Grief: An Overview Stephanie Eckhaus, LCSW

Transcription

1 Grief: An Overview Stephanie Eckhaus, LCSW Dr. Desai: Welcome to the Kaiser Permanente HealthCast. My name is Dr. Kavin Desai and I ll be your host today. Today we re going to be speaking about something that all of us have experienced at one time or another in our lives. Whether it s the loss of a pet, a loved one, or a job, we have all experienced grief in one form or another. And today, to help us understand that topic better, we have in our studio Stephanie Eckhaus, who is a Licensed Clinical Social Worker, and Bereavement Coordinator at the Kaiser Permanente HealthCare Hospice Program at the Greater Southern Alameda Area. Welcome Stephanie. Stephanie Eckhaus: Thank you very much. Dr. Desai: So let s just get right into it. Why don t we start with understanding what exactly do we mean when we say grief? Stephanie Eckhaus: Well, like you said, grief is an experience that all of us will have, probably several times throughout our lifetime. It s a normal human reaction to loss and sometimes we have very big griefs, such as after the loss of a loved one. And sometimes it s a smaller grief, like children experience grief even when they re very young. I remember my children having a very hard time letting go of a favorite t-shirt when they ve outgrown it, and that was a grief reaction as well. Most of what I m hoping we can talk about today is the reactions that occur after one of those bigger losses, such as the loss of a loved one. The length and depth of a grief can vary both from person to person and from relationship to relationship but each time we have a grief, we need to readjust ourselves to a world without that loved one, or that favorite t-shirt, or that job in it. So it s an adjustment that each person needs to make over and over again. Dr. Desai: And, what are some of the symptoms that we might expect when we re grieving? Stephanie Eckhaus: Grief affects us on many levels. There s the physical reactions to grief and these are often most present during the early stages of grief but can hold onto us for a while. There can be changes in appetite, eating more or less than usual, changes in sleep, difficulty sleeping, waking up in the middle of the night, being unable to go back to sleep, or being tired and sleeping all the time. People really can describe their grief in a very physical way such as, it s hard to breathe or there s a hole in my heart. And so our bodies really can hold that grief and create a stress in our bodies. We can also have cognitive or thinking reactions to grief. We can have an inability to concentrate. We can forget where we left our keys. We can feel like it takes all day to get organized and make a phone call or keep track of paperwork. Most people think, of course, of the emotional reactions to grief and sadness, of course, is one of the main underpinnings of grief but Page 1

2 anger, loneliness, guilt, shame, yearning, and many others are part of our grief experiences. There is a spiritual reaction that can occur with grief as well. It can be a sense of a loved ones presence, an awareness of our own mortality and our awareness that we go from thinking in our heads that, yes, we know that we will all die some day to a real knowing of that in our body and in our heart. And finally there can be a change in our relationship to our spiritual beliefs so people can have a change in their relationship to God, or being angry at God, or questioning their belief in God. Our social experiences may change after grief. There are a lot of paradoxes that exist when we are grieving; we don t want to be alone and we don t want to be with anybody, we don t want to stay home alone and we don t want to go out. We re not sure where we fit anymore, if we were someone s daughter and both of our parents have passed, then are we still someone s daughter? If we were always part of a couple and the couples go out with other couples, then our experience in that social network can change as well. Some people, in addition to all those reactions, may have a very traumatic reaction to a grief and there can be moments within someone s passing that can become intrusive in our thoughts, so watching a loved one pass away, or seeing somebody on machines, hearing some sounds of gurgling, or other parts of a dying process can create a traumatic reaction and we can see those again, over and over again like a movie, or we can think about them over and over again while we are trying to concentrate on something else. Usually, those types of reactions will lessen over time but for some people they may get stuck and take over for a little while. Dr. Desai: So these are some of the symptoms we are talking about. Is it important for a person to self-identify those symptoms or is this something that your healthcare provider or even your relative or loved one, somebody, should be identifying? Stephanie Eckhaus: Most of these symptoms are pretty uncomfortable and a lot of people want them to hurry up and go away, and part of, I think, having a good grief process is sort of accepting that these reactions are normal and natural. And even if they re harder than we wish, or last longer than we wish, people do better when they accept that this is just part of a normal grief. Sometimes those around us don t necessarily have patience with our process either, they want us to hurry up and get over it or hurry up and have fun, or if you ve been invited out two or three times and have said no, the invitations stop coming, instead of people understanding you just need some quiet time for a little while. So in that end, I think accepting that your own experience is yours is probably a good path towards having some patience. There are times where some of these experiences may get in the way of your daily functioning. So, it s okay not to sleep well for a short time in our lives but if our sleep patterns don t return to normal, then it might be time to see a doctor and consider whether there is anything else we want to do to take care of that symptom. Or, it s okay to be sad and not want to go out and see your friends for a while but, again, if those persist it might be a good time to speak with a doctor or other professional. Dr. Desai: So, at what point do you know when to get help? Are there certain criteria that we use to say, okay this is too much, this is where I need to seek help? Page 2

3 Stephanie Eckhaus: I think anybody in grief needs and deserves a little extra help. It s a very challenging time in our lives. It s an extraordinary event if you have a deep and big loss and so whether that help comes from your friends and family versus a professional is partly up to the individual and where they are most likely to seek and get the comfort they need. I think it s okay to get help from a professional, even if it s not a crisis, just because it would be helpful. And some people think going to a grief support group or seeing your doctor or your counselor is only something you do when nothing else works. But in fact, anytime you feel like a little extra support would be good or a little extra help would be good is a fine time to go. It doesn t have to be a crisis. Dr. Desai: So should we all go? I mean, should everybody that is experiencing some form of grief get help? Stephanie Eckhaus: So, it s really, in some ways, individualized. Some people very much prefer to grieve only within their own support system and don t want to seek outside help. That being said, I would say if after two or three months after a major loss, the sleeping has not improved, or the ability to get organized and get your paperwork done has not improved, or you really never want to go out ever or answer any phone calls ever, then that would be a good time to check with a professional. Dr. Desai: Okay, how do you know that your grief isn t normal? How do you know that it s beyond what we should expect during the normal grieving process and that we really need to seek help? Stephanie Eckhaus: Right, so when to worry that your grief absolutely must get extra attention. Dr. Desai: Yes, exactly. Stephanie Eckhaus: Right, there are several red flags that you d want to look for, either in yourself or in a loved one: I think if someone s grief is prolonged and there is a feeling of hopelessness, a feeling it will never get better, feeling it will always be this bad, that would be a good time to check. Certainly, anyone who has any thoughts of suicide or giving up on life, that would be a good trigger to go seek professional help. And if you find that after the first short time period, you re not able to manage your day to day life. If the idea of getting the housework done or going to work or keeping your bills paid is too overwhelming to manage, that would also be a good time. Dr. Desai: So as a grief counselor, what are some of the difficulties you encounter with patients who are grieving and dealing with patients who are grieving, some of the misconceptions, some of the misunderstandings, and some of the sort of obstacles that you have to deal with when you re counseling someone? Stephanie Eckhaus: One of the greatest misconceptions about grief is that it should be quick and neat and orderly. One of the most common questions I get when folks call me Page 3

4 or come into my office is how long will this take? or tell me what to do to have this hurry up and be finished because it isn t comfortable and it isn t fun. And in fact, grief cannot be hurried, it is not neat and orderly. People think that there are stages of grief, that first I ll be angry, and then I ll be sad, and then I ll have some acceptance about this. And in fact, not everybody experiences all of those different states. Stages are never neat and orderly. We can be triggered by grief and be doing better for a while but then a special day or a special anniversary might trigger our grief again. We can also be triggered by very simple things like being in the grocery store and seeing someone s favorite food, or having someone wearing the same perfume step by as we walk across the street. I think there are some other misconceptions people have about grief, especially related to grief as sadness. And grief is primarily sadness but people associate that with crying and people have a lot of opinions about how much crying they should do or other people should do. There is, of course, a cultural component to how people express grief and some cultures sort of require or expect there to be a lot of loud sobbing initially or an extended period of mourning, while other cultures very much allow some expression of sadness frown upon extraordinarily large or expressive experiences of sadness or public displays of sadness, as they interpret that as questioning God s will or not accepting the person s fate. Crying is neither required to express sadness, nor are there rules and limits to how much we should cry or for how long we should cry. There are certainly a lot of beliefs that men should not cry and women should and tears are our body s way of releasing some stress and releasing some sadness and they are a perfectly healthy experience that can last again, longer than people would like. Dr. Desai: Are there certain things that people can take from this to say, maybe this will help me if I do this and help myself?, you know, even before seeking help necessarily outside. Stephanie Eckhaus: Um, yes and no. One way to think about grief is it s a major life experience that impresses or imprints upon our being, that our being needs to really adjust to the world looking and feeling differently without that person in it anymore. But how each person expresses, or gets out their grief, will be individualized. Now certainly for many people talking about that experience is helpful and sharing that. For some people, that will be their primary way of expressing their grief and their experience but some people need to do it more by doing. A great example of that is the Taj Mahal. The Taj Mahal was built as a symbol of someone s love towards their wife who had passed away. And I don t know how many tears were shed in the process of building that but certainly it was a glorious expression via doing, of someone s grief. People also express their grief by creating rituals, making alters in their house, making a donation, starting a charity. There are lots of ways to do as well as talk about our grief and make meaning out of that loss of our loved one. Most people, of course, do a little of talking and a little of doing and both are great ways to sort of process and express your grief. Dr. Desai: How long is too long to be grieving? Page 4

5 Stephanie Eckhaus: We will grieve forever the loss of our loved ones. There will never be a time when you don t wish they were still here. One of my favorite stories was a daughter was telling me she was visiting her mom, who was 98 and in the process of dying in a nursing home and the daughter said to her mom, mom I know you re 98 but I m going to miss you. And the mom said, that s okay, I m dying and I m scared and I m 98 and I wish my mom were here to take care of me. So there is a point of which we will never stop missing that loved one but it becomes part of our life story and not the biggest part of our life. I do think that people have a belief that at the end of the first year they should be done, that it shouldn t be hard anymore, that they ve done their year of first whatever days without their loved one. And that, in fact, is a misconception. Some people actually will readjust and grieve in a much shorter time period. There are other people though who will find that the second year, in some ways, is harder, that the first year was just surviving that year of firsts and getting adapted and the second year is when the reality of oh, this is really it forever hits them for the first time. So again, it s one of those things that will depend very much from individual to individual but, no, there is no timeframe in grief. Dr. Desai: What would you tell people that are grieving right now, or somebody that knows somebody that s grieving, what s the advice you would give them? Stephanie Eckhaus: I think the biggest thing is to have patience with the process and to know that most of us will experience it at some point or another and if you haven t experienced it already, it s important not to have preconceived notions of how someone else should be doing. There are many things that most of us have heard at funerals that we love not to repeat ourselves, and that is, I know exactly how you feel or they re in a better place now. But mostly that people need our time and our patience and our support in our grief process. Dr. Desai: That s great. That s really helpful information. If somebody wants more information from our organization, where can they go? Stephanie Eckhaus: Kaiser has a website, kp.org, and there is some information about grief on that website. Also, our Health Education departments often have access to books, classes, resource material, and can help with web browsing. And finally, someone s primary care physician or other healthcare provider is also a great resource, especially if you think you need more help or have more questions. Dr. Desai: Well, Stephanie Eckhaus, thank you for spending time with us talking about grief. I think it s been a very timely topic and you ve provided some great information for us and some resources that our folks that are listening can go to, to get help. Stephanie Eckhaus: Thanks for having me this morning. Dr. Desai: And so we come to the end of another Kaiser Permanente HealthCast. We hope you ve enjoyed yourself and learned something today. If you d like to hear some of our other podcasts on healthcare, please visit our website at And Page 5

6 this is Kavin Desai at Kaiser Permanente in Hayward, California signing out, reminding everybody to stay healthy and THRIVE. Page 6