Grief in the 21st Century: Saying Goodbye by Okun & Nowinski

In an earlier post, I described how author Nina Sankovitch chose to read her way through grief by reading a book a day for one year. I turn to books for help in many areas of life, including books on death, dying, grief and grief recovery, etc. Here's one worth sharing.

Saying Goodbye: How Families Can Find Renewal Through Loss

by Barbara Okun, Ph.D. and Joseph Nowinski, Ph.D.

Hardcover, 313 pages. Berkley Books, NY. 2011

I learned of the book on my favorite radio interview program, THINK, hosted by Krys Boyd of KERA Radio in Dallas, TX. She interviewed Dr. Okun, who made some insightful comments on grief during the program.

Key Insights

She said two things that are particularly valuable to anyone coping with loss:

Grief is chronic.

Grief is not pathological.

Okun has the credentials and experience to back up those statements, being a professor of counseling at Northeastern University and a clinical instructor at Harvard Medical School, as well as having her own counseling practice for 30 years.  Her insights help explain why I started this blog. Once grief comes, it stays. It can become easier on us, change its shape and weight, diminish and lighten, but it does not evaporate, or disappear on a deadline.  

This doesn't mean that we won't or can't experience great happiness and joy after a loss. Life will bring us this, yes, but more and more we find that life is a both-and proposition.  Joy helps restore balance in our lives, without necessarily erasing grief or sadness.  And, fortunately, grief, no matter how deep, is not capable of destroying our capacity for joy. 

But is grief chronic? It does not have to be, may not always be, but it certainly can be.  Is it pathological? Is it a "disease?"  Not in and of itself.  This last point is important to remember, because sometimes grief can knock us down so hard that it does indeed feel like a disease that has invaded our every cell.

So, keep those two insights in mind as you progress in your journey .... now, to the book.

What you can gain from reading this book:

Saying Goodbye is especially helpful to people and families who have a family member who has a terminal illness. It gives specific, compassionate, intelligent advice on how we can use the event of the illness to prepare for a final departure, and it provides concrete examples of how to live through complicated family communications, duties, and conflicts that can arise during this time. Case studies of families with whom Okun and Nowinski have worked are frequent throughout the book. The book is also very easy to read and written in an accessible style.

New Model: Stages of Family Grief

Elisbeth Kübler-Ross

In 1969, Elisabeth Kübler-Ross broke new ground in her book On Death and Dying when she described  five stages a person diagnosed with a terminal illness goes through: 

1) Denial   2) Anger   3) Bargaining   4) Depression  5) Acceptance.  

(As with any "model," there are always exceptions. I have known people who did not experience all of these stages as they faced the end of their lives due to illness. However, Kübler-Ross's recognition of these stages was and still is one of the most important insights delivered on this subject.)

Okun and Nowinski rightly point out that medical treatment and technologies have advanced and changed so much since the publication of On Death and Dying, that people with terminal illnesses may live quite some time before they die. Hence, they have modeled another set of stages that reflect this 21st Century situation. According to Okun and Nowinski, after the diagnosis of a terminal illness, the stages the patient and family go through are: 

1) Crisis, 2) Unity, 3) Upheaval, 4) Resolution, 5) Renewal.

Authors Okun & Nowinski

The authors do a very good job of taking the reader through these stages, providing sound advice and ideas for living through them all, with meaning, grace, and positivism.

Who should read this book:  If you have a family member with a terminal illness or have yourself been diagnosed with one, this book can be EXTREMELY helpful for you.  If you have recently lost a loved one, the book will be less helpful to you in terms of specific advice for your current situation, but can provide valuable insight into what you have just lived through. 

Criticisms:  Just one: This book needs an index! I hope a second edition will include that.

The Second Year: Different, Not Necessarily "Better"

Lily Pincus wrote: "Regression in grief must be seen and supported as a means toward adaptation and health." Pincus was the author of Death and the Family, a book I own, but have not yet read. I found this quote in Silver Linings: Words to Encourage New Beginnings, published by Darling & Company.

I've written in other postings about anniversaries of loved ones' deaths. Those can be hard in their own way. But, as I move into the second year of my sister's absence, I experience something I've felt in grieving other loved ones, as well.

The first year is hard. The second year is cold. In the second year, the person's absence takes on a solidity, as though it has gone from clay to rock ... maybe even is on its way to obsidian. I find this stage especially hard and I find it helpful to read quotes like the one above from Pincus, because the second year can indeed feel more like regression than progress in the grieving process.

If you are past year one of grieving for a loved one and don't feel that the grieving is done, honor that feeling. The world around you will not acknowledge your second year as it does your first few months, but don't measure your progress by quick "wisdom" from our secular culture.  Keep taking and giving yourself time to honor and acknowledge the loss, in whatever way makes the most sense for you. Don't judge yourself on a recovery "scale" or schedule.  Just keep getting along with your grief.... and know that getting along is, in fact, no small accomplishment.