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Death From an Overdose: Managing the Grief

March 26, 2015

heroin overdose


According to the Centers for Disease Control and Prevention, death rates from drug poisoning have tripled since 2012. The researchers found an average increase in heroin-related drug poisoning deaths of 6% per year from 2000 through 2010. The increase from 2010 through 2013 was an astonishing 37%. Deaths have shifted from middle and older-aged men to younger white men from Middle America.

It’s tragic and impacts the bereaved on many levels.

Grief reactions are often intricate and complex. When you add that the person died from an overdose, accidental or not, it complicates matters. There is a myriad of emotions that occur when someone dies and when someone dies from an overdose, the most difficult ones rise to the surface.

Shame, blame, guilt, stigma, isolation, loneliness, fear and anxiety are prevalent.

Sometimes the bereaved feel guilty. They relive over and over the “should haves, could haves” and “if onlys.”  The bereaved often blame themselves and they blame others. Shame is a common reaction. Some feel judged for loving someone with an addiction or for having an addiction themselves. Unfortunately, the shame makes people hesitant to share. Consequently, they don’t reach out but rather become isolated and lonely. It is a sad, downward spiral.

Fear and anxiety are also prevalent grief reactions with a substance abuse death. There is the fear that other family members or friends will overdose or that people who are currently using might die. And, there is the fear of relapse for people in recovery.

The stigma society imposes for substance abuse loss is overwhelming and there is an overlap between intentional overdose and unintentional overdose. Unfortunately, people deeply misunderstand addiction and mental illness. suggests the following to help manage grief after a substance abuse death:

  1. Accept the role substances played in the death.
  2. Find a way to work through and express emotions. This could be through talking, writing, making art or music, hiking, etc. Do whatever works for you.
  3. Educate yourself and understand addiction. Understanding addiction can help put to rest feelings of guilt and blame. One thing to learn is that we are powerless and we don’t have control over someone else’s addiction.
  4. Surround yourself with the right support system. Avoid those who disenfranchise your grief. You might find comfort with a counselor or a support group with others who are also experiencing grief of an overdose death.

Grief includes all kinds of feelings. If you feel overwhelmed with emotion, trust the grief process and give yourself permission to be with all your feelings. Know that there are others out there who feel the same. And, there are counselors and support groups that will welcome and support you. You do not have to grieve alone.

Diane Snyder Cowan, Hospice of the Western Reserve ©2015

LGBTQ, Art Therapy and Grief

February 25, 2015

Grieving the loss of a loved one is difficult enough, but when the relationship is non-traditional it can become even more complicated. When an LGBTQ person cannot openly mourn the death of a loved one or when society at large disenfranchises this grief, heartache is turned inward and the healing process suffers. Sadly, sometimes folks disenfranchise their own grief. Secrecy, shame and guilt are a few of the grief reactions commonly expressed in the LGBTQ community. Turning grief inward can result in isolation, use of unhealthy coping strategies and feelings of depression.

Members of the LGBTQ community who have experienced the death of a loved one, especially of their significant other, may not have the support from family and friends that heterosexuals come to expect when a loved one dies. Family and friends may not understand the relationship or may be angry at their loved one and partner. Some family and friends may not have known about these relationships as couples could have kept them hidden for years. This all complicates the mourning process and impacts mourning rituals.

LGBTQ art therapy workshops offer this community the opportunity to come together in a safe environment to creatively work through their grief as well as to create art in honor of their loved one.

Michael created this beautiful rose Suncatcher (dyes on silk) to honor his late partner. His partner loved roses and had a beautiful rose garden. Unable to get support from his family and friends, Michael relied on his deceased partner’s family to comfort him on his grief journey.


Maggie’s grief was also disenfranchised by her partner’s family. In fact, shortly after the death, her partner’s children arrived at her home to take out their mother’s bedroom set. Maggie was assertive and didn’t allow this to happen. Sadly though, Maggie’s loss was complicated because her partner was the breadwinner. In addition to her death, Maggie lost her home and had to move to a smaller community away from her supports. The art therapy workshops allowed her to work through her feelings of grief and come to some acceptance. The groups provided a safe place for her to come, create and meet other members of her community who were grieving. Her piece, Door to Tomorrow, shows her feeling alone but hopeful.



Members of the LGBTQ community need to know that they have the right to grieve and that support is available.  Please consider attending one of our LGBTQ art therapy events. For more information, contact the bereavement center at 216.486.6838.



Click here to see our Spring Support Groups 2015.


Diane Snyder Cowan, Director, The Elisabeth Severance Prentiss Bereavement Center ©2015

Food and the Grief Connection

February 2, 2015

95168617After the death of a loved one, many newly bereaved lose their appetite and interest in food. However food can play an important role in grief work. Food is a harbinger of memories.  Aromas often transport us to the past, providing comfort and joy in treasured remembrances.

Think about the food that connects you with your deceased loved one. Was it a special meal? Was it the meal where he or she proposed? Was it associated with a holiday? Was it a late-night snack at the kitchen table or a picnic on a beach? Take a minute and you will most likely come up with many dishes. One or two will stand out.

Of all the special dishes my mother-in-law prepared, my husband’s childhood favorite was apple pancakes. With his eyes lit and mouth-watering, he is able to describe how his mother and grandmother would carefully core an apple, thinly peel the outer layer and slice it into circles. After the batter was on the griddle his mom would place one apple slice on it and then flip it over.

A master baker recently described a simple cheesy potato recipe that her mother used to make. With tears in her eyes she recalled how this dish, more than any fancy meal or celebration, connected her with her mother.

After my dad died, I could not look at a lemon bar without tearing up. Now I smile and take a bite on his behalf.

Many bereaved share stories about duplicating their deceased loved one’s recipes. One routinely makes her aunt’s cranberry relish for Thanksgiving despite the fact that no one eats it. For her, this ritual connects her with her aunt.

In grief work, continuing bonds are the objects or events that connect us to the deceased.  Continuing bonds are dynamic. They shift and change over time. Preparing your deceased loved one’s recipe can be one way to make and find meaning in your relationship. If you’re not into cooking, simply having that tasty treat or going to a restaurant that you both frequented will provide that bond.

Appetizers, entrées and desserts that transport us to special memories can provide meaning and comfort during the grief journey.

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When the unthinkable happens: Homicide and Grief

January 9, 2015

It seems as if the news is filled with senseless murders and of inexplicable interactions between the police and the community. The inconceivable happens – a special person dies in a sudden and unexpected way. When a loved one is murdered, family and friends often experience traumatic symptoms along with grief reactions.

Homicide is so sudden and unanticipated. It falls outside the usual experience of what one expects life to be like.  Abruptly losing a person in this manner can shatter one’s sense of well-being. Strong reactions are common, including fear, helplessness, shock, anger and even horror. These trauma reactions are normal responses to an extremely difficult time in our lives. But when you mix these reactions with grief, the results can be overwhelming.

Grieving parents of murdered children and grandchildren often mention that they feel like they are in “another world,” but the world around them doesn’t stop. It’s common to feel a sense of numbness, of “being in a fog.”

You may also feel:

  • Disbelief at what happened
  • Intense rage at the guilty party
  • Guilty as if somehow you could have prevented this tragedy
  • Preoccupied with visual images or sounds
  • Fear, distrust, helplessness, and hypervigilance
  • Blame, isolation, exploitation
  • Anger

The signs and symptoms of a stress reaction may last a few days, a few weeks, a few months, or longer, depending on the severity of the traumatic death.  The understanding and support of family and friends can help the stress reactions pass more quickly.  Here are a number of tips that can help during this very difficult time:

  • Maintain as normal a schedule as possible (as impossible as it seems); structure your time
  • Follow the basics for good health (even when you don’t feel like it) – rest, eat well, exercise
  • Reduce other stressors as much as possible – make to do lists, be patient with yourself when you can’t find your keys, limit distractions that might interfere with concentration
  • Be aware of numbing the pain with overuse of drugs or alcohol; go easy on caffeine
  • Talk to people – reach out, spend time with others
  • Do things that feel good to you – take a walk, listen to music, keep a feelings journal, etc.
  • Set boundaries with law enforcement officials, news media and friends and family
  • Give yourself permission to feel the pain and share these feelings with others
  • Don’t feel the need to fight reoccurring thoughts, dreams or flashbacks; they are normal and will decrease overtime and become less painful

Above all, know that you’re not going crazy. Your reactions are normal. However, there are times when a traumatic death is so painful that professional assistance may be helpful. Seek professional help if anger, anxiety and depression persist, worsen or begin to interfere with your life, job or relationships. Be kind and gentle with yourself and remember that there is no right or wrong way to grieve.

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Holidays and Grief

December 5, 2014


The inevitable question grieving people ask at this time of the year is, “How will I ever get through the holidays?” Whether it’s the first or second holiday season they face, the added strains can create increased pressure for people already experiencing the intense feelings of grief. So how do you “get through” them? There is no single answer. Let this be the guiding thought: Do what is comfortable for you.

Be mindful –Anticipating the day is often much worse than the day itself. Recognize that the holidays will be different this year. In addition to the absence of your loved one, you too are different this season. Slow yourself down by taking deep breaths. Do what feels comfortable and remember to take time to nurture yourself.

Plan – Talk over your plans with the family. Respect each other’s choices and needs while preserving your own, and compromise as needed. Avoid additional stress. Decide what you really want to do and make changes where you can. Maybe purchase gift certificates this year instead of dealing with the large crowds at shopping malls, or ask someone else to bake the cookies or holiday dinner.

Consider rituals and traditions – Family traditions may have changed since the death. It may seem like nothing is the same as it used to be or everything is exactly the same, except that your loved one is missing. Rituals support the connection and bond between you and your loved one. Consider honoring your loved one by lighting a candle, donating a gift in his or her memory or creating a new ritual.

Look ahead – The past year has been a change event for you. As you look towards 2015, consider all that has occurred and what you have learned. As you search to find meaning in the loss and revise your life story, you may begin to understand some of what has happened and find a bridge between the past and future that makes sense to you.

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Grieving and Giving Thanks

November 7, 2014

thanks2As Thanksgiving and the holiday season approaches, you may be wondering what you have to be thankful for this year. This time of year can be so challenging when loss is at the center of your life. Perhaps this year rather than thinking about being thankful, think more about giving thanks.

You may ask what can I give thanks for? Here are some questions to consider:

What did you learn from the person who died? What life lessons were passed on? How many hugs did that person give you? Or how many meals and deep conversations were experienced? Who taught you how to be a mother, daughter, sister, or aunt – or how to act and dress appropriately? Who cuddled with you? Who did you take long quiet walks with? Who taught you that secret recipe? Who gave you bliss? Perhaps this year you can give thanks for these moments.

In what ways did your loved one make your life sweeter and richer? What was the value of loving this person not only as a family member but as a friend?  Although it is perfectly okay to still grieve and mourn your loss, remember that grief is about love. Give thanks for being able to give and receive love.

Sometimes it’s helpful to slow things down and focus on the small moments of gratitude first. So this holiday season, try to stay in the moment. Taste the first cup of coffee or tea in the morning and be mindful of the warmth it brings. Allow small moments of pleasure and presence to move you toward healing. Being able to notice the small moments of grace are enough for now. In time, these moments may become more frequent and obvious in your life, as may the gifts your loved one has bestowed in your heart forever.

Give thanks this year for the gifts of yesterdays, the gifts of memories, love and laughter as they create the hopes of tomorrows.

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When Illness Prevails, Time Can Be a Gift

October 13, 2014

All of us will experience the death of a loved one at some point in our lives. Perhaps it will be the expected death of an elderly, ailing relative or maybe it will be the sudden and unexpected demise of a young motorcyclist.  Another more common scenario is that the one you love becomes seriously ill and although you know he or she is dying, when it happens it comes as a great shock. You are overwhelmed by powerful emotions and it feels like a sudden death.

In sudden or traumatic death, the event is unexpected and abrupt. Life is turned upside down. The person you loved was taken away without any warning. Nothing makes sense. And, there was no time to do any of the end-of-life “things” that one can address when the death can be anticipated. There was no time for reconciliation, for finishing unfinished business, for saying “I love you” or “Good-bye.”

But when your loved one is seriously ill and you know that the end of his or her life is near, you can use this luxury of time as an opportunity to be together – to share thoughts, feelings and memories. During this pre-death time, as the illness advances, wonderful things can happen and while it won’t take away the pain of grief post death, it may soften it.

Here are some considerations: Communication between individuals can be difficult even when things are good, but it’s so important to figure out how to communicate during this time without hurting feelings. It is through communication that we can learn what is meaningful and important at this time. It is through communication, that one can reconcile relationships and find closure.

This can be a time to reflect on the past. Remembering and telling stories, looking at pictures and listening to familiar music can be helpful.  Good memories can be fuel for conversation and the stories produced can be passed on from generation to generation, keeping the spirit of the person alive.  Reminiscences often kindle the feelings of meaning and purpose.

There is no right or wrong way to grieve and no one can be truly prepared when death happens. Whether death is sudden or expected, grief hurts. If you are able to share time together as an illness progresses, it will be a gift you always cherish.  Remember, you do not have to grieve alone.


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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)

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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.

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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.

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