Here at Counselling Connections this week we have been talking about how bereavement and loss surface at this time of year. One of the things that struck us in talking about it is the wide variety of different kinds of loss and how these are experienced. There is the loss of a baby either postnatally, by miscarriage or stillbirth. Then there is death brought about by lifestyle factors such as alcoholism, obesity, smoking or other addiction. Death by suicide can also bring its own particular difficulties for those left behind and struggling to come to terms with it. All of these losses can be felt particularly poignantly at this time of year. We remember times past spent with our loved one and how we celebrated Christmas with them.

How we mourn a loss is a very personal thing. Often the course of mourning follows a similar path to that of our relationship with the person whom we have lost. If for example it was a fractious relationship characterised by falling out and making up we may experience the process of mourning as a very stop start affair. We may feel we are coming to terms with our loss only to find an old anger resurfacing again. And the appearance of feelings of anger as part of mourning can be a real source of difficulty. Anger is said to be a natural part of the mourning process but if for whatever reason we feel we can’t express it we may get a bit stuck and prolong the mourning period.

An example of anger becoming difficult to express can be in death which is caused by lifestyle choices. We may feel abandoned by a loved one who has died as a result of alcoholism for example. The question of the part the deceased played in their own death may be very difficult for us to face. It may be that we cannot freely admit to feeling angry at the choices they made. This can be the case with addictions or illnesses caused by complications of obesity like diabetes, heart attack or stroke. Our grief is added to if we rue that our loved one did not take better care of themselves.

Death by suicide can leave a similar legacy. It can leave a number of unanswered questions. Sometimes we hear of people deliberately falling out with loved ones before taking their own lives. The reasons for this are complicated but in part it may be because they feel it will make their loss easier to bear. This is not true of course and can serve to make the process of mourning all the more difficult. It also raises so many ‘what if’ questions that it is difficult to try to make some sort of sense of it all as part of coming to terms with it. Friends and work colleagues can also find it difficult to know what to say and this can lead to increased feelings of isolation or shame.

Christmas is a time for family and in particular for children. It feels wrong to us that a child dies before its parents. It feels like the natural order of things is turned on its head. Sometimes people say to us that they never fully get over the death of a child. Maybe that is the case with all loss. Perhaps we never do fully get over it but only come to terms with it to the extent that the strength of feeling eases and the loss gradually becomes more bearable. Loss of a baby is particularly strongly felt at this time as we imagine of they had lived what way they would be responding to and enjoying Christmas. This is probably a loss that a mother feels in her heart like no other. This is no less true for a loss by miscarriage where the mother may have bonded with her baby and where this loss might feel less real for others.

There is no prescribed path for dealing with bereavement. It is experienced as such a personal thing and it depends on the nature of our relationship with the one we have lost. It is good to talk about it; if we can. Sometimes this is with a friend or family member; or sometimes with a counsellor. There are times too when it is good to have some quiet time alone to reflect and remember and maybe even shed a few tears. Grieving is a natural process as we acknowledge and try to come to terms with the loss. Different family members will deal with a loss in different ways and to a different timescale. With patience and understanding we hope that the loss becomes less difficult to bear and that our loved one can be talked about and remembered as life following a death gradually returns to some sort of normal. We get along with living knowing we have been influenced in one way or another by the person who is now gone.

Counselling Connections, Dundalk. 15^th December 2011.

29th Sept 2011

Death by terminal illness is an everyday concern in our human existence. We can truly sympathise from afar, acknowledging how awful and how unfair it is for other families but it is only when it comes to our own door, so to speak, that we realise it’s impact. Think how shocked we can be to hear of the death of someone of the same age or younger. It brings the issue of death a whole lot closer to home. ‘It could be me’, as a fleeting thought is abruptly dismissed. We look for reasons why that person might have died that don’t apply to us… a heavy drinker, a heavy smoker, cancer in the family and we can feel the relief at our not fitting into this category. We are safe from death anxiety. This week at Counselling Connections, we take a look at how it is for people who are dealing with their own terminal diagnosis.

Yalom (Professor of Psychiatry & author) talks about facing our own death and the anxiety this evokes in us as human beings. We may think about how it would be if someone close to us dies, like a partner or spouse and we may wonder how we would survive without them. But our own sense of mortality is difficult to conceive. As children we are brought up to believe we are individual and special. This doesn’t fit in with the inevitability that we will all suffer the same fate eventually, that is, death. As children we are brought up to believe that we will be protected from things that frighten us by our parents….as adults we realise we cannot avoid our own death, a frightening concept.

Being told one has a diagnosis of terminal cancer is hard to grasp. In fact most people do not grasp it on first hearing. Even if it is heard, it is not truly believed and most people enter a phase of denial…. ‘Maybe they are wrong’, ‘Maybe they were looking at someone else’s results’, ‘Maybe I should get a second opinion’….all very understandable reactions in the face of death. It is not unusual to feel numb or to experience a whole range of emotions like anger, sadness, fear and anxiety.

A study by Hinton correlates satisfaction with life lived to the lessening of death anxiety. It is much easier generally for us as a society to accept the death of an older person, i.e. one we see as having ‘lived life’ ther than one in his prime,. This is not meant to undermine the pain felt by those who lose older relatives and friends with whom one may have had a close relationship. Often our perspective on our lived life shifts with a terminal diagnosis. We see things differently and can come to terms with regrets in life in a few short days or weeks. Ambivalent relationships are often repaired in the face of death.

As part of therapy, coming to terms with one’s own death requires that the person approach his dread and anxiety over and over again until he has become so familiar with it that it isn’t so scary anymore.  This is why it can be helpful for some people to talk about their death, which isn’t always easy to do. It is important that this is in line with the person’s wishes. Many individuals find it difficult to come to terms with the feelings of helplessness surrounding dying, the lack of control over one’s destiny. While this is a fate we must all face in one way or another, it can help to take control over some of the things in one’s life that are controllable even at this time. Choosing what type of treatment or Doctor, organising one’s funeral and making a will can give a person a sense of accomplishment and peace.  However, making these final decisions is difficult when one’s own death as a reality hasn’t quite sunk in.  There is no right or wrong approach to facing death and no two people do it in exactly the same way. The important thing is that we each do it in a way that feels right for us.

The recent loss of a young person has had us here at counselling connections reflecting on bereavement and the process of mourning. There are no words to say to those who have been affected by the sudden loss of a loved one. Shock, disbelief and an inability to process what has happened are initial reactions. We just can’t believe what has happened. We just can’t grasp that we will never again see the person we loved and who is now gone for good. It seems impossible to take it in.

A loss like this can make us wonder about our own position in life. We may question why we would get stressed for example about our personal finances or exam results. What is the point, we may argue in worrying about these things? We could be dead tomorrow. This is a natural reaction to bereavement and can be considered as a sort of anger at the whole world following our loss. There may even be times when we are tempted just to give up; to drop out because there seems no point

One of the things that people say when trying to comfort the bereaved is that ‘time is a great healer’. While this is true to an extent it is not really time itself that does the healing. The role that time plays is simply to facilitate the natural process of grieving. Sometimes this process can become blocked. Some aspect of the loss of our loved one may be too traumatic or upsetting to deal with. At times like this we can bury our feelings and just put our head down and try to plough on.

That is where bereavement counselling may be able to help. The aim of the counselling is to work through the full range of feelings and meanings attached with a loss. Indeed one of the aspects of this process as it develops is that there may be many losses associated with the death of a loved one. There are all the possibilities of what life may have brought and the potential which will now go unfulfilled. Friendship and love are among these losses.

There are often questions surrounding the actual death itself. There may be any number of ‘what ifs’ which we can become preoccupied with. The fragility of life and the often random nature of loss are real fundamental questions which we don’t normally stop to consider but which may be forced on us when dealing with bereavement. These things can be talked about in counselling and gently and respectfully considered. Our whole outlook on life can be changed in this way.

Mourning is a natural process. At times the scale of a loss can cause this process to become delayed or stalled. Bereavement counselling is there to facilitate a movement through the various stages of grief. The idea is to explore and express the full range of feelings about our loss. Sometimes feelings of anger or depression are difficult to get in touch with. We hope that counselling would help with this and we further hope that it would lead to eventually achieving some level of acceptance in coming to terms with the loss.

Counselling Connections, Dundalk.

Bereavement is part of the human experience. Every day people die in different circumstances and at different ages. Yet it is something that is always difficult and can have devastating effects on those ‘left behind’. Although there are feelings and behaviours which come under the umbrella of ‘normal grief reactions’, it is still individual to the person and will be influenced by a number of factors. Our relationship to the deceased, whether that relationship was a good or difficult one, how the person died and at what age, will all impact on our reaction to the death. Our own previous history of losses and also concurrent stresses in a short space of time, will be difficult for the strongest of people.
The amount of support available to us from family and friends will also influence how we deal with death. Research has shown that if we feel supported, the amount of stress we feel post bereavement can be reduced. However one of the difficulties with social support like this is that it is often around the time of the bereavement and not so much later on, when the person really needs it. There is a general sense that as people move on with their lives, the bereaved person is encouraged to do the same. If you have lost someone close to you, you will know it is not that simple.
In order to fully understand why death is so difficult for us, it is important to look at the bonds we make with other people. As human beings we naturally make affectionate bonds as a way to survive and enjoy our experience of this world. This is known as Attachment. When someone close to us is dying, this bond is threatened and when death occurs it feels like this bond is broken. This has a huge impact on us at every level, emotionally, physically and spiritually. Being attached to others is what makes us feel safe and not so alone in the world, so when someone close dies those feelings of security are shook and we can be left questioning our place in the world and what our lives are about. It can be a very lonely time.
Normal grief reactions can be described in terms of the range of feelings, the physical sensations in our bodies, the way it can affect our thinking and the things we do in order to cope. Sadness is the most common feeling and is not necessarily expressed through tears. Crying helps some people feel a sense of relief but it is not for everyone. What matters is that the sadness is expressed in some way and not held in. Anger is often felt after someone dies and can be rooted in being angry that you could do nothing to prevent the death and also the pain of that bond being broken. It is quite normal to feel angry at the person who has died for leaving you to cope alone. There can be feelings of guilt around possibly not calling an ambulance sooner or not having been the best partner or parent in the world. Anxiety and loneliness, particularly for those who lose someone who was in their everyday lives. There can be feelings of helplessness especially with those who have lost a spouse, where the deceased took control of all household affairs. There may be shock, even with deaths that are not so sudden. Where there has been a long illness, relief may be predominant. Numbness is often experienced in the early days and can be a way of defending against overwhelming emotion. All of the above are part of the normal grieving process.
There are many potential physical symptoms which play a significant role in the grieving process. Lack of energy, sleeplessness, breathlessness, tightness in the chest or throat, emptiness in the stomach are all symptoms reported by people who have suffered the death of a close person.
Our thinking can become confused and we can have difficulty concentrating on ordinary tasks. There may be preoccupation with thoughts of the deceased and through the experience of yearning, a sense that the person is still with us. It is not unusual for people to report having seen the dead person, which may be attributable to hallucinations, showing that there can be a profound effect on all aspects of our person through the process of grieving.
With good support from family and friends many people can come through the trauma of bereavement without professional help. There are support groups in most local towns to help communities help each other get through. Where grief is complicated or where social support is lacking, bereavement counselling can help people to come to terms with their loss. Counselling looks at helping the person come to terms with the reality of their loss, acceptance being the key part of this. Working through the pain of the grief is a necessary part of mourning. The level of pain experienced differs from person to person but it is not possible to avoid feeling the emotional pain of losing someone you were greatly attached to. Adjusting to one’s environment without the person can be difficult and learning how to be in the world without that connection. Death will have an impact on one’s external environment, if the person was in your everyday life but equally there are inner adjustments to come to terms with like being a single person again and how this may affect your sense of yourself. Our sense of the world can be turned upside-down and it can be hard to find a sense of direction especially with sudden and untimely deaths. Our beliefs can be challenged in this way. The final task in dealing with death is to emotionally relocate the deceased and be able to move on with life. This can be a scary thought and can evoke huge anxiety. We are talking about finding a way to continue to be connected to the person but not in a way that prevents the bereaved from continuing his/her life in this world as this is necessary for him/her to do. The timing of this is loosely defined. There are many variables that will influence how a person deals with the mourning process.
When there comes a time when the person who is left can think about the person who has died without feeling huge pain, we can conclude that they have dealt with their loss. A rough guide of two years can be expected though for some this is shorter and for others longer. For those who are going through this process as you read this, the intensity of the pain of loss is hard to explain. Accept whatever help you can get, to get through this time. The pain will pass, you will feel more hopeful and you will adjust to life without your loved one as you work through your unavoidable pain.