Change and Loss in the Seasons of Life
Anne Coscarelli, Ph.D.
To every thing there is a season,
and a time to every purpose
under the heaven:
A time to be born, and a time to die;
A time to plant, and a time to pluck up
that which is planted;
A time to kill, and a time to heal;
A time to break down, and a time to build up;
A time to weep, and a time to laugh;
A time to mourn, and a time to dance.
(Eccles.3: 1-4)
Change is an inevitable part of our human condition, and most change is precipitated by loss. Loss can be permanent or temporary. The fear of loss can create the same psychological consequences as the loss itself. We all understand the profound loss when someone dies but loss also can take the more subtle form of not having an expectation fulfilled. Losses of all types and magnitudes shape our lives beginning at birth and extending throughout.
Loss and grief
Loss sets into motion a chain of feelings, which we know as grief. The grieving process allows us to express the emotional and physical pain associated with loss. It is a time when the emotions and states of being that we regard as normal may be absent or fleeting. Grief includes sad and anxious feelings, lethargy, cognitive impairment, difficulty coping, impaired judgment, and can be marked by social withdrawal, tearfulness, and disruptions in sleep, eating, sexuality, and activity patterns. Grieving helps us come to terms with loss and change, and it helps us to move forward in life. It is a process that should not be denied. But our society is not comfortable with loss and grief. We don't like seeing people unhappy or in pain - it makes us feel uncomfortable so we try to distract them and make them feel better. Doing so, I believe, can be harmful. Experiencing and expressing the pain of loss is a normal and healthy part of the grieving process and helps people come to terms with and accept loss.
I learned first-hand about profound loss and grief when my mother died this past year. She had been diagnosed with ALS seven years ago. This disease, like many types of cancer, steadily stole away pieces of her. I experienced grief with each loss, which helped me accept the change and move forward to enjoy and appreciate what we still had of her. When she died, I was struck by how much grief I still had even though I had been working through these losses for seven years. I remember talking afterward to one of my staff members who had lost her mother earlier. I was amazed by the power of this experience and how comforted I was as we shared our stories.
Loss and grief in the cancer experience
Loss and grief are inextricably bound to the cancer experience, whether it leads to death or it produces a profound change in one's life. Beginning at the time of diagnosis, cancer brings about a series of losses. There is the loss of innocence that one's body is trustworthy. There is loss of the fantasy that one can live forever, and with that comes the fear of death. Often, cancer brings about losses of body parts, bodily functions and appearance as well as losses in activity, joy and carefree moments. Loss of social contact and the ability to be with others can be quite significant. Some losses such as the loss of time and income are predictable and concrete, while others such as the loss of the fulfillment of dreams and expectations are subtle and often not recognized. All losses are real and significant. Many people feel that their greatest loss in the cancer experience is not having the opportunity to bear and raise biological children or to see grandchildren born and raised.
Family members and friends of cancer patients also experience profound losses and grief. The losses are somewhat different, but the feelings and suffering often are similar. All of us at some point in time will experience loss and grief.
Becoming more comfortable with this process and finding ways to cope is healthy for each of us.
Coping with loss and grief
I believe that recognizing loss is highly important in adapting to cancer and in one's ability to live and die well. One way that people work through their loss and grief is to find meaning in the experience. This is a very individualized process and can bring about personal growth and the understanding that loss and grief can co-exist perfectly well with life's more pleasant experiences. Victor Frankl's writings about concentration camp survivors illustrate that finding meaning is an important way to adapt to situations that otherwise seem like pure suffering. Because this is an intensely personal experience, there is no one way. Each person creates his or her own path. I would like to offer, however, a few practical considerations for dealing with loss and grief, as follows:
Acknowledge the loss. Sometimes just recognizing the event as a loss can open the doors to understanding your feelings about it. When you acknowledge a loss, you give it acceptance, which can be a powerful first step in moving forward.
Expect emotions. Loss creates a wide range of emotions. Pay attention to them; let them exist by allowing yourself to feel them. Embracing their existence rather than trying to push them away may help to lessen the pain.
Express your emotions. Acknowledging to yourself that you have these emotions is important, but giving yourself permission to talk about them with others can be extremely powerful. The number of people who have had feelings similar to yours will surprise you! Take comfort in this commonality. The process of expressing feelings also is a process of rejuvenation. Let yourself have a "good cry." Allowing yourself to feel, experience and express sadness may have a cleansing effect, making you temporarily feel better. It is a release.
Examine past loss. Looking at past experiences of loss and how you coped with them can be insightful and may help you to understand the meaning of a current loss. New loss often triggers feelings from past losses. In examining a past loss, you have an opportunity to consider your style of coping, which may help you to identify different ways to deal with your current loss.
Value and utilize rituals and symbolism. Rituals often help us to accept loss by providing a means of saying good-bye or letting go. Funerals and memorial services often provide opportunities to let people express their feelings, say final words of good-bye and to seek comfort in the practices of their faith. Many of the losses associated with cancer do not involve the end of life but are nonetheless quite significant, and they often have no rituals associated with them. Many women with cancer have created their own symbolic rituals as ways of letting go. Some women prior to having surgery or chemotherapy have gathered friends together in a supportive environment to say good-bye to their breast or their hair. Others have combined serious and symbolic practices with personal touches of whimsy and humor. These symbolic practices can recognize both an ending and a new beginning and as such can be powerful psychological healers during this otherwise painful experience.
If such a ritual appeals to you, but you don't know what to do, start by talking to your friends and family. Brainstorm and toss out ideas that might help you accomplish your goals. Allow yourself to be creative and non-censoring. You may find that this process alone is very healing. Consider your favorite music, poems, artwork and other personal expressions. Look into practices from a range of cultures that are used in ceremonies to assist in transitions. Loss is a transition, and marking its beginning and end can help you to move forward into the next phase of your life.
Maintain routines. Routines help us to keep life normal. Our bodies operate on biological routines or cycles, which regulate the production of neurotransmitters and brain activities that govern our normal waking and sleep cycles and keep us "running smoothly." These cycles often can be disrupted during periods of change and loss. The extent to which you can maintain your routines may enhance your ability to cope and your general well-being. Try to keep your eating, sleeping and exercise routines on as regular a basis as possible.
Look for meaning and where possible find gain. While the loss you are experiencing may be devastating, try to keep in mind that it may have a silver lining in the form of an insight, a new perspective or a deepening of a relationship that happened as part of this loss. Recognizing the gain in the midst of loss is a way of finding meaning in the experience. During my own time of loss I came to appreciate the words of Kahlil Gibran - "The deeper that sorrow carves into your being, the more joy you can contain." While we don't choose sadness, it may be a blessing. In its simplest form, it helps us learn to treasure our more joyful moments.
For many, the losses brought about by cancer marked the beginning of changes that improved aspects of their lives. Although they may not have felt positively about them at the time, these changes in retrospect were the shedding of an old and no longer useful skin. Cancer survivors often report that the "good thing" about the experience was that it got them out of a bad job or an unhealthy relationship. Sometimes, the old has to go to make room for the new.
Remember that memories and relationships live on. As we experience loss, we still have our memories that stay with us. Hold on to these memories for comfort. While I miss my mother intensely, I hold my memories of our times together close to my heart. My relationship with her lives on, in part because of my memories. The depth of a relationship cannot ever be taken away.
Seek professional assistance. Ask for help and know that there are many different types of professional assistance. For some people, a grief group can be beneficial especially after the recent death of a loved one. For individuals who are struggling with the changes brought about by cancer, a support group can provide a means to process, understand and find deeper meaning in the losses associated with the disease. Our Resource Center offers a wide variety of groups designed to provide different types of support. Look at the groups and classes described on page 14. The Healing through Art and Journal Writing workshops as well as the traditional groups all provide opportunities to heal the soul. We also offer individual counseling and can help identify therapists in the community to help manage loss and grief.
There are times when a grief reaction can become clinical depression. In these situations, professional consultation with a psychiatrist, psychologist, or other licensed therapist is imperative. Taking medication for a period of time may help to re-establish normal sleep patterns, stabilize mood, and assist in the day-to-day experience of living.
Clinical depression and the initial stages of grief often appear similar to the untrained eye. Listed below are some of the signs that clinical depression may be present. Please keep in mind that people who are in the early stages of grief experience many of these symptoms, and they are normal to this stage of the grief process. It is important therefore, to pay attention to their severity and persistence. If you have any doubt, please seek a professional consultation.
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Severe disruption of sleep patterns - difficulty falling asleep, staying asleep, or waking up.
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Persistent appetite changes including significant decrease or increase in food intake.
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Inability to experience joy in any activities.
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Significant and persistent difficulty in getting through the day.
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Persistent feelings that life is "not worth living" or intrusive thoughts of suicide.
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Unremitting feelings of sadness.
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High anxiety levels and/ or recurring panic states.
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Impaired cognitive function - a noticeable decrease in ability to "think clearly" such that it makes it difficult to work and carry on normal activity.
Find ways to give. Sometimes when you are hurting the most, one of the most healing things you can do is to give to someone else. This healing giving happens in support groups, where group members help each other cope. In addition to receiving comfort and support, members also find tremendous satisfaction, meaning and joy in helping others. This newsletter contains other examples of healing giving. Many patients or family members have volunteered their time as a means of giving back. Many have given gifts in memory or in honor of others. Several people have found ways to raise funds to support our programs, thus assisting others who are in crisis. You'll see on pages 10-13 several specific examples of ways that people gave to the Center during the past year. I know that many of these efforts brought healing to those who gave.
Look for joy. Even when faced with significant loss, you may be able to find ways to experience a bit of fun or joy. You have to know what brings joy into your life to do this. This may be a good time to start cultivating more ways to bring joy and fun in your life and to include ways that do and do not require physical activity. Most of us will experience periods of disability during our lives, and we would do well to make sure that we have a few things that we will enjoy doing during these times. What can you do when you do not have your full physical abilities that will bring fun into your life? Start cultivating these activities now. They will make your present life more enjoyable and they will serve as invaluable tools for coping with the inevitable changes and losses that life brings.
Let me remind you that our Center is here to help you and your family members through the cancer experience. We hope to provide a safety net to help you find meaning as the seasons of life change.
Finally, I want to thank all of you who reached out to me and to my family this past year. Your kind words, shared stories, and heartfelt kindness touched our hearts and made us appreciate that through pain and sorrow there are deep connections that warm our hearts and heal our souls. Many of you gave gifts to the Center, and I thank you for remembering my mom and for helping us to continue our work. Many will feel your generosity. My deepest gratitude goes to all of you.
Anne Coscarelli, Ph.D.
Wallis Annenberg Director’s Initiative in Psychosocial Oncology
© Anne Coscarelli, Ph.D. All rights reserved.
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