I. Reaction to Death

As previously noted, primitive man's reaction to death was one of fear.

In this enlightened age, man still reacts to death with fear.

Death is still an unknown. No one obviously, has ever died and returned to tell us what death is really like. Man naturally fears what he does not understand and can not control.

The so-called "near-death" experience is still not a death experience. We can never know exactly what death is, so we can never fully understand it.

Therefore we can never stop totally from fearing it.

Much of our response to death is avoidance. Death is not a pleasant topic of conversation. When death must be talked about, it is usually done in academic terms.

Talking about death on a personal level creates discomfort. It is much easier to talk about death in terms of, "People die," rather than in terms of, "Someday I will die."

Within the last 20 years or so, much has been written about death and dying. At times it seemed like everyone who has suffered a loss was writing a book about it.

Each death is unique and therefore each person's experience is unique. That makes much of the material available unusable for another person experiencing a loss through death.

Indeed some of the advice available becomes contradictory simply because each person must deal with their own grief in their own way.

II. The "Grief-Cycle"

Dr. Elisabeth Kubler-Ross, a Swiss psychiatrist did landmark work with the terminally ill patient in the 1960's which resulted in the establishment of a "cycle" that she found each patient went through upon learning of their imminent death.

• The first reaction was shock. The universal first reaction to hearing the news was, "No."
• The second stage that quickly followed was denial. "This can't be happening to me."
• The third stage was anger. This anger was usually directed at God, nature, or luck, but needed to be understood by the family because it usually became directed at them at some point.
• The fourth stage was bargaining. The patient typically hoped that God would extend their life or cure them in exchange for promised behavior.
• The fifth stage was grieving. This is usually the longest lasting stage of the cycle and is marked by deep depression and mood changes.
• The final stage was acceptance. Once this stage is reached, the patient usually used whatever time remaining to "put their house in order." There was a marked peace in the patient's mood. Death was not a feared event.

A similar "grief-cycle" has also been developed that describes the stages a person goes through upon the death of a family member or close friend. It is really more accurate to use the word "phases" because people do not go through the grief process in an orderly manner.

• The first phase is shock. Similar to learning of a terminal illness, the first reaction of a person who is told that a loved one has died is, "No." A feeling of numbness sets in. Some people simply say that life seems unreal.
• The second phase is denial. We are a death denying society. Even our language tends to deny the reality of death by using terms such as "passed away" instead of the word "dead." We want to deny that death has taken place. In the denial phase, people hope that it isn't true. They may feel like this is just a bad dream and when they wake up, every thing will be all right. However, healing from grief can not take place until the person is past this step and has accepted the reality of death.
• The third phase is anger. Once our minds accept the fact that death has indeed taken place, anger usually erupts. Again, this anger may be directed at God (which for a religious person results in a feeling of guilt for feeling that way about the Almighty) or it may be directed to doctors, medicine in general, another family member or even directed inwards ("If only I had…"). Again, guilt enters. Anger may also be directed at the world in general. "How can everyone just go about their business when such a tragedy has just happened?"
• The fourth phase is mourning. This is usually the longest lasting phase. It can last for months or years. It may be characterized by feelings of depression, continued guilt, physical illness, loneliness, panic, and periods of crying triggered for no apparent reason.
• The fifth phase is recovery. Some would not call this phase recovery, because it can be said that one never "recovers" from a death. Death changes our lives forever. Things will never be "right" again. Although the pain of death will diminish in time, it never goes away. We will always long for a person we truly loved. But at some point, we usually find ourselves re-establishing our lives and moving on. That is seen in this phase.

There are several problems with the "grief-cycle." First, it tends to over-simplify the grief process. Stages or phases overlap. A person can exhibit anger without leaving the denial stage. Real-life grief is not as neat as the cycle would seem to indicate.

People whose grief experience does not fit nicely into the "mold" are thought (or may think of themselves) as abnormal. But as stated earlier, each death is unique, each person is unique, and therefore, each person’s reaction to it will also be unique.

In addition, grief is not really a cycle. A cycle implies that you return to the beginning which was a "normal" life as it was prior to the death. Of course this is not true. Life will never be the same again.

Additional landmark work in the area of understanding grief was done by Dr. Eric Lindemann, who identified six "stages" of grieving during the acute grief stage that his research showed to last for 2-5 years.

• Somatic Distress (Comes in waves and lasts 20-60 minutes)
  • Tightness of the throat
  • Choking
  • Shortness of breath
  • Sighing
  • Empty feeling in the stomach
  • Loss of strength
  • Tension
• Pre-occupation with the deceased
  • Hallucinations (Actually see the deceased or sense presence)
  • Sense of unreality
• Guilt
• Hostility
• Changes in patterns of conduct
  • Restlessness
  • Aimlessness
  • Loss of concentration
• Identification with the deceased
  • Assume traits of the deceased
  • Show signs of last illness of deceased

As previously noted, every person must grieve in their own way.

Grief is seen as a process. It is long-lasting and does not follow a fixed pattern.

Grief has also been termed "work." A person must "work-through" their own grief. Anyone who has been through grief knows that it is indeed "work."

Grief hurts. When we refer to the pain of grief, that pain is very real.

Grief is a hurt. Just as one must heal from a physical wound, one must also heal from the emotional and psychological wound known as grief.

Grief can become physical. Many real physical diseases and conditions can be traced to grief as a cause.

One author compares grief to peeling an onion. "It comes in layers, and you cry a lot."

Grief is very personal. Everyone must heal in their own way in their own time. There is no magical point on the calendar when grief is over.

While everyone's reaction to death is different, the following general statements can be made to the person experiencing a death.

• Accept advice with caution. Everyone will have advice for you. Someone will say, "Don’t try to run away from the death by taking a trip, it won’t help." Someone else will advise you to "Get away for a few weeks." Accept it as an honest attempt at caring, but do what you feel is right for you. There are few if any "rights" and "wrongs" when it comes to grieving.
• Accept your emotions. You may feel all of the emotions previously mentioned-- panic, guilt, anger, etc. and many others. These are normal reactions to death.
• Forgive others. Many will say, "Call me if I can do anything." And then they quickly go about their business like nothing has happened. They leave you alone to your grief. Life has returned to normal for them much quicker than it has for you.
• Accept platitudes as sincere but misguided expressions of sympathy. "I know how you feel." is a lie of course. No one knows how you feel. You want to scream that this is not God's will. He or she is not better off. And if just one more person tells you can have another child after you just lost this one, you will choke them.
• Express your emotions. While many of your friends may feel uncomfortable around you when you want to talk about the death, the deceased, or your feelings, feel free to do so anyway. Find a good friend that will listen. If necessary, talk to your pastor, priest or other religious person, your doctor, your funeral director, or a professional counselor.
• Cry. Tears are said to be the "pressure release valve of the soul." Screaming is okay too. Punch a pillow. Emotions kept inside are a poison.
• Grieve in your own way. Don't allow others to tell you what you should feel or discourage you from expressing it.
• Avoid alcohol and drugs. Neither will speed the process or ease the pain.
• Watch your diet. Stay healthy by eating healthy, even when you don’t feel like it.
• Get your rest.
• Do things. Even routine chores will help get your life started again, as it must. Get out. Take a walk. Go to a movie. Laugh.
• Be prepared for set-backs. Just when you think you might be making headway, you will suddenly break down crying. Its okay. Its normal.
• The only "cure" for grief is time. Grief can last for 1-2 years or more. Don’t expect to be "over it" in 3 months, six months or a year, just because someone thinks you should be.
• Seek out others. Support groups are available for those suffering a loss. Groups are also available for those suffering a particular type of loss such as the loss of a child, death by suicide, etc. No one knows exactly how you feel, but others are going through some of the same things you are. They can be of great comfort and support.

III. Abnormal Grief

Many people think they are having a serious mental illness because of what they might be experiencing. Generally, as long as a person is "progressing" through the various phases of grief, they will be okay. Most reactions to grief are considered normal unless they become all-consuming or last for an extended period of time. Persons in this position should seek or be advised to seek assistance from a qualified mental health professional.

For instance, thoughts of suicide are normal. Serious contemplation is not normal.

Feelings of hopelessness are normal. If weeks or months pass with no change, assistance should be sought. There is hope. Life is worth living.

Depression is normal. Depression over a period of weeks or months with no signs of improvement is not normal.

Imagining seeing or hearing the deceased is normal. If these occurrences continue and become consuming, professional help should be considered.

Hesitation in or delaying the disposal of the deceased’s clothing or possessions is normal. Trying to maintain their room "as it was" forever is a sign of denial of the death. True healing can not take place in such an environment. Professional assistance should be considered when this hesitation or delay turns into refusal to ever do this unwelcome but necessary task.

Everyone wants to be left alone once in awhile. A grieving person may show no emotion for a period of time. This is normal. If this persists however, it may be a sign that the person is in need of "getting going" again and professional assistance may be necessary.

IV. Children and Grief

Children suffer from death much like adults, but with even less understanding.

When dealing with children, it is important to realize that they probably know more than what we give them credit for.

While parents naturally want to "protect" their children from hurt, even the youngest child knows that something is terribly wrong and wants to know why everyone is crying.

Such overprotection only serves to rob the child of an opportunity to develop coping skills necessary later on in life, when no parent can protect them from grief because it is the parent who has died.

Preschoolers generally view death as temporary. They play games where someone is "dead’ and then gets back up again.

Children ages 5-9 generally view death as permanent, final, and universal. They tend to personify death as a person or ghost that carries off people. (So do some adults.)

Children from age 10 and up into their teens may show an unwillingness to talk about their feelings. Being young, they believe that death is a long ways off and rarely consider it on a personal level.

To help a child deal with a death:

• Be open to their questions. Answer them truthfully and as completely as possible, given the age of the child. If you don’t know the answer, just say so.
• Include the child. If they want to attend the funeral, let them. If they want to view the body with the rest of the family, let them. Make them feel a part of the family. Do not however, force them to participate in things they do want to participate in.
• Avoid euphemisms. The person did not "pass away" they died. The person is not "lost."
• Watch your terminology. Do not equate death with a journey. The person may fear a parent going away on a trip for fear they will never return. Do not equate death with sleep or the child may be afraid to go to bed. Do not say the person is "with Jesus" without further explanation. The child may hate Jesus for taking their grandparent away from them or be mad at the grandparent for leaving them to go to be with Jesus.
• Make sure the child understands the difference between minor illness and fatal illness. The child may think they will die the next time they get a cold.
• Accept attempts at humor. We all react to situations of stress with laughter at times. Accept this also from the child. Accept all expressions without criticism.
• Give the child affection. Don’t allow them to feel they are being abandoned, especially at the loss of a parent. Assure the child that they are loved and will be cared for.
• Explain things as you go along. Don’t expect the child to have all the questions let alone all the answers.

V. SIDS

One particular cause of death deserves special mention—SIDS.

SIDS stands for Sudden Infant Death Syndrome.

SIDS is the sudden unexpected death of an apparently healthy infant whose death remains unexplained after a thorough investigation and autopsy.

SIDS may initially be treated as a case of suspected abuse. This further traumatizes the parents. In fact, the child is dead for no apparent reason and with no fault.

It commonly strikes infants from 2 weeks to 1 year of age. The peak incidence is between 2-4 months of age. It is estimated that 6,500 to 8,000 babies a year die of SIDS which is a rate of 1-3 per 1,000 births.

While we do not know what SIDS is, we do know what it is not.

• SIDS is not neglect or abuse. It can not be predicted or prevented.
• SIDS is not suffocation, aspiration, regurgitation, pneumonia, or heart attack.
• SIDS is not prevented or eliminated by any type of baby care such as nursing or bottle-feeding, use of disposable diapers or clothe diapers, or keeping the baby too warm or too chilled.
• SIDS shows no regards for socio-economic status or race. It is not hereditary or contagious.
• SIDS does not effect a subsequent sibling at a higher rate than any other child.

Researchers have identified some "high-risk" babies whose breathing has stopped and were immediately revived by parents or medical personnel and have placed these babies on monitors to alert the parents that the child has stopped breathing, but this does not explain why a child would suddenly stop breathing in the first place.

Placing all babies on these monitors to prevent SIDS is not only financially impractical, but many doctors feel that it would place the parents in an unnecessary constant state of emotional tension. It is also not determined that these periods of breathing stoppages are necessarily SIDS or SIDS related.

Researchers have also noted a decrease in the incidence of SIDS when babies are put to sleep on their backs as opposed to the common practice of placing babies on their stomachs. While this appears to decrease the incidence of SIDS it does not eliminate it or explain it.

Those who deal with a family who have suffered the loss of a baby due to SIDS must be especially understanding and avoid any words or actions that might be interpreted by the parents as expressing thoughts of blame or suspicion.