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Surviving Grief . . .andLearning to LiveAgain

FFIRS 07/14/2015 0:32:47 Page ii

FFIRS 07/14/2015 0:32:47 Page iii

Surviving Grief . . .andLearning to LiveAgain

Catherine M. Sanders, PhD

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Copyright 1992 by John Wiley & Sons, Inc.

All rights reserved. Published simultaneously in Canada.

Reproduction or translation of any part of this work beyond that permittedby Section 107 or 108 of the 1976 United States Copyright Act without thepermission of the copyright owner is unlawful. Requests for permission orfurther information should be addressed to the Permissions Department,John Wiley & Sons, Inc.

This publication is designed to provide accurate and authoritativeinformation in regard to the subject matter covered. It is sold with theunderstanding that the publisher is not engaged in rendering legal,accounting, or other professional services. If legal advice or other expertassistance is required, the services of a competent professional person shouldbe sought. From a Declaration of Principles jointly adopted by a Committee of theAmerican Bar Association and a Committee of Publishers.

Library of Congress Catalqging-in-Publication DataSanders, Catherine M.

Surviving grief and learning to live again /Catherine M. Sanders.

p. cm.Includes bibliographical references.ISBN 0-471-53471-4 (pbk.)1. Grief. 2. Bereavement—Psychological aspects. I. Title.

BF575.G7S263 1992155.9´37—dc20 91-43605

CIP

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I dedicate this bookTo the wonderful people in the Tampa Bereavement Studywho, with broken hearts and spirits, willingly shared theirstories with me in the hope that they could be of some help

to others. My deepest gratitude goes to each one.

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Preface

When I was writing Grief: TheMourning After, my earlier book for caregiving practitioners,I kept slipping into sentences that were speaking directly togrieving persons rather than to the professional caregivers.I think I had already decided that a second, more personalbook, written for those who are experiencing grief firsthand,could reach and help many more people.I ’ve drawn from a wide variety of resources to write this

second book: my own research, therapy with bereavedindividuals, and my personal experience with deaths in myimmediate family. A large part of the information here isbased on a research project I conducted in the Tampa,Florida, area. I met with 125 bereaved individuals who hadlost a spouse, a child, or a parent. I followed each personthrough his or her first two years of bereavement. I met witheach of them several times, and we usually became goodfriends. Throughout the book, I refer to my research projectas the Tampa Study. The information gained from this studyhas givenme valuable insight into the course of bereavement,and it is the cornerstone for the phases of grief I describe inChapters 2 through 6. I call this whole approach the Inte-grative Theory of Bereavement.Most of us don’t know what grief is like until we lose

someone we love, and no two experiences of loss are

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exactly the same. The closeness to us of the person whodies; the time in his or her life—and in ours—when deathcomes; and the unique circumstances of each death all makea difference in the way we grieve and in the length of timewe take to heal.Grief ’s common denominator for us all, however, is pain.

When we lose a dearly loved person, we feel unbearableemotional pain. There is no getting around the pain; wemustmove through it if we are to heal. Trying to avoid the painfulemotions of grief only leads to greater problems—illness orserious chronic distress. Worst of all, avoiding the painfulfeelings of grief leaves us psychologically stuck where we are,unable to change and grow.Grief is felt on many levels at the same time. Physically, the

symptoms include headaches, gastrointestinal discomfort,palpitations, dizziness, and, possibly, panic attacks. Psycho-logically, the distress can be experienced as yearning, crying,anger, frustration, and feelings of guilt and shame. Socialdeprivation is another level of grief. When we lose a sig-nificant person, we experience social isolation and alienationbecause we see ourselves as different from others and dif-ferent from ourselves before the death occurred. When ourhusband or wife dies, our roles in the community and in ourclose circle of friends can change drastically.What heals us finally? When we activelymove through the

phases of grief, we work toward restoring a healthy per-spective. We can’t deal with grief passively; we have toparticipate fully.Each of us experiences each loss of a loved one in a unique

way, often depending on how close we were to the personduring life and how prepared we were, together, for thereality of the person’s death. Still, the best preparation cannotprotect us from the intense pain that follows the loss.My prologue is a description of my own losses, across three

generations of my family. Read it, and you will understandthat I do know a survivor’s devastating pain.I think it is important for you to know the level of your

own pain. Draw your own Self-Profile of Bereavement by

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answering the questionnaire on pages 19–21. Put a date atthe top of your answer sheet. A few months after you finishthis book and actively put into effect the help I am offering,fill out the Self-Profile of Bereavement again, and compareyour results against your present score. This will give you anidea of the progress you have made toward resolving yourgrief.My book explains the complete process of bereavement.

As survivors, you move through five phases of grief: shock,awareness of loss, conservation/withdrawal, healing, andrenewal. You’re in one of those phases now. When youunderstand those phases, it will become easier for you tomove more calmly into each new phase. You may oftenwonder whether you’re going crazy; this book will help youto accept grief as a natural experience. You’ll see yourreactions as part of a normal process that you must movethrough, to accomplish healing and renewal. The stress youare feeling will then be greatly reduced.In surviving the death of someone dear, we face one of

life’s most agonizing challenges. We have the opportunity,once we have worked through the phases of grief, tosurface as a stronger, more competent, new individual. The“working through” takes time, energy, and a perseveringheart. Many times, we feel like quitting. In these times ofloneliness and defeat, our courage is at its lowest. And yet,something carries us through: something, call it what youwill—God, providence, or a higher power—gives us thestrength to begin again. I believe that unless we can rely onsome higher power to help us through the long andarduous journey of grief, we can’t deal with the need toforgive, to love, or to fully belong to other importantrelationships.In this book, I join the disciplines of experimental

research and clinical application with spiritual dimensions. Iam firmly convinced that grief deals with issues of the soulas well as emotional and physical issues. To understand thegrieving process, it is important to be able to embrace allthree.

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My hope in writing this book is that you will understandthat grief has a progressive course and that your grief willmove through the steps of that course. Through all your pain,I hope to reassure you that you will survive and, in time, youwill feel alive once more.

CATHERINE M. SANDERS

Charlotte, North Carolina

April 1992

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Acknowledgments

First and foremost, I want tothank all the bereaved people who have contributed theirstories, their suggestions, and their enormous courage andwisdom to this book: participants in the Tampa Study,patients who allowed me to share their journey, and themany other bereaved persons I have met along the way.Their stories are all here, although I have changed theirnames and shifted some of the situations surrounding thedeaths in order to preserve their privacy and confidentiality.I am deeply indebted to each of them.I am grateful to my daughter, Catherine Merrill, for her

careful reading and professional comments as well as herstrong support all during the writing of this book. How luckyI am to have a writer in my family.To my long-time friend, Mary Howerton, I owe two

debts of gratitude. Not only did she spend many hoursscanning each chapter as I finished it, but she allowed me touse her beautiful poem, “Flight,”which is in print for the firsttime. I appreciate having it become a part of this bookbecause she has become a part of my life.“Ours and Mine,” another original poem, was written by

my dear friend, Harold Boysen, shortly after the death of hisfirst wife, when he was in deep grief. It is with a great deal oflove and pride that I include his poem.

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In Chapter 11, on mourning rituals, I have drawn exten-sively on the work of my good friend, Virginia Hine. Virginiawas a teacher for me inmany ways, and I miss her deeply. I amgrateful for the time we had together.I am most appreciative of the interest, patience, and

support I received from Herb Reich, senior editor at JohnWiley. He was brave enough to attempt a second book withme, thank goodness.Maryan Malone, of Publications Development Company

of Texas, the manuscript editor for the book, did an out-standing job in adjusting the text to readmore smoothly. I amfortunate to have had such an experienced and capableperson handling this end of the production.Particular mention goes to my office manager, Kay Burns,

who typed all the drafts, deciphering my marginal hiero-glyphics with amazing accuracy. I am grateful for her help.Finally, appreciation must go to my daughters, Sue La-

bella, Sally Bowers, and Catherine Merrill, and to my sister,Mary McKinney, who encouraged and supported me allalong the way. They shared the losses and the griefs thatprovided the springboard for the writing of this book. I amfortunate indeed to have such staunch fellow journeyers.

C.M.S.

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Contents

Prologue: An Autobiography of Grief 1

1 The Pain of Grief 23

2 The First Phase: Shock 40

3 The Second Phase: Awareness of Loss 52

4 The Third Phase: Conservation and theNeed to Withdraw 74

5 The Fourth Phase: Healing—The TurningPoint 86

6 The Fifth Phase: Renewal 104

7 When a Child Dies—Parental Bereavement 120

8 Death of a Spouse—Losing a Mate 138

9 On Becoming an Adult Orphan—A Parent Dies 156

10 How the Family Grieves 171

11 The Power of Mourning Rituals 179

12 Transcending Grief—Alive Again 193

Appendix: Support Groups That Offer Help 213

References 215

Index 217

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EPIGRAPH 07/11/2015 3:53:33 Page xv

To One in Sorrow

Let me come in where you are weeping,friend,And let me take your hand.I who have known a sorrow such asyours,Can understand.Let me come in. I would be very stillbeside you in your grief;I would not bid you cease your weeping,friend,Tears bring relief.Let me come in—I would only breathe aprayer,And hold your hand,For I have known a sorrow such as yours,And understand.

Grace Noll Crowell

“To One in Sorrow” from SONGS OF HOPE byGrace Noll Crowell. Copyright 1938 by Harper &Brothers; copyright renewed 1966 by Grace NollCrowell, reprinted by permission of HarperCollinsPublishers Inc.

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Prologue: An Autobiography of Grief

I was four years old when myAunt Ada died. She was living in our home when shebecame ill with cancer. Mother nursed her through her longillness and was with her when she died. I don’t rememberany of these events but, from age four, I had an image ofAunt Ada lying in state on our sunporch, in a white wickercasket. The casket wasn’t made of wicker, yet I retained thatmemory for many years without ever questioning the use ofwicker as a casket material. Because we rarely talked aboutdeath in our family, I was a teenager before I asked Mother,“Is it true that Aunt Ada was buried in a wicker casket?” Shelaughingly assured me that it was not true. The fact thatAunt Ada’s casket was white had confused my memory.I did not look at my aunt in her casket nor did I attend the

funeral. All the children in the family were quickly whiskedaway for some time in the country with close family friends.Children then, as now, were sheltered from “morbid sights”that might traumatize them. My mother had a realisticacceptance of death, for she had dealt with many familydeaths herself, but that was the way things were done then.There were no deaths in my immediate family until my

father died, when I was eighteen. Twomonths earlier, he hadbeen given a diagnosis of lung cancer. Although he becamevery ill, the words “cancer” and “death” were never heard,

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and the entire family spoke only in terms of his recovery. Myparents had been separated since I was five and my fatherlived in another state. Yet, his three children were with himduring his hospitalization. When he died, we were com-pletely unprepared, and suffered shock more than anythingelse. We had been disengaged from him for such a long timethat our loss was of a father figure more than of the manhimself.We had no guidelines to follow. My brother wanted to sit

up all night with my father’s body at the funeral home, but avigil wasn’t allowed. (The funeral industry has a tremendouscontrol over our death rituals.) I remember being terrifiedwhen I stepped into the viewing room alone. I wanted to saygood-bye, but I was not able to approach this silent, still bodyof the person who had been my father. I felt ashamed that Icouldn’t go near the casket, but it didn’t occur to me to talkaboutmy feelings with anyone. Death and one’s reactions to itwere simply not discussed. I accepted the rule that onemust bevery brave, and felt I had somehow fallen short of my duties.I can only guess how agonized my brother must have

been; he was much closer to Dad than I was. But he kept hisreactions to himself like a young soldier. It was surely nocoincidence that his first alcohol-related problems began ashort time later.After the funeral, our family went our different ways.

Death did not touch me again for many years. Then it hitwith all the force of an earthquake, and my life and myfamily’s were changed forever.When my husband’s work took him to Florida, we moved

there with our two younger children. Our two olderdaughters remained up north, one beginning work inNew York and the other entering nurses’ training atMassachusetts General Hospital in Boston. Our move left usfeeling terribly fragmented, and we tried to compensate bydoing things together.Even with a busy life in our new home, I had more free

time than I was used to. We hadn’t yet made enough newfriends nor had we become involved in the community. Jim,

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our son, was making a poor academic adjustment, after histransfer from a small private school up north to a large publicschool in Florida. I decided to enroll in some courses at thelocal junior college and chose subjects that were giving Jimtrouble. Classes began for me the last week of August, and Iplunged in determined to show him how tough school couldbe for some of us.On Labor Day, we decided to stay home and enjoy our

own pool, our dock, and our boat for water skiing.Wewouldplay it safe, away from highway traffic. I settled myself by thepool with my French textbook. Catherine, our youngest,went off with some newfound friends. Hersh, my husband,stretched out for a nap, and Jim, with a group of friends, fueledthe boat and took off for some water skiing. I rememberwatching my tall seventeen-year-old walk toward the dock,and thinking to myself, “How well he is developing, fillingout. How fine he is becoming.”He had everything going forhim. That was the last time I saw him alive.Not more than an hour later, a strange boat careened

toward our dock. As it drew nearer, I made out my son’s bestfriend, standing up and shouting, “Get an ambulance— Jim’sbeen hurt.” (I get sick to my stomach again as I write this.Strange, how that awful fear and nausea still reemerge when Ifocus on details of that day.)The freak accident was partly caused, we guessed, by Jim’s

poor eyesight. Without his glasses, his vision was roughly 20/200. Skiing behind our boat, he had made a wide swingwhen another boat was approaching from the oppositedirection.We supposed that Jim spotted the boat too late. Hedropped the ski rope and, as he slipped into the water, he wasstruck in the head by the oncoming boat. The impact was sogreat that a passenger in the other boat was hurled into thewater. We didn’t know it at the time, but Jim had sustained amassive cerebral hemorrhage and a broken neck. We waitedfor the ambulance and watched helplessly as various liferesuscitative methods were attempted. We were in a con-fused blur, not allowing ourselves to believe Jim would die.I know he was seriously injured but somehow I didn’t admit

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the thought that he would die. (How could he? Childrendon’t die.)When he was placed in the ambulance, he was inter-

mittently breathing and his color was good. My husband andI jumped into our car and tried to follow close behind theambulance, but we couldn’t keep up. We arrived at thehospital emergency room a few minutes after Jim did. Weraced toward the desk and asked for our son. When the nurseasked us to wait in a tiny examining room, a cold terror sweptover me. Even then, I don’t think I allowed the possibility ofdeath to enter my awareness.We waited about five minutes, alone, neither of us daring

to speak, before a doctor appeared. He was a young man,probably a resident; he seemed angry. His first question was,“What happened?” I quickly countered, “Never mind whathappened. How is my son?” He answered without hesita-tion, “Your son is dead.” Just like that. Not, “I’m sorry. Wedid all we could.” No other words to help ease thepronouncement.I couldn’t move. I couldn’t respond. I sat there numb,

staring straight ahead, unable to comprehend the impact ofwhat had been said. I don’t know what I thought. I wasplummeting downward on a roller coaster, with sightsexploding on each other, and I was incapable of separatingthem or stopping the ride.The doctor said a few words to Hersh and left. A nurse

came in and said to me, “For God’s sake, why don’t youcry?”Would she have been more comfortable, had I brokendown then? Ironically, she may have been the only personthroughout the whole funeral who may have been mademore comfortable by seeing tears. I later became aware ofhow afraid most people are of another’s tears. I learned tokeep mine to myself as I stumbled through my bereavement.I asked the nurse if I could see Jim, but she didn’t think it

was a good idea. It would be better, she said, if I waited untilhe was at the funeral home. To this day, I have been sorrythat I did not insist. I have since learned that the periodimmediately after a death is a most important time for

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good-byes. We were asked a name of a funeral home, I wasgiven one sleeping pill, and we left. Empty hands, emptylives, changed, diminished, broken.We were ill prepared, both emotionally and practically, to

deal with grief. Because we had never thought much aboutdeath, we had no concept of the therapeutic aspects of afuneral home. Funerals, in our way of thinking, were bar-baric rituals to be avoided whenever possible.Years earlier, my husband and I had attended the wake of a

five-year-old child of friends of ours. The little girl had beenquite ill with a debilitating disease during most of her shortlife. When she died, it was heartbreaking to see such a valiantbattle lost. Her parents were very brave. At the wake, thechild was lying in a white casket, wearing a lovely dress thatexactly matched the dress on the doll she held in her arms.The parents greeted each visitor unfalteringly and withimmense courage. Not only did they have to live through thewake we attended, but they were planning a similar onethe next day, in their hometown in Pennsylvania. We wereincredulous that they would expose themselves to so muchpain. We resolved that, if anything ever happened to either ofus (God forbid we should even think about one of ourchildren), we would have no wake and would make thefuneral short and simple.We saw no gain in dragging out suchan emotion-wrenching affair. How much we had to learn.At the death of our son, with no experience or guidelines

to follow, we fell back on that memory and the strongreactions we had experienced. As a result, we did everythingwrong. Now, in retrospect, I can count the mistakes wemade, one by one.First, we decided to hold the funeral as quickly as possible.

Perhaps we thought that once the funeral was over, some ofthe pain would be over as well and we would more quicklyget our lives back together again. What we did, in fact, wasexclude anyone who needed to travel any distance to get tothe funeral—all our closest, dearest family and friends thatwe’d left in Massachusetts, the people who could havesupported and helped us had they been there.

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Our next error was not having a wake. We did not go tothe funeral home at all, until the funeral; the memory of ourfriend’s daughter was still too strong. The evening before thefuneral, all Jim’s friends gathered at the funeral home,without us, to pay their respects. Not one person was there tohelp them with their grief and this was probably their firstdeath experience. In not joining them and sharing theirloss, we perpetuated the denial of grief, truncating ourbereavement and theirs even further.Our third mistake was to have a private funeral. In our

confusion and anger, we felt that it was important to“protect” all the teenagers who had been involved in theaccident. After all, we thought, grief is really a private matteranyhow. What we failed to realize was that Jim’s friendsneeded to mourn their loss too, and the ritual of a funeralserves this purpose. By having a private funeral, we excludedall those who needed permission to grieve, and we blockedout our opportunity to benefit from their support. We eventold our daughter, Sally, then in nurses’ training, not to comehome; we said it would not be wise to interrupt her studies. Ittook Sally several difficult years to resolve her grief and tomake real an event that happened so far away.It’s hard to imagine how we could have made such serious

blunders. I can only say that, with our limited knowledge ofdeath and mourning, we had no guidelines to follow. Whendeath is upon you and suddenly your world comes crashingabout your head, it is nearly impossible to make rationaldecisions. This is why it is important to develop firm con-victions about funeral arrangements ahead of time. Suddendeaths do not provide planning periods.The months and years that followed convinced me that

our treatment of our grief and mourning had made ourbereavement unnecessarily hard to live through.After Jim’s death, each member of the family withdrew

into a separate compartment. His name was rarely men-tioned, but his presence was like a huge boulder sitting in themiddle of the house. Hersh and I blamed each other in wayswe could not articulate. Catherine, so young, was left on her

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own to manage the terrible agony of losing her wonderfulolder brother.I plunged into a frenzy of activity. I had always worked

through tough times this way in the past; why not now? Mycompulsive self-reliance had never become more active.Continuing my classes, I often had to wear dark glasses tohide my tear-swollen eyes. My church work took on newmomentum as I tried to show by “witnessing” that God givesus courage. I don’t know how I did it, but I sang a solo inchurch two months after Jim’s death. By April, seven monthsafter Jim’s death, I was exhausted and filled with despair. Ihad cried and grieved, but I had done it privately in my roomor while driving my car. I would scream and sob until I pulledto a stop light where other drivers could see me; then I wouldcompose my face until the light had turned green and I couldmove forward and sob again.By April, the stress of grief had caught up with me. I

became almost catatonic. Our physician, a former flightsurgeon, diagnosed my condition as “battle fatigue.” Myneed to withdraw and conserve energy was possibly the mostfrightening aspect of my bereavement. In our society, wheredepression is greatly feared but broadly experienced, we tendto avoid retreat. We fear that we might become emotionallyill if we sequester ourselves or surrender to our emotions. Forthe bereaved, however, withdrawal is necessary to heal thebody after the emotional trauma of loss. Just as one mustconserve inner resources and withdraw when recuperatingfrom any physical assault, so the bereaved person needs theprotection of a period of quiescence and retreat.Indeed, I was to need all the energy and understanding I

could muster; in the next decade, my family faced deathrepeatedly.Wedeveloped an expectancy of death that grippedus each time the phone rang in the late evening hours.All the while that we were battling to survive Jim’s death,

my sister-in-law was fighting for her life against cancer. Shehad had two mastectomies, and each time she came out ofsurgery, she felt confident that the cancer had been stopped.She and my brother had never been able to have children.

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