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Loss and Grief (Part 2)

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Anshu Bahanda: This is Anshu Bahanda on Wellness Curated. Thanks for joining me on this podcast. My mission is to empower you with health and wellness so that you can then go and empower others. 
Hi everyone. Thank you for being here with us today for part two of: Loss and Grief with Dr Ramesh Pattni. Hello, Ramesh bhai. How are you?

Dr Ramesh Pattni: Hello, how are you?

AB: Welcome to the chat again. I’m delighted you’re back today.

Dr. RP: Thank you so much.  Thank you for inviting me.

AB: Thank you. So, Ramesh bhai, I was reading about what happened with Prince Philip and they said that the Queen was preparing for it for a while because of health conditions. But the experience when it takes place is actually different.

Dr. RP: It is.

AB: So how did you deal with it when there is some sort of loss in your life?

Dr. RP: Yeah, so even when we think about loss and grief, we can observe other people grieving and losing. But when it comes to the experience itself, things are very different because then it becomes your own subjective experience. So, in terms of giving advice, if we think about two scenarios, one somebody who has not lost it just like you mentioned about Her Majesty The Queen— that she kind of may have thought, yes, it’s coming to an end and therefore somehow I need to prepare for it. So that is anticipatory grief. In other words, that’s the grief that’s going to come and you’re anticipating grief to come, but you need another scenario where somebody has actually lost somebody and then how do you actually advise them to deal with the grief? And some of these things we already kind of discussed in the first session, but we can think about the two scenarios.

So, the first session which we did, becomes the basis on which you can kind of talk about loss and grief to anybody and say, look, this is what I know about grief, this is how it happens. I know that your relative is in the hospice, is in a terminal condition and therefore you need to kind of start thinking about these things so that then provides a framework within which they can start thinking about it. It’s not necessarily that they’re going to respond to it when the death actually occurs, but at least they know that there is a process, there are stages that one has to go through. Now, suppose somebody has actually lost a person. So, for them, first of all, just tell them, put aside some time for thinking about the person you have lost. Don’t get caught up in everything, because then you’re kind of not only denying yourself, but maybe kind of refusing to think about it. So, you need to, first of all, take time and stay with yourself. Stay with the kind of person you have lost and the memories which are arising in your mind. Secondly, if you want to kind of advise them, build up a routine in your life. Build up a day-to-day plan and have a certain sense of control over your life. Because when you get lost in your life normally, you think oh my god, I didn’t have any control, I couldn’t do anything. And there is a kind of grief even about that. So, getting control of your life is another thing… to build up a routine. Number three, understand that other people’s reactions and comments are about them, they are not about you. So, when they talk to you about grief and talk about this person and that person and how this relation was,  those are the perspectives on yourself and the other person who has been lost. And it is not necessarily that you have to accept them. So, you kind of frame them within your own context.

Number four, look for support. Look for support wherever you can. So, whether it’s family, whether it’s friends, whatever it is, just try and look for support. And support means just talking to somebody and it could be a friend, it could be anybody who you are connected with. And the last thing I would say, don’t rush into judging yourself with negative emotion and say look, I could have done this, I could have done that, maybe this could have been prevented. That makes you judge and blame yourself which might make you feel guilty and ashamed.

AB: So, this framework you’re giving us is applicable for any loss? Not just a person. Is it even for the loss of a relationship or a job?

Dr. RP: Yes, because the principles are the same. Because loss is loss, and as I was saying, it can be symbolic loss or it can be a personal loss. You lose somebody because that person has died or you can have a symbolic loss like a relationship has come to an end, or a person is going through a divorce, and that intense feeling can be there as well. So, that is also another loss. But remember, [for] every loss there is grief. And there is a grieving process and therefore the same principles will probably apply. But you may need to kind of adjust your kind of wording in one way or the other.

AB: Okay. And these principles will help you deal with the grieving process?

Dr. RP: Yes, as long… the thing Anshu, is that first of all you have to intellectually understand. So, you have some framework within which you can process your grief. So, if you have that framework, then it is possible for you to start understanding grief in the first place and understanding loss. And we talked about that quite a lot in the first session. But basically, you [have] got a certain framework within which to think about it, to process your loss and grief, and then come to terms with it. But of course, one can go further and think about other things as well.

AB: So, can you give us some tools? Because at that point, sometimes the whole intellectual stuff just leaves our brain. Are there some tools that we can use every day without fail or twice a day which will help us not sink into deep, deep, deep grief? 

Dr. RP: Yes. So, it’s important to remember that there are tools and techniques available to deal with grief and loss. And some of these principles I already mentioned to you, but we can kind of think about it in a slightly different way. So, for example, sharing your feelings, very important. Now, how do you share feelings with others? It is to be open, to be honest, to be a trusting person. If you know this person is somebody you can talk to openly without being judged or anything, share your feelings with that person. That is number one. Number two is to think about keeping a journal. Write things down. If you can’t express to somebody, here’s another layer of dealing with loss and grief. Start writing things down because it is a mode of expression as well. So that’s number two. Number three is do something creative now at that point, depending on which stage of grief you are. But certainly if you begin, kind of take your mind away from the loss and the grief in a creative way of dealing with it. So, for example, you can paint or start drawing and making pictures and so on, or you can write poetry. You can write about the person you have lost, the relationship you have lost. and you start being creative about it because that involves another part of your brain which is not so locked up in terms of ruminating about the loss again and again and again. So, that is your right part of the brain, which is to do with creativity. So, it gives another kind of relief for the person who is there. That’s number three. Number four, as I said before, set aside time and space for yourself. So, it doesn’t mean that you isolate yourself completely, but it sounds as if, no, don’t leave somebody alone. But in a sense, that person needs to be on their own. So, imagine that if somebody has passed away, people are calling, people are sending messages, people are even coming to visit you. You need your own space and time. Because there is also time to kind of grieve about it and say, yes, I know this is a space I can use for myself. Number five, avoid making any big changes in your life at that time because you already had a big change in your life. If you lose somebody significant, you don’t want to start creating more changes. Just stay stable at that point. And therefore, that becomes another approach whereby you say to yourself, okay, I was thinking about this, that I don’t want to make any further changes. Then going on to number six. Physical exercise… very important. Even if you go out for a walk, 10-15 minutes, just go out for a walk, be with yourself and just you know, this kind of physical exercise itself has got, you know, its own value to calm the body, calm the mind. And this takes care of your emotional self as well. And sometimes you can have a punching bag…

AB: Oh right.

Dr. RP: You know, what the boxers use. And if you feel that anger coming into you, get a few pillows too.

AB: Pillows and bashing.

Dr. RP: Yes. Bash, bash, and bash. And that kind of gets rid of that kind of emotional energy which is there inside you. The next thing is participating as much as you can, as much as it’s appropriate for you— in social connection. See, the whole purpose of this is that you are not alone in the world. People are there to help you, and they will help you as much as you reach out to them. So, as much as you engage in some kind of social connection, even if it’s picking up the phone and talking to somebody, it can kind of bring you outside of yourself. You see what I mean when you connect with somebody else.

The last thing, Anshu, is that we know there’s a whole dimension of spirituality and religion. And there are so many techniques there. For example, prayer is there, mantra chanting is there. There is meditation, there is mindfulness. All these are such valuable techniques to be used when you are in this kind of loss and grief. So, here are eight different things which one can do to support anybody, and these are the tools which they can learn themselves and begin to employ them. And as I said, that long term resilience can be built up by these kinds of things as well. So, it’s worth keeping in mind that there are tools… There are tools which are practical tools which you can use and you can adopt them at once and then start using them as much as you want to.

AB: Okay. How can we support someone else when they’re going through loss of grief?

Dr. RP: Okay, so again, taking the same principles, because what I’m describing is how we can support people, support themselves through various tools and techniques. But of course, we can also help them to go through them, as it were. So that, for example, if somebody comes to you and says, Anshu, I’ve lost somebody, I would just like to come and speak to you, connect with you, and then you can support them by just being with them. 

So, let’s think about specifically how we can help people who are already grieving. Now, first of all, you yourself have to understand the grieving process. If you have got a good understanding about what is loss, what is grief, what is the connection between loss and grief, what are the five stages of grieving, what are the four tasks of grieving, etc. Now you have got a clear picture in your mind, so first of all, number one, understand loss and grief for yourself and you may have, of course, been through some [kind of] loss yourself. So, you can combine the experience with this knowledge which we are talking about just now. And it may involve so many kinds of intense reactions and responses and it’s important that not only do you understand grief, but avoid judging anybody and saying this person is grieving too much and he’s taking too long and so on and so on. Because if you understand the grieving process, you’re not going to push anybody to do anything which is beyond them, right?

Number two, know what to say when somebody is grieving. This is a skill of communication and you need to give the right message at the right time, with the right intensity of feeling, with the right approach, with the right attitude. You see what I mean? It is a communication skill so that when you are with somebody, you have to say the right thing in the right way. But even more important is the ability to listen. Listening is so important and by that I mean just very carefully listening to this person who is maybe even in silence. But to be with that person as a presence, as a reality with that person, with yourself can be a tremendous help to that person. And then when they start talking, listen very carefully because they are expressing some of their deepest kind of emotion and connection with the things that they have lost. So, listen very carefully and be present for them, presence means that you don’t have to kind of keep on talking or doing something or trying to ask them questions. No, just stay with them, be present with them. Just by your presence you are telling them I’m here and I’m here to support you. So, that’s number two. And then number three, coming back to practicalities. So, you can offer practical assistance. See, a person, for example, is living on their own, they’ve lost their husband and now they are kind of very enclosed in themselves and trying to manage the whole process. So, just kind of telling them I’m here to help you. Actually, there are ways of even putting that because you don’t want to kind of impose on them and say, look, tell me what you want me to do. You can put it in another way and say, look, I was just going out to the shops. Would you like me to kind of bring you something? Or is there anything I can help you with at this moment? And so on. So practical assistance, whether it is getting something physical for them or dropping children to the school or whatever it is, some kind of practical support. Number four is to remember that this grieving process can be long term. So, you don’t say to yourself, okay, this is a friend and I’ve done what I can, now it’s up to them. Be prepared to support over a long period of time because this is how we can help people who have experienced loss. And there may be family members, at a certain point people begin to say, okay, now I want to leave this person alone because I’ve done whatever I can.

AB: I’ve done whatever I can…

Dr. RP: Yes, but I think it requires long term support. You may not be talking to them every day, but once in a while you can say, okay, I’m here, what can I do? There’s something which… Let’s have a cup of tea together and we can talk about it. So, be prepared for that long term kind of support. Now, the important thing here, Anshu, is to watch out for warning signs of depression. If you want to help other people, watch out for these signs of depression.

AB: That’s what I was going to ask you about next, is when do you know you want to take someone for professional health?

Dr. RP: That’s right. So, this is it. And we can begin to see these signs and symptoms of somebody who is continuing into depression because they are not functioning well. They’re not able to look after themselves, they’re not able to look after family members. They become withdrawn, and they become anxious about various different things. And these are warning signs. And if we see these people grieving, it is going on and on, and they’re kind of slipping into a depressive mode all the time, then that’s the time to then ask for professional help. So, this is what the next thing is: when is the time to get professional help?

AB: So, I have to ask you something. All these things you’ve said that they’re not able to look after themselves, they’re not able to look after the family. They’re feeling anxious. So, a lot of people go through this for a certain period of time. When do you know that now is the time to try and help them professionally.

Dr. RP: Yes. So, when it becomes prolonged, when this kind of phase lasts a long time and those symptoms become more intense. So, for example, functioning in daily life, as I mentioned, they become less and less functioning so that they can’t even dress themselves. Those are signs of depression; excessive anger, excessive guilt and they are kind of screaming and shouting every day for many, many days. Neglecting their own self, you know, even personal hygiene. Some people kind of withdraw themselves so much that they can’t even get out of bed and they don’t change and they don’t even have a bath. And there is extreme focus on death or whatever the loss was, and inability to enjoy anything, withdrawing from everybody else. And one important thing is, there is a kind of rumination about suicidal thoughts.

AB: Oh goodness, okay.

Dr. RP: So, people then, if they’re getting to that point of extreme depression, they start having suicidal thoughts. Now that is the risk. Once you know that this person has started thinking about suicide, that becomes the risk. And even further, if they start planning, that is an extremely high-risk situation. If you’re helping somebody, you have to recognize, and it can be very tricky to even say to somebody, okay, I think you need to get some professional help. So, it has to be done sensitively. It has to be done sometimes in an indirect way. I’m recognizing that you’re not sleeping well at all. Would you like me to kind of put you in touch with somebody who can help you with sleeping? So that opens up the doorway. So again, dealing sensitively with people who are experiencing this kind of loss.

AB: Okay, so that was a lot again, but tell me something, what advice would you like to give?

Dr. RP: Okay, I’ve got some tips which I think would be very useful. Number one, face the loss. Don’t run away from it, don’t deny it, don’t try to cover it up. Face the loss. Accept the reality of the loss. That’s number one. Number two, give yourself time to grieve. Don’t rush into it, don’t do anything, just take time. But at the same time know that the tears are going to flow, they’re going to flow for a long time. And grieving openly is something which is expressive of your emotion without trying to restrict yourself and deny yourself that expression. So, number two, give yourself time and a space in which you can grieve. Acknowledge and share your feelings with others. This is what I was saying again as well, is that you need to kind of think about: let me share my feelings with others, because sharing is also halving your pressure, your stress, and there are other people who are there to support you and say, okay, unload it onto me, I’m here to help you. I’m here in this presence. Again, the same thing which I mentioned before. Number four, be gentle with yourself. Just be very gentle. Don’t blame yourself. Don’t beat yourself up, because people do that all the time. They beat themselves. I should have done, I should have done. But validate your feelings, acknowledge your feelings and be gentle with yourself and take care of yourself. That is also very important. As I mentioned before, number five, occupy yourself with some routine on a daily basis. You know that this is the time I need to get up. This is the time I need to have breakfast. This is the time I’m going to go out for a walk. This kind of routine and daily activities can be very helpful in supporting. Number six, don’t forget to ask and to look at all the positive things in your life. Sometimes when we get into such a negative mode of functioning, we forget to celebrate what we have and that we have kind of gone through an experience. So, whatever experience, positive experiences, keep them bringing to your mind, because that kind of diminishes the grief and the loss to a certain extent. So, remember, there are plenty of things we can celebrate and there are plenty of positive experiences we will have. Those are our friends as well. We can bring them into our mind and they will help us and they will support us.

AB: Yes, you’re right. There’s always something to be grateful for no matter what you’re going through.

Dr. RP: Yes, exactly. And reach out to others dealing with loss as well. See, you’re not alone. There are other people who experience loss and there’s somebody last month who might have experienced loss and this month you are experiencing. You know, reach out to them and kind of it becomes like a group which is sharing and caring. And sharing and caring can be a wonderful system of support as well. And then finally seek out support for yourself from any source… family, friends, connections, even if you have to get some professional help as well. And then the last thing, begin to accept your new reality, that acceptance is also very important. Say for example if somebody loses somebody, it’s a big empty space which is left in the elements. To accept that and to adjust to this new reality is also another process which then begins to take you into a new forward-looking space and you don’t have to push it, but it will come at a time where you are beginning to accept it. Just like I mentioned, in the five stages of grief, when you come towards the end— it’s about accepting that reality and saying to yourself yes, I know this has happened, I’ve gone through this grieving process. Now let me look forward.

AB: Yes, thank you, thank you so much. That was incredible. I have one question that’s come in for you and someone here said that when they’ve recently gone through a loss and it’s made them numb. So, they’re saying that we understand all the things you’ve said about the different processes but currently they’re not being able to feel anything. So, what advice do you have for them?

Dr. RP: Yeah, so numbness is a part of that stage whereby you begin to withdraw. So, it’s like you’re shutting off the emotion, you are shutting it off because it is too intense for you to experience. Now here, the numbness is a defensive mechanism, which means that you have to kind of work with yourself slowly by slowly, one bit at a time and begin to kind of reflect on this and say to yourself I’m having this numbness but why am I allowing myself to be numb? And with the help of your friends, you can begin to kind of process that emotion bit by bit, slowly by slowly so that the numbness then begins to open a door for the expression of emotion. And that then becomes… sometimes it can become like a floodgate. And I’ve seen people who know who are numb to start with, but when I am talking to them, slowly by slowly, they open up, and all of a sudden, the tears start flowing. They become so, kind of, intensely aware of that emotion, the grief which is there… So, don’t rush it, but at the same time, try to kind of get help from your friends and try to kind of reflect on where this numbness is coming from. And try to kind of think about how you can begin to process the grief.

AB: Thank you. Thank you. That was such an incredible chat. And thank you so much. I know you’re going to help a lot of people with this. Thank you. Thank you for being here.

Dr. RP: Well, thank you, Anshu. And thank you for inviting me and giving me the space and time to talk. This is a topic which people tend to push away. Nobody likes to talk about loss and death and dying, but this is something which is so important, and you’re doing a great job in bringing this to the people.

AB: Thank you. Thank you again. Ramesh bhai, thank you so much. Thanks for joining us. Hope you enjoyed the Wellness curated podcast. Please subscribe and tell your friends and family about it. And here’s to you leading your best life.