There are two different types of grief that can occur during the holiday season. The first, and most obvious, is when a loved one dies during that time. The second is for those who have been bereaved for some time, whether it is weeks, months, or years before the current season begins. It's important to realize that while there are differences in each experience, both have the potential to become intense during the holidays, and chaplains need to be aware of how persons in either category may need support.
Writing a list of what to know when caring for grieving persons during the holidays can be endless, and many that you will find on websites, books, or other literature may be quite long. What I want to provide is a short list, the three things that both professionals, such as health care providers, co-workers, and others who know and love persons living with grief can and should keep front and center as they consider their care.
Because I am both a clinician -- a board-certified professional chaplain -- and a bereaved parent, I'm offering these three things with examples from each perspective.
1. It's a Fog. For those who are dealing with acute grief, remember that they are probably living in a fog: nothing seems real because of the shock that grief causes. The holidays are probably the last thing on their mind, and if they are, there can be a sense of panic over what to do next. Simple things may become difficult. You can help by normalizing those feelings. Don't focus on trying to "solve" the emotions or the practical questions because the fog affects one's ability to think clearly.
For those living with longer grief, remember that the sense of holiday spirit may still have been damaged, or at least challenged. The "firsts" of everything after the death of a loved one are traumatic, as are the second, thirds, tenths... the rest of one's life, and it's not unusual for that fog to descend again during the holiday season. It may last for a day or two, it may go through the entire season. Don't be quick to assume that the person is experiencing a major depressive episode that requires medical intervention -- bereavement carries many of the same symptoms. (On the other hand it's not unusual for that to happen if the person has a history of clinical depression, so if they do, you might want to explore if they have talked with their medical provider about their current symptoms).
- As a Professional Chaplain: When completing a spiritual assessment, and learning a patient's story, especially during the holiday season, I would listen carefully for any reference to a death in the patient's family. An elderly woman once told me that while her husband had died 15 years ago, she still missed him every day. The simple statement of "It must be very difficult when someone you loved so much isn't here to celebrate the holidays with you. Were there special things you used to do together?" led to a conversation in which she could not only share her memories, but have her grief acknowledged and talk about ways she carried on some of their traditions. I alerted the staff to her sadness and her desire to talk openly about her husband even though she would become tearful and feel "foggy", telling them that the best way to give her support was simply to be present, listen and give her affirmation.
- As a Bereaved Parent: Our daughter was killed in early December. Gifts for her had already been bought. In the midst of our grief, we had to face the questions of what to do with them, as they were already under our Christmas tree. In addition, we wondered how we would deal with the holiday, especially since we wanted to ensure that our son received attention in the midst of his own grief. The fog that surrounded us was so dark and thick that making decisions was beyond difficult -- it was nearly impossible. It was hard to explain that fog to family and friends and to attempt to do so was exhausting. It was through the support of a friend -- a bereavement expert, not a chaplain -- that we got the affirmation we needed that what we were experiencing was normal. In the end, we chose to give Sarah's gifts to a charity that was seeking donations of gifts, and after conversations with our son chose to keep some of our familiar traditions while eliminating others and creating new ones.
2. What You Say. This cannot be stressed enough. To give a cheerful greeting of "Happy Holidays," "Merry Christmas," "Enjoy the Season!" can be a knife through the heart of anyone grieving, whether the death has occurred recently or not. Be mindful to think about what you are going to say when the setting you're in most likely has "holiday talk" going on. And speaking of environment, take a look at that as well: the decorations in the lobby, of your place of work, on patient doors in the hospital, or painted on building windows. The holidays are often referred to as a "Season of Hope." Remember that for a grieving or bereaved person, their beliefs and values may likely have been shaken to the core. Don't assume what those beliefs and values are, certainly don't impose your own on the person by trying to convince them what to believe, and be careful when you talk about hope until you know what the person believes or is struggling with.
- As a Professional Chaplain: When a patient was admitted that was facing end of life, or when I discovered in my spiritual assessment that family members were wrestling with grief and the holidays, I would ask the family if the decorations were a help or a painful reminder. If painful, I would see that the staff was informed, the decorations were removed, and any planned events such as carolers would be discussed with the patient/family to see if they wanted to have them stop by. I also would ask the staff to be mindful of the language they used and to avoid the "Merry Christmas" greetings.
- As a Bereaved Parent: This month a mark ten years since our daughter was killed -- which feels impossible because it seems like yesterday. Yet one thing I have learned I my journey is that "Grief is forever" and it changes your life from what was once normal to having to create a new life without your child or another loved one. Since Sarah loved Christmas -- and died during December -- the holidays have been difficult in these past years, some more so than others. Despite the fact that it has now been ten years, December is a very tough month for me. Honestly, I still can't enjoy hearing the cheerful "Merry Christmases" that everyone likes to offer, and crowded malls bring back too many memories of happier shopping time. I have learned to get my shopping done early to avoid the crowds and I remember to stop and take a slow breath before I enter a situation where I'm likely to hear a holiday greeting.
- As a Professional Chaplain: The idea concept of "creating new rituals" may be helpful to a grieving/bereaved person. Be sure that you've done a lot of listening and have asked the person what they are currently doing before you start offering suggestions. You may want to be familiar with some of what has been helpful to others by taking a look at some of the suggestions provided by grief lists prepared by both bereavement specialists and bereaved persons. These include such things as lighting a special candle, buying an ornament or decoration that reminds you of the person, having a story-telling time, or adopting a special project in the person's memory.
- As a Bereaved Parent: For bereaved parents especially this can be one of the most difficult issues to face. Do you continue to hang your child's special ornaments on the Christmas tree and put out their stocking? What about the family ritual that before death included going to a certain religious service, caroling, or a meal that ensured everyone's favorite dishes were included? (By the way, we fall into the hang-Sarah's-ornaments-and-stocking-every-year category.) We buy gifts every year that are donated in our daughter's memory to an Angel Tree for needy children because she wanted to teach. Buying a new ornament every year to commemorate a loved one, following the practice of "the empty chair" with a place-setting at a holiday meal, having a time to share memories, changing the ways in which the house was decorated... there are a variety of things one can do. Encourage creativity. Most of all encourage simplicity: remember that a griever's energy level may be very low.
Three things to remember during this holiday season whether you are a professional clinician, a co-worker, or someone who knows and loves someone who is grieving -- they will likely not cover everything that could be addressed when working with those that are grieving, but they are good places for all of us to start.
Rev. Sue Wintz is a board-certified health care chaplain with over 30 years of clinical, administrative, educational design, development and teaching experience. She is Director for Professional and Community Education at HealthCare Chaplaincy Network in New York, and managing editor of the online professional journal PlainViews. Sue is a past president of the Association of Professional Chaplains.
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