Grief

Loss is a part of life. Whether we’re talking about the death of a loved one, the end of a relationship with a partner or a friend, loss of a job you’ve had for years, etc., loss of some kind happens everyday. And with loss, comes grief. The purpose of this post is to demystify grief: I will be explaining what grief is, what it can look like, and the importance of mourning and mourning/grieving rituals as ways to hold onto the memories of beloved ones in a healthy way. In this piece, I will be mainly talking about grief after the death of a loved one, but again, there are many different kinds of losses one can experience. I hope this piece helps y’all start to make sense of what you have experienced.

What is grief?

Grief is the very common response to loss. Many people are familiar with the idea of the stages of grief, but I don’t like thinking of grief in that way. With the idea of set stages of grief, there is a risk of expecting people to fit into boxes that aren’t real for them.Grief looks different depending on each person. People are complicated. So the process of grieving is just as complicated. Everyone’s journey is their own and depends on life circumstances and the relationship you had with the deceased person. Trauma, issues with abandonment, other stressful things going on in your life, physical and mental health issues, etc. can add to and complicate the grieving process. Denial, anger, bargaining, depression, and acceptance are not the only emotions people feel while grieving. You could feel relief. You could be happy the person is no longer suffering. You could be glad on some level to be out of that job. You could be low-key grateful your partner is gone. Feeling emotions beyond those 5 doesn’t mean you are broken or an extra secret special messed up. Again, people are complicated. And while dealing with all these complicated feelings, it may feel like you are being swallowed up by an eternity of feelings. Regardless of how it can feel, grief is not forever. With time and active work towards healing, your often intense, painful feelings of grief will start to go away usually in about a year (in the case of death). I’m not saying you won’t miss your deceased loved one anymore. But you will be able to think about them and miss them without the feelings taking over your life. You could think about them without crying immediately, for example. That difference between actively mourning someone versus remembering someone fondly, etc.

The grieving process becomes a mental health issue when it starts to take over your life and you have been actively grieving for over a year. What do I mean by actively grieving? If 12 months have passed since your loss and your feelings are just as intense as the very first day, you may be experiencing what is known as “complicated grief”. Constantly thinking about the loss, feeling distress that is outside of what is usual for your society and/or culture, being unable to keep up with your commitments at work, school, with family, etc. like you used to, and passive and/or active suicidal ideation are all symptoms of complicated grief. Examples of passive suicidal ideation include wanting to go to sleep and not wake up, wishing you weren’t alive, or wishing you were dead. Examples of active suicidal ideation include thinking about ending your life, having the intention/desire to end your life, having the tools/method to do it, and/or having a specific plan (See my post on suicide here for more information explaining suicide).

Grief and Depression

Grief and depression can feel very cruel because they both can convince people that this is the way they are going to feel forever. They both change the way you see yourself and how you see the world while you’re in the middle of it. A huge difference between major depressive disorder and grief is the subject of the distressing feelings. A grieving person’s thoughts focus on the person who has died. On the other hand, depressive symptoms tend to focus on feelings of personal worthlessness. Basically, if a grieving person is feeling sad, it is most likely going to be related to a sense of loss, to missing the deceased, to wishing they could be with that person, etc. A depressed person’s sadness focuses only on themselves and any flaws (or “flaws”).

In my piece about depression here, I break down the symptoms of depression in more detail. To have clinical depression, someone must have at least a depressed mood most of the time, almost every day, or not able to feel pleasure/joy from things that used to make them happy. Depression is self-critical. A depressed person’s inner monologue/their self-talk/the majority of their thoughts (to be REALLY blunt) is mainly about how they feel they ain’t shit. Depressed thoughts are pessimistic and any related suicidal ideation is about wanting to escape their situation. Again, grief, though, focuses specifically on the loss. And a grieving person’s thoughts are mixed with the positive memories and emotions related to their dead loved one. Even the suicidal ideation that some grieving people experience is usually focused on wanting to be with their loved one, not escaping their misery as it would be with a depressed person.

Now to complicate things a little because life is complicated: Grief and a major depressive episode can happen at the same time. And the loss of a loved one can trigger depressive symptoms in people with a history of depression. Recent loss can kick up past emotions like fears of abandonment from past deaths and other kinds of losses. It’s important to be aware of yourself, especially if you have a history of depression, trauma, anxiety, etc.

Mourning

Mourning rituals and practices are an incredibly important part of healing. These rituals, both personal and public, allow people space and time to express emotions, process thoughts, and reflect on memories. Many cultures have their own mourning rituals and ceremonies in place as a part of community healing. In psychotherapy, therapists encourage clients to practice in their own culture’s mourning rituals and/or create their own personal rituals. These rituals allow for time to think, memorialize, feel feelings while also helping to contain the emotions and give them a proper place. These rituals are a way to set boundaries with yourself and your emotions so mourning doesn’t consume lots of your time and energy. If you need more information on how to set and maintain firm boundaries, I wrote a piece about that here. Learning to balance your thoughts of the deceased with your thoughts of the land of the living is important for the healing process and for your ability to continue to stay on top of bills, keep up the relationships with your living loved ones, etc. Many people feel trapped in their initial pain because they believe, on some level, if they don’t feel this pain, their loved one will be forgotten. And this isn’t true. You don’t need to be in pain to honor them. Your cultural and personal rituals are your special way of remembering them. They keep the memory of your loved one alive.

Some ideas for personal rituals and other ways to personalize your mourning process:

  • Creating physical or online memorials
  • Visiting the gravesite
  • Lighting candles alone or in a small ceremony and reflect on the deceased
  • Writing letters, poetry, or songs to the deceased
  • Going to grief counseling groups to commune with others going through similar situations
  • Having a dinner to celebrate the life of this person

As time passes, the sharp painful feelings of loss will start to fade. In therapy, checking in with clients is an important part of the healing process. I would have clients track their own emotions, their thoughts, etc. so we both can see how they change over time. Are their feelings of grief becoming less intense? Are they able to sleep as well as they used to? How much do their feelings of loss interrupt their day? Are they getting the support they need during this time? Check in with yourself. Try some mindfulness techniques (read more here) as self check-ins to see where you’re at, what you need, and how this changes as you heal. While checking in with yourself, see if there’s anything you can do via self care (my piece about the many types of self care here) to help yourself heal.

A REALLY IMPORTANT NOTE: Certain times of the year like holidays, birthdays, anniversaries, etc. can still be hard emotionally for you even years later. This is very common. In my clinical work, clients and I have worked together to make a safety plan (Check out the suicide post linked above for a sample safety plan) to figure out how clients can get the help they need before any problems start. Like a fire drill. That way, when things pop off, there’s no need to panic. Safety plan for yourself in advance for the hard days. And these moments and days when the sadness and grief come back can happen, but they won’t be as debilitating or world-crushing as the day 1. Seek therapy if mourning gets in the way of functioning and/or it has been longer than a year and your feelings feel as intense as it did on the 1st day of loss. You may need some professional assistance with going through the healing process. And that’s okay.

Loss is inescapable. Whether it is loss of a relationship, loss of a loved one via death, etc., everyone is going to grieve something at some point. And though feelings of grief are painful, they are a part of life and important to feel. Un-dealt with grief can build up inside someone and then come out in other, less healthy ways. On the other end, intense feelings of grief that last over a year can get in the way of living one’s life to the fullest. With all things, finding a balance is key. Mourning a loss is an important part of life, especially the death of a loved one. You can love and miss people without those feelings taking over your life. Love never really goes away. That’s facts, but personal and/or cultural mourning rituals and grieving ceremonies help people set boundaries, use mindfulness techniques, and get their support system in order in healthy ways. Beloved people won’t be forgotten because we can keep them alive in our hearts through rituals and remembrance. And we can live our lives to the fullest in their memory.

Thanks for reading. The next piece will be part 1 of a 2-part series in time for the holiday season about setting boundaries specifically with toxic/abusive people in your life.

Suicide

Suicide is a touchy subject. It’s complex topic that many people have strong feelings and opinions about. At the same time, it is an issue that not many people are really educated on. Suicide makes many of us uncomfortable and in this society, whatever makes the majority uncomfortable gets pushed under the rug at best. However, the misinformation that many people have about suicide leads to those in need not receiving the kind of support necessary from their loved ones, from healthcare professionals, and from society at large. In this piece, I want to talk about suicide: what suicide is, the difference between thinking about suicide and being at risk of actually doing it, bodily autonomy, and suicide prevention. I hope with this information, people are able to better support their loved ones and/or find the support they need while going through difficult times in their lives.

Suicide Is…?

Suicide is the act of ending one’s own life on purpose. As a psychotherapist, I know that people who are suicidal don’t necessarily want to die. They want an escape from their current situation. Many people tend to see someone killing themselves as the problem when actually suicide is usually a symptom of other problems. Something or some things else are going on in that person’s life. There are other issues adding stress to their lives, bringing them to what feels like a breaking point. And a person who is suicidal sees suicide as a definite way to escape from their pain.

Now, being at risk for committing suicide is different from having suicidal ideation. Suicidal ideation aka thinking about dying or killing one’s self is actually very common. Most people have had times in their lives where they have thought about wanting to die in their sleep or wishing they were dead/not alive anymore, which are examples of passive suicidal ideation. Many people have also fantasized about jumping in front a train or car, etc. for a second as it’s about to past them. This urge/fantasy is usually short and most people never actually do it. It’s so common that therapists are not generally concerned with just thoughts of death. Thinking about their death by itself does not make someone at risk for committing suicide. Thoughts of committing suicide without a method, intent/desire to die, and a clear plan are usually on the low risk end. However, someone is in immediate risk of suicide if they have a way to kill themselves on standby, a specific plan of how they’re going to do it, and the intent/desire to do it. Otherwise, thoughts of suicide on their own are opportunities for conversations.

I believe in bodily autonomy. There are times, unfortunately, when someone’s problems are not resolvable for them. All the suicide prevention efforts (which I’ll get into next) could have been attempted and everyone could have put their all into it and, for whatever reason, it is not enough for someone to want to stay alive. I believe people ultimately have bodily autonomy and even if they want to end their lives, it’s their body and their life. At the end of the day, when everyone leaves and goes back home and/or goes to sleep, they have to be alone with their pain. I think it is selfish and torture to force someone to stay alive who doesn’t want to be. If every measure of suicide prevention available has been used and every bit of support in the person’s life has been accessed and the person still does not want to be alive, from a humanistic perspective, it is unethical to force them to live with their pain for someone else’s personal values. If you want someone to stay alive, then it’s time to put in some work.

Suicide Prevention in Treatment

Because I believe in bodily autonomy, it is my obligation as a mental health professional to 1)provide a safe space for people to process what they’re going through, 2)help them receive as much clarity on their situation as possible, 3)find and weigh other options to escape their situation, and 4)help them build a support system. All with the hope that with more resources and more options, the person will be able to resolve their situation in other ways, using other options. Ultimately, suicide prevention is addressing people’s stressors and problems. Again usually people struggling with suicide want freedom from suffering, not necessarily to die. It’s a common reaction to want to avoid talking about suicide out of fear of pushing the person “over the edge” or “giving them any ideas,” but that’s not how suicide risk even works. In mental health treatment, when dealing with someone who is suicidal, it’s time to get curious, ask open-ended questions, and not be afraid to go deep with a client. What symptoms is the person experiencing? What is going on in their lives and how can that be addressed? Who is around that can support them?

With these kinds of questions in mind, therapists usually encourage at-risk clients to use a safety plan. In treatment, therapists help clients brainstorm and create their own personal safety plan, which usually involves about 4 steps.

Step 1: Identifying the situation. What are some signs that let you know you’re starting to feel hopeless, sad, frustrated, etc? Do you feel it in your body? Do you feel tired all the time? Do you lose your appetite or eat more than usual? Or is it more in your head/thoughts? Do you get racing thoughts, for example? Mindfulness techniques [Here’s a piece I wrote about how to find the find one for you] are great ways to get a clearer idea of how you’re feeling if you aren’t sure.

Step 2: Self-soothing. What can you do for yourself to go back to how you were feeling before? What are some things you can do to cope with these feelings/this situation? How did you get through difficult times in the past? What stops, if anything, you from you using these coping skills now and how can you get around whatever is in your way?

Step 3: Who your people? (I said what I said). Being able to self-soothe is important, but also don’t be afraid to reach out to trusted people in this difficult time. Who can you ask for help? And what kind of help do you want from each person? Do you wanna vent? Do you need to leave home for a couple days? Do you need someone to make sure you eat? Do you need help going to the Dr? Do you need help with classes? Do you need money or transportation? Do you need help filling out paperwork? Do you need someone to babysit your kids for a couple days? If your social circle is fairly small, what social agencies are in your area that provide free or low cost services? A lot of community organizations can provide resources or referrals to free or low cost assistance that many people are not aware of.

Step 4: Emergency services: Do you feel comfortable calling emergency services? What hospital would you want to go to in a worst case scenario? It’s better that you choose than to have a stranger choose for you. How would you get to the hospital if needed? Do you have any suicide hotlines handy (See the post on depression here for a brief list of hotlines at the end)?

I always suggest suicidal clients have multiple copies of their safety plan in different areas for emergencies. Keep copies in your bag, jacket pockets, wallet, car, in your room, at your partner’s place, in a few trusted friend’s homes. etc. Tell the people on your safety plan what their role is and what kind of support you need from them at those times.

How You Can Help Someone Who Is Suicidal

Let me start by saying that no amount of positive thinking and yoga is going to “fix” suicidal ideation and stop someone from wanting a permanent escape. It’s like trying to cure a tumor with just positive thinking and a vegan diet. Not gonna happen. You got to get at the root of the problem. What is making them want to escape from their lives in a permanent way? If you want to help people who are suicidal, listen to and support them in addressing the issues that led them to feeling this way. Go at their pace. Let them lead the discussion and ask them what kind of support you could give to them during this time. While also making sure to set firm boundaries for your own mental health. Here’s the piece I wrote here on how to set firm boundaries. Or if you can’t help fix the major issue(s), support them by listening to them when they ask AND do small things to make their life easier. What everyday struggles could you help them with? Laundry? Food? Do they need help with child care? Or do they need your company? The suicidal person has to wrestle with their main issues while trying to stay alive. Your support could go a long way in easing their burden and increasing their chances of survival.

Too many ppl use the hotlines as the first level of defense and I want to dispel that. The first level of defense should be community-based prevention. Meaning building up strong friendships, chosen families, community bonds, etc. to the point where it’s normal to sincerely check in on each other’s mental health and actually step in to help when needed. Yes, give people hotlines to call. Hotlines are good resources if you need to speak about something anonymously, if you literally don’t trust anyone else in your area, etc. Hotlines are incredibly important…and also is there anyone in their personal lives who can talk to them? Sometimes people don’t want to talk to a hotline. They want to know that someone in their personal life cares about their situation and supports their fight for survival. Check in on your friends and I’m not talking about hollow check-ins between acquaintances. The “You good, fam? I saw your TL…” and “Yeah, I’m good. Just tired and a little stressed from work/school, lol”. Not the polite, fake checking in. Most people don’t get real about checking in because they don’t believe the other person actually cares and/or wants to take on the extra burden of helping someone else. Let’s get real though. Who’s your crew? Them? Those folks? Protect them. What keeps a pair or a group strong is sincerely opening up to each other, checking in on one other, and supporting each other through life’s mess.

I talked about squads checking for each other in the 4th part of my parenting series here where I also briefly talked about how it’s “very Western, very colonizer, to rely on a nuclear family (spouse and kids) for everything”. And it honestly doesn’t work. And going the individualistic Western way of pulling yourself up by your own bootstraps is literally impossible. That phrase was originally meant to describe something impossible that no one should be expected to do. And look, capitalism twisted the original meaning to trick us into fighting towards an impossible goal. Draining us of our health and life to feed the machine. There are so many lonely people in this world under this system. We should be relying on each other too.

If someone is opening up to you and talking to you about their suicidal ideation, it is a huge sign of trust. More often than not, they just want to talk about/process their experiences without feeling like they have to protect other people’s feelings, comfort, etc. And they trust you to be that non-judgmental, not pushy person for them. If someone you know tells you they are suicidal, don’t make it about how sad you and others will be if they die. It’s cruel to emotionally blackmail people into staying alive if they are suffering. Psychological suffering is just as earth shattering and life changing as physical suffering. Guilting them makes their pain about you so now they have their personal hell AND your feelings to manage all at the same time, which can make their own symptoms even worse.

Suicide is not selfish. You don’t know people’s lives and people’s pain. If suicide offends everyone’s sensibilities and morality so much, it would be in everyone’s best interest to do their part to make life bearable for everyone. Many of the problems and stressors that make life so painful are made worse by and/or are ultimately caused by systemic oppression of all kinds. In this way, disability rights, racial oppression, misogyny, transgender rights, capitalism, etc. are all public health issues. That all said, again, there are situations that cannot be solved for some people and assuming all efforts were made towards prevention, that person’s bodily autonomy should be respected.

I want to make a separate note to highlight this point: Calling the cops is the very last option if someone is suicidal, especially for Black and Brown people. What are ways you can maintain safety before reaching a point where one might consider calling the police? If you can get the person into the hospital or other other forms of safety, without calling the cops and possibly further endangering a life, great.

Suicide is a very difficult topic to discuss and it’s even harder to actually be in a situation where life doesn’t appear to be worth living anymore. It feels like a losing battle and people can find themselves wishing for any kind of peace or escape. This is where support from chosen and/or biological families, friends, and ideally the community can come into play along with any necessary treatment. Coming together and addressing the actual problems going on in that person’s life instead of guilting them into living a life full of suffering without their consent. All this…while also coming to terms with the possibility that maybe all the words and support in the world might not be “enough” to prevent loved ones from making that final, permanent choice. And realizing, as I said before, that people ultimately have bodily autonomy. The sadness and loss experienced by people still living are real and legit, but those feelings are not more important than the deceased person’s pain. And finally, it’s not anyone’s “fault” for them doing what they felt needed to be done. I hope this was helpful in giving people some clarity on how to better support those in need and/or find the support they need themselves to make informed decisions.

Thanks for reading. The next piece on Sunday 11/11/18 will cover grief. I will be explaining what grief is, what it can look like, and the psychological importance of mourning and mourning/memorial rituals.

Intro to Self Care

Self care. This word has become popular on social media and in progressive spaces, especially with the new presidential administration, but there’s still a lot of confusion about what it is. Literally self care about taking care of yourself, physically, emotionally, etc. A way I like to think about self care is learning how to be in a relationship with yourself. Learning yourself and what your needs are. Being honest, kind, and considerate to yourself about what you realistically can and cannot do. Our society prides constantly being on the grind and never sleeping to secure the bag, but eventually you’re gonna burn out. Non-stop work is not working smart. Meaning the kingdom you’re trying to build will be made of weak foundations if you do not learn balance. Learning to take care of your body and mind while you are working to achieve your goals will keep you going for longer and healthier. Invest in yourself. Maintain yourself. Burning out after constant grinding is not the wave and repairing yourself from that takes more energy and time than doing things on a regular basis to take care of you.

 Self Care Is…?

There’s a lot of misunderstanding about what self care even is and what it can look like. I asked Twitter for some common misconceptions and I’m gonna take some time to debunk them right here.

Myth: But Ain’t Self Care Like Doing Nothing/Like a Spa Day?

There are many different ways to do self care. When most people think of self care, they think about face masks and drinking lemon water. That works for some people, but that’s not all that self care is. Self care literally depends on each individual person and what they need/want at that given moment.

Some other examples of self care: blocking/muting someone, buying your favorite snack every Tuesday, going for walks alone, going out with friends, reading your favorite fan fiction at home, setting an alarm to take your medication everyday, rock climbing, limiting how much time you spend around certain family members, being kind to yourself when you feel like a failure, etc.

Myth: But Ain’t Self Care Selfish?

Nah, it’s a part of your larger health. No one would call taking care of your physical health being selfish. It’s sad: the way this society treats mental health care. It would be weird and insensitive to call someone selfish for walking away from a stressful situation because of their high blood pressure or heart issues. Or if they cancelled hanging out because they caught the flu. Also mental health and physical health are connected. You, your mind, and body need some love to function. Taking care of yourself will affect your whole body and make you stronger. And if you’re worried about looking or feeling selfish while you also deal with all your other obligations: How can you take care of others if you’re running on fumes? Take care of yourself.

Myth: But Ain’t Self Care Like a Cure-All?

Self care isn’t magical. It isn’t a cure. You might not notice huge changes in your life after a few weeks or even a month. It’s an investment in yourself. Like brushing your teeth. It doesn’t exactly cure dental problems, but it prevents larger issues from happening if you take care of your teeth little by little every day. Slowly, over time you’ll see changes in your mood, ability to sleep, life satisfaction, etc. The impact depends on the kind of self care you decide to do.

Myth: But Ain’t Self Care Always Easy to Do and/or Always Fun? 

Sometimes self care is boring and monotonous. Sometimes it’s not easy to do. But at the end of the day, self care is always good for you. Some examples of times when self care is more for the greater good and less because it’s fun to do: taking some time to sit in your feelings/self-reflect, doing homework earlier, cutting ppl off, drinking more water, getting tested for STIs every 3-6 months if you are at all sexually active with anybody, flossing your teeth, etc. Again, you do it because it is an investment in yourself and you’ll feel better in the long run.

Myth: But Ain’t Self Care Expensive?

Self care ain’t just for those with extra money to spend. Self care doesn’t have to cost money because you decide what self care looks like for you. It’s interesting that taking care of yourself is seen as something that has to cost money and has to be expensive. That says a lot about capitalism and our society that people think being able to take care of oneself is only for those with money. Self care can be going to bed on time. That’s free & priceless at the same time.

Doing For You

Y’all should know by now that I’m Team Self-Reflection. Learn yourself. Ask yourself some questions. Know yourself. Here are some questions to get you started:

Relationship with yourself:
  1. How often do you do stuff for you? Just for you?
  2. How much sleep are you getting? What’s the quality of your sleep?
  3. How is your appetite? How does what your eating make you feel?
  4. How are your boundaries? How easy is it to say “No” when you need to?
  5. What are 5 small things you could do today that would make tomorrow a little easier?
  6. How’s your health? Are you taking your medication regularly as prescribed? Do you have a primary doctor? How often do you go get checked? How often do you get tested for STIs?

All sexually active adults need to get tested for all bacterial & viral sexually transmitted infections every 3-6 months. 1 more time: if you are “sucking and/or fucking” someone, you need to be getting tested every 3-6 months.

Social circle:
  1. Who can you call if something popped off right now?
  2. What kind of support do you need? How are you getting those needs met?
Coped in the past by:
  1. Being alone?
  2. Being with loved ones?
  3. Distracting yourself with activities, events, school, work, etc?
  4. Using relaxation exercises (deep breathing, meditation, etc.)?
  5. Using substances (marijuana, coke, coffee, cigarettes, adderall, etc.)?

I don’t judge. Substance use in and of itself isn’t a problem (it being illegal aside). If the substance use is stopping you from functioning (EG: can’t pay rent and/or severe difficulties raising children) and/or if it causes you distress then it becomes a substance use disorder. A substance use disorder is a symptom of a larger issue and how someone is coping with a deeper problem. Trying to deal with the substance use disorder without dealing with the root issue is cruel because you would be leaving the person with the original problem AND 1 less coping skill to deal with that problem. Long-lasting change happens when you address the root problem first. Generally, the person will use substances less over time until it is no longer a substance use disorder.

Pros and Cons:
  1. Compare the risks and benefits of each coping skill and order them by the ones with most benefits to least. It would be real useful to get rid of the ones that are the least beneficial and replace them with new ones with less negative side effects.

Example: Drinking when you have diabetes. Even though alcohol is legal and even if you may be technically drinking a relatively average amount of, let’s say, beer with your friends. Your health (i.e. diabetes) means your body cannot process glucose (sugar) in your body and alcohol turns into glucose and will raise your sugar levels. Having a couple beers a night might be cool for other people’s lifestyles, but for you, it could mean serious health issues (kidney issues, loss of limbs, teeth issues, etc). So you could weigh the pros and cons and decide that the potential negative effects of alcohol on your body outweigh the social or numbing benefits of drinking.

Think about your life. Think about what you can do to show yourself some love. Think about the people and things that drain energy without giving anything back. Think about the things that bring growth into your life. Think about the things in yourself that you wish were different or about the life lessons you have a hard time learning. These are the areas where you should focus on taking care of yourself. The world is harsh enough. You don’t need to be hard on yourself too. It won’t actually make you stronger. It will eventually burn you out though. In these days and times we’re living in, burning out should be avoided. Take care of yourself now for whatever will be coming later.

Thanks for reading. Next post will be the part 2 of the corporal punishment/public shaming 2-part series on 3/25/18.