Archive of ‘Grief and Loss’ category

When Thoughts and Prayers Aren’t Enough – Self-Care in the Aftermath of Tragedy

A personal note from the author: As I was writing this piece in the aftermath of the school shooting in Uvalde, TX, the gravity of the situation at hand sat heavy on my soul. The weight of the tragedies that inspired this piece is not lost on me. Over 336,000 students have experienced gun violence at school since the shooting at Columbine High School in 1999 (source). In an average year, over 10,300 hate crimes in the US involve a firearm – more than 28 each day (source). For decades, gun violence has reached every pocket, nook, and cranny of our country, and as a result millions of lives have been irrevocably changed. 

I feel called to name this as a preface to this blog: There is no amount of journaling, self-care, compassion, protesting, meditating, senator calling, donating, or volunteering that can take away or fix the deep wells of grief and despair felt by the survivors of those who have lost their lives to gun violence. 

I stand by the information collected and presented in this piece. However, I am fully aware that this is not nearly encompassing enough to soothe the collective grief we are all experiencing, nor will it ever touch the amount of support needed by the families and loved ones who have lost someone to gun violence. This blog is meant to be a consideration and a supplement for those who are struggling to bear witness to the pain we are subjected to on an almost daily basis as Americans living among two simultaneous crises in this country – the gun violence crisis, and the mental health crisis. They both demand our urgent attention. 

I plead with you to seek resources, gather support, and educate yourself on the subjects at hand. I plead with you to connect with your neighbors, contact your senators, and demand something be done to change the course of gun violence and mental health care in this country. Most of all, I deeply plead with you to take care of yourselves, so we can finally begin to take better care of each other. Thank you for your consideration – Sara

Self-Care in the Aftermath of Tragedy

“Every one of us needs to show how much we care for one another and, in the process, care for ourselves.”

Princess Diana

The last several years, as a nation, we have seen unspeakable tragedy unfold. The near constant continuation of mass shootings is wreaking havoc across our society. With the rise and spread of social media, we now have a front row seat to these tragedies in a way we never have before. These events permeate our newsfeeds, our conversations, our brains, and most importantly our hearts. Feelings of hopelessness, exhaustion, and fear are running rampant between us and within us due to neurobiological responses to trauma. While tensions are at an all-time high, our need for compassion, connection, and support is greater than ever. Self-care is a valuable necessity in meeting these needs. Let’s explore how to lean into these self-care needs, and the importance of caring for ourselves so we can care for each other.

“Love and compassion are necessities, not luxuries. Without them, humanity cannot survive.”

Dalai Lama XIV

The root of the word compassion comes from the Latin phrase compati, which means “suffer with”. Compassion is what drives us to see other people’s pain and deeply identify with it. Compassion holds evolutionary neurological purposes. Compassion developed as an emotion within the brain to help us to identify and bond with others, thus creating safety amongst groups of humans. As humans experience compassion, our heart rate slows, our breathing deepens, and oxytocin (the bonding/love neurotransmitter) is released. Often this is demonstrated as an outward, other-oriented experience – we give or show compassion to others who are suffering. But what would it be like to turn this inward? We are worthy of giving ourselves compassion. Our bodies and brains have gone through so much over the last few years, and yet we are often expected to maintain the same level of productivity, health, and well-being as years prior. If we practice the gift of self-compassion, we can allow for the same neurobiological response to heal and soothe ourselves in the same way it does for others.

Practice quietly speaking to yourself as you would a friend or a child – I know this is so painful for you. It is difficult to understand and comprehend. People are suffering and it is hard to watch. It is ok to be sad, angry, and fearful. You are allowed to cry, self, it is okay. You are struggling in the midst of this, and you have every right to be. Providing yourself with the permission and allowance to comfort and soothe yourself is self-care. When we develop more compassion for ourselves, we also deepen the compassion we can have for others. Self-compassion and compassion for others are woven like a braid to form the fabric of empathy. 

“Get yourself grounded, and you can navigate even the stormiest roads in peace.”

Steve Goodier

As the shooting in Uvalde, Texas unfolded on May 24th, 2022, we all watched from near and far in horror. Social media has created a nearly instantaneous avenue of communication and consumption of information. Neurobiologically, our brains are simply not evolved enough to withstand this level of information. As we watch the chaos unfold through Facebook live feeds, or hear the screams of the families through TikTok, we are giving our brains a hefty dose of secondary trauma. Although logically we know we are absorbing this information second hand through a screen, our brains don’t actually know that this is a second-hand experience. Our brains are wired to react and respond to threat and danger; thus, our trauma response begins through what is commonly known as fight/flight/freeze/fawn. As we watch these videos, our brains release cortisol and adrenaline, preparing our bodies for the danger at hand. As a result, this translates to overwhelming feelings of anxiety/restlessness (fight/fight) or depressive/hopelessness (freeze/fawn). The longer we engage with the secondary trauma, the longer this neurobiological response continues. 

One of the best ways to relieve ourselves of this cycle is grounding ourselves. Grounding refers to an increase in radical acceptance, mindfulness, and re-connection to the present. There are many ways to practice grounding, and no way is right or wrong. Sensory based grounding techniques are always a go-to in my practice simply because they are easy and reliable. Try taking deep belly breaths and exploring the following – 5 things you can see, 4 things you can feel/touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. Reflect on the physical sensations that come up for you, as well as the feelings that arise during this exercise. I also love incorporating grounding during regular every day activities. Cooking meals, walking my dogs, playing with my crystals, taking a shower – these are all rich with sensory input that we can tune ourselves into to get back to our present body and mind. 

Another great way to ground ourselves is through a creative outlet. Journaling is an amazing resource that we all have access to. Journaling helps us process our experience both internally and externally. In addition, think of all of the sensory based aspects of journaling. The smell of the paper, maybe the sound of the clicking as you type on your phone, what it looks like to see your words out in front of you. There are so many opportunities to check in with your body, mind, and soul in the midst of journaling. This also applies to other forms of creative outlets including painting, sculpting, drawing, and creating music. Anything that allows the charge of energy and emotion to move through us also provides us with an opportunity to check in with our own experience and utilize grounding to soothe ourselves. Things are treacherous in the outside world, but here in our body and mind we can create a peaceful, compassionate, and loving reprieve from what we are absorbing every day. 

Grounding is important for self-care, but it is also important for a larger purpose in solving the challenges we are faced with today. The greater the activation of our trauma response, the less access we have to our prefrontal cortex. This is the part of our brain that we need for decision making, problem solving, consequential thinking, rationalization, and impulse control. These are ALL things we need to have access to in order to begin to solve the problem of mass shootings in our country. We cannot begin to solve this problem when we are all operating from a place without access to the parts of our brain needed most. Individually and collectively, grounding is becoming increasingly more of a necessity in today’s world to solve the complex problems we are faced with as a society. 

“What I try to tell young people is that if you come together with a mission, and it’s grounded with love and a sense of community, you can make the impossible possible.”

John Lewis

Self-care is a crucial part of healing from tragedy. Although self-care can be relaxing and soothing, there are also forms of self-care that are more active and intentional. In light of large-scale events, some folks respond with a more intense drive to do something to prevent this from happening in the future. The lack of control and helplessness we feel bearing witness to these events pushes us to action. Finding a balance between grounding-based self-care and actionable steps is so crucial. One must occur alongside the other. We have to ensure we are in a healthy regulated mental space in addition to engaging with the resources available to help and create change.

One of the best ways to heal, feel connected, and process tragedy is in the company of your community. Community engagement is incredibly useful in creating a sense of togetherness, connection, and unity in the face of devastation. This large-scale form of co-regulation allows for us to think clearer, develop our compassion for others, and empowers us to seek the change we wish to see. When we all come together, strides can be made towards our end goal. 

There are so many ways to get involved with the community to enact change to end gun violence and increase access to mental health care. Here are a few ideas: 

  • Call Your Representatives – Contact your local and federal representatives to let them know you would like to see change to ensure the safety of you and your neighbors. The League of Women Voters has a great website that helps you find your elected officials and their contact information. 
    • If you are unsure of what to say when you call or email, review this script: “Hello, my name is NAME. I’m a constituent from STATE, ZIP CODE. I don’t need a response. I am concerned about the rise of gun violence and lack of mental health care funding in our communities. I strongly encourage the senator to please vote for legislation that solves this situation. Thank you for your hard work!”
  • Review Volunteer Opportunities – There are so many ways to volunteer in crisis. Organize a blood drive with your colleagues, gather donations (see below) to support the families and survivors, or find organizations such as Moms Demand Action or Everytown that support policy change and provide opportunity for connection and action. 
  • Donate – One of the best ways to assist is to provide monetary donations if you are able to. It is so important to do research on the legitimacy of donation sites to ensure your money is going to directly benefit families and survivors. 
    • To donate to the survivors of the Uvalde, TX school shooting, please CLICK HERE
    • To donate to the survivors of the Buffalo, NY supermarket shooting, please CLICK HERE

Self-care comes in many forms, and it looks different for each of us. There is no right or wrong way to self-care. If you are feeling like self-care feels overwhelming, especially in a time of tragedy, that is totally normal and ok. I would like to encourage you to remember to take it one step at a time. One small decision to self-care will add up over time. Maybe that looks like putting your phone down for 10 minutes or going for a small walk to get the mail or taking 30 seconds to practice deep breathing. Any forward movement, no matter how small, is better than no forward movement. Be kind to yourself, be kind to others, and reach out to a trusted therapist if you need extra support on your journey. 


The Giftcurse of Grief

Fall is often associated with grief. Celtic tradition has built rituals around the recognition that the veil is thinner this time of year. There is a cultural multiple-discovery of rituals during this specific season, one chosen to honor the dead and ancestors’ past, as well as to pay homage to grief itself. The Aztecs had a ritual that pre-dated and inspired Mexico’s Día de los Muertos, and the holiday continues to include Catholic influence around All Saints Day. Celts had Samhain, the Romans, Feralia; South Koreans celebrate in September during Paju. The Hungry Ghost Festival occurs a bit earlier in China, in August. 

This varied, yet overlapping ritual space that both honors and mourns is generally aligned during a time of the season where leaves die, fall, and reintegrate back into the earth’s biosphere. This fall, of 2021, grief seems particularly potent, with many of us either deeply exhaling, or holding our breath, after a long 20 months of pandemic living of varying scales. Many have experienced losses of magnitude and cadence that are out of the ordinary for this last eon. Grief has been experienced in both direct and indirect ways, as shared worry, depression, anxiety, insomnia, even studied as collective shifts in dreamlife.

It is this time of year where clients cite dreams that feel vibrant and potent, some report wanting to sleep more (daylight savings weirdness does not help this, does it?) And seasonally, grief seems more at the surface than in other months. Grief is often described by those experiencing it as a fog, a film, a visible haze that separates or delineates. CS Lewis defined grief as “a sort of invisible blanket between the world and me” after the death of his wife. Somatically, grief can show up in the head, gut, and chest. Grief can physically feel heavy. This is even noted in our idiomatic expressions of the blues, depression, sadness, loss. I feel down, it reduced me to tears, I have a lump in my throat, I am holding my breath. Unprocessed grief can compound and show up as a malaise, a depression, at times it can mirror PTSD symptomology. The DSM 5-TR has created a new diagnostic path for prolonged grief (Prolonged Grief Disorder) to give credence to the impacts an elongated, or multiple-event grief process, has on the brain and body, including sleep disturbance, substance use, and immune functioning. This addition is timely, and necessary, to witness the incredibly demanding time in which we are living.

James Hollis has described grief, or one of the giftcurses of it, as a “mythological disorientation.” At times when we encounter a loss, an earthquake in our senses of selves, the narratives we have built or lived under without question can be aptly rocked by grief and its preceding events. A false self, born under the desires of the family of origin, untapped unconscious material, or just the waves of societal norming might now be proven as outmoded based on what the more concrete situation of grief has unveiled. Therein lies the opportunity. Rather than attach yourself to the other common idiomatic mechanism we humans tend to pursue with grief: get over it; this invitation is instead to sit in it, move through it, let yourself be rocked, create some room for the ferns that grow from the char.

Here are some meditations and considerations on how you might sit with, experience, honor, express, or otherwise cool down from grief:

Stay With It

I adore Tara Brach and have gotten the chance to experience her silent meditation retreats. I often use one of my favorite tools of hers, RAIN, with clients and with myself- here is a 20-minute meditation that features this tool.

Breathe With and Through It

Try alternating nostril breathing (hold left nostril closed, inhale through the right; clamp right nostril and exhale through the left; switch/repeat) which can calm the mind and reduce stress.

Or box breathing which activates the parasympathetic nervous system – exhale for 4 seconds, pause at the bottom for 4 seconds holding your lungs empty, inhaling for 4 seconds, pause at the top, holding the air in your lungs before repeating the pattern.

Create a Ritual Space

Take a page from the aforementioned ritual book and create a space for offering. This could be a section of a table, a shelf, truly anywhere you’d like to place objects, visual reminders, remnants, and notes to a person, a pet, a part of self, a season in your life that has passed.

Open Your Chest

When we are cold we tend to turn inward, when we are grief-stricken we do the same. Doing chest- and heart-opening stretches and poses can help regulate breathing and offer a somatic pull of energy into a space we may be unconsciously holding or tightening.

Stimulate the Vagus Nerve

If you work with me you know I am obsessed with this wild gut-to-brain neural circuit. Here’s a video from the @the.holistic.psychologist demonstrating just one vagal stimulation pressure point.

Cool Off From It

Distraction can be a defense, but it can also be a great tool when grief turns to overwhelm. Get grounded and go for a walk, listen to a favorite album, draw, paint, dance the feeling out of your body.


Dementia: An Introduction

Have you been, or has your loved one been, diagnosed with dementia? Do you dread the journey that lies ahead? Here are a few facts and resources to help you face this difficult challenge.

Do not be afraid

Almost all of us who are over 50 fear that we will get dementia someday. But not many of us will actually get it. Among people who are over 65 years old, fewer than one out of 12 people (less than 8%) have dementia. Many centenarians (people over 100 years old) do not have dementia (source: The Merck Manual of Health and Aging, p. 307).  Dementia is very different from normal aging. 

What does normal aging look like? Each year, starting at age 25, our brains lose 1% of their processing speed. By age 50, we notice this, with chagrin. We also do not retrieve remembered information as quickly. Imagine how many names you learned before you were 20. Now imagine how many names you learned by age 50. When we are over 50, our “file cabinet” of names has a lot more items in it. No wonder it takes a little while to sift through that large volume of information to find the correct name when we see a familiar face, or hear a familiar voice. These are among the challenges of normal aging.

But remember that normal aging also has many advantages. At age 56, I value highly my life experiences. I would not trade in that hard-earned wisdom for the speed and agility that my brain had when it was young. As a grad student in my 50s, I was fascinated by classes about human behavior. Each concept that my professors presented was something that I could mentally illustrate with my observations of people whom I have known. 

Recall from history and literature that most cultures around the world, in most periods of history, have revered elderly persons as sources of wisdom and keepers of highly-valued traditions. Our culture might be in a minority in that it tends to glorify youth, and dismiss old age.

Get the facts

If you think that you or a loved one is experiencing some memory loss—not just normal aging—I encourage you to get the facts. As in many areas of life, even unpleasant facts are better than out-of-control fears. A good person to ask is your family doctor. He or she, or a member of the clinical staff, is likely to administer a standardized assessment at some point. There are several questionnaires for assessing memory loss that are well-researched, reliable (consistent) and valid (meaningful). These mental-status questionnaires take into account the person’s age and educational level, both of which can affect his or her scores. The questionnaires look not only at short-term memory, but also at the person’s ability to complete several different mental tasks. 

If you or your loved one scores below average for their age and educational level, that does not necessarily indicate dementia. There are several medical conditions that can mimic memory loss—but unlike memory loss, they are entirely reversible. During grad school, I interned in a medical clinic that primarily served older adults. Among my happiest moments were the times that I administered a mental-status questionnaire and found a normal result in a person whose result had previously been below average. These persons’ mental status returned to normal once they were treated for ordinary medical conditions such as urinary tract infection, vitamin B-12 deficiency, or depression. 

Safety first

If your doctor determines, after carefully eliminating all other possibilities, that you or your loved one has dementia, what comes next? Safety! You and your loved one need to think about safety, focusing on 5 areas of possible risk, namely:

  1. Driving. Is it still safe for your loved one to drive? If not, ask your doctor for help in having this difficult conversation with your loved one. What alternatives are available in your community (e.g. special public transportation services for handicapped persons, rural transportation that is sometimes covered by Medicaid, ridesharing services such as Lyft or Uber, and organizations of volunteers who serve elderly persons)? 
  2. Cooking. Sometimes persons with dementia forget to turn off burners on the stove, thereby causing fires. If needed, how can you protect against this?
  3. Medications. Sometimes persons with dementia skip doses or double-up doses of their medicines. Depending on the medicine, this can be dangerous. A first step in medication safety is to buy a pill container with a compartment for each day of the week and each time of day. Fill this pill container for your loved one each week, and check that the medicines have been consumed. Later, if the dementia progresses, you may need to hand medicines to your loved one, and watch him or her take them.
  4. Wandering. Sometimes persons with dementia get lost when they go out on walks. Even frail persons can walk surprisingly far. They may be searching with great determination for a place that they cannot find. Sometimes a person with dementia is searching for a place that no longer exists, such as a childhood home. Caring neighbors can be made aware of your loved one’s tendency to wander, so that they can gently redirect your loved one back home.
  5. Bills and taxes. Persons with dementia can inadvertently cause major financial problems by failing to pay bills or taxes, or by spending imprudently. If your loved one has been diagnosed with dementia, consider helping them find a financial services firm that can regularly pay their bills and taxes. Alternatively, try to persuade your loved one to sign a power of attorney that allows a responsible person to handle their finances for them when the need arises. 

A brain disease

Sometimes well-intentioned family members urge a loved one with dementia to try harder to remember information, or to practice skills. Unfortunately, the person with dementia cannot reduce the symptoms by trying harder. Urging them to try harder is based on a misunderstanding of the nature of dementia. Our common experience is the raising of children, who constantly learn new information and gain new skills. It is very hard for us to accept that in a person with dementia, the process goes in reverse—no matter how hard they try, and no matter how hard we try. 

Remind yourself frequently that dementia is a brain disease characterized by biological changes in the brain. Throughout the course of dementia, brain tissue is actually lost. The brain of a healthy, adult human weighs about 3 pounds. The brain of a person with end-stage dementia weighs only 1 pound. Recalling this fact can help a caregiver to be compassionate, patient, and understanding with their loved one who has dementia. Assume that at each stage of the disease, they are doing the best they can with the reduced amount of brain tissue that is left. 

An umbrella term

Dementia is an umbrella term that includes over 100 separate illnesses. Alzheimer’s is the most common form, accounting for over 60% of cases. The second most common form is Lewy Body Dementia, which has a distinctive pattern of symptoms. The third most common form is Vascular Dementia, which can result from strokes—either a major stroke, or a series of minor ones. 

Some helpful books

Here are my favorite books about dementia, with a brief description of each. 

The 36-hour day:  A family guide to caring for people who have Alzheimer Disease, related dementias, and memory loss, by N. L. Mace & P. V. Rabins. This is the classic, comprehensive guide to caring for a loved one with dementia. It can be used as a reference book: check the index for the topic you need, and read a few pages about it. 

Dementia caregiver guide: Teepa Snow’s Positive Approach to Care techniques for caregiving, Alzheimer’s, and other forms of dementia, by T. Snow. This book describes simply and briefly what life is like for a person who has dementia, at each stage of the disease; and gives practical instructions on how you as a caregiver can help the person. 

Alzheimer’s: A Broken Brain, by Dementia Education and Training Program, Tuscaloosa, Alabama. Available from the University of Alabama. Trigger warning: Do not look at this booklet if medical images bother you. This short booklet demonstrates in an unforgettable way that dementia is a brain disease. The booklet states 10 key facts about dementia, one sentence each. Each fact is illustrated with photos of 2 autopsied brains: the brain of someone who died from dementia, contrasted with the brain of someone who died of another cause. The difference between the brain images is dramatic. 

The whisper of the fallen oak: A family’s guide to early, middle, late, and end-stage dementia, by R. Wallace. Available from Wings of Change Publications. This booklet is a short, simple guide to the stages of dementia, and how to care for the person at each stage. 

Caregivers find meaning and purpose

Although caring for a person with dementia can be difficult and exhausting, it can also be extremely fulfilling. In 2016, researchers Cheng, Mak, Lau, Ng and Lam studied 57 caregivers of Alzheimer’s patients. The researchers identified ten positive themes that the caregivers reported, including “a sense of purpose and commitment to the caregiving role… increased patience and tolerance… cultivating positive meanings and humor… developing a closer relationship with the care recipient… and… feeling useful helping other caregivers.”

Key takeaway

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do.

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do. His or her value as a person is intrinsic, and does not depend on cognitive ability. In order to relate to your loved one, you may need to learn new skills. These skills are worth learning, because the person is worth relating to. If you make the effort to relate to a person with dementia, you will be rewarded in unexpected ways. 

[I wish to thank Laura A. Ellis, LMSW, James W. Ellor, Ph.D., D.Min., LCSW, Dennis R. Myers, Ph.D., LCSW, and Teepa Snow, MS, OTR/L, FAOTA, for teaching me the above material.] 

Written by: Catherine C. Stansbury, LMSW, supervised by Melissa L. Gould, LCSW-S. Catherine is a therapist here at Austin Family Counseling. She is an EMDR Trained Therapist specializing in trauma therapy for adults. She has a Master of Social Work from Baylor University. She is a Certified Practitioner of the MBTI, trained by The Myers & Briggs Foundation; a PAC Certified Independent Consultant, trained by the Positive Approach to Care organization; an associate member of the Aging Life Care Association; and an associate member of the EMDR International Association (EMDRIA).


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