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Grief and Mourning-- Knowing what to say to a friend or a child who has experienced the death of someone close is something we all wonder about. This issue provides guidance on what to say and when, to children, teens and adults when death occurs naturally, by suicide, or when a pet dies.

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Grief 101: How to Assist Mourners in the Grief Process

Lillian L. Meyers, Ph.D, FT

Margaret Mead said, "When a baby is born we rejoice. When a couple marries we jubilate. When someone dies we pretend that nothing happened." In our youth-oriented culture, death is the ultimate insult. Death is not a failure, as one out of one dies. No one gets out of this life alive!

To be human and alive means to suffer losses across the life cycle. Family and friends want to be helpful especially when the loss is the death of a close loved one. The key to being helpful is to recognize that you cannot fix grief, especially with words. Losing a loved one is painful and permanent. You can be helpful only if you understand that grief is a process and not a destination or event. I will give you an overview of GRIEF 101.

The grief process is very unique and no two people grieve the same at the same time. There is no right or wrong way to grieve. Men grieve differently from women. Children grieve differently from adults, and younger children grieve differently from older children. All children will regrieve losses at each developmental level. The grieving process is a series of "stages" or "experiences". This does not mean that grievers step from one stage to the next in an orderly way. These are not linear, but "dips" and "valleys."

STAGES OF THE GRIEF JOURNEY:

1st stage: SHOCK, DISBELIEF, DENIAL

This stage allows the griever to gradually absorb the full realization of the death. If fortunate enough to have close family, they will assist them in funeral plans, phone calls, etc., and others will not be as needed then. This first stage is very short and usually ends not long after the funeral and the mourner moves into the second stage. Continued...

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When Death Comes to Your Family: How You Can Help Your Child

Marolyn Morford, Ph.D.

Your second child was stillborn. Your child's grandfather, your father, died suddenly. The mother of your child's best friend died after a long illness. Your family dog had to be put down due to illness. How can you help your child cope? Not all children and families respond the same to loss, and children have different temperaments and understanding at different ages. Here are some general suggestions that can help you and your child through this time.

1. Be honest with your child as soon as possible: if an important family member or pet has died, for example, do not hesitate to talk to your child about the event, when appropriate. Don't wait for the child to hear about it through the community or a less-than-thoughtful sibling.

2. Don't use substitute words such as "sleeping with angels," "went to sleep," "went away," or that the person or animal was "lost". These are called euphemisms; they substitute one word for another to soften or distance the meaning, but can also create confusion and anxiety. You know what you mean, but your child may be understanding the concrete meaning of those words and become fearful of going to sleep at night, or of you going to sleep at night, or of you becoming lost. You can use the terms 'death' and 'dead'. This is how your child will learn about these words and concepts.

3. Don't assume children will be traumatized by learning about death or loss. Children have such a capacity for resilience, our genetic package having developed successfully over thousands of years of adverse conditions. In the recent and distant past, we had nary a support group and saw much more loss due to disease, malnutrition and occupational hazards. Young children, especially, are able to tolerate loss, even more so if their primary bonds remain stable. Continued...

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I Never Thought this Would Happen!

How to Help Teens Deal with Suicide Grief

Terri Erbacher, Ph.D.

Has your child lost a friend or loved one to suicide?

Not only is your child grieving the loss of someone close to him/her, but this grief is intensified because the death was a suicide. The healing process may be painful and may seem unnaturally slow as suicide grief is extremely complex. Helping your child understand his or her emotions, as well as learning something about suicide in general, may help to ease some of his/her pain.

The first question is often WHY do some teens complete suicide?

We don't know for sure because when youth die by suicide, they take the answers with them. But, we do know that many are experiencing a number of stressors and many have a mental disorder, like depression, which is often undiagnosed, untreated, or both.We also know that most teens do not want to die, they just want their emotional pain to end. Help your teen see this and see that there are other ways to deal with this emotional pain, such as by getting help when needed.

Grief Symptoms/Behaviors your child may experience:

Emotional Effects

Shock & disbelief, anger & irritability, depression/sadness,

despair or helplessness, terror/fear, guilt or self-blame,

anxiousness or worry, loss of pleasure in activities,

confusion.

Physical Effects

Fatigue, insomnia or disturbed sleep, stomach aches, headaches, decreased appetite, hyperarousal or easily startled.

Cognitive Effects

Difficulty concentrating, trouble making decisions,

trouble remembering, impaired self-esteem

intrusive thoughts or memories, nightmares.

Social/Behavioral Effects

Social withdrawal/isolation, increased relationship conflict,

refusal to go to school or activities, crying easily, change in daily patterns, regression in behavior,risk taking behaviors (substance use), aggression or oppositional behaviors.

Continued...

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When You Lose a Pet Christine Duprey

Christine Duprey, M.A.

For many who own pets, they are more than just animals, they are a part of the family. Pets can be wonderful sources of companionship, emotional support, unconditional love, acceptance, non-judgment and affection. Pets can provide their owners with a sense of purpose and can fulfill a nurturing need in many of us.

When a pet dies, it can seem as though a close family member has passed. The pain can be very similar to other losses, and you may feel overwhelming sadness and grief. You may have difficulty sleeping, eating, or concentrating. You may go through several stages of grief, including denial, bargaining, anger, depression and acceptance. The grieving process may depend on whether your pet passed away suddenly from an accident, or if your pet suffered from a prolonged illness. No matter what your individual grieving process is, this can be a difficult time, and it is important to allow yourself to cope and grieve as you need. Here are some suggestions for coping through this painful time:

Give yourself permission to grieve. Many people may say "I shouldn't be upset, it was just an animal." The truth is that pets are often sources of unconditional love and can be our closest confidants. Allow yourself to cry and express your emotions; only you know what your pet meant to you.

Be patient with yourself. It is important to allow yourself time to go through the grieving process. Understand that it may be painful for a while, and certain places or things may remind you of your pet, triggering sudden feelings of grief and sadness. Your emotions will ebb and flow like waves, but you will feel better eventually.

Be kind to yourself. Pay attention to your feelings and allow yourself to be kind and nurturing to yourself during this difficult time. You know how you have coped in the past with other losses, and you alone know what makes you feel better. This may include taking time to read, listen to music, express yourself through art or poetry, or going for long walks.

Surround yourself with people who understand your loss. It can be helpful to surround yourself with others who understand the bond you had with your pet, or with others who have lost pets themselves.

Memorialize your pet. Some people feel better after they hold a service or a funeral for their pet. You can remind yourself of the wonderful memories you have of your pet, what your pet meant to you, and what a wonderful life your pet led. You may decide to keep small mementos from your pet, such as a favorite collar or photographs of you and your pet. When you are feeling sad or overwhelmed, you can look at these mementos and remember all the love that you shared with your pet.

Give yourself time before getting another pet. When someone loses a beloved pet, there may be a strong urge to buy another pet to fulfill the void left. This will not be fair to you or the new pet; all animals have their own personalities, and the new pet cannot become a substitute for your lost companion. Only when you have gone through the grief process and will be able to fully commit to loving and taking care of this new animal is it a good idea to consider getting a new pet.

Seek additional help as needed. This can be an emotional and overwhelming time. It is important to reach out for help when you need it. You may decide to call your local humane shelter to join a pet loss support group, or you can speak to a grief counselor.

Losing a pet is never easy, and it is quite common to feel sad or depressed after a beloved animal passes away. It is important to do what you can to take care of yourself during this time, and know that eventually your grief will pass.

Christine Duprey, M.A., is a doctoral candidate in psychology at Marywood University and works on the Eating Disorders Unit at the Princeton University Medical Center.She has a pet cat named Sammy, who thinks she's a dog, and who is very much a part of her family.

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Grief 101, continued...

2nd stage: SUFFERING, DISORGANIZATION.

Now the mourner begins to experience a variety of emotions and feelings, all of which are normal. These include anger, guilt, poor concentration, disruptions in eating and sleeping, low energy level, sadness and tearfulness. At this time the griever needs to tell the story of "what happened" over and over again. It is very important for you not only to listen to their stories but to be patient with how often they need to repeat them. Henri Nouwen wrote, "Healing means, first of all, the creation of an empty but friendly space, where those who suffer can tell their story to someone who can listen with real attention."

3rd stage: MANAGEMENT, COPING.

Although the grief journey does not end as we understand ending, there is a final experience when the griever is managing and coping better with pain. This journey is significantly easier if the griever has joined a self-help/support group where s/he receives not only support, but the correct information about the grief process. Unfortunately most grievers were probably abandoned very soon by non-grievers who believed many of the myths about grief such as: the griever had found "closure", is "over" the loss or has "let go" of the loved one. These are appalling misconceptions. "Closure" is for bank accounts and closets, not love. A griever never "gets over" the loss of a loved one and does not "let go" of a loved one, but relocates them in a special place in their hearts where precious memories remain. A headstone in a cemetery in Ireland reads, "Death leaves a heartache no one can heal,love leaves a memory no one can steal."

WHAT YOU CAN DO TO HELP:

BE THERE: Just be with the griever. There may be long periods of silence. Honor them. Be patient with the long stories about the deceased. If you can, share your remembrance of him or her. This does not cause pain but is comforting to the griever.

SAY IT'S OK: The grieving person needs to express their feelings without concern that they may not be normal. "Normal" is a setting on the washer and is not part of the grief process. Validate these feelings by saying that you believe these feelings are normal.

BE PATIENT: Grieving the death of a loved one is a long journey and there will be ups and downs in the process. All the "firsts" -- anniversary, birthday, graduation, and the holidays -- are especially painful. A note, phone call or visit would be welcome to the griever as they realize you have remembered. Grievers fear the most that others will forget.

JUST DO IT: Be aware that grievers will rarely ask anyone for help. Do not ask them to call if they want to talk or need something. But you can visit or tell them you are going to the store and can pick up any items they need. If the griever has young children, it can be very helpful to take them out for the day.

FIND SELF-HELP/SUPPORT GROUPS: You can find support groups on the Internet and share the information. The Compassionate Friends is an international self-help/support group for parents, grandparents and siblings who are grieving the death of a child. Their website is www.compassionatefriends.org. Other websites can be found in the blue pages of the telephone directory. Most libraries have a self-help section with some excellent books. One I recommend is Good Friend For Bad Times by Deborah Bowen and Susan Strickler, Augsburg Books, 2004. It would make a nice gift.

WHAT NOT TO SAY: Avoid religious platitudes such as "this was God's will" or "it is a mystery you will someday understand" or "he/she is in a better place". Don't say "I know how you feel" unless you have suffered the same loss. Also, never tell a griever not to cry. Washington Irving wrote, "There is sacredness in tears. They are the messengers of over-whelming grief and unspeakable love."

Lillian L. Meyers, Ph.D., is a licensed psychologist recently retired from Western Psychiatric Institute and Clinic where she was the Director of the Grief Training Institute. Dr. Myers is a bereaved mother and program chair for The Compassionate Friends in Pittsburgh, where she continues to provide a variety of bereavement programs in her private practice.

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When Death Comes, continued...

4. Be careful not to confuse your own grief with your child's reaction. Your attachment to your family pet or to a friend or close relative is very different from your child's relationship with that person. Do not confuse the two. Your reaction may be very strong: it might be hard to keep from crying and you may feel uncertain about your future without that special person or pet in your life. Pay attention to your own reaction or grief and take care of yourself.

5. Do not blame your child if s/he has no observable reaction to the loss. Children understand death differently than we do. Accept that your child may have little or no reaction. As adults, we have an understanding of death and loss that can be powerful because we can foresee the effects our loss will have in our lives. Children do not have this knowledge. They had their own relationship with the family member who died. If they had no relationship (such as the case of a newborn sibling), don't have unrealistic and unfair expectations of their response (see #4 above). Their understanding of death is evolving and can be as simple as 'being gone a really long time,' without an understanding that there will be no return. It will not be possible or helpful for you to explain in detail the permanency of death; this is something the child, like you, has to come to experience, to build her own concept of loss through death. Your child will need to talk to you about this off and on over the years as his or her concept of death develops.

6.Listen to your child. By not assuming your child is feeling the same way you do and by listening to and observing your child, you will show s/he understands this event. Respect your child's response, which might be no apparent response at this time or might include unusual behavior or a temporary regression in independent skills. Give the child time to ask questions about death and about the person who died, and feel free to say you do not always know the answer to some of the questions.

7. Convey your confidence in your child's ability to live beyond this loss, and even thrive in spite of it, reinforcing that loss is a normal part of life, even when loss is a complete surprise, such as a tragic car accident. Even if the worst is to happen, such as the preschooler I worked with whose father killed his mother and then killed himself, children can survive this, too, given other family and community supports. Let your child know that even though it feels sad now, s/he can share that sadness with others. Make sure they know that you believe they can manage this experience.

8. Be aware that your child is watching you. How you respond to loss, discuss it, and integrate it into your life is a model for your child. In many instances, your child will take his or her cue from you about how important this loss is. You may have rituals that you and your community use to integrate the loss.The resources you use are the ones you are showing your child how to use. Reach out first to family and friends, then if you find that you or your child is preoccupied with the loss or find it difficult to do the things you used to do, attend a community or hospital bereavement group and consult with a psychologist familiar with child development and behavior.

Marolyn Morford, Ph.D., is a developmental and licensed psychologist, practicing at the Center for Child & Adult Development in State College, PA.

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I Never Thought, continued...

While the above are common symptoms, help your child understand that there is no right way to grieve. It is an individualized process and your child must grieve at his or her own pace. This is especially true for the complexity of suicide grief, which leaves many questions unanswered.

Some things you can do:

Be available and ask if your child wants to talk, but realize a teen may not come to you.
Listen to your child without judgment and let your teen tell his/her own story freely.
Share your own feelings and concerns honestly.
It is okay to tell your teen that you don't know answers to some difficult questions.
Try to re-establish a routine, with appropriate expectations, as soon as possible.
Try not to take anger or irritability personally as it may be directed toward parents.
Let your teen have his/her personal space.
Be careful not to glamorize, thereby positively reinforcing, suicide as an option.
Emphasize the importance of seeking help when needed.
Be aware of depression and/or suicidal ideation in your child (see warning signs)

Suicide Warning Signs:

A previous suicide attempt
Current talk of suicide or making a plan
Strong wish to die or a preoccupation with death
Signs of depression, such as moodiness, hopelessness, withdrawal
Increased alcohol and/or drug use
Hints at not being around in the future or saying good-bye
Accessibility to firearms
Impulsiveness and taking extreme or unnecessary risks
Lack of connection to family and friends (no one to talk to

What is a Suicidal Emergency?

It may be an emergency if your child expresses any of these:Intense feeling of being a burden, of not belonging, of hopelessness, that things will not get better; intense thoughts of lethal self-harm, describing a specific plan, or seeking means of self-harm.

These warning signs are especially noteworthy in light of a recent suicide death or other loss of someone close to your child. If your child mentions suicide, take it seriously. If there seems to be a suicide emergency, do not leave your child alone. Get help immediately: take the child to a local crisis center or call 911.If it is not an emergency, but you are concerned about your child, you may decide to contact your school's guidance office, your medical doctor, or a psychologist.

Remember that the number one protective factor in the life of a child is a caring adult who listens to a child without judgment. This is most often a parent!

For more information, visit:

www.afsp.org

www.suicidology.org

www.delcosuicideprevention.org

kidshealth.org/parent/emotions/behavior/suicide.html

www.americanhospice.org

Terri Erbacher, Ph.D., is a certified school psychologist and licensed psychologist with the Delaware County Intermediate Unit (DCIU) and Philadelphia College of Osteopathic Medicine (PCOM). She is a Clinical Advisor to the Board of Directors of Survivors of Suicide, Inc, and is a previous Executive Committee Chair of the Delaware County Suicide Prevention Task Force. Dr. Erbacher was the recipient of the 2007 Survivors of Suicide award for her dedication to Suicide Prevention Efforts.

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