A Guide to Help Youth with Grief

Sixteen-year-old Gaurav and Seventeen-year-olds Joshua and Tanish squeezed into the back seat of the tiny compact car. Madhav climbed into the front seat, and Mahesh who celebrated his eighteenth birth in beginning of the year, had obtained his driver's license two weeks earlier, slid behind the steering wheel.

The quintet of teammates headed to a surprise birthday party for a friend. Mahesh steered the car out of the little town where they live and onto the national highway heading west. The road soon turned northwest, and the car topped 120 km/hour. Suddenly, the right tires went off the side of the road onto the uneven divider; Mahesh swung the steering wheel sharply to the left. The car immediately went into a slide that carried it across the road, where it slammed into a utility pole and rolled over on its top, crumpling the roof.

At some point, the boys in front were thrown free of the car and received relatively minor injuries. Tanish, Joshua and Gaurav, who had been pushed tightly against the rear of the car as it spun off the road, were crushed as the roof crumpled beneath the weight of the car, all three died before help arrived.

The school and the community reeled from the news. The three victims were well liked students. Their family were highly involved in school and community events. Their friends, classmates, teachers, coaches sobbed in each other's arms in school hallways on the Monday morning following the accident. Some walked the halls in a daze. Others became physically sick.

The school administration arranged for counselors to be present all-day Monday and Tuesday, and students were not required to go to classes; they were permitted to linger in the cafeteria, talking to counselors and friends, for as long as they needed. The school's compassionate response was appreciated by the friends and families of the boys, but the grief felt by so many was nonetheless overwhelming.

"We're a very tight-knit community," the high school principal told the local newspaper, "And it's going to take us all a very long time to completely heal."

Problem of Grief

Death touches many teens and preteens. Many experience the death of a grandparent, Some lose a parent to cancer or other disease. Some must deal with the loss of a sibling. Others endure the death of a friend, an acquaintance from school, or a teacher.

The grief that attends the death of a friend or loved one is always difficult, but it can present a special challenge in youth. In the midst of a time of life that is characterized by turmoil and crisis - hormonal, psychological, emotional, spiritual, relational - teens are especially vulnerable to the psychological impact of loss.

Psychologist Gary R. Collins discusses grief in this way:

Grief is an important, normal response to the loss of any significant object or person.

It is an experience of deprivation and anxiety which can show itself physically, emotionally, cognitively, socially and spiritually. Any loss can bring about grief: separation, divorce, retirement from job, amputations, death of pet, departure of a child to college, moving from a friendly neighborhood, selling one's car, losing a home or valued object, loss of contest or athletic game, health failures, and even loss of confidence or enthusiasm. Doubts, the loss of one's faith, the wanning of one's spiritual vitality, or the inability to find meaning in life can all produce a sadness and emptiness which indicate grief. Indeed, whenever a part of life is removed there is grief.

Most discussion of grief, however, concern losses which come when a loved one or other meaningful person has died. Death, of course, happens to everyone and the mourners are left to grieve. Such grieving is never easy.... Most religions take comfort in the certainty of after life, but this does not soften the emptiness and pain of being forced to let go of someone we love. When we experience loss by death grievers are faced with an absolute, unalterable, irreversible, situation; there is nothing they can do to, for or about that relationship.

Grief can be devastating, but it is sometimes more so for a young person, due to the reactions of others and to their own age relative immaturity.

Authors Joan Sturkie and Siang-Yang Tan point out the dilemma facing many grieving youth: Often adults forget to consider that a young person is hurting.... Somehow, adults seem to think that young people do not feel the pain much. Of course, this is not true. Unfortunately, to compound the pain, young people often do not have someone who will listen to them talk about how they are felling. If a father dies in the family, the mother is comforted with many adults who want to help, to listen, to be there for her. But oftentimes the son or the daughter is overlooked, especially if he or she has not reached adulthood.

Young people who are confronted with the death of a friend or loved one face the difficult task of coping with a somewhat "adult" problem while they are still struggling toward adulthood. Though the experience if grief is a natural part of life that every person must deal with at one time or another, the adolescent or preadolescent may be experiencing grief for the first time - using emotional and spiritual resources that may yet be immature and coping mechanisms that may be sorely underdeveloped.

In general, counseling professionals agree that, while grief is natural, understandable and necessary, it is not always healthy. Normal grief, which can be quite severe, often involves "intense sorrow, pain, loneliness, anger, depression, physical symptoms and changes in interpersonal relations, all of which comprise a period of deprivation and transition- that may last for as long as three years - or more."

Normal grief, while sometimes extremely painful - even explosive - runs along fairly predictable lines and leads eventually to restored mental and emotional well-being.

The widely acclaimed work of Elizabeth Kubler-Ross has chronicled the five stages of grief, as Sturkie and Tan explains:

1. Denial - The person may refuse to believe that [the death has occurred.] This stage may vary in length, with some people staying in it longer than others. It is a temporary stage, but surface again at any time.
2. Anger - The [youth] may question why the death occurred. When the answer is not apparent, he or she lash out anger at the seeming unfairness of it all.
3. Bargaining - This is usually an attempt to postpone [an imminent] death [or "cut a deal" that will lessen the pain of grief or the reality of the separation]... The bargaining is done in secrecy, with God.
4. Depression - When the... person faces the reality of .... [the] death, depression often sets in....
5. Acceptance - When the... person works through the feelings and conflicts that have arisen, he or she may now be ready to accept the fact [of the] death.

But the pathological grief typically differs from normal grief in its depth, duration, and destination

The pathological grief typically differs from normal grief in its depth (symptoms of grief are much more intense), duration (the grief endures far longer), and destination (it does not lead to mental and emotional health but to further psychological problems). Psychiatrist V.D. Volkan and D. Josephthal points out three key processes that underlie pathological grief:

• Splitting is a process by which a "teenager gives intellectual assent to the death while responding emotionally and behaviorally as if nothing has happened," a process which allows the youth to avoid the mourning process.
• Internalization is the process by which the mourner seeks "to preserve [his or her] relationship with the deceased by taking in the lost person and focusing on his or her internal presence," a process which denies the reality and finality of the death.
• Externalization is the process by which the grieving person fixates on an object that is associated with the deceased, such as a photograph or piece of clothing, which serves to postpone the need to admit and cope with the loss.

Collins points out that several things tend to contribute to grieving that is pathological:

1. Beliefs (the absence of religious beliefs)
2. Background and personality ("People who are insecure, dependent, unable to control or express feelings and prone to depression often have more difficulty handling their grief.")
3. Social environment (Social attitude toward death that encourage the denial or quick dispatch of grief - whether communicated by family, region, ethnic tradition, or society in general - can greatly influence mourners' ability to cope with grief.
4. Circumstances accompanying the death (An untimely death, a tragic mode of death, the closeness of the survivor to the deceased, and other circumstances may intensify the grieving process and incite a pathological response.)

Causes and Effects of Grief

As a young person (or any person) works through the stages of grief, he or she is likely to encounter a widely varying array of emotions and other effects of the process. The effects of grief to be discussed here are not confined grief that arise from death; many will be experienced whenever loss of any kind occurs (the loss of a romantic relationship, for example). These effects can be intense, but they are nonetheless normal and usually healthy.

Physical Effects

The physical symptoms of grief described by Erich Lindemann (author of a landmark series of interviews, books, and articles on grief) are related by Dr. G. Keith Olson as follows:

• Laborious respiration marked by sighing and tightness in the throat
• Feelings of physical exhaustion and lack of physical strength and endurance
• Digestive symptoms, including altered sense of taste, loss of appetite, insufficient salivary production and hollow feeling in the stomach.

Other physical symptoms are likely to include sleeplessness (or sleeping too much more than usual), headaches, and uncontrollable and often unexpectable weeping.

Emotional Effects

Fear.

Fear and anxiety are common reactions during the grieving process.

Add Olson, "Anxieties about the future without the deceased reflect the person's dependency and insecurity. Fears about one's own mortality must also be confronted during the bereavement period." The young person may also fear the changes that may result from his or her changing roles: the male teen who must now be "the man in the family," the younger sibling who now the oldest in the family, etc.

Guilt.

Olson writes, "Many bereaved individuals experience a deep sense of guilt. Some feel guilty about past experiences or lack of contact with the deceased... Others feel guilty for not being able to prevent the death." Such guilt reactions, say Olson, "represent an attempt to again feel in control of life after it has dealt such a painful and shaking blow."

Helplessness.

One of the most unacceptable feelings for an adolescent is to feel helpless.

Death is irreversible, mourners often become keenly aware of their powerlessness to prevent or reverse it, and Olson points out that "one of the most unacceptable feelings for an adolescent is to feel helpless. To fight against this threatening feeling, the teenager often tries to take as sense of responsibility for what has happened. In this way, guilt is often selected over helplessness."

Anger.

Anger is a normal and frequent reaction to the loss of a friend or loved one. It may be directed at the deceased for dying, for "deserting" the youth. It may be directed at others - particularly adults - who didn't do enough to prevent the death. It may be directed towards God for allowing such a painful thing to happen.

Loneliness.

A deep feeling of having been abandoned leads to an intense sense of loneliness

Adds Olson, "To be alone by choice is one thing. To be forced by external event.... is quite another. The latter is much more conducive to lonely feelings. While some adolescents react to grief with anger, others withdraw into themselves. Karl Menninger asserts that teenagers who withdraw and become more isolated are in worse condition than those who act out their anger aggressively."

Doubt.

A common reaction to death is to ask, "Why?"

It is natural at such times to seek some explanation, some understanding of the possible reasons for our loss. Usually, however, a satisfying answer is elusive, even impossible. Such lack of answers may prompt doubt; a person may doubt God's love, God's wisdom - even His very existence. As real as the questions - and the doubt - may be, most grieving people are helped less by faith and intellectual explanations than by the sensitive comfort and consolation of others.

Relief.

When death comes after a period of disability or illness, the mourner often reacts with a sense of relief; the agony of waiting is over. Relief may also be experienced when the deceased was abusive, hostile, or controlling; the agony of the relationship is over. Such feelings of relief are quite normal in some circumstance, but they may lead to or heighten guilt feelings as well.

These emotional and physical effects are not, of course, the only effect that accompany and characterize grief, but they are perhaps the most prevalent and profound.

Response to the Problem of Grief

Grief is a painful and difficult experience for the most mature among us; it can be unimaginably more so for an adolescent or preadolescent. The following measures, however, may help a parent, teacher, or other concerned adult to counsel a grieving teen. The concerned adult who is not a parent should, of course, inform and involve the parents in helping a youth through grief.

LISTEN.

Grieving youths will not be looking for - and will not be helped by - "convenient, glib answers to ease every question from [their] aching hearts." What they want, and what they need, is someone who is willing to walk through the process of grief with them, always present, seldom talking, always listening. Gary D. Bennett offers wise guidance:

Encourage crying as a legitimate way to show. . . feelings, not as a sign of weakness. Statements such as "Hold your chin up" or "Be brave" should be avoided. It is better to remain quiet and supportive than to say anything that will interfere with the grief process.

Though Joshua's friends have been widely criticized and may have been more hindrance than help, it is worth remembering that when they heard of the deaths of their son, the family sat down with his parents for seven days and seven nights. No one said a word to his parents, because they saw how great their suffering was.

EMPATHIZE.

The parent or youth worker who hopes to help a teen through the grieving process should examine his or her past experiences with - and responses to - death. Is the adult conscious of his or her own finiteness? Olson says that

Empathic understanding, one of the most healing dynamics in any counseling relationship, is particularly important when counseling with the bereaved...

and empathic expression of understanding, caring and support have significant healing impact. Sharing sorrow and sensitively offering comfort are among the simplest and most effective help anyone can offer in times of grief.

AFFIRM.

An essential ingredient in successful grief counseling is an open acceptance of the feelings, thoughts, and emotional releases expressed by the teen

Olson adds, Many are shocked by the intense rage and fathomless anguish that pours forth from the grieving. . . . The counseling environment needs to be warm and supportive. . . . Teenagers do not need to be invaded or suffocated by loving care, but they need to be surrounded by it.

Pray is one key way of providing affirmation and comfort to grieving youth. Pray for him or her; let the youth hear you pray for him or her; let your concern and esteem reach the youth by letting him or her listen as you pour out your heart for that young person in prayer.

DIRECT.

Most of the help a parent, teacher, or other adult can offer a grieving young person will be to listen, empathize and affirm. However, some helpful directive measures include:

• Help the young person to face his or her loss. This can be done by encouraging him or her to talk about the loss, perhaps by asking:

How did it happen?

Where were you when you heard?

Where did it occur?

Who told you about it?

(If the loss was a death) What was the last rite like?

Help the young person identify and express his or her feelings. Typically, feelings associated with a loss include anger, guilt, anxiety, and frustration. Keep in mind that most people will not identify and express their feelings when asked directly. Instead, seek to facilitate expression of feelings by responding to youth: "I can see how that might make you angry," or "You really feel strongly about that, don't you?

• Help the youth turn to God of all comfort. Encourage dependence on Him and His limitless resources. Do not preach to or push the young person, but gently remind him or her that God is a refuge and strength, an ever-present help in trouble."
• Help the youth learn to live with the loss. Guide the conversation through the difficulties the young person faces now as a result of the loss and walk him or her through various problem-solving approaches (role-playing, playing "what if," listing pros and cons, etc.). Try to steer his or her attention away from the past (the loss itself) and toward the future (What is to be done now?).
• Allow the youth time to grieve. Grieving takes time. Be prepared for most difficult times in the process: the first three months after the loss, the first anniversary of the loss (in cases of death) and holidays and special days.
• Help the youth examine and admit inappropriate responses to the loss such as withdrawal or resorting to alcohol and drug use as a coping mechanism. Guide him or her to consider appropriate coping devices in place of such things.
• Provide ongoing support to the young person. Help with the many adjustments that follow a loss: changes in relationships, schedules, etc.

ENLIST.

As suggested above, one way to help the grieving youth might be to elicit his or her response to the question, "How are you going to deal with this. . .?" The concerned adult may help facilitate healthy grieving by enlisting the young person's participation in such decisions as, Will he or she attend or participate in the last rites? and can he or she help others who are grieving (a spouse, family member, or friend of the deceased)? Such activities can be extremely freeing in working through grief.

REFER.

While parents and other caring adults must be involved in helping a young person cope with grief, other resources are often necessary. Olson advises:

Because adolescence is a life stage that is so marked with turmoil and transition, whenever a teenager loses a loved relative or close friend, counseling is advised. Symptoms may or may not be present. Remember, however, that symptom severity is not always a valid indication of the need for counseling intervention. In just a few sessions a counselor can assist bereaved teenagers through grief process. The counselor can plan a crucial role by listening, supporting, and empathically caring as the adolescent mourner readjusts and adapts to a future without the presence of the deceased.

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Bijo Joseph?is the founder of Bijoyful Foundation, a faith-based NGO (reg. 357152/sec. 8 co.) that aims to deliver positive changes in the lives of young people troubled with adverse mental health, addiction or other life challenges through range of strength-based, recovery and livelihood programs and support offered by counsellors, social workers and volunteers. He has the youth leadership experience of 17 years and with educational foundation from TISS, Mumbai & IIM Calcutta.