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Sudden Loss: How to Help?

By on May 11, 2010 – 12:00 am  16 Comments

Kathryn Britton, MAPP '06, former software engineer, is a coach working with professionals to increase well-being, energy, and meaning (Theano Coaching LLC). She teaches positive workplace concepts at the University of Maryland. She recently published a book,Smarts and Stamina, on using positive psychology principles to build strong health habits. Her blog is Positive Psychology Reflections. Full bio. Kathryn's articles are here.



Linda Pointing to Site of Snakebite, 1974

Linda Pointing to Site of Snakebite, 1974

On April 16, my dear friend, Linda Frank, died in a traffic accident. I’ve gone through a wide range of emotions over the last month — numbness, sadness, humor (as we remember events like the time Linda tried to drive herself to the hospital after she stepped on a copperhead snake while wearing flip flops), confusion, emptiness, … But above and beyond my own grief, I’ve worried about her family. What do they need? How can I best be there for them?

I’ve also looked around and seen many people who want to do something. There are neighbors, members of Linda’s choir, her church, her yoga classes, her voice teacher, her language teachers, people she’d helped, her husband’s colleagues, people she visited. Many people ask, “What can I do?” or say, “I’ll do anything. Just ask.” Linda’s husband and daughter are ill equipped to ask.

So if you find yourself wanting to help others in a vortex of grief, here are some thoughts on using your strengths for their service and comfort.

What’s Going On?

Linda Frank, After a Concert

Linda Frank, After a Concert

Be aware that family members are experiencing a confusion of different thoughts, and their feelings may be changing from moment to moment. Nancy Hogan, now at the Marcella Niehoff School of Nursing, and colleagues came up with the following list for responses to sudden death:

  • Finding out
    • Responding to the news
  • Facing realities
    • Going through the motions
  • Becoming engulfed with suffering
    • Missing, longing, and yearning
    • Enduring hopelessness
    • Existing in the present
    • Reliving the past
  • Making sense
    • Aching with physical pain
    • Getting through the day
  • Emerging from the suffering
    • Embracing hope
    • Getting on with life
    • Experiencing personal growth
    • Becoming
Linda and partner singing Anything You Can DO

Linda and partner singing Anything You Can DO

The bereaved may also need to modulate the dosage of grief, and back away from it periodically. So when you come by to talk, don’t be surprised if the conversation takes several turns, or if you find people laughing. Telling funny stories about the person who died can be an important part of healing.

One thing to remember following a sudden death is that the survivors haven’t had a chance to prepare. So they will need help drawing their network in. Another friend and I made a lot of calls letting people know. Just don’t leave the message on any answering machines!

Support through Your Strengths
I have a close friend who is always there with food and practical support. I’m more comfortable on the Web, so I took over setting up an online community where we could post pictures, people could write memories, and we could ask for help. We used LotsaHelpingHands, but there are other choices available. What are your most natural ways to contribute? Some people like to drive. There are trips to and from the airport to pick up family members coming in for the service.

We found that our friend needed company as much as food. So we started asking the people who brought meals to stay and eat with him.

Benkel and colleagues at Gothenburg University in Sweden found that people need a mixture of practical and psycho-social support. As an example of practical support, I printed out lists of things that need to be done following a death. But Benkel points out that good advice can sometimes be helpful but sometimes be seen as pressure to do things a particular way.

Psycho-social Support

Sharing the rain

Sharing the rain

Benkel and colleagues observed three things about the needs of the bereaved for conversation following the event:

  1. They may discuss different things with different people to avoid burdening any particular individual or saying the same thing over and over to the same individual.
  2. They may have certain people with whom they don’t talk about their grief at all, in order to have a zone of life that is free of grief.
  3. They may find it relieving to speak to others who have gone through similar losses “in that such persons were able to understand their feelings without having to explain them in words.”

So if you have had similar losses, it may help if you identify your experience, so the person knows you understand without words. If you hear nothing about grief, you may be in a very needed grief-free zone. Who knows, you may be the person who can give a much needed hug, like the man Rodger and colleagues interviewed, who turned to a nurse that he knew slightly right after he learned of his wife’s death, “she felt there . . . was nothing I can do, but someone like her did something by being there, and you know, I couldn’t hug the bloody surgeon.”

Several sources mentioned that people need to know that their grief is normal, but that people go through grief differently. Being part of the network, you can make a difference. In their cluster studies of grieving spouses, Carol Ott at the College of Nursing at University of Wisconsin – Milwaukee and her colleagues found that 5 out of 6 older bereaved spouses come through suffering, including experiencing depressive symptoms, to adjustment over time. About a third of their sample had resilient responses.

“The resilient cluster had the highest scores on self esteem (i.e., comparison of self to others) and advice/appraisal (i.e., having someone to talk to about one’s problems). … Findings from this study are supportive of other research that has demonstrated social support may buffer individuals from the deleterious effects of stressful life events.”

Martin Rodger and colleagues at the Edith Cowan University in Australia observed that the time required to incorporate the change in the survivor’s life may be greatly underestimated by friends or even the professional community.

Practical Support
Here are some suggestions from Zoe Ulshen, the bereavement coordinator at Linda’s church, based on her experiences receiving care from a friends and neighbors after a major accident:

Bringing food

Bringing food

  • When I was receiving care from a support team, I really appreciated it when folks would call or email to confirm what they were going to do the next day (e.g., “Just confirming that I’ll pick you up at 9:30 for a 10:00 appointment”).
  • I also really appreciated it when people offered something concrete, rather than “just let me know what you want.” For example, Cindy said, “I’ve got Friday afternoon free. I can come over and we can decide then what you’d like to do with that time. We can shop, go for coffee, whatever you feel like doing.” Another friend said she was going to the store the next day, so what did I need?
  • The other “lesson” I learned from receiving care was how important cards were, especially cards that came weeks after my accident. You get tons of cards and support immediately after an event, but then people necessarily go back to their own routines and you’re left in a life that is anything but normal. Cards I got two, four, seven weeks later were so precious, because healing takes a long, long time, and I needed tangible reminders that people recognized my need for ongoing support.So my message to people ever since then has been: if you forgot to write, not to worry! Go ahead and send the card, but do go ahead and send the card!
  • Same goes with checking in with the person periodically for the following year, by phone and in person whenever you see them. Just a simple, “How are things going?” is all that’s needed, along with the willingness to listen to the response. That kind of open-ended question let me chose how much or little I wanted to talk at that particular moment.

My friend talks about 3 time frames: Up to and including the memorial service, short-term, and long-term. The memorial service was last Saturday, with many people attending, 2 choirs and a soloist, and several people talking about memories. Short-term means creating a new routine, getting through the days without Linda’s help and company. Long-term means recreating life direction, creating new images of the future. I hope we, his social network, can find the right ways to help him reach a resilient response!


References
Benkel, I., Wijk, H., & Molander, U. (2009). Family and friends provide most social support for the bereaved. Palliative Medicine, 23, 141-149.

Bozarth, A. L. (1994). Life Is Goodbye Life Is Hello: Grieving Well Through All Kinds Of Loss. Hazelden Publishing.

I haven’t read this book, but it was recommended to me by Zoe Ulshen.

Hogan, N., Morse, J., & Tason, M. C. (1996). Toward an experiential theory of bereavement.
Omega: Journal of Death and Dying, 31(1), 43-65.

Ott, C. H., Lueger, R. J., Kelber, S. T., & Prigerson, H. G. (2007). Spousal bereavement in older adults: Common, resilient, and chronic grief with defining characteristics. The Journal of Nervous and Mental Disease, 195(4), 332-341.

Rodger, M. L., Sherwood, P., O’Connor, M., & Leslie, G. (2006-2007). Living beyond the unanticipated sudden death of a partner: A phenomenological study. Omega, 54(2), 107-133.

Walsh, T., Foreman, M., Curry, P., O’Driscoll, S., & McCormack, M. (2008). Bereavement support in an acute hospital: An Irish model. Death Studies, 32, 768-786.


Images
All images used here were posted to the Lotsahelpinghands network for the Frank family by Linda’s friends. Mike Kalt took the picture of Linda pointing to the snakebite site, Ed Britton took the picture of Linda following her concert, Tony Armer provided the picture of Linda in Anything You Can Do, I Can Do Better, and Christopher Frank provided the picture of Linda walking with a friend in the rain.

Grandma brings her casseroles
courtesy of szlea

16 Comments »

  • Gloria Miele says:

    What a timely post. Our community just lost a beloved 13 year old girl whose parents’ sorrow is unimaginable for the many families who want to help. I especially appreciate your comments on offering specific help and keeping in touch and offering support long after the memorial service is over. Any further wisdom on dealing with the profound grief of losing a child?

    Thank you again for your thoughtful article.

  • I am probably one of the people who said “let me know if I can do anything at all…” In saying that, people do mean to be helpful, and want to let the other person free to choose what would be most helpful to them. But after reading your article, I now realize that concrete is better – because of the confusion, fear of imposing, emptimess, etc. I’ll keep your suggestion in mind and feel more empowered next time I want to help someone.

    Very best,
    MarieJ

  • Thank you, Gloria,

    I noticed at the public library yesterday that there are books specifically on understanding grief about the loss of a child. I wonder if people who will be particularly helpful are others who themselves have lost children — the experience bond that needs no words.

    Also, I think it is important to be open that you too are grieving for her. That’s one of the things I think was comforting about the memorial service. A lot of people participated. I also think it is important to be open to discussion. I once had a friend who lost her little daughter and was hurt that most of her friends weren’t able to talk to her about her daughter any more. They seemed to feel the topic was now off limits.

    We don’t expect to live past our children. Sometimes I think we forget how fortunate we are — a century or more ago, children often died before their parents. But it makes losses now especially grievous. Handling the grief will not be a short-term thing. There will be opportunities to be present for the family.

    Kathryn

  • Marie-Josee,
    I too have said, “Just let me know what I can do to help.” And now that I think of it, nobody ever responds. When I started writing this article, I thought about helping people move from a general state of wanting to contribute to a specific state of offering something tangible, something that comes from their own strengths.

    It’s also important to know if you miss the first window of opportunity, there is still time to make a difference. Needs may change, but they don’t go away quickly.

    So if I made you feel empowered, Yea! That was my hope.

    Kathryn

  • Hi Kathryn, thank you for sharing this timely post. A friend of mine has lost her father to a brutal murder last year, and it was devastating for me to see her in so much pain. She’s slowly coming to terms to what happened to her father, but there are times that she still loses it. It was so hard to think of things to comfort her, because it wasn’t just an natural death. My friends and I just made it a point to check up on her once in a while. She mentioned to us that she greatly appreciated our concern because even though she feels like nobody can understand what she’s going through, it helps her feel “normal” if her friends are around. Healing takes time, and I think it’s important to give her the space that she needs without her feeling that we are rushing her to go through her grief.

  • JM, Yes, the rest of the world may gather around and say, “Come on now, time to get on with your life,” but healing takes time — often more time than others (even professionals) think is reasonable. The big question is how to tell the difference between the natural slow pace of grieving and grief that becomes complicated and stuck. Ott and colleagues did a cluster analysis and found common, resilient, and chronic grief clusters. They found 5 out of 6 spouses were in either the common or resilient clusters. The 1 out of 6 in the chronic grief cluster may eventually need outside assistance. It’s so hard to know with a particular person, since grieving is highly individual.

    But friends are one of the “ordinary assets” that contribute to resilience. So keep on being there. Kathryn

  • Amanda Horne says:

    Hi Kathryn – a timely article, thank you. A friend went through loss, and it’s in the forthcoming weeks we need to remember to stay in touch. Your article also comes at a time when some clients are concerned about ‘managing change’ – what they are going through is put into perspective when I read your post.

    Amanda

  • Amanda,
    Yes, I think one of the important lessons I’ve learned is that the need goes on. I liked the way Zoe Ulshen put it, that her life was still anything but normal for a long time. Also, big shocks do serve to put worries in perspective. An event like this is a reminder to perceive blessings, the everyday things that it is so easy to take for granted.

    Thanks for responding!
    Kathryn

  • Senia says:

    Kathryn,

    Thank you so much for this article.
    Especially for the research in here – giving us specific techniques for “How to Help.” That’s always been my favorite thing about positive psychology – that there are techniques and tools – that it’s not just “oooh la la, things are great.”

    I like the Nancy Hogan observations especially – that these are things people go through. I once read research (don’t have the citation) that in an fMRI brain imaging machine, when people felt sad, angry, bothered, and they named that emotion (literally, by saying, “I’m sad”) that the activity in the brain associated with that emotion calmed down. And I can imagine that here too, in seeing Nancy Hogan’s suggestions, if people know that this is a normal part of being human, then it – hopefully – might be easier.

    Warm thoughts, merci for the tools in this article,
    Senia

  • Senia,

    Wayne Jencke posted a comment about the naming emotions research to Resilience in the Face of Adversity. Sorry I can’t create a link to the specific comment — scroll down. He doesn’t cite the researchers – but maybe will provide chapter and verse now.

    Thanks for your warm thoughts.

    Kathryn

  • Oz says:

    Kathryn – link to research on expressing emotions

    http://www.innate-intelligence.com.au/blog/?p=87

  • Danielle says:

    Hi,

    I usually cringe when I hear someone say to someone in need, “Just let me know if you need anything!”. While I realize they mean well, I know it is ineffective. They won’t get a call or request, more than likely. It used to frustrate me, because I responded to others in need the same way, and would receive no request for help. Somehow along the way, I gained his insight, which goes along with the “offering something concrete” idea). Instead of waiting to be asked, I make something for the family/person in need- usually baked goods, homestyle meals, etc.- so I whip up something that I know they’ll like (I usually make one for them and one for us). After all, they are my friends, so I know their likes and dislikes:) Then I call them, after I’ve made it (so they can’t talk me out of it) and say something along the line of, “I was making a Mexican Casserole for dinner and made extra for you. We have that and some homemade cookies, too! Could we drop them by this afternoon?” The answer is always a “Yes”. Which makes my heart happy, because I have the opportunity to reach out to my friends in need. This works well for people that have had other difficulties, such as surgery, loss of a pet, etc.( ie., anytime someone needs encouragement).

    Thank you for this wonderful article. Its very helpful.
    Danielle

  • Nora says:

    I have experienced 2 deaths by suicide within my circle of aquaintances. I have done a lot of research into this unique form of grief for these survivors. All of your recomendations are great. I just want to add that sometimes even making a small decisions can be too overwhelming for a person in some stages of grief. If you are close enough and you know of something that needs to be done, just do it. There are many things that fall into this category but simple examples I can think of would be household chores: cutting the grass, walking the dog, picking up drycleaning or groceries.

  • Danielle,

    Great approach. It’s like saying, “I’m opening up the circle of people I cook for to include you.”

    I will comment that right after the event, my friend was a bit overwhelmed by food. So it helps if some friends wait a little time and then offer.

    Also, I have noticed from an older friend whose neighborhood was absolutely wonderful after she was injured — that people sometimes bring too much food. One or two servings is sometimes more welcome than an entire casserole.

    You also confirm Zoe Ulshen’s suggestion of calling first. It may be that the person is overwhelmed with food, and you’d be better to pop it into your freezer for a week or two.

    The other thing we started doing was packaging up leftovers into one-serving size containers and freezing them — for days in the future when food is needed. If you brought well-labeled food in containers for the freezer, that might be wonderful to have for the person who is struggling to get back into a routine.

    Thanks for adding your ideas, Danielle.
    Kathryn

  • Nora,

    I love your suggestions about just doing things that you see need to be done. As my friend said, he wasn’t in shape to organize anything.

    My husband went over to garden with Linda’s husband, partly to get him outside in the fresh air because we know he finds gardening energizing. But a good deal of the time, my husband was out pulling weeds by himself. Life — and weeds and dogs — don’t stop needing attention because the world has suddenly changed for someone.

    Kathryn

  • Here’s an interesting mother-daughter interaction right before the mother died.

    My friend had traveled to be with her mother, who was in end-of-life hospice care. One morning her mother said to her, “Today we’re going to make a list. Get a piece of paper.”

    Then she explained that when her husband died, she had gotten many offers of help but had been completely nonplussed about what to ask for. So she wanted to help her daughter make the list of things the family would need when she died. She told her daughter to just put the list on the front door and people could come by and check off things they wanted to do.

    That struck me as such an interesting way for the mother to contribute to the welfare of her family after her death.

    Kathryn

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