Mind Matters, Jeannette Kennedy
In July 2013, I wrote an article on Kübler-Ross’ model of the stages of grief.
I promptly received a kind e-mail from social worker Michelle Rigby at the palliative care unit at the Colchester East Hants Health Centre.
Michelle thanked me for writing about grief as it is a taboo subject. She also wanted to let me know that the Kübler-Ross model is cautiously used as it has been found that the stage model can actually interfere with the processing of a loss. It sets people up to expect something that they themselves may not experience. When I responded to her e-mail and asked about a new model, she suggested I consult with the social workers at the Colchester East Hants Hospice Society. I eagerly requested we meet and I could write a follow-up article with the new information.
Given the hectic summer schedules we agreed to meet Sept. 25. When we set the date, it seemed so far in the future but came in the blink of an eye. Ironically, while walking to the hospital doors, there was a gentleman I noticed out of the corner of my eye and I had a momentary wave of sadness and missing my grandfather. This happens quite frequently when I see an elderly man in a wheelchair.
I was pleasantly surprised to discover Rigby is an acquaintance I have known for years, but did not make the connection as to who she was during our email exchanges. She took me on a quick tour of the new hospital inpatient care unit.
We then met with Janet Allen, registered social worker (RSW), and Linda Turner RSW, from the hospice society. What amazing services these women are part of. I was wishing I had taken a tape recorder because there was so much wisdom in the room and a lot of great statements to quote. There were many that I did not get a chance to write down. The following is a description of our conversation.
As a society we do not talk about death, as if not talking about it prevents it, and yet it is going to happen to every one of us.
As Rigby said, “They teach about sex in school but not death. I can’t guarantee that you will have sex but I can guarantee death.”
So, why aren’t we talking about death? There are probably as many reasons as there are individuals.
It is an uncomfortable topic, and we want to focus on living not dying. However, many people have to face the fact they are dying or their loved one is dying. With the advances in modern medicine people are living longer with dying, and this is changing the dynamics of grief interventions. And it is not just cancer that we are dying with. It is such things as ALS (Lou Gehrig’s Disease), Multiple Sclerosis, COPD (Chronic obstructive pulmonary disease), heart conditions, Alzheimer’s, or simply the end-of-the-life cycle.
The palliative care is a service offered while you are in the hospital and the hospice society helps those in the community. Both services are a must for anyone who is experiencing loss. As mentioned, the Kübler-Ross model is too restrictive. While there is some good information about what you might experience, people use it as a checklist causing them to become more distressed when they get stuck or revert back to an earlier stage.
As Allen said, “There may be no endpoint; the loss may require lifelong integration.” As well, the model does not allow for so many individual experiences. For some they may experience relief at the death of a loved one and there are things that they don’t miss; cultural differences influence reactions; if the death was sudden versus years of suffering; age of death, whether it was a suicide, homicide, or the result of a horrific tragedy (9-11) can all influence the type of grief reaction.
Another interesting fact was that the grief reaction can be more intense if the relationship is more complicated. If there is an unhealthy relationship between two people you are not only grieving the loss of the person but it also triggers other grief related to the relationship (disappointments, rejections, hurts) whereas, when the relationship is healthy there is nothing left unresolved – no old injuries that flare up.
Complicated grief can arise when there is a significant change in financial status, loss of social support, loss of assistance, relocation, socioeconomic status and mental illness. Turner observed that people are even concerned about stigma when they are dead, worrying how they will be perceived if they have a ‘poor man’s funeral.’ Many of these are things are not always considered at the time of loss. Rigby also talked about STUG – Sudden Temporary Upsurges of Grief – these are triggers that activate the grief response, much like how I felt when I saw the gentleman that looked like my Grampy as I walked into the hospital.
So, these amazing services assist people using the approach that death is a reality, normalizing our experience. One of the goals is to demonstrate how to hold onto the person when they are gone in a way that is healthy grieving rather than suffering because of the loss. Rather than pathologize grief, let’s have more open conversations and increase knowledge about the services that are available in the community.
Follow the link for more information on Palliative services. http://www.cehha.nshealth.ca/Services/pallative.htm
Information about the hospice society can be found via this link http://cehhospice.org/mission/
I am grateful to Rigby, Allen and Turner for their time and expertise. I learned more about how to help people with their grief and the services that are offered through palliative care and the hospice society. I still have a lot to learn, but know where to direct people in matters related to loss.