Fighting Grief With Positive Activities

His diagnosis was schizophrenia, but this man in his mid forties looked more sad than schizophrenic.  I asked his story. He hadn’t had any of the symptoms of schizophrenia for years; as a matter of fact, he was doing fine; no voices, no symptoms, working as a peer counselor.  But he was sad.

His white hair looked so distinguished; I would have guessed he was a businessman, not a schizophrenic.  But the downcast eyes, the slow shuffle of his walk, told me that sadness had taken over his daily life.  As for the white hair, he told me his hair had turned quickly, at the time of his loss; a story I had heard before.  To me, this was more empirical evidence of the Mind-Body connection — emotions affect bodily functions in a large number of ways. Sometimes we know more about the biochemistry than others, but everything I learn amazes me.

Like many with his diagnosis, he had struggled with relationships.  He thought he had won the game, for he found a woman about whom he cared greatly. Then, she died.  

The death had been sudden and unexpected, he said.  She was younger than he, and of course he had found her beautiful.

She had died by drowning in a swimming pool.  He was not sure he could understand what had happened, because he said she had been an excellent swimmer.  It was the pool of a friend.  He thought it had something to do with the drainage system, and he did not really understand it.  It made little sense to me, but I listened to his sadness, perhaps one of the most important things you can do with someone who is suffering this way.

I wanted to tell him there would be other women, that he was plainly caring and sensitive, and that another woman would see this.  But I said none of that; he was not ready.  Her death had happened only a few weeks ago.  I simply tried to set up support groups and such and told him I would see him more often.  I offered to crank up his existing antidepressant dosage, but he did not want that.

What’s more, he was right.  Antidepressants treat what are known as the “neurovegetative” or bodily symptoms of depression.  Qualities such as sleep, energy, ability to concentrate, hunger.  We both knew that no medicine was going to bring her back.

We simply talked about life and loves and changes.  I tried to express empathy without drowning the poor man in platitudes.  That would be too easy and would probably be what other people had done.  Here are some pretty good sites with quick overviews of this process and how people might deal with it either in themselves or in friends.

A good place to start is the groundbreaking work done by Dr. Elisabeth Kubler-Ross.

Of course, people don’t do grief in rigid stages; everyone moves through their pain at their own rate and sooner or later gets to the “getting on with life.”

Sometimes people want more.

I usually give patients one thing that does not usually show up on the grief sites or handbooks.  I tell them to do something to memorialize the passage of the loved one.  Not necessarily the customary funeral and gravestone, although for many folks that is a very good thing.  It serves the historical purpose of placing the deceased in the system of ancestors, giving them honor.  It brings together the living family for reminiscences.  It gives a sense of permanence through ceremony.

I tell people, especially in situations like this one, to do something to memorialize the deceased as the victim of a force that must be reckoned with.

So I sent our grieving schizophrenic to a government web site all about swimming pool safety. I told him to go to the library, and use the free internet access, and see what could be done locally for pool safety.  Maybe he could give a little money for a plaque or something with her name, or start an association with her name, if there was nothing locally for work in pool safety.  He perked up, and I thought I almost saw a little bit of a smile.  He started doing a bit better, getting out more, soon after.

The first time I helped a patient with a very complicated grieving process was one of the first patients I saw in my private practice right after I finished my outpatient training.  Her son had died in a prison riot, in a locality where the prison system was particularly poor.  I had her on every antidepressant then available until she joined a group that was really militant about prison reform. She went back to her customary employment soon after.

I think that getting people involved in this way, subsequent to the surprise death of loved one by outrageous forces, is that it deals with two aspects of the grieving process that seem to be pretty much universal.  One is the anger.  Sure, people get angry at God or the Universe.  It is a lot easier to express anger when there is a clearly identifiable object — for example, the state legislature for the woman whose son died in prison, or the swimming pool industry for my patient who lost a friend to drowning.

The other is the sense of impotence — the ruminating feeling of “why couldn’t I have done something to prevent this?” becomes “maybe I can prevent this happening to somebody else.”

Then, I learned that something mechanical about pool drains can cause people to get stuck to them, unable to pull away; and ultimately, drowned.  Then, someone, with a company that makes something that sounds like a concave drain, says this is cheaper and as good, so there is a change in standards.  I can certainly understand why those who lost their loved ones to this kind of accident are up in arms.

It is no accident that the mother of a child lost has been a key crusader.

What is concerning is that the “round” drain has been championed by the company that makes it, whereas “pool safety experts” say it is not enough.

It is not difficult to find the website of the person – and company — who make the new, less-expensive drain alternative, and who is very happy, understandably, that it is considered safe enough for pools.

There are more issues raised here than we can possibly answer.

The first concern has to do with science.  I am not sure how an experiment could “prove” safety.  Maybe a human shaped dummy could be sunk to the pool’s floor and someone could see if it got stuck to the drain and compare results to the anti-entrapment devices?  I cannot find such a study.  We are in the realm of opinions, perhaps learned ones but opinions.  We are talking about a life or death situation.  The new product is “cheaper.”  But its adequacy remains controversial.

In America we seem to turf this kind of decision to a court, or to a government court-like entity.  We have done this with everything from the “responsibility” of pharmaceuticals for life-threatening situations (Prozac has been exonerated by the courts in suicide cases several times) to the possible side effects of vaccines (the ‘jury is still out’ on the relationship of vaccines to autism, according to “vaccine court”).  I have actually heard a few other idealists and moralists besides me assert that human life is beyond price.  Comforting the grieving can be hard work, too.

We certainly do not act as if human life is beyond price.