The Paradox of Grief and Gratitude ...

Wherever there's change, there's loss

and wherever there's loss, there's grief.

Bill Bridges

Hello, Everyone,

I have used the quotation above often in workshops and writings and here it is once again. Appropriate for the times, I think ... 

So much has changed in recent months and these changes have brought with them loss and grief in abundance, especially for family caregivers already coping with chronic sorrow and helping professionals carrying years of cumulative grief.

Since the pandemic has taken hold,  family caregivers have lost already-scarce freedoms, resources and supports -  the coffee shops that once provided a brief haven at the end of a morning's respite, the familiar care aides who knew the needs of an ill loved one and didn't require training each time they arrived, the day programs that offered respite as well as support and advice, the volunteers who helped with transportation or yard work or exercise regimes or meals, the warmth and encouragement of a simple hug. Some caregivers have had the worst of anticipatory griefs - standing by as loved ones with worsening COVID symptoms were transferred to acute care facilities, perhaps never to be seen again.

Healthcare professionals have also carried the weight of grief. They've grieved the loss of patients they had hoped to save, relinquished long-held standards of care and infection control, worked without essential equipment, given up contact with their own families, forsaken any semblance of a balanced personal life and mourned the loss of cherished co-workers and friends.

And then, together, we've felt the collective grief of watching as our systems of work, healthcare, education, transportation and economics wavered under the weight of the virus. The tangible losses of unemployment, closed churches and mosques and food insecurity have been multiplied by the broader intangible losses of predictability, control, justice and our assumptions that we could protect the weak and the vulnerable.

This COVID-19 grief is natural and expectable and it will come in waves for a long time after the losses cease. Grief is the way we heal from broken attachments - and it happens automatically provided nothing gets in its way. Grief is a turning inward to reflect, to feel, to recalibrate. There are resources to support this highly individual healing process and we will explore some of them next time.

Paradoxically, the losses stemming from the COVID virus, and their attendant grief, are often accompanied by a sense of deep gratitude. There is something about walking at the edge of life that brings authentic blessings into sharp relief - spring blossoms in a time of death, the kindness of nurses holding phones to unite families in their last goodbyes, messages of support and encouragement painted by children on apartment windows, meals left on doorsteps, 7pm clapping and cheers as healthcare workers change shifts, songs that connect the isolated. We can draw upon this natural pairing of grief and gratitude to nurture ourselves during difficult times.

Brother David Steindl-Rast, the Austrian founder of A Network for Grateful Living and a 93 year old survivor of the Nazi occupation, is a beloved teacher of the practice of gratefulness. In a 2016 interview with Krista Tippett, he said,

To open your eyes and know another day - we can't take it for granted. In my youth, we couldn't take it for granted because every night, the bombs fell. There are all sorts of reasons why you (might not) see another day, and you do. And that's a wonderful thing."

His words could apply equally to these days of pandemic.  The practice of gratefulness is not about being grateful for the pandemic, itself, nor for the numbing pain and despair of these times. Nor is it about avoiding or minimizing our sadness, anger, fear and confusion.  Rather, a gratefulness practice offers the opportunity to experience more than one feeling, in full, at the same time - to know gratitude at the same moment that your heart is breaking with grief. To know sorrow and joy in the same breath.

A gratefulness practice allows us a pause to heal, grow and reconnect with ourselves, others and what or whomever we hold sacred. It doesn't take away our grief but it does help to balance it. So, when you wake in the morning or before you go to bed at night, take some time to think of - or,  better yet, write down - the things for which you're grateful. Some days there will be a long list and other days, as gratitude writer, Sara Breathnacht, says, the only thing you'll be grateful for is that the day is over. Either way, recording your gratefulness will not only help balance your grief in the moment, it will provide a wealth of positive memories from which to draw strength in the future.

Keep well, everyone! I'm grateful for all of you!

A Word About Words: Chronic Sorrow ...

Where there's change there's loss

and where there's loss there's grief.

Bill Bridges

Hi Everyone,

I've been writing about the grief of family caregivers this weekend and I was struck by how many terms now exist to describe this experience. The professional writings about caregiver grief are fraught with confusion and contradiction due to the increasing number of overlapping terms and concepts.  This differing terminology arises from different professional fields, the study of different medical conditions, research in different nations and cultures, and studies from different times in history. I'll share a few of them with you here:

1.  Anticipatory Grief is the earliest of the overlapping concepts applied to the natural and expectable grief of family caregivers.  It was coined by German psychiatrist, Erich Lindemann, in 1944, to describe grief we experience before a loss actually occurs.  Later, Therese Rando expanded the concept, defining it as:

The mourning, coping, interaction, planning and psychological reorganization that are stimulated and begun, in part, in response to the impending loss of a loved one and the recognition of associated losses in the past, present and future.  (2000, p29)

Many writers assume that anticipatory grief is synonymous with caregiver grief.  However, in my personal and professional experience, anticipatory grief comprises only a portion of a family caregiver's heartbreak. To a great extent, caregiver grief also includes responses to current loss.  Workshop participants tell me that while the pain associated with the anticipated death of a loved one is certainly part of their reality, their greatest source of sorrow is the daily losses associated with current changes and adaptations.

2.  Chronic Sorrow (CS) is the second term used to describe caregiver grief. It first appeared in the literature in 1962 in an article written by American social worker and advocate for families of developmentally delayed children, Simon Olshansky. At the time, family caregivers were seen as being unaccepting of their children's diagnoses, stuck in their grief and, therefore, difficult to deal with. Olshansky offered  another viewpoint, saying that these parents were suffering from  expectable, continuing, episodes of grief that flowed from the losses occurring across their children's lifespans. He pushed for caregiver support rather than medical attitudes of pathologizing and criticism.

After an initial flush of interest in Olshansky's ideas, CS disappeared from the literature until the mid-1990's when the Nursing Consortium for Research on Chronic Sorrow published several studies confirming the concept and studying its characteristics. Later, in 2002, family caregiver and psychologist, Susan Roos, PhD, gathered the research to date and combined it with her considerable personal and professional experience to publish the first (and only) psychotherapy textbook on CS. Her book included this comprehensive definition of caregiver grief, one which includes both the grief of people with serious, permanent, medical conditions and that of those who love them:

Chronic sorrow is a set of pervasive, profound, continuing and recurring grief responses resulting from the loss or absence of crucial aspects of oneself (self-loss) and another living person (other-loss) to whom there is a deep attachment. (2000, p29

At its core, CS is the grief resulting from resulting from an aching discrepancy between life as it is and life as it could or should have been had the illness or injury not occurred.

Since 2002, multiple research articles have continued to be published.


3.  Ambiguous Loss is the third concept to describe the unresolved grief of family caregivers It appeared in the literature in 1999, much later than Chronic Sorrow. The notion was developed by educator and researcher, Pauline Boss, PhD, with little or no knowledge of the prior CS research.  Arising from the study of families whose soldier relatives were missing in action, and then applied to the dementia and adoption fields, it describes the losses and grief related to caring for people who are physically present but psychologically absent or psychologically present but physically absent. Thus, the reality of the loss remains ambiguous or uncertain.

(I see this and the other concepts described here as subsets of Chronic Sorrow.)


4.   Non-finite Loss, our fourth concept, was developed by Bruce and Schultz in 2001 to describe the lifetime of continuous and insidious loss and grief experienced by parents of developmentally delayed children.  They focused attention on the parents' gradual discovery of the impact of illness or disability with the accompanying loss of hopes, dreams and expectations.  This term has also been applied to family caregivers of those with degenerative diseases such as MS, motor neurone disease and dementia. It has been used to describe the reactions of families with non-medical losses such as those with a relative waiting on death row as well.


5.  Pre-death Grief  is the fifth and final term to be considered here.  It was coined in 2014 to provide a standardized  definition of caregiver grief upon which to base professional theories and research questions.  Pre-death grief is defined as the caregiver's emotional and physical response to the perceived losses of a valued care recipient.


While facilitating workshops on caregiver grief, I tend to use the term, Chronic Sorrow. Why? Because, while the other terms all reflect important aspects of caregiver grief and there are logical reasons for their presence in the literature, they are all in some way incomplete. CS, on the other hand, has a specific, comprehensive definition that includes the grief of both patient and caregiver, it offers the clearest demarkation between pre and post-death grief, it has a long medically and psychologically-oriented research history, and, most importantly, it has the most immediate and profound emotional resonance with family caregivers.

When I ask workshop participants which term they prefer in describing their grief, they are emphatic, and usually unanimous, in choosing Chronic Sorrow.  It most accurately and empathically communicates their experience and that, it seems to me, is the single most important reason for choosing any terminology.

I'm hoping to offer a community workshop on Chronic Sorrow for family caregivers in Vancouver again next spring. If you think you might be interested in attending, just subscribe to the mailing list in the left hand column of the website and you will automatically receive a registration brochure.