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  1. 64 Things I Wish Someone Had Told Me About Grief
  2. Unwoven Coalesce
  3. Bereavement During Childhood and Adolescence - Bereavement - NCBI Bookshelf
  4. Understanding The Five Stages of Grief and Loss
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A stage theory can offer new ways of understanding complex systems of human behavior, ways that may be helpful for diagnostic purposes and to guide intervention McGorry, However, those stage theories that have proven valuable show the evidence of scientifically based principles e. Does the stage theory of grief meet such criteria? Is it a valid and useful model of grief and grieving? Answering such questions requires evaluation of both its scientific and practical value. Therefore, the aim of this article is to review and assess the contribution of the stage theory of grief.

To this end, in the next section, we trace how stage theory emerged historically, documenting its remarkable, persisting popularity in the face of ongoing opposition. Then we focus on emergent lines of argument against stage theory, covering conceptual concerns, lack of empirical validity, its failure to assist in identifying those at risk or with complications, and the potentially negative consequences for bereaved persons themselves. As we show, the stage theory of grief falls short in all these respects.

There is no scientific foundation, and decades of research have shown that most people do not grieve in stages. Using stages as a guide in work with bereaved is unhelpful and may even cause harm. Our critical assessment leads to the conclusion that stage theory should be relegated to the past and eliminated from contemporary clinical practice. We discuss what actions can be taken to move on, suggesting an alternative approach and providing initial guidelines for health-care professionals and bereaved persons.

Family members undergo different stages of adjustment similar to the ones described for our patients. At first many of them cannot believe it is true. They may deny the fact that there is such an illness in the family. Just as the patient goes through a stage of anger, the immediate family will experience the same emotional reaction. When anger, resentment, and guilt can be worked through, the family will then go through a phase of preparatory grief, just as the dying person does.

Significant others. It is beyond our scope to review all, but our arguments can be considered in the context of these approaches. By , On Death and Dying reached a remarkable figure of well over 11, citations in Google Scholar. The notion of stages might lead people to expect the bereaved to proceed from one clearly identifiable reaction to another in a more orderly fashion than usually occurs. It might also result in inappropriate behavior toward the bereaved, including hasty assessments of where individuals are or ought to be in the grieving process.

Many other researchers and clinicians have taken issue with stage theory. Similarly, Jacobs drew attention to oversimplification:. Although it is sometimes instructive to conceptualize the manifestations of grief in this manner, it is important to emphasize that the idea that grief unfolds inexorably in regular phases is an oversimplification of the highly complex, personal waxing and waning of the emotional process.

Since the early s, Corr , has become a major opponent of the stage theory approach for dying patients and for the bereaved Corr, , reviewing earlier criticisms e. This volume, like its forerunner, continued to strongly divide opinion among readers it was positively reviewed by Bolden The authors responded to the criticisms from previous years in the opening lines of Chapter The stages have evolved since their introduction, and they have been very misunderstood over the past three decades. They were never meant to tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss.

Our grief is as individual as our lives. Such a disclaimer seems inadequate in the face of lack of evidence for the stages. The authors still assumed that people experience the stages. To this day, stage theory is still widely known, taught, and used in clinical practice.

64 Things I Wish Someone Had Told Me About Grief

As a final illustration of perseverance, the stages approach has recently been claimed state of the science of bereavement theorizing in an article by Jurecic Worryingly, her claims may even promote the use of stages. Again the enormous resistance to moving beyond the stages approach is demonstrated. There are compelling arguments to be made as to why this situation must change. From the claims and refutations traced earlier, five main categories of criticism emerge:.

This therefore fails to address the question: What is the function of grief? No such underlying principles were postulated for the stages. Bonanno and Boerner expressed their doubts as follows:. Grief stages tell us little about how people might cope with the loss; why they might experience varying degrees and kinds of distress at different times; and how, over time, they adjust to a life without their loved one.

The aforementioned shortcomings have a further, major implication: Stage theory does not help us identify those at high risk or with complications in the grieving process of great importance for diagnostic systems such as Diagnostic and Statistical Manual of Mental Disorders DSM-5 and International Statistical Classification of Diseases and Related Health Problems ICD Conceptual confusion and misrepresentation of grief and grieving.

Among this class of critical comments, the following stands out: It is unclear what the sequential stages i. Some denote affective states, others cognitive processes. So there is a mixture of different types of constructs which do not fit coherently or sequentially together. There is no theoretical rationale for this particular arbitrary use of dividing lines between states. Further examples of conceptual concerns are given in Table 1. Lack of empirical evidence. Surprisingly little empirical testing of stage theory has been subsequently undertaken—as Archer pointed out, this is difficult to do.

Table 2 reviews relevant studies, indicating little support and quite some refutation of the stages. In conclusion: While there is empirical evidence that people experience some of the emotional and cognitive reactions some of the time, there is little to support the sequential development of these in stages. The availability of alternative models.

The devastating consequences of using stage theory. Last, but certainly not least, it is important to recognize that using the stages approach as a guideline in supporting bereaved persons may raise undue expectations, even presumptions about the course that grief should take. However, such positive appraisal does not provide evidence for the sequence of stages in general, nor does it follow that the stages should be taught or used in therapy.

Silver and Wortman stated:. A mistaken belief in the stage model. Not only can it lead bereaved persons to feel that they are not coping appropriately, but it also can result in ineffective support provision by members of their social network as well as unhelpful and potentially harmful responses by health care professional. Many writers have also drawn attention to the dangers for bereaved people of prescriptive interpretation. The stages, it was often said, were meant to be descriptive.

However, they have been taken to be prescriptive browsing the Internet provides ample evidence. Whatever the intention, the theory promotes the idea of an orderly progression through distinct periods of grief and grieving, ones which can be identified and described by particular features. Where do these criticisms leave us? Her writing indeed, her whole extraordinary career drastically altered the care and treatment of dying patients see, e.

Her work brought death and dying out of the closet. Furthermore, bereaved people stand to benefit from her compassionate, easily accessible writing and teaching. However, such merits are on a completely different level from evaluation of the actual stages; it does not follow that the stages are adequate representations of what grieving people go through.

Why has stage theory been so impossible to dislodge from its favored position among many teachers, clinicians, and clients? The abiding appeal is perhaps its simplicity. In the midst of such emotional complexity as characterizes the bereavement experience, the stages offer something to hold on to, both descriptively and prescriptively.

What we need, then, is not a plethora of alternative perspectives but an accessible, easily comprehensible, informative, single substitute for stages but one that at least attempts explanation at a theoretical level. In our view, we should aim for further theoretical integration. Having a range of alternatives presents a weak, nonunited front to stage theory. That is perhaps a major next step for researchers to take: to work toward developing a theory that explains the process of dealing with loss and ongoing life, reflecting the experience of bereaved persons, their thoughts, and feelings.

Indeed, some of the perspectives [e. Furthermore, concrete steps must be taken to encourage the move beyond stages in practical as well as in such theoretical terms see Table 3. In summary, the critical points outlined earlier provide a strong case for abandoning the stage theory of grief and grieving. An opportunity was provided for catharsis while therapists helped supply realistic perspectives about in ner and outer realities e. The most important preventive intervention may be how parents and others deal with children who have been bereaved.

In the interests of helping parents to provide their children with a supportive, understanding environment, this section offers some specific suggestions based on information in the literature and on the best judgment of the committee. Providing optimal support to grieving children may be difficult, not only because the parents themselves are extremely upset, but also because they may be uncertain of what to expect from a child.

Thus, it is important that parents learn about the grieving process in children so they will know what to expect and will not become alarmed about the differences between childhood and adult grieving.

When Someone You Love Dies,There Is No Such Thing as Moving On - Kelley Lynn - TEDxAdelphiUniversity

Knowing that the child may ask distressing questions, such as when will there be a new parent or sibling to replace the one who was lost, may eliminate surprise and hurt. Such questions do not indicate a shallow attachment to the deceased, but rather the manner in which young children typically respond to loss.

Children may confront strangers with news of the death to test reactions and gauge their own responses. They may play "funeral or "undertaker" games for a few days following the death of a family member in order to master the situation. Children may manifest a superficially milder reaction to the loss because of the strong defenses that protect them from becoming flooded with overwhelming emotions.

As noted earlier, troubling emotions or behaviors emerging months or years after the death may be related to the bereavement, because children give up their attachment to the deceased much more slowly than adults usually do. Providing concrete recollections of the deceased parent or sibling may also be helpful. Most authors agree that there is preventive value in educating children about death when they are young, long before death is likely to enter their lives in an emotionally threatening way.

As Reed points out, children begin asking questions about death at an early age. They are naturally curious about such phenomena and provide adults with opportunities to intervene. Various educational tools have been suggested. Chaloner, 39 Ema Furman, 54 and Koocher 85 recommend using the death of a child's pet or other naturally occurring teaching moment to introduce the concept. Opportunities such as driving past a cemetery or coming across a dead animal while on a nature walk can also be used to provide awareness and understanding, especially that the deceased animal or person will never return.

Moreover, it will provide the child with the reassurance that death is not a topic to be avoided with adults. Other means to help children gain awareness about death include children's books see Goldreich 60 for a list and formal death education classes. When informing a child of a family member's death, a number of variables may be important, including who tells the child, the timing of the information, and the manner in which the child is informed.

In most cases, a family's existing belief system will determine what they do. However, families sometimes contact health care professionals to ask for advice. Professionals need to be cautious in making recommendations under these circumstances. Since there is wide cultural and family variation, it is important for the health care provider to draw upon his or her knowledge of that family and their culture, taking into consideration the family's own wishes and inclinations.

The child's level of social, emotional, and cognitive development, the meaning of the event to the child and family, and the child's fantasies about the death should all be kept in mind when determining what is appropriate for a particular child to be told. When possible, decisions should be made within the context of a dialogue with the family. Use of religious explanations, in particular, is controversial. Some Western observers think that explanations about the deceased going to heaven may be upsetting to children who think and interpret things more concretely than adults.

A few basic approaches have been found helpful across most families and cultures. For example, it is generally recommended that a child be told the truth, in simple terms he can understand. Invariably, they sense the strained and sinister, and if not helped to clarify what they think happened, the adults' silence may increase their fears in fantasy, rather than spare them sorrows. Encouraging questions is often an effective way to elicit concerns or fears that adults would not have thought might be worrying the child. In the case of sudden death, the surviving parent can acknowledge a child's observations and clarify misperceptions or misinterpretations.

Specific facts may be added as the child is able to integrate them. In disturbing situations or crises, feelings of helplessness increase with ignorance of the facts. It is relieving for bereaved children to be told that they will not succumb to the same fate as the deceased, and that they will continue to be cared for.

Particularly when dealing with young children, it can be important to reassure a child that the family will remain together and that he or she will be told step by step as each arrangement is planned. Telling them that neither they nor other surviving family members will die just because of the other death can help the children differentiate reality from fantasy.

Children's questions about death may reflect an unexpressed need for reassurance and emotional security rather than a desire for an intellectual explanation. Sensitivity to a child's intent 85 can help him verbalize anxiety, which can then be responded to with understanding. Behind questions about death may be fears that the child will be abandoned or stricken with illness. Under the age of seven, such concerns may be only indirectly communicated. It may be helpful to ask children for a replay of what they have understood by saying something like, "Now pretend that one of your friends asks you about this.

What would you answer? It may be useful for parents to become aware of potential pitfalls that can emerge following bereavement. For example, parents' capacities to nurture their children may diminish after the death of a family member due to their own grief and loneliness. Because of their own needs during this time, parents may be inclined to turn to their children for emotional support.

It may feel gratifying to a child to be able to help a dis traught parent, but this responsibility may also be experienced as frightening and overwhelming. Feeling excessive responsibility for a parent can also impede subsequent establishment of autonomy and intimacy with others. Missing the deceased spouse or child, a parent may look for or notice similarities between the deceased and a surviving child, and even comment on these similarities, implicitly suggesting that the child should function as a replacement for the person who died.

The child's sense of personal worth and value may be compromised by this view of being a replacement for someone else, and such perceptions may result in unrealistic life plans. Krell and Rabkin 87 have identified some family maneuvers that place surviving children at risk following sibling death: indirect or evasive communication about the death due to the parents' belief that it was preventable, and a tendency to accord surviving children special status by overprotecting and shielding them. Hagin and Corwin 67 warn that this need to treasure surviving children can stifle emotional development.

Also, holding up the dead child as perfect can have the unintended effect of making the surviving one feel that he can never measure up or that he should have died instead. Parents frequently express uncertainty about whether children should attend funeral services, fearing that such participation might frighten or otherwise upset them. Most authors who deal with this subject recommend that children be allowed, but not forced, to participate in family mourning and funeral rites if they wish to do so.

As with adults, participating in mourning rituals helps children to mark the death and cope with their feelings. Such participation may help children understand the finality of death and aid in dispelling fantasies.

Unwoven Coalesce

The parent can help prepare the child for the funeral service by explaining in advance how the room will look, where they will be sitting, and what they can expect to see and hear. Arranging to have a relative or close family friend sit with the child and be available to leave with him should the child wish to may be helpful.

It should be noted, however, that there is great diversity in funerals across cultures and some services might be more difficult for a child to handle than others. Erna Furman 53 has observed that even a young child can take in stride some aspects that might otherwise be upsetting as long as the parent s feel comfortable with the funeral service. She adds, however, that parents can modify customs to ease the experience for the child. For example, arrangements could be made to shorten the service or to have a closed casket. Children should be told in advance if the casket is to remain open, and may be given the opportunity to look at or touch the deceased one last time if they want.

Observers agree that it is unwise to insist, however, that a child touch a corpse. In general, by anticipating and addressing all the things a child might see, hear, or have concerns about regarding the funeral procedures, adults may be better prepared to discuss the event in an emotionally supportive manner. A cemetery, for example, may be explained as a pretty and quiet place where people can go whenever they want to be near the dead person's body and remember that individual.

As discussed in the preceding chapters on adults, not all long-term consequences of bereavement are pathologic. For example, in a pilot study of bereaved former psychiatric patients, Plotkin found that reactions to birthdays, holidays, and anniversaries of the death were a normal and predictable part of the grieving process. She argues that such late-occurring manifestations of grief should not be confused with pathologic grief, and she advocates using such reactions as healthy opportunities to express feelings about the death.

Johnson and Rosenblatt 76 also distinguish between late-occurring " incomplete" or "pathological" grief and the grief that reemerges in children as a result of maturation and new experience. Sometimes anniversaries or life marker events provide occasions for the emergence of psychopathologic symptoms for the first time in previously well-adjusted youngsters; but more commonly, quite normal manifestations of grief will recur with such developmentally significant events as communion, graduation, pregnancy, or the return to a place an individual previously visited with the deceased parent or sibling.

Such feelings may be associated with a conscious realization that the deceased is not present to share the event or they may take place without any understanding of why the distress has surfaced at that time. The most helpful intervention for this type of grief is supportive assurance that sadness under these circumstances is normal and common among those who have lost a significant person.

As with adults, the distinction between normal and pathologic grieving in children is not always clear. Following a loss as profound as the death of a parent or sibling, some behaviors and reactions are to be expected that otherwise might be considered pathologic. In normal childhood grieving, it is not unusual to see clinical symptoms of emotional disturbance, some regression, denial, and an inability to function. Children may not report much distress, but their behavior may seem immature for their age. As discussed in earlier chapters, factors such as intensity and duration are usually used to differentiate the normal from pathologic response, but the limits of these descriptors are difficult to establish.

A few clinicians have attempted to delineate some bereavement reactions that signal a need for help. Bowlby's 27 warning signals regarding bereaved children include the presence of persistent anxieties such as fears of further loss or fear that the self will die , hopes of reunion and a desire to die, persistent blame and guilt, patterns of overactivity with aggressive and destructive outbursts, compulsive care-giving and self-reliance, euphoria with depersonalization and identification symptoms, and accident proneness.

Raphael categorizes disturbed behaviors in these groups: suppressed or inhibited bereavement responses, distorted grief or mourning e. In discussions at one of the committee's site visits, Kliman added to this list the inability or unwillingness to speak of the deceased parent, exaggerated clinging to the surviving parent, and expression of only positive or only negative feelings about the deceased.

A manifest absence of grief, strong resistance to forming new attachments, complete absorption in daydreaming resulting in a prolonged dysfunction in school, or new stealing or other illegal acts may also be a cry for help. Some clinicians e. From this perspective, each child who loses a significant family member would be assessed periodically as a preventive measure.

It is important for parents to be aware of danger signals so that they can know if and when professional help should be sought. Educating parents about normal versus pathologic responses can help them make such decisions. Although there is little scientific evidence regarding the effect of intervention either prior or subsequent to bereavement during childhood, there is general agreement that promptness, honesty, and supportiveness help.

Information should be geared to the child's emotional and intellectual level and ample opportunities provided for the child to ask questions about the death. Children need rituals in order to memorialize loved ones just as adults do, and should be allowed to participate in funeral or memorial services to the degree to which they feel comfortable. Although both short- and long-term distress should be expected and are normal, some professional mental health intervention conceivably may be useful for all bereaved children, or at least when particular patterns of troublesome response become evident.

In order to achieve better understanding of the nature of the bereavement process and its potential impact, there is a need for methodologically sound studies in which representative samples of bereaved children are followed for several years and are compared with nonbereaved children. Following are some of the important questions that should be addressed:.

Particular attention should be paid to the design of studies seeking to address questions such as these so that methodological shortcomings do not compromise the conclusions. Grieving children who are not in psychotherapy should be directly observed and assessed. Too much emphasis in the existing literature has been placed on retrospective analysis, memories and extrapolations from adulthood, on parental reports of children's reactions, and on observations of children in treatment who may or may not be representative of grieving children generally.

Although clinical case studies will continue to provide useful, in-depth information, prospective, clinically sensitive, longitudinal studies of community samples are also needed in order to further current understanding and resolve controversy about the nature of grieving and the impact of loss on children. Another series of potentially very important studies would involve the random assignment of bereaved children to a variety of different treatment or control groups to determine whether treatment facilitates adaptation to the extent that certain treatment approaches are indeed successful; other studies should identify the essential process or mechanisms by which children are helped.

Identification of the most effective methods of preventive intervention for particular children or groups of children, and at what stage of life and what distance from the loss these interventions should take place, would add significantly to current knowledge. In sum, it is time to move to modern standards of research in the area of childhood bereavement. Young people who have lost a parent or sibling through death need to be tracked to determine both short- and long-term consequences of bereavement and to identify subgroups most at risk for pathologic developments.

Methods of intervention must be subjected to tests of efficacy to determine how best to help children, with new or modified techniques being particularly designed for the pathologically grieving child. This chapter was prepared by Janice L. Krupnick, M. Background materials and assistance were provided by committee members Gerald Koocher, Ph. Turn recording back on. National Center for Biotechnology Information , U. Search term. Immediate Reactions Children, like adults, experience a range of emotional and behavioral reactions immediately following parental or sibling death.

Intermediate Effects A limited number of investigators 45 , 46 , 81 , , , followed cohorts of parentally bereaved children for one to six years after death. Long-Term Delayed Effects A number of researchers have conducted retrospective studies to investigate a hypothesized link between childhood bereavement and vulnerability during adulthood to a variety of serious disorders, including neurosis, psychosis, physical illness, depression, schizophrenia, and antisocial behavior. Conclusions About Outcomes It is difficult to draw conclusions about the long-term consequences of bereavement during childhood or adolescence.

Shifts in Self-Concepts Following Bereavement A major area of concern regarding psychological functioning following bereavement relates to negative shifts in self-concepts and selfesteem. The Role of Identification in Grieving Identification with a deceased person has been described as more common and dramatic in children than in adults. Common Thoughts, Concerns, and Fantasies As with adults, 88 a number of common themes emerge in bereaved children, typically associated with or underlying feelings of sadness, rage, fear, shame, and guilt.

Common Defensive Strategies Many of the reactions in bereaved children that have been described— denial, idealization of the dead parent, inhibition or isolation of griefrelated affects, identification with the lost parent, displacement—are common defensive strategies.

Conclusions About the Grieving Process Although many of the reactions children display in response to a loss are similar to those observed in adults, the time frame and overt process of grieving in young people are clearly different. Quality of Preexisting Relationship with the Deceased As is true of adults, children's reactions to loss are more difficult to resolve when the prior relationship with the deceased person was marked by high levels of ambivalence or dependence.

Sex of Deceased Parent and Bereaved Child Studies of the impact of and interaction between the sex of the deceased parent and that of the child have produced interesting but somewhat contradictory results. Quality of the Child's Support System As discussed throughout this report, social support is a modifying variable that can soften trauma. Remarriage of the Surviving Parent In a controlled retrospective study of women in a community whose mothers died before they reached age 11, Birtchnell 18 found that only those who experienced poor relationships with mother replacements emerged with major psychological problems.

Cultural Background Although it has been suggested that cultural factors, such as ethnic background, social class, and religion, play a role in determining the child's understanding of and response to loss, this is an area in which very little research has been done. Circumstances of the Death The type of death experienced—e.

Summary of Risk Factors in Childhood Bereavement A review of the clinical and research data suggests that the following factors increase the risk of psychological morbidity following the death of a parent or sibling during childhood years: loss occurs at an age below 5 years or during early adolescence,. Anticipating Parental Death When a parent is terminally ill, Erna Furman 53 recommends maintenance of personal contact between child and parent for as long as the parent is not drastically altered in appearance or in the ability to communicate with feeling.

Helping Parents to Help Their Children The most important preventive intervention may be how parents and others deal with children who have been bereaved. Talking to Children About a Family Member's Death Most authors agree that there is preventive value in educating children about death when they are young, long before death is likely to enter their lives in an emotionally threatening way.

Attending the Funeral Parents frequently express uncertainty about whether children should attend funeral services, fearing that such participation might frighten or otherwise upset them. Anniversary Reactions: A Normal Long-Term Consequence As discussed in the preceding chapters on adults, not all long-term consequences of bereavement are pathologic. When to Seek Professional Help As with adults, the distinction between normal and pathologic grieving in children is not always clear.

Conclusions About Interventions Although there is little scientific evidence regarding the effect of intervention either prior or subsequent to bereavement during childhood, there is general agreement that promptness, honesty, and supportiveness help. Following are some of the important questions that should be addressed: What are the signs and symptoms of pathologic versus normal grief following parental or sibling death?

What are the preexisting or concurrent risk factors associated with poor outcomes, including major psychiatric disorder? How do identified risk factors hold up over the course of the first several years following bereavement? What is the relationship between the sex of the deceased parent and the age and sex of surviving children on the course of bereavement reactions? How do children who are in various stages of normal cognitive and personality development at the time of bereavement do in comparison with each other and how do they compare with nonbereaved children of the same developmental stage?

How do the effects of bereavement and the process of grieving differ for surviving parents and children? Abrahams, M. Childhood experiences and depression. British Journal of Psychiatry , Alexander, I. Affective responses to the concept of death in a population of children and early adolescents. Journal of Genetic Psychology , Altschul, S.

Bereavement During Childhood and Adolescence - Bereavement - NCBI Bookshelf

Denial and ego arrest. Journal of the American Psychoanalytic Association , The effect of parent loss by death in early childhood on the function of parenting. New York: Guilford Press, Anthony, S. The Child's Discovery of Death. London: Routledge and Kegan Paul, Archibald, H. Bereavement in childhood and adult psychiatric disturbance. Psychosomatic Medicine 4: , Arthur, B. Bereavement in childhood. Journal of Child Psychology and Psychiatry 5: , Balk, D. Effects of sibling death on teenagers. Journal of School Health , Barry, H. Significance of maternal bereavement before the age of eight in psychiatric patients.

Archives of Neurology and Psychiatry , Critical ages for maternal bereavement in psychoneuroses. Psychosomatic Medicine , Beck, A. Childhood bereavement and adult depression. Archives of General Psychiatry 9: , Bendiksen, R. Death and the child. In: Death and Identity Fulton, R.

Baltimore: Charles Press, Birtchnell, J. The possible consequences of early parent death. British Journal of Medical Psychology , Early parent death and mental illness. Depression in relation to early and recent parent death. The relationship between attempted suicide, depression, and parent death. Early parent death and psychiatric diagnosis. Social Psychiatry 7: , Women whose mothers died in childhood: an outcome study. Psychological Medicine , Blachley, P.

Understanding The Five Stages of Grief and Loss

Suicide by physicians. Bulletin of Suicidology , December: , Black, D. What happens to bereaved children? Proceedings, Royal Society of Medicine , The bereaved child. Journal of Child Psychology and Psychiatry , Blinder, B. Sibling death in childhood. Child Psychiatry and Human Development 2: , Bluebond-Langer, M.

The Private Worlds of Dying Children. Bowlby, J. Grief and mourning in infancy and early childhood. Psychoanalytic Study of the Child , Childhood mourning and its implications for psychiatry. American Journal of Psychiatry , Pathological mourning and childhood mourning. Attachment and Loss. III: Loss. New York: Basic Books, Brown, D. Sex-role development in a changing culture.

Psychological Bulletin , Brown, F. Depression and childhood bereavement. Journal of Mental Science , Childhood bereavement and subsequent psychiatric disorder. Brown, G. Depression and loss. Brown, R. Childhood bereavement and subsequent crime. Buxbaum, E. Pathological grief reactions in children. Cain, A. Children's disturbed reactions to parent suicide. American Journal of Orthopsychiatry , Children's disturbed reactions to parent suicide: distortions of guilt, communication, and identification. In: Survivors of Suicide Cain, A. Springfield, Ill. Children's disturbed reactions to the death of a sibling.

Call, J. Effects on adults of object loss in the first five years. Journal of the American Psychoanalytic Association 24 : , Caplan, M. Incidence of parental loss in children with depressed mood. Chaloner, L. How to answer questions children ask about death. Parent's Magazine, November: , Darwin, C. A biographical sketch of an infant. Mind 2: , Dennehy, C. Childhood bereavement and psychiatric illness. Deutsch, H. Absence of grief. Psychoanalytic Quarterly 6: , Dorpat, L. Psychological effects of parental suicide on surviving children.

Broken homes and attempted and completed suicides. Archives of General Psychiatry , Elizur, E. Children's bereavement reactions following death of the father: II. Journal of the American Academy of Child Psychiatry , Factors influencing the severity of childhood bereavement reactions. Farberow, N.

Suicide in Los Angeles and Vienna: an intercultural report. In the eyes of the world she was an adult, but to me she was still my precious little girl. During that first year following her death, I wrote almost forty poems, which describe my attempt at coming to terms with her loss through the medium of poetry.

This is one of them: How Do You Do? How do you describe an empty heart Or a mind that will not sleep? How do you measure the depth of pain Or the volume of tears that weep? How do you find new direction When life's compass has no reference points? How do you energise listless limbs With death's arthritic joints? How do you see the future Through a lens of opaque glass? How do you reconcile her name On a plaque of tarnished brass? How do you rekindle interest In a life that was complete? How you overcome loss and pain And the desire for social retreat? How do you explain to those you know The pretence that you have to project?

How do you smile when expected to But your facial muscles object? How do you trust a God you once knew Or the power of goodness and prayer? How you put your faith in his hands When those hands threw the switch of despair? How do you absorb the colours of Spring Through eyes that see only black?

How do you control the endless pain Of wishing she was back? Kerry www. I lovingly call this The Pearl Principle: no pain, no transformative gain. Inside an oyster, it takes an irritant — like a grain of sand or a bit of shell — to produce the mucous juices that engulf and surround the irritant, eventually hardening into a precious pearl. It is the same for us, regardless of how much we wish it to be otherwise. Difficulties and suffering produce the aspiration for spiritual enlightenment, and it is this aspiration which is needed to motivate us along the path of awakening and liberation.

There is no growth without growing pains— and the labor pains of giving birth to a new world and a new way of being can be the most painful yet rewarding of all. Or for teaching us by your example, The value of hard work, good judgment, Courage and integrity? We wonder if we ever thanked you For the sacrifices you made. To let us have the very best? And for the simple things Like laughter, smiles and times we shared?

If we have forgotten to show our Gratitude enough for all the things you did, We're thanking you now. And we are hoping you knew all along, How much you meant to us. So the man yelled, "God, speak to me! The man looked around and said, "God, let me see you," and a star shined brightly, but the man did not notice. And the man shouted, "God, show me a miracle! So the man cried out in despair, "Touch me, God, and let me know you are here! I told you I wouldn't leave. My memories, my thoughts are imbedded deep in your heart.

I still love you. Do not for one moment think that you have been abandoned. I am in the Light. My spirit rises every time you pray for me, but my energy comes closer to you. Love does not diminish; it grows stronger. I am the feather that finds you in the yard, the dimmed light that grows brighter in your mind, I place our memories for you to see. We lived in our special way, a way that now has its focus changed. I still crave your understanding and long for the many words of prayer and good fortune for my soul.

As you struggle to adjust without me, I watch silently. Sometimes I summon up all the strength of my new world to make you notice me. Impressed by your grief, I try to impress my love deeper into your consciousness. As you should, I call out to the Heavens for help. You should know that the fountain of youth does exist. My soul is now healthy. Your love sends me new found energy. I am adjusting to this new world. I am with you and I am in the Light. Please don't feel bad that you can't see me. I am with you wherever you go.

I protect you, just as you protected me so many times. Talk to me and somehow I will find a way to answer you. Mother, Father, son or daughter, it makes no difference. Brother, sister, lover, husband or wife, it makes no difference. I am learning to help wherever you are, wherever I am needed. This can be done because I am in the Light. When you feel despair, reach out to me. I will come. My love for you truly does transcend from Heaven to Earth. Finish your life with the enthusiasm and zest that you had when we were together in the physical sense. You owe this to me, but more importantly, you owe it to yourself.

Life continues for both of us. I am with you because I love you and I am in the Light. Deep peace of the flowing air to you. Deep peace of the quiet earth to you. Deep peace of the shining stars to you. Deep peace of the infinite peace to you. It seems that even when I escape it for a while, it is waiting not too far away. We have had long talks, loneliness and I, and I have to say that I have learned much more from our journeying together. We have become friends. But the friendship was a long time in coming.

Loneliness did not just come into my life with the accident that left me a widow but it did become immensely intensified then. Could it be that loneliness is given to us as a reminder that this world was never intended to be our home and the things of this world were never intended to satisfy us? In the most unlikely places -- the dentist's, restaurants, creative meetings, sitting on the john -- I can still be engulfed in sobs.

In public I have to excuse myself or pretend something's gone down the wrong pipe. Once, in L. I could hardly tell him it was okay, I was only choking on grief. Love me now while I am living. Do not wait until I am gone and then have it chiseled in marble, sweet words in cold stone. If you have tender thoughts of me, please tell me now. If you wait until I'm sleeping, never to awaken, there will be death between us, and I won't hear you then. So if you love me, even a little bit, let me know it while I'm living so I can treasure it.

I forgive you. Thank you. I love you. These four simple statements are powerful tools for improving your relationships and your life. As a doctor caring for seriously ill patients for nearly 15 years of emergency medicine practice and more than 25 years in hospice and palliative care, I have taught hundreds of patients who were facing life's end, when suffering can be profound, to say The Four Things.

But the Four Things apply at any time. Comprising just eleven words, these four short sentences carry the core wisdom of what people who are dying have taught me about what matters most in life. We are all sons and daughters, whether we are six years of age or ninety-six. Even the most loving parent-child relationship can feel forever incomplete if your mother or father dies without having explicitly expressed affection for you or without having acknowledged past tensions.

I've learned from my patients and their families about the painful regret that comes from not speaking these most basic feelings. Again and again, I've witnessed the value of stating the obvious. When you love someone, it is never too soon to say, "I love you," or premature to say, "Thank you," "I forgive you," or "Will you please forgive me? Because accidents and sudden illness do happen, it is never too soon to express forgiveness, to say thank you and I love you to the people who have been an integral or intimate part of our lives, and to say good-bye is a blessing.

These simple words hold essential wisdom for transforming that which matters most in our lives -- our relationships with the people we love. Free Press, New York Sweet Remembrance Let fate do her worst; there are relics of joy, Bright dreams of the past, which she cannot destroy; And which come in the night-time of sorrow and care, To bring back the features that joy used to wear. Long, long be my heart with such memories filled, Like the vase in which roses have once been distilled; You may break, you may ruin the vase, if you will, But the scent of the roses will hang round it still.

Deep within the stillness I can hear you speak. And I believethat angels breathe and that love will live on and never leave. Knowing you are doing something to keep your loved one's memory alive keeps you passionately busy, allows you to tell your sacred story, adds joy to your heart, brings an array of beautiful, loving people into your life, and rewards you with a meaningful life again.

Your loud voice will echo in many hearts making sure your loved one is never erased from memory. Forget unkind words I have spoken; remember some good I have done. Forget that I've stumbled and blundered and sometimes fell by the way. Remember I have fought some hard battles and won, ere the close of the day. Then forget to grieve for my going; I would not have you sad for a day, but in summer just gather some flowers and remember the place where I lay, and come in the shade of the evening when the sun paints the sky in the west. Stand for a few moments beside me and remember only my best.

Since then, Marshall had lost his wife, two siblings, and son-in-law, as well as many friends and colleagues. He was glad to give advice to others. Marshall explained: "The loss of cherished persons is never completely overcome. The relationships continue. They are always with us. I have preserved the father-space inside me. If you would only know that nothing that comes to you is negative. I mean nothing. All the trials and tribulations, and the biggest losses that you ever experience, things that make you say, "If I had known about this, I would never have been able to make it through," are gifts to you, opportunities that you are given to grow.

That is the sole purpose of existence on this planet Earth. You will not grow if you sit in a beautiful flower garden and somebody brings you gorgeous food on a silver platter. But you will grow if you are sick, if you are in pain, if you experience losses, and if you do not put your head in the sand, but take the pain and learn to accept it, not as a curse or punishment, but as a gift to you with a very, very specific purpose. He just listens and lets you work it out for yourself. Effectively: not hiding from pain, not eliminating it, not denying it, not continuing it -- but working through it and getting past it through very practical methods.

It is a whisper in the world and a clamor within. More than sex, more than faith, even more than its usher death, grief is unspoken, publicly ignored except for those few moments at the funeral that are over too quickly, or the conversations among the cognoscenti, those of us who recognize in one another a kindred chasm deep in the center of who we are. Maybe we do not speak of it because death will mark all of us, sooner or later. Or maybe it is unspoken because grief is only the first part of it.

After a time it becomes something less sharp but larger, too, a more enduring thing called loss. Perhaps that is why this is the least explored passage: because it has no end. The world loves closure, loves a thing that can, as they say, be gotten through. This is why it comes as a great surprise to find that loss is forever, that two decades after the event there are those occasions when something in you cries out at the continual presence of an absence.

I miss him more, I find, in the unexpected moments that remind me of how he was in day-to-day life. The discovery of a volume on maritime history at a used-book sale, for example, can make my throat close up momentarily as I recall how he'd settle in after dinner with just such a treasure. These are the details that bring my father back to me, and also remind me of my loss. Halfway through the second year after my husband's death, the cycles of intense pain and sadness were continuing, and I felt a fresh fear that my grief would never finish.

Part of me wanted to ignore this intense pain returning month after month, to push it down and avoid it all together. Yet I suspected that repressing my own pain would not help in the long run either, so I decided to bring more awareness to my situation. I asked myself if I was doing anything that might be prolonging the mourning process. Then I uncovered the secret thoughts I was generating each time I felt deep sadness and pain: I can't live without you. I hate being alone. I want you back. There was so much grasping in my mind, so many wishes that could never be satisfied! If I continued to think and feel this way, I realized, there would be no end to my grief and despair.

It was clear that I needed to replace my grasping with a new way of thinking: I am letting you go and wishing you well. I am going to survive and be strong. I am going to make a new life for myself. When I felt the deep pain and sadness rising again, I began practicing letting go in this way. After a few months of taking this approach, my process of mourning finished. Vulnerability to death is one of the given conditions of life. We can't explain it any more than we can explain life itself. We can't control it, or sometimes even postpone it. All we can do is try to rise beyond the question, "Why did it happen?

Kushner, in When Bad Things Happen to Good People It may be quite possible that we are not necessarily undergoing 'unresolved loss' when a past death comes up for us. Instead, this could be our opportunity to experience the older loss in a different light, one with some perspective and yes, even wisdom. Even if the feelings that come up are quite painful, this may not mean that you didn't do 'grief work' right the first time!

It may just be that now is the time for you to experience that loss and your current one at a deeper level, given who you are today and what you now know about yourself. Many of us still have parts of our losses that may remain on some level 'unresolved. We may still be asking sometimes unanswerable questions about older losses, but perhaps how we ask them has changed significantly.

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  3. Cautioning Health-Care Professionals!

And perhaps we have a greater comfort level for these questions being unanswered. And perhaps, we have a greater tolerance for ourselves in not having all the answers. I thought that I needed to discover the real cause of his hopelessness. I studied and analyzed what I believed to be his suicide note. Finally, I perceived that a death by suicide is a result of factors too numerous to count.

I wanted to know why, but I didn't have to have an answer in order to go on living my own life. Even the most experienced and astute investigators are finally forced to make what at best is only an educated guess. It is important, however, to ask why. It is important to worry about why, because one finally exhausts possibility after possibility and ultimately one tires of the fruitless search. Then it is time to let it go and to start healing. Com BoltonPress aol. This phrase is often misunderstood. Does it mean forgetting, letting go of our memories?

Not at all. Does it mean letting go of a relationship with our deceased loved ones? Our relationship is changed, not ended. In doing so we let go of our pain. We do not need it anymore. For the living, this means that, to the degree that we continue to respond to the meanings generated in conversation with someone before they died, those meanings continue to live on. In a quite tangible sense, people can live on after death in and through words and our relationships with the dead need not be considered closed with the nailing down of the lid of a coffin.

Maddy is a very significant part of me, and I will carry her along for the rest of my life journey. She resides within my heart, and as such she will never be "gotten over. To resolve, to let go, to move on, means denying my family history. Not only does that diminish Maddy, it diminishes who I am and my place in the world. It is perfectly normal to search for a continued connection with my granddaughter. It is neither pathological nor dysfunctional to think about her, to miss her, and to talk about her. Once I started thinking about the word renewal and all its implications, I felt a sense of calm.

I could invest my energy in discovering not only how to incorporate the stillbirth experience into my being, but also the life lessons. I could actively look for ways to honor and memorialize Maddy. She had no visible presence in the world, but I do. My thoughts, my actions, and my words can ensure that she will not be forgotten. I am able to explore and appreciate things in a new way and no longer believe in coincidence. He takes his seat, unhinges the clasps of his legs, Tucking one leg back, extending the other, Laying down his crutches, placing the violin under his chin.

On one occasion one of his violin strings broke. The audience grew silent but the violinist did not leave the stage. He signaled the maestro, and the orchestra began its part. The violinist played with power and intensity on only three strings. With three strings, he modulated, changed and Recomposed the piece in his head He retuned the strings to get different sounds, Turned them upward and downward. The audience screamed with delight, Applauded their appreciation. Asked later how he had accomplished this feat, The violinist answered, "It is my task to make music with what remains.

A legacy mightier than a concert. Make music with what remains. Complete the song left for us to sing, Transcend the loss, Play it out with heart, soul and might With all remaining strength within us. Schulweis You cannot prevent the birds of sorrow from flying overhead, but you can prevent them from making nests in your hair. Hold on to what you believe even if it is a tree which stands by itself. Hold on to what you must do even if it is a long way from here.

Hold on to life even when it is easier letting go. Hold on to my hand even when I have gone away from you. I stand near the coffee and watch the gathering. Her smile falters; Her composure is complete, A feat, I think, of fear and fatigue. How can I warn her That the numbness leaves And agony becomes one's bedfellow As anger roosts in the breast? Now is not the best Time for reality. But when the friends and family Have all gone away, And her house is naked In its emptiness, Then, then I'll visit -- For tea, and trust, and truthtelling.

And you looked away and quickly began to talk again. All the attention you had given me drained away. I do better when people listen, though I may shed a tear or two. These feelings are indescribable. Yet I need you. Your attention means more than you can ever know. Really, tears are not a bad sign, you know! They relieve some of the stress of sadness. My tears make my loss more visible to you, but you did not cause this sadness. It was already there. When I cry, could it be that you feel helpless, not knowing what to do? You need not speak. Your silence is all I need.

Be patient. When I hold back my tears, my throat grows tight, my chest aches, my stomach knots.

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  • Then we both hurt. So please, take my hand and see me through my tears. Whether they are the result of joy or sorrow, tears are a response to emotions for which we can find no words. They reveal our most vulnerable self.


    When we cry we are releasing the pain of the loss, not the memory of the one we cherish. The most dramatic rainbows seem to follow the most severe storms. Now when my eyes overflow, I use a guided imagery technique to visualize my tears washing away the pain that I carry inside my heart and soul. And when they finally stop, I look for the brilliant rainbow of love and hope. Worst of all, anyone who tries to comfort me moves those bones, hurts me worse. I don't think I will ever reach a place where I could consider [my son] Seth's death a "gift" any more than I consider rape or child abductions, terrorist attacks, murder, genocide, or famine "gifts.

    Why can't we just admit that painful things are painful? Why can't we just sit down with people and cry along with them as we admit that what happened is cause for tears? We don't need people to rush in and frantically try to wrap it all up pretty with a bow, like it is something we should savor. In time, we may see goodness that seeped out of badness, but we should leave it to God to show us that, when our eyes are not so full of tears and we can see more clearly. When love ends, be it the first mad romance of adolescence, the love that will not sustain a marriage, or the love of a failed friendship, it is the same.

    A death. Likewise in the event of a miscarriage or an abortion: a possibility is dead. And there is no public or even private funeral. Sometimes only regret and nostalgia mark the passage. The one gift you were blessed with That needle that you felt Has left your heart completely empty And your head filled up with Guilt. Memory is the overwhelming theme, the eventual comfort. But burying infants, we bury the future, unwieldy and unknown, full of promise and possibilities, outcomes punctuated by our rosy hopes.

    The grief has no borders, no limits, no known ends and the little infant graves that edge the corners and fencerows of every cemetery are never quite big enough to contain that grief. Some sadnesses are permanent. Dead babies do not give us memories. They give us dreams.

    Fingerprints that teach me about caring. Fingerprints that teach me about love. Fingerprints that teach me about courage. Fingerprints that teach me about hope. Fingerprints that bring me closer to my loved ones. Fingerprints that bring me closer to myself. In the time I cared for you my whole life changed -- never to be the same again All this from tiny fingerprints that touch my heart.

    You will live in my heart forever - never to be forgotten. I will always love you. You are my child. And you learn that love doesn't mean leaning and company doesn't always mean security. And you begin to learn that kisses aren't contracts and presents aren't promises And you begin to accept your defeats with your head up and your eyes ahead with the grace of an adult, not the grief of a child And you learn to build all your roads on today because tomorrow's ground is too uncertain for plans and futures have a way of falling down in mid-flight.

    After a while you learn that even sunshine burns if you get too much. So you plant your own garden and decorate your own soul instead of waiting for someone to bring you flowers. And you learn that you really can endure that you really are strong and you really do have worth. And you learn and you learn with every goodbye you learn. Shoffstall [Click here to see this poem in flash animation] Apparently, the messages that come from beyond can be swift and delicate and if we are not open and receptive they will fly by unseen and unheard, and will fall to earth, we know not where.

    If we can catch them in their flight, we will find that peace descends upon us and we will feel the breeze of an angel's wing as it gently reaches out and touches us. For lovely eyes, seek out the good in people. For a slim figure, share your food with the hungry. For beautiful hair, let a child run his or her fingers through it once a day.

    For poise, walk with the knowledge that you never walk alone. People, even more than things, have to be restored, renewed, revived, reclaimed, and redeemed; never throw out anyone. Remember, if you ever need a helping hand, you will find one at the end of each of your arms. As you grow older, you will discover that you have two hands: one for helping yourself, and the other for helping others. And if you need to cry, cry with your brother or sister who walks in grief beside you.

    And when you need me, put your arms around anyone and give to them what you need to give to me. There are so many who need so much. I want to leave you something -- something much better than words or sounds. Look for me in the people I've known or helped in some special way. Let me live in your heart as well as in your mind. You can love me most by letting your love reach out to our loved ones, by embracing them and living in their love.

    Love does not die, people do. So, when all that's left of me is love, give me away as best you can. Death ends a life but death does not end a relationship. If we allow ourselves to be still and if we take responsibility for our grief, the grief becomes as polished and luminous and mysterious as death itself. When it does, we learn to love anew, not only the one who has died. We learn to love anew those who yet live.

    He maketh me to lie down in green pastures; He leadeth me beside the still waters. He restoreth my soul; He leadeth me in the paths of righteousness for His name's sake. Yea, though I walk through the valley of the shadow of death, I will fear no evil; for Thou art with me; Thy rod and they staff they comfort me.

    Thou preparest a table before me in the presence of mine enemies: Thou anointest my head with oil, my cup runneth over. Surely goodness and mercy shall follow me all the days of my life: and I shall dwell in the house of the Lord forever. His daily migration always leads to the foot of our bed and is followed by our rude awakening as he wedges between me and my wife. Our bed does not comfortably fit the three of us. I'm forced to sleep on my left side and my wife on her right. My wife goes through similar pains as she wrestles back to sleep.

    This arrangement leave us tired and sore each morning. If I find myself resting next to a bed with tubes and wires invading my son as monitors watch his motionless sleep, I will desperately pray for him and his pillow to come home and shatter the morning's peace at the foot of our bed. If I find myself resting next to a slab marked by a stone that speaks of my son, I will heartfully beg to reset the clock to when my side of the bed was not my own.

    It's now a. Deep peace, a soft white dove to you; Deep peace, a quiet rain to you; Deep peace, an ebbing wave to you! Deep peace, red wind of the east from you; Deep peace, gray wind of the west to you; Deep peace, dark wind of the north from you; Deep peace, pure red of the flame to you; Deep peace, pure white of the moon to you; Deep peace, pure green of the grass to you; Deep peace, pure brown of the living earth to you; Deep peace, pure gray of the dew to you; Deep peace, pure blue of the sky to you; Deep peace of the running wave to you, Deep peace of the flowing air to you, Deep peace of the quiet Earth to you, Deep peace of the sleeping stones to you, Deep peace of the yellow shepherd to you, Deep peace of the wandering shepherdess to you, Deep peace of the Flock of Stars to You.

    Deep peace of the Son of Peace to You. Deep Peace, Deep Peace. Living one day at a time, enjoying one moment at a time, accepting hardship as the pathway to peace. Taking, as He did, this sinful world as it is, not as I would have it; trusting that He will make all things right if I surrender to His will; that I may be reasonably happy in this life and supremely happy with Him forever in the next. I hate the word closure when connected with the loss of a loved one. You know what I mean -- a spouse, a sibling, a friend dies. Weeks later there are those who want to know when the bereaved will find closure.

    The dictionary defines closure as '. Though the intention is meant to be sympathetic, there is evoked a note of chastisement for failing to end the mourning process. In the eloquent words of Dr. And even after weeks, months, and years later, grief may ebb, but never ends. The Song of Songs has an insightful perspective on the death of a beloved. Instead of a word like closure 'to end' , are the thoughts of never forgetting, always remembering.

    The final day of Passover. In the synagogue is a 'wall of remembrance' of past members who are recalled with lights lit by their names. There is no closure. The beauty of their lives never ends. The life of the dead is now placed in the memory of the living. For 'love is strong as death' It was given to him by the minister who read it at her sister's funeral 47 years ago: Safely Home I am home in Heaven, dear ones Oh so happy and so bright There is perfect joy and beauty In this everlasting light All the grief and pain are over Every restless tossing passed I am now at peace forever Safely home in Heaven at last Did you wonder how I so calmly Trod the valley of the shade?

    Then you must not grieve so sorely For I love you dearly still Try to look beyond Earth's shadows Pray to trust our Father's will There is work still waiting for you So you must not idly stand Do it now while life remaineth You shall rest in our Father's land When the work is all completed He will gently call you home Oh the rapture of that meeting Oh the joy to see you come!

    Ennis and Ellen Ann Ennis bblennis aol. Francis of Assisi Lord, make me an instrument of Your peace. Where there is hatred, let me sow love; where there is injury, pardon; where there is doubt, faith; where there is despair, hope; where there is darkness, light and where there is sadness, joy.

    O Divine Master, grant that I may not so much seek to be consoled as to console; to be understood as to understand; to be loved as to love. For it is in giving that we receive; It is in pardoning that we are pardoned, and it is in dying that we are born to eternal life.