Dr. Gilda on Grieving
7 Emotions to Grief Relief
Dr. Gilda Carle

Grief occurs when there is loss. Loss can occur through death, divorce, or even job dismissal. But as horrible as it seems, loss is a natural part of living.

We may occasionally lose our wallets. We will eventually lose our parents. Many trees are certain to lose their leaves.

Judith Viorst's classic book, "Necessary Losses," detailed how vital loss is to the life cycle, and how the passing of the author's own beloved sister to cancer made her grow in very surprising ways.

But to grow and heal, we must deal. And dealing requires immersing yourself in the muck of sorrow, muddling through the darkness of confusion and dismay, and recognizing that the comfortable and predictable equilibrium you once enjoyed has come to a screeching halt. Woefully, not only must you come to grips with the emptiness you now feel, but you must also devise a new life plan devoid of what--and who--you once had.

According to the Pew Research Center, 9 days after the September 11th attacks on New York and Washington, 70 percent of Americans polled experienced symptoms of depression. Suddenly, life had changed . . . and people could not cope. A traumatic, life-threatening event, such as war, assault, rape, an accident, or a natural disaster can wreak havoc on a person's emotional state.

    Symptoms of psychic infection involve sleeplessness, irritability, inappropriate anger, difficulty concentrating, exaggerated startle responses, even in things as benign as a car's backfiring, illusions, hallucinations, disassociation (the loss of awareness of time or surroundings), or a host of physiological responses, from dilated pupils, to perspiration, to a racing heart, to shortness of breath.

Traumatic memories can become so anxiety-provoking that victims are unable to regulate their emotional responses, and the physiological reactions that accompany them overpower their lives.

Experiencing any or many of these symptoms suggests a need for treatment, but sometimes symptoms don't appear until weeks, or months, or even years later. Six months after the Oklahoma City bombing, 1/3 of those directly exposed to the attack were still suffering from aftereffects.

When symptoms last for less than 30 days, the diagnosis is usually acute stress disorder, or A.S.D. But if symptoms persist for a longer period of time, the diagnosis can be post-traumatic stress disorder, or P.T.S.D. Dr. John Wilson, director of the Forensic Center for Traumatic Stress and P.T.S.D. in Cleveland, calls P.T.S.D. "one of the main psychiatric disorders studied around the world." It shows itself through intense feelings of fear, horror, or helplessness. Curiously, not everyone faced with such an event suffers P.T.S.D., and, although it is not entirely understood why some people are emotionally vulnerable while others are not, symptoms can often be traced back to old traumatic wounds that have never been managed.

In a perfect world, before dealing with new trauma, previous injuries should heal. Further, findings from Ohio State University and the University of Amsterdam suggest that when subjects feel they can take an active role in shaping the consequences of their recovery, their return to health is quicker. It is, therefore, suggested that sufferers adapt a "take charge" stance, even if they are relatively passive. Such stand-up resilience recently showed itself when the "I love New York" logo from the 70's became the more assertive scream of "I AM New York." Israeli psychologist, Alon Gratch, advises people to make terrorism a fact of life, not a way of life. Clarissa Pinkola Estes, author of "Women Who Run with the Wolves," reminds us to remain self-assured to stave off the terrorists' real objective, which is not as much to kill as it is to create psychic trauma.

As much as we postulate that people should heal one trauma's wounds before another crisis occurs, barely two months after the terror of 9/11, Flight #587 nose-dived into the Rockaways section of New York. Before Americans could be certain that it was not another terrorist attack, they assumed the worst. I found myself before a bank of cameras at the site of the wreckage the day after the crash, explaining America's, and specifically, New Yorkers', reactions to viewers of "Canada AM," the Canadian version of "Good Morning America." I described how we were still reeling from 9/11, without having been able to go through all the necessary emotions of mourning--and I named the emotions. Now, again, I said, we were faced with another plane plummeting to earth, striking more fears of terrorism. Media people from the BBC listened to my interview with the Canadians, and as soon as it ended, they asked me to repeat the information for their audience throughout Europe. Apparently, it could not be said enough times: it's very difficult to effectively cope with one trauma after another. Unfortunately, no one can control when horror hits. So, as innocent and stunned bystanders, the best we can do is recognize the symptoms of emotional dissonance, and know that we must take care of ourselves when we are in pain.

While medical science has made great strides in dealing with trauma, experts continue to disagree about the best treatments. They also disagree on whether therapy plus medication might be superior to one single method. And they are not sure about how to treat P.T.S.D. when it is coupled with alcohol or drug abuse or personality disorders. Paxil and Zoloft, two antidepressant medications, have been found to help many people with P.T.S.D. Exposure therapy that re-positions familiar trauma into a safe environment helps people control their fear. Eye movement desensitization and reprocessing, or E.M.D.R., summons up a traumatic image while a therapist moves a finger back and forth in front of the client's face. Afterwards, the client purportedly lets go of the memory and discusses his emotions, thoughts, and physical sensations as a result of the procedure. A crisis-intervention method called "debriefing," in which survivors share their experiences in a single group session is similar in theory to traditional group therapy that meets survivors over a period of time. Yet, the most common therapy is still talk therapy, or psychoanalysis, used since the early 1900's, to treat combat veterans, Holocaust survivors, and others faced with death. Of course, the goal is to summon the therapy that works best for each person.

Some experts point out that suffering from the aftereffects of highly abnormal events is an appropriate "reaction," rather than a "disorder." Nonetheless, trauma can take its toll as a physical as well as an emotional assault. The worst thing a person can do is not allow himself an outlet for his sadness.

Some people are able to talk things out, the preferred palliative to grief, and New York Magazine rightly names it, "The Talking Cure." "Talking" may involve speaking into a tape recorder, writing emotions on paper, or finding a good listener you can trust.



You can also "talk" your way through your pain with music or dance or art. But other people are not so relaxed with the many variations of palaver, and instead turn to drugs or alcohol or sex to find a sense of security through such artificial numbing. In those cases, since the trauma will not disappear by itself, the situation must eventually still be treated.

Following Viorst's reasoning is my Gilda-Gram, "Whatever loss does TO us, it really does FOR us." Like it or not, loss propels us into uncharted discovery of who we really are. For most, that presents a painful "ouch factor" never before experienced. Yet it's this feeling of discomfort that pushes us off the proverbial "fence," and gets us to probe untapped resources that will stretch us way beyond our usual circumstances.

Surely, dealing with the reality of grief is more difficult for some people than it is for others. Our corporate business cultures are founded on fierce competition, rather than on congenial compatibility. So tradition dictates that on the Myers-Briggs personality test, employees should rate low on the score of "Feelings." And men, habitually reared as knights in emotionally-protective armor, have traditionally been rewarded for demonstrating anger, but chastised for shedding tears. Yet, after trauma, no matter what their gender or work environment, everyone suffers compassion fatigue. It is during such crises when women must come face-to-face with their customary role of overwhelmed caretaker that tends to make them sick, and when men must recognize the need to express their feelings despite the expected politically-correct stance.

    After September 11th, what were once considered appropriate and usual behaviors began to change. The ever-stoic CBS anchorman, Dan Rather, wept when he appeared on "Late Show with David Letterman." Letterman, also teary, reached out with a hug of compassion and comfort. The result? The ratings shot up over 100 percent, according to Nielsen estimates.
The usually-combative New York Mayor, Rudy Giuliani, openly wept, in full view of America. The result? He became a national hero, a man who would go down in history as one of our great leaders.

Even the fictitious superhero, Spiderman, broke down and wept after seeing the devastation at the World Trade Center. These male role models, along with those in sweat-stained search-and-rescue uniforms, set a new standard. At last, the display of raw male despair was viewed, no longer as weakness, but as strength. And onlookers applauded them for their honesty and courage.

However, the average Joe still had difficulty discarding the macho image. Since women comprise the bulk of self-help seekers, they are more likely to recognize the need for help. But it is our men who really have the challenge. The New York Police Department, the nation's largest police force, ordered all 55,000 of its employees, including their uniformed officers, to attend mental health counseling to relieve the stress of 9/11. A 3-part series, it consists of a group therapy "rap" session in groups of 20, the creation of an emergency telephone line to schedule free, anonymous counseling, and a health fair to discuss additional emotional issues. But the prospect of counseling ran counter to what The New York Post called "the muscular culture of the department." Officers feared that "perceived weakness" might damage their careers. So the department made counseling compulsory for everyone. In contrast, the Fire Department, which lost 343 people in the attack, did not institute mandatory counseling, but added $3 million to the department's counseling unit to deal with stress. Yet, a firefighter confided that most of his "brothers" rejected the outside help; he said that these guys, living and sleeping under the same roof, are a "family," and they would draw from their personal resources to help themselves. The way their job is set up in the fire house provides the kind of close human connection that does not exist on the police force. Whether it's a family or a fire unit, emotional closeness aids in coping and healing.

As much aid as outside agencies generously provided, there was still resistance to assistance--and it was not limited only to New York's bravest and finest. The tristate region's largest HMO, Oxford Health Plans, said that many people had gone as far as to make appointments with psychotherapists, only to get cold feet somewhere between the request for consolation and the couch. Despite their anxiety, people fear straying beyond the box. The general fantasy, of course, was to return to the status quo. But Oprah Winfrey prayed "that we transcend what was [once considered] normal." She said she hoped that we become better human beings than we were before the tragedy.

Maybe Oprah's prayer is already coming true. A survey by psychologists at the University of Michigan found that people are now describing themselves as kinder, more loving, and more grateful. With a new sense of patriotism, frivolity is out and faith is in. There is a surge in inspirational music sales since our nation's tragedy, with religious music sales hitting a record of more than $850 million. An "agnostic" writer quoted in New York Magazine said she was "jealous" of religious people during this time of need, because her usual cosmopolitan pain-killers, Starbucks and Barnes & Noble, no longer sufficed. In a Ladies Home Journal poll, 56 percent of the respondents said they have deepened their faith in God and 40 percent plan to volunteer their time to help others. Time Magazine reports, "prayer, long banned from schools, is making a post-terror comeback"--and there weren't the usual protesters.

    Old glory is flying off the shelves, along with songs like "God Bless America" and Whitney Houston's "The Star-Spangled Banner." There is a new politeness, a new reaching-out, and a new love for the nostalgic.
Perhaps with these changes in spirit, following Viorst's reasoning, we could somehow make sense of these awful human sacrifices.

"Telling Nicholas" accurately portrays our culture's typical emotionally shut-down man in Robert, 7-year-old Nicholas' dad. The audience experiences the torture he has in trying to open up. During our discussions and my prompting, he readily joked with me that men were indeed "from Mars" when it came to expressing their feelings. Despite the fact that his wife, Michele, had been killed, he could not utter the word "dead" to describe her disappearance. He was dealing with the fact that Michele's body had not been recovered. This is called "ambiguous loss," since there was no closure without a body, a burial, or a funeral. Since Robert could not say the "d" word himself, he could not tell his young son that Mommy was never coming home.

Over the course of many days, we met, spoke, cried, ate, and walked, on camera and off. He and Michele had been separated, and when I met him, there was little explanation as to what went wrong in their marriage. So in addition to the ambiguous loss, Nicholas' father was also experiencing "unfinished grieving" over his marital breakup. Such incomplete emotions and unsaid goodbyes were now added to his new role as single parent. The movie depicts Robert's "transcendence," to use Oprah's word.

Recent research reveals that children raised by single fathers do at least as well as those raised by single moms. But for anyone who wants to reclaim a life of joy, grieving must be allowed to wend its way through its natural process. It cannot be rushed and it cannot be prodded. This was the course through which I gently began to guide Robert. Not without pain, the journey was necessary for father and son to establish a healthy bond. To insure that good emerges from tragedy, death must be allowed to give life its fullest meaning. Robert is learning much about himself as he continues to shape his new role. Unfortunately, like the New Yorkers suddenly faced with another terrorist scare in the Rockaways before they had been able to cope with the tragedy of 9/11, Robert had not yet begun to mourn his marriage's demise before he was put to the test of mourning his dead wife. As I said earlier, since we don't get to choose when horror hits, we can only deal as best we can with what we have. The abiding lesson is to cope with issues as they arise.

Elisabeth Kubler-Ross wrote the seminal best-seller, "On Death and Dying," in which she established her 5 distinct "stages of grief": denial and isolation, anger, bargaining, depression, and acceptance. Jennifer Marshall, C.S.W., shortened these stages to 4: shock/denial, searching/yearning, disorganization, and reorganization. Mark Goulston, psychiatrist and author of "Get Out of Your Own Way," further shrunk them to 3: denial, depression, and resolution.

I address the model of grieving and healing from a different perspective. Instead of constricting the process into a set number of stages, I acknowledge the breadth and depth of people's feelings. So I expand the traditional "pattern" of grieving to 7 non-sequential emotions: shock, denial, anger, blame, depression, acceptance, and moving on. Used as a general guide, grievers discover that the length of time spent on each emotion differs for each person--and sometimes it's not unusual to go from Shock to Blame then back to Anger. The most important thing is for people to be able to recognize these 7 emotions when they feel them, and acknowledge their presence without fear. Based on my research, this is the easiest and quickest way to grief relief.

Dr. Gilda's 7 Emotions to Grief Relief are:

You are caught off guard over the news you have just heard. In a contracted emotional state, you have difficulty processing the information.

As a survival mechanism, you may now acknowledge what you have heard, but you refuse to believe it is true. You continue to repeat, "No, it can't be!"

You become enraged over your loss. You are furious that things aren't the way they were, and you're outraged that you need to make changes to regain your equilibrium. Change is scary for everyone, and all anger is based on fear.

You place blame on others because your loss makes little rational sense. After the 9/11 attack, as irrational as it seemed, some Americans laid blame on all Muslims, all men with turbans, all Arabs. In some neighborhoods, Muslim youths began to pack guns for fear of being attacked. The sufferer who plays the blame game rationalizes someone as his scapegoat to make himself feel better.

Depression is anger turned inward. You internalize your pain and suffer personally over your loss. Some depressed people commit self-destructive acts, and smoke, overeat, or drink too much as a way of relieving their stress.

You accept your loss for exactly what it is. Although you still have no rational answers as to why your loss occurred, you acknowledge it as real, and you allow yourself to feel its accompanying pain. You re-structure your life without the person who is gone, but you no longer hide from the emotional emptiness, or try to bury the pain in denial, anger, blame, or depression.

You make plans to regain your comfort and peace of mind. While you may still continue to mourn, you are willing to acknowledge that through your loss, you have gained insight and growth. Life goes on around you--and soon you become part of the ever-revolving world.

Each of these 7 emotions is difficult to feel, yet necessary. There is light at the end of mourning. The pain that was processed and dislodged is supplanted by growth. With added insight, people around you can benefit from your wisdom.

For additional information, contact Dr. Gilda
For information on books by
Dr. Gilda Carle: www.drgilda.com

   © 2001-03 James Ronald Whitney
See the Web sites for the director's other films: Just, Melvin, TheWorkingGirl.com and Games People Play
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