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Showing posts with label death and dying. Show all posts
Showing posts with label death and dying. Show all posts

Monday, February 22, 2010

Bereavement

I’m up and it’s only 2:30 a.m., happen to catch a glimpse of myself in the mirror. In a shiva house the mirrors are covered, for the most part, for that first week of mourning following the passing of a first degree relative. There are all kinds of superstitious reasons, frankly I’m not interested in them. All I know is that one of the towels fell off the bathroom mirror and there I am, looking at me, and it isn’t pretty.

Has it aged me, losing my father? Or should we say, wizened me. Both right. It is a new experience, not at all like I thought it would be. It feels as if I’ve been hit in the back of the head with a baseball bat, still, over a week later, and that I’m in some kind of daze. It is surreal, detached.

We call it Bereavement, a V code, V62.82. Thankfully I have very few of the symptoms that distinguish bereavement from Major Depressive Episode. I haven’t got the guilt over what I didn’t do, no morbid preoccupation with death, no marked psychomotor retardation (although driving has been a little scary, haven't quite got the coordination back). No hallucinations, although my dreams, really scary.

And sure, it’s hard to sleep, and it is very early in the morning. I throw on a heavy FBI sweatshirt, one that my youngest son bought on his senior trip to Washington, DC, take a tour downstairs to the kitchen. I haven’t been home in a few days, have stayed overnight with my mom. It is traditional to choose a site for visitation, so my brother and I, without ever discussing it, have been at her home for the week, receiving visitors.

It is the flip of being a therapist, ideally. Being a therapist is all listening, or 80% listening, 20% feedback. Being a mourner, in my tradition, is talking or sitting quietly, but the mourner is the initiator. You don't impose your stuff on a mourner. Visitors come to sit with you for seven days, keep you company. It's about consolation, paying condolences.

You talk about whatever you want to talk about, so if you don’t want to discuss your father you don’t have to. But this is your chance, so to speak, to honor his memory, to publicize his goodness, his life experience.

We learn about life from the obituaries, at a certain age, and the eulogies.

I'm sitting near the toy box, see toys on top, not inside, remember putting them there, picking them up from the living room. My daughter and son came in for the funeral of their grandfather, one with an almost toddler, and after they left I didn’t want to put it all away. I look at the toys and it feels as if the visit was years ago.

I make a stab at reading from a novel, American Wife, by Curtis Sittenfeld, a wonderful treatment of Laura and George Bush, but can’t concentrate. There are a few newspapers on the table, but the words don’t penetrate. Something about winter Olympics and bobsleds. And of course, Tiger Woods. I think, I should blog about Tiger. Then I think, I should blog about my father.

He buried my brother 40 years ago to the day of his death. Isn't that amazing? Someone says to FD, Sometimes you get a glimpse of how things are actually run. It's not all random.

Here are some of the things I said at the funeral:
My father was such a complicated man that I can’t tell you if he would want me to make you cry, or not. I think not, because he was such a social guy. He would be happy to see such a nice crowd.

He simply had this magnanimous warmth, he greeted everyone as if he’d been waiting all week for you to stop by. Always someone knocking at the front door window, the telephone always ringing. Almost always for my Dad.

Last Wednesday morning, we're in the ER. He's in terrible pain. They put a gown on him, hook him up to an IV, his clothes are in a plastic bag. He’s on oxygen.

“You never saw me like this,” he says to me, for the hundredth time since he’s been so ill. This has been his mantra for months, now, “You never saw me like this.”

Every day it surprises him, embarrasses him that he’s weak, short of breath, and he’s embarrassed about it. Like many men of his generation who did not experience the hunger of the concentration camps, being physically weak is unfathomable. It isn’t who we are, he would say, for he encouraged us to take good care of ourselves, always. You eat right, lots of garlic, you sleep right. Your body cooperates. He has to remind me; this isn’t him.

And I tell him that it’s okay. I know who he is.

A story: Kovel, Poland: the end of the Russio-Poland War, 1920. Bands of marauding Cossacks, White Russians; they're raiding towns everywhere, especially the ones with Jews. They pillage and rape and kill babies with their bayonets, toss them into the air.

My grandfather is running an errand, probably buying something for the farm. My grandmother is in bed nursing my infant father. A gang of these animals bursts in on her. They see my grandmother, a beautiful woman, probably all of twenty, nursing. One says something, probably in Russian, to the others. They argue, banter back and forth. They stare at her, they look at my father, they look at one another. The toughest one says something. They shrug. And they leave.

My grandfather returns from the store, he hears what has happened, and he packs a few things, takes this little family to the forest at the outskirts of town for as long as it takes until the hooligans move on to another.

But you know, a small town family, they’re always waiting for another gang of Cossacks.

Probably in response to my grandmother’s fears, and being the oldest son, my father takes the protector role in life when he can, which is how I see him as a kid, watchful. Bigger than life, really. I’m a naturally fearful person, irrationally afraid of home invaders, as you know. But if he's home, I'm not afraid.
There are too many stories, a blog is just a blog. Okay, just a little more.
Things not everyone knows:

He was charitable, he couldn’t say no, especially not if people asked him for something directly. A total softy, if you looked my father in the eye, respected him for who he was, he would give you the universe if he could find a way. And honestly, he believed he owned that, too, that the world was created for him.

Which is how we’re supposed to think.

He would teach that it’s what’s inside that counts, not what you have. It’s not acquiring things, it’s living that counts, living fully. This in the heart of of the suburbs, a very material world.
The world is not going to be the same, not for a lot of people, without my father.

therapydoc

Monday, March 30, 2009

Nobody Said It Was Easy

Not to overdo it with the music videos, but sometimes video gives a whole new meaning to a song. It's like doing therapy. As soon as you get the rest of the story in therapy, a person's life makes more sense. You get it when you get the whole truth, the history.

ColdPlay has a song that I like, The Scientist.

I listened to it over and over again, which I do, like a four-year old, if I like a melody. After the tenth time on this one, I thought I had it figured out.

A couple has a fight, The Big Fight, and in The Big Fight they break up. ColdPlay bemoans the break-up in the ballad.
Nobody said it was easy

It's such a shame for us to part

Nobody said it was easy

No one ever said it would be this hard

Oh take me back to the start
.
He wants to try again, go back to the start. Take Two.

It's what we do in therapy, really. We go back to the start, take a look at what went wrong, try something different. Generally the try something different is called an intervention, a part of a treatment plan. We determine which intervention by putting our heads together. It helps to have a therapist armed with dozens of these things different.

Trying something different, being somebody different is much harder than it sounds. Change is packed with difficulty. And it feels like a risk, usually. We like things the same.

But I got it wrong, the meaning of the song. It's not about The Big Fight, the one that you never forget, hard as you try.

The Scientist by Cold Play

Come up to meet ya, tell you I'm sorry
You don't know how lovely you are
I had to find you, tell you I need ya
And tell you I set you apart
Tell me your secrets, and nurse me your questions
Oh let's go back to the start
Running in circles, coming in tails
Heads on a science apart

Nobody said it was easy
It's such a shame for us to part
Nobody said it was easy
No one ever said it would be this hard
Oh take me back to the start

I was just guessing at numbers and figures
Pulling the puzzles apart.
Questions of science, science and progress
Don't speak as loud as my heart.
Tell me you love me, and come back and haunt me,
Oh, when I rush to the start
Running in circles, chasing tails
coming back as we are.

Nobody said it was easy
It's such a shame for us to part
Nobody said it was easy.
No one ever said it would be so hard
I'm going back to the start.



Surely about regret.

And whether or not it was his fault is immaterial. He wants to roll back time.

When something bad happens, something unexpected, something out of the ordinary, life threatening perhaps, there are emotional stages of grief. We think that for most of us, these are unavoidable, quintessentially human emotions.

We want to turn back the clock, do something different.

Forget ColdPlay for a moment.

Say you've been told you have cancer and have only so long to live (not the norm, that kind of news, but it happens). You'll grieve your future loss of life. Even if you've been told that your prognosis is good, that you'll be fine, that it is not life-threatening, your mind will play tricks on you. You'll still worry. You'll regret not having lived your life to the maximum, you'll think you've done something wrong, that you're being punished for the disease.

Forty years ago Elizabeth Kubler Ross (1969) let us in on the ways we grieve, even when we haven't lost anything yet. Anticipating loss can make us sick, just as having lost someone or something (money, for example) can make us sick.

I read her wonderful little book, On Death and Dying, in high school, and felt as if I had been let in on some big secret. Someone recommended it to me when I was dealing with my brother's death. It is probably still required or recommended reading for most graduate students in mental health fields, for mental health is all about holding it together. And loss wrecks our equilibrium. Maybe by now undergrads read it, too, high school students even.

Kubler-Ross defines the five stages of grief work, but there are more. We can thank my son-in-law for reminding me about guilt and self-blame. Kubler-Ross would have filed those under depression:

denial (this can't be happening, it isn't true);

anger (this is SO wrong, I don't deserve this);

bargaining (I'll give more charity, I'll be a better person, just change the decree!);

depression (no point in even trying to be happy here, life is meaningless now);

and acceptance (It is what it is, keep cool and play it out, stay in the moment, don't catastrophize, don't make it what it isn't just because you can, just because you have an imagination).

Acceptance tends to be the baseline for emotional management, but it's a goal, not a given. That's why Kubler-Ross puts it last. I would call it a mediating variable. Without it, no matter the intervention, the resolution of the problem isn't likely to happen. We'll still feel we're in the grieving process.

Acceptance underlies one of the lesser known cognitive-behavioral treatment modalities, Acceptance and Commitment Therapy (ACT) . Here acceptance is the springboard, the starting point, the place from which the real work in treatment begins.

Obviously you can't rush it, you're going to have to feel all of those bad feelings first, you have to, it's the way we're made. If you don't, you will eventually. They come back to bite you. But the idea in either case is to shoot for accepting things as they are.

Impossible. It really feels that way. Impossible.

So in therapy we try to make it possible. You work through the stages, the emotions, try all kinds of interventions, and at some point, miraculously, over time, if you don't rush it, you're there. Or you accept that you can never accept. That's accepting, too.

We'll talk more about ACT another day. It can wait.

But let's go back to the start, to ColdPlay. The fellow in the video, the one who regrets his part in the accident, is going to be stuck feeling bad for quite awhile. By making a video, turning grief into something creative, he has worked a fabulous intervention, something therapists forget to recommend sometimes. Stimulating another part of the brain like that, creating something new, if only for a little while, relieves some of the pain.

Unless. . .

he took Ecstasy the night before the accident, or maybe had some other drug in his system at the time. In that case, in therapy he might be encouraged to work a program* of some sort, commit to changing something about himself. We would stress behavioral change in this case, shoot beyond acceptance. Some kind of program.

I'd say, one that puts his science where his heart is.

therapydoc

*Working a behavioral program is not exclusive to the Anonymous programs for individuals with substance abuse problems. The 12 steps are really just a form of treatment protocol. You can see how they "work if you work them" at The Second Road).

Transitions

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