Palliative care patients often face many challenges when making end-of-life decisions. This is especially true for people of faith, such as Christians and Muslims, who need to consider the spiritual consequences of such decisions.

The Government of Canada formally legalized Medical Assistance in Dying (MAID) in the years following the 2015 Canadian Supreme Court ruling in Carter v. Canada. MAID includes voluntary active euthanasia (VAE), defined as “clinician-administered medical assistance in dying” (Government of Canada, 2024). Given that VAE is now legal, palliative patients, including those that identify as Christian or Muslim, can now consider this option when making end of life decisions. For Christians and Muslims, VAE is not merely discouraged, it is forbidden. Here are 5 major reasons why VAE contradicts the fundamental teachings of their respective faiths:

1. Voluntary Active Euthanasia is Against the Sanctity of Life

This stems from the commandment Thou Shalt Not Kill for Christians; and the principle of No Harm, No Harassment for Muslims. Human life has inherent value because it is a gift from God.

2. Voluntary Active Euthanasia Ignores the Relational Dimension of Humans

Humans have a fundamental need for relationships. People who advocate for VAE may be ignoring the wishes of loved one who will be most impacted by such autonomous end-of-life decisions. As a result, end-of-life discussions between healthcare professionals and patients should also involve loved ones.

3. Voluntary Active Euthanasia Ignores the Spiritual Dimension of Humans

Good spiritual care allows individuals to find meaning in life and experience wellbeing despite their suffering (Wong, 2004; Wong & Yu, 2021). Therefore, by introducing VAE, it prevents the healthcare system and workers from recognizing the real needs of dying individuals, which is not the termination of life, but rather compassionate psychological, spiritual, and palliative care (Cherry, 2018, p. 3; Fitzgerald, 2019, p. 107). Only by providing such care can one truly respect the dignity of the dying individual.

4. Voluntary Active Euthanasia Leads to Worse Problems

Firstly, as Cherry (2018, p. 3) noted, this may lead to the discrimination of individuals in certain groups, such as the elderly and the terminally ill. In his view, by only offering euthanasia to these people, not only does the medical system isolates them from the rest of the population, but also suggests that their life is not worth living. Discrimination of vulnerable people goes against the respect of human dignity. Secondly, more troubling than just discrimination is if euthanasia became the norm. As Callahan (1992, p. 54) noted, this would equate to the legitimization of killing. The entire practice of medicine would be turned upside down if the definition of healing included intentional killing, a shift that has been called “Hippocratic anxiety” (Cherry, 2018, p. 4). Pratt (2017, p. 5) clearly lays out this slippery slope argument:

“Physicians – and society at large – could become accustomed to the idea that euthanasia is a cheap and convenient solution to suffering. This convenient solution might be seen as a preferable alternative to treatments which require greater resources or are more expensive.”

Thus, intentional killing, whether it is called murder or euthanasia, needs to be prohibited because one cannot clearly distinguish the two. As Sachedina (2009) noted, from an Islamic perspective, “there is no immunity in Islamic law for the physician who unilaterally and actively decides to assist a patient to die.” (p. 169)

5. Voluntary Active Euthanasia Rejects That Suffering Can be Beneficial

Although medicine is tasked with reducing suffering whenever possible, both Christianity and Islam also recognize the benefits of suffering, especially suffering that cannot be avoided. End-of-life suffering may be a blessing in disguise from a benevolent God because it provides new opportunities for both the patient and caregiver to live their faith at a deeper level. For Christians and Muslims, suffering helps develop virtues such as perseverance, patience, trust, faith, hope, and love, and grow closer to God. Furthermore, suffering is part of God’s larger plan to care for the faithful. Having faith means believing that God knows best. As a result, similar to Frankl’s (1946/1985) self- transcendence, patients can find meaning in their suffering because it may be for a higher purpose, and allows them to discover some value in their continued existence. For caregivers, end-of-life suffering is an opportunity to bear witness, inspired by the patient’s perseverance and courage in the face of terrible suffering. VAE ends any possibility that the patient will develop virtues, become closer to his or her God, or find meaning in their suffering. For Christians and Muslims, VAE is the ultimate turning away from God.

Further Readings

For more on Christian and Muslim perspectives on VAE, please consult the following resources:

• Brockopp, J. E. (2002). The “good death” in Islamic theology and law. In J. E. Brockopp (Ed.), Islamic ethics of life: Abortion, war, and euthanasia (pp. 177–193). University of South Carolina Press.
• Callahan, D. (1992). When self-determination runs amok. Hastings Center Report, 22(2), 52-55.
• Catholic Church. (1995). Catechism of the Catholic Church. Image book.
• Cherry, M. J. (2017). The scandal of secular bioethics: What happens when the culture acts as if there is no God? Christian Bioethics, 23(2), 85–99. https://doi.org/10.1093/cb/cbx006
• Cherry, M. J. (2018). Physician-assisted suicide and voluntary euthanasia: How not to die as a Christian. Christian Bioethics, 24, 1–16. https://doi.org/10.1093/cb/cbx021
• Choudry, M., Latif, A., & Warburton, K. G. (2018). An overview of the spiritual importances of end-of-life care among the five major faiths of the United Kingdom. Clinical Medicine (London, England), 18(1), 23–31. https://doi.org/10.7861/clinmedicine.18-1-23
• Daar, A. S., & al Khitamy, A. B. (2001). Bioethics for clinicians: 21. Islamic bioethics. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne, 164(1), 60–63.
• Fitzgerald, J. J. (2019). A considerably common morality: Catholic ethics and secular principlism in dialogue. Christian Bioethics, 25(1), 86–127. https://doi.org/10.1093/cb/cby016
• Ghuddah, A. S. A. (2016). Governing principles of Islamic ethics in medicine. In M. Ghaly (Ed.), Islamic perspectives on the principles of biomedical ethics: Intercultural dialogue in bioethics book 1 (pp. 263—291). World Scientific Publishing Europe Ltd./Imperial College Press.
• Lozano, A. J. (2004). Principles of bioethics for Christian physicians: Autonomy and respect. The Linacre Quarterly, 71(2), 104–113. https://doi.org/10.1080/20508549.2004.11877708
• Mattson, I. (2002, July 17). Dignity and patient care: An Islamic perspective. Ziyara: Muslim Spiritual Care. https://ziyara.org/resources/dignity-and-patient-care-an-islamic-perspective/
• Michel, T. S. J. (2010). God’s justice in relation to natural disasters. In I. M. Abu Rabi (Ed.), Theodicy and justice in modern Islamic thought: The case of Said Nursi ( 219–226). Routledge.
• New International Version (NIV) Bible. (2011). New International Version (NIV) Bible Online. (Original work published 1978)
• Pratt, E. (2017). The legalization of physician-assisted suicide. Aporia, 27(1), 1–10. https://aporia.byu.edu/pdfs/pratt-legalization_physician_assisted_suicide.pdf
• Qur’an. (S. H. Nasr, Ed.). (2015). HarperOne.
• Rouzati N. (2018). Evil and human suffering in Islamic thought—Towards a mystical theodicy. Religions, 9(2), 47. https://doi.org/10.3390/rel9020047
• Sachedina, A. (2009). Islamic biomedical ethics: Principles and application. Oxford University Press.
• Tayeb, M. A., Al-Zamel, E., Fareed, M. M., Abouellail, H. A. (2010). A “good death”: Perspectives of Muslim patients and health care providers. Annals of Saudi Medicine, 30(3), 215–221. https://doi.org/10.4103/0256-4947.62836.

References

Cherry, M. J. (2018). Physician-assisted suicide and voluntary euthanasia: How not to die as a Christian. Christian Bioethics, 24, 1–16. https://doi.org/10.1093/cb/cbx021

Fitzgerald, J. J. (2019). A considerably common morality: Catholic ethics and secular principlism in dialogue. Christian Bioethics, 25(1), 86–127. https://doi.org/10.1093/cb/cby016

Frankl, V. E. (1985). Man’s search for meaning. Washington Square Press. (Originally published in 1946)

Government of Canada. (2024, March 1). Medical assistance in dying: Overview. https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

Pratt, E. (2017). The legalization of physician-assisted suicide. Aporia, 27(1), 1–10. https://aporia.byu.edu/pdfs/pratt-legalization_physician_assisted_suicide.pdf

Sachedina, A. (2009). Islamic biomedical ethics: Principles and application. Oxford University Press.

Wong, P. T. P. (2004). Compassionate and spiritual care: A vision of positive holistic medicine. International Network on Personal Meaning. http://www.meaning.ca/archives/archive/pdfs/wong-spiritual-care.pdf

Wong, P. T. P., & Yu, T. T. F. (2021). Existential suffering in palliative care: An existential positive psychology perspective. Medicina, 57(9), 924. https://doi.org/10.3390/medicina57090924

The post 5 Reasons Why Christians and Muslims Reject Euthanasia appeared first on International Network on Personal Meaning.

Are we still a civilized people governed by the rule of law? Have we regressed to barbaric savages in a jungle? Why can’t all the progress in psychology, education, and political science prevent ruthless dictators from murdering innocent people?

More specifically, how can positive psychology help when ordinary people go about their daily business of going to school, enjoying family time, or doing the things they enjoy, but in a split second, find that their happiness and dreams gone up in smoke and reduced to ashes?

As a War Baby, I Know How it Feels to Live Under Attack and Occupation by an Enemy

I feel their pain deeply because I was born in the year when Japan launched a full-scale invasion of China and committed the Nanking massacre, which made Japan the enemy of the international community (Dedes, 2020).

For a period of six weeks the soldiers of the Imperial Japanese Army had a killing orgy, murdering over 300,000 people, with widespread rape and looting. Millions of refugees escaped to safer areas before the army seized control of Nanking. My wife’s family were among the displaced.

Living in Tianjin did not spare me from the horrors of war. Just imagine that you are a little boy (about five years old) and you witness a group of Japanese solders bursting into your house, threatening your family with bayonets, and ordering your family to vacate your residence to the Japanese. Worse still, you aren’t even allowed to take your belongings, not even your favourite toys.

Naturally you would feel shocked and angry. Deep down in your child’s heart, you already know that what they did is wrong and unfair, but no one has the power to stop them.

The same night, all my family had to move out, and I was sent to a relative’s house alone to spend the night in their basement on a wooden board infested with lice. Added to my trauma of being ejected from my own house by force, I felt abandoned and thrown into a dark pit to rot.

This horrible experience might be the seed of my lifelong interest in existentialism and resistance to the naïve idea that the world is safe and sweet. It may also be the reason why I felt the calling to learn more about human nature and how to end suffering.

Based on my own experience and all my knowledge about human nature, I have come to the conclusion that the enterprise of pursing happiness only for oneself is doomed to fail, because we are more interconnected as a human family, and many are suffering. Even when I try to enjoy my food and simple pleasure, the sight and sound of human suffering in Ukraine still fills my heart with grief.

The Horrors of the Vietnam War and the “Boat People”

Human history is a bloody one. Not too long ago, we witnessed the humanitarian crisis in Afghanistan. Further back, we had the Vietnam war, Korean war, and World War II.

One only needs to watch the film Apocalypse Now Redux (Coppola, 2001) to have a sense of the madness and atrocities of the Vietnam war. It tells a powerful story showing how ordinary people are capable of doing very horrible things to other humans. During that war, so many innocent people were killed or wounded, not including the soldiers on both sides of the conflict.

Perhaps, the following photo of the naked “napalm girl” visually tells the pointless brutality of the Vietnam war. Kim Phucin was only 9 years old in 1972 when she was photographed, screaming and running in pain after a U.S. commander ordered South Vietnamese planes to drop napalm bombs near her village.

Burns covered about half of her body, but miraculously she was able to find refuge and healing. Eventually, she grew up to be a beautiful woman with forgiveness and joy in her heart. She has devoted her life to be a motivation speaker in Canada (Stockton, 2017).

Her story restores some faith in humanity and gives us hope that most of the refugees have the resilience to survive and thrive regardless of the trauma they have gone through. I can bear witness that she is just one of the many success stories of refugees from Vietnam.

In the early 80s, while I was still a professor at Trent University in Peterborough, I was personally involved in helping hundreds of “boat people” to resettle. Some of them even came to our home each week for fellowship and Bible study; they were able to share their stories with us while their children played with our children.

Some were raped by the pirates. Some witnessed their family members killed by North Vietnamese solders. Most of them had endured terrible ordeals in their escape from Vietnam, as shown in the following photo (Do & Tran, 2021).

One may wonder what has happened to these “boat people”? I am pleased to say that with their work ethics and willingness to do anything to rebuild a new life in Canada, most of the people that came through my house (as seen in the next photo) have done very well. This picture shows a gathering of refugees, sponsors, local families, and foreign students in my home for some special celebration.

I can provide a long list of accomplishments of these “boat people”, but this may embarrass some Canadians who have not gone through the ordeal by fire and water. Here, I just want to mention the Minh van family. Minh van’s sponsor wanted him to work in his furniture store, but Minh told me that he really wanted to start his own business.

After some negotiation with his sponsor, Minh was allowed to start a small booth in Peterborough’s farmers market, selling home made Vietnamese spring rolls. On some Saturdays, I was able to see how he and his wife operated their business with their broken English but with inviting smiles.

From such a humble beginning, with hard work and resourcefulness, they were able to grow a successful business. Minh’s whole family are in this picture. Years later, their daughter became a pharmacist, and all their sons also became professionals – chartered accountant, optometrist, and physiotherapist. Most amazingly, the tiny booth in farmers market has become a well-established Chinese grocery store as show in the photo of Minh’s Chinese Grocery.

Their success did not come by chance. A great deal of hard work, sacrifice, and discipline have gone into it. They did not complain or protest but put their hands to the plow and turn a desert into a productive farm. Their success provides support of my brand of existential positive psychology – flourishing comes from overcoming suffering.

The Best Possible Life of Flourishing Through Suffering

There is already a great deal of research supporting my suffering hypothesis (Wong, 2021a). More recent research evidence shows that our psychological immune system is stronger than we thought (Aknin et al., 2021; Bonanno, 2021). We can even become better and stronger through suffering according to the new science of existential positive psychology (EPP or PP2.0; Wong, Mayer, & Arslan, 2021), and happiness is possible even in palliative care and for chronical pain patients (Wong, 2022; Wong & Yu, 2021).

In fact, it is an impossibility to have a life full of happiness without suffering as illustrated by the story of the historic Buddha (Lopez, 2020). Recent research has supported this hypothesis, such as research on tragic optimism (Leung et al., 2021) and self-transcendence (Wong, Mayer & Arslan, 2021).

The following principles represent the 7 principles of flourishing through suffering:

1. Accept life as it is with gratitude.
2. Believe in creating a better future with help from Providence.
3. Commit to worthy goals and a life purpose.
4. Discover the hidden treasures by digging deeper.
5. Enjoy and value life.
6. Fear (God) and obey boundaries.
7. Love others as yourself.

A great deal has been written about the above principles. For example, acceptance is the key not only to a meaningful life (Wong, 1998), but also to resilience (Wong 2013; Wong et al., 2006).

The first five principles are the pathways to resilience (Wong, 2016a). The last two principles represent the two greatest commandments taught by Jesus (Matthew 22:36-40); they are the universal principles of spiritual happiness of love, joy, and peace (Galatians 5:22-26). I plan to write a book about these principles of positive mental health.

Conclusion

Suffering is unavoidable and inescapable. The only way to survival and flourishing is learning how to overcome suffering. According to the first Noble truth, life is suffering.

In addition to our inner demons, there are also systemic problems and evil people who can make our lives miserable. History has shown that neither the psychology of happiness nor scientific progress can automatically eliminate suffering. However, there are ways one can overcome and transform suffering, but it requires sacrifice, discipline, and collaborative efforts.

Practicing all the above seven principles daily will transform you into a self-transcendent person. The psychology of the last century may be described as self psychology, with its research agenda focusing on such themes as internal locus of control, self efficacy, self esteem, self-actualization etc. I propose that the new paradigm of psychology for the 21st century is self-transcendence. This is partly dictated by the changes in society and partly by the new trends in research.

The concept of self-transcendence is not new. Frankl’s (1946/1985) concept of the search for meaning revolves around self-transcendence, Maslow’s (1971) revised need hierarchy placed transcendence as the crowing glory of human development. Recently, Kaufman (2020) has extended Maslow’s work and I have extended Frankl’s work (Wong 2016b, 2021b; Wong et al., 2021).

Until there is a re-orientation from ego to others, from self-enhancement to self-transcendence, we will not be able to end suffering and transform it to flourishing. We will also not be able to experience selfless happiness. However, self-transcendence can become our second nature, when we are practicing the activities listed in the previous three sections.

May we catch the vision of self-transcendence. Let our hearts be moved by compassion for the suffering masses. Let our souls be set aflame by the passion to save people from the bondage of suffering into the spiritual happiness of love, joy, and peace. We trust that not only refugees, but all people can become contributing citizens and live productive, fulfilling lives, if they are willing to pay the price of living a responsible and meaningful life.

References

Aknin, L., Zaki, J., & Dunn, E. (2021, July 4). The pandemic did not affect mental health the way you think. The Atlantic. https://www.theatlantic.com/ideas/archive/2021/07/covid-19-did-not-affect-mental-health-way-you-think/619354/

Bonanno, G. A. (2021). The end of trauma: How the new science of resilience is changing how we think about PTSD. Basic Books.

Coppola, F. F. (Director). (2001). Apocalypse now redux [Film]. Francis Ford Coppola and Kim Aubry.

Dedes, I. (2020, December 22). The massacre that made Japan the enemy of the International Community. The Medium. https://medium.datadriveninvestor.com/the-massacre-that-made-japan-the-enemy-of-the-international-community-12027bf847b4

Deutsche Welle. (2022, March 9). Russia admits to use of conscripts in Ukraine invasion — as it happened. https://www.dw.com/en/russia-admits-to-use-of-conscripts-in-ukraine-invasion-as-it-happened/a-61059223

Do, A., & Tran, M. (2021, September 3). As children of Vietnamese refugees, we believe Trudeau must do more for Afghan migrants and refugees. Toronto Star. https://www.thestar.com/opinion/contributors/2021/09/02/as-children-of-vietnamese-refugees-we-believe-trudeau-must-do-more-for-afghan-migrants-and-refugees.html

Frankl, V. E. (1985). Man’s search for meaning. Washington Square Press. (First published in 1946)

Kaufman, S. B. (2020). Transcend: The new science of self-actualization. Tarcher Perigee.

Leung, M. M., Arslan, G., & Wong, P. T. P. (2021). Tragic optimism as a buffer against COVID-19 suffering and the psychometric properties of a brief version of the life attitudes scale (LAS-B). Frontiers, 12, 646843. https://doi.org/10.3389/fpsyg.2021.646843

Lopez, D. S. (2020, February 19). Buddha: Founder of Buddhism. Britannica. https://www.britannica.com/biography/Buddha-founder-of-Buddhism

Maslow, A. (1971). Farther reaches of human nature. McGraw-Hill.

Stockton, R. (2017, June 6). The true story of Phan Thi Kim Phuc, the “Napalm Girl” All That is Interesting. https://allthatsinteresting.com/napalm-girl

Wille, B. (2020, December 17). Why are Russians paying for bombing schools in Syria? Human Rights Watch. https://www.hrw.org/news/2020/12/17/why-are-russians-paying-bombing-schools-syria

Wong, P. T. P. (1998). Implicit theories of meaningful life and the development of the Personal Meaning Profile. In P. T. P. Wong, & P. Fry (Eds.), The human quest for meaning: A handbook of psychological research and clinical applications (pp. 111-140). Erlbaum.

Wong, P. T. P. (2013, October). Acceptance and well-being: A meaning-management perspective [Invited lecture]. Presented at Lotus Hospice Care Foundation, Taipei, Taiwan.

Wong, P. T. P. (2016a). Integrative meaning therapy: From logotherapy to existential positive interventions. In P. Russo-Netzer, S. E. Schulenberg, & A. Batthyány (Eds.), Clinical perspectives on meaning: Positive and existential psychotherapy (pp. 323-342). Springer.

Wong, P. T. P. (2016b). Self-Transcendence: A paradoxical way to become your best. International Journal of Existential Positive Psychology, 6(1), 9. https://www.meaning.ca/web/wp-content/uploads/2019/10/178-13-321-2-10-20171211.pdf /

Wong, P. T. P. (2021a, December 20). The suffering hypothesis: How the new science supports the ancient wisdom of meaningful suffering [President’s Column]. Positive Living Newsletter. https://www.meaning.ca/article/the-suffering-hypothesis-how-the-new-science-supports-the-ancient-wisdom-of-meaningful-suffering/

Wong, P. T. P. (2021b). The Frankl cure for the 21st century: Why self-transcendence is the key to mental health and flourishing. The International Forum for Logotherapy, 41(2), 33-50. Doi: 10.31234/osf.io/tbx3f

Wong, P. T. P. (2022 March 14). My conversation with the National Institute of Aging regarding their death and dying workshop [Invited Talk]. US National Institute on Aging. http://www.drpaulwong.com/national-institute-of-aging-death-and-dying-workshop

Wong, P. T. P., & Yu, T. T. F. (2021). Existential suffering in palliative care: An existential positive psychology perspective. Medicina, 57(9), 924. https://doi.org/10.3390/medicina57090924

Wong, P. T. P., Arslan, G., Bowers, V. L., Peacock, E. J., Kjell, O. N. E., Ivtzan, I., Lomas, T. (2021). Self-transcendence as a buffer against COVID-19 suffering: The development and validation of the Self-Transcendence measure-B. Frontiers, 12, 4229. https://doi.org/10.3389/fpsyg.2021.648549

Wong, P. T. P., Mayer, C.-H., & Arslan, G. (Eds.). (2021). COVID-19 and Existential Positive Psychology (PP 2.0): The new science of self-transcendence [Special Issue]. Frontiers. https://www.frontiersin.org/research-topics/14988/covid-19-and-existential-positive-psychology-pp20-the-new-science-of-self-transcendence

Wong, P. T. P., Reker, G. T. & Peacock, E. (2006). The resource-congruence model of coping and the development of the Coping Schema Inventory. In P. T. P. Wong, & L. C. J., Wong (Eds.), Handbook of Multicultural perspectives on stress and coping (pp. 223-283). Springer.

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This book provides an “existential positive psychology framework” (p. 3) for mental health clinicians whose clients are struggling with issues that have no solution or hope of resolve. The framework helps these clients learn to live positively, in spite of their suffering.

The husband-and-wife authors—a clinical psychologist and a clinical social worker—explain that their personal suffering catalyzed writing the book. One of the author’s brothers died of a genetic medical condition, and the doctors warned the author that he could also have inherited the disease. One more complication was the doctor’s warning that having kids was too risky. Years later, under medical advice, the authors planned a family but were infertile. “Our story was not a cognitive distortion; our suffering was not a set of irrational thoughts that needed to be corrected. No amount of therapeutic mental gymnastics could make us feel unbroken” (p. 4).

Mainstream psychological therapies, say the authors, offer little help to those suffering from irremediable conditions. “Boiled down to its most basic level, many clinical approaches view suffering as a problem to be fixed, and then, once the symptoms subside, disregard the effect of the event itself” (p. 5). The authors argue that we need another form of therapy, one focused on meaning.

Meaning, for the authors, is about coherence (making sense of one’s life), significance (feeling that my life matters), and purpose (choosing a direction). Yet for those plunged into life-altering conditions, a felt sense of meaningful living disappears. They suffer from “existential themes”: groundlessness (loss of control, burden of freedom), isolation (being alone), identity (determining who I am), and death (loss). How does one find direction in life when they struggle to answer Who am I? How does one feel their life is significant when they feel their lives are out of control? How does one make sense of one’s life when the ground under them feels marshy?

The clinical framework to help such clients is a five-phase plan, couched in a sunset to daylight metaphor:

• Sunset (“the sting of suffering”): Typically, clients feel senseless and out of control, and they develop a negative self-view. Their assumptions of who they are and what their world is like are shattered. The authors borrow the term depressive realism to describe this phase. The idea of depressive realism is that having a low mood enhances the ability to see the world (and one’s self) more objectively and accurately. The role of the therapist is to understand how clients make sense of things and help them stabilize.
• Dusk (“into the darkness”): The goal of this phase is acceptance of reality. Whatever coping skills clients have relied on—problem-focused, emotion-focused, or avoidance—no longer work for them. They feel the depth of their suffering but cannot name it and so cannot explore it. This is a difficult phase for clients, and the therapist helps them learn emotion self-regulation. Emotion regulation is required to face struggles and work through them, which the authors describe as “Pushing into the pain” (p. 66).
• Midnight (“the deconstruction process”): Most (mainstream) therapies end before this phase. Yet, it is precisely at this point that clients actively question many of their deeply held beliefs, which no longer resonate with their reality. Such reflection “will begin to rid themselves of whatever does not feel authentic” (p. 79). The therapist helps the client actively question how they have been making sense of their suffering, themselves, and the world around them.
• Dawn (“the reconstruction process”): The client reconstructs beliefs, but this time in ways that are authentic to their suffering. This process helps clients “revise their identity” (p. 14). This phase is essential for the client to develop autonomy, becoming the active authors of their lives. The therapist helps clients through this phase by guiding clients on revising their narratives.
• Daylight (“living authentically”): “Choosing a life that fits with their revised beliefs and identity” (p. 14). The therapist supports clients in their revised identities and realities.

This five-phase plan aims to help clients by “building meaning in life” (p. 12), and specifically finding meaning in their suffering. The authors tell us that meaning is so important because (1) research suggests it is integral to positive client outcomes; and (2) “meaning can transform already deeply painful experiences into something more without invalidating or excusing them” (p. 12). Essentially, if a client finds meaning in suffering, then they are able to transcend it.

As clinicians, the authors are more interested in practice than theory. This is not a book probing into the nature of meaning and purpose. To that end, many of the theories they cite are touched on only briefly, such as Dweck’s growth versus fixed mindset or Rotter’s locus of control. We don’t know why the authors looked to Dweck and Rotter, rather than others. Similarly, we don’t find much exploration into the nature of the research presented to support each of their therapeutic phases.

But the book’s purpose is not to deal with these issues. It’s intended to show therapists how to work with suffering at an existential level. And it regularly cautions therapists that existential issues are very human ones, which affect the therapist as much as they do the client. Working with clients whose problems are life-changing demands the clinicians, themselves, explore the meaning they give to these clients and their problems.

On a personal note, what is particularly fascinating about the phases of therapy is that they are similar to the program I developed at a residential facility for men suffering from addiction and other mental health issues. I have never met the authors or read their work before reading The Courage to Suffer. Yet the authors’ therapeutic direction—experiencing shattered assumptions about self and world, accepting reality no matter how bleak, deconstructing current narratives, reconstructing new life narratives, and supporting clients in their new ways of making sense of themselves and the world—are precisely how we help clients.

The post Descriptive Review of The Courage to Suffer appeared first on International Network on Personal Meaning.

As could be imagined, this was very hard for our family. Nonno was always healthy, never sick; so this was a big shock. He was slowly loosing his memory as the years went by, but this year was definitely the hardest. When my Nonno forgot who I was, I did not know how to take it all in. I understood what the disease did to the brain and no one could stop the process of the brain dying. I took it very hard, but I did not let my emotion get the best of me, I pushed my feelings aside and accepted it.
In April 2006 my Nonno was sent to a nursing home. This was a very difficult decision for his sons and his wife. It was like leaving a new born baby with a babysitter. I never wanted to visit the nursing home, because it hurt too much to see him there. I thought if he did not know who I was, what was the point? My dad went all the time, as well his brothers.

I finally decided I needed to go to the nursing home. When I did, I hated every moment there. Watching him deteriorate right in front of my eyes, I could do nothing to help him. I realized I did not want to go to the nursing home because watching him die made me feel helpless. Every time my Nonno saw us, he thought he was going home. But we had to lie to him, telling him, “No, Nonno you have to stay here, because you have to work and the new house is being built.

So, Nonno stayed and he waited. Even though he was in the nursing home, in his mind he was still working. One day Nonno used the chair as a vacuum cleaner. That was the first job he had when he first came to Canada, at The Bay. He was reliving his earliest years in Canada.

Dying and death of Nonno

Nonno was in the Nursing home for 6 months before he passed away. He began to get very sick around the end of September and we all had very strong intuition that he would die very soon. The first time we took Nonno to the hospital was for not wanting to eat. For Nonno that sounded crazy. Eating was what Nonno loved, even in the nursing home. He never turned away his food and it kept him alive. When he turned away food we knew it was only a matter of time. But the hospital kept turning him away, telling us he was fine and that he would resume eating soon.
The next visit to the hospital was because he fell and hit is head very badly and the scar was still there when we buried him. The last visit to the hospital was when he was vomiting all day in the Nursing home. My dad brought him to a different hospital, Saint Joseph’s in Toronto. This time Nonno never left the hospital and he was diagnosed with Stomach Cancer. We could not believe how ironic it was that what Nonno loved the most, and what kept him alive, was what finally killed him.

Anticipating that Nonno might die any time was very hard. The doctors prepared my family, with the greatest compassion at heart. The doctors told us how the cancer will eat him away, and what will shut down first in his body. Because Nonno was 92 he would not be getting any treatment for cancer. Therefore, we had to watch him die. I went to the hospital once, before he was diagnosed, because I had a feeling he would die very soon. It was such a busy time in the semester of school, but I knew I needed to see him one last time, even though he did not remember me.
When I saw him, he was very thin. Nonno was always a bigger man, hence his love for food. But in my memory Nonno was always strong. When we went to see Nonno, he said “finally you here, take me home.” My dad had to tell him that he was sick and the doctors needed to take tests. Nonno did not understand this, because, never in his life was he in the hospital; he felt tied down and useless. The nurses kept telling us that he was trying to escape when we were not there.
When Nonno figured out we were not taking him home, he thanked us for visiting and asked us to leave. We laughed, and told him we were not leaving and that we would stay with him for a little longer. When I finally said goodbye to Nonno, I kissed him on the forehead for the last time. Tears flew from my eyes as I left the hospital.

On the Thursday before he died, Nonno called my Nonna (grandmother) “Ma” because of his memory loss. That day he called her Maria and asked her to tell everyone that he wanted to say goodbye and this was life. On that Saturday October 28th Nonno passed away.

An Italian family

Let me first introduce you to an Italian family. Italians, to begin are incredibly family orientated, my grandparents were my baby-sitters, and I saw them once a week for as long as I could remember, both set of grandparents. Every holiday, every birthday, which, there were two every month, was another party. Let me just say my grandparents were very much a part of my life. They spoiled me; they gave me culture and tradition, they taught me what it was to be Italian. How to cook Italian, how to love each other, and most of all they taught me everything there was to know about their life. For example, My Nonno worked from the time he was 6 years old to help out in his family, and every time he saw me he would tell me the stories of his youth.

My Nonno also made wine, exceptionally good wine, that was his water growing up, that was all he drank. Every time we went over to visit, we had to drink his wine, it was a must. The Garden was also my Nonno’s life, it was a beautiful garden, he had pear trees, a fig vine, a grape vine, you name it, he had it. Often when I went over, we would get a tour of how things were growing, what fruit and vegetables looked like when they were ready, and the stories could go on forever.

Nonno taught me a lot about life, and that we need to work hard for everything. Which was a very important lesson for me, working hard, nothing in this life comes easy, and we must do everything with our best effort. So as it can be seen, to Italians, family, food, wine and love is everything, when one of passes away it is a tragedy, the chain is broken.

The death and mourning

When we all found out Nonno died, life stopped, and family was the only thing that mattered. I left work and immediately went to the hospital. In the hospital in critical care, my Nonno was surrounded by his whole family, there was about 30 people gathered together. It was a very loud gathering and often the nurses had to tell us to keep it down, very embarrassing. Even close friends to my grandparents had to come.

We stayed with Nonno until his body had to be taken away to the morgue. Now Italians are very dramatic people, my aunts were screaming and crying. Right after the body was taken away we went directly to my Nonna’s house; now keep in mind this was 1:00pm on a Saturday. The immediate family stayed with my Nonna for dinner, and then visitations at the house began. This visitation lasted for hours, and we saw at least 20 different people.

To paint a picture of what the evening looked like: My Nonna had a huge table in the basement, and there were 20 people sitting at this table. There was a tremendous amount of food, cookies, buns, cheese, pizza, everything. Even though it was a sad occasion there was not one moment of silence.

I left my Nonna’s house at 10:00pm. Exhausted and traumatized, I went home confused and not looking forward to the events to follow. The next morning we did not attend church, because Sunday was the first viewing and lunch was being prepared for the whole family.

An Italian funeral

During Italian funerals there are many customs and traditions that must be followed. So we went to Nonna’s house and helped her around the home. The funeral home had everything ready for us regarding the viewing. The second viewing was on Monday then the burial on the Tuesday.

Sunday was an extremely long day. We arrived at the funeral home, and seeing my Nonno in the casket was very hard. The reality would not sink in that he was dead. The body that lay in front of me looked like someone else, someone I did not know. My cousin had lost her Nonno a while ago and was a little more familiar with the events to follow. She was able to kiss him and touch him. I could not — I felt strange touching something dead. The tears did not stop; they flowed down my face throughout the night. People came to see us and giving us words of comfort. All I could do was to stare at the casket, trying to let everything sink in, but it did not.

Kissing and greeting is a big part of an Italian family. A lot of people came the first evening to give their condolences. Meanwhile my Nonno’s only brother that was in Canada (Zio (uncle) Peppino) was in the hospital for intestinal problems. Ironic? He was trying to get released from the hospital so that he could be with his family. I kissed and greeted every older person I could ever imagine. They all told me how they remembered me when I was little.

The funeral home was loud and people standing every where, in general the funeral was incredibly dramatic. After the viewing we went to my Nonna’s house again as there was food prepared for us to eat. Food is the most important part, because it gives us the strength to continue especially during this time.

The next day was the next viewing. To Italians, the people that come to visit are very important. People from my father’s work came, from my uncle’s work came. Many friends and family members came. It is important to us that we know that people support us and love us. There were numerous amounts of flowers, many sent from Italy.

My Nonno’s sister passed away a month ago. On the day of the viewing, my Nonno’s brother in Italy had a heart attack. So one can only imagine the time our family was going through. Monday was the longest day. By now all of us were drained and going through the motions. I had to prepare the eulogy. I felt honored to share my Nonno’s life with everyone. At the end of all the viewings at my Nonno’s house, we sat at the table again and we all remembered my Nonno’s life, laughing and crying, missing the stories he always told. I was able to take what my Nonno’s life meant to all of us and incorporate into a beautiful speech. That captured the listeners the following Tuesday morning at the funeral service.

That Tuesday was the hardest day for all of us. Of course there was drama to begin; we had to be there at 8:30 am. We were taken from my Nonna’s house by limos to the funeral home, and we were left with the body for an hour to say goodbye. My Zio Peppino was discharged from the hospital so he could be with his family. Seeing my Zio was emotional for all of us, when he saw my Nonno in the casket he waved his hand like he always did when they saw each other. He waved his hand at my Nonno, crying “why Saverio, how could this happen, I love you, why.” For us to see our Zio in this way we cried uncontrollably. Now for some reason in the room, visitors were coming in, and of course this made my aunts and uncles upset because it was just supposed to be us.

The visitors were asked to leave. Once they were gone, one by one we each said goodbye to Nonno before the closing of the casket. When I got up there, I went with my sisters, we each said goodbye, this time I held my Nonno’s hand and it felt so cold, so empty. We held each other as the tears flowed down our faces, we said goodbye to Nonno for the last time. Now as Italians respect is a big thing, and the grandchildren know this, we went to our parents and to our aunts and uncles, and our Nonna to give them our condolences. This is a sign of respect to them and this made us all very close.

Then it was time for the casket to close, at this moment I was not prepared for what was coming, they lowered my Nonno in and I could not hold any emotion in and I cried and I screamed as well as everyone else. My aunt was yelling and once the casket was closed we all held on to the family that was beside us. At this moment I was in shock I could not keep my eyes off the casket and my body just shook, my eyes did not blink.

Visitors were now allowed to enter, and the service began. We sang a few songs, everything felt like I was in a daze until I gave my eulogy. I went up there with my Mother and my cousin, my Mother was doing the eulogy in Italian, I was doing it in English. I gave the speech honoring my Nonno, I told some of his favorite stories. I looked at everyone’s face — some smiling at the memories, most in grief. When I ended the eulogy I thought I was not going to cry, but I cried when I ended. I wanted to say goodbye for my Nonno, because Nonno always gave a speech when he would say goodbye to his grandchildren. He would always say “Thank you for visiting, be careful wherever you go, be safe, you do not know the dangers out there, and drive carefully.” I could see my dad and my uncle’s hearts broken and my cousins as I said this, and words cannot describe what we all felt at that moment. However, it was comforting to know that we all understood, and we all remembered Nonno in our own special way.

As the service ended the men carried the casket to the car as we followed to our limos. The drive to the cemetery was quiet and we were all very tired, there were four limos as our family is quite large. When the casket reached the mausoleum where he was to be rest each grandchild put a white rose on top of Nonno’s casket and each son put a red rose. Nonno was lifted and put away in the hollow hole in the wall. My Zio Peppino was waving his hand again telling his brother it was going to get dark and to be safe. As the wall was being closed, people screamed and cried, walking arm and arm, to line up as everyone was to give their final condolences.

Preceding the burial, the church had prepared lunch. For us the lunch was loud and a joyful time, as we laughed and enjoyed each others company. Our family was prayed for and we sat together knowing Nonno was in a better place no matter how much we missed him. The limos then brought us back to Nonna’s house; we brought all the flowers there and helped her clean up the home. The following day we had to go back to our normal routine. My sisters, my parents and I stayed home, now we had to clean our home, it was a disaster. But life did not feel the same; I could not believe how fast the past few days went by. I could not believe we had just buried my grandfather and he was gone.

Grieving the loss

The days and weeks to follow were difficult. It was very hard going back to school and trying to concentrate on the assignments that needed to get done. Trying to concentrate and focus was easier said than done. I know in my heart everything happened for a reason and I felt comforted knowing Nonno was with Jesus, but still it felt like something was missing. It still feels that way, but I know I will see Nonno again one day and I am thankful for all the meaning Nonno has brought to my life. I will keep the memories of him alive in my heart. I will enjoy my family, my food, my friends and my life that much more.

In all that I have experienced I have been searching for meaning of my Nonno passing away. I cannot begin to explain all the wonderful things that have happened during this time. My family grew so much closer, and not just my immediate family but my extended family. During this time, people were there for us, they reached out a helping loving hand. I reconnected with an old friend; after we had lost touch, which then brought forgiveness to our friendship. My Nonno became a believer before he died, which brought the most meaning out of the whole experience.

Reflection on the meaning of death

As I mentioned before my Nonno had dementia. Although it was tragic, I believe it was what brought him to God. During my Nonno’s life he was a very proud man. He did not want to believe in God, because he thought Christians were to be perfect. He could not see himself surrendering to God’s control, because he always needed to be in control. When dementia took over his life, he no longer had control, he was helpless, and became a child again. My father knew he needed to pray with my Nonno, and asked him if he wanted to accept Christ, he did not say a word but just looked at my Dad. My dad told him to repeat these words, and they prayed together, before my Nonno died, he accepted Christ; he accepted that he needed God. For my dad he always knew in his heart one day he was going to pray with his father and that day brought significant meaning to his life. I believe God can use even the worst situations to bring his children back to him, for it is our heart that belongs to him.

Many other Italians have experienced funerals in the same way. I asked my father what the original Italian funeral was like in Italy. The body is taken to the house and kept there for 24 hours, family and friends visit at the home, there is a lot of food as always. The close family does not sleep, as they stay with the body. After the short visitation the burial takes place. He told me that Italians use to have a band that followed the family. “Funeral bands ceased escorting the body to the church around 1955 and the church outlawed tombstone pictures, very tall stones, and planting at the grave sites.” As well “by the mid-1940s the Italians had accepted embalming and the undertaker would generally come to the house, take the body to his establishment for preparation, and then return it to the house where it would be laid out in a casket surrounded by elaborate floral arrangements, until the time came to go on foot to the nearby church for the mass immediately before the trip to the cemetery.

Real grief was present, of course, and the older members of the family still lamented openly and loudly, feared the soul, and slipped salt under the pillow in the casket and sprinkled it on the door steps after the body had been removed from the house” (Mathias, 1972, p. 36). Not much has changed, only we do not keep the body in the home, and we do sleep, but the grieving and the dramatic experience is as much the same today as it was before.

A real life experience from a woman named Deirdre Straughan (2006) talks about the customs she went through when she lost her father in law. “In the US, it seems to be common during times of grief for neighbors to show up with food. So, in Abruzzi, I was amused when a neighbor delivered a watermelon. A few days later, this same lady brought over a timballo (the Abruzzi’s version of lasagna), which was wonderful” (p.2). At my Nonna’s house the neighbour that lives beside her for over 30 years did the same thing, she brought us breakfast both mornings we were there, as sign of respect and care. “The phone rang constantly, forcing Enrico and his mother to repeat the story over and over. But perhaps that helped, as a sort of catharsis, as did the many personal visits from old friends and colleagues” (Straughan, 2006, p.2).

Part of an Italian family, when something happens, a death, a wedding, anything; the whole world has to know. The phone chain just happens and in a matter of moments everyone knows. In my house for two weeks the phone would not stop ringing. There are also some Italian customs that people will follow, it does not have to be followed but the older Italian generation believes it is a must. For example, “Mourning is expected to last approximately one year. The women are typically expected to wear black out of respect for the dead. It is seen as a disgrace to wear colors. There are areas in Italy where the women will dress in black for the remainder of their lives and never remarry. The age at which remarriage is not appropriate was not clear, but most definitely women in their 40s and above would not remarry” (Sirman, L., 1997, p.2). As well “Comfort is received by the knowledge that the loved one is in Heaven, a much better place and from the support of the family. Family appeared to me, to be an integral part of Italian life and the people to whom one turned for support in times of crisis and loss” (Sirman, L., 1997, p.2). Most Italian traditions are followed, but it does vary from family to family. All Italian funerals I have ever been to, have all been the same. Keeping the tradition is important to us, as it brings comfort knowing that these traditions are like those in Italy.

After my Nonno passed away I realized I needed to make some sense from the whole situation. I would ask my self normal questions, why did Nonno have to get sick? Why did he develop Dementia? Why did he have to die in the hospital? Why did he have to forget me? Although I knew the answers to these questions, I did not want to think about them. I knew if I thought about them, his death would turn into reality and I did not want it to be reality. Being in school was difficult; it did not allow me to grieve properly, because as soon as the funeral was over I was forced back into it without reflecting and allowing time to heal. I realized not being able to reflect has taken quite a toll on me mentally and spiritually. I found life to loose meaning, and I lacked motivation. I felt like I was living in a daze, I realized I needed to change my attitude as I was going nowhere. I took what concepts I was learning in class and I made them make sense to me. The whole time in class I was learning to make meaning out of traumatic experiences and here I was doing the opposite, but that is all part of the learning process. I took Frankls concept in Logotherapy. Logotherapy teaches us that everything can be taken away from us, our loved ones, our health, our material possessions, our final freedom—our freedom to decide how we will respond to the circumstances of our life. In other words, what happens to us in life is less important than how we respond to what happens to us; it is not the load we carry, but how we carry it that matters.

This idea really made me think – I had the freedom to choose how to respond to my Nonno’s death. I could not just be sad all the time, but I should be rejoicing that my Nonno lived a great life and found God, and that he was with God, not here on this earth suffering. I first needed to discover the purpose of everything that happened; I needed to focus on the higher purpose. Without realizing the purpose in this situation I would have been lost. I learned so much from this whole experience, I grew tremendously as a person. My grandfather’s death helped me understand the psychology of meaning. There is a purpose in my suffering, my family’s suffering and my grandfather’s suffering. This significant lesson of loss, helped me appreciate the people I love more, not take life for granted, and to be thankful for every moment God has given me on this earth to serve him.

Once I found purpose I came to understand everything happens for a reason. My grandfather was not going to live for ever and this was his time, God was calling him home, and for him this was his own life journey not just mine and my family’s. This was my grandfather’s journey finding God, and I understood that I could not stand in the way; God was completing his perfect will in my grandfather’s life. Now I needed to respond, I had the freedom to choose how to react to this situation. In the beginning I did not react in a positive manner, I was angry, confused and frustrated. However, now that I have cognitively discovered seeking meaning from this traumatic experience, life makes sense, and it is in me to choose how to respond. I visit my grandparents more often, I let my friends a family know how much I appreciate them. As well, rather then sinking into a depression I am allowing God to do his good work in me. I am choosing to live life rather then wasting it away on sadness. The last concept of evaluation is a process I continue to work on. I do not believe grieving will just stop, I believe it takes time. I am adjusting to the realization that life does end and this is a reality we must all face. I am continuing to evaluate my purpose in life, and what God has called me to do. This assignment was a big step in meaning making for me. I was able to go back and grieve again, allowing the Holy Spirit to move in me and heal the brokenness. Although it was a difficult assignment, reliving each moment again, I am thankful I was able to share my heart with someone else. I have been given a life to live; a life to live for God, for this is my purpose.

References

Mathis, E. (1972). The Italian-American funeral: persistence through change. Italian Folktales in America. P. 35-50. http://www.italianancestry.com/m=athias/

Straughan, D. (2006). The Italian way of death. Countries Beginning with I. P. 1-6. http://www.beginningwithi.com/italy/living/death.htm

Sirman, L. (1997). Interview with Maria: a Canadian Italian. Cultural Interviews. p. 1-5. http://www.indiana.edu/~famlygrf/culture/esirman.html

The post Italian Funerals: My experience of the death of my Nonno appeared first on International Network on Personal Meaning.

The Asian tsunami trauma is a different category of natural disaster in terms of scale and impact. Unlike most natural disasters, which tend to be one-time blows at a specific geographic location, the Asian tsunami catastrophe is almost worldwide in its scale; and its devastating impact on poor and highly populated nations may last for a generation. It is a prolonged natural disaster that will affect the ecology, economy, health and livelihood of millions of people for a long, long time. Traditional ways of providing therapy may not be adequate without being accompanied by massive international aid and government interventions in many areas, such as medicine, public health, infrastructure rebuilding, community involvement, and the infusion of economic capital, etc.

The path to healing will be long and difficult, but ultimately the key to the restoration of positive mental health is to cultivate a unique, personalized blend of strengths and vulnerabilities, which balance despair with hope, doubt with faith, death with rebirth, and loss with gain.

Whenever possible, seek professional help. Within the secure confines of a clinic or counseling office, and with the help of a competent therapist, a traumatized victim has the best prospect to recover. The present guide is primarily intended for those who have no access to professional help at the moment.

My approach is existential-humanistic, because it acknowledges that suffering is an inevitable part of the human condition, and that affirmation of meaning is the foundation for hope and recovery. The present paper offers the following 12-step trauma recovery guide:

1. Stay alive to allow time for healing. Unbearable pain can drive you to the brink of self-destruction or to the state of dissociation. You may feel very frightened, disturbed, demoralized, or disoriented. Whatever your emotional, mental state, just don’t do anything to harm yourself. Try to seek whatever help available so that your basic needs for food, water, shelter, security, and medicine are met. Learn to monitor and regulate your own emotions so that you can exercise some self-control. Seek social support and re-establish personal relationships. Try to take care of yourself and give yourself sufficient time to recover. Live one day at a time. Do whatever you can to contain the injury and stay alive in order to give hope and healing a chance.

2. Accept the horror of the loss. It may be hard to believe what has happened to your family and your community. It may take time to realize the full extent of your loss. Avoidance is a natural response, but you cannot spend the rest of your life running away from bad memories. Eventually, you need to recognize the devastating reality and confront your own feelings of shock, anger, fear, panic, pain, loneliness, helplessness and hopelessness. Accepting the loss is a necessary step towards self-acceptance and recovery.

3. Surrender yourself and let go of what cannot be controlled. Resign yourself to the fact that you may never recover or identify the bodies of your loved ones; that the life you knew will never return. Surrender yourself to the overwhelming tragedy, to forces beyond human control or to your God, if you are a believer. Imagine yourself a broken glass – no longer able to hold the water within it. Give up your pride, your defenses, and your biases. Give up your desperate but futile attempt to put the broken glass back together again. Accept the fact that all that you have cherished has been washed away, and can never be reclaimed. At this point, life may feel like a dream…a nightmare…a vanishing cloud. By letting go of yourself, and relinquishing control of what cannot be controlled, you begin to feel some release from guilt, fear, anxiety and the need for blaming. When you are willing to reduce life to nothingness, to ground zero, then you are ready to start the process of rebuilding.

4. Affirm the inherent meaning and value of life. The first building block in the process of restoration is affirmation. The fact that you have not given up on life indicates that you are implicitly affirming that life has meaning and purpose, and that life is worth living in spite of the pain. You may still feel confused, overwhelmed and fearful, but you have the inner conviction that your ordeal will be over, and that you can start afresh. You begin to focus on the positive aspects of life and on the promises of tomorrows. Once you have affirmed your faith in the meaning of life and in a hopeful future, your life begins to rise above the debris and ashes.

5. Have the courage to endure and observe your painful feelings. The next step is to learn to endure the pain rather than run away from it. It takes courage, endurance, and the defiant human spirit to continue the bumpy journey of healing. But it also takes stills. Learn to observe all the unpleasant and terrifying feelings until you can name and articulate them. At the same time, learn to recall positive moments and discover positive meanings of negative moments. This exercise of cultivating positive emotions will help cushion the blow of tragic reality. Be careful not to re-traumatize yourself. Make sure to give yourself breaks by taking a walk or talking to a friend, when you feel overwhelmed by torrents of painful emotions. Give yourself permission to express your anguish, grief and fear. More importantly, learn to observe and listen to your feelings with mindfulness and attentiveness, no matter how unpleasant and threatening. By learning to “mentalize” your painful feelings in a nonjudgmental, honest manner, eventually your feelings become your teacher and your guide.

6. Revisit and reconstruct the tragedy. Initially, you may be obsessed with only the negative and painful aspects of the tragedy. But do enquire about the calamity. Read about it. Talk about it. Write about it. Share it with someone. Eventually, you will be able to give a more complete account of the larger picture. Once you are able to place your loss in a global perspective, your unbearable pain becomes more bearable. More importantly, it will help you make sense of the trauma by creating a coherent story about it.

7. Make sense of the loss. You may never fully understand the cause or the reason for the catastrophe, but you need to make some sense of what has happened to you. You have already affirmed the meaning of life. It enables you to begin the process of rebuilding your shattered assumptions about the world, about God, and about yourself, in order to accommodate past and future tragedies. Through managing your personal meanings, beliefs and life goals, you learn not to ask why bad things happen to you, but how you can make the best of your loss. You are able to make sense of the loss through a creating a personal narrative that includes the past, the present, and a hopeful future.

8. Restore your faith. Meaning and faith are the two pillars of an enduring hope. Regardless of whether your faith is in God, Buddha, Allah, or Higher Power, it would be difficult for you to beat the odds without faith. Often, faith is the only light glimmering in an otherwise dark tunnel. Yes, you may be very angry with God and question his benevolence, but deep down you realize that you are in no position to judge God. Human suffering will be forever shrouded in mystery. But you can experience God’s grace and comfort, when you pray for courage and help. Faith enables you to see beyond the tragedy and transcend your present circumstances. Faith provides an unshakable foundation for hope.

9. Participate in acts of compassion. Faith and meaning always express themselves in concrete actions of compassion. You reach out to fellow sufferers, and try to bring hope and comfort to their lives. By being reconnected with others, you become more grounded to reality and experience more social support yourself.

10. Adapt to the new reality. Now you are ready to make the necessary adjustments to adapt to the new circumstances. You start from the ground floor up, one step at a time. You begin to make new friends and seek new opportunities for work. By developing a new routine of daily activities, life gradually returns to “normalcy”.

11. Transform the loss. You still feel the pain and grieve the loss. Sometimes, you find yourself sinking into a black void, not knowing how to extricate yourself. But as you refurbish your inner space, cultivate positive meanings, your life is elevated and enriched. In the process, your loss is gradually transformed and integrated into your tapestry of personal meaning.

12. Build a new future. You continue to work toward rebuilding your life, with a new found purpose and renewed passion for living. You have developed a new appreciation of life and relationships. Every day becomes a precious gift to be enjoyed, valued and used for the betterment of humanity. You have more than survived the tsunami — you have flourished!

Bibliography:

Allen, J. G. (2005). Coping with trauma: Hope through understanding. (2nd Ed.). Washington DC: American Psychiatric Publishing.

Herman, J. (1997). Trauma and recovery. New York: Basic Books.

Levine, P.A., & Frederick, A. (1997). Walking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. New York: North Atlantic Books.

Schiraldi, G. R. (2000). Post-traumatic stress disorder sourcebook. New York: McCraw-Hill.

Van Der Kolk, B. A., McFarlane, A. C., & Weisaeth, L. (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: Guilford Press.

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Last summer, I learned how to die. Not that I want to practice everything I learn (how often do you actually use that high school trig?). In fact, I wouldn’t mind waiting a while on that one, but it was interesting to sit at the feet of a master.

The opportunity was a rare one. I co-write books for young readers with Dave Barry, the Pulitzer Prize winning newspaper columnist. Say what you will about the death of the newspaper, journalists are a clubby bunch. Sports writers know each other like they’ve shared locker rooms; the entertainment writers share beverages before major award ceremonies; war reporters share hotels; columnists share their perspectives on life.

I think that explains how Dave Barry knew Art Buchwald. They admired each other’s writing, they corresponded, they developed a long-distance friendship. Until last summer, I’d seen Art Buchwald just once: He was riding in the back seat of Dave’s car as Dave left a parking garage in Miami. Dave happened to see me, stopped the car and put the back window down, and there was Art. A jolly face. A handshake through the window. Tail lights. I’d met Art Buchwald.

This past July, Dave and I were doing a reading for one of our children’s books in an unusual place: Martha’s Vineyard. It’s not exactly on the authors circuit. But there we were. We landed by small plane, ate lunch at a beautiful little hotel, and had time on our hands.

“Want to come with me to visit a friend?” Dave asked.

“Sure,” I said.

“It’s Art Buchwald.”

“Oh, I met him once.”

We walked down gorgeously lit lanes in mottled afternoon sunlight, two fiftysomething guys looking out of place in our book-tour clothes. We passed picturesque Capes and white-painted cottages, finally arriving at a driveway across from a small town library, the location somehow so appropriate. We knocked and were admitted into a charming house, by a woman with a sweet face and high voice.

Art was on the sun porch, holding court over a late lunch with two gentlemen who left within minutes of our arrival. Art was in a wheelchair, his right leg cut off just below the knee. There was some kind of socket there, like something was missing. Later he would fumble with a prosthetic, finding it difficult to attach.

His eyes lit up upon seeing Dave. Sparkled like a 17-year-old on the way to the prom. He shook our hands, and directed us across the porch, and we sat on a comfortable couch, while Art ordered – he didn’t ask, he ordered – Dave to help him with his chair and his leg. Dave took to it like he’d cared for this man for months. And of course he had.

I was learning things here.

Dave lifted and adjusted Art’s sawed-off leg onto a pillow, which rested on an ottoman. Art was already talking, like he was picking up a conversation with Dave midsentence. And maybe they were. Journalists.

We stayed the better part of an hour, sitting on that porch. I don’t remember saying anything. It struck me at some point that I was in a pinch-me moment: in the company of two journalism legends, two of the most widely read columnists in the world. The dividend: Both are incredibly funny and self-deprecating. Art proved himself genuinely interested in everything Dave was working on, including our children’s books; he knew of, and had read, recent columns by Dave, and they talked about friends they had in common.

At some point Dave got Art talking about his health, and here was when the two of us sat rapt. Art explained that the larger world had all but declared him dead six months earlier. There had been some newspaper reports of some setbacks, and no one had expected him to live beyond a couple of weeks. I seem to remember that Art had declined some treatments prescribed for him, despite the doctors giving him only weeks if he chose not to take them. And he lived. And then he lived a little longer.

They cut off his leg at some point, and Art talked about it like it was a punch line he was building up to. He had Dave and me guffawing over his waking up to discover he had lost his leg and, with it, his independence. He had tears of laughter gushing from our eyes as he described the doctors astonishment at his recovery and sending him home – to die. And again, he didn’t die.

Watching this wonderful old man – for he looked like an old man in that wheelchair, despite the laughs – I came to realize he’d chosen to live. He’d made a decision not to fear death, and not to cave in to the public’s perception he was dead already. But to live.

He wrote a book (“Too Soon to Say Goodbye”). With all that he was going through, he sat down each day and wrote a book. Journalists. The subject was an easy one: the untimely call of his demise. Living beyond expectations. Listening not to the doctors, but to one’s own heart.

I was learning something here.

He joked about maybe not making his own publication date. “I told them to hurry up and get it out. You never know ….”

They got it out. It was published last fall to good reviews and strong sales. As Dave put it, “Art won’t be doing a book tour.” But for all I know, he probably did some radio by phone. He was determined that people should read this book.

Dave and I dried our eyes. Some of the tears lingered from the laughter, but not all. He and Dave hugged a goodbye, and I think both men knew they wouldn’t see each other again. Their friendship spanned over 20 years, and in this sunlit screened-in porch, at least a chapter of that friendship came to a close.

We were pretty quiet on the walk back to the hotel. Sounds of summer. A warm wind. Each of us would spontaneously burst out laughing, without explanation; we both knew the other guy was reliving something Art had said. Reliving – the Art of dying.

Art had relived his life. He’d risen from his own ashes for long enough for one last flight between the pages. He’d said his goodbyes, he’d shared even more laughter.

And he left two guys walking down a peaceful street reflecting not on death, but on life and what it should mean to each of us, every single day. Like today. And tomorrow.

I learned something here.

—

Pulitzer Prize-winner Art Buchwald died Jan. 17. He was 81 years old.

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A Psychiatrist’s Approach to Death

Men have tiptoed around the subject of death for centuries. They have avoided speaking the word death by using many euphemisms. But in recent years the taboo has been lessened by a great deal of writing that deals explicitly with death. Research papers, magazine articles and books have multiplied prodigiously. So much, in fact, has been written that the Journal of the American Medical Association recently carried an article titled “Dying is Worked to Death.”

One of the most widely read books is Death and Dying, written in 1969 by Elisabeth Kübler-Ross, a psychiatrist. Her book, together with her many appearances as a lecturer, have encouraged free discussion, and have helped to focus upon the needs of the dying. She has described several stages through which she believes most dying patients pass. She considers these “defense mechanisms” as ways of coping with approaching death.

The first phase, she believes, is denial of impending death, expressed by the attitude, “It cannot be true.” Denial, Kübler-Ross asserts, is followed by a period of anger, rage, envy and resentment, implying the question, “Why me?” Anger is followed by bargaining, with the patient seeking to barter some change of attitude on his part for prolongation of his life. According to Kübler-Ross’s observations, depression is the last phase before acceptance – the final stage in which the patient’s struggle is over, and he begins to restrict his interest in mundane affairs.

Death and the Living Christ

Death and Dying takes little notice of the resources of Christian faith for the dying. The Bible has a great deal to say about death. Anyone who has opened it often is familiar with the attention given by Jesus and Paul to death and future life. A biblical faith includes the theological concepts of a living Christ, man’s “eternal contemporary,” and of divine grace, administered to man’s need by the Holy Spirit. Jesus asserted sovereignty over death when he admonished his followers, “Let not your hearts be troubled…. My peace I give to you; not as the world gives do I give to you.” (John 14:27)

Paul established a relation “in Christ” that enabled him to write,
So we do not lose heart. Though our outer nature is wasting away, our inner nature is being renewed every day…. For we know that if the earthly tent we live in is destroyed, we have a building from God, a house not made with hands, eternal in the heavens. (2Cor. 4:16; 5:1)

It is difficult to imagine the writer of these words working through anxiety over approaching death in the troubled stages currently associated with dying. Since Paul, countless persons in every century have found comfort in these words and have found courage to face death without fear because they are “in Christ.”

There is a bumper sticker type of faith affirmation that seems simplistic, but which, nevertheless, lends itself to analysis with as much plausibility as some more sophisticated declarations: “My God is alive; I talked to him this morning.” This may seem grossly presumptuous or highly mystical. It is, in fact, the confident expression of underlying pre-suppositions that God is personal, that He is accessible through prayer, and that the reality of God’s nearness may be discerned by faith, even though it is beyond the grasp of science. Those who scorn these premises, which may not be asserted or even conceptualized, necessarily have a different set of assumptions. The credo of those who derive their beliefs from science is found upon analysis to be only an alternative philosophy, scientism. This system must compete in the marketplace of ideas with personal theism, “the old time religion,” on the basis of explanatory scope, durability under criticism, and the contribution that makes to human equanimity in facing the contingencies of existence. A cold, sterile and brash scientism, when stripped down to its inductive presuppositions, requires a greater leap of faith that belief in the God of revelation, who has been man’s dwelling place in all generations. Humanism, with its brave but shaky trust in man, requires an even greater exercise of faith.

Jesus asserted sovereignty over death.

One of the finest traditions associated with the early Christian concerned their poise and confident faith in the face of death. The process of dying cannot be adequately understood by applying a rigid phenomenological framework that does not do justice to the resource of biblical faith and the contribution that faith makes to the acceptance of death. A great mass of Christian testimony to victory over the fear of death has accrued through the centuries. Should Freud’s deterministic premises be invoked to reject such historical evidence, it must be recognized that there is an increasing decline of faith in an irrational unconscious and a widespread return of trust in the validity of conscious reports.

Living with Death

When I had surgery over two years ago for cancer of the stomach, I was aware of the overall statistics for five year survival – one chance in ten. Even though there were encouraging aspects that favored complete removal of the tumor, I tried to take a realistic view of the odds. My surgeon, a mature and highly trained professor of surgery, was supportively optimistic, but candid. I was given a copy of the pathological report, which indicated extensive infiltration and rapid growth. When periodic examinations and tests were made later, I received copies of the reports. Since these were negative for two years, I maintained a guarded optimism, balanced by a sober realism based upon the statistical chances of survival. The appearance of symptoms at the end of two years led to exploratory surgery. I was barely out of the recovery room when my surgeon standing at the foot of the bed, confirmed recurrence and spread of the primary disease.

Two years of living with ambiguity concerning surgical cure of the cancer did not require any radical reorientation of life. I have been a committed Christian since age seventeen, and have tried to practice my faith across the years as a medical school teacher, president of church junior college, family physician, psychiatrist, and university medical administrator. The experience of God’s presence has been a consistently ongoing reality. I believe the vitality of that relationship made possible the acceptance of uncertainty concerning the end of my earthly life. I continued to work with troubled people, commending the resources of divine grace wherever I could do so effectively. With the self awareness t hat is required in the competent psychiatrist, I cannot identify in my own experience the stages commonly attributed to the dying patient.

I did find reason to be grateful for two years in which to enjoy nature to the fullest, to appreciate the simple beauty of life – deep blue sky and spreading trees, warm sunshiny days and the culture of growing things. I found enhancement of love for a devoted life-comrade, gratitude for two strong sons and a daughter who have established Christian homes and vocations, and grandchildren who are exploring Christian faith for themselves. I have kept up my hobbies – flower-growing and photography – trying to capture and perpetuate some of nature’s delicate loveliness. I have been thankful for the lingering movement of my illness. The time has brought articulation of renewed appreciation on the part of friends, deepening love of family, opportunity to complete unfinished business, and even the planning of my own final rites.

I cannot identify in my
Own experience the
Stages commonly
Attributed to the
Dying patient.

An Affirmation of Life

The statement that follows is in the hands of my doctors and will be entered into my clinical record if I become a hospital patient. The first two paragraphs are slightly modified from the Catholic Hospital Association’s “Christian Affirmation of Life,” and are followed by my own statement of faith.

I believe that God our Father has entrusted to me a shared dominion with him over my earthly existence so that I am bound to use ordinary means to preserve my life but I am free to refuse extraordinary means to prolong my life.

I request that, if possible, I be consulted concerning the medical procedures that might be used to prolong my life as death approaches. If I can no longer take part in decisions concerning my own future, and if there is no reasonable expectation of my recovery, I request that no extraordinary means be used to prolong my life.

I am ready to give up this life with awareness of my own defects and inadequacies, but with confidence in a loving personal God, who cares for individuals as well as worlds. I face death with faith in a living Christ who came to reconcile us to God; who, by his own atoning death on the cross enables us to become sons of God and joint heirs with himself. I approach death with a deep sense of gratitude for the abundant life that has been mine through grace ministered by the Holy Spirit and through the fellowship of God’s people. “Thanks be to God who giveth us the victory through our Lord Jesus Christ.”

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Theorists like Shelley Taylor (1989) argue the maintenance of self-control beliefs is so primary to adaptive living that we overcompensate by holding unrealistic beliefs about the degree to which we control events in our everyday lives. This is particularly salient when things are going favorably – we are much more likely to see ourselves as responsible, which in turn promotes a sense of self-efficacy. Interestingly when things go wrong this bias reverses and we are much more likely to point the finger of accountability at someone or something else – once again preserving a positive self-view.

‘Terror management’ theorists believe that we promote these beliefs in self-control and self- esteem in order to protect ourselves from deeply rooted existential fears of our vulnerability and mortality (Pyszczynski, Greenberg, & Solomon, 1998). Thus the occurrence of an unpredictable, uncontrollable threat to our wellbeing, or even our very existence, often create a crisis of meaning. The comforting notion that we are good people who undertake the appropriate behaviors to ward off danger is revoked by the trauma and we are left searching for some modicum of control in the uncontrollable.

My own research with people diagnosed with one of the blood cancers (leukemia, lymphoma, & myeloma) is examining this response. The cancer experience presents us with a life threatening malignant process within our body over which we have no direct personal control. To address this threat we are forced to hand over control for our continued existence to medical professionals who practice a jargon-ridden enigma of biology, chemistry and statistics which they themselves require around 10 years of rigorous training to master. This inability to ensure our basic survival is surely the ultimate challenge to our sense of self-control and in the case of illnesses such as cancer, it is not the only one. Physical illness can hinder the sense of control we maintain through pursuit of desired outcomes in life roles such as professional, partner, parent, friend and helper. For instance, people in my study who receive a diagnosis of acute leukemia are hospitalized immediately then confined to isolation rooms for weeks on end when chemotherapy destroys their immune systems. Beyond being unable to undertake the activities of everyday living, their loss of control often extends to the basic functions of eating, sleeping and toileting. Even when treatment is completed, the return to pre-illness functioning is slow with side effects of the highly toxic chemotherapy lasting for many months. With the ability to exercise control in almost every domain of their lives undermined, how do these people maintain a sense of self-control and protect themselves against helplessness?

One way to achieve peace of mind is to shift the focus of control behaviors toward achievable ends. For someone with cancer, having control over what may appear to others to be insignificant details, such input into the circumstances of an inevitable treatment, may go a long way in protecting against a sense of helplessness. One woman confined to an isolation room for over a month while undergoing stem cell transplantation, decorated her room with personal furnishings, diffused aromatherapy oils in an electric burner and placed a collection of flowering plants outside the window. Being able to exercise direct control on these aspects of the room she transformed what would be regarded by many as a prison into what she described as a “sacred space”.

Even in situations where opportunities to exercise this kind of direct control in associated domains is unavailable, other more cognitive devices can help preserve a protective sense of self-control (Thompson & Collins, 1995). To explain how this can be achieved, we need to understand the difference between direct (or primary) control and perceived (or secondary) control. In the former, our actions have a straight causal effect on outcomes, whereas in the latter there is no direct link between what we do and the desired outcome. Regardless of this both can produce a feeling of being in control.

Three types of secondary control, evident in the people I talk to who are in the very early stages of their cancer experience, are described in the personal control literature as: vicarious, illusory and interpretive (Rothbaum, Weisz, & Snyder, 1982). Vicarious control is gained through a personal affiliation with a ‘powerful’ other who can ostensibly exercise direct control over the situation. It does not seem to matter if that other is God, a doctor or a loved one, as long they are perceived as being in control, benevolent and trustworthy. In illusory control, a person acknowledges the randomness and unpredictability inherent in living but sees him/herself as having these random forces onside, that chance or fate as working in their favor. Even though they have cancer they still consider themselves as a lucky person. Interpretive control, more often referred to as ‘meaning making’ represents the oft felt need of people experiencing trauma to answer the question “why me?”. Arriving at a satisfactory explanation for the incident seems can help promote acceptance as well as a sense of mastery through solving the ‘why?’ puzzle. Such a process is reflected in the words of a woman in her twenties undergoing treatment for acute leukemia:

“I’ve gotten cancer, it’s shown me things – the important things that people don’t realize until they’re 65. I’m going through so much, the pain of it but I’m also getting good things, all these important lessons. I don’t want to forget them quickly because the way I think life works, it keeps giving you lessons over and over until you learn them, until you remember them…I don’t want to lose sight a year or two years from now of what I’ve learnt. Then, it might sound silly, but I think the cancer will come back to show me again, to put things back in perspective. I’ve got to keep in mind what I’ve learned and take that along…if I go back to the way I used to think, putting value on the wrong kind of things…I wouldn’t be surprised if I relapsed again.”

It is tempting to label this young woman’s interpretation about the contingency between ‘life lessons’ and malignant processes in her body as inaccurate, perhaps even dangerous, in so much as she vests direct control for continued remission in her adherence to these learnings. If the disease relapses there is great potential for her sense of control to transform into self-blame and guilt (Doan & Gray, 1992). It is for these reasons, those of us working with people experiencing cancer are well wary of the “double-edged sword” of such control beliefs (Wong, 1992). Nonetheless, we also know that maintenance of a sense of self-control in a person coping with such a highly averse event is vital to wellbeing, thus it is essential we learn to recognize and support control-preserving strategies that are both personally meaningful and contextually appropriate.

REFERENCES

Doan, B. D., & Gray, R. E. (1992). The heroic cancer patient: A critical analysis of the relationship between illusion and mental health. Canadian Journal of Behavioral Science, 24(2), 253-266.

Peterson, C., Maier, S., & Seligman, M. E. P. (1993). Learned helplessness: A theory for the age of personal control. New York: Oxford University Press.

Pyszczynski, T., Greenberg, J., & Solomon, S. (1998). A terror management perspective on the psychology of control. In M. Kofta & G. Weary (Eds.), Personal control in action: Cognitive and motivational mechanisms. The Plenum series in social/clinical psychology (pp. 85-108). New York, NY: Plenum Press.

Rothbaum, F., Weisz, J. R., & Snyder, S. S. (1982). Changing the world and changing the self: A two-process model of perceived control. Journal of Personality & Social Psychology, 42(1), 5-37.

Taylor, S. E. (1989). Positive illusions: Creative self-deception and the healthy mind. New York: Basic Books.

Thompson, S. C., & Collins, M. A. (1995). Applications of perceived control to cancer: An overview of theory and measurement. Journal of Psychosocial Oncology, 13(1-2), 11-26.

Wong, P. T. P. (1992). Control is a double-edged sword. Canadian Journal of Behavioral Science, 24(2), 143-146.

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There is no doubt that times of tragedy as well as conflict in our lives are extremely painful on an emotional level. The gift of these moments, however, is that through tragedy we can achieve a greater sense of clarity into our own character as well as value system. During tragedy and conflict, we have the opportunity to test our strength in character and utilise our abilities. In essence, we get to see what we are made out of on a deeper personality level in order to address the challenges at hand.

In times of tragedy, we develop focus instead of being distracted by petty matters that may occupy our thinking. Suddenly, we have to contend with a greater problem and there is an incredible sense of unity that occurs when we focus our energies on the outside difficulty. Even during times of war, people are able to forget their minor squabbles as they bond together against the higher purpose of defending their rights as well as liberties.

During tragedy and conflict, our illusions of what we think are important fade away because we now have a gift of realizing what is truly precious in life. Consider the family member who is on the verge of passing away. During this moment, the love and value of the relationship are the most important factors. The minor arguments throughout life are of no significance during this time. Instead, we have an awareness of the impermanence of life and our loving relationships become even more special.

In times of national disaster, communities of people unite together to help others in need. As human beings, we achieve amazing levels of compassion when our characters are tested during these tumultuous events. Even in the crisis of September 11, 2001 (911) in the United States of America, each individual citizen asked what they could do to help in response to the terrorist attacks in which thousands of people died. Many individuals lined up for hours to offer a donation of blood for potential survivors of this national tragedy. Several funds were set up to help the surviving family members of firefighters and police officers who died in the World Trade Centre Building. When airline routes were redirected and thousands of passengers were stranded, people offered these strangers a place to stay in their homes. Endless numbers of people even risked their own lives to search through the remains of the World Trade Centre in an attempt to find survivors in the wreckage.

When tragedies or conflicts occur, people have the choice to feel like victims and question how this world could be so unfair or they can use these situations as a gift of insight into their own higher purpose in this world. In tragedies, we have a moment of clarity to understand who we really are and what is truly important in life.

In fact, the tragedies in our lives may be part of a greater plan to fulfill a higher purpose in society. For example, actor Michael J. Fox has used his condition of Parkinsons disease as a gift to bring awareness to this medical issue. Christopher Reeves was paralyzed from an equestrian accident and he made it his mission to make people aware of the importance of spinal cord research.

During times of tragedy and conflict, people are given an intense experience in contending with pain as well as disappointment. This heartache can be turned into motivation when individuals pay attention to a certain area in life that has been highlighted as a result of experiencing the tragedy. Individuals may ask themselves the following questions. What do I now understand as a result of enduring tragedy or conflict? Is this greater problem really a lesson in courage that I am meant to show others? Did I experience an injustice because I may be meant to bring attention to this issue in society? Many people have experienced this pain firsthand and they have the ability to turn this anguish into the betterment of other individuals’ lives by helping others truly understand the impact of this problem. When people find value in painful experiences, then these situations somehow become worthwhile and the heartache that they endured relates to a higher purpose. The result is that magnificent spiritual meaning can emerge from the darkness or despair of tragedy.

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This group liked to talk. They lived to “process their feelings” at endless staff meetings. This was normally a very “touchy feely” group. But bring death into the mix. Wow. That sure shut them up.

Death is uncomfortable. We don’t know what to say. So unfortunately we say nothing. This is the worst possible thing you can do.

In the following weeks after my Mom died, the thing that surprised me the most was reaction from others. Friends didn’t send cards. Phone conversations went dead silent the minute I told callers my Mom died. I never received a single flower from a personal friend. I was one of the lucky ones. I did have at least a couple of friends who called & were very kind and let me cry endlessly. Without that support I am not sure what I would have done.

The grieving person feels shocked, afraid, depressed, suicidal, hopeless, and angry. Don’t let these feelings scare you. They are normal.

In thinking about people’s lack of reaction I thought how interesting because death isn’t a freak occurrence. Given that the one thing we are guaranteed in life is…well…death. It strikes me as odd that people don’t know how to react to it. I thought what if someone gave a primer on WHAT TO DO WHEN A FRIEND LOSES A LOVED ONE 101.

• Always send a card. It hurts so much worse to not be acknowledged.
• Send a single flower, a plant, or a bunch of daisies. It doesn’t have to be costly. Your friend will appreciate the thoughtfulness of the gesture.
• Bring food. This is so helpful.
• Don’t think if we “bring it up” that they are going to get upset. They are already upset. So “bring it up”. The alternative is ignoring the death and that is significantly worse.
• Call and ‘check in” on your friend. It is OK to say, “I am so sorry your mom died”. Your friend will appreciate this. Then call them every week. If this is wildly outside your comfort level, then at least leave them a message on their home machine telling them that you are thinking of them.
• Understand that your friend may isolate. They probably do not want to be cheered up.
• Ask your friend “What can I do for you?” They may need you to just listen, they may need you to call and know that you care.
• Make sure you are specific. Please don’t say, “I’m sorry for your loss” Say “I’m sorry Pat died”. It is always better to use the person’s name. It is more personal.
• If you are grieving for the deceased person…say that. Say for example “I will miss your Mom also, she sure was special”. It helped me to know that other people miss her as much as I do.
• Know that grieving isn’t something that ends in 6 months, or a year. People have the subliminal attitude such as “Aren’t you over it…it has been a year already?”
• Send them a book on grief. That helps. Really.
• Don’t overlook the child or teen that is grieving, they are just as hurt and confused, as you would be. There are books written especially for them.
• Go to the funeral…to support your friend. They will never forget that you showed up. You do not need to have known the deceased.
• It is ok to say; “I don’t know what to say”.
• Offer to pick up the children. Offer to finish that report. Offer to pick up the dry-cleaning. Often they feel helpless to take care of the mundane tasks.
• Be extra sensitive for milestones. Acknowledge that it’s been one year since the loved one died. Be aware that its Mothers Day & the person is feeling especially alone. Or Valentines Day for the loss of a partner. Or the deceased persons birthday. Or the first Thanksgiving without their family member or friend.
• Your friend may be angry with God, the world, and the deceased. This is normal.
• Be aware they may feel guilt.
• Tell stories about the person who died, they are cherished.

People think that death is contagious. It is not.

Don’t say:

• “They are in a better place”.
• “You need to see a therapist”. They already feel low; they don’t need your implication that they are crazy too or that their grief is inappropriate.
• “Aren’t you over it?” The pain takes years to subside.
• “You are lucky you still have a husband” (or children) or whatever. They do not feel lucky.
• “You will get over it”. You never get over it.
• “Thank God I still have my Mom, I don’t know what I would do”. This is extremely insensitive.

The second year after a death is very hard because everyone thinks it is behind you, however you still need the support.

Your silence tells your friend that their loved ones’ life was not important.

After a death we feel lonely. It is an aloneness that goes so deep. If you ever needed a friend it is now. To ignore your friend when they need you the most is the ultimate social shunning. One day, you too will experience a profound loss, consider how you would like to be treated.

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