always hearing voices

If I’ve ever felt sadder in my 41 years on this unforgiving planet earth than I did when I wrote “Always Hearing Voices”, I do not know when it would have been. As many of you know, unfortunately, and as Elizabeth McCracken wrote, “grief lasts longer than sympathy” and this song was written in the sober realization of that singular, undeniable fact.  

One of the casualties of hitting the bottom of the well (which I tend to believe is a special place reserved for someone who loses a child), is that it hammers a spike right into the center of your life, and fault lines splinter out in every direction. They create divides between you and everyone, even (and sometimes especially) those that are the closest to you. The spike creates a hole through which every reserve you have is emptied. Every bit of patience, understanding, forgiveness and even, sometimes, love is sucked down the hole, leaving you a twitchy, angry shell, unrecognizable even to yourself.

This song is about feeling wounded by the people in your life who love you the most, and how lonely that feeling is. It’s about feeling lost in the dark, months after your loss. I did not seriously consider suicide because I had a living 4-year old in my house. It’s a pretty raw thing to admit, but if it weren’t for him I have no doubt in my mind that there is an excellent chance I would have eaten a bullet that night. I felt crazy, wounded, lost and completely alone. The concept of suicide was less scary to me that night than was living. It was as simple as that. Sometimes, continuing to draw breath is the bravest thing in the world. I fantasized about suicide, not as a real option, but in the same way someone might fantasize about a night alone with Johnny Depp or Scarlett Johanssen. It ain’t gonna happen, but man, it can be fun to think about.

At the time, I felt like those closest to me were limping away from the accident, not realizing that I was still trapped under the car. I couldn’t even scream, so I just wrote this song.  Grief can have a terribly selfish, self-absorbed face, and it can be as lonesome as lonesome gets.

On the phone, it don’t seem like she remembers me
Or the shape that I’ve been in
On the phone, making noises
I am always hearing voices
On the phone, in the hall and on the run
There’s a rattle in my brain
I am always hearing voices
And they’re flowering your grave
And they decorate your portrait
On the phone, beating hard and back to listening
Where’d you go?
In the dark, we make our choices
I am always hearing voices
In the dark and talking to the gun
And it’s funny how you laugh
How you laugh when nothing’s funny
And I’m picking up my map
And I’m hitting the high ground running
There’s a rattle in my brain
I am always hearing voices
And they’re flowering your grave
And they decorate your portrait

Ever been here? You're absolutely not alone. National Suicide Prevention Lifeline: 1-800-273-8255

The Answer

The intersection of grief, creativity, and writing remains a place of such deep beauty and personal horror, I stand in awe of people getting their hands and souls dirty in it, exploring it with art, music, and writing. Kenny is a songwriter and musician from Bloomington, IN, whose band Gentleman Caller, has just released their fourth record, Wake (Mariel Recording Company). This record meditates on the loss of his daughter, Roxy Jean, who was stillborn at thirty-eight weeks on August 1, 2007. His music breaks me wide open in such an important way. I learn more about my own grief. Kenny agreed to join us at Glow as a regular contributor where he will be exploring his grief with his wise insights, brutal honesty, and dark humor, and of course through his music and words.  —Angie

In the year following Roxy’s death, I was just hunched, squinting and holding on.  I tried to outrun my thoughts, but they were in every hiding place I ran to.  I self-medicated with booze for a few weeks.  Became an expert on panic attacks. Sometimes I just waited, counting days away from the day she died. There was more comfort in math than hugs. I held on and flailed, as quietly as possible, inside my hollowed-out flesh-cage. I went to therapy, took anxiety meds and tried to get to know and understand my new, messed up self. 

During that god-forsaken year, 3 friends also died early, tragic deaths.  One by house fire.  One by drowning.  One by aneurysm.  All three under the age of 40. It seemed unreal and impossible at first… then, inevitable.  Remember, in The Empire Strikes Back, when Han Solo snaps “NEVER TELL ME THE ODDS!” before successfully flying through an asteroid field?  My life, the lives of my friends and family… ours had become the exact opposite of that.  We weren’t beating the odds, but being destroyed by them, and those odds were giggling.  

Hollowed out by losing my beautiful, dark-haired daughter, and managing my anxiety with medication (prescription and other), I was sliding down and increasingly absent of hope. I started recognizing patterns in the memorial services I was attending. The hollow, crying eyes of the mother, the trembling, shaking hand of the father, all while speakers talked about what the deceased loved, how they loved and who they were… and there was always a song. I was so embittered by all the loss, and death just seemed right around the corner for everyone I loved. I was certain I would not live to be an old man. I felt that no one I knew would. 

So, I decided to write my own funeral song.

I wanted a song that would just tell the bleak truths of my life… a song that wouldn’t put a bow on the end of my life, but a thudding and appropriate period. Somehow, it felt like the bravest thing I could do.

It happened immediately upon returning home after the last memorial service I would attend that year. It took literally the amount of time to write that it does to sing it. It remains, easily, the quickest I’ve ever written a song. It also remains the most cathartic:

THE ANSWER

I did not find the answer in church
I did not find the answer in church
I did not want a god that would not spare the rod
I did not find the answer in church
I did not find the answer in my home
I did not find the answer in my home
I was a stranger to my kin
I was a stranger to them
I did not find the answer in my home
I did not find the answer in school
I did not find the answer in school
I was sucker-punched and thin
I was not like the other kids
I did not find the answer in school
I did not find the answer at the bar
I did not find the answer at the bar
Beneath the stale embrace
I was always out of place
I did not find the answer at the bar
I did not find the answer in prescription drugs
I did not find the answer in prescription drugs
I took every pill they make
But I was still awake
I did not find the answer in prescription drugs
I did not find the answer in your eyes
I did not find the answer in your eyes
Not your hands and not your lips
We were always passing ships
I did not find the answer in your eyes

 What songs, if any, have been a comfort to you since your loss?  What songs can you no longer listen to? What would be your funeral song?

What They Say

Today's post isn't going to be lyrical or beautiful.  It's not going to uplift you or share a new perspective on the terrible tragedy of losing a baby.  And it also contains a fair bit of swearing so be forewarned.  

Today's post is about other people, the ones that have all their kids and don't know one single thing about how to talk to us, how to behave like a true friend, how to navigate in our dark depths and instead say incredibly stupid and insensitive things without using their heart or brain before opening their mouths.  So, let's start with my favorite:

"Well, everything happens for a reason."

What I want to say & do in reply:

Oh really?  It does?  So when I wind up my arm and clench it into a fist and punch that person directly in their disgusting, thoughtless mouth, I can just chalk it up to 'everything happening for a reason?'  What a relief!  I thought the Universe was just random, brutal and unforgiving, but here you are with your deep wisdom born of nothing, telling me I can do whatever the fuck I want because hey!  It all happens for a reason!  And the reason you are flat on your back from my knuckle sandwich is because you're an unthinking, insensitive ass.

What I say instead:

I disagree.  There could never be a good reason for my son dying.  What you are saying is very offensive to me, and I would appreciate it if you would keep those sentiments to yourself.  I know you're just trying to help, but it's not and you aren't and please, please stop. (or else, see above, I say with my eyes)

"Whatever doesn't kill you makes you stronger."

What I want to say:

Hmmm, let's see, no.  Not true.  Some things that don't kill you make you weak and fragile and bitter and sad.  Some things, like losing your child before they had a chance to make a breath or live a day, make you hollow and desolate and open your eyes to how bad life can get.  The strength I relied upon to live through that terrible experience came from who I was before he died.  His death did nothing but rip the naivety and innocence from my soul and lay the world bare in all its brutal viciousness.

What I say instead:

My son dying didn't make me stronger.  It made me nearly dead myself, and I'm not stronger for his death. I would have been made stronger by getting to be his father. What you are saying is painfully insensitive.  Please stop.

"At least you're young, you can have another."

What I want to say:

Wonderful!  Thank you so much for being a fucking idiot.  Because as you know all kids are replaceable. One breaks or dies, just go out and pick up another one.  How about this?  How about I take one of your four kids and raise it as mine?  After all, you've got plenty!  Spare one for someone who misplaced theirs when they fucking died.  How about it?  Since you're such a dumbass you will probably raise awful children anyway.

What I say instead:

Nothing.  I say nothing to those people.  I just look at them for a moment, shake my head and walk away.

"God works in mysterious ways."

What I want to say:

Fuck you.  Get out of my house.

What I say instead:

That's the stupidest thing I've ever heard.  If this is God's mysterious way of teaching me some kind of lesson, He/She/It can go fuck themselves.

"Is he your first?"

What I want to say:

Why do you want to know?  Or are you just asking things without thinking about it?  Do you really want to know about my first, about how he died?  About how we are still devastated by his absence?  About all our hopes for him and us dashed against the black shards of death?  Or are you just some blissfully ignorant stranger who can't keep their mouth shut and don't really give one fuck about us at all?  Ah, I thought so.

What I say instead:

No, our first son died due to complications during birth.  Then I just look at them while they crumble into despair and I think to myself be careful what you ask people, they just might tell you the truth.

~~~~~~~~~~~~~~

What insane, awful and horrific things have people said to you when they learn that your child died?  Let's rage on this together with the only people that know the truth and feel a little better by getting it all out for once.

 

The thin (disappearing?) line

I'm sure you're all anxiously awaiting the new edition of the Diagnostic and Statistical Manual of Mental Disorders V (also known as DSM V, replacing DSM IV). You should be. In now-outdated edition IV there apparently was a footnote of sorts that made grief an exclusion to depression. In the draft edition of V however, the footnote is removed, and grief is essentially enveloped into the definition of depression. Which means, you, me, anyone who experiences a loss that s/he mourns (well, mourns deeply for more than say two weeks), will be thusly classified as suffering from depression. (To reiterate, right now V is in draft stage. The following discussion is on a possible -- but significant -- change in psychiatric diagnosis.)

If you've ever been hit up in a doctor's office by the quicky depression Q&A, you know it asks such things as, Do you have trouble sleeping? Do you have trouble focussing and making decisions? Has your appetite changed recently? And if you check yes to a certain number of these, you go on the doc's radar as being depressed. But if you're grieving the death of your child(ren), many of us probably answer yes to these questions, too. Have you lost joy? Does it take a great effort to do small things? Do you ever think about killing yourself?

So how to tell the difference between grief and depression? Is there a difference or is this a matter of semantics? Does it help or hurt our case when we say things like, "You never really get over it, you get through it and learn to live with it"?

There's an NPR news article on this shift in classification here.  According to this article, there is in fact a difference between bereavement and depression, but according to the doctor quoted therein it seems to be one of time: weeks. Not months, but weeks. If you're not rethinking some of those questions above in the space of 14-21 days, you will now be hit with a diagnosis of depression.

Huh.

Allen Frances has emerged as one of the lead critics against this particular change. Frances was the chairman of the group who devised DSM IV, and wrote an op-ed in the New York Times highlighting his concerns. (Op-ed can be found here; sign in may be required.) Among Frances' problems with the proposed change from IV to V are that healthy people who happen to be hit upside the head with a loss will now be labeled as depressed. Which is a problem if you're applying for health care or a job. Frances also worries that drugs will now be willy-nilly doled out to people in mourning, who either won't need them, or will unnecessarily remain on them. Frances writes,

Turning bereavement into major depression would substitute a shallow, Johnny-come-lately medical ritual for the sacred mourning rites that have survived for millenniums. To slap on a diagnosis and prescribe a pill would be to reduce the dignity of the life lost and the broken heart left behind. Psychiatry should instead tread lightly and only when it is on solid footing.

+++

I used anti-depressants, but they were not foisted on me by a doctor in the hospital. They also came later than two-three weeks. On the contrary, I went about a month or six weeks until it hit me one day that I was no longer functioning in a capacity that I needed to for the safety and well-being of my two-and-a-half year old. (I wrote about my decision to use anti-depressants here on Glow; the post can be found here.) I was also in the care of a psychoanalyst, and the decision to go on medication was entirely mine -- as was the decision to go off them in six months. They did not take away my pain or mitigate my grief. They did not put me in a fog, or even make me feel better. They helped me function. I still felt the awful full force, but could now drive and lift myself out of bed and otherwise make sure my toddler didn't play with knives while I hid under the covers.

Perhaps I'm different in that I actually sought help, and I'm wondering if there are babyloss parents out there who should but are caught in that whole "Can't make decisions" and "Small things are difficult" mode and don't pick up the phone to make that appointment. Or maybe I'm the rarity of which Frances speaks who actually needed treatment.

I'm a bit confused about the change from IV to V because it seems that there are already clear markers in place in order to make this distinction, markers that medical professionals are quite comfortable with. When I interviewed a grief counsellor for this site (interview found here) I asked her point blank what the difference was between grief and depression, and she gave a long and nuanced answer involving "normal" and "complicated" mourning, and the ability to "bracket" one's feelings later in the process and keep them somewhat separate from other parts of their lives. She also pointed out that it takes much longer than a few weeks to process loss and go through some of the more severe feelings. It seems to me this makes an enormous amount of sense. Are the people writing version V worried that psychoanalysts won't be able to do their jobs properly and discern these gradations? (Hey wait, aren't psychoanalysts doing the re-writing? Are they saying this is too difficult a job, or they can't be bothered, or what?)

Although I agreed almost entirely with Frances' arguments, I bristled a bit at " the sacred mourning rites that have survived for millenniums." Because I think babyloss is it's own little dark corner of bereavement, and I think we show here and on our blogs on a weekly basis that contemporary society has a ways to go before it wholesale accepts our particular grief as a healthy if not painful and uncomfortable process that people experience. Babyloss parents frequently speak of having no one to turn to or talk to, and in fact, document people turning and running in the other direction when given their news. God bless the internet, because places like this -- here, online -- have become a life-line for many who need to grieve and make sure they're in some bounds of normalcy. As we all showed a month or so ago when I asked for input on funeral services, there aren't as much "rites" as there is "getting through the moment to the best of our abilities." So where does this put us on the analytic scale? Are we difficult to place? So difficult that we might as well just lump us in the larger definition of depressed? I'm not saying because we as a group lack a cohesive and common social experience ergo we need Zoloft; perhaps this is a clarion call to examine babyloss more closely and for society to agree to abide and sympathize with us and give us the support that we so desperately need.

+++

I want to open this to discussion to the people whom it actually affects. You. And find out what you think.

But.

I don't mind anyone here getting defensive about being labeled depressed right out of the gate. Hell, I'm a bit pissed about it all, too. But I think we need to be a bit careful that our arguments against Draft DSM V's line of thinking don't play into any preconceived negative notions of depression, therapy, and anti-depressants. Society may not know how to deal with babyloss parents, but let's face it -- we're also battling a stigma of depression that paints its sufferers as weak. Weak and perhaps suicidal, delusional, or even alcoholic depending on what Lifetime movie you've seen recently. And there are people here, who read here, who have sought out therapy and used anti-depressants to their advantage, who have crossed that line between mourning and depression. Let's not take them down, too.

And what I'd really regret is slamming the new proposed change and taking down anti-depressants with it and then leaving a newly bereaved parent saying, "Well hell, I'm just grieving goddammit." And not wanting to eat his or her words two months later when they get knocked to the ground and are scraping the barrel because sometimes it's hard to make a decision, and sometimes its really hard to make a decision where you have to admit you were wrong about something, publicly. It shouldn't be that tough to ask for help, and to get it.

If I've learned nothing else writing and reading around here over the past few years, it's that everyone grieves differently. So I ask that in the comments, we're mindful of this.

So let's hear it. How do you feel about the proposed change that will essentially make grief a mental disorder? Semantics? Do you see a problem that could impact your life directly? Do you feel funny being labeled as such, or relieved that someone is even paying attention? Do you think you ever crossed that line between grief and depression, or think that you could? If you could address the people drafting DSM V, what would you tell them that you think might be helpful in making their decision? I realize many of you have already addressed this issue on your blogs -- please post a link to any posts in the comments.

signs signs everywhere signs

'Is there someone you have who can spot your warning signs?'

'Sorry?'

'Is there anyone who you talk to. Someone who will notice any signs.'

'Can you give me an example?'

I knew exactly what she was talking about, but I wanted to make her say it out loud. I wanted to hear how she would articulate that the emotions I consider normal cohorts to grief are what she considers 'warning signs'.

I had explained upon arrival at her office that I was finished my prescription and was not planning on refilling it. Her first words?

'Oh. Oh, my.'

Ah. Signs.

WARNING: SHE IS LOOKING SAD TODAY.
WARNING: SHE APPEARS TO BE FEELING A LITTLE ANTISOCIAL.
WARNING: LET’S GET HER BACK ON THE DRUGS, IMMEDIATELY.

---

'You mentioned your temper before. And crying often.'

In my mind: ‘OH MY GOD Lady. THAT’S what you call signs? Then I’m fucking CERTIFIABLE, with or without the antidepressants.’

In reality: 'My husband and I are close. My mother and I are close. I have a good friend here now.'

‘That’s good. They’ll know you well enough to spot the signs.’

Next I tried in vain to describe the physical side effects I’d been suffering from over the previous 48 hours since stopping because frankly, I was pretty freaked out. I was dismissed, albeit in a very polite manner.

---

Walking home from my appointment, I realized with a shiver that my bare legs and flops would soon go the way of the closet in order to make room for tights and boots and English wind and rain. Why hadn’t I noticed the temperature two hours earlier? Was it the same reason I forgot to open the window for the dryer exhaust? Or why I left the milk out all day?

I imagined with the seasons changing that I might have an embroidered toque I could pull on, serving the dual purpose of alerting anyone to the difference between these infamous signs and a banal annoyed mood resulting from a hard day at work.

It could be white, with pink letters sewn in. And reversible!

On one side: BAD DAY & BITCHY

And the other: DEAD BABY MAMA

How's that for a sign?

---

I've had to take two days off from work this week after finishing my last pill over the weekend. I'm dizzy; really fucking emotional. I feel dopey and foggy and have tried unsuccessfully too many times to count to describe the weirdo tracer vibe I've got going on. Every blink feels as though it's taking me three steps further than I'd intended. Does that even make sense? I guess I'm Coming Down.

Is there a rehab for this kind of situation? Cause believe me, I'd love to go. Three weeks would be perfect. Goodbye world: I'm taking a well earned breather.

In the end, Doc's only explanation was 'heightened awareness'. I've been dulled profoundly around the edges for almost a year now, leveled out by a magical chemical concoction that has kept me on a relatively even keel.

Don't get me wrong - as opposed as I was to antidepressants in the beginning - my opinion has changed completely. I was several months into our loss when I saw Christmas on the horizon and started to lose my shit all over again. I couldn't cope. I sought medical intervention. It helped - no question. I just wish I'd known how profoundly and physically I'd be affected by the removal of said chemicals from my system.

So far, I'm hanging in there. Five days in, one tentative step at a time.

I am 100%, honest-to-goodness, wholeheartedly of the Whatever Works for You camp. I can't say with certainty I won't go back to this form of help in the future. But right now, fulfilling the promise to myself of weaning back to my 'natural state' (HA, I know) within a year is important to me. The idea of another pregnancy this year plays a huge role in my decision, of course. But more than anything, right now I just need to follow through on ONE thing. With my most basic self.

I worry minute to minute how my revived and heightened awareness will affect my progress in moving forward. How will I cope, just me?

Only time will tell.

.::.

Have you had experience with antidepressant since your loss?  Have they helped you? If so, would you mind sharing what led you to the decision, and whether or not you've decided to continue?

In Your Head: An Interview with Dr. Sara Corse, Ph.D., Clinical Psychologist

Seeking help from a therapist in the aftermath of babyloss often raises conflicting emotions within the bereaved based on their preconception of grief, and of the psych-profession in general. "I'm not depressed, I'm grieving!" babyloss parents scream from their blogs, in defense of their decision to not seek outside help.

Maybe.

Do we really know the difference between the two sets of emotions? And why are we all worked up about seeing a therapist anyway? Does it signal that we're weak? Can't handle it? Need to take our ugly emotions inside, out of public, into an office with a shut door? Or (gulp) maybe we're even a wee bit crazy?

What about those of you who sought help and were confronted with professionals who told you to buck up? Who didn't understand what infertility and babyloss had to do with each other? Who glossed over the loss and focused on something else -- or vice versa, assumed the loss was the be-all-and-end-all to your problems? And you were left wondering: was it them, or me?

In order to try and clarify some of these issues I went directly to the source. Dr. Sara Corse is a psychologist who specializes in grief counseling and the author of Cradled all the While, a memoir of her experience in dealing with her mother's terminal illness. Dr. Corse sees individuals, couples and families at Council for Relationships in Philadelphia. (Disclosure: I, Tash, interviewer, saw a grief therapist regularly, until recently. I consider it on the whole, a positive experience.)

Tash:  Thank you so much for agreeing to this interview. How does one become "a psychologist who specializes in Grief Counseling?" That is, are there special courses or training that you do?

Dr. Corse: There are several professional pathways to working with people who are grieving. A grief counselor may have training as a psychologist, social worker, couple and family therapist or nurse. Grief is a normal life process, and as such is covered in courses on lifespan development. Therapists learn to work with both normal and complicated grieving in courses and supervised experience in counseling. Some programs offer semester-long courses in grief and there are many opportunities to specialize through self-guided readings, advanced supervision, workshops and conferences.

Why did you decide to go into this particular avenue of psychology?

I developed an expertise in grief counseling several years into my career, motivated by my own experience of loss. When I was 36, I cared for my mother as she was dying of cancer. I’d lost my father to a heart attack when I was 18, and I was struck by how different the two losses were for me emotionally. I have always been one to read everything I can get my hands on when I’m trying to process something distressing, so I read widely on death and grief. I also began writing what became “Cradled all the while” a few months after my mother’s death, and found the process of writing to be helpful, both in terms of my own grief and in terms of opening my interest in grief counseling. It is more than a decade since my mother’s death, and I now have a wide and varied clinical practice. About 20% of my clients come specifically for grief counseling and many others have had losses in their life that they have not fully grieved, and this becomes part of their therapeutic work.

I know I felt this early on (I no longer do) and I've seen it expressed by others: how do you answer the grieving parent who responds, "Well what do you know! Have you ever been through this?" What is it exactly that you can offer someone regardless of whether you've been through that particular situation or not?

It is common for people who are grieving to feel very alone with their experience. There is often a deep desire for connection with others who’ve been through the same thing, and at the same time, a wish for acknowledgement or appreciation that their loss is unique. I openly share with clients whether or not I have experienced a loss like theirs personally. In fact it is sometimes more difficult to work with someone who is grieving a loss similar to my own, because I have more of my own experiences to filter out in order to be responsive to the client’s emotions. What I try to offer all clients, however, is an open-minded curiosity and interest in their unique story of loss and a commitment to accompany them in their grieving process.

I know you don't want to start analyzing people who you don't even know, but are there any ground rules for how someone would know perhaps it's time to seek out this particular kind of help? I know a common refrain around here is, "Of course I'm depressed! My baby died!" and some people are just reluctant to seek out this kind of help due to monetary constraints, preconceptions regarding psychotherapy that were in place before their loss, or just not understanding the profession and what it can offer.

To understand when it’s time to seek grief counseling, it might be helpful to first have an idea of what normal grieving looks like. I like Theresa Rando’s model of mourning (grief refers to emotional, behavioral, physical and social reactions to loss; mourning refers to the work of processing and integrating the experience of loss).

She calls the first phase of mourning the Avoidance Phase, during which time the person in grief comes to recognize the loss. This includes acknowledging the death and working to understand the death.

The second phase is the Confrontation Phase, in which the grieving individual experiences the deep emotional pain of the loss. The work of mourning during this phase is reacting to the separation from the loved one through feeling, identifying, accepting, and expressing one’s emotions. It also involves identifying and mourning secondary losses that coincide with or develop as a consequence of the initial loss, such as the loss of the role relationship one had or would have had with that individual. During this phase, mourners recollect and reexperience the deceased and the relationship—reviewing and remembering their life, and reviving and reexperiencing the feelings engendered by that relationship. The person in mourning relinquishes old attachments to the deceased and to previous beliefs about how the world works.

The final phase of mourning is the Accommodation Phase. A new relationship is developed with the deceased, new ways of being in the world are adopted and a new identity is formed…one that incorporates the experience of grief and loss but is not wholly defined by it. And finally there is a reinvestment in life. The process of mourning a specific death can take place over many months and years, and may be revisited and reworked at different points throughout life.

This model of “normal” mourning serves as a backdrop for addressing complicated mourning. (I use quotes because the word normal seems to trivialize the pain of grief. I know that when I have been in mourning, nothing felt normal about it, and I wouldn’t have wanted anyone to suggest that it was). Complicated mourning is associated with several risk factors. These include specific circumstances of the death, such as a sudden, unexpected loss, death from an overly lengthy illness, the loss of a child, or the perception that the death was preventable. Other risk factors are related to the griever’s prior or concurrent condition, such as previous losses that were not fully mourned, high levels of life stress, depression and anxiety or a perceived lack of social support.

Grief counseling can help with both types of mourning, but is particularly useful in complicated mourning (or during complicated periods of normal mourning). So how does one know if it’s time to seek counseling?

One indicator that counseling might be helpful is feeling stuck—as with struggling to move from the Avoidance Phase of mourning into the Confrontation Phase. Denial is sometimes a cause of that feeling of stuckness. It is often a feature of the Avoidance Phase, manifesting either as not acknowledging the reality of the death or not acknowledging the feelings associated with it. Denial is not something we do, but something that happens—a natural psychological reaction which provides us with a time-out—a temporary delay of grief until we can gather the psychological resources necessary for experiencing the devastating pain associated with the loss. Although initially adaptive, if denial continues for too long, it becomes maladaptive and delays us coming to terms with the loss. Counseling can offer support in coming to acknowledge and confront the grief.

Another indicator is a persistence of depression or anxiety. Grief and depression share common symptoms, such as sadness, difficulty sleeping, loss of appetite and loss of energy. But in grief, our moods, such as sadness, anger, despair, or hopelessness, are triggered by sights, sounds, memories and thoughts about the loss. In depression, the symptoms are more persistent and pervasive. In grief, moods and symptoms change over time—from acute grief, which may be debilitating and immobilizing, to later stages of mourning when feelings can be bracketed—at least enough to function at work or at home. The feelings may not be any less strong and may still hit powerfully and unexpectedly, but they can be felt and expressed without interfering with overall functioning. In depression, bracketing is far more difficult. Mood and energy are more consistently down.

In terms of how long is too long for feeling depressed during normal grieving, some professionals use two months as a marker. On the one hand, I think 2 months is too short a time to diagnose depression in someone who is grieving the death of a child. On the other hand, if someone is struggling with feeling depressed, and having trouble resuming normal activities two months after the death, therapy can be such a helpful tool that I encourage it even if it is a part of grieving and not depression.

We've all been told at least from within this community that grief is a normal life process, and there is no wrong way to grieve. What benefits are there then to seeing a therapist as opposed to, say, duking it out on your own?

Here are some things clients have shared with me about how therapy has been helpful for them:

* feeling validated, feeling heard, feeling listened to

* feeling not alone: being able to reflect on and express their feelings with another person rather than keeping them inside

* not feeling blamed or judged

* appreciating that they don't have to reciprocate with the therapist--they don't have to take care of or listen to the therapist's feelings. They don't have to prove to the therapist that they will be okay. They don't have to take any responsibility for making the therapist feel like he or she is being helpful.

* being able to talk about the experience as many times in as many ways as they want or need without worrying about being a burden.

* being able to ask questions and get feedback and learn a framework for understanding their experiences that can support them through the phases of mourning.

* being encouraged to explore feelings that they may shy away from with the support of the therapist, and thus learning how to tolerate these emotions as they come and go during mourning.

* having a space to grieve that feels safe and where time and expectations don't (or shouldn't) matter.

* being able to talk about their feelings about or worries about other family members confidentially, and explore in therapy ways to address them.

* with couples, helping partners understand and appreciate the different ways people have of mourning, and learn to support each other and stay connect through the grieving process.

* having a place to explore other issues that are kicked up by the loss and may be important to address at this point in life.

Do you have any suggestions on "finding a good fit?" I feel as though I rather lucked out, although I did look for someone who specialized in "grief." Others in these parts have not been very fortunate in finding doctors that they feel are helpful (some sound downright oblivious to the basic issues surrounding infant death). What should we look for when we go in the first time (or few times)?

* someone who makes you feel comfortable telling your story and sharing your feelings.

* someone who has some experience with working with grief.

* someone who communicates an interest and curiosity in you.

* someone who will answer your questions, even if they come across as challenging, without being defensive or dismissive.

* someone who will engage with you around questions of fit, and doesn't suggest that he or she is the only person who can help you.

* someone you respect.

* someone who respects your boundaries—not imposing their beliefs or experiences on you and not pushing you before you have developed trust.

Along the lines of "there is no wrong way to grieve": It seems to me that, sadly, for some members of society at large there are indeed "right ways." It's not uncommon for us to occasionally get comments to the effect of "hurry it up already," or, strangely, "You need Grief Counseling!" One of our contributors (Bon) recently wrote a hospital to ask them to change the language on their fund-raising literature as she found it offensive to someone who had lost a family member at this institution. The campaign went public, a newspaper picked a line out of Bon's argument, built a story around it, gave it a controversial title, and then posted it on the internet -- and opened the comments. The public comments were stunningly offensive in my mind, one of them though told Bon to "Get Grief Counseling."

I thought that was a rather strange insult; it seemed to be indicating that the commenter was uncomfortable with Bon's emotions and that Bon was better off dealing with these feelings privately (preferably in an office with a doctor present, apparently) -- not publicly. But it also really tiptoes the line as to how the public at large views therapy, and it's worth.

Our society does communicate a strong message of intolerance for the wide range of feelings that grief entails. Tears and sadness, maybe. Anger and advocacy, not so much. And our society follows up the intolerance for the full range of emotions with intolerance for any of those emotions that last longer than a few days or weeks. Bon handled the whole situation, from beginning to end, with grace and balance. She was attuned to the impact the hospital’s fundraising letter had, not just on her but on any parent who’s baby did not survive, and took action to raise the level of awareness and sensitivity of the fund-raising world to this point of view. The public comments suggesting that Bon get grief counseling miss the mark. In fact, a healthy processing of grief often leads to an action such as Bon's. When we have done (or are doing) the work of mourning, we are able to speak out regarding the universal truths of grieving and loss and can advocate for societal change. When we embrace the full range of feelings that loss brings to our lives, and integrate our most painful experiences into a new way of being in the world, we find energy for transforming our experience of loss into something positive for others.

What do you see as the biggest hindrance to grieving?

I don’t think there is one big single hindrance, but there are several roadblocks, some internal to the person who is grieving and some external. Earlier I mentioned denial. It is the persistence of denial, not its early existence, which proves problematic. If we cannot sustain knowledge of the fact of the death and the irreversibility of the death, we cannot mourn. Another hindrance to grieving is the inability to gain necessary information to answer questions about how and why the death occurred. We often hold off on feelings of loss until there is greater understanding.

External hindrances include the impact of commonly held myths about mourning, such as the notion that grief follows a set path or sequence of stages, resolves in a matter of months or comes to complete resolution. Another external hindrance for parents grieving the loss of a baby is society’s tendency to minimize the loss. In fact, grieving the death of a child means not only experiencing the loss of the brief relationship, but also the loss of potential, about which they are continually reminded. The perpetuation of societal attitudes about grief makes it hard for people in mourning to acknowledge their feelings, both to themselves and to others, to be patient with themselves and to seek and gain support from others.

What then do you see as the most helpful thing (or things!) one can do to process grief?

In terms of denial, there are various experiences early on that can help grievers acknowledge the death and begin to experience and express their feelings. These include having the opportunity to hold or touch or view the body of the deceased, and to participate in rituals that acknowledge the death, such as a funeral.

As the process of grieving continues, it helps to talk about the death and any feelings, and to find people who are willing to listen and ask questions.

Participating in a support group with people who are experiencing or have experienced a similar loss can be helpful for exploring and validating feelings. This includes on-line support groups.

It helps to create rituals or memorials that are meaningful. Some people plant a tree or garden, donate to a cause, or launch an initiative in their loved one’s memory, enacting love and the pain of loss in a way that benefits others.

And as we’ve discussed, grief counseling is helpful, particularly when we feel stuck or alone, when we are experiencing a complicated period of grieving or when we have an inner sense that in processing this loss, we are provided an opportunity for making other important life changes in therapy.

How do you feel about online support -- like this site -- or blogging as a means of self-help?

I think it is a fantastic medium for several important processes of grieving: The work that people do in writing about their experiences, whether blogging or commenting on other people’s posts, is transformative. The writer must engage her or his emotions in the crafting of a post, which then offers both an expressive outlet and a mode of working through the experience that deepens personal understanding and connection to the experience. In posting on the internet, writers have an immediate outlet for sharing their experiences with others. Because there is an intended audience, the emotional, intellectual and creative work of blogging is different from personal journal writing—in considering what one wants to share publicly, the writer’s perspective is lifted to the universal (or at least in that direction). This process of moving from the personal to the universal is something that gradually happens during the process of mourning, and writing for an audience facilitates it.

Blogging also offers a wonderful way to network with others who have experienced something similar. Particularly for those who are new to grief, being able to read and comment on posts by people who are further along in their mourning can be very validating. For parents grieving the loss of an infant, being part of a blogging community is a way to create a set of loving relationships around oneself and one’s lost baby. Sharing grief this way brings meaning to the baby’s short life, and when others in the blogging community respond to or even anticipate one’s own grief reaction, the grieving parent feels far less lonely.

The one caveat I would mention about on-line communication is that it is different from face to face communication in terms of how people filter emotions, opinions and reactions. On the one hand, people may hide certain reactions and reveal other reactions in order to gain social acceptance or approval. On the other hand, sometimes people are inappropriately unfiltered in their reactions, such that they say things and say them in certain ways that they never would if they were face to face (internet bullying, perpetuating conflict and misunderstanding, etc.). So I would encourage people to continue to nurture supportive face-to-face relationships for grieving as well.

Have you sought out therapy in the aftermath of your babyloss?  Why or why not?  Did you find it useful/helpful?