“Grief is not a disorder, a disease or sign of weakness. It is an emotional, physical and spiritual necessity, the price you pay for love. The only cure for grief is to grieve.”
– Rabbi Earl A. Grollman
“Grieving doesn’t make you imperfect. It makes you human.”
– Sarah Dessen
Do you feel free to experience your emotions as they authentically are, both in your personal and professional lives?
Or do you (or others in your circle) have rigid rules about what emotional responses are acceptable and appropriate?
Grief is one area in which physicians often perceive constraints on their emotional experience..
Grief that is unacknowledged or invalidated by others or by social norms is called disenfranchised grief. The concept was first proposed in 1989 by Dr. Kenneth Doka and has accumulated significant research support since that time. Disenfranchised grief can occur in a number of different situations, including loss when that loss is “part of the job.”
Many healthcare professionals work in roles exposing them to intense and repeated loss. Since these losses are an expected part of the work, individuals can begin to feel that they should be able to take them in stride and not be bothered. But just because losses are expected, that doesn’t mean that they don’t hurt.
When we feel like our grief is not valid or that we need to hide our grief, we can experience additional distress on top of the grief itself. We may even begin to disenfranchise our own feelings (“maybe I shouldn’t feel this sad”) and blame ourselves for “inappropriate” reactions. When our grief isn’t recognized and we aren’t given permission to grieve, our recovery is more difficult.
I invite you to consider holding space for your grief even if it feels like nobody else is. You feel what you feel and your feelings cannot be wrong.
You may find that people in your life want to tell you what you should (or should not) be feeling and how long those feelings should last. You may even be giving these messages to yourself. But once we begin putting those kinds of constraints on our emotions, we introduce inauthenticity. We are no longer dealing with our actual emotions, but with our interpretation of which emotional responses are acceptable.
Also consider that grief does not usually resolve in the sense that it goes away completely, never to be heard from again. It’s actually quite common for grief to reawaken with new losses or at new stages of life.
When you face the death of a patient or another loss in the workplace, you do so with the weight and history of all of your previous losses.
The previous losses may be personal losses or other patients or both.
Be kind to yourself if you begin to feel like you are grieving “old” losses all over again.
It may be helpful to engage in a ritual marking the loss. This does not have to be an elaborate ceremony; a brief moment of silence and reflection may be enough to honor the loss and begin to move forward. The best ritual is the one that’s best for you. Grief is an intensely personal experience and so is coping.
Your ritual may involve writing. Journaling, poetry, and other written forms of expression are powerful tools for processing and managing emotions. If you worry that writing will feel like too much, set a timer for yourself before you start. When the timer goes off, it will not switch off your emotions but will bring you back to the present.
Emotional self–regulation is the capacity to exercise control over one’s own emotions. We’re really talking about down-regulating or reducing the intensity of the emotions. Emotional self-regulation is not about not feeling our feelings, but about managing them adaptively.
To that end, you may find it helpful to use grounding techniques. One effective grounding exercise can be called 5-4-3-2-1. Gently focus your attention on yourself and your environment and identify:
- 5 things you can see;
- 4 things you can touch;
- 3 things you can hear;
- 2 things you can smell; and
- 1 thing you can taste.
If you are unable or prefer not to do one of these steps, simply leave it out.
But what if you face a patient loss and you don’t feel grief, or you don’t feel as much grief as you think you “should?” Does that mean that you didn’t really care or that you are burned out?
There are many different reasons why your experience of grief may be what it is. This could be your general emotional reactivity, your history of loss experiences, your spiritual beliefs, your detached compassion, whatever. I just want to emphasize that these reasons are explanations and not justifications. You feel what you feel. And while it is true that burnout may be one explanation for low reactivity, it is far from the only one.
Make it a practice to offer yourself kindness and understanding, and to accept your emotions as they genuinely are.
Additional Resources:
-Emotional PPE Project offers a directory of volunteer therapists providing psychotherapy to healthcare workers across disciplines. There is also an advocacy arm dedicated to reducing barriers to appropriate mental healthcare. https://emotionalppe.org/
-The American Psychiatric Association Foundation’s Center for Workplace Health has an arm specifically dedicated to workplace health in medical settings, with emphasis areas in fear and shame, peer support, clinician cultural competency training, and suicide prevention, among others. https://frontlineconnect.org/toolkit/
-Togather is a collective care platform built by and for healthcare providers to reduce burnout and amplify the impact of those pursuing health justice. Some peer support opportunities, some work on addressing moral injury. **Requires a membership fee.** https://www.togathernow.com/about
-Physicians Anonymous is a resource for physicians, residents, and medical students. It also offers 1:1 coaching and free anonymous support groups. Finally, Physicians Anonymous maintains a blog that includes firsthand stories intended to reduce shame and stigma. https://physiciansanonymous.org/
-Physician Support Line (1-888-409-0141) is a free and confidential support line run by volunteer psychiatrists. It is open Mon-Fri (except federal holidays) 8:00 AM-12:00 AM EST. In addition to working with physicians, it also serves medical students. https://www.physiciansupportline.com/
-988 is the National Suicide and Crisis Lifeline.