There are moments of time that are captured in eternity. The first “good” kiss, the first rhythm of childbirth, the first orgasm. Awareness of the extreme sense of being alive…in contrast to watching someone you love breathe labored breaths. The gift of being present and the privilege of being available to someone you love who is dying is sacred. Contrasts and contradictions…

For twenty three years I’ve worked with bereavement groups and individuals, being educated in this realm. However, reading the books, knowing the language system, the material is totally different when it comes home.

On June 22, 2001, my mother died at home in New York. I was with her, her granddaughters were with her, her sister was there. We talked to her, held her hand, gave her permission to die and gave her morphine for comfort-care. All of years of hospice training were blown away. It was my turn. Did I do well with it? I haven’t a clue what that would mean. People said I was strong. I didn’t particularly like that. At the end, she thought I was the nurse. My daughter Dana said, “Mom, did that bother you?” I said, “No, because I knew who she was. She was the mom that wove ‘genius sweaters.” As the years went on, I gave her complicated stitches and yarn, not because I needed sweaters but because it would become an excuse for her to come to L.A.

So many friends and family reached out to make things easier. I felt really blessed by two capable, competent grown daughters – one who writes grants for environmental protection and the other who oversees ten grants for the Department of Health in the area of AIDS.

The grieving overlapped my work, the work overlapped the mourning. One day I had two handbags in the car without a clue as to how one got there. I laughed. I remembered saying in the bereavement group, “You will put a cup of coffee down in one room and not know how it got there.”

Loving and dying are part of the same. If you love a person, by definition, one day they will not be there. Friends wrote me notes about “memories”, really nice words of comfort, and that helped. My group members were supportive and I, mindful that I was there as the therapist, not the participant, felt the circle of love widening. While working with a distraught patient, I encouraged her to volunteer and help others at a time when she was depleted. Now, the “Wounded healer” theory had new meaning. The healer, in healing the wounds of others is healing his own wounds.

Finally, I found it interesting that when called upon to write an article about H.O.P.E. that required something from a feeling place, I could do nothing more than a press release. My heart was not in it. The human feelings and emotions were going towards people, “talk” communication and work. I was losing temporarily the human touch in my writing. But, I knew that the energy was going to the groups, to my patients, just not yet available to me in producing “heart” words on paper. I gave myself permission for it to be what it was.

Loving and dying are part of the same circle of life. By being available to each other, we are part of the continuum of healing.

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The death of your spouse most likely turned your whole world upside down … out of balance. Everything seemed to change in your life … especially you. Your belief system, physical routines such as sleep, energy and eating, emotional stability, relationships … even your environment has taken on a different meaning. That feeling of safety, comfort and familiarity about your life no longer seems to exist.

Grieving is a difficult journey, as you already know. In the process you and your life will change. Learning to re-create a sense of balance is essential. Balance assists the healing process and maintains emotional, spiritual and physical health and stability.

An architect needs a blueprint to build a new masterpiece. A ship’s captain needs a compass and maps to reach his destination safely. As you build a new identity and life, you too can benefit from a “blueprint” or guide to creating balance in your life. I have created such a “map”, an acronym “S.P.A.C.E.”, which represents balance and stands for all the areas in which we spend time in our lives. If you learn to create balance around and within you, you can feel good about life again.

S: Spiritual – How do you spend time with your soul?

Maybe you are questioning your spirituality or religious beliefs and this may feel like a difficult area … one of confusion, anger, emptiness and possibly representing another loss. “If there were a God, why would he allow this to happen?” As you walk through the grieving process, you can find answers in many ways.

• Seek professional help through therapy or religious counseling.
• Plan ways to ease your soul and find some peace … sunsets, walks in nature, gardening; service to others, spending time with children; listen to nurturing music; practiced meditation and deep breathing exercises.
• Prayer – sometimes it’s nice to share your thoughts without getting advice and judgments.
• Begin a journal – write about one blessing that you have each day. Blessings are often “small” things that we take for granted, like our health, food and shelter. Everyone has blessings. You just need to acknowledge them.

P: Physical – how do you spend time with your body?

With your loss, your entire being may feel as though it has been traumatized. Physically, your strength and energy may have declined, leaving you feeling weak and exhausted. Along with depression and grieving, many of our physical habits are changed: SLEEP, you may experience insomnia, many awakenings or not wanting to wake up or get out of bed; APPETITE, you may be eating very little or wanting to stuff down all those feelings by eating too much, causing a loss or gain in normal weight; and, ENERGY, you may fee like you have to drag yourself to do even the smallest task, or maybe you keep extremely busy so you won’t have to feel.

This is the time to be aware of your body’s needs and to nurture it back to health and balance. Nurture your body and the awareness and feelings will follow.

• Exercise. This is a well-documents way to lift depression and energy. Walking for 20 – 30minutes three times a week is a great beginning. (If you have health problems, confer with your doctor.)
• Get outside. The natural Vitamin D from sunshine (in moderation) profoundly affects hormonal balance.
• Get a massage. Touch is often terribly missed after the loss of a spouse.
• Take a yoga class. Yoga poses improve blood circulation, which could improve your energy and feelings of lethargy.
• Deep breathing and meditation. Both help to lower anxiety and improve much needed sleep.
• Aromatherapy can alter brain chemistry right through your nose! Lavender, for example, induces restfulness for many.

A: Affect –How do you spend time with your feelings?

Affect is a psychological term for the range of ups and downs of your everyday feelings. You may feel as though you are no longer interested in pleasurable activities. That is normal. Do things to nurture and honor your feelings.

• Be around positive, supportive people. That’s why bereavement support groups are so important.
• Honor your feelings—there is healing in tears. If you find that you “can’t cry,” know that it may be time or maybe your tears have already been shed. Don’t judge them. Just let them be.
• Music can be a very healing therapy. Listen to music that you like. Slow and relaxing music can help you calm down and sleep better. It can also lift your spirits and let you sing.
• Seek professional help if you feel stuck or the pain is just too intense. It doesn’t mean that you are weak or “crazy,” rather in more pain than you can get through alone.
• Commune with nature. Visit the mountains, seashore or sit in your garden. Nature has a way of healing and lifting your spirits.
• Give yourself permission to laugh. It doesn’t take away form the grieving process. It honors the memory of your spouse and the life that you had together.

C: Cognitive – How do you spend your time with your thoughts?

Your thoughts are a very important part of the healing process that can either impede or support healthy grieving. Often, it is difficult to “turn off” your thoughts … fears about the future, memories about the past and anxious thoughts about what you will possibly do without your spouse by your side.

The way that we think affects the way that we feel which affects our behavior and the way that we perceive the world (i.e., “I’ll always be alone now.” = feelings of sadness, hopelessness = a behavior of staying home alone = a perception that the world is a lonely place).

Be aware of your thoughts and begin to learn to “reprogram” them to support your healing process, (i.e., “I feel lonely since my spouse died, but I’ll get through this with the help of others.” = feelings of hope and support = the behavior of going to a bereavement support group = a perception that you are not alone in this world).

• Begin to use “affirmations” (positive statements about yourself) such as “I am a strong, loving person who will survive.”
• Utilize a therapist to identify and change your thoughts.
• Write your thoughts in a journal. You’ll begin to see patterns and have a place to express your feelings.
• Take a class such as art, music or history, to expand your thinking.

E: Environment – How do I spend time in my environment?

Think about your environment, such as pets, plants, light, music, garden, pictures, people, etc. The way that we mold our environment has an effect on the way that we feel and think. Create your environment to work for you in this healing process, not against you. If a sad song comes on the radio that causes you distress, it’s okay to turn the knob to find a station that is uplifting.

• Clean up the clutter. If need be, have a friend or a professional organizer assist you. “Clutter creates confusion.” Right now you have enough confusion in your life.
• If you like spending time outdoors in nature, remember to do that. Often we sit inside in front of the TV or staring out the window. Energy follows energy. You need to move your energy and eventually more energy will follow.
• Be with positive people that you enjoy and like.
• Go places that you enjoy and/or feel safe (i.e., art museums and theater, a favorite park, temple or church).
• Music can be positively distracting and nurturing.

Think about the five areas of S.P.A.C.E.: Spiritual, Physical, Affect, Cognitive and Environment. Write “S. P.A.C.E.” vertically on a piece of paper and write your own ideas or activities in each of the five areas. This will become your “blueprint” to rebalancing your life. Plan to include something from each area of your life on a weekly basis. Eventually, one step at a time, one day at a time, your life will again begin to have balance and you will begin to heal.

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When you suffer the loss of a spouse, you embark on the difficult, lonely journey of grieving. Somewhere in the process of grieving, and healing, you will move through the “world in-between”. You might be thinking, “what is this world in-between? It must be a mistake. I’m not supposed to be here….but yet, I am. It no longer feels like my world.” Everything is changed…hopes, dreams, lifestyles, aspirations, family, friends…the life that you once knew is suddenly gone. Life no longer seems familiar, no longer feels comfortable, no longer is the one that you knew and created. There are so many changes, both externally and internally.

One of my grief group members once said "I feel like I'm living in a parallel universe since my husband died. I'm over here watching everyone else live life". .Suddenly, you feel like a "stranger in a strange land", living in a twilight place. The "world in between can be a confusing, painful and disorienting place. It’s the place that must be visited between an ending and a new beginning, between feeling hopeless and finding hope, between loss and beginning a changed life.

This is the place of transition, the place between an ending and a beginning, the place of being lost and of finding, of re-identifying and reinventing, the place of healing through grief and learning to integrate that your world has changed forever and will begin again. It will never again be the same…but you will begin again.

The book, “The Way of Transition: Embracing Life’s Most Difficult Moments” by William Bridges offers guidelines and knowledge for traveling through the “world in between”. Although he had written several other books and had been an authority on transition at a corporate level for many years, he best began to understand it as he went through his own grief process after the loss of his wife to cancer. After her death, this book was written from his personal experience and journey through his transition through and to his changed life Although his works apply to transition during any kind of loss, not just the death of a loved one, I will use some of his ideas to specifically address the loss of a spouse.

According to Mr. Bridges, there are six “ cardinal aspects of loss”.

Using some of Mr. Bridges thoughts, as well as my own, I will briefly explain and give examples of these concepts.

1. Dis engagement - the separation from your spouse through death. This separation occurs on many levels: physically, emotionally and mentally. It doesn’t mean that you will forget…
2. Dis identification - the way that the loss destroys your old identity. You’re no longer the person or the roles that you used to feel, believe or live. “If I’m no longer a wife/husband/caregiver, then who am I?”
3. Dis enchantment - the way that the loss tears you out of the old reality you accepted unthinkingly.
4. Dis orientation - how, as a result of losing the object of your feeling and the identity you had together and the reality you shared, you feel bewildered and lost.
5. Dis covery - the discovery of a new life, a new identity and a new outlook.
6. Dis loyalty - the idea that something new and meaningful can evolve after a death causes one to question if they are being disloyal to their deceased spouse

As you go through these stages of transition, you will begin to find light and to heal. It is normal to have loss. It is normal to grieve. It is normal to begin again. That is the way of life. I offer a few suggestions to help you through the process of grief/transition and healing.

1. If your grief is complicated, seek professional help from a licensed therapist.
2. Read books that will educate, support, bring comfort and inspire. Recommendations are available.
3. Having a transitional object, something that belonged to your spouse (i.e. ring, shirt, socks, picture, keychain) can bring comfort during a time when nothing seems to bring comfort. It’s ok to carry it with you, to touch it, to remember.
4. Talk to yourself in a way that perpetuates healing. The way you talk to yourself can make a difference. If you can, keep your thoughts in the present moment. Read inspirational thoughts that give you support and comfort. It’s too easy to feel hopeless and predict the worst by going into the future.. It’s not here yet…and you will change. Determining what the future holds will only reflect the pain that you feel now.
5. Having the belief that you can survive this loss and heal will help to bring hope, courage and something to hold on to. Some people find that their religion and faith give them support. Seek beliefs that support your healing and recovery.
6. Grieving is an individual journey. Making comparisons or judging others will not assist you in your healing. Trust that, with the support of others, you will heal…in your own unique way.
7. Seek support through friends, family and support groups. Being in a support group with others on a similar journey can feel comfort and reassurance during this difficult time.
8. Give yourself the time that you need to grieve and to heal. Sometimes you need to visit the grief. Sometimes you need to visit the distractions and resources in your life. Allow room for both. It’s the “space” in between where the healing begins.

I want to remind you that grieving, transition and healing are a process, not an event. It will take as long as it takes for you to travel this journey. You won’t do it “wrong”. You will do it the way that you need to heal. Statistically, it is believed that normal, healthy, uncomplicated grieving takes about 2 years. For some individuals, it will be shorter and for others, longer. Trust YOUR process and your journey. Trust that you, too, will heal. Trust that you will find life and light again.

My loving thoughts and heart go with you on your most difficult journey. I believe in you and your ability to heal...

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What is grief?

From the moment we're born, we begin to experience loss. We lose loved ones, cherished dreams, physical strength, work and relationships. The "Law of Impermanence" means that the older we get, the more we lose. Nothing stays the same. Often we experience loss upon loss, leaving us feeling overwhelmed and wondering how we will get through. Unfortunately, we are not often taught how to grieve. In addition, we often don't even know if it is “okay” to grieve.

In his book, Still Here , Ram Dass states:

"In a culture that emphasizes stoicism and forward movement, in which time is deemed "of the essence" and there is little tolerance for slowness, inwardness, and melancholy, grieving - a healthy, necessary aspect of life - is often overlooked."

Rather than recognizing death as the natural companion of life, death continues to be an enemy, something to fear. While we fear death, we don't fully live our lives.

By acknowledging death and learning how to grieve, we can learn how to allow ourselves to come out of our past and live fully in the present moment.

I would like to address a few aspects of the grieving process and ways to learn how to grieve.

During time of loss, it might seem as though you are more alone and lonelier than you have ever been in your life. Grieving is an "individual journey". Just as we go through the birth canal alone, we die alone, and in many ways, we grieve alone. No one else can cry for us, mourn for us or feel our feelings of pain for us. We have to do all of that. We often feel isolated from people who surround us...feeling different....alone. We realize that our pain is so deep that no one can else share it. As Rabbi Naomi Levy states in her book, Begin Again:

“Friends may empathize, but no one can live inside another person's wounded heart."

So, how does one heal?

Stephen Levine has recommended that we build temples specifically for the purpose of grieving, ritual sites where we can feel safe to pour out our sadness and loss. In the Jewish tradition, they sit Shiva. In the Irish tradition, they hold a wake. Rituals like these are becoming more rare in culture and infrequently practiced. It is so important to "honor" the feelings of loss and find a way and place to express them. Often I'm asked...."how long does it take". Each person's grief has its own timetable. The crisis stage of grief passes in time, but the deep feelings of grieve remain.

How does one find comfort in their suffering and grief? Even though no one can grieve your loss, others can provide a "space" for you to grieve. The presence of others can help to strengthen us, to provide a "container" for us to grieve...a safe place.

Just as in temples and churches people come together to pray and find strength, coming together in bereavement groups to grieve can provide strength during our time of loss. Being with others who are grieving normalizes our grief and the depth of our pain. Being with others who have a "knowing" of what you are going through helps you to realize that you are not "going crazy" and that you can survive the intense feelings and loss. They can provide support and friendships that lighten the loneliness. There is nothing like opening up your heart to someone who will listen. Coming together as a group to grieve can provide:

• A place to come together who others who understand and have a knowing about your journey....a "community" of support.
• A place to share your solitude and your silence
• A place to share your feelings, thoughts and beliefs.....and also learn by listening to others.
• A place to share your tears and sadness, anger and eventually your laughter and joy
• A place to share your hopelessness...and eventually your hope
• A place to experience the healing power of hugs
• A place to lighten your loneliness, find strength in support and often make lasting friendship
• A place to share your memories and keep them alive
• A place to find resources, both within and without
• A place to realize that we are connected, not by our physicalness, but by our invisibleness…our love, our memories, our kind deeds and the essence of who we are.

An excerpt from the poem by William Blake carries a hopeful perspective about life, death, grief and healing:

To see the world in a grain of sand,
And a heaven in a wildflower,
To hold infinity in the palm of your hand,
And eternity in an hour.

We are led to believe a lie!
When we see with...not through the eye.
Which was born in a night...
To perish in a night...
When the soul slept in beams of light.

Acknowledging, allowing., honoring, expressing and sharing your feelings are important in the process of grieving and healing.

Groups and community provide the opportunity for unity and connectedness. Connectedness provides the opportunity to come together to pray, to grieve and to heal.

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The issue of whether or not to take medication is a commonly posed question in the bereavement groups I facilitate. Many fear or have been told that medication will mask or inhibit their grieving process. Others who have been prescribed medications provide supportive subjective experiences, reporting that an anti depressant, anti anxiety medication or a sleep aid have actually assisted their ability to grieve with increased clarity and improved functioning overall.

In Grief Counseling and Grief Therapy, Dr. J. William Worden reports that it is more advisable to treat anxiety and insomnia with pharmaceuticals than a depression (depression being seen as a “normal” component of the grieving process). However, no research has been found to support that notion that antidepressants could pave the way for abnormal grief reactions.

While there is no definitive answer to the medication question, my observations do support the use of pharmaceuticals for “some” people given “certain” circumstances. For instance, if you are experiencing insomnia (difficulty falling or staying asleep, or sleeping too much) you may be experiencing a serious impairment of your daily functioning. While too much sleep could keep you from performing your essential daily functions (i.e., work, hygiene, child rearing, selfcare) sleep deprivation could result in heightened irritability or agit6ation, day fatigue, headaches and impaired reflexes, all posing a threat to yourself or others. In this case, a prescribed sleep aid or anti anxiety drug may be beneficial.

Sometimes anxiety becomes unmanageable or manifests itself as “panic attacks” which negatively impact your quality of life and challenge your natural grieving response. An antianxiety or antidepressant drug can oftentimes “cut the edge” of the anxiety and restore you to a more manageable and productive grief process.

We all know that one of the “natural” stages of grieving is depression. While it may appear acute during the first few months of mourning, it may also linger on well into the first or second year, though, generally less intense. While this is considered “normal”, each person possesses different coping strategies and tolerance levels for emotional pain and some have propensities toward major depressions, which could actually increase the risk of suicide. In either case, the depression becomes the main focus and can impair the grieving response. These individual cases need to be assessed carefully by a trained professional. Antidepressants may be utilized to restore emotional balance to the mourner.

Oftentimes, I will discuss that conservative measures to psychopharmaceuticals can be a first consideration. These measures may include good sleep hygiene techniques, to include a warm glass of milk before bed (the tryptophan in milk stimulates serotonin production known to aid the sleep process), a warm bath, soothing reading or music, a cup of herbal tea (non-caffeinated, i.e., chamomile or Sleepytime Tea). And should you have difficulty going to sleep after a10 to15 minute attempt, get out of bed and do something relaxing to decrease the association of insomnia with your bed. Many mourners report having ruminating thoughts at night and I suggest that they interrupt the barrage of unwanted thoughts with the repetition of a positive word, mantra, or affirmation, such as “peace and calm”, “relaxed and sleepy”, “I am at peace”, or “I am relaxed and calm”. Identify and experiment with the words or method that works for you.

Taking long, deep, slow breaths, expanding the lower lobes of the lungs (otherwise known as belly breathing) is an effective way of relaxing tense muscles and stimulating the parasympathetic nervous system (the part of the autonomic nervous system which promotes a relaxed state).

Many people are exploring alternatives to use in combination with or instead of traditional measures. Some of my clients have reported great success with herbal products and aromatherapy essences, as well as acupuncture, and massage to name a few. It is advisable to check with your own physician, based on your own health history, whether these products are suitable for you.

What works for one person may or may not work for another. Whether you are experiencing a “normal” grief related depression or an aggravated depression, an apathetic depression or an agitated depression, it is strongly advised that you be medically examined and professionally advised of a course of action depending on your individual circumstances.

Marcia Craig-Smith, Psy.D. is a licensed clinical psychologist in private practice with offices in Auburn and Grass Valley, California . For over 2 years she facilitated bereavement groups for the H.O.P.E. Unit Foundation in Los Angeles. Dr. Smith has worked extensively with caregivers of people with dementia, in addition to having been a program director of an older adult day service center. Dr. Smith has worked as a consultant with the Alzheimer’s Association of Los Angeles and Didi Hirsch Community Mental Health Center conducting professional trainings and program reconstruction. Since 1992, Dr. Smith conducted a Stress Reduction Workshop at Santa Monica College and is certified as a Master Clinical and Medical Hypnotherapist as well as a Yoga Instructor. Dr. Smith can be reached at (530) 320-6577 .

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1. We have the right to express our grieving in our own way, recognizing that we move through the stages of grief and not necessarily in any neat order.
2. We have the right to know that grieving is slow and hard work and people move through it at their own pace.
3. We have the right to express our feelings about grief and explore them.
4. We have a right to forgive ourselves for the things we think we “should” have done or “might” have done and realize that what we did in that moment of time was with the information at hand and we did the best we could with the knowledge we had.
5. We have the right to be ourselves and recognize our strengths and our limitations.
6. We have a right to participate actively in our mourning, remember the past with fond memories and allow ourselves to enjoy our lives again.
7. We have a right to move forward and speak of our pain, whether that makes people uncomfortable or not.
8. We have a right to go back and forth in our grieving, some days making progress and other days feeling as though we are slipping back.
9. We have a right to express our emotions and have others bear witness to our story.
10. We have a right to believe that we will have a whole life again..

Marilyn Stolzman, Ph.D.

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