by Lucy Hone
In direct contrast to old-school bereavement theories, these researchers are adamant that this form of denial is in fact a beneficial strategy for the bereaved to adopt—as long as denial is not extreme and/or persistent. ‘Confrontation with the reality of loss is the essence of adaptive grieving. It needs to be done, the cognitive business needs to be undertaken, but not relentlessly, and not at the expense of attending to other tasks that are concomitant with loss. It needs “dosage”.’7 Dosage refers to the different levels of grief individual people can bear before requiring a rest from their grieving—using Claire Rushton’s terminology, how far we can dip our toe into the water before we need to withdraw. We can’t grieve all the time, but we also can’t avoid it entirely—there are aspects of the death we are forced to face eventually. Neither confrontation nor avoidance is sustainable, and both the processes of actively grieving and respite from grieving are vital for recovery.
Across the months I’ve been aware of oscillating not only between positive emotions and negative emotions, and approach and withdrawal, but also backwards and forwards in terms of functioning progress. One week I feel I am coping really well, feeling bright and cheerful and full of purpose, and then, without much warning, I’m weeping and desolate. Yesterday, for example, I cried about eight times, though the week before I’d been feeling really good. Having grieved over my mother, I’m at least aware that this is very common in bereavement. The gaps between bad patches seem to get longer and longer—at first there’s only a good day, then I’ll have a good few days, a week, or even a few weeks—and then, suddenly, I start to feel blue, a bit lacklustre, and the world turns flat again. Forward and back, forward and back the gradual progress goes.
Conjuring a mental picture of how we oscillate (approaching and withdrawing, approaching and withdrawing, up and down, back and forth) has helped me through the days and weeks. Sometimes there’s just no avoiding all those emotions, and I find the strength to lean into them, experience the lot and, in doing so, seem to get out the other side. At others I know I need to withdraw and avoid confronting my grief, even if momentarily.
Distracting activities give us the opportunity to recover, to build up our strengths, so we can do it all again. Similarly there are times when we need to retreat: to lick our wounds, put our heads on the table, and lie down exhausted. Approach, retreat, approach, retreat. And so it goes.
Here’s a list of the things I use to snap me out of my grief when it’s too debilitating and I know I need a break:
• Music—Spotify is my saviour, offering something for every mood. Don’t underestimate the power of music either to shift your mood when you get down or, at other times, just to reflect your feelings.
• Listen to podcasts—‘Desert Island Discs’ is my favourite because it takes people of wildly different backgrounds through their life stories and reminds me that most people experience massively unpredictable twists and turns and yet still get somewhere in the end.8
• Phone a friend—someone I know will make me laugh (usually my sister).
• Walk the dog—mad Jack, the Jack Russell terrier, always makes for a good diversion as he chases the shadows of seagulls or any passing motorbikes.
• Read—my Kindle is my number one source of distraction, particularly in the middle of the night when my mind is not a place I want to linger in.
• Netflix—spending time with my ‘other favourite men’ (that’s you, Ragnar Lothbrok, Tommy Shelby or even those idiots from Top Gear) works without fail.
• Going to the movies with Trevor (my real-life favourite man).
• Cooking/baking.
• Meeting friends for a drink.
Exercise in finding distractions
Distraction is important because grieving is an exhausting business. Do whatever occupies your thoughts and consumes your attention. Don’t be hard on yourself: if that means watching entire TV series, or getting lost in movies, or listening to talking books, then do it.
On the next page, list five things you can do to help take your mind off your loss. Remember, they don’t all have to be worthy. Claire Rushton’s tidying the teaspoon drawer is a great example of a simple activity she finds achievable and sufficiently distracting to draw her out of her grief and back into the world.
Five ways to distract your thoughts
1. _____________
2. _____________
3. _____________
4. _____________
5. _____________
When you are lying on the couch, or stuck in bed, which one of these is simple and accessible enough to get you up?
Chapter 9
Three habits of resilient thinking
PSYCHOLOGISTS HAVE BEEN INVESTIGATING the impact of our thinking processes on our resilience for more than three decades. Back in the classrooms at UPenn, Karen Reivich went to great lengths to explain that the way we think has a substantial impact on the way we feel and function. ‘Research conducted around the world shows conclusively that how we analyse the events that befall us has a profound effect on our resilience. How you respond to situations reflects something called thinking style. Thinking style is like a lens through which we view the world. Everyone has such a lens, and it colours the way we interpret the events of our life. Your thinking style determines your level of resilience—your ability to overcome, steer through, and bounce back when adversity strikes,’ Reivich and Andrew Shatté explain in their book, The Resilience Factor.1
Realistic optimism
Recent psychological studies have demonstrated that optimism is a key protective mechanism against depressive symptoms in the face of trauma, regardless of individuals’ culture of origin.2
Back in March, nine months after the girls died, I wrote a piece on my blog (www.1wildandpreciouslife.com) about trusting the process.3 Looking at it now, I can detect the optimism I felt. Not a full-blown clarion cry of optimism—I was still far too bruised for that—but a certain faith that somehow we’d get through. ‘As I try to wrap my head around what has happened to our family, and step uncertainly towards our own unknown future, I find myself resurrecting the mantra of one of my university professors, who, when navigating new terrain, constantly reminded us to “Trust the Process”,’ I wrote, going on to explain that ‘trusting the process doesn’t imply inertia, rather embarking on small steps forward in the belief that they’ll get you there in the end’.
At the time, I wouldn’t have recognised this as optimistic thinking. But, reviewing old lecture notes in which Reivich taught that ‘being conscious that the present might be bad but to keep looking forward to the future’ is the very essence of optimism practised by resilient people, I can see how my attitude fits this mould. She also told us that optimists focus on solutions when change is possible, and use acceptance and humour when it’s not. They’re also more accurate in their assessment of how much control they have, and less likely to deny and avoid problems.
I would not have described myself as optimistic through the first year after losing Abi but, in psychological terms, I can now see that I was. I turned away from being identified as a ‘victim’, baulking at the helpless connotations of that phrase; I knew what I could change and what I couldn’t. I knew there was no bringing Abi back, but I hoped we could find a way to get through the loss and survive it with our marriage, family and sanity intact.
OPTIMISTS FOCUS ON SOLUTIONS WHEN CHANGE IS POSSIBLE, AND USE ACCEPTANCE AND HUMOUR WHEN IT’S NOT.
Reivich and Shatté explain how this kind of flexible thinking style relates to resilience. ‘The most resilient people are those who have cognitive flexibility and can identify all the significant causes of the adversities they face . . . They are realists in that they don’t ignore the factors that are permanent or pervasive. Nor do they waste their valuable reserves of resilience ruminating about events or circumstances outside of their control. They channel their problem-solving resources into the factors they can control, and, through incremental change, they begi
n to overcome, steer through, bounce back and reach out.’4
The key words for me here are flexible and realist. In the lecture theatre, Reivich drummed it into us, time and again, that ‘realistic optimism’ is the key. On the basis that studies have demonstrated the pitfalls associated with runaway optimism (or as she would call it ‘Pollyanna optimism’, whereby people always assume everything will turn out for the best), realistic optimism requires maintaining a positive outlook without denying reality, appreciating the positive aspects of any given situation without overlooking the negatives. Resilience requires an accurate appraisal of the situation—extreme pessimism and extreme optimism only end in (more) tears.
To sum up, people who can think realistically and optimistically seem to work better with what they’ve got, differentiating more effectively between things they can change and things that are set, and working out a viable plan to deal with the elements that are in their control.
Redefining hope: What are you hoping for now?
The Chronicles of Narnia were my favourite books when I was a child. I remember how much I cried, at 13, when Aslan died. Decades later I went to see Shadowlands, the movie, with Trevor and my mum. In it, Anthony Hopkins, playing C.S. Lewis, the author of the Narnia books, describes his grief at his wife’s diagnosis with cancer and her death. The three of us sat in the cinema and sobbed. Years later, I still remember the words: ‘the pain now is part of the happiness then’.
Flicking through his memoir A Grief Observed more recently, I was struck by C.S. Lewis’s description of the happiness he and his wife, Joy, found together even ‘after all hope was gone’.5 It struck a chord with me and sent me scuttling off to re-read old lecture notes from one of my professors who described the power of hope in the context of death and grief. Chris Feudtner is one of those professors a student never forgets. A pediatrician at CHOP, the Children’s Hospital of Philadelphia, Feudtner told us how he uses psychological hope theory in his work in the children’s oncology department. I remember wondering what hope could possibly be present in such a place. Then he relayed to us Mason’s story.
Mason was three months old, and had already been in the hospital for two months when Feudtner met him and his family. Mason had a metabolic disease, and his parents had been told a week earlier that it was terminal. Feudtner recalled the moment when he asked the parents, ‘Given what Mason is up against, what are you hoping for?’ This, at first glance, seems like an absurdly insensitive question. What were they hoping for? For Mason to live, obviously, but they’d just been told that wasn’t going to happen. As far as they were concerned, all hope was gone.
But the rest of the story that Feudtner relayed that day gave us, his students, a remarkable and unique insight into the power and nature of hope. Until Feudtner became involved in Mason’s case, the hospital team’s goal was to get the baby to put on weight. But after careful coaxing and patient discussion with the parents, this remarkable doctor managed to discover that their greatest remaining hopes for Mason were to stop further testing, take him home, have him baptised, and for him to live what time he had left at home among his family. So that’s what they did. Mason went home with his family that day; he was baptised and died peacefully three weeks later. A year later, Mason’s parents went on to have twins.
Chris Feudtner described how inquiring about new hopes palpably changed the mood in the room for those parents, and the course of Mason’s treatment. ‘We had confirmed the worst news for parents but left them with hopes to look forward to. Pediatric palliative care is not all sad, there are moments of joy and celebration as to what it means to be alive,’ he explained. This experience had a huge impact on his career, which now sees him work with patients and their families around the notion of hope, even in the direst circumstances. ‘There are so many parents who feel lost because once the big hope was shut down nobody thinks to nurture their other hopes. In the face of no curative options, parents need a new goal to strive for.’ He now works to ensure that parents at CHOP get the chance to collaborate in the decision-making around their children’s outcomes by asking them quite simply, ‘So, what are you hoping for now?’ Answers to this question demonstrate that hope isn’t a single entity—humans don’t have just one hope, but a collection of smaller hopes. In the face of even terrible news, of something as final as death, other hopes remain or emerge; the process of hoping endures. Identifying these hopes is important.
HOPE ISN’T A SINGLE ENTITY—HUMANS DON’T HAVE JUST ONE HOPE, BUT A COLLECTION OF SMALLER HOPES.
In the immediate aftermath of the girls’ deaths my focus quickly became about reducing additional stress and narrowing my priorities and expectations. Setting myself a new goal of surviving, which started with just aiming for ‘mainly functioning’, I narrowed the goal posts to accept that any day I got out of bed and went through the motions of vaguely functioning was an achievement. My goals had shifted overnight and, while it was easy to think that all hope had gone, I still had other life goals and priorities.
Knowing what it was that I was aiming for (having a goal, however small) helped me work out which actions to take and changed my definition of success. I had forgotten about Feudtner’s work at the time, but looking back I wish someone had explicitly asked me to consider what my new, smaller hopes were.
There has been a great deal of research into the power and importance of hope for mental health over the last decade. For example, psychologists commonly recognise that hope counteracts mental illness and that hopeful individuals have a greater sense of meaning in life, and generally accomplish their goals more frequently, as well as doing better academically and in sports performance.6 Rick Snyder and Shane Lopez, the academic partners leading this body of research, describe how by generating the motivation (the ‘will power’) and pathways (the ‘way power’) to get where we want to go, hope helps shape our lives and defines our goals. Very often the presence of hope makes all the difference between coping and depression.
Having goals is important; the absence of a goal is almost like depression—feeling listless, and lacking interest and a feeling of control over our actions. These are not goals like meeting deadlines; they’re more about identifying what’s important to you—the things you value. Doing so helps you focus where you put your energy, time and commitment; the things you chase, and the issues and complaints you let go.
What matters now may not be the same as what mattered to you before the death of your loved one. As one woman explained to me, ‘Before my daughter’s death I was obsessed with how the house looked and having everything in its right place. These things seem utterly irrelevant now.’ Similarly, I read somewhere about a woman who, after the death of her husband, decided that what mattered now was staying healthy so that she could raise her children. She had previously cancelled two scheduled mammograms, but now she made sure she attended the appointments. Her motivations had changed, prompting a different course of action. Identifying your remaining or new, smaller hopes can be a worthwhile exercise.
Exercise in identifying hopes
Now that all hope of saving the person you love is gone, now that they are dead, what are you hoping for now?
Answering this question helps to identify the other, remaining hopes in life, and to in turn guide your decision-making. It helped me realise I did still have hope—multiple hopes, in fact. I hoped that we’d manage to survive this tragedy; that we’d stay sane; that we’d manage to remain a normal connected family; that my boys would be close friends and together cherish their little sister’s memory. Identifying these other hopes has helped guide my decision-making over the past months.
Given what you are up against, what are you hoping for now?
What’s important?
What’s going on from your point of view?
If we decide to do _________, is this decision taking us closer to our true goals?
What things do matter to you now?
What can you do to help you get there?
; Mindfulness
There’s been a great deal of talk about mindfulness in recent years. It is a word that gets bandied about with good reason: mindfulness is a powerful force. Greater mindfulness has been shown to be associated with a host of desirable outcomes, from reduced stress, anxiety and depression, and increased longevity, to better physical health (including greater immunity and reduced pain), improved relationships and greater wellbeing.
Like resilience, mindfulness is a multi-dimensional, dynamic construct. Put more simply, there are many elements to mindfulness. While my academic training introduced me to the concept of mindfulness, it wasn’t until the girls died that I truly came to understand its usefulness and particularly its relevance to grieving. Mindfulness is described in academic terms as ‘the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment’.7 In real life, that translates as being able to intentionally focus our attention, to fully attending to the present moment and successfully refraining from being easily distracted, and letting our thoughts wander aimlessly. Practising mindfulness is good for calming and focusing a racing mind. While mindfulness sits at the core of Buddha’s teachings, it is neither a belief, nor an ideology, nor a philosophy. Rather, explains Jon Kabat-Zinn, Professor at the University of Massachusetts Medical School, there is nothing particularly Buddhist about it. ‘We are all mindful to one degree or another, moment by moment. It is an inherent human capacity.’8
Although the best way to boost mindfulness is by developing a regular meditation practice (historically, mindfulness has been referred to as ‘the heart’ of Buddhist meditation), it doesn’t have to involve meditation; we can all be more mindful in our everyday lives. In this sense, two types of mindfulness are recognised: formal mindfulness practice, which involves daily meditation and breathing exercises; and informal mindfulness practice, which involves bringing mindful attention to all aspects of our day-to-day lives. This means making an effort to be aware of our thoughts, emotions, feelings and the environment on a moment-to-moment basis, and to keep our minds focused on the present rather than wandering aimlessly.