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Joseph Nowinski, Ph.D.

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New Ways of Thinking About Grief

Posted: 03/18/11 09:43 AM ET

In her book, "The Truth About Grief," Ruth Davis Konigsberg challenges the idea that we all can expect to experience the loss of a loved one in a similar way. In particular, she challenges the "five stage" model of grief that is now familiar to most of us -- the one that begins with "denial" and ends in "acceptance." Konigsberg argues that people grieve in different ways. Perhaps most importantly, Konigsberg asserts that people are in fact more psychologically resilient that we generally think they are, and that a relatively brief period of mourning may be the norm.

In the process of writing our own book on grief, Dr. Barbara Okun and I relied on in-depth interviews with family members who had the experience of losing a loved one to a terminal illness. Some of their stories are posted on our website. The "roadmap" of grief that emerged from this work confirms in some ways what Konigsberg has written -- in particular, that grief is indeed a diverse, not a uniform, process. At the same time, we learned that grief has changed rather dramatically in the 40 years since Elisabeth Kubler-Ross' "On Death and Dying" was published.

In short, grief in the past was often triggered by an event -- the sudden or quick death of a loved one. Steady advances in medicine, however, have transformed dying so that it is increasingly a protracted process. In turn, grief has evolved to the point where it is now a parallel process that often goes on for years. This "new grief" begins when a loved one is diagnosed with a terminal illness. It then proceeds through a long period of diagnosis, treatment, remission, relapse, etc. Elizabeth Edwards, for example, worked with her doctors to contain metastatic breast cancer for several years. The realities of modern medicine dictate that more and more of us will find ourselves confronting this new grief, sooner or later.

This new grief is different. For one thing, it includes the loved one with the diagnosis. It also draws in the entire family into a prolonged crisis that some of our interviewees aptly described as "learning to live with death." It presents unique challenges to families who today tend to be more far-flung than ever before, and whose day to day lives were complicated enough before the diagnosis was rendered. This new grief creates ongoing stresses, not only for the patient, but for his or her loved ones and, in turn, on their own families.

Our goal in writing "Saying Goodbye: How Families Can Find Renewal through Loss" was to collect, organize and then share the collective wisdom we were able to derive from the stories we heard. Indeed, we discovered that this new grief is messy, and that individuals and families experience it in diverse ways. At the same time, we learned a few things that others have said they found valuable as they confronted this situation:

  • There are differences in terms of how "resilient" not only individuals, but families, are. Moreover, there are ways to build that resilience.
  • Although the ways in which they cope with them vary, there are some fairly predictable experiences that families will find themselves confronted with after a loved one receives a terminal diagnosis. Being able to anticipate these can be helpful.
  • Knowing in advance about the complexity of medical and legal issues that await the patient and his or her family can reduce (though not eliminate) stress and its potentially deleterious effects on everyone.
  • Clear communication and end-of-life planning, along with effective palliative care, can improve the lives of terminal patients and their loved ones alike.

As for whether a brief period of mourning is the norm, we have found that this, too, is subject to a great deal of variability. Truth be told, the vast majority of those we've spoken with assert that mourning never truly ends; rather, it waxes and wanes over time. Mourning does not, however, need to be debilitating. The way people mourn seems reflect the nature of the relationship they had with their loved one. It hardly needs to be said that marriages are not all the same; accordingly, mourning is anything but a uniform process. Those we love become part or our identity -- our sense of who we are, and why we are here. The more central a loved one is to our identity, the more profound our mourning will be. Helen Nearing, married to the writer Scott Nearing, described her mourning in her memoir, "Loving and Leaving the Good Life," this way:

Our love had lasted half a century, and still goes on now, eight years after he died at the honorable age of 100. The love continues on my part, and on his side too, I believe. From where else could come the glad certainty every morning, evening and hour of the day that I live in love and am charged with it -- outgoing and incoming.
 
 
 

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In her book, "The Truth About Grief," Ruth Davis Konigsberg challenges the idea that we all can expect to experience the loss of a loved one in a similar way. In particular, she challenges the "five s...
In her book, "The Truth About Grief," Ruth Davis Konigsberg challenges the idea that we all can expect to experience the loss of a loved one in a similar way. In particular, she challenges the "five s...
 
 
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05:29 PM on 03/20/2011
Quite rightly as Brooklyncitizen says in reply to my first comment, our lives never get back to the way there but they can get back on track. As much as life sucks after losing someone, life does have to go on and we must choose to start breathing again, walking again and seeing again. But this will only happen when we are ready.

Another observation that I totally agree with is that after each loss we become a different person – some part of us changes permanently. Unlike any other event in life, I don’t believe there is anything like the death of a loved one that creates such an uncontrollable transformation within us. And each time we experience death, that transformation is totally different.

After I lost my father and then a few years later my younger sister, the resulting man in the mirror was a stranger. That was almost as hard to come to terms with as the loss itself. And this is the very reason that I cringe when another “expert” is bringing out a new book detailing how to deal with grief or death or any such event. It is simply too unique to model, document or box.

We are all unique and so therefore by definition will our reactions and actions be through life and in death. Lets keep it that way please.

Also I happen to agree with VirgoLinnea that grief can be triggered by things other than death!

Craig Ing
www.craiging.com
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librainstars
even the smallest things in life make a difference
09:43 AM on 03/21/2011
wow , You so hit home with your post. I lost 10 very close people in 4 years. All were relatives except for two who were my best friends.
Each time I changed. My parents passed 28 days apart. Both me and my 2 children from that have PTSD.
Its way better then it was.
With that much loss, my life will never be the same. My kids are young adults now. The way they look at life will never be the same. I know for me it can get triggered by other things and up comes the grief.
You saying "the man in the mirror is a stranger."
Is so true. I look in the mirror at times and think "who is that woman"
I wonder where did the person go that I knew before all this took place.
04:39 PM on 03/23/2011
You have been through a lot of pain and each time the eternal question of "why" cannot be answered with anything near a satisfactory response.

The ways in which death affects us will never be truly understood. We are supposed to know ourselves best and until death comes into our lives I bet most of us would say we do/did.

The most frustrating period of time after a death is the awareness that you no longer know yourself. I spent too long in this limbo of self-analysis, trying to find the person I was. It was really distressing and the pro-longed agony of analysis merged into the grieving so that I couldn’t tell one thing from another, one emotion from another, one thought from another. It was like I suddenly needed a dictionary to translate life, something that told me how to feel and what the feelings meant.

In the end, after many hours of mediation and deep thought the epiphany came to me. That ‘before’ person no longer exists and the new man in the mirror needed to be introduced to me. I needed to get to know that person and in fact, I had the very rare chance in life of deciding who I would be. Out of the death came my own rebirth. It was incredibly positive and this is what I ask my clients to focus on – at the right time. Release the ‘before’ person and live as you are now.
04:08 PM on 03/20/2011
Konigsberg's points are well taken, but they tell only part of the story. In a blog post from SAVE (Suicide Awareness Voices of Education, http://www.save.org) titled "Researchers Say 'Truth about Grief' Misses Essential Point," (http://suicidegrief.save.org/node/13) two of the researchers she quotes in her book object to her narrow interpretation of their findings and point out that "new approaches to therapy are demonstrably effective for mourners whose losses are sudden and traumatic, or whose grief is disabling and seemingly without end. With one in seven survivors struggling to make sense of their loss and move forward with their lives, professionals who specialize in helping them do so can be a godsend" (Robert Neimeyer and Joseph Currier, in a letter to the New York Times).
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03:47 PM on 03/20/2011
I'm so tired of articles and books on grief only acknowledging grief as of the death of a loved one, or of being in war. There are SO many other things that trigger grief.
Konnie
PO'd PROGRESSIVE
11:22 AM on 03/20/2011
raised the only catholics in an evangelical family, i have spent years finding my own beliefs, what reasonates with my soul. i embraced reincarnation and karma long before it became the faith du jour or cause celebe.

most people find my reaction to death and dying bewildering. i show no sense of loss, because i don't believe that person is gone, only that the suffering is over. i just can't see them. they are here, still with me - still hearing and seeing
everything i hear and see. i have had too many personal experiences to believe otherwise. the comfort
of this philosophy and the fearlessness it provides is priceless.
02:09 AM on 03/20/2011
I have faced a lot of grief -- the "new" variety you describe in your article; as well as the sudden, incomprehensible loss of a child. The Kubler Ross model still holds....it just isn't defined "stages" and there can be NO timeline put on grief recovery. Each person's grief is as individual as the person and the relationship with the deceased. I am pleased to be reading more about grief in the popular press; as it has been considered a "natural" life process and as such no further education/support/resources were discussed. The sudden, unexpected loss of my child, was for me WAY worse than the loss of my parents, which were both following lengthy illnesses. All are hard.
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01:28 AM on 03/23/2011
"The Kubler Ross model still holds...."

One of my high school theology teachers once pointed out, apropos of nothing, that Kubler-Ross was pretty sensitive about any omission of the hyphen in her name. Even so--or maybe as a result--"On Death and Dying" changed my life.

- bvf
07:33 PM on 03/19/2011
First thing is first, I am so pleased that no-one here has dared utter the phrase that can only ever be said by those that have not experienced death....”time is a healer”.......what a load of bull!

Mourning never stops. Mourning and memories are intimately linked and for years to come you will find something jogs a memory of a lost one and that memory will seamlessly merge into mourning (as said by brooklyncitizen), albeit maybe only for a few moments.

My heart goes to Joyce and others like her. I have lived through too many direct family members dying and also have worked with a number of Private Clients in similar situations. It is great that Joyce is gaining strength from articles/forums such as this and I for one always prescribe a huge amount of information sharing and communication as a baseline form of medication. I then mix this with changing the perspective and focusing on the positive. The one thing I can tell you (which may help Walfred Michele with the research) is that grief, mourning and “getting life back on track” is as unique to us as our DNA. I have had to deal with every client in a unique way and I would encourage all "experts" to do the same.

Craig Ing
www.craiging.com
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brooklyncitizen
Quaerite primum regnum dei
07:52 AM on 03/20/2011
Great post.

I'm not sure we "get life back on track". Really everything that happens to us gets folded into our life very much like ingredients are folded into a recipe for baking bread ....it just creates something new and adds its own flavor.....even if it is slightly bitter.For myself, I realized that after my father's death ,which was shortly followed by my brother's death , there was no getting back to who I was before. IF we allow it, death can push us to go a bit deeper it also gives us a new way of seeing.

After I lost both I came across Joan Didion's "Year of Magical Thinking" and in that book found a mirror for much of how I felt and experienced.Grief can be surreal.
11:22 AM on 03/23/2011
Thank you Craig for bringing up the "time is a healer" myth. Psychologist and thanatologist Dr. Robert Neimeyer (and his crew at the University of Memphis, including Joe Currier) report that time only has a 1% effect on bereavement. It isn't the amount of time, but what is done with the time that matters. (Yes, many of us know that line is often uttered by well meaning people who have no idea what to say, however it is nice to have some mathematical data to back it up.)

Jai! Heather Whittington
www.mindfulgrief.com
12:34 PM on 03/19/2011
Hi Ellen
One of the things that jumped out at me from the interviews we did in preparation for writing Saying Goodbye was the enormous difference that ANY kind of advanced thought and planning can make for the person confronting terminal illness and the family. Lack of planning tends to lead to many loose ends. The most painful stories were from families who, not being clear about what the dying person would want, hesitated to make end-of-life decisions. The result was often an undignified end in an intensive care unit or nursing home. Contrast this with the story of woman who was clear when she wanted in-home hospice care, established a rotation for her children to visit, and let it be known when her grandchildren could (and could not) visit. She took charge of saying goodbye, and I admire her for that.
JN
10:27 PM on 03/19/2011
Hi Joe... your words are an excellent push to get me moving on this. I have discussed my wanting to be cremated.. but have given no thought as to what to do with my ashes. I prefer to die in the hospital hospice unit and not at home.. and have put off this discussion as I suspect this news will disappoint my family. I've been thinking of putting together a ' who to contact ' list .. but haven't. I've been wanting to update my beneficiaries on financial investments - but haven't. I don't even have a will. Maybe my thinking is that if I ignore death issues- death will ignore me!? So.. thanks for the push.
Ellen
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brooklyncitizen
Quaerite primum regnum dei
12:08 AM on 03/19/2011
I think mourning doesn't go away....it actually presents itself in different ways.One thing that occurred to me is that not only do we lose the person but we lose so many of the details that enriched our lives.Sometimes we miss the details of how we interacted and it hits us that we haven't seen that particular smile or heard the familiar words or even gestures of the departed.It always hits me this way when someone reminds me of a loved one and it triggers the mourning.
11:29 AM on 03/18/2011
I wanted to post a link but it might not have gone through moderation, which I understand. So this is an open question. Do you think it is appropriate for those who learn they have a terminal illness- to throw themselves a party? They are being called goodbye parties, living wakes, etc. Timothy Leary had one when he learned he had prostrate cancer. They are controversial, but happening more and more in U.S. But I think they can be comforting too- being around friends, the laughter and positive feelings that come from them. But it might strike some as weird. I lost my dad to cancer- he was a very happy, boisterous person and now I wish I might have celebrated him while he was still alive.
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notadumbblonde
IndependentNonHater
02:45 PM on 03/18/2011
I think anything is appropriate if those who are dying choose to do so without duress or guilt. I think it's a wonderful way for friends and family to get together and reminisce, to take the lead of the dying person. Most of us don't know what to do or say in the presence of a dying person.

I recently went to a wake for the mother of a friend; I was silently praying, head bowed, in fron of the casket when I was interrupted by the friend's daughter. She called my name out, squealing "Oh my God, I haven't see you for ages, how are you?" I was mortified to be interrupted during the paying of my respects.

Then the interrupter's daughter (age 11) told me her grandmother looked different to her. Her mother (the interrupter) said, "Just pretend she's sleeping and it will be the same." I was mortified again.

I think grief and grieving behavior is so diverse, so it's always best to defer to the wishes of the soon-to-be deceased.
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Arithrianos
reality has already (w)on(e), surrender!
09:12 PM on 03/18/2011
what a great idea, thanks! i am pretty selfish so i want people vibrating as highly as possible around my transition, it has a tendancy to be a bummer so anything to cheer up would be welcome. if death is understood it should be celebrated, the body should be celebrated for successfuly doing it job of carrying Awareness from one "end" of the bardo to the other "end". regret is not needed though to honor your father really, just the willingness to think about him is enough and also you could be more open to celebration in the ongoing wow that is NOW, things you do now matter much more than thoughts about unchangable events. just a thought, may all your funerals be bright ;)
10:19 PM on 03/18/2011
Thanks everyone. I am doing graduate research on this subject. If you'd like to take a survey I'd appreciate it. http://bit.ly/hcsZT4 It's one of those Google Doc surveys. In our class we've been learning about Buddhism and I am intrigued to learn more and think that having positive energy helps in the transition.If I am given the opportunity to plan, I think I will break with tradition and do something like that.
10:41 AM on 03/18/2011
I think this article is really in tune with the song of grief that I hear. I compiled a book of letters, "Merceda's touch: Grace for the Grief" to my niece, Merceda from family and friends which gave all of us our voice in dealing with her death. We were able to bring her memory to life as a way to honor her. We were truly given the blessing of grace.
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Arithrianos
reality has already (w)on(e), surrender!
10:20 AM on 03/18/2011
i have never grieved for anyone, mainly because i never "lost" anyone, my loved ones are not at all my property, they are realitys property, and when reality says thats all, it is not a loss, it is just reality. grief is caused by attatchment, by unskillful selfish love, unselfish, big love cannot be ended by death, ever, so no need to grieve, but there is space for sadness at the transformation of the relationship, a few tears but really there is no need to grieve, really what would your loved one want, especially after "death" when they are pure unbiased love? what they would want, at least what they communicate to me, it for me to be glad and grateful they showed up at all, i got a free gift of being a fellow co-being-ist for a time, to ask for more leads to the idea of "loss" and to grief, quite naturally. so the choice as always is yours, choose wisely and get a little sadness mixed with joy and gratitude, or chose poorly and get grief. may all beings choose wisely, may noone mourn my recycling.
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notadumbblonde
IndependentNonHater
02:55 PM on 03/18/2011
Truly a unique prose; I think we cannot control our feelings; we control our reactions to our feelings; I believe as you do that I was blessed with the presence of other beings in my life, and when they're gone, I will be sad, but my sadness will be replaced with memories to be cherished. Sadness because a truly unique relationship has come to an active end (only I had that relationship with the deceased, no matter the type), and the loss of such closeness requires me to dance solo in that relationship until I figure out my life without my loved one.

I also believe as you do that my loved ones are in a state of pure love when they leave this world. Whatever that means to each of us, it provides me comfort.

Peace to you, my friend.
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Arithrianos
reality has already (w)on(e), surrender!
09:17 PM on 03/18/2011
peace and reality right back to you, when dancing solo who you are includes everyone you have ever been "touched" by, for "good" or "ill" that is scientific, we are al contagious, our vibrations travel throughout our networks. so really it never solo really nother ever really leaves, as olgra said paraphrased, the "dead" could be anywhere, even inside.
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brooklyncitizen
Quaerite primum regnum dei
12:11 AM on 03/19/2011
I would buy what you are saying but it sounds a bit critical of those that are going through a natural process.Tell this to the many that lost loved ones in Japan that they are simply suffering from attachment and selfishness.
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Arithrianos
reality has already (w)on(e), surrender!
03:48 PM on 03/19/2011
they have zen for that, it teaches the same. grief is not a natural process, it has its roots in primordial ignorance of our true nature, luminous emptiness maifesting as the 8(or 6) types of appearance-arising within/as emptiness. grief is the result of karma and is not a "Fault" of any "one" because of egolessness, the one at fault is already gone, gone, really gone., what is manifesting now is not what creates karma, how choose to react sows further karmic seeds, the future is manifesting NOW, choose wisely or suffer, dosn't seem harsh to me.
04:21 AM on 03/29/2011
brooklyncitizen,

Arith... isn't being very specific here but probably alluding to the 8 types of unwholesome consciousness of which you apparently are either:

type 6 - One consciousness, accompanied by equanimity, associated with wrong view prompted.

or

type 8 - One consciousness, accompanied by equanimity, dissociated from wrong view prompted.

these particular cittas are rooted in greed. Pure enlightened compassion no?
10:15 AM on 03/18/2011
This concept of "speed" grief worries me a bit. The hardest thing to hear when grieving is that it is "time to move on". There are no rule books for how long one grieves, as the timeline is very personal.
11:45 AM on 03/18/2011
I think the grieving process is indefinite, but perhaps its intensity is lessened or it becomes merged with love and good feelings. My father died in 1994 and he was larger than life to me. His death was a profound experience. Sixteen years later, if I linger on those events, I feel the pain acutely, but more often than not, it's love I feel- missing him- but mostly remembering the great stories, valuing that I was lucky to have him. I never want to let go of that- if feeling the pain means also feeling the love-to me that keeps both me and him alive.
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notadumbblonde
IndependentNonHater
03:00 PM on 03/18/2011
I agree. We try to help one another in times of grief, and sometimes things are said out of discomfort, but are well meaning.

I think only when grief stagnates a life should the grieving person take a good look at why moving on has not been possible. By stagnate, I mean no further growth, no active participation, no motivation to move on. I would not want my left-behind loved ones to remain stuck in their grief for me. I have already told my loved ones I want each of them to write a little paragraph of the joy we experienced together in life, and post them in a notebook at my wake. No funeral, just the cremation after my friends and family have gathered to pay their respects.
11:04 AM on 03/19/2011
intresting comment to have friends and family write a little note of the joy experienced. I was thinking of MY doing that in preparation for my death.. there are so many I want to express thanks to and share memories with...
The trick seems, for me, to be in knowing when to do this. Right now I am not actively dying.. it is a slow process. But then I wonder if, overnight, I will become unable to function..and hence, should have those all done now while my mind is clear and I have good thoughts in my head.
Something to think on.....
09:21 AM on 03/18/2011
Thank you for tackling the process of grief. The timing is right for me since I was diagnosed with lung and a separate pancreatic cancer. Although the doctors are giving me a chance for cure, I watch my daughter mourn in starts and stops and am thankful that I can share it with her and hopefully make it a little easier. As for my own mourning - maybe I am in denial but I'm fccusing on living for now..
Your columns are helping me through the process and I'm very grateful.
Joyce Rothman www.http://makingsenseofitall.joycerothman.com
HUFFPOST SUPER USER
Honora
09:48 AM on 03/19/2011
Dying & grieving are such individual & personal ways of being. I think whatever one does is fine & certainly know one needs to be told how to do it. We are unique human beings & will react in our own unigue way & that's just fine. Just being kind to those in pain is a gift. fan joycerothman
07:47 PM on 03/22/2011
Thank you Honora. Your kindness shows through.