Psychology Lecture Coping with Grief and Loss by Sheila Schindler

>> Good afternoon, and welcome to... the first of this year's Psychology Department Speaker Series. I'm Dr. Frank Connor-- I am the Psychology department chair. It is my honor to welcome to our stage, Sheila Schindler. Sheila is a faculty member and adjunct member in the Psychology department, teaching Social Work. Sheila has her-- she's a licensed Master Social Worker. She currently is on the pediatric team at Hospice of West Michigan. Sheila received her Bachelor's degree from MSU, and her Master's of Social Work is from Western Michigan University. Sheila. >> Hi, thank you. Well, hi, welcome! Welcome to "Coping with Grief and Loss." I'm really happy to be here to talk to you about this topic. I think it's an important topic, because, well, it's a part of life, and I think everybody in this room will probably experience grief and loss... once or many times in your life. I think there's varying degrees of this experience that we go through, but the truth is that if you're human, it's pretty unavoidable. I think the only way to avoid going through grief and loss would be to not care about anybody or anything, and I think that's probably a pretty bad idea. So, the good news is that there is a fair amount of research out there that helps us to understand ways to cope with grief and loss that will ease the suffering and pain, and also possibly even bring about opportunities for good things to come from the loss. So that's what we'll talk about this afternoon. We'll look at the research and what it says, and try to understand better how to approach grief and loss in a way that eases the suffering and pain, and also maybe even creates opportunities for personal growth. So I think the best way to start would be to tell you about two of the families that I worked with in my career that really helped me to see the way we approach grief and loss can make a big difference in how we experience it. First, I should probably explain what I do for a living. I am a pediatric hospice social worker for Hospice of Michigan, so this means I work with really sick kids, and their families, sometimes at the end of life. And... I also provide bereavement care for these families, sometimes for years after the loss of a child. And I have met so many incredible families and learned so much from them. But two of these families that I thought really helped to kinda show how the way you cope with grief and loss can have a pretty big impact on how you experience it, would be these two wonderful families that are both very strong families, fiercely loving, fiercely protective, but they approached it in such very different ways that their experiences were really different. So, okay, the first family was this fiercely loving, protective single mom, and she had three teenage daughters. Her youngest daughter was very, very sick. And this mom was a fighter-- I mean, she's a single mom-- so were her daughters. They were 16 and 19, but the 12-year-old was really sick. So what this mom said to me was, "Even thinking about the possibility "of my child not making it... is like giving up on my child. "I won't do it. "I will not talk about death and dying. "I don't wanna even think about it. "I'm gonna punch cancer in the face-- we all are. "We're not gonna give up. "We're not even gonna let death in the house, period." So... so, she-- can you blame her? I mean, she was just this really tough, strong mom. So one night, her daughter got really sick and uncomfortable. She was having trouble breathing. So they called 911, and the ambulance came and took her to the hospital, and they put her on oxygen, and she stabilized. So at that point, the mom said to her daughters, "Let's go downstairs, get some food, "we'll come right back up, right back up, "and then we'll settle in for the long haul "to fight this through one more time." And... so they went down to the cafeteria and they were gone, oh, 10 minutes? And there could be a lotta reasons for what happened, but I think sometimes when very sick people's adrenaline kind of goes down, they're comfortable, they're at peace, their body can crash, and I think that's what happened. So she died, very peacefully, very quickly. And, um... oh, oh, the family came back up, maybe 15, 20 minutes after they had gone downstairs. And the nurse had to tell them what happened. And it was so painful and traumatic. They were distraught. They were angry at themselves, I think, more than anything. They felt like they had let her down. They were angry at the hospital because the hospital said she was stable and they had gone down. And then, they were angry at each other because there was some disagreement about going downstairs to get the food. So, they separated, and they went different directions to grieve. And it was so painful to see that, and I think about them to this day. Okay. So, around the same time, around the same time, I had another family, and this little family was on a farm, and they had four young children. So, on a farm, it's very different, right? Like, animals die, people slaughter animals for food, animals are born. Death is not something that's foreign, so this family talked about death right from the start. They did some wish trips. They talked about the possibility that he would-- their 12-year-old would not get better. They talked about it with their 4-year-old, 6-year-old, and 9-year-old, and they were able to ask questions. They'd had family photos taken, they had some wonderful memories, and then when he got very sick, towards the end of his life, he was in a hospital bed in the middle of the living room, and they did his favorite thing in the world... they made a camp out. They pitched a nice tent, and they made a fire in the fireplace, and they sang songs, and they roasted marshmallows. And then, as he got very close to the end, they all crawled into the bed with him, and they held him and each other, and they talked to each other the whole time. And it was incredibly peaceful. It was still painful, but it was so peaceful and it bonded them together. So, okay, how to put this into words. I mean, it doesn't matter how strong the family is. I mean, both families were strong, and protective, and loving, and doing the best they could... but there was a different way of coping, right? So, the image that comes to me is that grief is like a wave... or many waves. It kinda feels like waves, if you've experienced it. So when that wave comes at you, if you've ever played in waves, you know that you can face a wave, head on, and be ready to fight it. But if that wave is big enough, you know, the sand goes out from under you and you just get tossed, and it's scary, and you're battered. It's really an unpleasant exp-- you feel out of control. But if you know anything about waves, you know that when that wave kinda hits, comes close, you have the option of diving right in to the heart of that wave. And you know how you still get sloshed around but it's not battering... and you know that it's gonna end, so there's this peace that if you hold on, it will pass. So I kinda see approaching grief in a healthy way as kinda this-- learning how these waves work and how to jump into them and become part of them, rather than getting completely battered by them. So I hope that makes sense. What I'd like to do is start learning about these waves now, and the first step... the first step, I think, in doing that is to recognize the different forms of grief in our lives, and the prevalence of it. So briefly-- I think some of you have clickers and I apologize if you don't. I got my hands on as many as I could. I think there's about 60 clickers out there, and what I'd like to do is-- and my students who are here know I do this a lot. (laughing) I like getting numbers. I like understanding what's going on in the room, and figuring out what the experiences are in this room. If you've never used the clickers before, I'll talk you through it. There's only four questions, and we'll get kind of a reading on the experiences in the room. I have two student volunteers, so if they could come up quickly. We will do this just the way they do it in class. So here are the questions. We're gonna get a sense for the prevalence of grief and loss in the room, and then the intensity, and look at how there's different levels of intensity. So, who's my writer? (laughing) Okay, here you go. And then, I thought when you pull it off you could maybe-- yep, maybe it'll stick there. There's four questions. So, let's look at the first question here. So the first question, before you vote-- you can't do it until I open the voting, but I do wanna say a quick thing to clarify. Have you ever experienced the loss of someone very important to you? Notice it says "important to you" and not "close to you," because there's something called "shadow losses" that I would like to include here. So for example, if you've had a miscarriage or maybe a parent died that you never had a chance to be close to, or, in my own personal life, I was born into a family where my brother died shortly before I was born, so I grew up in a family where grief was kind of a big deal, but I never met him. He was important, but I wasn't close to him, so I hope that makes sense. So... turn on your clickers by hitting the yellow button, and you should see a welcome. I'm sorry if you don't have a clicker, but I still think it'll be interesting to get a reading on the room. So what I'll do is hit the green button up here. So "A" is "yes," you've lost someone very important to you, "B" is "no." Oh, 58... got a few. 59. Okay. All right, any thoughts? I have no idea. This is totally anonymous. I have no idea what the result will be, but let's find out. So, 50 said "yes" and 9 said "no." So 85% of the people in this room have lost someone close to you already. So the next question is-- we're gonna add other losses in life. We need to be aware of them in order for us to cope with them well. So, other losses in life. Death of a pet. I am a big animal lover and I know that can be wildly painful. Another type of loss could be relationship, a bad breakup, or divorce. "Sense of safety" means if you've ever been in an accident. That kinda ruins your sense of safety. Suddenly, its fear-inducing just to get in a car. Or if you've been diagnosed with a serious illness or if you've been the victim of a crime, these are all different things that can create loss in life. So "A" is "yes," "B" is "no." If you said "yes" to the first one, you'll say "yes" again, 'cause this is-- you have experienced loss of someone important to you as well as a different loss, okay? So, here we go. So, okay. (chuckling) We have 95% of the people in this room have had a significant loss, either a person or a different sort of loss. It's just being human, right? I mean, it is part of life. So hopefully if you are grieving, you don't feel quite as alone. And if you are not, you realize this is a very, very common human experience. Okay, so next, we're gonna kinda look at-- there's different intensity level to these grief experiences. So, I'd like to check out how people are on their intensity level. Whoops, I'm pointing it the wrong way. No. Oh, I have to click on this. There we go. Okay. So this next poll is to look at how intense it is for you. So at the time of the loss, how would you describe the intensity of your experience? Unable-- like you had to take time off school and work. Moderate, yeah, you could get through a day but you had to leave and go to your car and cry for a while. Or you're on no sleep and no food. Or life is definitely being much more difficult to get through. And then, mild is-- it's pretty painful but no change in daily activity. And then, D is, "I have not had a loss." So, hope that makes sense. Let's find out. I will open it up. Wow, that was fast. (laughing) 57. Okay, so. "A" is very intense. "B" is moderate, and that's 30. Okay, so "A" was 15, "B" is 30, "C" is 11, and then the two people who have not had a loss. So, 26% of people in here have had that grief experience where it is all-encompassing, very intense. One in four. And then, finally, one more question. This one is about today... how you are right this minute. So we're looking at how many people in here are having the experience of grief, today, right now, sitting here, listening to this. But also, kinda paying attention to if it has changed over time. So how does that same loss feel now? How would you describe it? And I will open it up. Go ahead. Okay, so only one is "A," very intense. 9 at moderate, 38 at mild, and then 1 at no loss. All right, so I will X out of that. So hopefully you can see by these numbers, you're not alone. If you're in here and you have been grieving... something to notice that, look at the intensity of grief and how it has shifted over time for many people. So at first, there were people-- 15 said it was so intense that they had trouble functioning in life, and now that's down to 1. So 30 went down to 9, and 11 for mild went up to 38. So, this is important because one of the points today is grief doesn't necessarily go away, especially these very intense losses. Some grief can only be carried. Have you heard that quote? I really like that. Some grief cannot be fixed, it doesn't go away, it can only be carried. So today, we're gonna talk about how to do that in a healthy way. So here's a little bit of the research and what it says, and you can see it kinda falls in line with what we just saw. "Most bereaved persons experience intense, "time-limited periods of grief, 20 to 30 minutes at a time," but that varies, too. So those are the waves that come. And then, normal-- oh, okay, "normal"-- so you're not abnormal if this is not your experience. I prefer-- (chuckling) they call it "complicated grief." So this is less complicated grief, not normal. But the literature says "normal grief." Normal grief appears to occur in about 85% of persons following a loss, largely subsides within a year or two. So that is pretty much what we're looking at with the numbers in this room as well. So okay, let's start talking about this experience of grief and learning about it, so we can cope better with it. First, we'll talk about what grief is, how it affects us. Then, we'll shift into actual ways to cope with it, research driven, that can ease suffering and create possibly opportunities for personal growth from this incredibly painful human experience. So here's our terms, just so we're on the same page. Bereavement is the umbrella term for the loss of a loved one, grief is the internal experience of the loss, and then, mourning is the outward expression of the loss. All right. The experience of grief. So here's the big thing about this bio, psycho, social, and spiritual-- when you're talking about grief, there is definitely a spiritual piece to it. Most people tend to think of grief as an emotional experience, when, in fact, it is all-encompassing. It involves our whole beings. I had a mom say to me, she felt like she was hit by a truck. It's that physical. And if you think about how to describe grief... your stomach, right, it feels like wanting to throw up. There's a tightening in the throat. there's this ache, and the need to cry, sometimes feeling like you can't stop crying. There's aches and pains, fatigue, irritability, anxiety, the heart is racing. Maybe a feeling of unreality. Maybe a feeling of relief. Many times, there's a feeling of relief and giggling-- that's okay, too. It's a very confusing experience. (chuckling) It also affects us socially. As one mom said, she felt-- she lost her child, and she felt like she had this letter on her forehead that said, "I lost a child. "Don't talk to me 'cause you'll say the wrong thing." So she felt pretty socially isolated. So it can both socially isolate people but also bring them closer to some people who do understand the experience. And spiritually, many people go through a lot of questioning as far as, "Why would God do this? "I thought I was doing everything right." It can be a very disorienting experience where people have to reorient themselves to their spiritual beliefs. So, I've a study to show you that's really interesting, and I wanna make sure you get this because grief is not just emotional. And this study shows how physiological it is, how it affects us in very physical ways. So the first part of the study focused on acute, like those waves that come at you. But the second part of the study is what I really want you to notice. There's all these different chronic background disturbances that last weeks to months. Notice, just for everyday functioning, there's decreased concentration, and agitation, inability to have attention. There's restlessness and anxiety. Notice, also, all these system changes-- cardiovascular, endocrine, which is our hormone system which tends to regulate mood and behavior, so that's being affected. And immunologic changes which means that people get sick a lot easier. So I think the point to be taken from this research is grievers, first, they're not crazy if they're exhausted and sick and physical. Second, they have to take care of their physical well-being, as well as their emotional well-being, because it is so all-encompassing, not to mention their spiritual and their social. So, okay. (laughing) So let's try to start making sense of this crazy emotional experience of grief and loss, because it can be so confusing, and there's all these stage theories out there. I'm not a big fan of stage theories because it kind of implies you're doing it wrong if you don't go through the stages. And... my favorite-- I do have a favorite stage theory. it's the two-stage theory. It is one where you believe in stages, and then two is when you actually grieve and go... "There's no stages. "This is just chaos! "I don't feel like I'm moving from one thing to another." So, my favorite research. Okay, it's weird that my favorite research in grief, but this is my favorite research. (chuckling) This helped me make a lot of sense of how people progress through grief, because this was done by a researcher named Davidson... and what he did was he tracked 1,200 mourners and he followed them through a two-year period and recorded common experiences. He didn't look for stage 1, 2, 3. He looked for common experiences, so really just looking at patterns. So this is the typical patterns that people who are in grief will experience. Not for everyone. Everyone goes through these phases in different ways, but 85% pretty much go through what he has put into four phases of bereavement. This is how people get through the first two to three weeks. So this peak's the most intense the first two to three weeks of the loss. It's called "shock and numbness." The number one emotion at this time is stunned. Just stunned. And then, that is punctuated by moments of flooding, intrusive thoughts. You can't maybe refocus. It's all the person thinks about is the loss. So notice, it peaks in intensity right away, and then, again, at the one year anniversary. People in this phase... if you are supporting someone in this phase, you know, the old casserole thing is a really good idea. They have time confusion. They have different kinds of needs that they aren't able to get for themselves, like food, sleep, just helping them make decisions, maybe possibly making decisions about the memorial service. It's a very confusing time where people go from stunned, to overwhelmed, to feeling numb. So, this is shock and numbness. Phase two-- this hits right after shock and numbness. And you can feel all of these anytime, but this is when they peak. So we're looking from two weeks to about four months, that searching and yearning, that people feel that pain, and they're moving forward. The hallmark of this phase is energy, so people wanna set up. They may be blogging a lot, they may be setting up memorials, they may be putting up scholarship funds, going to support groups, talking to people. There's lots of support for them still. So, this is an interesting-- a really interesting thing that Davidson came up with, that 81% of people in searching and yearning experience what he called "bizarre experiences." Okay, bizarre experiences are having visions of the person who's gone, hearing their voice, sometimes having things that feel like the person is close to them and communicating with them. So for example, this happened pretty recently. I talked to a mom, and she had gone for a bike ride. And she was in the woods, and she stopped just for a minute, and bizarrely these two butterflies just sorta came floating by, and sat down on her handle bar, and looked at her. And she was very baffled, and then they just sorta fluttered away. And then, she realized-- she said as soon as she realized this, she was so filled with peace. But the daughter who had died was a twin and she realized it was, to her, it felt like both of these lost children had given her a message, and that message was that they were okay. And she had this flood of peace and calm. So another mom talked about looking up in the sky, and she saw, literally, her son's face in the clouds. Not a shape that looked kinda like him, but his face. So I hear these things a lot. 81% experience it. Not everybody, but it's definitely part of this searching, and yearning, and needing to be close. If you are supporting someone in this phase, then helping them not feel crazy, just being present, reminding them... One of the things we tend to do is say to people, "Oh, they're in a better place, "and they're not suffering anymore." But that kind of implies they need to let go. Maybe a different question to ask them is, "When do you feel closest to their loved one?" And they will tell you, "When I'm in church." "When I see a dragonfly." I mean, it's different for everyone. So it's a very hard period, but high energy, and searching and yearning. So okay, phase three. This is a slog. This is when most of the support systems have dropped off. Bills still have to be paid. It goes down at first, and then peaks right around the fifth to the ninth month. One woman said to me-- and I think this sums it up-- she said, "I don't wanna die, "but I don't care if I wake up anymore." It's just this incredible fatigue. If you're supporting someone in this period, don't forget about them. A lotta people don't check in after that fourth month, and this can be one of the most challenging times because of that. So it's also a period where the person is trying to reorganize their life. Things don't make sense anymore. The person they loved is gone. Like, one dad-- he used to play music with his son in a band, and he literally couldn't play his guitar anymore. He felt like he had to relearn chords. His fingers just wouldn't work, and I think that's kind of a metaphor for what a lot of people have to do. They have to say, "Okay, this person is gone, "but the relationship is still there." The love is still there. What do I do with that? So, disorganization, depression, and disorientation. So finally, here's the good news. Okay, the vast majority, 85% of mourners will get to this point. It may occur sooner, but it peaks, as you can see, as time goes on, 18th to the 24th month. Energy starts to return, people go out and have a good time and come home and feel guilty 'cause they had a good time. Maybe they woke up and it wasn't the first thing they thought about that morning. So reorganization is coming to a point where the grief isn't gone, but it's being carried in a healthy way forward, if that makes sense. And we'll talk more about exactly how to do that. So if-- okay, my favorite research is that phases because it helps give people some sense of where they're at, and some understanding that they're not crazy. If that is sort of like a road map of how grief goes, the Tasks of Mourning by Worden are the work... the work you need to do to get from one phase to the next. And he talks about accepting the reality of the loss-- again, not in order. This could go all over the place. But to experience the pain of grief, adjust to the environment in which the deceased is missing, and find an enduring connection while going forward. I'd like to just talk about that second one for a second. So we're not-- the research helps us ease suffering, but not take it away. If you feel pain, there are ways to cope with it that are healthy. There's also ways that are not so healthy, which we all do, and we'll talk about that, too. But if you don't feel pain, that's okay. The research has changed on this. So some people who didn't feel pain, there was this big fear that they would have delayed grief. But newer research shows that delayed grief doesn't tend to happen most of the time. If you don't feel pain, don't feel guilty. You're fine. If you do feel pain, then the problem comes if it's overwhelming and you don't have enough positive coping skills to cope with it. All right, so we're back to this, to sum it up. Characteristics of normal grief-- so most people have these waves of grief, 20 to 30 minutes that largely subside in a year or two. Here's where I really wanna stress... (chuckling) the number one predictor of normal grief is a social support system. And this theme comes up over and over again when you're talking about healing from trauma, healing from grief, and tonight-- I'm gonna put in a little plug-- tonight, over at Fountain Street Church, maybe you've heard, we're having the Diversity Learning Series has a wonderful speaker who is highly respected in the field of social connection, loneliness, and the impact that it has on human beings. So, I highly recommend you go over there tonight, as well, and check that out. His name is Cacioppo...? Or Cachee, Caziopp-- I don't know. Cacioppo-- it must be Italian? >> He is Italian. >> Okay. So, my apologies to Mr. Cacioppo, if it's not the right way to say it, but there it is. Normal grief really is helped by social support. So now, let's talk about the 15% who maybe don't have this experience. This doesn't mean they're weak, okay? This is huge. So people who have that-- the 15% who struggle, here's the hallmarks of complicated grief. Pervasive sadness. It's constant. There's never a break. You are sad all the time. That would be a good time to get some help. The feelings of self-loathing. So instead of feeling like, "I'm bad," you feel like-- or, "I feel bad," you start to feel like, "I am bad." Self-loathing is another indication... outside help would be a good idea. And again, isolation and social withdrawal-- big factor, big factor. Suicidal thoughts. So here's the big predictors of having that 15% of complicated grief experience... poor social support, number one, right in there. Multiple life stressors include things like mental health issues, maybe an addiction, anxiety, depression. Previous life losses, which can accumulate during a lifetime. So every time you lose someone in the present, it can bring back all these memories and emotions and trauma from a previous loss. And then, the nature of the loss. So, unfortunat-- some losses are just traumatic. They may be sudden, they may be violent, they may be of a child, or for a child, it may be of a parent. There can be some sense of responsibility sometimes, like a parent who looks away for a minute and the child wanders into a pool. All of these things can complicate the experience of grief, as well. So to put some words on these different kinds of grief, again, awareness is huge. Sometimes, we just-- we're in a culture where you're supposed to be strong, and if you're strong enough, you don't need help, and you can just get through it. And people don't wanna hear about how you're really doing. Suffering is, like, noble. I mean, notice how we say people died after a "courageous battle with cancer." I don't think suffering is noble. So here's how suffering looks, that we should probably acknowledge and be very compassionate with ourselves and other people for. Traumatic grief, if the loss is sudden, violent... sometimes, it can come after a very long, long drawn out-- like, the families I work with, sometimes their kids are sick for years, and the illness is punctuated by trips to the hospital where all hell breaks loose, and they think the child's gonna die, the crisis passes, and they go back. So it's this chronic stress that goes years at a time. Disenfranchised grief... that's grief that the larger culture-- again, this is about social support, right? So disenfranchised would be... maybe somebody's having an affair and the person dies. Suicide can be something people don't wanna talk about, they don't understand it, and people can feel like that's not something they can talk about. Abortion, in some cases, can be this kind of grief. So disenfranchised. Cumulative, we talked about. It just all accumulates over a lifetime. And finally, secondary losses... two forms of secondary losses. So, say you lose a spouse, then you also lose a good parent, co-parent, you lose somebody who mows the lawn and does the finances, maybe. You lose your couple friends. There's all these secondary losses, these layers. And then, there's those losses of anniversaries and birthdays and weddings. So, just to be compassionate to yourself if this is something that you experience. It's real, and it can make the experience of grieving a lot more complicated over time. Okay, so... we all do this stuff. This is all about pain, right? It's all about coping with pain. So... and I think about the wave when I look at this. "Power over pain" would be taking that wave on and wanting to fight it. "Succumbing" would be overwhelmed by the wave. And then, "escaping" would be trying to outrun the wave, and I think maybe you can, if the wave isn't big enough, but over time, these things can lead to isolation and more pain. So as long as it's not the primary pattern of coping, we all do some of this, but if this is taking over and there's no other way to cope with the pain, and then it's time to get help. Okay, wow, so... (laughing) Here it is. The wave is coming. How do we handle it? Let's switch gears into, "What do we do?" We've learned a lot about grief, kinda dissected it a little bit, seen it's a very common human experience. What do we actually do to cope in a healthy way that will ease suffering and create some opportunities even for personal growth? So here's the three goals for healing-- continuing bonds, finding meaning, and telling your story. We'll go into each one of these. Continuing bonds. Even our language to people, kind of... it pressures them to move on, to detach, to let go, right? It's, "They're in a better place." "And-- but you have your other kids." (laughing) "You look so good, you're doing great!" We don't mean to kinda cut them off from this but this is much healthier. The idea is, "The person's gone, "the relationship is still there," so it's an adaptive response to bringing that person into your current life in a way that is new. A new normal. So, some things you can do is talk to the person. Not crazy-- talk to them. Visualize them with you. Think about anniversaries coming up and plan for them, plan to recognize that person. The holidays are coming up, right? So if you are grieving... that can be a really challenging period of time. I recommend... simplify life, draw boundaries around what you need and want, and take care of yourself as you bring that person into your rituals. Maybe put ornaments on the tree. However you celebrate, add new rituals. Donate-- like one family donated-- they lost a 5-year-old, they donated gifts for 5-year-old kids to Santa Claus Girls. So you find ways to continue that bond into the future. Oh, I had this one young woman who... her sister died and she carried her picture down the aisle at her wedding, because she would have been her maid of honor. I know. So, it was such a beautiful way to keep her sister with her. Okay. Find meaning. So, this is a quote right out of the research. "Making sense of the event "and finding benefits from the experience "result in a significantly lower distress "and healthier outcomes." So there's two big ways to find meaning. One is called "intuitive grieving," which is more going in. That's where you sit there and you contemplate how things are going. You try to turn it back into a world that makes sense, feels safe again, and where there's a feeling, like, of belonging. So intuitive grieving is very introspective. Instrumental grieving is doing things-- plant a tree, help other people, make donations, go for a walk to end cancer. There-- there are-- oh, I had-- oh, this was a sweet girl. She-- this was a young girl who loved to give away clothes to kids in need, so they created Katie's Closet, and they had a room in the school where any kid who needed any kind of coat could just go in and take it for free. So that would be a way to find meaning. But it results in significantly lower distress and healthier outcomes. So, one way to help you get to this point where you have continuing bonds and you find meaning... would be to tell your story. So this is where expressive therapies come in. And this means a lot more than just talking. You can join a support group. I've got a list at the end here of all kinds of support groups you can join, which can be fabulous, by the way. You can do some writing, art, music, exercise. Anything that tells the story and helps you process it. So this is something called "sand tray work." I do this a lot with families because all ages seem to like it, including the parents. It's simply a tray of sand, and then I dump out this giant bag of miniatures. So they create a story. This is created by a 17-year-old. This was actually the first young girl that I worked with-- 10 years ago. And she... she hated me. (laughing) She was mad. My students have heard this story. She was really tough to work with. She didn't wanna cry, she didn't wanna talk, but she would do art. And so, this is her sand tray 10 days before she died. And how she explained it was... this is her past, her childhood. There was a little treasure chest in that cave and it was being protected by the wizard and the child. Notice, she is not connected to the ground. She's in a separate-- she didn't feel part of this world anymore. And notice the present is empty, 'cause she felt like she was in transition. And then, in the future, she has this white-winged horse which... I don't know if it symbolized it to her but, to me, that means going to heaven, something peaceful, white. Then, she has kind of a fearful-- I don't know if you can tell, that's a skull that that fearful creature is holding at the end. So she has this barrier, but if you notice past the barrier, there's a garden. This kid would never have told me these things. I don't think she knew she felt this way, but giving her this expressive way of putting it down gave her mom tremendous comfort, because she was able to see her daughter actually kinda thought there might be something beyond. And her daughter, also... that was her book of writings. She dictated letters right before she died, to her mom and her sister, telling them she was-- so these are the things that people who are dying need to say in grief. "Thank you for... I'm sorry for... "I forgive you for... I love you, and goodbye." And so, I just gave her prompts, and she finished the sentences, and it was so powerful. We had a volunteer put it into this decorative book to give to her family. So she's grieving her own death, but this applies to all grief and loss. It's, "Tell the story in whatever way "is comfortable to you." And then, here's, hopefully, those positive things that can come out of the experience. So we have post traumatic growth syndrome. This research says that up to 100% of grievers experience these things. They just don't recognize it. So part of finding meaning is seeing this in life. I'm not saying grief and loss is a good thing... but good things can come from grief and loss. So these are some of the things to watch for as ways to make meaning. New opportunities-- I've had families create new businesses to help other families who are grieving. A mom makes Christmas ornaments with memorabilia from their child in the Christmas ornament. Um, new relationships as well as closer relationships and a connection to others who are not afraid to connect. Suffer-- er, increased sense of one's strength and greater appreciation for life in general, as well as a deepening of spiritual life. It doesn't always happen, and frankly, it happens in spurts, and it may happen and then go away, but you can always try to make meaning and keep it alive. Okay. So I'm going to start closing up here so we can take some questions, but I have one more story. I know, my stories-- my class tells me this, too-- they're all sad. I'm sorry. (laughing) But hang in there. This one is not all sad. But... Okay, so this dad sums up everything I want you to take from this today, in three words. So this was a really, really sweet, just a very kind dad. And his daughter was 14, and had advanced cancer, and been through all the treatments. But in remission, but then she had some headaches. And she went into the hospital to see what was going on. She had an MRI, which showed that the cancer had spread to her brain. And it was in such a way that they weren't even sure she was gonna make it home. So the hospital recommended she get a room, and they would make her comfortable. She wanted to go home. We asked her what she wanted, and she just kept saying, "I wanna go home, "I wanna see my mom at home, "I wanna see my sister and my dog." So... here's the other piece. She would not go home by ambulance even, because if she died in the ambulance, they would have to turn around. This is how strongly she felt. She was going home. So we wrapped her in a blanket, made her comfortable, and they lived about an hour away. So the nurse and I followed her as she went towards the home, and the parents were driving. And they made it. They tucked her in. She went to sleep, she was so happy, her dog next to her. And the parents said to us, "Go ahead, go home. "We're all right. "We'll call you if anything happens, get some sleep." So the nurse and I headed home, and then called at about 7:00 in the morning. She was still doin' okay. So at about 10 o'clock in the morning, the nurse and I went back up, about an hour away, and we were coming towards the house, and we heard music, like really loud music, like ground-shaking music, 'cause they lived down this long dirt driveway. And I'm thinkin', "I'm gonna talk to the neighbors. "That's really rude. "They have no idea what this family's going through. "This is not cool." So we finally get to her house... and okay, the house was on the right, and the driveway went straight through, and there was this big field on the left, and on the right was this girl and she was wrapped in a blanket and she was surrounded by her principal and all the parents and all her friends, and it was a mob! It was just a mob scene. And on the other side of the driveway was the entire high school band, and they were just jamming. I mean, the ground was shaking, people were dancing. And every now and then, she would turn to the people around her and shout, "I love you, guys!" And they would turn around and shout, "We love you!" And it was just like this beautiful magical moment. So the dad and mom took us into the house, and the dad looked at us and said, "You know, when you left last night, "I didn't think I could do this. "I thought, 'I'm not a strong person, I can't handle this.'" But then, he looked around and he said, "Now, today, I realize that even though I'm not strong, "we are strong. "We are strong." And those are the three words, right there, because I think that sums up the importance of supporting each other. You're not alone, right? And we saw through the clickers, it's a wildly common human experience. There's varying degrees of intensity, but we all go through it. Working with people at the end of life has taught me, there is nothing more important than our relationships, and each other, and our communities, and it's how we heal, and frankly, I think it's why we're here. So... if you don't feel strong, that's okay. Reach out, support other people, and support yourself, tell your story, find meaning, continue the bonds. We're all in it together as a community. So, we are strong. So thank you, thank you. (applause) >> (indistinct). >> Yeah, I'm happy to answer any questions, and I'll stay after, too, if you want, and talk about things that are maybe more personal. Any questions? I encourage you to reach out to different support, if you need it. Oh, no? It's kind of a hard thing to ask questions about, right? It's personal, but... any-- yes? Kelly. (chuckling) >> (indistinct). >> Right? >> How do you deal with the emotions you feel helping take care of these people? >> Well, that's a great-- yeah. I mean, I've struggled with that question myself. This is an ongoing theme in social work class, too-- "How do you provide support and take care of yourself?" Well, at first, I wasn't so good at it. I had some nightmares, I cried, but I get to see these beautiful experiences. I get to see people doing wildly loving, generous, connected things that help each other at times of crisis. And I've had families even take me by the hand and ask me to sit with them at the funeral in the family section. I mean, you-- if you... if you can just be present with people in grief. It's not something we are often comfortable with. It's scary, because it speaks to our deepest fears, right? So if you can just know, you don't have to say anything. Your presence is so powerful, and the rewards of that. Like, I don't know if you've had the experience-- when my dad died, knowing people were at the funeral made a huge difference to me. I never woulda thought. But people came for me, not him. My people I worked with. It was really nice. So being present. The rewards you get from connecting people with people who are probably pretty socially isolated. Any other questions? Yes. >> How do you handle helping people on a spiritual level? Like, you know, people (indistinct) with themselves, with the world. (indistinct). How do you help them with that concept, or whatever spiritual grief they may have while going through that process? Either, you know, dying, or the people that are around that, having a loved one or something like that go through the process of death? >> I don't judge anything. I think I ask mostly just a lot of open-ended questions, and let people search that out for themselves. I certainly can't give them the answers. We do have a chaplain as a part of hospice, at Hospice of Michigan, and all hospices have a chaplain who is available to, again, non-judgmentally listen, because people feel guilty. They have a lotta guilt, a lot of fear, a lot of anger, and it can just help to talk it out with people that-- like sometimes at church, maybe it's not safe to question and be angry. Go to someone who's safe, and it's okay to have these questions and not know how it's gonna resolve. Tell the story. That's how you figure it out. It's just... healing. There's no magic wand. It's painful, but many people do make it to this deeper spiritual awareness. I did, when my dad died. I wouldn't be doing this work if it weren't for his death. Yeah. >> (indistinct). >> Yeah. >> (indistinct). >> Everybody feels that, right? (laughing) That is a very common feeling. >> (indistinct). >> You can say that. "I don't know if I can ask you how you're doing. "What can I do to be helpful? "Do you wanna talk? "Do you not wanna talk?" Either way is fine. So you're putting it back on her. And honestly, the most powerful thing I think people can do is just be present. Just be there. You don't have to say anything. Like, I tell my class this, "WAIT, W-A-I-T. "Why Am I Talking?" Sometimes it's fine to just say, "Is it okay if I sit here with you?" Or, "Is it okay if I mow your lawn? (laughing) "Make sure you're eating, help you pay bills, "get the bills written out?" I mean, there's a lotta ways to provide either tangible help or just presence... compassionate presence is huge. You can't say any-- okay, I went to a conference with Worden, this guru on grief and loss, and my question to him was, "I work with people who are bereaved all the time. "What do you want me to know?" And his one piece of advice was, "If you're trying to put a Band-Aid on it, stop. "There's no Band-Aid, and if you try, "you're gonna make the person probably pull away "because they are not ready." So, don't try to put a Band-Aid on it. Just let them tell you what they need. Any other questions? Well, thank you... so much. (applause)

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