Good Morning Thinkers!

The Missing Stage

Perhaps it's a bit foolish to fly in the face of an established field of research and science but after my last post, I began to think even more about the stages of grief.  Kubler-Ross suggested 5:  denial - anger - bargaining - depression - acceptance and the JAMA article suggested a different 5:  disbelief - yearning -anger - depression - acceptance.  While the JAMA stages felt more like my own experience, I suddenly realized they both stopped with acceptance.

That's the best we can hope for -- acceptance of the loss?  I don't think so.  There are too many examples of people who suffer horrible losses and then turn the loss into something new:  Christopher Reeve and his work for spinal cord injury, Candy Lightner forming the MADD foundation after the death of her daughter, and thousands of other examples.  There has to be another stage -- new growth, transformation, something that gives the loss meaning.  Not that every loss has to turn into a charitable foundation but somehow the loss has to provide space for something new that is meaningful.  Acceptance seems to imply a stopping point.  It's over and we're moving on.  But, within loss there is a huge energy that can, eventually, be used to fuel new growth.

So, I think we need to change the model and give people something to hope for, something to watch for, a belief that the phoenix will rise out of the ashes.  My stages of grief proposal would be:  disbelief - yearning - anger - depression - acceptance - rebirth.

In the process of thinking about this, I had to remind myself about the Phoenix myth.  The Wikipedia entry is posted below.

Science of Grief

Richard died three months ago and just as I’m starting to expect things to get better, they seem to be getting worse.  Obviously, grief doesn’t operate on a linear curve.  The surprising thing is depression.  I’ve lived most of my life with people who have been officially diagnosed with depression, or probably should have been.  I never really understood it even though I tried and hope I was at least somewhat empathetic about it.

I’m a sanguine person, a glass-half-full, no-point-crying-over-spilled-milk, Sagittarian- with-a-smiley-sun-in-Jupiter-type of person.  I believe in letting go and getting on with it; making lemonade when life hands you lemons. But, in the past few weeks I’ve noticed a niggling sense of meaninglessness taking root … and rational thinking, counting my many blessings and working harder don’t seem to be making it go away. 

It’s hard to make sense of these feelings.  I have a rich life and hundreds of things I want to do.  I understand that there is a gaping hole in my life and expect to feel sad but meaninglessness puzzles me.  The only thing that’s different in my life is my husband is gone.  I still have work that challenges and engages me.   Art calls to me, young grandchildren delight me, the land around me lifts my spirit.  Which brings me back to depression and reminds me of conversations I’ve had with people who suffer from that condition and the lack of understanding I had for how they could possibly feel meaninglessness when they had so many things to live for.  I now have a tiny inkling of how they must feel and am very sorry that I wasn’t able to be more understanding before.

I guess depression shouldn’t have been a surprise and could possibly be seen as a positive sign since it’s the fourth stage of the grief cycle (Kubler-Roth’s model:  denial, anger, bargaining, depression, acceptance) however a new study from JAMA, supports some of the stage theory while also contradicting some basic elements.  Here’s a brief from the abstract:

Counter to stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from 1 to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at 1 month postloss, yearning peaked at 4 months postloss, anger peaked at 5 months postloss, and depression peaked at 6 months postloss. Acceptance increased throughout the study observation period. The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief.

Yearning is the stage that replaces bargaining and feels much more appropriate for me.  But none of this seems to be clear “stages” but rather a blending of all of them at once with some getting bigger while others are getting smaller.  Right now yearning and depression seem to be getting bigger while disbelief is fading.  Anger is only occasionally peeking into the scene and acceptance is hopefully waiting in the wings.

Passages

On November 27th, an era ended for me.  After a long struggle with prostate cancer, my husband passed into a different dimension.  And, while we had been advancing toward this passage for three years, I still find it hard to believe that he went on this journey without me.  The phone rings at night and there is a flash of thinking that he's calling to say he's on his way home.  Or, I come home after being gone for awhile and walk in expecting to see him in his chair.

Slowly I begin to adjust to being in a new world ... a world not run by the dictates of the medical industry.  No three-hour waits in the doctors' offices, no prescriptions to fill three times a week, no medications to dose out every four hours, no more constant worry about pain and whether or not to try the next painful, debilitating treatment.

It's a strange world where time is all mine; decisions are all mine; responsibility is all mine.  It's a lot to deal with when I can't seem to even handle the pronouns.  After a combined total of 40 years of marriage to two husbands, "we" is the reigning pronoun.  Telling a story to a neighbor, I hear myself saying, "We really like ..." only to realize there is no we, there's only me.  I give someone directions to "our house" and wonder how I'll ever call it "my house."

On top of losing my best friend, I'm not sure of my own identity.  I am no longer a wife ... now I'm a  widow.  But, what does that mean? I get invited to a New Year's Eve party by someone I've just met.  Does she know I'm coming alone?  Do widows even go to parties?

Perhaps the worst part of this whole thing is that the one person who could help me sort it all out is Richard ... but he's gone.  I ask him what to do and the answer comes back, "Just keep breathing." But, it doesn't sound like his voice and it provides little comfort.