In Sane Grief

...I wrote very early this morning at the main journal, something I forgot to mention:
    While I was waiting in line at the Post Office, yesterday (always try to avoid the post office on the Friday before Mother's Day), to requisition a U-cart for transporting (Mom's and) my food donations to the managing office, I noticed a display of the two types of Passport applications and, having nothing better to do and being in a line of people who didn't seem particularly amenable to casual chat, decided to peruse a copy of each (application in person and application by mail). Strange but true, although the geographical parameters of my life range over half the globe, including crossing U.S. political borders, I've never needed a passport so I've never had one. As I read the application an alternate mind-track teased me with travels in and out of the U.S. that I've considered since December 8, 2008: Wandering the world to research how elders are incorporated in a variety of societies; Seeking work and residence in a socially democratic country with a decent universal health care system; Learning a new language (several possibilities have arisen since Mom died and I'm continuing to investigate which to pursue first) then visiting the country in which the language is spoken in order to sharpen my skills; acknowledging and taking up the invitations of a few online journaling friends to visit them and their areas; visiting famous high rain areas like Milford Sound, New Zealand, and Mt. Wai'ale'ale, Kauai.
    Once I'd been admitted to the post office office (sorry, I couldn't resist the redundancy) I noticed a camera set-up through an open door into another area. After the impromptu Food Donation Celebration wound down, I asked the office manager about applying for a passport. Aside from reviewing the obvious technical information (hours applications are accepted, who to approach first, etc.) she offered me several helpful tips:

• Don't pay the post office for passport photos. They charge twice as much as the pharmacy across the street. Don't use a particular chain pharmacy, either: Their photos are often too dark to use. Just prior to my visit yesterday, she'd had to send away a family who had solicited photos from this pharmacy.
• If I'm planning any major change to my appearance [coloring or drastically changing my hair; plastic surgery; significant weight gain or loss; a tattoo within portrait range; having an ear amputated (she snickered at this one)], wait until my appearance has stabilized before having a passport photo taken. If I don't, I'll wish I had the first time I use the passport.
• No, I don't have to have a trip in mind in order to apply for a passport; if I don't, leave that section blank.
• Yes, Birth Certificates are returned relatively promptly and in fine shape. She's never had a complaint about this, although she's received anxious calls because "it takes awhile" to get them back. "For god sakes," make sure I copy it before sending it off.
• At this time, if you apply in person, stifle the urge to joke about terrorist activities. "You'd be surprised," she said, "how many people do this. We're obligated to note this on an application and this can slow the process," which, normally, takes four to six weeks.

    Although I'm sure the passport application display has been ubiquitous at our local post office since the USPS became an "agent of application" on behalf of the U.S Department of State, I think it is not incidental that I didn't notice it until five months, to the day, of my mother's death. I think it's also a landmark in my grief process. By chance, the Hospice Grief Counselor called me Thursday. As we chatted, I mentioned to her that between her last call and this one I'd begun to read through selected books on grief, especially pertaining to losing a spouse, since I identified more with this than with losing a mother. I also told her that, around the time I decided to do some in depth reading, I wondered if I might be a candidate for "complicated grief" and wanted to read more about that.
    "You're not," she said, and went on to clarify that people experiencing complicated grief tended toward silence. She didn't find it necessary mention that grief silence is not my problem. It's obvious.
    I told her that I was aware of this because one of the books I'd checked out was what amounted to a text on "Complicated Mourning" by Therese A. Rando, the contents of which clearly indicated that the chief hallmark of complicated mourning, blocked mourning, didn't apply to me, although I was finding the book extremely helpful in understanding my grief process. I asked her if she'd heard of the book. Only cursorily, she mentioned, but as we discussed the book I realized I hadn't absorbed as much from scanning through it as I thought I had. When our conversation ended I opened the book and reviewed its peculiar and distinctive definitions of, among other aspects of loss, mourning. Rando, in Chapter 2, which includes a section of "Definitions", Rando devotes a little over three pages to defining mourning, versus a little over a page defining grief. She distinguishes the definition included in her book from the traditional definition of mourning, "the cultural and/or public display of grief through one's behaviors", thusly: She emphasizes "the psychoanalytic tradition of focusing on intra-psychic work, expanding on it by incuding adaptive behaviors necessitated by the loss..." [all quotes from Treatment of Complicated Mourning copyright 1993 by Therese Rando].
    In addition, she devotes a majority of the chapter to a further, meticulous elucidation of mourning, including "The Six 'R' Processes of Mourning". As I reacquainted myself with these, I realized that my food donation experience, including my writing about it afterward, fell into a variety of categories:

• "Feel, identify, accept, and give some form of expression to all the psychological reactions to the loss"
• "Identify and mourn secondary losses"
• "Review and remember realistically"
• "Revive and reexperience the feelings"
• "Readjust to move adaptively into the new world without forgetting the old" [bolding SIC]
• "Develop a new relationship with the deceased"
• "Adopt new ways of being in the world"
• "Form a new identity"
• "Reinvest" [bolding SIC]

    Although I've listed these categories in order, my experience of them through this one experience was all over the map, another accepted hallmark of mourning: The processes, as observers of grief and mourning have labeled them for better understanding, don't happen in any particular order, nor do they necessarily end; they evolve, sometimes into another process, sometimes into a regurgitation and/or refinement of the same process.
    The main reason why I wrote the post to which the title above links is that, after yesterday's food donation episode was over and I was reviewing the experience, I noticed a new and distinct difference in the way I am handling my mother's death. It feels like a movement, although not necessarily along a grade like "better/worse", "higher/lower" "more/less competent". The reason I took note is that, previous to yesterday, I've experienced my grief process, for lack of a better analogy (although please assume that this one isn't exactly right, either), as centrifugally closed. Yesterday, I felt as though I'd begun to spiral...not out of anything, but to an area that, hmmm...allows me to reach for more...does that make sense?
    Specifically, yesterday was the first time since Mom's death that I "talked" to her for so long a time and with so much concentration. I didn't feel as though Mom was "there", in the same sense as I took for granted that she was "there" with me when she was alive, at home and I was out doing errands. There was none of the palpable psychic impress that her alive existence engendered in me when she was at home and I was not. She was, however, with me in a way to which the phrase "in memory" does only paltry, demeaning justice. I'm at a loss for words, here, but I suspect that other survivors will understand what I mean.
    It's the first time I can remember, too, that I've taken an "alive" and common episode in our lived together lives and adapted it successfully and joyfully into my present survivor experience. Finally, as I did so, I autonomically leapt from adapting an old experience to considering new experiences that have nothing to do with Mom's and my lived together life. It felt hopeful...not as though I was leaving anything behind but as though the world around me was widening in a way I hadn't expected.
    That's a Survivor's Mother's Day with which I can live. Gladly.

Labels: Celebrations, Complicated Grief, Grief Fantasies, Grief Literature, Grief Self-assessment, Life after Death, Mother's Day, Mourning Processes, Rando

    Despite my amusement with the concept behind the Texas Revised Inventory of Grief [TRIG] I am, at heart, a product (sometimes a proud product) of my industrial-civilized upbringing and usually can't pass up the opportunity to take a self-"help" test, which is one of the possible uses of this particular grief assessment. I'm not alone in this. Meghan O'Rourke, whose series of articles about grief in Slate brought my attention to the TRIG (she mentions it and provides the same link to it I've posted above, in the ninth paragraph of the third article in her series, which is linked to the above reference to Slate) also found the assessment intriguing enough to "take".
    Punching the name of the assessment into Google unrolls a list of 27,200 references. If you surround the phrase with quotation marks, the list narrows to 1,310. This, I think, speaks on behalf of the popularity of the assessment, if not its reliability. Most sources advise professionals to use the assessment with circumspection. There has been at least one adaptation of the assessment with an eye to grief involving the loss of a child. This assessment is interesting because it rewords the statements to apply to losing a child and adds a third section, entitled "Related Facts", the statements of which are evaluated on a simple "True/False" scale and are designed to add further insight into the long term grief process of the assessee.
    The unadulterated assessment is divided into two lists of statements, Past Behavior and Present Emotional Feelings. Participation requires the assessee to rank her/his agreement with each statement on a five level scale as follows: a = completely true; b = mostly true; c = neutral; d = mostly false; e = completely false.
    It's hard to find any specific information about scoring on the internet. This may be because distributors of the test are wary about its use for self-assessment. The most complete explanation I found is on page 2 of 6 when this article is opened in one's Adobe Reader; the journal in which the article appears lists the page number as 516. This explanation is particularly interesting because it compares responses to Part I with responses to Part II in an attempt to assess the possibilities of delayed grief and prolonged grief. Pages 10 an 11 of this Power Point article (which opens as a pdf file) presents a scoring explanation which is down and dirty, thus easier to understand and utilize casually. Essentially, when rating one's answers, one scores one's a-e selection on a five point scale, giving one point to "a" answers and sequentially upgrading to five points for "e" answers. The lowest to highest score one can accumulate on Part I is 8 - 40. For Part II: 13 - 65. Informally speaking, the higher one scores, the lower is one's experience of grief. In my research of the TRIG (which was admittedly brief, confined to maybe an hour and a half of clicking into links from my Google search and scanning the articles) I found no evidence of anyone using the assessment to determine levels of "healthy" or "unhealthy" grief. I find this a relief, as it indicates to me something advocated by some of the grief literature I've lately perused: That grief is a highly individual experience and the meaning of ease or difficulty with grief must be considered within the unique circumstances of each Grieving One's life.
    The assessment (and its adaptation) is meant to be administered to the grieving survivor a fair while after the death. Although I found nothing specific to suggest the following, my guess is that Part II and Part III of the adaptation, depending on the circumstances in which the assessment is used, can be and probably are administered multiple times. In the original TRIG, Part I focuses on memories of fresh grief responses immediately after the death; Part II attempts to assess how one has moved through grief and where one is "now" in the process.
    Although it is meant to be used in a formal setting, no doubt proctored and evaluated by a professional, I found that self-(ab)use (I couldn't resist), reading the statements, considering them, even assigning a number to one's grief and comparing it to highest and lowest scores, can be enlightening. On April 14, 2009, when I discovered the TRIG, I decided to take it "straight". My results on Part I were 26 out of a possible 40. My results on Part II were 43 out of a possible 65. Considering that I scored about the same (by percentage) in Part I (65%) and Part II (66%), I surmised that this might indicate that I am handling my grief about the same now as I was when my mother died. This surprised me because it has seemed to me that I am grieving more than I did right after Mom died. As I looked back over the statements and rummaged through the thoughts that each statement aroused when rating them according to how they applied to me I realized that what is likely happening is that I am expressing my grief more freely and understanding it better than in the immediate death wake; responses the TRIG doesn't differentiate in terms of "more" or "less" grief.
    Because I am obsessively self-analytical, I thought it would be entertaining (more for me than you, I suspect) if I include here a review of thoughts I had as I rated the statements, along with how I rated them. Keep in mind that the statements (which I'll display in this color) were developed by Thomas R. Faschingbauer, Richard A. DeVaul, and Sidney Zisook and copyright by TRIGs publisher, American Psychiatric Press:

• Part I:
  1. After this person died I found it hard to get along with certain people.My rating: c (neutral)
     My thoughts: Yes, in that I was unable to contemplate any kind of difficulty in sorting out death business during the week immediately after my mother died while relatives were here. Two examples: One relative, the day that my mother died, warned me to immediately transfer almost all money in Mom's & my joint checking account into a new checking account before the bank found out about the death because the experience of friends told him banks tend to freeze accounts when one of the holders dies. My response was, "I can't handle this, I don't want to hear about it." The relative was wrong about this. Some days later, after immediate death business had revealed itself to be pretty easy, straightforward and not at all threatening, yet another relative related experiences of yet more friends who had been devastated by inheritance and estate taxes, losing "40%" of their assets to such. My response was the same as to the example above. Again, the relative was wrong, at least about my situation. My mother's estate is subject to no death taxes from either the state or the feds and I am not subject to any inheritance taxes.
     Other than abruptly dismissing what I considered frightful absurdities, which I usually don't do (I usually take them on and analyze them in order to confront the absurdity and dissipate the fright) I was just as sociable, more so, actually, than usual, as quick to laughter and to tears, as good at listening as I was at talking and had no specific, unusual problems with anyone.
  2. I found it hard to work well after this person died.My rating: a (completely true)
     My thoughts: I was numb, completely unable to attend to household duties or death business. I left it up to everyone else. I was, however, aware enough to realize what people were doing for me and thank them profusely.
  3. After this person's death I lost interest in my family, friends, and outside activities. My rating: c (neutral)
     My thoughts: I did lose interest in activities that involved my mother [watching movies; reading, both silently (which I'd lost interest in over the last four years of my mother's life, anyway) and aloud; cooking; some areas of conversation; internet related activities; stuff like that], which accounted for quite a few activities. However, I redoubled my interest in most activities that didn't involve my mother and which had lain fallow over the last several years; and, I did this almost immediately after the first wave of relatives left. It was a relief to do so. The only people I could be said to have lost interest in were the many Hospice people who had become indigenous to our lives for seven months. I didn't think much about this. They were no longer contacting us (except for the grief counselor) and my assumption was that they were no longer funded, so they dropped off my list of people to contact.
  4. I felt a need to do things that the deceased had wanted to do.My rating: e (completely false)
     My thoughts: Unless the "thing" was expedient, using the ordered Christmas dinner and goodies, for instance, to feed mourning visitors and using the rest to provide a Christmas feast at one of my sister's homes (I attended the feast), there was absolutely nothing that I felt I "needed" to do in deference to my mother's desires after she died. I was, in fact relieved that there were some things I wouldn't be doing: Christmas baking, for instance; continuing to watch episodes of Touched by An Angel.
  5. I was unusually irritable after this person died.My rating: c (neutral)
     My thoughts: This harked, for me, back to #1. While my response to the fright and absurdity factors suggested by others was unusual, my disdain for them was not. Otherwise, I was no more or less irritable than usual.
  6. I couldn't keep up with my normal activities for the first 3 months after this person died.My rating: c (neutral)
     My thoughts: Considering that most of my normal activities involved caring for my mother, which I was doing to a heightened degree by the time she died, this, I figured, was obvious but to be expected; nothing unusual. Otherwise, I cared for myself and my life in pretty much the same way that I did when my mother was alive.
  7. I was angry that the person who died left me.My rating: e (absolutely false)
     My thoughts: I was not angry that my mother left me. I didn't even think about this one. Her death had nothing to do with her choice in the matter. Later, though, in my grieving process, I became (and remain) angry that there is such a thing as death.
  8. I found it hard to sleep after this person died.My rating: c (neutral)
     My thoughts: I didn't find it hard to sleep and have never gotten any more or less sleep than I did when my mother was alive. I did find it hard to sleep in my room after my mother died. I still do, occasionally. I prefer sleeping in the living room. I've decided that this is because the heart of our home is there and my preference, still, often, is to snuggle in that heart.
• Part II:
  1. I still cry when I think of the person who died.My rating: a (completely true)
     My thoughts: Absolutely, and without shame or discomfort. It feels good to cry, so I don't try to stop tears, ever, even in public.
  2. I still get upset when I think about the person who died.My rating: d (mostly false)
     My thoughts: I have almost never gotten upset when I think about my mother after her death. Occasionally I am upset with Death, but not about my mother or her death. I know, sounds confusing, but that's how I'm processing it.
  3. I cannot accept this person's death.My rating: e (completely false)
     My thoughts: I can accept my mother's death. I'm just having a hard time accepting Death, which is a surprise because I never thought I'd ever have a hard time accepting Death. I've done really well with this, up to now.
  4. Sometimes I very much miss the person who died.My rating: a (completely true)
     My thoughts: Oh, always...always. I can't, yet, imagine not missing her. This also causes me no shame or discomfort.
  5. Even now it's painful to recall memories of the person who died.My rating: e (completely false)
     My thoughts: I LOVE remembering my mother, love talking about her, love thinking about her. There is nothing in my memories of her and our life together that has been the least bit painful.
  6. I am preoccupied with thoughts (often think) about the person who died.My rating: d (mostly false)
     My thoughts: I wavered between "d" and "e" on this one. I chose "d" primarily because there have been a few times, even now, when I've been unpleasantly surprised by sudden intrusions of my mother and the stab of longing these evoke: When, for instance, I am in Costco but no longer buying supplies for our lived-together life; when I buy fast food for one but cannot divest myself of my mother's preferences (even though I don't buy those preferences, I buy my own).
  7. I hide my tears when I think about the person who died.My rating: e (completely false)
     My thoughts: Nope. Not a chance. I'm not wired that way.
  8. No one will ever take the place in my life of the person who died.My rating: a (completely true)
     My thoughts: I consider this a rational and completely good response. Of course no one will ever take her place. No one has ever taken the place of anyone who has left my life. This just isn't possible. I don't believe this is possible for anyone. I further wonder if it isn't both unrealistic, suspect (from the point of view of grief) and maladaptive if people think this can happen and look for it to happen. If I had set up the scoring standard for this test, I would have reworded the statement thus: "I'm expecting, or have already found, someone to take the place in my life of the person who died," thus giving the "high grief" (which would be the lowest numerical) score to those who rated the reworded statement "a".
  9. I can't avoid thinking about the person who died.My rating: c (neutral)
     My thoughts: Of course I can't avoid this. Nor would I want to, not even when the thoughts seem like an intrusion, as mentioned above. I suspect the underlying assumption with this statement is that the respondent might want to avoid thoughts or considers the thoughts as obstacles to other thoughts. I don't, even when those thoughts are intrusive.
  10. I feel it's unfair that this person died.My rating: e (completely false)
      My thoughts: I don't consider it unfair that my mother died. Death is what happens to all of us. I have lately, however, been feeling that Death, itself, is unfair. I wonder, in fact, why grief assessments and grief counseling don't seem to distinguish between feelings about the death of a person and feelings about Death, in general, especially since, in my case, the two have separated themselves and I'm having a problem with the latter, not with the former. Although I may be wrong, I'm guessing that I'm not the only grief-stricken survivor who does this. I've considered that my separation of these might be a response my psychology has designed to keep me from realizing that I am angry with my mother for dying, but this just doesn't fit. It makes no sense to me to be angry with her or cite her, personally, with the unfairness of Death. She didn't create the circumstance of Death. In fact, in her own mind, she erased that option well over a year before she died. Even in the case of suicides, and I've known two people who committed suicide, I can't bring myself around to thinking that their choice of the option to die is what creates the circumstance of Death...thus, anger and a sense of unfairness didn't, in either of those deaths, enter into my equation, either. Call it a personal quirk.
  11. Things and people around me still remind me of the person who died.My rating: c (neutral)
      My thoughts: When I thought about this I was surprised that, despite occasional unwelcome and unpleasant intrusive reminders, I am not more often reminded of my mother by "things and people around me"; not uncomfortably surprised, just surprised. Considering how close we became, how every aspect of each of our lives echoed in the life of the other, you'd think that I would be constantly and disturbingly reminded of her. But, I'm not.
  12. I am unable to accept the death of the person who died.My rating: e (completely false)
      My thoughts: Once again, it's not my mother's death I am having trouble accepting. It's Death.
  13. At times I still feel the need to cry for the person who died.My rating: a (completely true)
      My thoughts: I remember, when rating this statement, thinking, "Actually, I don't feel the need to cry for my mother, rather, about my mother and how much I miss her." I almost rated this one "completely false" but decided to give the benefit of the doubt to the statement and assume that the developers were implying "about" when they chose "for".

    What did I find "enlightening" about self-administering this assessment?

1. Although I knew that, for me, there exists a dichotomy between my mother's death and Death, I didn't realize, until performing this assessment, that there isn't professional grief counseling acknowledgment of this dichotomy, why it might exist and what the consequences are of allowing it.
2. Previous to assessing myself I suspected that I was not handling my need to grieve as well as it seems as though I am.
3. The assessment informed me about aspects of grief and allowed me to confront them as specific events, sometimes isolated from other grief events, rather than thinking of grief as one amorphous event. The former approach makes grieving easier, for me, anyway, because it helps me locate myself within the process. The latter approach tended to make me feel as though I was traveling through a labyrinth, one out of which I might never emerge.
4. It helped me realize what, about my behavior, might be specific to grieving and what isn't. Although my confusion about this wasn't overwhelming, it was barely noticeable, in fact, the added clarity was welcome.

    The TRIG appears to be a tool fairly widely used by professionals dealing with those of us ensconced in grief. This suggests that it is useful. It isn't the only tool. I've run across another, the G(rief) A(nd) M(ourning) S(tatus) I(nterview) [and] I(nventory) [GAMSII], especially applicable to complicated mourning, that is equally intriguing and upon which I will probably comment in a later post because it promotes a decidedly different and more personal method of assessment. Since I'm not a professional counselor, let alone a grief counselor, I'm not inclined to criticize the TRIG, despite my critique of Item #8 in Part II. I can see that it's a good organizational tool for thinking about someone who's grieving and seeking information about unique grief profiles. I'm not worried that it might be misused by encouraging counselors to ignore the eccentricities of one person's grief in favor of simply locating them, à la psychological GPS, in The Forest of Grief. I think that viewing grief is an experience that is most likely to provoke awe from any observer, professional or not, and would tend to cause a professional counselor to be more, rather than less, careful about soliciting information and giving advice.
    Would I recommend self-administration of this assessment to people? I would to people who tend toward and enjoy rigorous self-examination and are not prone to diffuse and critical worry about whatever psychological state in which they might find themselves at any particular time for any particular reason. I would to people who tend to harbor a lively and objective curiosity about themselves even if they aren't particularly self-conscious or self-absorbed. I would not to people who might tend to frighten themselves unduly with discovery about their psychological states or if they were normally intent on being oblivious to their psychological states. I also would not recommend it to people who seemed, at the time of the consideration, emotionally fragile, no matter what their previous behavior revealed about their normal emotional profile and self-interest.
    If you're as intrigued as was I, though, give it a go. It's involving and fun, yes, fun, if nothing else.

Labels: Complicated Grief, Grief Self-assessment, Slate, TRIG