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Coping with Loss

by Andre S. Cuartas, Ph.D.

The holiday season is supposed to be full of joy, cheer, parties and family gatherings, but for many people, it is a time of self-evaluation, loneliness, reflection on past failures, and anxiety about an uncertain future. These feelings may be magnified in residents of our community who are still dealing with the stress and aftermath of Hurricane Katrina.

A Harvard University study, conducted earlier this year and funded in part by the U.S. National Institute of Public Health, interviewed 1,043 adults who live in the hurricane-affected areas (www.hurricanekatrina.med.harvard.edu). Their responses were compared with results of another survey conducted in 2001 and 2003, involving a separate sample of 826 adults in the same census areas of Alabama, Louisiana and Mississippi. Results showed that post-Katrina respondents were about twice as likely to have serious mental illness (11.3 vs. 6.1 percent) and mild to moderate mental illness (19.9 percent vs. 9.7 percent). An estimated one-third to one-half suffer from post-traumatic-stress disorder. Others exhibit symptoms of depression or generalized anxiety. One of the study’s collaborators, Ronald Kessler, notes that symptoms may actually become most pronounced now—18 months after the disaster. “After about 18 months, people start wearing out,” Kessler says. “It’s the psychological equivalent of a high-adrenaline phase. That’s the underbelly that we’re concerned about.”

Here, Mandeville’s Andre Cuartas, a psychotherapist who specializes in therapy for those suffering with depression, anxiety, trauma, substance abuse and grief issues, offers insight into dealing with loss in our lives and managing stress during difficult times.

Feeling loss means that there is something to be grieved, in much the same way that we grieve other losses in our lives, such as the death of a loved one or the termination of a friendship. It is important that individuals realize the need to grieve these changes, and give themselves permission to do so. Too often, people think it’s silly to express their sense that they are enduring a loss of some type, and thereby deny themselves the chance to face their emotions and go through a process of grief. Not grieving can ultimately lead to the continuation of negative emotions that they may or may not be aware of and that impact overall outlook, relationships, and often the healing process.

The Grief Process

The first aspect of loss to explore is the grief process itself. There are several stages in the grief process: denial, anger, bargaining, depression and acceptance. These stages can vary in length, and many people may repeat stages more than once. Initially following a loss, denying the reality of the situation is common. Individuals might make comments to themselves or others such as, “This just can’t be,” or “There is no way this could happen to me.” After denial is no longer a viable option, people move into the anger stage. They become angry with a variety of entities for various reasons, such as with God for allowing this to happen to them (or maybe even “doing” this to them), with themselves or with others. Once anger starts to dissipate, people move into the stage of bargaining. Usually, people bargain with God (or their higher power), promising to make some change in their lives in exchange for repairing their situation. Once they become aware that bargaining is not working and that they are actually going to have go through the process of dealing with the stressful situation, they might become depressed. Depression is often signaled by irritability, tearfulness, hopelessness, fatigue or physical agitation, changes in eating patterns and/or severe weight gain or loss, and a sense of sadness. If a person is to complete the entire grieving process, he or she will reach a state of acceptance about what is happening. This may be the stage that many people find themselves now in. However, reaching the acceptance stage does not mean that the grieving process is complete, as a person can go back and forth between stages for some time.

Flawed Thinking

A second concept to explore in dealing appropriately with loss is flawed thinking. As humans, we all engage in various types of flawed thinking that influence the way that we feel and how we act. Flawed thinking develops because we have a natural tendency to take mental shortcuts when we process information in order to keep our mental energy and resources as freed up as possible to process other information coming into our minds. We make shortcuts based on experiences with how things have happened in our lives and relationships as a result of a certain activating circumstances. In other words, we develop thought process and belief systems based on a few examples of how certain things affect our lives. There are a variety of types of flawed thinking, also known as “cognitive distortions” in the world of psychotherapy. The list is too extensive to present here, but the following are a few examples. Thinking known as “filtering” occurs when a person pays attention to only the negative details of a situation and filters out the positive details, thus creating an entirely negative perspective. Thinking identified as “shoulds” means that we have a list of iron-clad rules about how we and others should act. People who break these rules leave us feeling angry and resentful. “Polarized thinking” happens when people see events or thoughts as either all good or all bad, and don’t allow for middle ground. This short list demonstrates that by engaging in cognitive distortions we create emotional turmoil for ourselves and also affect our responses to certain situations. Because we all engage in these types of thinking from time to time, we are well advised to become aware of when we think irrationally, and how it impacts our feelings and behavior.

Stress Management

Thirdly is the idea of stress management. Because Western society is competitive, fast-paced and individualistic, we learn to live with stress as a part of our daily lives. One may find that stress is much more pronounced during the holiday season. Many of us handle an inordinate amount of stress without really even being aware that we are doing so. Unprocessed loss, especially when combined with upcoming holidays, increases our sense of being stressed out. While small amounts of stress can actually sharpen our minds and improve our performance and functioning, research has determined that prolonged amounts of stress can be responsible for the development of problematic symptoms and health conditions including depression, anxiety, lower self-esteem, problems with memory and concentration, ulcers, hypertension, strokes, allergies, drug abuse, intolerance of people, and cancer. Therefore, it is imperative for individuals to be aware of, monitor, and learn how to effectively manage stress. The first step to doing so is accurately assessing all sources of stress.

Sources of stress that should be considered include work and school issues, having few supportive relationships, unrealistic goals, problems setting boundaries or effectively communicating with others, failure to build in relaxation or self-care time and spending too much time lamenting about the past. Aside from the more obvious symptoms of stress such as mood problems and irritability, other more subtle signs include neglecting a proper diet, attempting to do everything without any help from others, neglecting exercise, making a big deal out of everything, having problems making decisions, and being easily angered. Some people find it helpful to listen to feedback from others about their behavior to be able to determine just how stressed they truly are; it is sometimes difficult to assess that for ourselves, especially when we are consumed with the minutiae of our own stress.

After the sources of stress are identified, the next step is to list them, grouping them according to those that we are able to alter or change and those that we have no control over. For the group that we are able to change, those items should then be ranked in terms of the things that we have more control over to those that we have diminishing amounts of control over. Then it is time to take each of these sources, starting with those over which you have the most control in making a change, and write two or three ways that each can be reasonably altered in a way that will reduce overall stress. Finally, with these new options laid out for each source of stress, pick a few from the group and start implementing them, being careful to implement those that will have the most impact with the least amount of effort.

Healthy Coping Skills

Another concept in processing loss and stress management is using healthy coping skills. Since our culture does not look like it is going to become less stressful anytime soon, we need preventative ways to avoid too much stress build-up in the first place. While everyone can probably identify such skills, few people implement them on a regular basis, usually because we are not in the habit of doing so and because we often convince ourselves that it is too much trouble. The truth is that such skills can be very easy to include in a daily routine, and once people are in the habit of using them, they become second nature. The following small list of coping skills can serve as a reminder about some things that you might find helpful: knowing your limitations and letting others know them too; anticipating your needs; writing things down that you need to remember; stretching; writing a note to a friend; practicing unconditional love once a week; being cheerful and optimistic; prioritizing; allowing yourself to be playful; and—smiling! Probably the most effective technique, and one that is getting a lot of attention in recent research for its psychological and health benefits, is laughter. Laughing, in spite of its simple role in our everyday lives, has a powerful effect on our overall health, the speed with which our bodies heal, and our mental health and ability to remain positive. Therapists often readily acknowledge the importance for clients to bring laughter into their daily experience. Laughing might very well be the single most important activity in dealing with stress and promoting health.

The “Superwoman/Superman” Mentality

In trying to manage stress, it is important to avoid the “superwoman/superman” mentality. According to this way of thinking, a woman will believe that she is capable of doing and, therefore should do, all things—and single-handedly manage all aspects of her life. This condition seems to be more accepted in our society as just a quality of a successful man; however, this does not mean the approach is any healthier. It is simply unreasonable, and a type of distorted thinking, to believe that any one person can manage everything in his or her life without occasional help. The superwoman mentality, and corresponding mentality for men, quickly causes a buildup of stress, and definitely needs to be avoided. Also, to underestimate the importance of talking to supportive people in our lives as a valuable stress management technique would be an egregious error. Sharing our difficulties with those who are able to listen and offer support is key in feeling connected with others, understood, and helping us maintain a healthy perspective. Finally, practicing visualizations of healing and stress reduction are very helpful. Research has consistently demonstrated the positive effects of visualization on psychological and physical health. Stress-reduction visualizations are powerful tools in maintaining a healthy level of stress.

Spirituality

Spirituality plays an important role in dealing with loss and managing stress. Spirituality is distinguished from religion in that the former is each person’s experience and expression of his or her connection with a higher power, while the latter is a formal set of rules and guidelines practiced in the same way by a group with the same belief systems. We experience our spirituality in our daily lives when we forgive someone after they have committed some error in our view, when we offer a patient and listening ear to a friend, when we help someone in need, when we pray, when we engage in activities that represent an expression of ourselves or thoughts (art, dance, exercise) and when we spend quiet time connecting with ourselves, to list but a few examples. Spirituality helps us to make meaning of a painful experience. Some people say that the hurricane was a life-changing experience, a wake-up call of sorts, that brought to light “the things that are really important” in life. Some people forgive others for things when they were never willing to do so before. In any case, spirituality is the background from which meaning can emerge in a crisis. It is often the mechanism through which people are able to remain strong when they otherwise might feel extremely drained.

Creation of a New Ideal

The culmination of dealing with loss in an emotionally healthy manner is the creation of a new ideal for one’s self. This new ideal is based on the realization that the “old you” has permanently been altered (some even say “lost”), the acceptance that change is inevitable (both physical and emotional), and looking to create a “new” person who is both different and improved. The ideal represents someone better than the “older” version, someone who thrives because of going through the stressful situation. Our minds are very powerful in dictating our outcomes, and seeing ourselves in the form in which we want to be creates the path to help us get there. We are very much like bridled horses—our lives go in the direction in which our heads are turned—giving a crucial role to the direction and form of our images and thoughts of ourselves. We become what we see ourselves becoming. Therefore, one of the most powerful tools in life rests with the power of our minds and our mental health.

In closing, the following advice from the front of an encouragement card called “Let Miracles Happen” encapsulates some of these concepts beautifully:

Spread joy. Paint a rainbow of happiness. Live fully. Gaze at the moon.
Invite pleasure. Accept tranquility.
Treasure golden moments.
Laugh out loud. Feel enough to cry.
Have fun. Share good news.
Start a conversation. Make the
first move. Mend a friendship.
Smile at a stranger. Make a new friend.
Realize the power of your love.
Share your happiness.
See your own beauty. Feel your own strength. Praise others. Praise yourself.
Let your spirit soar. Open your heart.
Fill it with love. Stay open to wonder.

SIdebar--Paul LeBlanc's story

Although not a doctor or therapist, Covington resident Susan LeBlanc could be considered an expert on dealing with loss. She has spent nearly four years coming to terms with the literal “loss” of her father. Paul A. LeBlanc went missing from his Covington home on February 2, 2003 and has never been found. You may recall the story: Mr. LeBlanc was 69 years old and had been suffering with Parkinson’s disease. Many days he battled to find mobility, but on that particular day, Susan remembers that her father seemed to be doing well, having taken his medication. “We had spent the morning out together with friends,” she says. “After I brought him home, I headed down to the Mandeville lakefront to get in my afternoon walk.” Susan thought her dad would go inside and rest for the afternoon, but he did not. Instead, he went for a bike ride and never returned. Susan was on the lakefront when she began receiving calls from family members wondering where he could be. “I had visions of him on the ground, stiff and rigid. I imagined him lost in the woods all alone.”

The Sheriff’s office and its Special Operations Division led a search for Susan’s father, and the U.S. Coast Guard conducted a helicopter search over the area where he disappeared. But not one clue ever surfaced—no body, clothing, jewelry, or even the bike. Susan spent years in anguish, frustrated with the media—and feeling that law enforcement had given on the case. “It seems only youth and sensationalism capture the media’s attention,” she says. “My dad was not young, female or ‘newsworthy.’”

Susan eventually realized that her father’s disappearance might never be resolved and that she had to find ways to come to terms with her loss. In 2005, she worked with a national agency called A Child is Missing to lobby the state legislature to approve a program that assists law enforcement in finding missing adults with various disabilities. “Unfortunately, Dad had to be a statistic that helped to enforce such a support system,” she says.

Susan also found healing in naming a memorial to her father. A park bench was installed on the Mandeville lakefront in September, at the corner of Lakeshore Drive and Coffee Street, bearing a message from Susan to her dad. “I must give thanks to the city for providing me a place to go to remember Dad,” Susan notes. “I really don’t think Mayor Eddie Price knows what it meant to give me something to hold on to.”