Coping with Grief and Loss

Abstract

This greatly needed publication is a straightforward guide and support for professionals and for those who are themselves experiencing recent or imminent loss. The report includes material on: how grief affects one's health, essentials for self-care, guidance for coping with necessary steps following someone's death, preplanning when a loved one has a life-threatening illness, supporting others who are grieving, life stages and losses, and planning a memorial service or funeral. It also includes resources consisting of organizations, websites, and books (for both children and adults), a funeral/memorial service planning form, a glossary, and a space for notes.The opening “What is Grief?” section includes the customary explanations and characteristics of the grieving process, as well as some background on the development of our current “take” on grieving, including feeling states and how personal loss history affects current grief style. So-called stages of grief are dealt with by alluding to them as feeling states when they (or any of them) exist, while the individual nature of grief is emphasized. Emphasis is also placed on helpful connections with others. Processing the loss and grief as fully as possible is stressed throughout the publication and appears to be somewhat thematic. The inclusion of grief and its application to children is a plus not always found in grief literature.Tips for dealing with a loved one's impending death are well-taken. These include a focus on what actually can be possible as well as a focus on the here and now. Specific steps for stress management are helpfully included, especially for the caregiver. Emphasis is placed on communication with the treatment team, palliative care, hospice care, and decisions regarding organ and tissue donation. Practical and direct decisions regarding advance care directives and available life-support measures are a very positive inclusion in this publication. Care has been taken to include four types of life support measures. This inclusion can be helpful in guiding decisions of utmost importance—both at the moment of need and well into the future. The history of orders for life-sustaining treatment (Physician Orders for Scope of Treatment and Medical Orders for Scope of Treatment) is addressed. Inclusion of information about these orders as well as other disclosures of what is wanted are especially useful in that they are effective across care settings, while it is not always the case that a DNR (a do-not-resuscitate order) will be honored by a different care facility than the one in which the DNR originated. POLST and MOLST forms define goals for care and the level of treatment desired; they include concrete orders enabling emergency personnel and physicians to take action that is wanted. They can be shared through electronic medical records, and they can be revised if/when circumstances or wishes change.I am especially pleased with the section on happenings immediately before death. This section cites Dr. Ira Byock, well-known as a hospice advocate, who fosters the exchange between families and dying people of words such as: “I love you,” “I forgive you,” and “thank you.” This exchange is believed to be a way of healing relationships and of obtaining a sense of completion. Also included is the suggestion that it is appropriate and often assuring for the dying person to know that it is all right to let go when ready to do so.While not explicitly stated, the tone of this booklet is that grieving can be resolved by “letting go.” “Letting go” (or decathecting from the lost object), while reasonable in theory, is not always possible and has not been supported by research or by clinical practice. The most current understanding in thanatology is that while “letting go” may be desirable, it is not always possible in certain relationships. What may sometimes be the necessary and optimal step toward a peaceful accommodation is the internalization of the person who has been lost. When we are able to internalize the deeply loved one who is in reality absent, and when we can feel peace and comfort as a result of the internalization, then we can sometimes have feelings of “more” rather than “less.” Though perhaps often sad, we can feel peaceful, and the internalization can be a resource, a comfort, and self-assurance rather than the cause of feeling incomplete and lacking.Somewhat disappointing is that this publication does not include the most recent model of grieving as a process; it is not the most up-to-date information source regarding the actual experience of grieving as understood today. It is, however, a source of sound information that can be a very useful comfort and strength to those who face loss and all that loss involves.