Where Does Sadness End and Depression Begin After the Death of a Child?: Dr. Robert Thompson

HEALING THE GRIEVING HEART
Where Does Sadness End and Depression Begin After the Death of a Child?
Host: Dr. Gloria Horsley
With guest: Dr. Robert R. Thompson
June 30, 2005

G: Welcome to Healing the Grieving Heart. There are no simple or quick solutions to dealing with death. Our topic today is where does sadness end and depression begin after the death of a child and it gives me great pleasure to introduce my very special guest, Dr. Robert R. Thompson. Dr. Thompson is a family practitioner, bereaved parent of Paul, and noted author of Remembering the Death of a Child. This excellent book was winner of the National Book Award in 2003. Dr. Thompson, welcome to Healing the Grieving Heart.
B: Thank you, Gloria, glad to be here.
G: May I call you, Bob.
B: Please do. Yes, that would be fine.
G: Well, Bob, I wondered if you could start our program today for our listeners by sharing your story with us.
B: Sure, I’d be happy to do that. Our son, Paul, I says ours. Martha and my son, Paul, was 18 years and 10 months. He was a freshman in college. This was in 1989. In the early morning hours, he was riding in a car with other students and they were going to another college to participate in some activity and the car skidded on a slippery, frost-covered road. This was in April in Northern Minnesota. And almost came to a stop and overturned in a small stream. The stream was about 8 feet wide, just wide enough to accommodate the width of the car. The car sunk completely out of sight. All accidents, I think, are unique and freakish, if you want to use that term. But this one also was no exception because another week either way and the car wouldn’t have even hardly gotten wet. It just would have been barely covered. So Paul was in the back seat in a two-door car, had no chance of getting out, and he drowned, and the driver also drowned. The passenger got out and it’s interesting. We wanted to know all the details of the accident and sometime afterwards, we talked to the boy who survived, who we didn’t know, and he was not injured too much but he got frostbitten trying to get help. I asked him to write a page or two on the details of the accident as he could recall them. He actually wrote about ten pages. Somehow, that was very helpful to us knowing all the details.
G: When were you able to ask him to do that? Did you ask him right away?
B: We met him for the first time at the funeral, at Paul’s funeral. He was on crutches. He had been to Eric’s funeral, also. The other boy’s funeral the day before. And he was at the funeral, introduced himself, and it was very emotional for us talking to him, seeing him, meeting him for the first time, and at the same time empathizing with him as best we could because he was a survivor of a very difficult accident. It turns out, he had a lot of trouble after that.
G: I was going to ask you if he had some survival guilt.
B: Well, he did. And we hooked up with him about a year ago for the first time and we had dinner with him and we talked about that and he’s doing very well now. He’s had a lot of counseling, a lot of support from his family and his wife and two small children now. But he was not very well for a long time. We asked him to do that, to write all the details, and he was kind enough to do it.
G: And did you go to the accident site.
B: You know, we did. For some reason it was important to us. Paul was killed on a Saturday and we buried him on Wednesday. And our two older boys, two other boys, the oldest boy was working in Colorado, the other boy was a senior student in college. And they wanted to see the scene of the accident and we all went there. We had to go to the college town and get Paul’s things anyway. And I asked everybody, do you really want to go see where Paul died? And they all said, oh, yeah. That’s really important to us. And it was. It turned out to be very important to us.
G: Now who went with you?
B: My wife and the two boys.
G: I remember it was important for me to go back to the site where my son was killed. I think that’s part of getting our story together.
B: I think you’re right, Gloria, and not everybody feels that way. There are others who can’t go and just as there are people who tend their loved one’s graves on a daily basis and there are other ones who can’t go to the grave at all ever. It’s a wide variation and you have to give people that freedom to be a little different.
G: Right, the individuality. Also seeing the body and not seeing the body. Some people really grieve the fact that they didn’t and carry that for years and I always have to say to them, you know, we have to remember you did the best you could at the time.
B: Yeah, I think that’s very good. And that was important to us too. I don’t think in our deepest heart we ever accept the death until we see the body. That was particularly true with Martha. When we viewed the body and I remember her comment to this day she said, oh, Bob, it’s him, it’s really him. And we’d already known about his death for 12 hours and it was like, I really didn’t believe it but now I have to believe it.
G: I also found it a wonderful thing to be able to hug them and say goodbye. I just wanted to tell you and the listeners that I really found your book to be very profound and wonderful and generous and it was just a wonderful book, Remembering the Death of a Child and I would highly recommend that people get the book. How could they get it?
B: Well, it’s available at our website at www.sugarloafpublishing.com. If they want to get it there, it’s a discounted price, and otherwise they can get it on Amazon or in book stores.
G: I really like the comment by Eli Wiesel that you and your wife Martha put in the preface of the book. I believe he’s a nazi hunter, is that correct?
B: Yeah, he was a victim of nazi-ism, sure.
G: And he’s made this comment which you put in the front which I think is wonderful. It says “whoever survives the test whatever it may be, must tell the story, that is his duty.” And I think that really sums up why we’re here today talking about our losses is to testify to survival and to let others know that we have made it and so can you.
B: I agree with that Gloria, very much.
G: I wanted to ask you, what is the difference between sadness and depression?
B: Well, that’s kind of a tough one and some people might think that we’re splitting hairs but I think if there is an important distinction, and let me just command it this way. I think, first of all, depression is a disease and requires treatment and supervision. I think that’s an important distinction. Sadness, particularly over the death of a loved one, is not a disease. It’s a human condition and sadness I would describe as more a feeling along a broad spectrum of feelings. The sad person is usually sad about a particular event. In this case, we’re talking about the death of a child or grandchild or sibling. But they’re also capable of feeling joy and empathy as well as sadness. Whereas the depressed person, I think, is very limited in their emotional responses. They feel so bad so much of the time that they really cannot relate to other people and experience any joy in their life at all. If you’ll talk to, as I’m sure you do all the time, people who are severely depressed, they can’t feel any pleasure. They can’t feel any joy. And that’s not true of sadness. Sadness stays with us, more or less intense, for our entire life. I don’t think it’s something we can run away from nor do we want to. Whereas, depression usually has a beginning and an end, hopefully. So I would say those are the main differences.
G: And one of the things about depression is you really don’t hear most bereaved people saying they want to kill themselves or whatever. They may say they wish they weren’t living or they wish they could join the person but that is very different from the idea that they really want to kill themselves or whatever.
B: Yeah, I agree with that, and I think that was well documented in Ronald Knapp’s book of 155 families Beyond Endurance. That’s kind of an old book now but it’s still the only longitudinal study I know that really looked at people over a period of six months and what you just described was one characteristic of the things that all those families have in common and that was a general desire to follow the child. Where is he or she? Where did that child go and how can I get there with them? That’s a natural parental instinct. But that’s not the same. There were no suicides in his group. I think you’re right. It’s more of a feeling than it is a fact.
G: And I think sometimes therapists can mistake that and not realize that it is not a suicidal thought. It is a thought of wanting to rejoin the person. My son was killed in an automobile accident and my daughter was 14 and she felt she wished she had been with him. That kind of thing.
B: I remember saying many things that I would gladly have traded places. I was 50 years old at the time and I said, “gee, wouldn’t it have been so much better had it been me.” And my wife said the same thing but we didn’t really contemplate doing that.
G: What are the physical symptoms? Are there physical symptoms of grief that accompany the death of a child that we could expect to have?
B: There are and I think that’s one of the problems with sorting out this depression. Is it depression or is it sadness? There’s such an overlap particularly in the acute phase. There are physical symptoms and there are mental symptoms and I have to relate to our own situation and to the people I’ve talked to, but crying is an obvious. one When does the crying stop? Dr. Richard Dew has a great answer to that, he says, it stops when all the tears are gone. Obviously, depressed people cry and people who are sad cry. Loss of appetite although some people gain weight, some people lose weight. A general loss of effectiveness. I think just not an effective person. If we’re a secretary, we’re not as effective at that work. If we’re a golf pro, we’re not as effective at that work. One thing we noticed, Martha and I are in our early 50s, is that pretty much our hair turned gray. Maybe it would have anyway, but
G: I’ve heard people say that, that it speeded up that process. I’ve even heard some women say they felt like they went through menopause earlier.
B: Well, guess what. Martha did and she doesn’t mind my sharing that even in a broad audience. We’ve done it before. She had never missed a menstrual period and was just as regular as clockwork except when she was pregnant with our three boys and immediately, almost within a week after Paul’s death, she began experiencing estrogen withdrawal symptoms. In other words, hot flashes and sweat, and had to be put on supplemental estrogens and she never again had a menstrual period. So I think that the physical symptoms may vary but it’s a tremendous assault on the body.
G: It really is. You almost feel like you’ve hit a brick wall.
B: Yeah. Brick wall and bounced down and been hit again. I mention fatigue, and one of the things we noted was coming home at night. We both, we’ll say more about that later, I guess, returning to work, but we noticed coming home after a day’s work and sitting down in a chair. We were just exhausted and just couldn’t even wait for the news and we were in bed even though we couldn’t always sleep and just fatigued. That’s a symptom.
G: Let me say one thing about the crying, too. I think there are certain substances that are released when we cry that are tension relievers and I think that one of the differences between grief and depression is in grief crying can be a tension reliever. I think in depression I think it can just be there and even pull you down more.
B: I think you’re right. Wallowing or inexplicable crying that we don’t understand sometimes just makes it worse. But I think in grief we know why we’re crying.
G: One of the problems is where do we cry? It’s difficult particularly, I think, for men if they feel like they want to cry at the office.
B: That’s hard. We have to compartmentalize our feelings to a certain extent. As I mentioned, we both returned to work fairly soon because we didn’t know what else to do. And I’m not saying everyone should do that. Martha worked for a national airlines and her passengers had no idea what she’d gone through so they didn’t cut her any slack. But her co-workers did and that helped. And of course I practiced in a small town and everybody knew and I got a lot of support from my patients. They gave me an opportunity to talk about it or not talk about it and most of the time if we did talk about it, it was only for a few minutes and then I could focus on the problem that they came in with. I think that’s a hard thing to put a gauge on. I wouldn’t recommend that everyone return to work.
G: Well, I went back to work after two weeks. I was teaching at the University of Rochester and I had students and I was in a mental health setting on a locked ward, psychiatric ward, so I had a lot of mental health people around me, but it’s hard to concentrate, but you do your job. One of the things that I found is you almost have to be overly competent. You’re kind of like really wanting to show the world that you’re there. But I found I was late for work. I’d have 45 minute showers. People did cut me some slack. I was on time for my students but I’d get in a little later and maybe leave a little earlier but it’s a stressor. But first, though, you feel like wow, I’m getting back to work. It’s time for us to take a break now. You’re listening to Healing the Grieving Heart and I’m your host, Dr. Gloria, and my guest today is Dr. Robert Thompson, physician and author. Our topic today is where does sadness end and depression begin after the death of a child. If you’d like to join our show with comments for Dr. Gloria or Dr. Robert Thompson, please call toll free 1-866-369-3742 or email me at gchorsley@aol.com.
Well, Bob, we’re back and I believe we have a call from Bell. Welcome to the show. You have a question for Dr. Thompson?
Bell: You were talking about depression today and when it is grief and when it is depression. My question was, I had a brother that was killed in a car accident oh about 20 years or so ago and then I had a son almost die, came very, very close to almost dying about 10 years ago. This is my question. I didn’t think I had depression. I wasn’t sure but I suffer some anxiety and so I was wondering, is anxiety a form of depression? It’s just manifesting in untraditional ways.
B: Let me give you the short answer on that. I think the answer is it can be the manifestation of depression. It can be one of the early manifestations. It would be interesting to know a little more about the circumstances of your brother’s death and how you related to that at the time and whether or not you were able to express some of your feelings and grieve.
Bell: I think it was just more unexpected than anything else and it was I think a time in my life when you kind of feel invincible. You’re young and then when he died so unexpectedly it was almost like reality set in. I was 19 at the time.
B: I think that’s really a hard time and we have sibling groups in Compassionate Friends and the reason for that is because I think often siblings experience the death of a child differently and I know I’ve talked to my boys since Paul’s death and indeed it’s a very different feeling. Their parents are vulnerable. They’re not necessarily there to support them in the same way and their peer groups may or may not be. So to be an adolescent and experience the death of a sibling is a very hard thing. And it may be that you never completely resolve the anxiety and depression that you had at that time.
G: And also, you might want to, Bell, think about anniversaries, too, and track your anxiety. Is it all the time or is it coming up to the anniversary, a birthday, whatever? And you said your son almost died. He reminds you of your brother.
Bell: Very close. And they connected themselves when it happened because even though my son didn’t die, we were told we were just minutes away. He had a heart condition and by the time we got him some help, he was on death’s door and hovered near death for several days. And so, they connected themselves because it was that reality hitting again. I didn’t think I had depression but then I thought is the anxiety manifesting because I’m not dealing with it?
B: How long has it been since your son’s problem that was corrected?
Bell: He’s 10.
B: And how old was he at the time?
Bell: Just days old.
B: And so your symptoms have persisted all this time?
Bell: They’re better, but they’re still there. So maybe there’s stuff I’m not resolving.
G: You know what I would suggest that you do, Bell, is that in October mental health practitioners are doing a free mental health screening and it’s going to be all over the United States and you can access it online or set up an appointment for yourself or others. The site to go to this is www.mentalhealthscreening.org and that’s going to be all over the United States. So there will probably be somebody in your area who will sign up to be part of the mental health screening and I think that would be good for them. Wouldn’t you say, Bob, it’s been a long time.
B: I agree with that and also have you been to a support group such as Compassionate Friends?
Bell: No, I wasn’t aware of it when my brother died, and maybe if I had gotten some help, it would have been more resolved.
B: It’s never too late. I think your call is timely and you really should work on that.
G: I think that is a good idea. Do both. Go to the Compassionate Friends and then sign up for this mental health screening. Thank you so much for your call. Well, there are a huge number of people in the United States that are said to suffer from depression. It would be interesting to know, really, how many of those are loss related and how many of them are actually depression that can be helped by anti-depressants, wouldn’t you say?
B: Yeah, I do, and that brings up the question of who. My concern is that people go to physicians or health practitioners and depression has kind of become a diagnosis now instead of a symptom. In other words, I’m sad, I’m not doing well, and so forth. People are more apt to express that as going to the doctor or health practitioner and saying I’m depressed. That triggers a whole cascade of thought, prescription writing, and in this day of 10-15 minute office visits, bingo, I have the diagnosis, here’s the prescription pad, and we put somebody on an SSRI or some other anti-depressant when in fact, I think we’re treating sadness. And I’m not saying that anybody who says they’re depressed is sad but I do think there’s a difference. Maybe we could just talk a little bit about that. I do think and I want to make this clear that if people have a history of a mood disorder and they’re currently under supervision or have been under supervision that the death of a child or sibling or grandchild could certainly trigger that again. Don’t you agree with that?
G: Absolutely. I think looking at those histories are very important.
B: And certainly self-destructive thoughts. Suicidal thought should not be a part of the normal grieving process for a child. My guideline is if after a reasonable period of time you’re not functioning at some daily routine or if you’re getting worse instead of better or if you’re acting out your feelings in a negative or sometimes destructive way. This often occurs in relationships with spouses. Then I think that it’s a reasonable thing to say, well, depression is the answer here. This is more than just grief.
G: Right. But not jump to it quickly. I recently was at my husband’s office and an associate that he works with came in and my husband mentioned that his daughter had been walking to school holding her mother’s hand and been hit by a car and killed. I was talking to him about it and said how are you doing? Like a lot of people, he wasn’t too comfortable talking about it I’m sure because he was at the office. However, he said but we’re doing really well. We’ve gone to a psychiatrist and we’re all on anti-depressants. And I’m like, oh, my gosh.
B: And maybe that was okay. You’d have to know a lot more about it, I guess. But I’m afraid from depression as being a mood to being a diagnosis. And it is. It is a diagnosable condition but lay people often use it to describe a feeling. I’m sad. And the doctor or nurse or practitioner says, oh, got a little depression here. And they’re really not the same thing.
G: And there’s something to do for depression, we know it’s anti-depressants.
B: It’s so easy to grab that prescription pad.
G: Because one of the things that we know is that natural normal grief is going to look like depression. I mean, what are some of the symptoms that we’d expect to see with both?
B: Well, a general feeling of sadness. Sometimes associated sleep disorders either waking up early in the morning or not being able to get to sleep. Appetite. Some people actually gain weight. Others lose weight, just have no interest in food. Relationships—that’s a whole area we could spend an hour on, I’m sure sometimes begin to deteriorate. Job performance. Sexual functioning. I know it’s very hard to recover those joyful things of our life that we experience whether it’s laughter or sexual relationships. Those are things that are hard to do after the death of a child. They’re also characteristic of depression. Part of it I think is the time and support and how are things going and there clearly are people, and I’ve talked to some people and you have to, who simply cannot get up off the couch. They can’t function. They can’t get out the door. Those people clearly are beyond just grief process and need something. Whether just giving them a pill is the answer or whether they need a lot more support and so forth.
G: We’re going to take a break in a minute and when we get back from break, I would like to talk about anti-depressants and about how long you should take them and should they be over a long period of time. When we get back, I’ll read an email that addresses that topic. So let’s take a break and you’re listening to Healing the Grieving Heart. I’m your host Dr. Gloria Horsley and my guest today is Dr. Robert Thompson, physician and author. And our topic today is where does sadness end and depression begin after the death of a child. If you would like to email me about this or uncoming shows, my email is gchorsley@aol.com. Welcome back. I’m your host, Dr. Gloria, with my guest, medical doctor Robert Thompson, bereaved parent and author of Remembering the Death of a Child and our topic is knowing the difference between grief and depression after the death of a child. If you’d like to email me about this or upcoming shows, my email is gchorsley@aol.com. Well, Bob, I think we have a call here now.
M: This is Mandy from Virginia. I’ve been following your show and listening and I do have a question. My brother was killed five years ago and since that time I’ve adopted a child. I’m a 9 on the enneagram.
G: Oh, that’s a personalities typing system, Dr. Thompson, that I’m involved with.
M: My concern is this. I have been put on anti-depressants three years ago for depression concerns concerning the death of my brother and the adoption of a child and my question is this. That was three years ago. Is there concern about the long term of the anti-depressant?
G: What medication are you on? I was just curious.
M: On Paxil, 30 mg a day. I’m looking for a solution to this. I’ve been back to my primary care physician and he doesn’t quite know how to go about handling this situation with my medication. I seem to not be able to get off it. I’m looking for a good resolution to the depression and trying to work the anti-depressants out of my life.
B: What happens when you go off the anti-depressant?
M: My world starts caving in. The first day I feel pretty good. The second day, I start going downhill. By the third day, my coping skills go down and my stress level goes high.
G: When you go off, do you go off completely? Do you taper it or do you just go off?
M: I’ve done this a couple of ways. One way is I’ve just gone off it. And that definitely I know through research and talking to people doesn’t work. One thing I started doing was cutting down the pill and gradually tapering off and that still doesn’t seem to work. My doctor actually wants to send me to a psychiatrist but I feel like that’s not really a solution. So I’m kind of caught in a catch-22.
B: Have you been able to talk about the death and integrate that into your own life in a group setting?
M: You know, I haven’t.
B: I would certainly start there. The medication sounds like you’ve given it a trial and there’s something else going on. This is not simply a biochemical problem. It sounds to me like there are some associations with the death that you need to talk about and that’s where I would start and leave the medication alone for right now and not stop it. Just continue it and go to Compassionate Friends, or if the psychiatrist that your family doctor is going to refer you to is someone experienced in dealing with death and depression, then I would go that route.
G: But I do think you need to find somebody who is an expert in death and loss and not everyone is. The other thing I’d like to say to you Mandy is you talked about adopting a child. Have you dealt with your own loss and grief over your infertility?
M: I thought I had and maybe as I’m talking to you guys it sounds like I do have some unresolved issues.
B: That’s what I would say. It sounds to me like there are some more talk about things in here and you’re not on a very, you’re not on a hugely high dose of Paxil. And you’re tolerating it. You’re being monitored for it. I wouldn’t put that as the primary concern right now. I think you’ve tested it and it doesn’t work to just stop it and you just need to leave it alone for awhile and go on to the next step and then it may be obvious what needs to happen after that. Do you agree with that, Gloria?
G: Yeah, I would agree with that.
M: So it sounds like there are some grieving issues versus the depression at this point that I still need to deal with.
G: I think you might want to try a Compassionate Friends group, I really do, and be with some people who are dealing with the grief issues.
M: How would I look into that?
G: Go to the website, www.thecompassionatefriends.org and they’ll have a list of chapters in your area.
M: Okay. Oh, I appreciate this. This gives me a lot of hope. I’ve been pretty concerned.
G: Sometimes going head on with the problem isn’t the way to go.
M: All right. Well, thank you, I feel a lot better and I appreciate you taking the time to talk to me.
G: Thanks a lot for calling. So there we have an interesting issue of the past loss and then the adoption and how these things become cumulative also.
B: And let me say, I don’t want to sound completely negative about medication because I’m not. There’s a place for it and a time for it, and I know you feel that way, too, but I think it has to be integrated with other means of supporting the death of a child. And that can be, there are none better than group settings, Compassionate Friends, obviously. And bereaved parents and other groups. I think they’re not mutually exclusive. You can still go on anti-depressants. But here’s another thing and I’d be interested in knowing your opinion on this, too. I think even the SSRIs which are probably the best anti-depressants we have now, and that would include serotonin, re-uptake inhibitors, and paxil and so forth. They still affect the way we feel and affect the way we process the death and sometimes I think that gets in the way. I personally as a practicing physician had a whole medicine sample cabinet full of anti-depressants. They don’t do that so much any more. But I never took any. I never wanted to take away that bad feeling. I wanted to experience it. Does that make any sense?
G: Absolutely, because one of the things I believe they do and people that I’ve worked with is they cut off the highs and the lows. When you cut off the lows, you also cut off the highs. You can become fairly monotone in your feeling and miss some of the energy.
B: Short-term gain and maybe a long-term loss in terms of resolving. I agree with that.
G: Some people have said that in our society, rather than medicating depressed people, we should be taking care of them.
B: That’s a great quote. I love it.
G: And letting them – how can I serve you? how can I help you be depressed? In your depression, what can I do for you?
B: Clearly, I’m not anti-depressant but it’s a clinical state. It does occur and you have to look at it and the medicine has been wonderful but it’s not the first thing to reach for.
G: No, and especially when you’ve got a loss. And I also think that people really need to look like Mandy at her past losses and see if they’re not cumulative. Because if you haven’t grieved the loss, maybe even of a parent or whatever, and then you have a child. You don’t have the experience of grieving those losses and you may have to go back and revisit.
B: And there are some excellent examples of that in the literature. Unresolved grief. I suppose that brings up the question, who should take anti-depressants?
G: Right. And who do you think should be taking anti-depressants?
B: Well, I think clearly people who have a history of a mood disorder that has been recurrent. That have been under supervision. People who have self-destructive thoughts would be another category. Have a plan, not just kind of oh, I’m miserable, I wish I could die. We’ve all thought that when our children died. Wish I could follow them there. Didn’t you have that feeling?
G: Absolutely. Why wasn’t it me and as I said my daughter was wondering why she wasn’t in the car with him?
B: I always say after a reasonable, what’s reasonable, period of time, some people generally after the loss of a child should be able to function a little bit at some daily routine. There are lots of lists of things you can do. Just get up, boil water, and go back to bed. Something. Have some kind of a routine. If after a period of time people are feeling worse instead of better, clearly if people are acting out and feeling negative or in a destructive way, and I think we haven’t talked about spousal relationships, but that’s a huge area where you can get in trouble if we don’t share. I found what happened is some spouses want to talk about their child’s death all the time, and other ones don’t want to talk about it at all and there’s a problem there.
G: Well, let’s get into that spousal relationship and talk about, I know for myself, I’m more outgoing than my husband is, who is a little more conservative, and we did get into well, I don’t want to say, hassles about it, but over the funeral, I wanted to have a couple of funerals one where we lived, and one in our home town, and he kind of put up with it so sometimes we do have to put up with things from our partner that wouldn’t be our choice.
B: I can relate to that. I can remember coming home the first time feeling pretty good. I guess it was probably months after Paul died, and I had a pretty good day and I wasn’t dancing and singing or anything but I felt like maybe there’s light at the end of the tunnel. Martha, my wife, had a really bad day and it became apparent right away when I was making some lighthearted comments or smiling or laughing. I don’t remember exactly what I was doing but she didn’t like it. It wasn’t fitting her. So we had to talk about that. There are spousal differences.
G: Right and people do grieve differently and it takes a certain amount of patience and sometimes we have to get outside help. Compassionate Friends, it may be a minister, there are a lot of ways to go as far as having somebody else besides our spouse to talk to. Sometimes there’s a lot of pressure on them and we need to talk to someone else.
B: I agree and sometimes the spouses need to go different places. Compassionate Friends might work for her but not for him.
G: Sometimes we expect our partner to do what we do and that’s a tough one. One of the things I wanted to say regarding depression is that we can be kind of thrown for a loop that second year. The first year you’re kind of proud that you’re able to do some of the things or feeling like wow, I can do that or I did more. And then the second year sometimes you can feel really like this is it. And I think there’s some depression for some people that can set in that year that’s normal.
B: I think you’re right and I guess I would say that kind of shades over into sadness. I don’t know how you feel but I’ve always felt that I will never, I don’t even like the terms “get over it” or “healing” even. There are so many euphemisms for our grief. And I don’t like any of them too much. Make a conscious decision to re-enter life at some point. That soreness and hurt is always there and I like to revisit that once in awhile. Not to wallow in it, but to remember Paul and that he lived and that he was a real person and we had a relationship and we like to talk about that. It’s kind of an interesting thing, too. We have grandchildren now who were not around when Paul was killed but they see pictures and they ask questions and it’s really interesting to hear their questions. They kind of look and test you to see if this is going to be okay to bring this up. They’ll say what did Uncle Paul do about this or that? And you can tell a little story and I think that’s kind of a good feeling for us rather than just seal it over and let’s never talk about Uncle Paul again.
G: We’re looking at the literature now, the Kubler-Ross model of the last anger, denial, depression acceptance. She was actually working with terminally ill people and the acceptance thing is now we’re looking at something called continuing bonds which is how do we take the continuing family member with us like you have just talked about? We take it through pictures, stories, and we keep these relationships and we establish a new normal. It’s time for us to come up on break again and after break I’d like to read you a couple of emails I’ve received regarding the show. You’re listening to Healing the Grieving Heart. I’m Dr. Gloria Horsley and my guest today is Dr. Robert Thompson, physician and author. Our topic today is where does sadness end and depression begin after the death of a child. If you would like to email me about this or upcoming shows, my email is gchorsley@aol.com. Bob, when we took the break, I was saying that I had received a couple of emails about the show and I’ll read one of those today. It’s from Mike in Canton, Ohio.
Dear Gloria,
My sister suggests that I email you. My daughter was hit and killed by a drunk driver last summer. I have joined a group against drunk driving and I’m very active. We also have a court case pending. I’m very distracted at work which is a problem as I am foreman on a construction site. I sometimes feel like crying when I’m on the job. This can be a problem as we are building a new hotel and I am working 30 floors up. Do you have any suggestions for me?
G: Wow.
B: Lots of issues in that email. How long since the death?
G: Last summer.
B: See that’s so early in the whole grief spectrum and I think that the other issue is the legal issues that are surrounding and I think Dr. Dew talked about this a little bit last week how one has to compartmentalize the feeling when there are legal issues pending because they can get easily distracted. So one issue is the grief and one issue is the legal things and let’s not get them mixed up although it’s pretty easy to say that and it’s pretty hard to do it.
G: And he says he feels like crying on the job and I think that’s normal.
B: Oh, sure, it’s normal especially after just a year.
G: And especially if he’s involved in this court case, which I think makes it even more like picking a wound.
B: It’s very hard. And probably the worst is yet to come if it’s like most court cases.
G: And I don’t know, he’s working 30 floors up. I think him telling us that makes me kind of feel like he wants us to say get off the ladder. I think he may need to go in and talk to his boss.
B: There are some jobs that one can continue to do during this grief, I hate the term “resolution” because I don’t think there is totally ever any resolution, but you know what I’m talking about where we begin to process this grief. There are certain jobs that will allow us to continue to function and may even, in my case, I actually think I grew strength from my patients. In my wife’s case, Martha grew strength from her co-workers. So I think it was a good thing. But if I was 30 floors up looking down, I might feel differently about that.
G: Yeah, I think he might want to talk to somebody. I was working as a psychiatric nursing consultant to this surgical service when my son was killed and I was working with a lot of families whose children were killed or they were in the hospital in emergency or they were in intensive care, and I was on call. And I did that for about eight months and then I decided I needed to move on. So maybe he needs to think about how he can move into a little less stress.
B: I think that would be a constructive thing and a reasonable thing to do and the crying, he mentioned that, too.
G: Yeah. He said I sometimes feel like crying on the job.
B: Well, there’s some jobs where you can do that. I know when my co-workers certainly tolerated some tearfulness at certain times, my patients would often join me in that tearfulness. But there are some places where it wouldn’t be tolerated and wouldn’t be appropriate. I think that maybe it’s time to have a little chat with the boss.
G: Well, Mike, first of all we want to tell you that you’re normal to start with. We’re a little bit concerned about your high-risk job and you’re telling us that so it sounds to me like you might want to just go in and just say for awhile I might want to do some lower-level work. Thanks for sending us that email. Obviously, Mike is able to grieve. What are some of the reasons that you see that people aren’t able to grieve?
B: I think sometimes the pain is just too much. I think that’s one reason that is it depends on. We are humans and we bring a certain, I don’t want to use the term “baggage,” but we have a certain personality with who we are and sometimes that just won’t tolerate grief, the pain of it. We talk about an unspeakable loss. You’ve heard that expression and that can be taken literally. There are some people who simply cannot speak of it.
G: I know when my son went on outward bound the year before he was killed and we visited some friends in the mountains on the way to take him and their son had been a forest ranger and been killed and they were telling us that they never mentioned their son’s name again. That was their only child and I thought, wow.
B: That would be tough. How long ago was that?
G: It was quite a few years ago.
B: Don’t you think in our culture that that kind of healing over has changed a little bit?
G: I think it has but one of the things I noticed frankly, Bob, I think it was the husband that wanted to do that and the wife went along with it. So that’s one of the things I think Compassionate Friends can give us. It’s a separate place to go so if your husband doesn’t want to talk about it or your wife doesn’t want to talk about it, you can go somewhere else and talk about it.
B: Exactly. I think sometimes men in particular feel that if the crying starts, it will never stop. Sometimes just reassuring no, you won’t, it doesn’t work that way. I think other times that people feel like if they let go of the pain that it’s the same as letting go of the loved one.
G: Yeah, there’s that fear that you’ll forget. And the interesting thing is the further out it goes, the more you remember.
B: Yeah, and more of those happy memories.
G: Yeah, who they were, and telling their little stories like you did with the grandkids.
B: Oh, yeah, that’s so much fun.
G: They become a rich part of your life.
B: I always say we made Paul sound better than he really was.
G: That’s one of the things you have to be careful about, too, with your other children. When I work with teens, they’ve talked about the fact that our sibling that dies was not superhuman. We knew them. And you know, please don’t build them up to be that. It’s always the angels, always the good ones who die and all that, and then the poor siblings that are left over are feeling like the good one’s gone. So I wanted to just remind our listeners about your book again, Remembering the Death of a Child. Could you also tell them how to get ahold of it. Why don’t you tell them a little something about what’s in it?
B: It’s mainly autobiographical but we walk through what happened was I just felt this compulsion to tell my story and many people do that. And we had been to Compassionate Friends and told our story and listened to other stories, but somehow I needed to, I suppose it’s an extension of journaling. You hear a lot of people talk about how helpful journaling is and I really, even though it was nine or ten years after Paul’s death, I really abreacted if you will or relived his death when I wrote that. So I think writing can be very therapeutic. Having said that, I tried to make it helpful to other people and put in some references and some philosophy and some quotes and some discussions.
G: It’s a wonderful book. And how can our listeners get it?
B: It’s available in bookstores on request and it’s available on amazon.com by entering Remembering the Death of Child. It’s also available on our website at sugarloafpublishing.com.
G: Tell me about getting the book award. That was pretty exciting, huh?
B: That was kind of a surprise. We were not expecting that and it was the independent publisher’s book award and we got a call one day and said congratulations and we were supposed to go to a meeting to receive their award but we were on vacation so we didn’t but it was quite an honor and a thrill to have it recognized.
G: Wonderful. It’s great. I know Dr. Dew, too, has written a book and it’s wonderful when people can do that creativity to deal with it.
B: A lot of people journaled and that helps, I think, if you’re disposed to that sort of thing. Not everyone is. But lots of people do that. Back to talking about not talking about it, I remember a couple who she couldn’t stop talking about their daughter’s death and he couldn’t talk about it at all. But when it came time to award the scholarship at the school before four or five hundred people, he’s the one who stood up and told about his daughter’s death. Isn’t that interesting?
G: Oh, that really is.
B: He would not share with her or with other people one-to-one, but he could stand before 500 people and tell them.
G: I notice we have Compassionate Friends conferences every year which are wonderful and there will be a conference next July in Dearborn, Michigan, and there are many, many workshops, and I notice when I do a workshop that many of the husbands are very protective of their wife and I feel that sometimes I see that it’s hard for them to see their wife upset or cry. And I think that’s sometimes why men don’t want to talk about it because it hurts them so much to see their wife so hurt.
B: I think that’s true. That protective instinct perhaps and they don’t also want to show their own vulnerable side. I had that problem a little bit with patients who asked about Paul when he died but I was okay with that. I think most people don’t really hold it against you if you shed a tear about the death of your child and I certainly felt it was appropriate and it felt good to do it.
G: Well, I wanted to go on and read another email because I think it’s something we haven’t touched on yet and I think it’s an important topic. It’s from Wendy from Portland, Oregon. It says:
Dear Gloria,
I heard about your show at my Compassionate Friends group. My son and two friends were killed when the driver of their car lost control and hit a tree. This was three months ago. Our family physician suggested that I try taking sleeping pills. I’ve been taking them for a month and I find that they really help, however, I am concerned that I will become addicted. Do you have any advice?
B: Wow. My question rhetorically would be, “they help a lot, but help what?” I think that I would be very, very cautious about prescribing sedatives, minor tranquilizers, sleeping pills.
G: So for our audience, we’re talking about valium,
B: Valium, Librium, alcohol, of course.
G: And especially those together with alcohol.
B: Oh, yeah. The long-term benefit is you get to sleep but I don’t know that sleep is really the priority there. You would have to know what her job is. I didn’t always tell patients this because I’ve prescribed sleeping medications at times in appropriate settings. But nobody ever died from lack of sleep so when you get tired enough and sick enough, you’ll go to sleep and it will be a very sound sleep. I would be concerned, I guess, Gloria, at that point, it’s too early to be taking that avenue.
G: And I would suggest to Wendy that she get some exercise. Just a walk even. I know it’s hard but just a walk around the block could be important. And water, too, and make sure your room is real cool if you can when you go to bed. Do some of those sleep kinds of things. This is Dr. Gloria Horsley. We’re coming up on the end of the show. Today my guest has been medical doctor Dr. Robert Thompson, bereaved parent and author of Remembering the Death of a Child. Just before we close the show, I wanted to ask you is there anything else you’d like to mention before we close?
B: Well, I think there are things we could say, coping suggestions, perhaps. I do think it’s important to talk about your loved one and share your thoughts and ideas with other people. On the other end of the spectrum, I think it’s important to do something physical each day. I think forcing yourself to be outside and walking, running. I would say I think it’s a good idea to pray for guidance and support and I know some people say well, what if I don’t believe in God. And I say pray anyway, it doesn’t hurt.
G: Okay. Well, Dr. Thompson, thank you for being on our show today. This is Dr. Gloria Horsley. Please join us next Thursday 9:00 Pacific Standard Time, 12:00 Eastern time, for more of Healing the Grieving Heart, a show of hope, renewal and support. Remember, others have been there before you and we made it. You can, too, and you need not walk alone. Thanks for listening. I’m Dr. Gloria Horsley.