January 2012

Back and Forth to Go Forward

Most of us likely have learned or at least heard about the five stages of grief that were proposed by Elizabeth Kübler-Ross in her book, On Death and Dying, back in 1969. Those stages were denial, anger, bargaining, depression, and acceptance. Many of us have also heard or read the increasing commentary about how this five-stage model is flawed and limited in its helpfulness. Research since 1969 does not support that our experience of grief occurs in universal stages or in these stages in particular. Certainly there are touchpoints for many of us with these stages, but that doesn't mean that they rise to the level of being the model for understanding and coping with grief.

Of course, there was part of us that has known this for a long time. Our grief experiences are too messy and varied to fit into such neat categories. Even when presented as a model, often there were caveats-not everyone experiences all these stages, some experience them in different orders, sometimes we go back to previous stages, and so on. So many exceptions make the rule not very meaningful. Kübler-Ross certainly did us a great favor by listening with care and compassion to the dying, sharing her thoughts and observations, and helping the broader culture go both deeper and wider in the needed conversation on death and dying, grief and grieving. Fortunately, that conversation has continued and we've learned some things since then.

One of the lessons we've learned is that there are two important things that we naturally do most of the time and need to do following a significant loss, including the death of someone important: We give attention to the loss and its pain, and we figure out ways to live in this new and changed world after the loss. Researchers Stroebe and Schut did some important work on this concept and called it the "Dual Process Model". One process was "loss orientation" and the other "restoration orientation". In loss orientation, we wrestle with the pain of the loss and the grief that comes in its wake. It is a focus on the past, what we had but no longer have. With restoration orientation, we sort out how we will live in wake of the loss and its practical consequences. We develop new routines, new skills and new roles. The focus is on the present and future and not on the past. The idea from Stroebe and Schut is that we move back and forth between these two orientations as each demand and deserves attention, focus and energy.

In the beginning of our grief, we feel and get little choice about moving back and forth as the experience yanks us herky-jerky from one to the other. Some days we would rather stay home all by ourselves in our sadness but our work and responsibilities demand that we leave to deal with the world, a world that no longer looks and feels the same. We immerse ourselves in our activities, sometimes staying busy to avoid those painful thoughts and feelings, when they hit us out of nowhere as a song, turn of phrase, image or smell brings the loss to the surface and we're "back in the howl," as writer Anne Lamott would say. Over time, however, we get more and more choice about moving back and forth between loss/pain/grief and restoration/new world/new roles. Some days we choose to get out the pictures, tell a story, or mention a name. Other days we choose to go out with friends, make new plans and friends, or turn the page in some small but significant way.

We get into trouble when we neglect one part or the other. If we do try to stay "busy, busy" to avoid the pain, it will find its way to us nonetheless through bodily discomforts, mood changes, or memories and feelings haunting us in the still times in our days and nights. If we pull back to let ourselves drown in our sorrow until it is over and done, we find that the well is too deep to deplete before the world beckons and demands our attention and involvement. It's a balance of back and forth.

A middle-age father of two boys shared his experience with a grief and loss class in social work graduate school: Years before, he had been on a trip and returned late at night to learn that while traveling home, his wife had been killed in a car accident. His young sons were asleep at a friend's home and he spent the remainder of the night reflecting on his wife, their life together and what he had lost. As morning came, his thoughts turned to practical matters-what needed to be arranged for his sons that day, who needed to be called, what legal, financial, funeral tasks were waiting for him. In one brief period he had entered into the dance of loss and restoration, past and present, pain and learning to walk again, back and forth.

This two-part way of thinking of grief seems to ring true in a way that those five stages never did. It seems to describe what we instinctively do when loss comes and how finding ways to grieve and mourn what we had takes turns with finding ways to walk a new road with what we have. Losing and finding. Back and forth to go forward.

Greg Adams
Director
Center for Good Mourning

goodmourning@archildrens.org

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In central Arkansas, it's the Alliance for Grief and Loss, spring Good Mourning Grief Support Groups and Camp Healing Hearts. Nationally, the Association of Death Education and Counseling and the Hospice Foundation of America have excellent spring program offerings-some of which will be available during Alliance for Grief and Loss meetings.

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Sometimes the best questions in grief support group discussions (children through adults) come from the group members rather than the group leaders. Here is one way to help facilitate those questions and the meaningful discussion that can follow.

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Two books about new and helpful ideas concerning grief and coping with death. Both engaging, readable, useful and encouraging.

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Why do we fear the dead?

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Most parents of grieving children are also grieving themselves and benefit from understanding and practical assistance from others as well as activities which give them a break from the heaviness of grief. This approach is a way to take positive advantage of those friends and relatives who want to help. By getting the support they need, parents are better able to be there in support for their children.

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We often call them "memory objects" as they connect us with those who are no longer present to make new memories. Sometimes a burden but more often a comfort. Here is a story of an aging father with cancer, a caring and sensitive daughter and two sweaters with memories and meaning.

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Almost all the stories and essays in The Mourning News are for your eyes. This one is for your ears. It's short, just a couple of minutes long, and well worth the listen as it tells one of the truths of a serious illness-how the worst of times can also be the best of times.

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Arkansas Children's Hospital - Center for Good Mourning
1 Children's Way, Slot 690 - Little Rock, AR 72202
501.364.7000 - adamsjg@archildrens.org

The Center for Good Mourning is supported by the generous support of the Arkansas Children's Hospital Auxiliary.