During those four years, my personal experience with grief was eclipsed by a much greater understanding. I saw every kind of loss—spouses, children, siblings, best friends. Some of them lost to long-drawn-out illnesses, some of them quite sudden or even violent. And then because there was a shortage of grief resources in the area, I opened up my groups to people outside our hospice and began to encounter people who had lost loved ones to events other than illness—murder, suicide, tragic accidents. What I thought I knew about grief before this experience was completely turned on its head.
During those early years, I was also a young wife and gave birth to my first child. It was a peculiar experience to be working in the realm of the dead while bringing life into the world. I drove my big pregnant belly around to nursing homes and hushed suburban houses inhabited by dying patients, and as my belly grew larger and I began to prepare for my daughter’s arrival, I couldn’t help but notice how much emphasis is placed on bringing people into this world when we make such little effort to ferry people out.
Simply put, our culture has no idea how to face death. Even now, children are shielded from it, given vague explanations, kept home from funerals and memorial services. Our current workplaces give us maybe a week off after a significant family member dies, and we are expected to move on and “get back to normal” very quickly.
So it’s no wonder, given those messages throughout our lives, that when it comes time to actually face death—to die ourselves or to help someone else enter that phase—we have no idea how to do it. Even our own physicians in the medical community shrink from death. I can’t tell you how many hospice patients we had that came on with only a day or two to live—the doctors and the family members working up until the last minute to try to keep them alive by any measure. What would have been more healing for all involved, including the patient, would have been an approach that acknowledged the death and sought to create a peaceful setting for all those facing it.
For this reason, the theme I encountered most commonly in the bereaved clients I counseled in hospice was regret. If only I’d known that she had just a week left… I didn’t know he was going to die so soon… Now when I look back, I can see how sick she really was, but no one told me…
Hearing these tales of regret broke my heart. Today I spend countless hours walking clients through those last days, helping them to see that it was the fault of the culture at large, not themselves individually, for their inability to face the loss.
It has become my life’s work to help change the culture of death and dying. The truth is we will all die. Every single one of us. If we could better lean into that fact, and support each other as we face it together, we could live less anxious, more peaceful, and more vibrant lives.
I have now been a therapist specializing in grief for more than a decade. I currently have a busy private practice in Los Angeles, I offer online grief support, and I regularly lead grief retreats around the country. I have counseled hundreds of people experiencing the loss of a loved one.
A few years ago I had an epiphany. I realized that the predominant symptom I was seeing in my clients—even more than depression or anger—was anxiety. Month after month, my office had become filled with clients who told me stories that mirrored my own. They described panic attacks, hypochondria, and a constant underlying feeling of dread—all since experiencing a significant loss.
To this day, my clients seek me out, desperate for a way to grapple with their anxiety, but they also come because they are not sure how to process their grief. They arrive in my office filled with confusion about Elisabeth Kübler-Ross’s famed five stages. They are worried that they have gone about the grieving process all wrong, that they haven’t followed the formula correctly, or that they’ve skipped a stage or dwelled too long in another.
I take time to remind them that the five stages were originally written for people who were dying, not people who were grieving, and because of this the stages don’t organically fit the emotions that a person experiences following a loss. And in fact, there are elements of grief that are still being explored, anxiety being a significant one.
I do believe that there is a very real process to grief, but I think that it looks different for every individual. I think that each person must sift through their own waves of sadness and anger, anxiety and regret. And most of all, I believe that the part of the grieving process that can bring the most healing is when we can find ways to stay connected to our loved ones rather than feeling like we have to let go of them.
The idea for this book came from the countless hours I have spent counseling people. I felt called to write this book when I realized how many people were struggling with anxiety during their grief and that there was nowhere to turn for more information about this very real symptom.
You are reading this book because you are experiencing anxiety. You are trying to figure out how to get a handle on it, and you are trying to understand where it came from. Like my clients, you’ve probably had panic attacks or other common symptoms of anxiety—and, like them, you may not have realized the source of that anxiety. This book will help you understand how loss can create anxiety and how to move through those difficult emotions.
You are reading this book because you have lost someone you deeply cared about. Perhaps the loss was recent and it feels as though your world has fallen apart. You are not sure where to turn, how to make the pain stop, how to quell your fear, or how to calm your thoughts. You feel alone among your peers, in the workplace, and perhaps even among family members who have experienced the same loss. Above all, you are sitting with the realization that life is not what you thought it was.
For others, you may have experienced a loss years ago, or maybe even during childhood, and you are just now connecting the dots that losing your person was the catalyst for the anxiety you have been struggling with for decades. No matter how long it’s been since your loss, it’s not too late to work through it and restore a sense of peace to your life.
Within these pages you will find stories of real-life people who have walked the same path you are walking now. You will read about their struggles with anxiety and grief and about how they overcame these difficult symptoms. While working on this book, I interviewed more than a dozen former clients, tracking how and why their losses prompted anxiety and what that looked like for each of them individually. Then I dissected their healing processes to better understand what works and doesn’t work to alleviate these symptoms. To maintain the complete confidentiality of my clients, the names and identifying characteristics have been changed.
In addition, I called upon the vast network of resources I have worked with over the years: renowned physicians, death doulas, hospice nurses, and advanced-planning experts. I interviewed them about their own experiences of grief and anxiety, both with their patients and within themselves, and I asked them all the questions I would have loved to ask when I was grappling with this at the beginning of my journey. They gave me detailed information that will help you better understand things like the physiology of anxiety, that is, how our bodies react to fear and sadness, and they also provided many practical solutions and coping strategies, all of which you will find within these chapters.
My wish for you as you turn these pages is that you pause now and then to take a deep breath and to understand that you are not alone. As I walk you through a broader understanding of how grief and anxiety are intertwined, my intention is that you close the cover of this book with a newfound strength to overcome the symptoms you are experiencing, tools to relinquish your anxiety, and a greater sense of peace about your loss.
Although you can skip around and choose to read various chapters that stand out to you, know that I have written this as a sort of guidebook and that each chapter builds on the next. I ask that you read the book slowly. Underline or highlight passages that resonate with you. Keep a journal as you read, or speak with a therapist about the insights you are gaining. Reread sections if necessary, and take time to engage with th
e exercises provided. Note when you read something that you feel especially resistant to; if you’re not ready to tackle it, then make a note to return to it later. Doing all of this will deepen the healing process this book provides.
It makes sense that loss causes anxiety. Losing someone we love is one of the most difficult things we will ever experience during our lifetime. The impact of loss permeates all areas of our life and can often bring us to a standstill. Death reminds us that our lives are nothing if not precarious and that everything can change at a moment’s notice. It is an experience unlike anything else. And it is one that we cannot prepare for, no matter how hard we try.
In grief, we must walk a path of fire and pain, of deep sadness and crippling anxiety, in order to get to the other side, to a place where we can experience the beauty life has to offer and to find a renewed appreciation for our time here. It is by understanding this journey, and stopping to take stock of what it means to live and die in this world, that we can emerge more peacefully on the other side, having been transformed into a person with greater compassion and empathy, not just for the world at large but for ourselves as well.
We will never get over the death of someone we love, but we can learn to live with it. We can learn to connect with our lost loved ones in new ways, we can free ourselves of anxiety, and we can open ourselves up to the world again.
You have picked up this book because you are ready to heal.
1 | What Is Anxiety?
No one ever told me that grief felt so like fear.
—C. S. L EWIS
W HAT IS ANXIETY? W HERE DOES IT COME FROM, AND HOW CAN you gain control over it? And why is it so frequently spurred by the loss of a loved one? These are often the first questions I address when meeting with a new client, because understanding anxiety is the first step in learning how to overcome it. But understanding how it is tied to the loss of a loved one is even more important.
I have been a grief counselor for more than a decade. I’ve worked in both hospice and private practice. I’ve held the hands of many people in their final moments of life, including my own father. And I’ve worked with countless people who have struggled to cope in the wake of grief after losing someone they love.
Yet while I’ve written and spoken and worked with death in so many capacities, it is this one issue that I have encountered more than any other: anxiety following a loss.
It is understandable that death makes us anxious. We experience anxiety after a loss because losing someone we love thrusts us into a vulnerable place. Loss changes our day-to-day lives. It forces us to confront our mortality. And facing these fundamental human truths about life’s unpredictability can cause fear and anxiety to surface in profound and unexpected ways.
In this book we will explore all of these feelings and more. But before we can get into the deeper work, first we must cover the basics, and that means helping you feel better fast. I’ve chosen to structure this book in the same way I work with my clients, moving through the same process and work we do together in person. The first session always begins with a basic lesson about anxiety—what it is, how it works, and, more important, how to get some quick relief. So that’s exactly what we’re going to do here.
To help give you this foundational understanding, this chapter will provide some questions that will assist you in determining your anxiety level, give you practical information and advice from a renowned medical doctor, offer quick tips for coping with an anxiety attack, and cover a real-life case whose story will help illustrate the process of alleviating anxiety.
The first thing to know is that anxiety is more common than you may even realize. Recent studies show that 18 percent of the population of the United States, roughly forty million people, have suffered from anxiety in the past year. Not only that, but it also seems to be on the uptick. Anxiety is leading far ahead of depression as the most common health issue on college campuses. And even higher than the national average, data from the National Institute of Mental Health shows that 38 percent of teenage girls and 26 percent of teenage boys have an anxiety disorder.
Just in the past five years, Google Trends reports that Internet searches involving the term anxiety have nearly doubled. These statistics may seem surprising, but anxiety is often kept hidden by most of the people afflicted. In fact, it can actually be quite easy for you to mask your symptoms and go about your regular life while experiencing this very real struggle. On the other hand, anxiety can also be debilitating, causing you to withdraw from career and social obligations and preventing you from living a normal life.
The good news is that anxiety is also highly treatable.
THE BASICS OF ANXIETY
So what exactly is anxiety? At its core, anxiety is fear of something, real or imagined. Specifically, anxiety comes from fear-based thoughts about things that are not necessarily occurring in the present moment or that may never occur. Anxiety is intrinsically linked to our physiology. You may have a physical pain or sensation that then generates a fear-based thought or memory. Or you may have a fear-based thought that generates a physical sensation.
Anxiety is a feeling of dread or foreboding. Anxiety can be as simple as a general sense of uneasiness, a feeling that all is not right, or it can be as specific as worrying that you have cancer or that the plane you are flying in will crash. Anxiety comes from the Latin word anxius, which means a state of agitation and distress. This distress is often felt on a deep level, in both the mind and the body. It is the sense of danger but not always a specific one that you can identify.
Anxiety is also a practical and useful emotion. We actually need anxiety in certain situations. Anxiety helps us prepare for an exam or think about all the things we might need to pack for a trip. Anxiety helps us stay alert and present to our well-being. But when anxiety goes beyond these practicalities and we begin to worry all the time, it can become problematic. Worry is the mind’s expression of anxiety. When we find ourselves worrying incessantly about things beyond our control, that is when we need to take steps to calm the mind.
When feelings of fear become very intense or come on suddenly and feel overwhelming, without any specific cause, this is called panic. Your fear reaction, at both low levels of anxiety and high levels of panic, is experienced in the body by very real physical sensations. Muscles tighten and constrict, your heart pounds, breathing becomes strained, and you may feel dizzy or faint. In terms of anxiety, these sensations arise in reaction to a thought you are having rather than an actual physical threat, like an intruder entering your house.
Anxiety also begets anxiety. So even reading this passage may cause you to feel anxious. If that is the case, take a deep breath and know that your body is having a reaction to your thoughts about anxiety. What’s helpful to know is that your body and mind can be gently trained to not react as strongly as they are now to fearful thoughts.
Your body is designed to react to fear. And this is a useful tool with which all humans are wired. We all have a built-in fight-or-flight response to threats. If someone is coming at you with a baseball bat or if you face a wild animal, your body goes into an automatic fight-or-flight response, and with this response come the same feelings that you may feel when anxious—racing heart, coiled muscles, dizziness. You are familiar with these feelings because we have all experienced them at one time or another.
Our fear-response system involves several brain and body systems that send messages that are transmitted over nerve pathways throughout our entire body, using a vast assortment of hormones, proteins, and other neuroendocrine substances. When you encounter a situation that stimulates the fear response, your entire body sends an alarm that prepares you to face the danger or choose to flee.
We do not even have to be actively thinking about these fears on a conscious level for them to impact our level of anxiety. Even when we push away anxious thoughts, the subconscious continues to register them, exploring them in ways of which we are not necessarily aware. In fact, suppressing fear and pani
c often leads to even more pronounced anxiety. It is when we are able to turn into the fear, like a car turning into a skid on an icy road, that we are better able to gain control of the situation and adequately process it.
After the death of a loved one, many of the fears that run through your mind can be perceived as more of a threat than before the loss. You have witnessed someone die, and now that inevitability is more real than ever before in your life. So when you have a fear-based thought about that person’s death, or about your own mortality, or a worry about losing someone else, your body and mind are reacting stronger than before you experienced loss.
The intense amount of emotions that come with grief can also heighten your sense of fear and danger. Most people have never felt such strong emotions as they do when they lose someone they love. It can be very frightening to find yourself overwhelmed with sadness or anger, and this can lead to even more anxiety, even years after the loss.
Anxiety can also perpetuate itself. I can’t tell you how many clients confess that what they are most anxious about is experiencing more anxiety. Once they have had one panic attack or one truly anxious spell, they often find themselves worrying that they will have another. They worry that they will be at an event, at work, or on a plane and that they will suddenly get hit with a bout of anxiety and be unable to cope with it. Thus, the fear-based thoughts become simply about having more of them. It’s a tricky cycle, one that can last far beyond the actual loss, but it is one that can be brought under control.
One of the things I find most fascinating about anxiety is that it can become addictive. Worrying about something can make a person feel as though they are doing something proactive about their specific fear, when really they are just perpetuating a heightened state of alert that keeps them in an anxious state. Choosing to remain in a hypervigilant state rather than adopting a relaxed state can make you feel like you won’t be prepared for the thing you are most afraid of, but that is not true. Allowing yourself to remain in an indefinite state of alert is exhausting and can have a severe impact on your health.
Anxiety- The Missing Stage of Grief Page 2