Standing Not Alone: Notes on Grief by Rea L. Ginsberg, LCSW-C, ACSW, BCD

Standing Not Alone: Notes on Grief by Rea L. Ginsberg, LCSW-C, ACSW, BCD


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“The Bereavement,” marble, 2010

Grief is a synonym for intense psychic pain. It is seldom invited and never welcomed. Death is not a gentle teacher. Everyone loses someone they love, and everyone dies someday. Everyone is afraid of it and everyone is angry at it. Some people say no no, I’m not mad and scared. Unfortunately, the truth doesn’t change because it is denied. Usually, everyone dies only once, and almost no one comes back to report the journey or the destination. For some, maybe that is one of the scarier aspects of death – the unknown. At least, it is intriguing. It is surely the essence of awe. We are left alive to wonder and imagine. We have lively imaginations.

For survivors, peace isn’t immediate, after the death. We have to talk ourselves into it. That is the way grief works. That is grief work. It takes awhile. Each of us has our own personal timelines for healing. There is no need to hurry up just because someone else says so. The time may be 2 years or 10 or 2 forevers. To each his own way.

Also, none of us are condemned to be a failure. We do not have to be defined by our negative thoughts. We can find and observe them, confront them, and refuse to be defeated by them. Negative thoughts cannot dictate our behavior without our permission. We have a choice of our response, of what we do. Between the thoughts and the response fall decisions. We can decide to turn “I can’t do this” into “I will do my best, one day at a time, and succeed.” Call it self-determination reinvented.

And the past can be reimagined, reframed as the post-death relationship forms between the survivors and the lost. To reframe is to alter our perspective, to see things differently. That changes the past! It is amended. We can then make significant predictions about the past; for instance, that unresolved relationship issues will receive further painstaking attention toward reconciliation. Predicting the past! It is a privilege of the human mind. Imagine. That is strength and growth.

Therein lies the route to composure and the new emotional balance we seek. It is peace on a different plane of existence, a plane that does not depend on the physical presence of the one who was lost. Even then, a part of us remains grieved when we lose loved ones, and that is natural. It is normal. It is to be expected. It is not a mental disorder.

How we grieve and find our way from keen distress to new inner balance requires remarkable time and tears and talk. Yes, it is certainly possible, making building blocks out of stumbling blocks. Honest self-awareness promotes the process. The sincere inward view is a lesson in courage and perseverance. The strong person is the one who can conquer himself. It is worth the hard work. All of us do our best to heal the outrageous wounds of loss. Those who find the way are a source of comfort and companionship to others still searching.

What I know is that love is stronger than death.

A grief story has no proper end. Whoever has the experience is required to tell the story. It is a moral imperative. It is healing and it keeps alive the memory of the one who died. It fulfills our promise to the dead: “I will always remember you.” (The double-negative form of this promise, “I will never forget you,” is insufficient.) We are the living continuation of their story. This life-after-life is our loved ones’ right. Indeed, love and respect make it so. Just so.

When someone also listens to those stories with kindness, caring, and hope, it matters. It makes all the difference. We need others to bring us back from the perceived isolation of mourning into the land of the living. It is a reminder of the meaningfulness of life. When we stand together, we are braver.

Listening is an art that transforms lives. It is an act of compassion and true concern. It can change our minds. It is still changing mine. Death teaches life. It is a vastly creative force.

Even in the exile of bereavement, friendship exists and can become an anchor.

Where there is dark shadow, there is also much light.

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“If ever there is tomorrow when we’re not together… there is something you must always remember. You are braver than you believe, stronger than you seem, and smarter than you think. But the most important thing [to remember] is, even if we’re apart… I’ll always be with you.” 

— A.A. Milne, Winnie the Pooh

rea

Rea Ginsberg is a retired director of social work services, hospice coordinator, and adjunct professor of clinical social work. She can be reached on LinkedIn and on Twitter @rginsberg2.

 

 



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FEAR AND THE BEREAVED CAREGIVER by Rea L. Ginsberg, LCSW-C, ACSW, BCD

FEAR AND THE BEREAVED CAREGIVER by Rea L. Ginsberg, LCSW-C, ACSW, BCD


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To ask is to believe that somewhere there is an answer. ~~ Jonathan H. Sacks, PhD

Fear of dying is an existential experience for everyone. It is a common denominator in the human condition. All of us experience it from time to time. It is further provoked by the dying and loss of the loved one. Watching the dying person raises this fear to a recognizable level. What will I do without my loved one? How will I survive? Am I strong enough to make the change and remain sane? Will I die, too? The fear can take at least several forms: fear of actual physical death, and fear of annihilation of the self (“going crazy”). 1  Just as anger can be frightening, fear can turn into anger and rage. The fear must be managed so that it does not spiral completely out of control – something it threatens to do. Defenses against fear may take many shapes. Among the easiest and most primitive defenses is plain denial: “It won’t happen to me.” 2 As every thinking person knows, internal dialogs – conversations with oneself – are not always rational. “Don’t believe everything you think” is a psychological imperative. That is necessary but far from effortless.

A physician, an anesthesiologist, provides a bold and anguished description of fear. He documented his own feelings when his wife developed breast cancer. His words are poignant, keenly distressed. It is raw fear, the instant wish to deny/repress, the what-if’s, sense of helplessness, questions of self-preservation.

“I opened up the radiology images on the computer, and then I saw it. My wife had breast cancer. At that moment, my world crumbled. I felt trapped. I wanted to run out of the operating room and scream…I wanted it to be a dream, a bad dream. But it wasn’t…I wanted to do something, anything to make things better. But despite my eight years of medical training, and three years of experience in private practice, I could not actively heal my wife. And I felt helpless…I never acknowledged to myself how scared I really was…I repressed all my fears. What might happen if the cancer came back [after successful surgery]? What if it metastasized? How would I raise our girls alone?

I started having trouble sleeping, and I noticed many new physical symptoms – muscle fatigue and weakness, numbness and tingling in my fingers and arms, and palpitations… I became convinced that I had either multiple sclerosis or ALS…

[He eventually found relief by talking about these fears and anxiety in highly focused discussions.] I learned to recognize the symptoms of anxiety, and by simply recognizing its existence, the anxiety no longer controlled me and my [physiological] symptoms subsided.” 3

Talk, introspection, and insight. Those were the healing powers for the caregiver.

This doctor-caregiver’s report is a good reminder of the mind-body connection. Anger is not the only emotion capable of producing alarming physiological symptoms when allowed out of control. Fear can do that, too.

From ancient times to the present day, much has been written about defense mechanisms against fear of dying and death. The writings amount to lessons in self-preservation. Each has his own nuanced ideas and insights. Fear strips away the bearer’s sense of worth and dignity and reduces him to feelings of inferiority, helplessness, and worthlessness. Everyone must find a way to survive in good health. Perhaps he follows the suggestions of others, or he creates his own path, or both. Once again, there is no recipe, no how-to formula, no one-size-fits-all.

The fearful caregiver craves a return to stability, to emotional balance. A new level of equilibrium is sought: adjustment or adaptation. The word “acceptance” could be added here. However, there is no such thing as “acceptance” of death. So don’t worry if you can’t get there from here. The word was poorly chosen. An adjustment may be made to account for death. We may adapt to the concept of a finite lifetime. We may resign ourselves to our fate as humans. However, we do not “accept” the idea of our own death or the death of our loved ones. The idea of acceptance is based on denial. It implies perfect control over, and suppression of, the self-preservation instinct. We have no such perfect control. We do not “accept” death. We do not receive it willingly, favorably, or with approval. Acceptance is then ultimately incapable of relieving death fears. 4

Something emotionally adaptive and stabilizing is gradually achieved. It is a situation in which things once again happen as the caregiver thinks they should, and there are no harmful changes. With effort, it becomes a new reality. That takes time and patience and hard work, grief work. It takes sympathetic support from others, a harmony of feelings, as well as inward focus on calming the anguish and uproar. Of course it can be done. Fear of dying does not go away. It does come back, but under far better control. We do not need to be perfect to be good. Appreciation of life is decidedly heightened by the experience. That is the reward. The controlled comeback is a distinct demonstration of the strength of the bereaved caregiver, his resilience and his ability to grow. Strength and growth.

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  1. One respected professor thinks of it – and teaches it – this way: “A distinction is made between fear of the process of dying, and fear of death itself and what may come when one is dead.”

Shelly Kagan, PhD, Open Yale Courses, Phil 176, Lecture 22: “Fear of Death”: Yale University, 2013. — http://oyc.yale.edu/philosophy/phil-176/lecture-22

However, the fear of death of the self is omitted from this suggested framework. The death of the self is a vital concept in any discussion of death fears.

  1. “Repression” may be a more appropriate term than “denial.” For a complete, formal definition and explanation of these complicated mechanisms of defense, see:

Anna Freud, The Ego and the Mechanisms of Defense, New York: International Universities Press, Inc., 1946, pp. 45-57.

  1. Scott Finkelstein, MD, “Being a caregiver has made me a better doctor,” blog: KevinMD.com, 17 May, 2013.

http://www.kevinmd.com/blog/2013/05/caregiver-doctor.html

  1. For notable further discussion, see: Bruno Bettelheim, PhD, Surviving and Other Essays, New York: Alfred A. Knopf, 1979, pp. 5-6.

Dr. Bettelheim was a child psychologist, Holocaust survivor, genocide scholar, and psychoanalyst.

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Image credit: www.thescrambler.com — Dale Chihuly’s glass ceiling

Tags: #fear #eol #hpm #GriefWork #resilience #growth

rea

Rea Ginsberg is a retired director of social work services, hospice coordinator, and adjunct professor of clinical social work. She can be reached on LinkedIn and on Twitter @rginsberg2.



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