“I’m Doing Okay” (but I’m not)

One of the most dreaded questions for people who are grieving is, “How are you doing?”

Where does one even begin to answer that question after a loss?

There seems to be a perception that if we are not puddles in a heap on the floor, soaking in a pool of our own tears, we must be “okay.” If we are going to work and maintaining a household, we may even be considered to be “doing well.” If we are taking care of other people and putting one foot in front of the other each day, others might tell us how “strong” we are, or how much they admire us.

But none of that really rings true when we are grieving, does it?

We want to say,

“I’m not okay. I lost someone I love and my entire world has been turned upside down.

Somehow I am functioning. I don’t understand how or why, but I can manage most of life despite this grief. And yet, I am not at all “okay”.”

We aren’t necessarily seeking pity, but we do want people to know the reality of our experience. If we can’t share the truth of our experience, then we can’t fully be known. We become alienated. That’s a lonely place to be.

So how do we respond when faced with that question?

I think it depends on whether the question comes from someone who sincerely wants to know how you are doing, or from someone who is making obligatory small talk. If the latter, a simple, “I’m hanging in there,” might be insincere, but is less damaging than baring your soul to someone who is not truly willing or prepared to support you.

If the question is posed by someone who cares about you and has historically been trustworthy to hold your feelings, an honest answer can feel like a huge relief. Sharing how you are really doing will allow you to “vent” a bit of those emotions and will allow the other to provide support. Your response could facilitate a helpful discourse that leads to increased connection between you and another; connection is a crucial part of grief recovery.

That said, sometimes when faced with the question, “How are you doing?” our mind goes blank or we default to our kneejerk responses like, “Oh, I’m hanging in there.” It’s not what we want to say; it’s just sort of what came out.

It can be really helpful to have a script for some potential responses. I find that most people resonate with one or two of the suggestions below. When they hear them, they say, “That is perfect! I need to remember that.” When they respond with them, they tell me that it felt liberating to be honest. Read through the potential responses below and adapt them to your own experience and style of speech.

Some possible responses:

“I am managing things, but I feel like I am living in a nightmare.”

“Honestly, when I am with people I can hold it together, but I am devastated.”

“I don’t know. Some moments I feel okay, but when it hits me, I feel like I could just fall over and never get up.”

“Everything is ten times harder now. This is brutal.”

“I’m grateful to have so much support, but it still feels like I can’t possibly survive this.”

“Somehow I am functioning, but I feel like I am just going through the motions.”

“Every moment is a struggle. I feel like I could just fall apart.”

Be careful not to tack on a statement meant to comfort the asker like, “…but I will be okay!” Your pain is uncomfortable, even to someone who is asking how you are, but easing the discomfort of the asker ultimately disconnects you. Hopefully the next time someone asks you how you’re doing, you can respond in a way that supports your grief recovery instead of alienating you. I would love to hear what has worked for you!

Grief Brain

An unexpected part of grief is the experience of “grief brain.” Because of the intensity of emotion and mental load that grief requires, cognitive function can decline temporarily. Grieving people may forget things often, lose words when speaking, repeat themselves unknowingly, blank on someone’s name, or feel unable to plan.

This phenomenon is so common, but so alarming to people. They say to me, “I think I’m losing my mind!” If you experience “grief brain,” take heart. It is temporary, and not indicative of a progressive cognitive decline.

It may help to put a few systems into place so you can stay on top of the important things. A few simple recommendations:

-Write lists

-Set alarms and calendar alerts

-Take notes

                For the time being, don’t rely on your brain to remember everything. Use these external supports consistently. Clients have also shared some other interventions, such as giving spare keys to a neighbor, setting their phone’s “find me” feature, using a voice recorder to save information, and  using post-its liberally throughout their home or office.

                Please know that this “grief brain” is a normal experience and will improve with time. If you have concerns about your cognitive function that seem beyond the scope of “grief brain” or that aren’t improving with time, so see your doctor to be evaluated. Most people will find, however, that this experience gets better over the course of a few months. Best wishes.

(For more on the actual neurological processes behind “grief brain” THIS ARTICLE provides a good overview)

“Anxiety” and “Stress”

Recently I worked with a client who wanted help with her anxiety. She worked full time, was in school, had a family and had significant crises to contend with. She had a history of anxiety and panic attacks, so wanted support as soon as possible. After hearing an overview from her I said, “You have a tremendous amount of stressors in your life. I don’t think this is anxiety; I think this is stress.” She was relieved at the distinction.

But what is the difference between stress and anxiety? Don’t we treat them the same way?

Stress is a natural and necessary response to triggers or demands. Stress is often the impetus for us to take action. We feel stress mounting as we approach a deadline, and we work harder to complete the work. The baby’s cry is getting shriller, and our stress prompts us to soothe her and figure out what is wrong. Stress has a cause and a reason.

Anxiety doesn’t need a trigger or demand. When we experience anxiety, we can’t point to a cause in the way we can with stress. We feel restless, scared, worried, or panicked; but for no good reason. Anxiety is like the background noise of fear, and it gets louder as out thoughts feed it. We begin to conjure scenarios and outcomes that increase our anxiety, and soon it feels like a runaway train.

Why is this distinction helpful?

If we can discern stress from anxiety, we can know how to better treat it. Some treatment interventions are the same for both, but not all.

For clients who are experiencing stress, I start by clarifying the three legs of treatment:

  • Minimize exposure to stressors- We look at ways that stressors can be reduced, such as delegating, avoiding new commitments, or reducing contact with someone.
  • Manage stress- We consider interventions that can help manage the onslaught of stressors, such as improved time management, cognitive-behavioral interventions, and relaxation efforts.
  • Bolster your baseline- We practice techniques that help reduce the physiological response to stress, so that the client can have a calmer baseline from which to process new stressors. These techniques include breathing exercises, visualization, and muscle relaxation.

For clients who are experiencing anxiety, the approach is different. While calming activities are part of the treatment, mindfulness, grounding techniques and body awareness take precedent.

To treat anxiety, I start with the following interventions:

  • Immediate physiological changes- Anxiety in the body perpetuates anxiety in the mind, and it becomes a vicious cycle. To intervene immediately in anxiety, I help clients become aware of their body’s responses and begin to alter them. This includes practices such as progressive muscle relaxation or the 4-7-8 breath.
  • Thought-stopping- Anxiety makes thoughts spiral, and one of the biggest complaints I get from anxious clients is that they are ruminating or can’t get these intrusive thoughts out of their head. We practice thought-stopping techniques, such as the “stop sign method” and replacing with alternate thoughts.
  • Alter sensory input- Anxiety is often sensitive to sensory input. Increased noise, busy visuals, physical contact and other stimuli can increase anxiety significantly. Often times this causes a client to either have a panic attack, or “zone out” in a way that is close to dissociation. I teach clients the 5-5-5 grounding technique if they have experienced this “zoning out.” For all clients with anxiety, we review sensory input, and look at ways to reduce unnecessary stimuli. This might mean using earplugs, coaching children to do a hand signal instead of tapping them for attention, or turning off background noise like a television.

Stress is something that can be addressed in some very concrete ways with good results. Anxiety is a little more insidious, and requires environment changes, mindfulness, and preventative interventions to best keep it at bay.

Staying Afloat in Grief- A Very Personal Story

“I just almost called mom to tell her my mom is dying.” My stunned face and dropped jaw drove the point home to my sister as I walked away from our mom’s living room hospital bed to get a little fresh air. Mom was a fixture in our lives. She was the default co-parent to my son as I was a single mom over 11 years. She was my emergency contact and my literal lifeline. She was the first person my sister and I would share anything with. And now she couldn’t speak and didn’t even seem to hear me. My reflex was to call my mom for help with this horrific tragedy; but my mom was dying.

The oxygen cannula hissed as my mom tugged the tubing away from her nose, and I turned and shrugged. Hospice means comfort, and if she doesn’t want the oxygen, I thought, we can give her that small dignity. It had been five days since I took her to the emergency room, due to a persistent cough that had not yielded to antibiotics. With a breakneck pace, she went from walking herself into the E.R. on a Wednesday, to being mostly unresponsive in the hospice wing by Friday, and then home in my childhood living room Saturday night as her body quietly and shockingly slipped away on Sunday evening.

We were reeling from the turn of events, but somehow magically met her needs in those final days. The experience of nursing a loved one to their death- when we spend a lifetime nursing loved ones back to health- was surreal and repugnant. When she died, my sister and I, along with our extended family, held a Coors Light toast over her body and then retreated into ourselves to process what had happened. The funeral director arrived after I matter-of-factly called to report my mother’s death. When they began to remove her body, my vision went white and my body gave way as I collapsed into a chair.

Not my mother. It seemed impossible.

The next few weeks, we shuffled through our days and duties. I returned to work. My sister moved into our mom’s house to begin clearing it out. We planned a memorial, complete with a playlist of our mom’s favorite tunes. We accepted condolences and managed affairs and somehow functioned despite our heartache. We also parented our own children through that grief; their “Mimom” was a special, doting presence in their lives and her absence was inconceivable. We managed, though, and resumed some semblance of normalcy fairly quickly.

Overall, I felt okay. Until I didn’t.

Within a couple of months, I found myself unable to get out of bed in the mornings. Work seemed an impossible task. My mind could not focus and my body was leaden. I was subsisting on a diet of leftover Christmas cookies and simple soups. Her final days replayed over and over in my mind, distracting me and disrupting my days. My train of thought derailed during the most menial tasks. I couldn’t form sentences, I couldn’t find the words, and I couldn’t remember a damn thing.  I wasn’t always sad; but I kind of just wasn’t there.

It was grief. This cognitive puddle, sieve-like mind was a symptom of grief that I never anticipated. It felt like quicksand and it was pulling me in.

A shift occurred when I realized that I was at risk of drowning in this grief. Somehow naturally, blessedly, I began to adapt in ways that allowed this grief but also allowed some life. Clearly I could not ignore the reality of my mother’s death and could certainly not avoid the intense and persistent emotions around that, but I also couldn’t wallow in the mire; it was intolerable. Too much pain, too much dysfunction, and too much to lose to get stuck there. I couldn’t drown. Yet I knew in my heart this was not some inspired “comeback” or triumphant “reinvention” after loss.

All I wanted was to keep my head above water.

The notion that we can kick grief to the curb to “come out on top” is, to me, ridiculous and lacking humanity. Grief is not something to beat; it is something to live with.

Over the next few months, I was able to adjust some thoughts and behaviors to stay afloat. It was my only goal. I had no aspirations other than to stay afloat.

In talking to other grieving people, I’ve learned that these simple interventions can be so helpful for most people. It is my life’s work to support people through grief, and these tips can go a long way in providing comfort after loss. Below are a few things that prevented me from drowning in grief. Consider experimenting with some or all of them to keep your head above water.

  1. Your Primary Goal is to Stay Afloat: When you adapt this mindset, it relieves myriad external pressures and self-imposed goals. For this acute grieving period- whether it lasts 6 months or 6 years- your primary goal is merely to stay afloat. Do not complicate this by pushing yourself into arbitrary goals and ambitious endeavors. Keep it simple.
  2. They Get 80% of You: When wracked with grief, we can not function at 100%, yet we expect to and try to and subsequently tire ourselves out. We thrash about as we are drowning, trying to swim, when really, we just need to tread water. Scale back your efforts, particularly as they pertain to others’ needs or perceptions. If you are functioning at 80% right now (or 60% or whatever-percent), that is what the world gets of you. They get 80% of you. It is temporary but it is essential.
  3. You Have a Concussion: When we are sick or injured, we generally scale back our activities and relinquish our commitments temporarily in order to fully recover. So it should be with grief.  A dear mentor of mine related grief to a concussion. She is a pediatrician, and when her own mother died, she recognized that the “grief brain” and other symptoms of her grief were starkly similar to the effects of concussion: Brain fog, concentration issues, queasiness or appetite issues, fatigue… And because she shared that with me, I was able to conceive of myself as having a “concussion” as I grieved. The treatment is quite similar too: Rest, hydrate, avoid screen time, engage in light physical activity and avoid unnecessary stimuli or stressors. The key part to concussion treatment? Time. Give it time and space while you nurse your wounds. So it is with grief.
  4. Write Your Grief: Even if you a not a “writer,” please consider this. “Grief brain” is akin to a tangled mass of yarn inhabiting your mind. When we write, the tactile component practically pulls at the strands and begins to unknot them. The process of writing, regardless of the content, is inherently therapeutic. There are many ways to approach this, including journal writing, letter writing, stream-of-consciousness writing or using prompts. The end result is irrelevant, and in fact for most people shredding the pages when finished is helpful. I offer one suggestion for a writing activity if you want to experiment with this: On loose paper, write a letter to the deceased. It can be free form, or you can use these starting prompts: “Since you’ve been gone….” or “What I really wish you knew is…” or “My life has changed since your death in these ways…” or “One thing I just can’t accept is…” Once you’ve written the letter, shred it or toss it. Don’t even review it. And then write again the following day. Try this for 5 days and see if there is a benefit.

Since the death of my mother (which was one year after the death of my grandmother and seven months prior to the unexpected death of my uncle), I continue to use the above techniques and I continue to recommend them without reservation. My hope is that, by starting with even one of these approaches, you can manage your grief in a way that helps you stay afloat. Stay gentle with yourself and take good care. I wish you peace and comfort in your grief experience.

The Grief of a Breakup

To recognize the intense grief that a breakup can trigger, we can look at some of the things that may be lost when a marriage or relationship ends:

A companion

A housemate

Help

Sex

In-laws

Friends of theirs

Social experiences

A confidante

Daily routines

Traditions

An ally

Touch

Inside jokes

Financial support

Your imagined future

It needn’t be an unwanted breakup to grieve these losses. When a relationship ends, your world as you know it ends. Or, if it was a relationship in early stages of development, your “world as you were hoping it would be with this person” ends. The disappointment can be crushing. The absence is palpable. The loss of so many aspects of life. The dashed hopes and plans for the future.

It is possible to grieve a breakup as intensely as a death, but the people around us don’t quite get the gravity of the loss- especially if we chose to end the relationship.

Grieving a breakup requires similar supports to grieving a death. Here are a few tips to help you cope:

  1. Treat yourself kindly and gently. Like any other grief, this experience can be exhausting and confusing. You may be emotionally drained and mentally overwhelmed. This is a time to scale back on non-essential responsibilities. Take extra naps. Lower your expectations of yourself. Allow your grief to bubble up without shaming yourself. Your grief is valid and appropriate.
  2. Seek counseling. The support of a counselor during this process is invaluable. Friends and family may not understand your grief, or may quickly urge you to move on and feel better. With a professional counselor, you can express more and explore more to heal after this loss.
  3. Conserve energy. Grief is draining and will tire you quickly. As you move throughout your day and are faced with choices such as new work, social commitments, activities and requests from others, consider this at each decision point:

Will this replenish my energy? Or will this deplete it?

The same choice may replenish one day and deplete another. For instance, sometimes we really need the company of other people and connecting can restore us and strengthen us, but other times we can’t muster the effort to even talk, and time in solitude has more replenishing benefit.

  • Don’t push yourself to “move on.” It is okay if you are grieving for months. It is okay if you take a dating hiatus. It is okay if you are not open to meeting someone else right now. People will urge you to “get back on the horse,” but this grief process is essential. If and when you are ready to move on, you may experience some trepidation, but you will know that it is time. Don’t push yourself to get there.

This loss has changed your life. Of course it is okay to grieve.

Boundaries as Gates

I’m noticing a trend of concern when it comes to the concept of boundaries. It seems that the word “boundary” is being misunderstood as being synonymous with the word “rule,” and I worry that in many cases this misunderstanding leads to disconnection and alienation in relationships.

In the literal sense, boundary means the designation of the end of an area, or a space to which one is bound. In the social-emotional realm, however, few relationships thrive when “boundaries” are set like chain link fence to tell others to stay out.  There are exceptions, of course. When you must maintain a relationship with someone who has a personality disorder, is abusive, or is perhaps in the throes of addiction, it is necessary to have those fences and clear rules of engagement. Sometimes those sorts of fences even need to be reinforced with barbed wire. But I think those same fences can be really damaging to other relationships.

There is a connotation in the common usage of “boundaries” that implies that we alone set the expectations for the relationship. That we call the shots. Unless you are stranded on an island with only “Wilson” as a companion, you alone do not set the expectations for a relationship. There is always another person in the equation.

In relationships, you decide what is okay with you and what is not okay with you, while the other person makes the same decisions for themself. Often, these decisions may be dynamic and contextual, changing from situation to situation. You’re not trying to keep someone out in relationships; you’re trying to let them in. So instead of imagining this chain-link fence around your heart, imagine a little gate. Each time someone approaches the gate with a request, a demand, a behavior or some unsolicited advice, you decide: Do I let them in with this today?

If the use of the word “boundary” in a given situation is synonymous with the word “rule,” it is missing the mark. Unfortunately, with the exception of parenting or management, we don’t get to tell other people what to do. We do get to decide how to respond to them, though. If someone continually rattles your gate, insisting that you let them in with something you don’t want, you get to decide how to respond. You might let them in, you might turn them away, or you might call the cops. But you won’t get far if you set a “rule” for them; my guess is that if they are someone who rattles gates, your rule is not something they will willingly abide. You don’t have to concede to their demands; you maintain that boundary by keeping the gate closed at that time. If they are persistently intrusive, you may never open the gate to them and that is okay.

Over time and with practice, you’ll begin to see that the people who don’t rattle your gate when it’s closed are the people you’ll most want to let in.

There is always value in recognizing where I end and where you begin, but do we want to further the gap between us by constructing fences made of rules and mandates? Life is complicated enough. Rather than fences, I see boundaries as gates to which we are always our own gate keeper.

“Unmoored”

When working with clients, particularly those grieving, they often pause and stumble while trying to describe a certain feeling that they can’t put words to.

“Unmoored?” I ask.

“YES! Exactly!” they say.

Unmoored. It means adrift. Uncertain. Floundering, Insecure. Un-secured.

It is how we feel when we have let go of the swinging vine before grabbing on to the next vine.

It is where we exist between what was and what will be.

It is how we are when our anchor is lifted and we are left out to sea.

I am sharing this word here in case it helps you give name to that vague feeling you’ve been having.

Therapeutic Writing

If you don’t like to write, consider reading this through anyway! It has helped so many “non-writers” and it may help you too.

                My regular clients will tell you that I encourage writing in many forms as part of our counseling process. While I specialize in grief, I also work with clients who have experienced trauma, dysfunctional families, self-sabotaging behaviors, intimacy issues and myriad concerns within their complex lives. For all of these clients and more, writing is a common “prescription.”

                Why writing? Writing can impose a structure on otherwise-amorphous thoughts and allow you to articulate and express things that you may not even have identified. Writing provides a mind-body link as the words in our heads come out through our fingers (handwriting can have additional benefits, but typing is good too!). Writing requires temporary focus, and focus clears the mind and settles the nervous system.

                Writing exercises can be applied therapeutically in so many ways, and this is not meant to be a comprehensive discussion at all. Instead, I will highlight three of the most useful and widely-applicable writing exercises so that you might experiment with them. All could benefit from discussion with a counselor, but all can be done independently.

  1. Stream of Consciousness Writing- Based on the concept of “morning pages” presented by Julia Cameron in her book The Artist’s Way, stream of consciousness writing provides a “brain dump” to help clear the mind. If you feel overwhelmed, foggy or “paralyzed,” this exercise might be for you. I recommend hand-writing for most people, but type if you need to. I also recommend loose paper that can be destroyed afterwards (or a document that can be deleted easily). Set a timer for 10 minutes and begin writing anything in your mind that can be translated into words. It needn’t have a format, it needn’t make sense. The object is to write what is in your head, regardless. If you get stuck as your are writing and can’t quite identify what to write next, simply rewrite the last written word repeatedly until the next thing gets to the paper. When the timer goes off, you are done. No need to re-read. Shred, tear or crumple the paper and discard it. Do this daily for a week or more to reap the benefits.
  2. Journaling- A personal journal can serve as a processing outlet or a mere log of your life. Both have value. Privacy tends to be best for journaling, but if your life doesn’t allow that, just write what you can as your people flit about around you. Journaling prompts may help if you are not used to facing a blank page. Or use a simple format like, “Today I did/felt/need/want” and elaborate on those. If sticking to journaling is tough for you but something you want to do, I recommend the book Atomic Habits by James Clear to help you learn how to create a daily habit.
  3. Letter Writing- Writing actual letters with intention to send them can be a great exercise in and of itself, but generally when I recommend letter-writing, it is for the client to write to a person they can’t talk to. This may be a deceased loved one, an estranged family member, a difficult personality in their life, or a person from their past. These may be hand-written or typed, saved or destroyed- whatever your comfort level. The fact that you won’t send them is key, though. It allows a frankness and vulnerability that makes this exercise worthwhile. You may have no problem scrawling out a letter like this, but if prompts are helpful, some good starting points are: “What I wish you knew is…,” “You impacted me by…” “I hope you feel…,” “My life is different because…,” or “If I could do one thing over again I would…” There are countless ways to write letters and anything goes.

If you are intrigued by writing and want to experiment more, look for online prompts, writing apps, letter templates, fillable journals and other resources to explore.

Recommended books:

The Artist’s Way by Julia Cameron

Wreck This Journal by Keri Smith

Spiritual Doodles and Mental Leapfrogs by Katherine Q. Revoir (out of print, but available through some second-hand outlets)

Grief for the Failing Body

“Time and health are two precious assets that we don’t recognize and appreciate until they have been depleted.” -Dr. Denis Waitley, author and speaker

                *Your doctor tells you that your best hope is a colostomy

                or

                *The fingers on your right hand have been going numb- and now they don’t work

                or

                *Your bad leg can’t be saved

                or

                *Your voice is gone…

                …and the list of things you’ll never do again or ways you’ll never be again grows in your mind until you can’t imagine living a full life without full use of your body. Worst of all? No one gets it.

                The devastation of failing health or bodily limitations is a grief rarely talked about in public forums, but a painfully valid grief nonetheless.

                When we lose function of any part of our bodies, we lose a part of our self. The impact on our daily life can be sweeping and can include loss of autonomy, communication, ease, pride, hobbies,  intimacy, social life, mobility, expression and countless other losses. The losses compound until losing the function of a body part becomes losing the function of your previously-happy marriage. The implications of these losses are hard to articulate, and that’s if you can even identify them.

                Like grief after a death, grieving non-death losses means reconciling the past with the future while recognizing the massive gaps now present.

                This is a time for extra support including counseling, practical help, and emotional support from friends and families. These losses- profound as they are- often go unacknowledged, even in the medical community. But these losses need to be recognized and processed in a way that allows grief and hope to coexist.

Unexpected Comforts

At times, the intensity of grief leaves us feeling like nothing could bring relief. Our sorrow is too deep, our despair too consuming. Yet somehow, we find unexpected comforts in the throes of our grief, and these become tiny lifelines that keep us from drowning. If you have not yet experienced any such comforts, please know that after working with hundreds of grieving people, I feel confident in reassuring you that you will.

                Very often these comforts are “random” or serendipitous- we stumble upon them without having sought them. But many are things we can seek out to provide a dose of relief in our pain. Below is a list of unexpected comforts that have supported clients in the past. Consider them with an open mind and with the understanding that what works in grief may be entirely different (unexpected!) than what has worked for you in other trying times. Experiment a bit, and I hope you find something comforting below.

Pets or animals- If you have none of your own and suspect they may help, volunteer at a shelter to walk dogs or brush cats.

Coloring- An adult coloring book and a pack of colored pencils can provide soothing repetition.

Beautiful music- Nostalgic or new, music heals.

Self-help books- Daily readers with brief passages are especially comforting. I like Healing After Loss by Martha W. Hickman.

Sunshine- Aside from the Vitamin D benefits, the enduring nature of the sun can be a comforting touchstone.

Yoga- Many discover yoga for the first time in grief; a beginner’s class or video on YouTube can help get you started.

Routine- Predictability brings comfort.

Nature- Peace and quiet and soothing fresh air.

Building- Whether wood-working or puzzle-solving, putting something together can be a comforting act.

Cooking- The repetition of cooking can be a comfort and the secondary benefit of sustenance helps too.

Prayer- Memorized, rote prayers can be soothing and easy to execute even with “grief brain.”

Writing- Letters to the departed are often surprisingly comforting! Other writing formats work too.

Daily walks- The cadence and fresh air combined can bring such comfort.

Other grievers- Being with those who “get it” can provide immeasurable comfort. Keep an eye out here for a new monthly grief support group starting in March 2022.

                If you have found unexpected comforts in grief and want to share with other grievers, please leave a comment letting us know what worked for you!