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Explaining Suicide to Children

September 10, 2014

In light of Robin Williams’ recent death, this post is about suicide – specifically explaining the suicide of a loved one to a child. Suicide is a difficult topic to speak about.  It’s hard for adults to understand and difficult to explain to children. Children can cope better with difficult topics and feelings when they are able to talk openly about them.

Here are some common feelings children experience after a suicide:

  • Abandonment
  • That the death is their fault
  • Afraid they will die too
  • Worried  someone else they love will die
  • Guilt, sadness, embarrassment
  • Confusion, shock, anger, loneliness, or numbness.

Beginning the conversation could be the most difficult part, but once you start you are on your way. Here are some tips to help you:

  • Find a place where you can talk quietly without interruption.
  • Include another adult to increase your comfort level.
  • Tell the truth.
  • Talk in a calm, straight forward manner and use age-appropriate language.
  • Begin by  saying, Johnny, sit down, I have something I need to tell you. If there is more than one child, you can tell them together but in a way that the youngest can understand. The older ones can ask more questions later.
  • Recognize that very young children (three and under) don’t understand the permanence of death. You can say, Daddy has      died and I am sad. I will take care of you.
  • Offer more information to children ages three to six. You can say, Daddy has died and I am very sad.  That’s why you’ve seen me crying. Dead means the person can’t eat, talk or hear. The body has stopped working and cannot be fixed.
  • Provide reassurance. If the child asks how Daddy died, you can say Daddy died by suicide which means he killed himself. The rest of the conversation will depend on the child’s response. That may be plenty of information for the moment.

 Older children will have more direct questions. Here are some possible answers: 

  • He had an illness called depression. It’s different from having a bad day.
  • I don’t know – I wish I knew.
  • He didn’t know how to get help or see any other way to stop the pain.
  • Suicide is complicated. We’ll never know exactly what went through his mind or what he was feeling, but he must have been in horrible pain.

It’s important to remember that the way depression impacts our lives varies greatly from normal reactions of sadness to extreme and persistent sadness that limits our day-to-day routines.

Extreme and persistent sadness is called clinical depression. In most cases, clinical depression is successfully treated by medical treatment and psychotherapy. Even so, a small number of people die as a result of depression. Make sure to reinforce that suicide is not a solution. Instead, there are always other choices to solve problems and access support.

Children need to know that the person who died loved them and they need to be assured over and over that they did not cause the death. Keep in mind that children are intermittent grievers. Be prepared to talk about the suicide several times. You may have this conversation multiple times over the days, weeks and years that follow. You may have it in small doses throughout the child’s development. Their need for information will transform over time. 

Please know that you do not have to grieve alone. Consider individual counseling and/or support groups. They can be very helpful for you and your child. Be kind to yourself and available to your child. 

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Please visit our on-line grief discussions groups at http://www.hospicewr.org/discussions/grief/.

Please like us on Facebook at https://www.facebook.com/ESPBCenter

This article can also be seen on ShareWIK.

The Aging of Adults with Special Needs

August 15, 2014

Do you know an adult with special needs living with elderly parents?  Do you have an adult sibling who fits this category?  Have you considered what will happen when your parents die?  Will your sibling need to relocate?  Will he or she come live with you?

Adults with autism, intellectual disabilities (formerly known as mental retardation), Down syndrome and other special needs are living longer and living at home with their elderly parents.  The aging of adult children with special needs presents unique challenges and demands.  One area to address is grief and loss. 

In the bereavement center, we serve a growing number of individuals with special needs who’ve been uprooted from their environment after the death of their last living parent.  In addition to grieving the death, they are experiencing many significant secondary losses.  These include having to move from their home, their city, their job and their friends.  All that was familiar and part of their routine has suddenly been pulled from them.  This is not only tragic, but overwhelming to the grieving person with special needs.  I knew who to call when I lived in Pittsburgh.  I don’t know who to call here.

One significant challenge is the unwillingness of elderly parents to place their aging special needs child in a group home.  They keep their child home out of love, but sometimes the best intentions are not always in the best interest for long term care. The elderly parent may have their own health challenges and have difficulty being a caregiver for an aging child with special needs. In addition, every elderly parent will die. It’s hard to think about this, but if the plan is to eventually move the adult child to a group, assisted living, or nursing home, it may be helpful to consider doing this before the parent dies. It can help ease the transition to a new living environment which makes for one less loss after the death.

Thinking long term about special needs adults takes the concepts of advance care planning to a whole new level.  Your town may have a Geriatric Case Manager or some such healthcare professional that can help you navigate the needs of this aging population.

Learn about:

  • Available entitlements and benefits
  • Community services for those with lifelong changes
  • Legal tools and attorneys who can create a long term plan for oversight of the whole family
  • Respite opportunities
  • Housing and group home living arrangements

Yes, these are difficult things to think about, but careful consideration and planning will be beneficial for everyone.

Start the conversation. 

Please visit our on-line grief discussions groups at http://www.hospicewr.org/discussions/grief/.

Please like us on Facebook at https://www.facebook.com/ESPBCenter.

This post can also be viewed at ShareWIK.com

Mindfulness and Grief

July 8, 2014

Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.    Jon Kabat-Zinn, Ph.D, Wherever You Go, There You Are

Mindfulness is a buzzword these days but what exactly is it and how does it relate to grief?  Mindfulness is the practice of purposely focusing your attention on the present moment and accepting it without judgment. Practicing mindfulness has been proven to improve both mental and physical health. As such, it can be a great tool to use during the grieving process when you find yourself both physically and mentally exhausted. 

Mindfulness can ease your physical symptoms of grief, help calm your mind, regulate difficult emotions and improve your ability to focus on the present. It can increase compassion toward yourself and others and help you make meaning of the loss.

There are many ways to practice mindfulness. All are a form of meditation. Some folks learn to meditate on their own by following instructions in books or recordings and others benefit from the support of an instructor or group.  It takes practice to become comfortable with these techniques. If one method doesn’t work for you, try another.

Learning to stay in the present is a less formal approach to mindfulness. You can practice during any activity.  Here are four helpful tips:

  1. Start by bringing your attention to the sensations in your body.
  2. Breathe in through your nose and out through your mouth.
  1. Proceed with the task at hand slowly and with intention.
  2. Engage all of your senses. Be aware of sight, touch, smell and sound.

When you notice that your mind has wandered from the task at hand, gently bring your attention back to the moment, focus on your breath and sensations.

The goal of any mindfulness practice is to achieve an alert state of focused relaxation by paying attention to thoughts and sensations without judgment. Accept whatever arises in your awareness at each moment. Most importantly, mindfulness involves being kind and forgiving toward yourself. 

Grief is a powerful emotion and can be overwhelming.  Mindfulness can help navigate the vast feelings of grief. You may find that you can allow the grief to rise up, observe it, hold it intentionally in awareness and notice that grief ebbs and flows.

 Please visit our on-line grief discussions groups at http://www.hospicewr.org/discussions/grief/.

Please like us on Facebook at https://www.facebook.com/ESPBCenter

This post can also be seen at ShareWIK.com.

Pregnancy Loss

June 9, 2014

As soon as couples find out they’re pregnant, a relationship forms with the unborn child. Pregnant moms are drawn to the windows of maternity stores. Prospective parents pick up little footballs, tiaras and tea sets. Outfits and car seats are carefully selected for the ride home from the hospital. But, all of those loving conversations between partners can come to an abrupt halt.

Pregnancy loss generally includes miscarriage, stillbirth, and neo-natal death which occurs in the first 28 days of life. While more and more folks acknowledge the hardship of pregnancy loss, it is generally minimized in our society. For those that have experienced it, there is nothing minimal about it. The symptoms and intensity of grief are the same as any other type of loss. There are also some unique grief issues that accompany pregnancy loss which aren’t present with other types of deaths.

There can be an extended physical & hormonal adjustment period for the mom. And there is the potential for future medical risks, as well as genetic and congenital factors.

Issues surround subsequent pregnancies. Couples struggle with whether or not to become pregnant again and if so, when. They may fear that what had just happened will happen again. Subsequent pregnancies are often laden with increased fears and anxiety. There is less “bliss” in being pregnant. Moms are hyper vigilant to any unrecognizable physical issues and contact their physician more often. They may not want to tell others they’re pregnant and some experience relief when the pregnancy lasts longer than when the previous baby died.

And there are triggers everywhere.

With the warmer weather, all those babies that were born during the winter seem to be out and about. The landscape is dotted with strollers that act as reminders of the loss. For some, it may be difficult to be around other pregnant women or to be excited for family or friends who are pregnant. Others may feel emotionally unable to go to a baby shower or perhaps are being avoided by pregnant friends.

Both the due date and the date-of-death can be difficult triggers.

Rituals and funerals can help. Quite often, there are few memories to draw on. Rituals do what words can’t. Rituals can help make a memory, add significance to the baby’s life and create an event for family participation. Many times families are unaware of these options, but you can create personalized rituals in addition to blessings, baptisms and funerals. It’s never too late to have a ritual. It’s a time where you can honor your deceased baby, validate the importance of their existence and celebrate their being.

Please know that families do not have to grieve alone. If family and friends are unable to support you, there are support groups, on-line communities and healthcare professionals to companion you on this difficult journey. 

Please visit our on-line grief discussions groups at http://www.hospicewr.org/discussions/grief/.

Please like us on Facebook at https://www.facebook.com/ESPBCenter

This post can also be found on ShareWIK.

Do Toddlers & Pre-schoolers Grieve? They Sure Do.

May 19, 2014

J Micah and DDChild: When is grandpa coming back?

Mom: I’m sorry sweetie. Grandpa died. He’s not coming back.

Child: Okay, when can we go visit him? 

Like adults, children will grieve in their own unique way. There is a wide variability in the understanding of death at a young age. Accepted developmental and grief responses of 3-5 year old children include a lack of time/space concepts, belief of death as temporary and reversible, magical thinking, fear of abandonment, and a need for physical comfort, reassurance and a stable routine. 

For younger children, death is experienced as separation. They have limited verbal ability to express themselves. They may fear for their own safety or fear another person will die.  Children ask questions repeatedly and often exhibit regressive behavior. They will need to hear the death story many times. 

Children often attune themselves to parent’s or adult’s needs. They may tell you what you want to hear. Feelings may include sadness, anger, anxiety, confusion, and loneliness. However, they often don’t have the verbal skills or vocabulary to articulate their feelings. Children take “breaks” from these big feelings, as they grieve intermittently and in spurts. 

Here are some tips for helping younger children: 

  • Use simple, direct language.
  • Don’t “protect your child from the truth” but use good judgment in how you explain the death.
  • Give yourself time to talk and time for your child to ask questions.
  • Let your children show their feelings.  Accept their process – don’t pressure them to “get over it.”
  • Explain that when people die, they don’t eat, sleep or breathe.
  • Reassure your child that you will be there for them.  Ask:  What can I do to help?
  • Keep your child’s life as normal as possible.
  • Find ways to help your child connect to the deceased person:  draw pictures, have pictures available, etc.
  • Share your feelings.
  • Each child’s behavior is the best solution they have for a problem at the moment.
  • Reassure them that they can cope with this and won’t forget their loved one.
  • Remember support, nurturance, and opportunities for creative play and stability are essential building blocks for your child’s development. 

All of your emotions are a tribute to the life you shared together.

 

Please visit our on-line grief discussions groups at http://www.hospicewr.org/discussions/grief/.

Please like us on Facebook at https://www.facebook.com/ESPBCenter

Grieving the Death of a Partner or Spouse

April 21, 2014

After your spouse or partner dies, you transition from being a couple to being alone. This loss can bring significant changes to your life and it can be difficult to function in a world that has suddenly become so different. The life you shared may feel like it’s crumbled. Here are some ideas to consider as you work your way through your grief:

  • There’s no right or wrong or good or bad way to grieve. Whatever you are feeling is okay.
  • You may find that you continue to turn to your loved one to share a story or ask a question. This is natural. In fact, many people find it helpful to continue to speak with their deceased partner or spouse.
  • Continue to attend to practical matters. Funeral arrangements, thank you notes, the estate, insurance, and bank accounts all require attention and energy. Do what you must and postpone what you can.
  • You may be struggling with what to do with your partner’s personal possessions. Others may offer you advice. Trust your instincts about when it’s the right time for you to go through these items. This is different for each person.
  • Communicate with friends and family about what is helpful and what is not helpful to you. You may feel shy about expressing how you feel but know that others will appreciate knowing best how to support you.
  • It may be painful to talk about your deceased love one. Continue to include them in your thoughts and conversation through your tears and honor the importance he or she played in your life.
  • Stress and grief can have an impact on the immune system. You may not feel like attending to your health, but work towards maintaining your health as soon as you feel able. Attend to getting proper nutrition and exercise.
  • Don’t be pushed into making decisions that you aren’t ready to make. You will need to take control of your financial resources and needs, but take the time to think things through before making any commitments.
  • If you think that your emotions are getting the best of you, know that there is help out there in the form of support groups and individual counselling. Reach out to others.

If you feel like you’re on a roller coaster of emotions, know that you aren’t alone. It’s okay to laugh and to cry. Don’t feel as if you need to hold onto only negative emotions. All of your emotions are a tribute to the life you shared together.

Please join one of our spousal loss support groups.

Please visit our on-line grief discussions groups.

This column is also posted on ShareWIK.com.

 

When Grief Breaks Your Heart

March 13, 2014

Can you die from a broken heart? Yes, you can.

There is a heart condition called stress induced cardiomyopathy or takotsubo cardiomyopathy—commonly referred to as “broken heart syndrome” because it often occurs during periods of high emotional stress and grief.

First recognized by Japanese doctors in the 1990s, the condition is characterized by a weakening of the left ventricle. The heart chamber changes shape, narrowing at the top and ballooning at the bottom. Thankfully it’s reversible.

Still, death during bereavement occurs more often than one might expect. At our hospice, time and again we see cases where spouses die 12 months apart. Recently, we had a situation where a woman had a heart attack at her husband’s funeral. It’s quite sad.

While we can attest to this anecdotally, research confirms our stories.

In a recent study by Carey et al, the authors found that the risk of stress-induced cardiomyopathy is highest in the first month after a death and then slowly declines during the first year. In a previous study (Shah, et al.), the same authors found that good health and material circumstances do no protect older adults from increased mortality rates while grieving the death of a loved one.
 
The stress of grief has health effects. Common grief reactions like loss of sleep and appetite can suppress the immune system which could exacerbate other medical conditions. 

So what can we do?

First, we can be aware that it’s a real risk. We can offer support to older adults during the first few weeks and months after the death of a loved one. In addition to offering support, we need to encourage older adults to seek medical attention and take care of themselves physically as well as emotionally. Many older adults disenfranchise their own grief and need to know that it’s okay to mourn the loss of their life partner. Support is available through grief groups, friends, faith communities and professional counselors.

No one needs to grieve alone.

 References:

Carey, Iain M.; Shah, Sunil M.; DeWilde, Stephen; Harris, Tess; Victor, Christina, R.; Cook, Derek G. Increased Risk of Acute Cardiovascular Events After Partner Bereavement: :  A Matched Cohort StudyJAMA Intern Med. Published online February 24, 2014.

Shah, Sunil M.; Carey, Iain M.; Harris, Tess; DeWilde, Stephen; Victor, Christina, R.; Cook, Derek G. Do Good Health and Material Circumstances Protect Older People From the Increased Risk of Death After Bereavement?American Journal of Epidemiology,(2013) 177 (4): 375.

Please join our grief discussion groups.

Online Condolences: Do they work for you?

February 11, 2014

 

The family cat died last week. I have often written about the death of a pet and how non-pet lovers often disenfranchise grief from the death of a cat or dog. More and more folks seem to accept that it wasn’t just a dog and acknowledge the role pets play in our lives.  What was quite remarkable to me was what occurred on my Facebook page.

I posted the photo of my aged, sad-looking furry friend with the caption, “Kenny RIP.”  I had never posted animal photos before.  Much to my surprise, there was an outpouring of empathy, sympathy and compassion from family, friends, high school acquaintances, professional colleagues, former work associates and others that I only keep in touch with out of curiosity. These comments touched my heart and I was delightfully surprised to hear from certain people.

Rumor has it that Facebook is developing a sympathy button. Currently, when someone posts sad news, the options are to “like” it and/or to comment. Some posters are offended when people “like” their sad news. I appreciated not having a sympathy button in this instance as it prompted folks to comment rather than to hit the “like” button.  My “friends” expressions of sympathy ranged from sorry to it’s so hard to lose a beloved pet who is a member of the family to the simple aw and my personal favorite…love and sympathy, hugs.

Is it right or wrong, good or bad to express condolences on Facebook? Is a letter or a greeting card the only acceptable way to offer sympathy?  While expressions of grief can sometimes be offensive, offering condolences online is certainly okay. 

Consider your relationship with the grieving person. If your co-worker is grieving and he or she is someone you see every day, what would be most appropriate? An email, card, letter, or phone call? What makes the most sense? What would the griever want?  The internet offers an immediate response. Postal mail can take a few days after you’ve already taken a few days to sit down and write the letter or card. Will your friend or co-worker think you don’t care if he or she hasn’t received a card by the time she returns to work?

Here are two examples: A Facebook friend yearly posts a picture of her deceased husband on the anniversary of his death. Many, many friends comment. They share stories and words of inspiration that provide great comfort. An elderly bereaved client yearly places an ad in the local obits honoring her deceased husband. The Facebook friend receives immediate feedback, the client brings in the clipping and receives support and hugs from group members and staff, weeks later. 

Some people might think condolences on Facebook are empty expressions of grief. They may be from people you are rarely in touch with. But personally, I appreciated the sentiments from everyone. One post was from a former co-worker who fondly remembered the story of how my cat earned his name.

Offering condolences on social networks is perfect for the sometimes partial or distant friend. HOWEVER, nothing can take the place of physically being with the people you love.

The bottom line is that it’s really up to the griever and his or her comfort level in expressing grief on the internet and social networks. The role of the friend is to be a friend and honor that grief whether it’s through a Facebook post, picking up the phone or showing up at the door with a meal.

Please visit our on-line grief discussions groups at http://www.hospicewr.org/discussions/grief/.

Please like us on Facebook at https://www.facebook.com/ESPBCenter

Reel Grief: What the Movies Can Teach Us

January 13, 2014

There are many ways to support the bereaved during their grieving process. Give gentle and unconditional support. Provide a listening ear.  Help with errands and chores.  Another approach is to recommend movies that focus on recovering from loss. A film’s lesson can be helpful and supportive, as well as facilitate and/or validate the grieving process.

 

1.13.14 Diane - The Movies and Grief

 

Movies are about the human experience, complete with love and loss. The complex, confusing and isolating feelings that are common to the bereaved are often portrayed on the screen. In addition, the movie can be fodder for eliciting these feelings or can act as a catalyst to start a conversation. Talking about a movie creates a safe way to share the difficult feelings of grief.

On some level (consciously or not), the bereaved can often relate to what the grieving characters in the film are going through. Identifying with a character can help develop confidence or remind the bereaved of his or her own inner strengths and resources. It can also be insightful when the relatable character in the movie is different or unlikable.

Watching movies often helps the viewer to step back and see the bigger picture. It can give you a more objective perspective on what’s happening.

Here are some questions to consider….

What are the main grief issues identified in the movie?

What strengths did you recognize in the characters that were grieving?

How does the main character build or maintain an enduring connection with the deceased love one?

What similarities do you see in your own life?

There are many movies that address grief and loss. Here are a few that might interest you and assist you through your grief journey.

 

FOR ADULTS

Rabbit Hole (2010) – Rabbit Hole is a moving, dark character study of what happens to a happily married couple when they suddenly lose the love of their life, their 4-year-old son.

Forrest Gump (1994) – This film depicts several decades in the life of Forest Gump who witnesses and in some cases influences some defining events in the 20th century. Along the way, he experiences grief and loss.

Steel Magnolias (1989) – A heartwarming story of life, love and loss in a small Louisiana Parish.

Truly Madly Deeply (1991) – This film can inspire those who have suffered a significant loss to discover new interests in life.

Ordinary People (1980) – This film offers an intense examination of a family being torn apart by tension and tragedy.

 

FOR CHILDREN

Bridge to Terabithia (2007) – This is a fantasy adventure film about the power of imagination and the magic of friendship and includes the death of a friend.

The Lion King (1994) – After the death of his father, the lion cub Simba goes into exile and eventually returns to the pride.

Up (2009) – A grieving widower and a young boy go on a great adventure together.

My Girl (1991) – A coming of age story about an 11-year-old girl that experiences death and transformation.

Post can also be seen on ShareWIK.

Tinsel and Grief

December 11, 2013

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Through the years we’ve offered many workshops for the bereaved on how to cope throughout the holiday season.  Today we offer you what we’ve learned from those grieving the death of a loved one.

  • My family collects superhero toys all year long. In December we go to the children’s hospital and donate them in honor of my son who died when he was eight.  Drew loved Spiderman.
  • It’s comforting to me to keep our old family traditions alive even though some moments can be painful. We do everything exactly the same as we always have.
  • I only shop online.  Mom and I always went holiday shopping together and now it hurts too much to go into the stores and see all the decorations.  So I just shop online.
  • We decorate our Christmas tree with Mother’s costume jewelry.  She had tons of it.  Our tree looks amazing and as we put up each necklace or pin or bracelet, we share stories about mom.  The first year it was really sad, but now it’s fun and has become a tradition.
  • I make my Auntie Clara’s cranberry relish.  Nobody likes it, but I still make it in her honor.
  • I give myself 30 minutes to listen to songs that make me cry.  I go into the depths of my sadness and then move on.
  • The first two years I stopped sending greeting cards, but I think I might start this year.  I think I might write one of those letters where you give updates on your family.  There are some people who would like to hear from us.
  • I will pull out my never-ending scrapbook and create a new page that both celebrates the holiday and honors my parents.  It’s been a tough year.
  • I volunteer at a soup kitchen and feed the homeless.  It gives me a sense of purpose.
  • I always have a get-away plan.  When I go to the family dinner or the office party, I drive my own car and park in the street so I don’t get stuck in the driveway.  That way I can leave whenever I want.
  • My children and I bake all the cookies and favorite dishes of my husband.  Joe loved sugar cookies and would make them with the kids.  Now it’s my job.  We make a day of it by playing Joe’s favorite music as loud as we can and making a mess in the kitchen.  We laugh and we cry.  It’s great.
  • We go to the cemetery.
  • Above the fireplace, we place candles and greenery around her photo.  It feels like she is there even though she isn’t physically present.
  • My grandfather loved sports and instilled the love for exercise in us.  We start a Thanksgiving morning with a 5K run and head back to the house for food and festivities.
  • I go to my daughter’s Facebook page and read the comments from all her friends.  It’s bittersweet but brings me comfort.

The holidays are a challenge for many who are grieving. Remember there is no right or wrong or good or bad way to grieve. Do what works for you and be kind to yourself this holiday season.

Please visit our online grief discussions groups.

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