Coping with Loss During the Holidays -- Aprile Naturale, CSW. -- Nov. 11, 2002.

WebMD Live Events Transcript

How can you cope with the after effects of loss during the holidays? Trauma stress expert April Naturale, from Project Liberty, joined us to answer your questions and offer advice.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Today's guest is social worker April Naturale, CSW, director of Project Liberty. Welcome back to WebMD Live, April.

Naturale: Thank you very much. It's good to have an opportunity to connect with you again in this anticipation of the holidays. Holidays can generally be a difficult time for many people for a variety of reasons. Holidays are really family-oriented and couple-oriented, so if you are away from home or are separated from family or a loved one, it can be especially hard.

Member: My son lost his wife last July and I would like to know how to help him, especially during the holidays. Should I speak about her or should I let him lead the way? Is it OK to bring up past Christmas with memories of her?

Naturale: First I would say it sounds like you are wonderfully sensitive. And you are asking the right questions. Some of the answers will depend on the type of person your son is. But let me try to and give you some basic ideas.

Firstly, I think it's always helpful to at least ask the person you are concerned about whether it's OK to bring up the memories of the lost loved one. And if so, how would they like to do this? Some people like to have a picture of their lost loved one or they might want to do something during a special moment of the day, like lighting a candle or taking a moment to reflect. Some like to do this in private, though, which is why asking is so important. Generally, though, I think you will find that people are grateful that others have not forgotten someone so important to them as well. Let me caution you, though, by saying that sometimes people are not ready to deal with things, so you might not get the response that you would like. If that's the case, then just politely say, "That's fine. Whatever you want to do, that's OK."

As far as past memories, again I would ask him, but I do think it's up to you to take the initiative. Grieving hurts and sometimes it's just too hard to start thinking about someone that meant so much to you. So it can be helpful if someone else breaks the ice. And it's often a relief for everyone as well as quite a healing thing to do. My best to you.

Member: My 18-year-old son died in an auto accident returning to college after celebrating Thanksgiving last year with our family. My husband, who is the stepfather, believes that I should be "over this" and ready to celebrate the holidays this year. I want to skip the whole season or at the most, create different holiday traditions and memories. I feel like he just doesn't understand what I'm going through. I'm wondering how someone who helped raise him and loves me could be so thoughtless. Is it me?

Naturale: First, let me say I am sorry for your recent loss. I emphasize "recent" because I can't imagine a mother getting over the loss of her son EVER. What I do hope for you is that time will allow you to have less pain and remember more enjoyable memories, but I am sure thoughts of your son and feelings of loss will always be with you to varying degrees.

In my opinion, you are right. Your husband is being quite insensitive. Starting an argument with him would not make things better, and I suspect that part of his insensitivity is because he's not dealing well with his own pain. What I would suggest is to gently say to your husband that you will deal with this loss in your own time, no matter how much time that takes, and that you would appreciate his understanding, to support you as you move through this horrific loss. I also agree with you that it's an excellent idea to change the way you celebrate the holidays. While many rituals bring us comfort, they can also be painful when they remind us of our losses.

I actually want to commend you. It sounds like in a small way you are thinking about ways to begin healing. You should choose what you would like to do on the holidays and not think about what you think you "should" do. You certainly will feel better if you take care of yourself rather than worrying about everyone else. So while your husband may want to do things the same it may be much more helpful to everyone if you create new ways and do not feel like you have to do things exactly as they have been done before. It is almost certain if you do the same things you did before, your loss will overtake your mood and that will affect everyone's holiday.

I hope this is helpful to you and maybe if you share it with your husband he will be more understanding. It might also be helpful for the two of you to talk about this loss together. Take care of yourself.

Member: I gave birth on Sept. 11, 2001 and had already made an adoption plan for her. I am fortunate to have an open relationship with her family and can see her anytime. My issue is that my emotions are/were so conflicted that day I couldn't and can't tell whether or not I should be sad, happy, proud, or angry. I felt/feel all of the above, all at once. This, being the first anniversary was like an instant replay and yet worse because she wasn't with me. And now the holidays are coming. Should I just take some Xanax or something and zone out, because if not, no one will dare come near me not knowing how I'll be!

Member: I imagine the plans for the adoption of your baby were made previous to the child's birth. I am sure the events of 9-11 brought on these conflicting emotions. Very often an event such as the 9-11 disaster can make people think differently, and it may be that some of the thoughts you have now are still a lingering effect of the disaster.

It would be advisable to talk with a counselor about outstanding issues and what they are, especially in this time between the anniversary date and the holidays. It's not likely that your emotions will settle down without some professional support. A general rule is not to make any major decisions when you have been through a critical incident, so again it would be most advisable to talk with someone before taking any action.

I imagine it must be a comfort to you that you have some sort of connection to the child's family. I would suggest you make plans during the holiday to be with people you know will be supportive. It's natural to feel loss, sadness, and even anger, especially when you see others around you enjoying themselves. Know that this is normal, and you will get past it as the anniversary date and the holidays move into the past. But you certainly should continue talking about what your concerns are and looking for ways to cope.

If a physician has prescribed you any medication, it is recommended that you take it as instructed. If you think it will be much harder for you to get through the days and you might need an adjustment in medication, certainly call your physician and let him or her know your concerns. As a word of caution, alcohol and other substances can exacerbate any symptoms of loss, grief, or depression you may already be feeling. So it's very unlikely that they will make you feel better.

Think about what you would really like to be doing during the tough days and whom you would like to be with. I know many who spend holidays at the movies, walking in the park, or having a quiet dinner with one or two special friends who they know will be supportive, no matter what mood they are in. Think about what kind of activities will help you get through tough times, and also think about talking to a counselor.

Project Liberty counselors are still out in the New York community in full force, especially during these difficult times. You can call 1-800-LIFENET and ask to connect with a Project Liberty counselor. You certainly have a unique situation, and I really believe it would be helpful for you to speak with someone about your conflicting emotions. Good luck to you.

Member: My mother-in-law passed away in January from cancer. We were both going through chemotherapy and radiation together as I had breast cancer. I feel guilty that I'm here to celebrate the holiday and she isn't. How do you suggest dealing with that? All year I have avoided the family as much as I could due to the guilt I feel.

Naturale: Survivor guilt is very common in many circumstances. And it sounds like it would be quite normal for you to be feeling this, even as you suffer with your own illness. There are a number of things I would be concerned about for you. The first is probably one you know and is the most difficult. That is of course that when you are trying to heal from a serious illness your energy must be focused on your own self if you are to continue to get better. So to deal with the family and still take care of yourself, I would suggest that you say to them what it is that you feel and what you need to do.

For example, it would probably be a relief to you and all of them to express what you just told me, "I feel really strange. I am grateful I'm alive, but feel terribly guilty that our other family member is not." You might say to the family, "I am also still concerned about my own health and it would be helpful to me to decide how we would like to get through the holidays." You may tell them you would like to remember your loved one but that you also need to focus on your own healing and your own future.

While I know it's difficult, it's hard to initiate discussions of loss. In addition to that you have the double trauma of suffering with cancer, which is another issue no one likes to talk about. Just like our community has come out and are starting to acknowledge the extensive number of women with breast cancer, it would be healing for you to do the same within your own family. Again, I suspect it will be a relief for everyone that someone has verbalized what everyone else is thinking.

Again, let me caution that because some individuals may not be dealing with their own emotions you may not get the response you are looking for. The important thing, though, is that you say the words, for yourself and for them, even though they might not recognize how helpful that is until much later. I also suggest you change your holiday routine and create new ways of celebrating you are here and that you are healing. My thoughts are with you.

Member: I lost my baby at 20 weeks of pregnancy in January. This year has been very difficult and now my sister-in-law is due to have her baby in three weeks. My husband and I are really dreading the family events. Any suggestions?

Naturale: First, let me tell you I am terribly sorry of the loss of your child. I am not surprised to hear you and your husband are struggling, and certainly even the idea of a birth in the family so close to your loss must be incredibly painful. When you think you have enough strength to say to your sister-in-law you are very joyful about her expected birth, but that it's very painful for you, I suggest you do so. And tell her what your plans are for coping with the coming holidays and how you would like to deal with the birth of her child. It could be very simple like just saying, "I need time to myself right now, and I hope you will understand."

Another good thing to do to reach out to someone when you think you might have difficulty in doing so is to make it less intense by writing a note and telling them how you are doing and wishing them well, and asking for patience as you work through your pain. It's OK to take care of yourself at this point, and that you can acknowledge someone else's joy other than you normally would. You also don't have to do what they would expect you to.

Might I suggest you and your husband plan to do something alone together, either during the holidays themselves or at the time you hear about your sister-in-law's actual giving birth. Think about going out together, talking to each other about how you are doing and feeling, about your loss, about your child. It might also be a good time to talk about your future plans and think about when you might be ready to deal with the issue of having a child again. That doesn't mean you have to do anything right now, but sometimes just thinking about the future might be helpful.

You and your husband might also want to plan a ritual for this coming January that might help you get through the day of your own loss. You might even invite other family members to join you in this. It might be a way to help you get through the next few weeks. When I say a ritual I mean simple things like looking at pictures, writing a note, lighting a candle. To tell this loved one (even this baby who you imagined becoming your child) -- tell them what your dreams and hopes were for them. And then send this note in your mind up and off into the universe. Anything that might help you to become more hopeful and allow your pain to start to decrease, even though we know that will take a long time. My thoughts are with you and your husband.

Member: I live in New York and on 9-11 I lost two college friends; today is a sad anniversary and I can't stop thinking about it. I feel really down and the rain does not help! Any suggestions on how to brighten up or should I just deal with it?

Naturale: I don't think there is ever a time one just "deals with it." I really do think there are things we can do to help ourselves. Let me say first thanks for writing. It's a good start to helping yourself get past the next few weeks. Let me say that you are not alone. New Yorkers who experienced the 9-11 disaster have been calling Project Liberty more in the last few weeks than in the past year. It seems that the build up to the one-year anniversary and now the holidays approaching has increased everyone's anxiety. This is not unusual, and I might suggest if you have not already done so you might want to give yourself a gift of talking to Project Liberty crisis counselor. It's free and confidential, and it is an opportunity to talk to someone about what your experience was in this horrific disaster.

It may also be helpful for you to join one of the many support groups for many just like you who lost someone close in the WTC attacks. There are many new groups forming as more and more people like yourself recognize it will take a long time to heal and that connecting with others is one of the best ways to start the process. You can call Project Liberty at 1-800-LIFENET or contact us via the web at www.project-liberty.com. We'll be there for you, ready to listen.

Member: Thanksgiving in New York won't be the same. Should this be something that should be brought up at the dinner table?

Member: As a counselor, it's my bias that it's usually better to bring up issues that we know everyone is thinking about but too afraid to speak about. I wouldn't bring it up in a way that's negative or makes everyone feel badly about this terrible disaster we have all been through. But it certainly would be appropriate to say just what you told me. That is that Thanksgiving won't be the same, but we all survived the awful feelings we have been experiencing and we are moving towards healing, repairing, and rebuilding our community again. So you might suggest in what ways Thanksgiving being different will be a good thing. While change can be frightening, it does usually signify growth. Think of ways you and your family can change your own patterns that would encourage healing and growth within your family and community as well.

I suspect some things will remain the same. For example, the Thanksgiving Day parade is on. And there are some new characters to brighten the atmosphere. Whatever you decide to talk about, bring it up in a way that your family can feel the closeness of Thanksgiving and that you can be grateful to be together. Happy Thanksgiving.

Member: As an New York resident, are you aware of any opportunities that community members can volunteer to help those in need over the holidays?

Naturale: Your thinking about volunteering during the holidays is a great way to heal and will start to bring your community towards the resilience we know exists in the hearts of so many who have gotten through this horrific disaster. There are so many organizations and agencies that continue to look for volunteers to assist many who are suffering in many ways throughout the city. Project Liberty's hotline, 1-800-LIFENET may be able to guide you to some of the mental health agencies that may be looking for volunteers. But I think the best resource is to go on New York's web site, www.nyc.gov and try to connect to one of the many, many organizations and agencies that provide services within the city.

Another great thing to do is to take a walk and find out who your neighbors are and who the agencies are who would benefit from volunteer help: hospitals, nursing homes, daycare centers, firehouses and schools that all have community activities that welcome local participation. What we know about how communities heal is that first they must come together and know each other in order to move forward. I recommend you pursue your question. Get to know your neighbors. Find out how you can help. Good luck to you.

Moderator: Before we wrap up for today, do you have any final comments for us, April?

Naturale: Know it's normal to think about a holiday or special day as it approaches, and it's normal to have fears and concerns about how the day will be. Do talk about your losses, know it will be natural to feel sad and angry and have other kinds of emotions. Allow yourself to have them. Surround yourself with those who will listen and understand. Think about what you would like to do, rather than what you should do.

Draw on whatever faith or spirituality or other supports you may have to give you strength and comfort. And also know that accepting kindness from others might be helpful for you. Even though there is a natural tendency to resist help when offered, once we get past the awkward point of saying yes and accepting help, this opening up may assist us in healing. Be gentle with yourself. Reach out with family and friends. And reach out to Project Liberty if you need support. You can call us at 1-800-LIFENET or contact us at Project-liberty.com. And we hope you are able to have some peace during the holidays within your family and within your community.

Moderator: Thanks for joining us, members, and thanks to April Naturale, for being our guest. For more information, please visit Project Liberty online at www.project-liberty.com or call 1-800-LIFENET.



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