GRIEF CAN BE MESSY

 

A common complaint of my grief therapy clients is that they don ‘t think they are “grieving right.” I assure them that’s there’s no “right” way to grieve, and that, in fact, grief can be downright messy.

Just from a superficial point of view, the face of a grieving person can be pretty darn messy – bloodshot eyes, runny, red nose, puffy eyelids, red nose and other outward appearances that we might want to hide. Grief can also throw other physical aspects out of whack. Individuals who are grieving may either not sleep well or get too much sleep. Eating patterns can get interrupted as well, and it’s not uncommon for a bereaved person to either lose or gain too much weight.

The emotional side of grief is equally messy and can also be unpredictable. Emotional outbursts can seemingly come out of nowhere. I remember many times after a significant loss sitting in my car at a red light and screaming or pounding on my steering wheel. At times like those, I’m tempted to say to the driver next to me: “Don’t worry. I’m not crazy. I’m just grieving.”

People who pride themselves as being patient and calm can find themselves being angry, irritable, intolerant and impatient in their grief. I reassure clients who are concerned about this that these are normal grief reactions. At the same time, however, I am vigilant as a clinician to make sure these clients are not depressed. There is a major difference between normal grief and depression. Whereas grief, though difficult is usually “normal”, depression is not, and needs additional care.

A pitfall for some grieving clients is that they believe grief should follow an orderly fashion, and may point to the five stages of grief described by Dr. Elizabeth Kubler-Ross, i.e., denial, anger, bargaining, depression and acceptance. Dr. Kubler-Ross never intended for these stages to be linear and predictable, but rather, touchstones in the grief process. We cycle in and out of these stages in a sequence that is neither predictable nor orderly, but rather, can be downright messy. However, if a griever believes these stages to be linear, after experiencing some initial denial, he or she may think “OK, I’m done with that stage. I’ll check it off my list and go on to the anger stage.” They may point to Kubler-Ross’s model as proof that they aren’t grieving “correctly.”

There are many ways to work in a healthy and healing way with the mess that is grief. Because grief’s myriad expressions and emotions are unpredictable, grief can be stressful and exhausting. Therefore, the first step in healing grief is to take care of your physical being, making sure to get enough sleep, eat healthily and get exercise.

Telling the story of your loss can also be immensely helpful, as a way to make meaning of the loss. This will help with the feelings of confusion, helplessness, hopelessness and despair that can accompany grief. In addition, telling the story can help the bereaved maintain an emotional connection to his or her deceased loved one. Telling the story can be done by talking to others, journaling, writing a letter to your loved one, painting, or by any other form of expression. Expression helps to literally push out all of the swirling, messy feelings in a way that makes them workable.

Reaching out for support is also extremely important in working with the mess of grief. Calling on friends, family or one’s spiritual community and calling on one’s inner strengths and resources are all very beneficial in preventing isolation and depression.

Working with the messiness of grief can be like tending an unruly garden. Gently pulling the weeds, giving the dirt nutrients and carefully tending to the growing plants allows them to bloom. Similarly, giving our grief tender loving care can allow the mess of grief to transform into healing and growth.

 LIVING WITH A PARTNER WITH DEPRESSION OR BIPOLAR DISORDER

 

The recent suicide of Robin Williams awakened many of us to the toll depression or bipolar disorder takes not only on the afflicted person, but also on those of us who love and live with the person with a mood disorder. As the tragedy of Robin Williams illustrates, there is no such thing as being “just” depressed. Depression and other mood disorders are serious illnesses, and mental illness should be treated as seriously as physical illness. Partners of mentally ill loved ones are often thrust into the role of caregiver, and self-care is paramount.

Here are some tips for caring of yourself while caring for someone with depression, bipolar disorder or other mood disorders.

1. Set healthy boundaries. It is tempting to forget your own needs when living with someone with a mood disorder. Remember that you need to take care of yourself. If you do not, you will become resentful and may suffer burn out and your own depression.

2. Do not isolate yourself. A person with a mood disorder is likely to isolate him or herself. This is a primary symptom of the disorder. It is also often a result of the shame or guilt the depressed person feels. Make sure to maintain your friendships, work life and the activities that give you satisfaction.

3. Learn about the disorder. This will help you understand your partner and give you tools for caring about yourself while caring for your loved one. If he or she suffers from bipolar disorder, learn not to say “he is bipolar.” He or she is not their illness, but someone with an illness. Learning about the disorder will also help you to….

4. Don’t take it personally. A symptom of many mood disorders is irritability and uncontrolled anger. Do not take it personally, as hard as that may seem when your loved one is lashing out and directing his or her anger toward you. Do not argue or defend yourself at those times – it is like trying to be rational with a baby having a temper tantrum. Arguing and expressing your anger at these times will only escalate the situation. If the anger is overly hurtful, disengage, and walk away, as unemotionally as you can, while not suppressing your own feelings. You can say “I know you are hurting right now, but you are also hurting me. We’ll talk after you feel a little better.”

5. Determine if the anger is abusive, and weigh honestly whether to stay or leave. Only you know if the personal attacks are overly abusive and if they outweigh the love and good in the relationship. If you are in danger physically or emotionally, it will likely be best for you to leave the relationship. Abuse is never acceptable. Determine if the angry outbursts and behaviors are simply that or if they cross the line into abuse. If it is only occasional emotional attacks, that may be acceptable, but only you can judge how much it is affecting you and your life.

6. Take care of your own feelings and health. It is important to preserve your own health, both physical and mental, when you are living with a person with mental illness. You need to express your feelings, or you will become depressed yourself. Allow yourself a good cry, take a walk, hit a pillow or stamp your feet to get the feelings out. It is best not to do this in front of your loved one, as this may result in further guilt, shame and depression for him or her. Talk to a trusted friend. Get professional counseling for yourself. Get a massage. Exercise. Stay connected to your spiritual community.

7. Do not try to “cure” or “fix” your loved one. He or she may hope, whether consciously or unconsciously, that you will be a savior/rescuer and cure the illness. Remember that this is not your role or job. Remind your loved one of this gently and firmly, and suggest professional help. This is a big piece in setting a healthy boundary. Do not nag about that, as tempting as that may be.  Make suggestions once, avoiding the word” should.” He or she will hear you, and may just not be ready to take the necessary steps toward healing. Remember that only your loved one can choose to get the help he or she needs, and forcing him or her into therapy or into taking other steps will backfire if he or she is not ready to commit to the process.

8. Do not feel guilty about your loved one’s depression or other mood disorder. Remember that you are not responsible for it. Offer support, understanding and love, and again, don’t take it personally.

9. Do not make excuses for your loved one. Unfortunately, the negative symptoms of a mood disorder, such as undue anger, irritability and self-isolation, often spill over into other areas of your loved one’s and can affect your relationships with others. Let your loved one know that you will not make dishonest excuses, while assuring him or her that you will not divulge confidential information. If we all start saying “We would love to see you, but my partner is dealing with depression and is unable to go out tonight” we will begin to take away the stigma associated with mental illness. We have no problem excusing ourselves when we have a cold – why should it be any different with symptoms of a mental illness?

10. Be willing to engage in activities without your loved one. This goes hand in hand with not isolating yourself. If your loved one’s illness prevents him or her from keeping a social commitment, go yourself, especially if it is a commitment with a friend or community that nurtures you.

11. Have compassion for yourself, and acknowledge the good you are doing. Living with someone with a mental illness is a difficult challenge. Know that staying with your loved one and acting in the best interest of both yourself and your partner are acts of courage and compassion. Remember that you cannot have compassion for another unless you have compassion first and foremost for yourself.

 

 

 

 

HOW UNDERSTANDING IMPERMANENCE CAN HEAL DEPRESSION AND GRIEF

 

One of the most important tenets in Buddhism is that all phenomena are impermanent. All things and all beings are constantly changing. Nothing stays the same, and ultimately everything dies. We tend to consider this bad news. However, accepting impermanence can also be considered good news. If everything stayed the same, there would be no possibility for growth. Also, understanding that nothing stays the same can alleviate feelings of hopelessness, helplessness and overwhelm.

We all struggle to hold on to others and to things, and resist impermanence. This leads to tremendous suffering. The incorrect belief that things are “stuck” and will never change also results in great suffering.   I have observed in my years as a psychotherapist that the struggle to resist impermanence and the belief that things don’t change are universal. It is only through letting go of the resistance to change and impermanence that true healing and growth is possible.

For example, many of my clients with depression feel mired in difficult situations that they believe are permanent. It can take a lot of work for them to give up the beliefs that keep them stuck. I too am prone to depression. My Buddhist practice and study have been invaluable in helping me let go of my negative beliefs. I now know that those beliefs are just insubstantial thoughts that I no longer need to hold on to. Of course, I get thrown back into feelings of hopelessness on occasion. When that happens, I call on a friend to remind me that whatever situation is getting me down is impermanent and will change. My friend’s reminders are just what the doctor ordered at those times, and I feel a tremendous weight lifting and the restoration of hope just from hearing the words “remember that it’s impermanent.”

A big part of my psychotherapy practice is working with grief and loss. I have found that clients who have difficulty acknowledging that everyone dies have a very difficult time processing their grief. Of course, the death of a loved one or beloved pet is never easy. Although death is never easy for those left behind, always remembering impermanence helps ease the way, and despite profound sadness and grief, those who “grieve well” know that death is a natural part of life.

One of the most significant moments in my meditation practice occurred about fifteen years ago. My wonderful cat Andy was “meditating” with me at the time. I recall having a clear realization that Andy would not be with me forever. My emotions went from sadness to acceptance. I was left with a profound sense of the preciousness of life, knowing that the fact that nothing lasts is what makes life so precious. Andy, who died last summer, has ever since been my reminder of both impermanence and the preciousness of life. As the great Buddhist master Dilgo Khyentse Rinpoche said:

                                     Life is fragile, like the dew hanging delicately on the grass,  crystal drops that will be carried away on the first morning breeze.                                

                                                                            

GRIEF AS AN ESSENTIAL INGREDIENT IN GROWTH AND HEALING

 

As a psychotherapist, I am constantly inspired by my clients’ courage and commitment to change, and their willingness to face their struggles with open eyes, minds and hearts. My clients have taught me that an essential ingredient in overcoming and healing from life’s difficulties is grieving what has been given up in the name of growth– even if it is something negative or dysfunctional like addiction or an abusive relationship.

My work with “Sally” beautifully illustrates the healing power of grief in growth. Sally came to see me regarding her difficult relationship with her mother. It became apparent to me early on that Sally was tethered to her mother and that her mother was controlling, narcissistic and manipulative. Sally clearly loved her mother, and it was understandably difficult for her to see how her life was enmeshed with her mother’s and controlled by her mother’s neediness. Despite being a “grown up” with a keen intellect, wonderful sense of humor and a successful career, Sally still lived with her mother. When declining health forced her mother to enter a nursing home, Sally lived alone for the first time in her forty years of life. At first, she was fearful of living alone, and was unclear about what she wanted in her living situation. Sally has gradually gained more confidence in her ability to live independently, and eventually bought the family home, which is now in her name alone.

More importantly, with the perspective of space and time, Sally was finally able to clearly see who her mother is and the impact she has had in Sally’s life. She has essentially gone through the stages of grief described by Dr. Elizabeth Kubler-Ross, a psychiatrist who delineated the process people in grief experience.

The first experience Dr. Kubler-Ross describes in the grief process is denial. Sally was in denial for many years about her mother’s manipulative and narcissistic nature. People consider denial a “bad” thing, but it is necessary to our survival until we are ready to move on. Sally’s denial allowed her to maintain the status quo, which included career success. It was only when the status quo became uncomfortable and no longer workable that Sally was able to move forward in her process of growth.

The second grief experience described by Kubler-Ross is anger. I was hopeful that at some point in our work together Sally would have the courage to be angry at her mother as a step on her path to separate and differentiate from her. As a deeply spiritual person, Sally believed that anger was “wrong.” It took a while for Sally to understand that there is an inherent wisdom in the energy of anger, simply telling us that something is not right. Sally was ultimately able to express anger about her mother’s manipulation and control. This was a huge factor in Sally’s emotional separation and differentiation from her mother. She was able to use the energy of her anger to make the wise decision to buy the family home.

The next stage in Kubler-Ross’s model, bargaining, played out in a number of ways in Sally’s journey to healing and growth. When her mother first moved to the nursing home, Sally visited her daily, at a great cost to her own health and emotional wellbeing. On the brink of exhaustion, Sally has made a “bargain” with herself to visit her mother less often. This has been a gradual process for her, and has become increasingly easier despite her mother’s protestations as Sally has come face to face with her mother’s control.

When I assess for depression in the grief process, I always listen to how the bereaved talks about the loss. If the focus is inward on what he or she “should” have done, it may indicate depression, whereas if the focus is outward toward what has been lost, it is a sign of healthy grief. Sally rarely presented as depressed in our sessions. However, in her process of healing and asserting her independence, Sally did have some moments of depression. For example, she would berate herself for allowing herself to be manipulated by her mother and not seeing how her mother controlled her. I assured her that she did the best she could at that time, given her mother’s narcissism.

The last stage in the Kubler-Ross model is acceptance. It has been inspiring and beautiful to watch Sally work with the process of acceptance. Acceptance necessarily includes forgiveness. Sally has come a long way in understanding who her mother is, and she now sees that her mother’s mental ills resulted in large part from being emotionally abused by her own mother. Sally has also come a long way in seeing that her mother’s actions toward her were also abusive. She is grieving the opportunities she has missed because of her enmeshment with her mother, and has developed self-understanding and self-forgiveness. In giving up what she considered an idyllic relationship with her mother, Sally has been grieving the loss of what was, while also rejoicing in her new wisdom, confidence and growth.

 

The Importance of Self-Compassion

We throw the word “compassion” around so much that it can seem like a trite cliché.  Yet, the more I listen to my therapy clients, the more I realize that compassion — particularly self-compassion – is the key to healing ourselves and our relationships.

Compassion means “to suffer with.”  The word is generally used to describe empathy toward another.  However, I am clear that one cannot really have true compassion toward another without experiencing his or her own suffering and having kindness and empathy toward him or herself first.

The Sanskrit word maitri has been defined by Tibetan Buddhist master Chogyam Trungpa as unconditional friendliness, particularly toward oneself.  Pema Chodron, a student of Trungpa’s and a master in her own right, observes:  ” I teach about maitri a lot. In fact, sometimes I think it’s the only thing I    teach. I also teach about        compassion a lot, but actually compassion is a form of maitri so this unconditional friendliness to oneself, it seems to be what most of us do not have”  (www.shambhala.org/teachers/pema).

I have made this same observation in my work as a psychotherapist.  Most of my clients come in complaining of depression and low self-esteem.  They think that something “out there”–even something as beneficial as caring for others —  is going to make them “better.”  When I tell them that what will heal their depression is kindness toward themselves, some look at me as if I were speaking a foreign language – the idea of self-compassion is that alien to them!

For many, the messages they received in their families of origin have contributed to their low self-esteem and negative self-talk. Western culture’s emphasis on perfection doesn’t help.  Because of these familial and cultural messages, many believe that’s just the way it is, and their beliefs about themselves can’t be changed.

For example, a client I’ll call “John” recounted in his first session with me his regrets about the breakup of his marriage, and concluded “I’m a failure.”  In my work using the modality of mindfulness-based cognitive therapy, I challenged John’s belief, asking how doing something that he now regrets means he’s a failure.  I told him that he did the best he could at that time, and encouraged him that the key to his healing will be having compassion for himself and his human imperfections and neuroses. My homework for John was to simply notice when he calls himself a failure, what triggers it, and to start to challenge that long-fixed belief.  Changing these thoughts takes time, practice and discipline because they are so habitual and deep-seated, but it certainly can be done

I can challenge and have compassion for John, because I had to do the same work myself.  As I have recounted in other articles, after a period of regular mindfulness meditation practice, I was able to not only notice my negative self-talk, but realize that was just another thought, and that I could relegate those thoughts to my mental trash heap.  In fact, I told myself that if someone could have magically heard the way I talked to myself, they would have to turn me in to the police for abuse!

The Buddhist teachings on buddhanature or basic goodness are very helpful in developing self-compassion.  Those teachings tell us that we all have buddhanature, but due to our habitual tendencies and patterns, it is obscured and we have difficulty experiencing it.  An image I have found helpful is that of the sun in a cloudy sky.  The sun is always there, even on a cloudy day, but we can’t see it.  Imagine being in a plane, and seeing the sun in a clear blue sky after rising to an altitude above the clouds.  Indeed, the sun was there the whole time.

The next time you make a mistake or do something you consider less than “perfect”, take a breath, and try not to go on automatic pilot and start beating yourself up.  Instead, have compassion for yourself and all others who suffer in that way and remember the image of the sun in a cloudy sky.  Yes, you made a mistake and you can feel regret about it, and resolve not to do it again. Remember that your thoughts about your mistakes and imperfections are just fleeting clouds, and the sun of your self-worth is there the whole time.

 

 

 

FACING THE GRIEF OF AGING AND EMBRACING YOUR LIFE

I look in the mirror and see new lines on my face, a bit of drooping in places that never drooped before. I could wallow in self-pity and mourn the loss of my youth.  Instead, I choose to celebrate my years and experience.

I reflect on the rich, crazy and wonderful times I experienced in my life – being a hippie in the ‘60s; being a denizen of CBGB’s and part of the burgeoning punk rock scene in NYC in the ‘70s; coming into my own in the ensuing years; experiencing life as an entertainment lawyer, and giving it up to follow my dream to become a psychotherapist.

Here are some tips I have learned for embracing aging and letting go of grieving the loss of youth:

  • Know that wisdom comes from life experience, not from reading about it.
  • Appreciate yourself and what you have learned.
  • Celebrate your accomplishments.
  • Acknowledge your imperfections without judgment.  No one is perfect, young and old alike.
  • Accept your limitations.  So what if you can no longer run a four- minute mile?
  • Embrace patience.
  • Have compassion for yourself, and for all others on this path called human existence.
  • Celebrate impermanence.  After all, if things were permanent, nothing whatsoever would be possible.
  • Relish interdependence.
  • Reinforce your personal sense of spirituality through the beauty of nature, the arts and life’s little miracles.
  • Share your gifts and experience with others, and teach them what you have learned through life’s trials and triumphs.
  • Enjoy the quiet times.
  • Create a list of things you’d like to accomplish, and set about doing them.  It’s not too late.
  • Have a sense of honest humility about the things you’d like to accomplish but know that you may not be able to.  It’s OK.
  • Don’t dwell on regrets.  Again, nobody is perfect.  Acknowledge what you’ve learned from mistakes along the way.
  • Maintain a sense of humor and perspective, and laugh often.

Treating Depression in the Elderly

Contrary to popular belief, depression is not a “normal” part of the aging process, but a treatable mental health condition. Symptoms of depression include feelings of worthlessness, hopelessness, helplessness, guilt, isolation and unrealistically negative beliefs about oneself. These feelings not only affect the depressed person, but also their family members, loved ones and caregivers.

Depression is unlikely to go away by itself, and the guidance of a professional counselor, in addition to a physician, is often warranted. In fact, psychotherapy has been found to very likely help the depressed senior live a happier, more fulfilling life and decrease the risk of suicide.

There are a number of things a loved one or caregiver can do to help alleviate a depressed senior’s depression. These include:

1. Make sure the depressed person sleeps and eats regularly.
2. Reinforce rewarding experiences and activities, including exercise.
3. Explore spiritual or religious beliefs as a source of personal comfort and support.
4. Allow the depressed person to tell his or her story, called “life review”, through techniques such as guided journaling, letter writing, autobiography or collage.

A counselor or psychotherapist trained in narrative therapy can be particularly helpful for helping seniors find meaning and a sense of integrity and ease their feelings of depression.  Narrative therapy is particularly helpful in helping depressed clients reconcile the inevitable losses incurred over a lifetime and find meaning in those losses in the context of their lives through the telling of the story of their lives. The role of the narrative therapist is to bear witness to the complexity and rich nuances of the evolving story and collaborate with the client in to make sense of his or her losses and find healing and growth through the process of reconciling those losses and acknowledging the contributions they have made in their lives.