about you.”
- Encourage your friend to join a support group. Most cities have caregivers’ support groups.
- Encourage journal writing.
- Allow your friend to vent, to express emotions, concerns, and frustrations.
- Help her cultivate her sense of humor. Create opportunities to laugh.
- Be nonjudgmental. Your friend is doing the best she can. Tell her so.
While there are similarities in grief with all long-term illnesses, HIV/AIDS deserves a special mention because of a concept called “disenfranchised grief.” Disenfranchised grief occurs when the illness or death of a loved one is not acknowledged or socially accepted. Those who grieve losing someone to HIV/AIDS are sometimes denied the opportunity to openly express their feelings and be emotionally supported by friends and family.
The social stigma attached to HIV/AIDS, unfortunately, has not lessened very much over the years since the virus/disease were discovered and named. Society still associates HIV/AIDS with risk-taking behaviors, so those who contract it, and their caregivers, often are often viewed negatively. Fear still plays a large part in the treatment of people living with HIV/AIDS. For example, we have spoken to health care providers who refused to care for patients with HIV/AIDS, and with family members who were afraid to visit their relative because they erroneously think they might “catch it.” (For more information on HIV/AIDS transmission click here to read the NASW HIV/AIDS General Overview.)
Peggy's Story
Peggy said that her son, who was HIV positive, developed cancer, which later was the actual cause of his death. Peggy stated that she believed people were far more sympathetic to her grief with a diagnosis of cancer than they would have been with a diagnosis of HIV/AIDS. “I was so relieved that he got cancer, because I didn’t have to tell anyone he also had HIV.”
HIV/AIDS, like Alzheimer’s disease, is sinister in its progression. We have known persons who had advanced HIV/AIDS that affected their brain and could no longer communicate verbally. We also have known people who have died from this illness without their brain being affected. In any case, the illness can move quickly or slowly, and can create tremendous anticipatory grief for both the person with HIV/AIDS and his or her caregiver.
Insightful therapist Carl Rogers coined the phrase “unconditional positive regard.” Rogers meant that we should hold others in the highest possible regard without demands or stipulations. It means caring without passing judgment. Perhaps with no other population does this concept mean so much as it does with people living with or dying from HIV/AIDS.
The list outlined above for Alzheimer’s disease also can be used here. Follow these suggestions as well:
- Be aware of your own feelings about HIV/AIDS and people living with it. If you are not sincere in your concern and actions, or are afraid, the people you are trying to help will know it immediately.
- Hug the patient and the caregiver. Your willingness to touch people living with AIDS speaks of your caring far more clearly than any words ever could.
- Assist with paperwork.
- Assist with research concerning legal rights of partners.
- Help the patient stay on his or her medication. Talk with the patient about side-effects and how to keep up with a complex medication schedule (if you feel qualified).
- Take the patient for an outing, if he or she feels up to it.
- If there are children, offer to baby-sit so the caregiver or the patient can get out for a while.
- Assist with birthday parties and holidays.
- Provide emotional support. Allow the caregiver and the patient an opportunity to express emotions.
- Listen. After a death, the caregiver needs all the support listed above, but pay special attention to the following: Enable the survivor to tell his story.
- Understand that survivors of someone who has died from AIDS may have strong emotional outpourings, particularly anger, fear, guilt, and shame. Allow your friend to express those emotions. Remember that emotions are not right or wrong. They simply are.
- Your friend may have feelings of abandonment, both by the deceased person and by friends and family who, for whatever reason, were not present during the illness and death. Allow your friend to express those feelings.
- Be patient. Remember that grief has peaks and valleys, and is a roller coaster. Give your friend time and space. Remember birthdays, anniversaries, holidays, and death days. Perhaps you and other friends and family members could assist in planning and carrying out a special ritual or memorial service on these days.
- Do not avoid the grieving person.
- Do not be judgmental.
- Do not avoid mentioning the name of the deceased.
- Do not get involved with family conflicts.
- Do not load up your friend with “shoulds.” You have no right to tell her what she or he needs to, or should, do or not do.
According to the National Institute of Child Health and Human Development, National Institutes of Health Web site, about 15 percent of all pregnancies end in miscarriages. Unfortunately, society does not attend nearly well enough to those grieving such deaths.
Some of the most callous comments we have heard in our work have come from well-meaning people to those suffering loss from miscarriages. “You didn’t really know this child because it wasn’t born yet.” “You can have others.” “You should try to get pregnant again right away.” “At least you have other children.” What awful, insensitive statements!
Most often, in an anticipated pregnancy, parents begin to bond with a baby the minute the pregnancy is confirmed. This bonding becomes stronger as gestation progresses. When a miscarriage occurs, grief can be overwhelming. All the stages of grief appear. The mother may also feel that she is a failure because she was unable to bring the baby to term.
Marcy's Story
Marcy miscarried her first child in August many years ago. Every August thereafter she has experienced depression, anger, sadness, and guilt over the life that might have been. Her feelings of loss never leave her.
In a stillbirth, like a miscarriage, a life is ended before it has an opportunity to develop. Also, like in a miscarriage, attempts at comforting the grieving parents can be clumsy at best.
The difference between miscarriage and stillbirth is that in a miscarriage the fetus does not come to term, while in stillbirth a body must be cared for. Parents may choose to have a Baptism or memorial service in the hospital chapel. Some parents find a picture or footprint of the baby comforting.
Remember that your friend not only grieves the loss of the child, but all the events in the child’s life that will never happen (the first tooth, high school graduation, marriage, children).
If you are a friend to someone grieving a stillbirth or miscarriage, some of the suggestions below may be helpful.
- Attend whatever rituals or services your friend chooses to hold.
- Plant a memorial tree or bush for the family.
- Suggest that your friend light a memorial candle on holidays and special days, and participate in the lighting of this candle.
- Suggest that your friend join a support group, such as Compassionate Friends, an international organization for those grieving the loss of children.
- Suggest that your friend keep a journal of her grief work. Remember the anniversary date with a card or a call.
While in theory we believe that all grief is equal, we feel that in reality there is no greater grief than the loss of a child, regardless of the age. Whether the child is a newborn infant or twenty-one years old, all the theories we know regarding grief work seem to be invalid or, at best, inadequate. In our experience, families who have children die never appear to reach the closure stages noted by the experts. Grief experts now understand that a bereaved individual or parent can have an ongoing bond with their deceased child.
Dan's Story
Dan, whose daughter was killed in a car accident, told us, “I learned to get through each day in a fog. I became a robot, doing what needed to be done at work, at home. The sharp, searing pain became a dull ache, which never goes away for a moment. Even as I learned to laugh again, I mourned that I could never laugh again with her.”
We expect elderly people to die. That is the order of nature. Somehow, the death of a young person disrupts this order. Most of us question the reason for death for anyone: “Why did he have to die of cancer? Of a heart attack?” There are, of course, no answers to these questions, but when they are asked about the death of a young person, the void seems bottomless: “Why so young? Why now?”
Often there is tremendous guilt surrounding the death of a youngster, regardless of the cause of death. The “if onlys” and the “what ifs” are endless.
April's Story
April’s daughter left home at sixteen, living on the road, calling home occasionally, and usually coming home for Christmas. At twenty-eight, she was found dead of a heroin overdose. April’s anguish was inconsolable. “I wish I could have locked her in her room until she was thirty, keeping her safe. If only I had been more aware of her drug problem . . . if only I had tried to stop her . . . if, if, if.” The answer is that there are no answers.
Beth's Story
Beth’s daughter died at age ten of leukemia. The years of treatments, the false promises of periods of remission, and the final acceptance of the illness took their toll on the whole family. Beth and her husband found themselves grieving the loss of their daughter differently from each other. Beth cried and wailed, while her husband maintained a stoic silence. The loss of a child can bring family members close to each other, or it can rip a family apart. Beth’s mother said, “Why did she have to die? Why couldn’t it have been me? I’m old and ready to go.” Again, there are no answers.
Use any of the suggestions mentioned earlier in this article, as well as the following:
- Listen . . . again and again and again. Your friend needs more than anything to talk about the child. She needs to tell stories about his life and to mourn all the events that will never be.
- Say the child’s name. Doing so validates his life. Remember anniversary dates with a card, a telephone call, or a visit.
- Honor the child with a memorial gift to a foundation or organization (such as a school, church, etc).
- Create a living memorial by planting a tree, giving books to the local library (or his school library) in his memory, or donating playground equipment to his favorite park.
According to suicide researcher and author Beryl S. Glover, suicide can be one of the most tragic forms of death. It is almost impossible to predict. According to the Centers for Disease Control, in the year 2000 alone, 29,350 lives were lost to suicide in America.
Suicide rates are especially high among the elderly, but often are misdiagnosed. Many elderly people suffer from chronic physical illness and cannot tolerate the loss of independence and self-sufficiency. Elder suicide often has been ruled as unintentional drug over-dose. Fortunately, medical professionals are becoming more aware of the growing trend of elderly depression and suicide, and are taking measures to help.
Suicide patterns have changed among young people recently, and attempts have risen dramatically. Suicidal adolescents, like suicidal adults, may be deeply depressed, but signs are sometimes difficult to recognize because they may manifest themselves as boredom or physical complaints.
There are many reasons people commit, or attempt to commit, suicide, but that discussion is beyond the scope of this article. However, it is important to note that any suicide attempt or threat should be treated seriously. If you suspect that a friend or coworker is planning a suicide attempt, seek professional assistance immediately.
The stigma of this type of death can entail more shock and denial than many other kinds of deaths. Survivors of a suicidal death certainly experience all the stages of grief, but they often have a prolonged period of numbness, so that there appears to be an absence of feeling.
The suicide survivor has the right to feel (or not to feel) any emotion after the death of a loved one. She may feel shame, guilt, or disbelief: “Why didn’t he leave me a note?” She may blame herself: “What did I do wrong?” “Could I have prevented it?” She also may feel anger or a sense of relief that the person no longer suffers from mental or physical illness.
Suicide survival can be thought of as another kind of disenfranchised grief, one not generally discussed. This often results in a lack of emotional and social support for the survivor. Fortunately, this stigma is changing, and the pain felt by the survivors is becoming more easily acknowledged.
- Encourage your friend to talk about her feelings. Help your friend deal with “unfinished business” (i.e., finding a way to say good-bye).
- Be careful about being judgmental. Avoid clichés.
- Allow your friend to cry, scream, or express emotions in any way. Be aware of potentially intense feelings. Help your friend to laugh and to celebrate the life of the deceased person.
- Encourage your friend to join a support group. Most cities have such groups for suicide survivors.
- Understand the uniqueness of suicide grief.
The death of a pet can be traumatic for both children and adults. Pets love unconditionally. They ask for little in return for affection and companionship. Fortunately, society is beginning to accept the reality of the grief felt when a pet dies.
Deb's Story
Deb lived for eighteen years with Merlin, the Magic Cat. He was her constant companion, loving to ride in the car, walk on the beach, and even ride in her boat. When he died, it was as if her best friend had died. Merlin also was special to many of Deb’s friends, and some of them were with Deb and Merlin in his final hours. Friends and family brought food and attended a memorial service honoring his life. Merlin was cremated, and Deb’s friends helped her scatter his ashes. A friend painted a portrait of him from a photograph. Her employer granted her three days of bereavement leave from work.
Grief over the death of a pet is no different from grief over a person, although the grief varies in intensity from person to person. One can experience all the emotions common to grieving the loss of a person, including anger (particularly if the pet was killed) and guilt (“I should not have left her outside”). It is important to note that each member of a family has a unique relationship with a family pet, and each relationship should be honored, including the variety of emotions that various family members may feel at any one given time.
Children should be involved in any rituals and memory sharing regarding a pet. If the decision is made to euthanize the pet, children should be informed beforehand, so that they can have their special time to say good-bye.
Older adults often have special relationships with their pets, particularly if they live alone with the pet. Sometimes the death of a pet can bring up old feelings regarding the death of a loved one, resulting in compounded grief.
Certainly, all the suggestions in this article regarding the death of any loved one can apply to the death of a pet. However, below are some special considerations:
- Be careful regarding how you express sympathy. Treat the death as you would any other loss. Do not minimize the death in any way. Do not say, “You can get another cat.” “I know someone who has a dog just like yours and she just had puppies.” “At least you can go out now without worrying about the dog.”
- Telephone, send a card, or visit.
- Offer to frame a special photograph of the pet. A friend who recently lost a pet was given a beautifully framed poem about, and photo of, his cat.
- Present your friend with an ornament or statue that symbolizes his relationship with his pet.
The book A Good Friend for Bad Times: Helping Others Through Grief, by Deborah E. Bowen, MSW and Susan L. Strickler is published by Augsburg Books and is available at www.augsburgbooks.com. It is also available at other Internet book retailers and at local bookstores.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
Related Articles:
Tags: alzheimer's, caregiver stress, coping, Deborah E. Bowen, grief, loss, miscarriage, pet, suicide
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