Monday, December 27, 2010

Interview with Susan Berger, Author of The Five Ways We Grieve

Susan, would you begin by briefly describing the five ways of grieving you mentioned in your book.

The five ways of grieving represent the different responses of survivors to losing their loved one. I named them:

1. Nomads are characterized by a range of emotions, including denial, anger and confusion, about what to do with their lives. In the acute stages of grief, most grievers are Nomads. If they do not go through the necessary process of grieving, they may develop complicated grief based on unresolved issues related to their loss. Unlike the other types, Nomads have yet to find meaning from their loss and create a sense of purpose for their changed lives. They lack a clear identity. The nomad’s challenge is to find an “post-loss identity” that will help them heal from their loss and align with one of the following ways for successful grieiving.

2. Memorialists are people whose main goal is to preserve the memory of their loved ones by creating concrete memorials and rituals to honor them. These range from buildings, art, gardens, poems and songs, to foundations in their loved one’s name. Nowadays, survivors create websites and other media to perpetuate their memories. They maintain connection with their loved one by integrating them into their life through these activities. I found that this is one of the most commonly adopted identities for survivors of loss.

3. Normalizers work to create the kind of life they either lost or wished they had. While they are guided by their loss, their main concern is the quality of their present and future life -- for themselves and their family. They appreciate that life is finite. Their values and priorities reflect their desire for “normalcy” and a good life. Normalizers place dominant priority on their family, friends and community. Normalizers who create new families through adoption after tragic loss of children, spouses who love being married and remarry to recapture that love and security, and adults who replicated their childhood dreams through their own families are examples. Many survivors choose this path for healing.

4. Activists have an increased awareness of the time-limited nature of existence, along with a desire to make a difference. Hungry for intense and varied life experiences, they are oriented primarily toward the future, striving for meaning through the positive impact they can make on people and the world. Their values and priorities are directed toward making this world a better place for all people, improving the quality of life, and sharing their hearts and minds with others. Often they devote themselves to contributing to the issues or causes that resulted in their loved one’s death. Some write books, enter public service, and join professions that help others.

5. Seekers look outward to the universe and ask the universal questions about their relationship to others and the world. Typically, Seekers experience their loss as a catalyst for spiritual or philosophical inquiry into the meaning of life. They tend to believe that humans are intended to fulfill some specific purpose in life, often acknowledging transcendence between this life and other forms of reality. Seekers value connection with each other, the natural world, and the Divine (however defined). They explore the mysteryr of human experience on this earth and the universe. While a less prevalent Identity, Seekers find comfort in belonging to groups or practicing lifestyles with others who share their spiritual beliefs.

What do you think is the greatest influence on our grieving style?

There are many ways in which individual characteristics influence the way their survivors grieve. After losing a loved one, nothing will ever be quite the same. I think our way of viewing ourselves and the world are changed, too.

I found four significant ways that influence a survivor’s grieving style. I call them ‘The Four Pillars of Identity.’ Survivors change their perspective in the following ways:

1) They become aware of their own mortality. Most people begin realizing that life is not a permanent condition. They begin thinking about their own mortality.

2) They become aware of ‘time’ and the fact that ‘time’ is a precious commodity.’ If everyone dies, we had better use our time wisely. They may have a sense of urgency to ‘hurry up and get as much done as possible, because you never know when your time will end.”

They also consciously and unconsciously develop a primary orientation to time: past, present, or future.

The past: For example, if they focus on the past and cannot move forward, they might become Nomads, who haven’t been able to accept and work through their grief. Those who choose to remember their loved one through their memories of them in the past can grieve successfully by preserving their loved one through various kinds of memorials: foundations and buildings, songs, poetry, photo albums and websites. These are Memorialists.

The present: Normalizers and Seekers learn to live in the moment, appreciate that we cannot change the past or predict the future. We can live in the present, “smell the roses, “ because it’s all we really have.

The future: Those who are oriented to the future often want to make things better for others, motivated by how their loved one died. They join a cause to improve the quality of life, perform a service in the helping professions – so that the future is better than the past or present.

3) Their priorities and values often change. Love and compassion for others is often heightened after losing a loved one. Family may become more important. Work may become less important. Saving money for a “rainy day” may override spending every penny you have. You may have valued your independence, but now choose to develop relationships with others that offer connection.

4) They view their relationship to the world differently. How they see themselves in the world, where they fit may shift. Some become more ‘family-oriented, some get involved in a group or organization that is dedicated to curing a disease, or offer a sense of belonging they lost when their loved one died. Some view the world more cosmically, understanding that our humanity is a small element in the universe.

Do you believe that bereaved people adopt one particular way of grieving that continues throughout life, or do (or can) we change from one to another?

Based on my research and clinical observations with many of my patients, I believe that the different combinations of the ‘four pillars’ create a ‘dominant identity” for most survivors of loss. However, life is not static. Crises could upset one’s established path in life, circumstances change. Individuals evolve based on their experiences over time. This is why I believe that grieving is a lifelong process. For some, the ways they were affected by loss reinforces their sense of identity. Others may shift from one identity to another due to important changes in their lives.

What is most important to me is that survivors know they have choices for how they define themselves after loss. Regardless of the path they take, my hope is that survivors will find a new and fulfilling sense of purpose for their lives.

The holidays are often the most difficult times for those grieving a loss. Do you have suggestions for the various types on how best to manage during the holidays? Or if you have general suggestions, that would be helpful, too.

If you have lost a loved one during the year, I think the five patterns of grieving I described in my book suggest some ways you can find comfort amidst your feelings during the holidays.

• Memorialists can preserve the memory of their loved one by lighting a candle, writing a poem, listening to some special music, or continuing a family tradition in honor of that person.

• Normalizers like to gather family and friends together as they always did when their loved one was alive. In this way, they sustain the memories of the ways they enjoyed being with their loved one during the holidays.

• Activists want to contribute to others as a way of giving back or paying forward. You might feel good about volunteering in activities that relate to your loved one’s death – a hospital, hospice, or charity that was with you in the last days of your loved one’s life.

• Seekers may turn to spiritual thoughts. You may want to spend some time in contemplation at your church, synagogue, mosque or temple. Join with others in your spiritual community connect with nature, pray, meditate, think about what is important to you in life and pursue it.

If you don’t relate to any of these ideas, create your own way to find comfort. Above all, be with others who understand your grief.

Why do you think some are better able to cope with their grief and move on? I don’t mean “move on” as in “get over it;” more as in to re-engage with life, perhaps on new terms. Is it the style they adopt? Something in their own nature? Their other experiences of coping? I ask that because I think the fact that I had a serious accident when I was in college (third-degree burns) and I realized I could overcome all that involved, has given me strength to face other painful situations such as the loss of my husband.

You have developed a great insight, Thelma, about what helps people adapt to significant challenges, such as loss of a loved one. The previous experiences one has and how they met these challenges can contribute to a person’s coping ability. Personality factors such as tending to be optimistic rather than pessimistic about life, having the a “glass half full vs. half empty” attitude can also influence how people cope.

Those who have difficulty often have what we call ‘complicated grief.’ For example, the relationship the survivor had with the deceased can be critical. If they had a dependent or distant relationship; if they had “mixed feelings” or unresolved issues with the person who died; if they wish they had handled things differently before the person died. They may very well have trouble re-engaging with life. They may get “stuck,” due to feelings of anger, guilt, or sadness, unless they can resolve these issues. Often professional help is needed in these situations.

Finally, survivors who have had depression, trauma, or anxiety during their lives may experience loss more intensely. They may experience “multiple losses” involving an accumulation of loss experiences that influence their mental health, and capacity to adjust.

Do you think that sudden, unexpected loss is hardest to deal with, or perhaps watching a loved one who has a long-term progressive disease?

Losing a loved one is painful however it occurs. One of the key differences between these ways of dying is the survivor’s ability to say “goodbye.”

When a person dies of a long illness, the family has the opportunity to assure that their loved one gets the best possible care and is spared any unnecessary suffering. They also have time to prepare, to say “goodbye,” “I love you,” or to share concerns and resolve differences previously not settled. A prolonged illness can offer time to make end-of-life plans and to think about the practical things that have to be done, such as financial affairs, living arrangements, even day-to-day living. Sometimes this advantage is overlooked due to denial

When a death occurs suddenly, preparation is impossible. The element of surprise compounds the inevitable shock a survivor feels. This is often prolonged because of many questions: How did my loved one die? Did they suffer? Who was responsible? What will be done? Accidents and sudden death, such as heart attack, also make it impossible to say “goodbye.” Suicide often brings the survivor additional guilt or responsibility. Violence of any kind raises further questions of finding justice which can prolong the grieving process, as these deaths must go through often lengthy and stressful court procedures.

Survivors of sudden loss may fall under the criteria of “complicated grief.” Joining a support group may be helpful; but often therapy is required.

Thelma, I have enjoyed responding to your excellent questions. I hope they will be helpful to your readers. Thank you. Susan


Su said... [Reply to comment]

I have an award for you on my blog! :)

Josie said... [Reply to comment]

This was thoughtful. I lost my husband to cancer after an 18 month struggle, and found little was written about being such a loss.
When I started blogging I knew I wanted to write a couple of posts on that topic- which I have- but also blog about more stuff.
I was interested to learn that I'm probably an activist. I have come to re-define who I am and my priorities have definitely changed, and I probably focus on the present and the future now.
I know I'm biased but losing someone over a very long period of time seemed particularly painful as I lost my husband slowly, and became slowly more of a carer than a wife. Plus living with that knowledge and not being able to escape the situation, or fix the situation was such a long, hard road.
With I had seen this during that time. . . I used to do searches of the library catalogue to find books but found nothing on the long-term illness.

thelmaz said... [Reply to comment]

Josie, check out How We Grieve by Thomas Attig.


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