Tag Archives: bereavement

Loneliness can kill you…Part 1

According to new research from the journal Nature, Human Behavior published on January 3, 2025, loneliness and social isolation lead to molecular changes that, in my simple terms, seem to set the body up for serious problems – increased risk for dementia, depression, cardiovascular disease, diabetes, stroke, and early death.  The researchers’ recommendations include routinely asking about loneliness and isolation, the way a health professional asks about sleep habits, alcohol use, and drug use.

If you are lonely on an ongoing basis, this is for you.

Loneliness can strike through no fault of one’s own.

Losing your spouse, for example, or a best friend, will almost inevitably lead to a long stretch of deep loneliness during the initial year or so of grief, and can continue beyond, as the bereaved person struggles to outsource some of that emotional, intellectual and spiritual intimacy to other relationships. In a healthy marriage, you share all sorts of confidences with a spouse that you simply might not share with anyone else – fears, dreams for the future, spiritual insights and struggles, and the warmth of shared memories that are no one else’s but the two of yours.  Somehow, some of that must be extended to others, and depth built over time. It an absolutely monumental task to parcel out these small slices of the immeasurable depth of a healthy marriage.

Moving, alone, to a new city, for a new job, can be exciting, but the reality can include aching loneliness when everyone at the new job goes home to their lives and you go to your apartment and try to figure out how to build a life. Developing the big, and small, connections that make a place feel like home can be daunting, and for most people, it takes longer than they had ever anticipated.

Loneliness hits other people, too. Those who are living primarily second-hand, separated by screens and trying to substitute electronic connections for human ones, are often intensely lonely. Some people interact with others in person, but the conversations are shallow, guarded and therefore nearly empty of connection and meaning. This type of loneliness can be even more painful, because it seems inexplicable; how can a person live with family or a partner and yet feel deeply lonely?

So, what to do? Unfortunately, the impetus is mostly on the lonely people to do something differently.

Here are some suggestions I would give to a client in such a situation.

  1. Go to church or synagogue. If you are grieving, try to go back to your own – but if that’s painful, go somewhere else, at least for now. If you are new to the area, just find a place that seems like a possibility. Then go to the hospitality time afterwards. Introduce yourself, and invite people to tell you about the faith community. Do not stand around with your cup of coffee and wait for people to notice you. Set a goal: perhaps that you will introduce yourself to three people, get their names, and ask a little about this community. See what happens. Try to focus on the other person; make the conversation a chance to get to know them and about their community – not about you. If it goes fairly well, go back the next week, greet those three people (and anyone else you met) by name if you can, re-introduce yourself without taking them forgetting your name personally, and see if you can meet a couple of other people. Within a month, you will have some acquaintance with a dozen or more people and have a solid idea if this community offers activities for education, worship and service for you to join.
  2. Even if you usually like to do things solo join at least one activity – one exercise class, one art class, one talk at the local bookstore, etc. – on a regular basis. Get to be a regular. Greet other people.
  3. Volunteer in your community. Do this with others. Doing good solo is beautiful, but if you’re not getting out of your head and focused on others in an interactive way, you are missing part of the point.
  4. Be friendly but don’t try to bully people into being your friends. For example, if you are new to the area, don’t wear out your welcome with the neighbors who came over to introduce themselves on moving day.
  5. Please do not use alcohol or other substances, or resort to hanging out having drinks as a way to cut loneliness.
  6. Be patient and keep trying! Think of these steps as experiments. Track what happens over time; be willing to change to a different experiment if the first one isn’t working after a month or so.

As you can see, the remedies for loneliness all include getting out of your head and into the world. Focusing on others, in small ways (such as greeting them and showing interest) to big ones (such as volunteering), is a critical part of overcoming loneliness. This can be really hard, because loneliness tends to make people even more withdrawn, more insular – it is a self-perpetuating problem unless you boldly step out, even with small but courageous steps, into focus on others.

More about connecting with others in Loneliness can Kill You, Part 2, coming soon.

For Those Mourning a suicide

If you have lost someone to suicide, my sincere condolences:  peace be upon you in these incredibly difficult times.

I have been involved in grief counseling for a long time. I began volunteering as a grief support group facilitator about 20 years ago. Grief is always painful – the Irish language word clumsily translated into English as “Troubles” actually means tearing apart.  Losing someone to suicide is definitely a tearing apart, and one that carries particular burdens.

  • They are even more likely than other mourners to look backwards and try to reinterpret events to make sense of what happened. We humans like for things to “make sense,” even things that can’t be understood. Looking back can lead to a lot of unnecessary suffering – self-blame, recrimination, guilt.  Our culture pretends we can control just about everything, but we cannot. Through the lens of grief looking backwards, even a passing sad day years before can seem like a sign that was “missed,” and the perfectly normal little disagreement turns into the possible cause. Every memory is scoured for warning signs. The lists of warning sides of suicidality are helpful, but not all people have them. In reality, about 70% of suicides are impulsive acts – there are no real warning signs or markers, beyond the events of life that many people experience without becoming suicidal:  relationship struggles, financial struggles, legal struggles, job loss.  Some people will show some of the warning signs but are not be suicidal at all, such as someone who is enthusiastically minimizing their possessions in order to downsize. Please try to refocus on something else, even a small physical task, when you find yourself looking back to try to see what you “should have” seen: you are at risk of burdening yourself with unnecessary guilt.
  • Those whose loved one committed suicide are likely to hear even more of the hurtful things people can say to those grieving. Granted, most people’s hurtful remarks to mourners are well-intentioned, and yet incredibly unhelpful, such as the dreadful, “You’re still young…you’ll have other children,” or, “You should be glad they’re not suffering any longer.”  There are some people, though, who say truly, intentionally horrible things about those who commit or attempt suicide, and this leads mourners to lie about the cause of death and/or isolate from others.  Avoid these people; seek the company of those who are compassionate.
  • Those who have lost someone to suicide are especially likely to avoid going to grief support groups, or will only go to those about suicide.  I encourage going to a general grief support group, too; it can be a place to learn a lot of skills and strategies that are helpful to all mourners, and can be that first, safe place to talk about what really happened and get support as you manage the tangle of terrible emotions. You will find strategies and support for how to take one step at a time into a world that seems to no longer make sense. Please do not isolate out of pain, unnecessary shame or unnecessary guilt.
  • See your primary care doctor, avoid any mind-altering substances, and try your best to follow medical guidance – even though you will often not feel like eating right or exercising.
  • Seek individual or family counseling to help with the grief process as needed.

And, of course, as this is not psychological guidance or advice – just information and encouragement – reach out for help if you are struggling with suicidal thoughts or fear for someone else. Besides your health care provider, the local emergency room, or 911, you might call the National Suicide Hotline at 988 or the 1-800-273-TALK (8255) National Mental Health Hotline.

If you are reading this and thinking of someone you know who has lost someone to suicide, please reach out with compassion. Be present; keep reaching out. Invite for simple things; offer specific help (with chores, for companionship, to go with them to a grief support group because going is, at first, absolutely terrifying). Please do not ask a lot of questions about the death; if the person is open, instead ask about the person: the happy memories of the past. Ask if you can help and don’t be surprised if you hear, “I’m fine,” or, “You can’t bring them back,” or, “I don’t need anything.”  In that case, come back another time with specific offers (“Can I come by sometime and help with the lawn?” “Are you up for a cup of coffee at the park?” etc.).  Be gentle with people who have been torn apart.

Thanks for reading.

Well…something’s crazy (but it’s probably not us)

Yesterday I attended the Florida Adlerian Society’s annual conference; it runs for three days but I was only able to commit to one. It was a great day: wonderful speakers, challenging information, and, of course, the warm and friendly Adlerians in attendance.

Adler is one of the great founders of psychotherapy, but often is relegated to a corner with a few remarks about birth order and maybe credit for starting the child guidance movement. He’s much more than that, and if you’re curious, visit www.alfredadler.org.

An interesting point made during yesterday’s talks was the evolution of bereavement in psychiatry over the past few decades.   The Diagnostic and Statistical Manual of Mental Disorders is the American Psychiatric Association’s published list of descriptions of various patterns of symptoms. The intention, back in the early 1980s and DSM-III, was to provide a structure for shared dialogue and research for the identified hypothesized mental disorders. No one was pretending these were all clearly identifiable and diagnosable, discrete brain diseases. In the DSM-III days, bereavement, as a category, covered up to a two year long period. If a grieving person was still sad more often than not, still struggling with aspects of grief and getting back to a (new) normal life, mental health professionals figured, depending on the relationship, two years was a reasonable time frame. Of course, some losses never heal – but people somehow figure out how to go on, just the same. The point is, no sensible person thought it was pathological to still have some regular bouts of tearfulness a year or more after your most beloved person died.

In 1994, the next edition of the DSM came along, DSM-IV. It gave people two months – not two years – to get over it and move on. If not – if the person was still crying, or numb, or having appetite and/or sleep disturbances, or otherwise met the minimum criteria for depression…well, that meant that bereavement was over and the person was now diagnosable with a major mental disorder – depression – which was now sometimes described as a permanent brain disease.

In 2013, the DSM-5 was published (note that the change from Roman numerals to integers was done by the APA – it’s not a typo on my part). The DSM-5 got rid of the bereavement issue entirely: now you get two weeks of being sad more days than not, plus the other possible symptoms, and you’re mentally ill with depression (according to the APA). There is no exception for bereavement, although it ought to be noted on the chart. One rationale provided, about which I’ve written in the past, is that this way people can get their health insurer to cover their grief counseling. Whether this makes it worthwhile to pathologize normal grief, I leave each reader to consider.

Are you mentally ill if you have trouble eating or sleeping, or burst into tears almost daily, two weeks after someone you dearly love passes away? I don’t know anyone who thinks so, but the manual that has become the healthcare provider’s and insurer’s standard frames it so.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.