Wednesday, April 22, 2009
TRIG-gering Grief
Despite my amusement with the concept behind the Texas Revised Inventory of Grief [TRIG] I am, at heart, a product (sometimes a proud product) of my industrial-civilized upbringing and usually can't pass up the opportunity to take a self-"help" test, which is one of the possible uses of this particular grief assessment. I'm not alone in this. Meghan O'Rourke, whose series of articles about grief in Slate brought my attention to the TRIG (she mentions it and provides the same link to it I've posted above, in the ninth paragraph of the third article in her series, which is linked to the above reference to Slate) also found the assessment intriguing enough to "take".
Punching the name of the assessment into Google unrolls a list of 27,200 references. If you surround the phrase with quotation marks, the list narrows to 1,310. This, I think, speaks on behalf of the popularity of the assessment, if not its reliability. Most sources advise professionals to use the assessment with circumspection. There has been at least one adaptation of the assessment with an eye to grief involving the loss of a child. This assessment is interesting because it rewords the statements to apply to losing a child and adds a third section, entitled "Related Facts", the statements of which are evaluated on a simple "True/False" scale and are designed to add further insight into the long term grief process of the assessee.
The unadulterated assessment is divided into two lists of statements, Past Behavior and Present Emotional Feelings. Participation requires the assessee to rank her/his agreement with each statement on a five level scale as follows: a = completely true; b = mostly true; c = neutral; d = mostly false; e = completely false.
It's hard to find any specific information about scoring on the internet. This may be because distributors of the test are wary about its use for self-assessment. The most complete explanation I found is on page 2 of 6 when this article is opened in one's Adobe Reader; the journal in which the article appears lists the page number as 516. This explanation is particularly interesting because it compares responses to Part I with responses to Part II in an attempt to assess the possibilities of delayed grief and prolonged grief. Pages 10 an 11 of this Power Point article (which opens as a pdf file) presents a scoring explanation which is down and dirty, thus easier to understand and utilize casually. Essentially, when rating one's answers, one scores one's a-e selection on a five point scale, giving one point to "a" answers and sequentially upgrading to five points for "e" answers. The lowest to highest score one can accumulate on Part I is 8 - 40. For Part II: 13 - 65. Informally speaking, the higher one scores, the lower is one's experience of grief. In my research of the TRIG (which was admittedly brief, confined to maybe an hour and a half of clicking into links from my Google search and scanning the articles) I found no evidence of anyone using the assessment to determine levels of "healthy" or "unhealthy" grief. I find this a relief, as it indicates to me something advocated by some of the grief literature I've lately perused: That grief is a highly individual experience and the meaning of ease or difficulty with grief must be considered within the unique circumstances of each Grieving One's life.
The assessment (and its adaptation) is meant to be administered to the grieving survivor a fair while after the death. Although I found nothing specific to suggest the following, my guess is that Part II and Part III of the adaptation, depending on the circumstances in which the assessment is used, can be and probably are administered multiple times. In the original TRIG, Part I focuses on memories of fresh grief responses immediately after the death; Part II attempts to assess how one has moved through grief and where one is "now" in the process.
Although it is meant to be used in a formal setting, no doubt proctored and evaluated by a professional, I found that self-(ab)use (I couldn't resist), reading the statements, considering them, even assigning a number to one's grief and comparing it to highest and lowest scores, can be enlightening. On April 14, 2009, when I discovered the TRIG, I decided to take it "straight". My results on Part I were 26 out of a possible 40. My results on Part II were 43 out of a possible 65. Considering that I scored about the same (by percentage) in Part I (65%) and Part II (66%), I surmised that this might indicate that I am handling my grief about the same now as I was when my mother died. This surprised me because it has seemed to me that I am grieving more than I did right after Mom died. As I looked back over the statements and rummaged through the thoughts that each statement aroused when rating them according to how they applied to me I realized that what is likely happening is that I am expressing my grief more freely and understanding it better than in the immediate death wake; responses the TRIG doesn't differentiate in terms of "more" or "less" grief.
Because I am obsessively self-analytical, I thought it would be entertaining (more for me than you, I suspect) if I include here a review of thoughts I had as I rated the statements, along with how I rated them. Keep in mind that the statements (which I'll display in this color) were developed by Thomas R. Faschingbauer, Richard A. DeVaul, and Sidney Zisook and copyright by TRIGs publisher, American Psychiatric Press:
Would I recommend self-administration of this assessment to people? I would to people who tend toward and enjoy rigorous self-examination and are not prone to diffuse and critical worry about whatever psychological state in which they might find themselves at any particular time for any particular reason. I would to people who tend to harbor a lively and objective curiosity about themselves even if they aren't particularly self-conscious or self-absorbed. I would not to people who might tend to frighten themselves unduly with discovery about their psychological states or if they were normally intent on being oblivious to their psychological states. I also would not recommend it to people who seemed, at the time of the consideration, emotionally fragile, no matter what their previous behavior revealed about their normal emotional profile and self-interest.
If you're as intrigued as was I, though, give it a go. It's involving and fun, yes, fun, if nothing else.
Punching the name of the assessment into Google unrolls a list of 27,200 references. If you surround the phrase with quotation marks, the list narrows to 1,310. This, I think, speaks on behalf of the popularity of the assessment, if not its reliability. Most sources advise professionals to use the assessment with circumspection. There has been at least one adaptation of the assessment with an eye to grief involving the loss of a child. This assessment is interesting because it rewords the statements to apply to losing a child and adds a third section, entitled "Related Facts", the statements of which are evaluated on a simple "True/False" scale and are designed to add further insight into the long term grief process of the assessee.
The unadulterated assessment is divided into two lists of statements, Past Behavior and Present Emotional Feelings. Participation requires the assessee to rank her/his agreement with each statement on a five level scale as follows: a = completely true; b = mostly true; c = neutral; d = mostly false; e = completely false.
It's hard to find any specific information about scoring on the internet. This may be because distributors of the test are wary about its use for self-assessment. The most complete explanation I found is on page 2 of 6 when this article is opened in one's Adobe Reader; the journal in which the article appears lists the page number as 516. This explanation is particularly interesting because it compares responses to Part I with responses to Part II in an attempt to assess the possibilities of delayed grief and prolonged grief. Pages 10 an 11 of this Power Point article (which opens as a pdf file) presents a scoring explanation which is down and dirty, thus easier to understand and utilize casually. Essentially, when rating one's answers, one scores one's a-e selection on a five point scale, giving one point to "a" answers and sequentially upgrading to five points for "e" answers. The lowest to highest score one can accumulate on Part I is 8 - 40. For Part II: 13 - 65. Informally speaking, the higher one scores, the lower is one's experience of grief. In my research of the TRIG (which was admittedly brief, confined to maybe an hour and a half of clicking into links from my Google search and scanning the articles) I found no evidence of anyone using the assessment to determine levels of "healthy" or "unhealthy" grief. I find this a relief, as it indicates to me something advocated by some of the grief literature I've lately perused: That grief is a highly individual experience and the meaning of ease or difficulty with grief must be considered within the unique circumstances of each Grieving One's life.
The assessment (and its adaptation) is meant to be administered to the grieving survivor a fair while after the death. Although I found nothing specific to suggest the following, my guess is that Part II and Part III of the adaptation, depending on the circumstances in which the assessment is used, can be and probably are administered multiple times. In the original TRIG, Part I focuses on memories of fresh grief responses immediately after the death; Part II attempts to assess how one has moved through grief and where one is "now" in the process.
Although it is meant to be used in a formal setting, no doubt proctored and evaluated by a professional, I found that self-(ab)use (I couldn't resist), reading the statements, considering them, even assigning a number to one's grief and comparing it to highest and lowest scores, can be enlightening. On April 14, 2009, when I discovered the TRIG, I decided to take it "straight". My results on Part I were 26 out of a possible 40. My results on Part II were 43 out of a possible 65. Considering that I scored about the same (by percentage) in Part I (65%) and Part II (66%), I surmised that this might indicate that I am handling my grief about the same now as I was when my mother died. This surprised me because it has seemed to me that I am grieving more than I did right after Mom died. As I looked back over the statements and rummaged through the thoughts that each statement aroused when rating them according to how they applied to me I realized that what is likely happening is that I am expressing my grief more freely and understanding it better than in the immediate death wake; responses the TRIG doesn't differentiate in terms of "more" or "less" grief.
Because I am obsessively self-analytical, I thought it would be entertaining (more for me than you, I suspect) if I include here a review of thoughts I had as I rated the statements, along with how I rated them. Keep in mind that the statements (which I'll display in this color) were developed by Thomas R. Faschingbauer, Richard A. DeVaul, and Sidney Zisook and copyright by TRIGs publisher, American Psychiatric Press:
- Part I:
- After this person died I found it hard to get along with certain people. My rating: c (neutral)
My thoughts: Yes, in that I was unable to contemplate any kind of difficulty in sorting out death business during the week immediately after my mother died while relatives were here. Two examples: One relative, the day that my mother died, warned me to immediately transfer almost all money in Mom's & my joint checking account into a new checking account before the bank found out about the death because the experience of friends told him banks tend to freeze accounts when one of the holders dies. My response was, "I can't handle this, I don't want to hear about it." The relative was wrong about this. Some days later, after immediate death business had revealed itself to be pretty easy, straightforward and not at all threatening, yet another relative related experiences of yet more friends who had been devastated by inheritance and estate taxes, losing "40%" of their assets to such. My response was the same as to the example above. Again, the relative was wrong, at least about my situation. My mother's estate is subject to no death taxes from either the state or the feds and I am not subject to any inheritance taxes.
Other than abruptly dismissing what I considered frightful absurdities, which I usually don't do (I usually take them on and analyze them in order to confront the absurdity and dissipate the fright) I was just as sociable, more so, actually, than usual, as quick to laughter and to tears, as good at listening as I was at talking and had no specific, unusual problems with anyone. - I found it hard to work well after this person died. My rating: a (completely true)
- After this person's death I lost interest in my family, friends, and outside activities. My rating: c (neutral)
- I felt a need to do things that the deceased had wanted to do. My rating: e (completely false)
- I was unusually irritable after this person died. My rating: c (neutral)
- I couldn't keep up with my normal activities for the first 3 months after this person died. My rating: c (neutral)
- I was angry that the person who died left me. My rating: e (absolutely false)
- I found it hard to sleep after this person died. My rating: c (neutral)
- Part II:
- I still cry when I think of the person who died. My rating: a (completely true)
My thoughts: Absolutely, and without shame or discomfort. It feels good to cry, so I don't try to stop tears, ever, even in public. - I still get upset when I think about the person who died. My rating: d (mostly false)
- I cannot accept this person's death. My rating: e (completely false)
- Sometimes I very much miss the person who died. My rating: a (completely true)
- Even now it's painful to recall memories of the person who died. My rating: e (completely false)
- I am preoccupied with thoughts (often think) about the person who died. My rating: d (mostly false)
- I hide my tears when I think about the person who died. My rating: e (completely false)
- No one will ever take the place in my life of the person who died. My rating: a (completely true)
- I can't avoid thinking about the person who died. My rating: c (neutral)
- I feel it's unfair that this person died. My rating: e (completely false)
- Things and people around me still remind me of the person who died. My rating: c (neutral)
- I am unable to accept the death of the person who died. My rating: e (completely false)
- At times I still feel the need to cry for the person who died. My rating: a (completely true)
My thoughts: I was numb, completely unable to attend to household duties or death business. I left it up to everyone else. I was, however, aware enough to realize what people were doing for me and thank them profusely.
My thoughts: I did lose interest in activities that involved my mother [watching movies; reading, both silently (which I'd lost interest in over the last four years of my mother's life, anyway) and aloud; cooking; some areas of conversation; internet related activities; stuff like that], which accounted for quite a few activities. However, I redoubled my interest in most activities that didn't involve my mother and which had lain fallow over the last several years; and, I did this almost immediately after the first wave of relatives left. It was a relief to do so. The only people I could be said to have lost interest in were the many Hospice people who had become indigenous to our lives for seven months. I didn't think much about this. They were no longer contacting us (except for the grief counselor) and my assumption was that they were no longer funded, so they dropped off my list of people to contact.
My thoughts: Unless the "thing" was expedient, using the ordered Christmas dinner and goodies, for instance, to feed mourning visitors and using the rest to provide a Christmas feast at one of my sister's homes (I attended the feast), there was absolutely nothing that I felt I "needed" to do in deference to my mother's desires after she died. I was, in fact relieved that there were some things I wouldn't be doing: Christmas baking, for instance; continuing to watch episodes of Touched by An Angel.
My thoughts: This harked, for me, back to #1. While my response to the fright and absurdity factors suggested by others was unusual, my disdain for them was not. Otherwise, I was no more or less irritable than usual.
My thoughts: Considering that most of my normal activities involved caring for my mother, which I was doing to a heightened degree by the time she died, this, I figured, was obvious but to be expected; nothing unusual. Otherwise, I cared for myself and my life in pretty much the same way that I did when my mother was alive.
My thoughts: I was not angry that my mother left me. I didn't even think about this one. Her death had nothing to do with her choice in the matter. Later, though, in my grieving process, I became (and remain) angry that there is such a thing as death.
My thoughts: I didn't find it hard to sleep and have never gotten any more or less sleep than I did when my mother was alive. I did find it hard to sleep in my room after my mother died. I still do, occasionally. I prefer sleeping in the living room. I've decided that this is because the heart of our home is there and my preference, still, often, is to snuggle in that heart.
My thoughts: I have almost never gotten upset when I think about my mother after her death. Occasionally I am upset with Death, but not about my mother or her death. I know, sounds confusing, but that's how I'm processing it.
My thoughts: I can accept my mother's death. I'm just having a hard time accepting Death, which is a surprise because I never thought I'd ever have a hard time accepting Death. I've done really well with this, up to now.
My thoughts: Oh, always...always. I can't, yet, imagine not missing her. This also causes me no shame or discomfort.
My thoughts: I LOVE remembering my mother, love talking about her, love thinking about her. There is nothing in my memories of her and our life together that has been the least bit painful.
My thoughts: I wavered between "d" and "e" on this one. I chose "d" primarily because there have been a few times, even now, when I've been unpleasantly surprised by sudden intrusions of my mother and the stab of longing these evoke: When, for instance, I am in Costco but no longer buying supplies for our lived-together life; when I buy fast food for one but cannot divest myself of my mother's preferences (even though I don't buy those preferences, I buy my own).
My thoughts: Nope. Not a chance. I'm not wired that way.
My thoughts: I consider this a rational and completely good response. Of course no one will ever take her place. No one has ever taken the place of anyone who has left my life. This just isn't possible. I don't believe this is possible for anyone. I further wonder if it isn't both unrealistic, suspect (from the point of view of grief) and maladaptive if people think this can happen and look for it to happen. If I had set up the scoring standard for this test, I would have reworded the statement thus: "I'm expecting, or have already found, someone to take the place in my life of the person who died," thus giving the "high grief" (which would be the lowest numerical) score to those who rated the reworded statement "a".
My thoughts: Of course I can't avoid this. Nor would I want to, not even when the thoughts seem like an intrusion, as mentioned above. I suspect the underlying assumption with this statement is that the respondent might want to avoid thoughts or considers the thoughts as obstacles to other thoughts. I don't, even when those thoughts are intrusive.
My thoughts: I don't consider it unfair that my mother died. Death is what happens to all of us. I have lately, however, been feeling that Death, itself, is unfair. I wonder, in fact, why grief assessments and grief counseling don't seem to distinguish between feelings about the death of a person and feelings about Death, in general, especially since, in my case, the two have separated themselves and I'm having a problem with the latter, not with the former. Although I may be wrong, I'm guessing that I'm not the only grief-stricken survivor who does this. I've considered that my separation of these might be a response my psychology has designed to keep me from realizing that I am angry with my mother for dying, but this just doesn't fit. It makes no sense to me to be angry with her or cite her, personally, with the unfairness of Death. She didn't create the circumstance of Death. In fact, in her own mind, she erased that option well over a year before she died. Even in the case of suicides, and I've known two people who committed suicide, I can't bring myself around to thinking that their choice of the option to die is what creates the circumstance of Death...thus, anger and a sense of unfairness didn't, in either of those deaths, enter into my equation, either. Call it a personal quirk.
My thoughts: When I thought about this I was surprised that, despite occasional unwelcome and unpleasant intrusive reminders, I am not more often reminded of my mother by "things and people around me"; not uncomfortably surprised, just surprised. Considering how close we became, how every aspect of each of our lives echoed in the life of the other, you'd think that I would be constantly and disturbingly reminded of her. But, I'm not.
My thoughts: Once again, it's not my mother's death I am having trouble accepting. It's Death.
My thoughts: I remember, when rating this statement, thinking, "Actually, I don't feel the need to cry for my mother, rather, about my mother and how much I miss her." I almost rated this one "completely false" but decided to give the benefit of the doubt to the statement and assume that the developers were implying "about" when they chose "for".
- Although I knew that, for me, there exists a dichotomy between my mother's death and Death, I didn't realize, until performing this assessment, that there isn't professional grief counseling acknowledgment of this dichotomy, why it might exist and what the consequences are of allowing it.
- Previous to assessing myself I suspected that I was not handling my need to grieve as well as it seems as though I am.
- The assessment informed me about aspects of grief and allowed me to confront them as specific events, sometimes isolated from other grief events, rather than thinking of grief as one amorphous event. The former approach makes grieving easier, for me, anyway, because it helps me locate myself within the process. The latter approach tended to make me feel as though I was traveling through a labyrinth, one out of which I might never emerge.
- It helped me realize what, about my behavior, might be specific to grieving and what isn't. Although my confusion about this wasn't overwhelming, it was barely noticeable, in fact, the added clarity was welcome.
Would I recommend self-administration of this assessment to people? I would to people who tend toward and enjoy rigorous self-examination and are not prone to diffuse and critical worry about whatever psychological state in which they might find themselves at any particular time for any particular reason. I would to people who tend to harbor a lively and objective curiosity about themselves even if they aren't particularly self-conscious or self-absorbed. I would not to people who might tend to frighten themselves unduly with discovery about their psychological states or if they were normally intent on being oblivious to their psychological states. I also would not recommend it to people who seemed, at the time of the consideration, emotionally fragile, no matter what their previous behavior revealed about their normal emotional profile and self-interest.
If you're as intrigued as was I, though, give it a go. It's involving and fun, yes, fun, if nothing else.
Labels: Complicated Grief, Grief Self-assessment, Slate, TRIG
Monday, April 20, 2009
To Begin Again: Why I'm Here and Not There
I conceived of this subsection of my journals at the same time I decided it was time for me to commence some serious reading about grief, as I mention in this post at my regular area, The Mom & Me Journals dot Net. It's just taken me awhile to get going over here.
My current plan is to write all my grief stuff, from here on out, in this area. That doesn't mean my main journal will stagnate. I continue to have a lot to write about caregiving and other aspects of my mother's and my journey. Those will continue to be posted in my main area. It just seems as though I'm ready to section off my grief, I guess that's the best way to put it, to make a distinction between my grieving and the rest of my life. I can't say what this indicates about my emotional state...for the time being I'll let others, if they are so inclined, speculate on that.
Currently, these are the books I've either checked out of the library or already have that I intend to read over the next few weeks to months. I'm placing them in the order in which I intend to read them, although I've already begun reading three of them at once and one is already read but is in the stack for rereading:
As I read through the series of articles I was intrigued by some of the concepts: finding a metaphor for death; mention of the Texas Revised Inventory of Grief, which I looked up and which amused me because it submits grief to an industrial-civilized test; the question of whether The Dying One accepts her or his Death. As well, I was attracted to the series because O'Rourke's mother died just seventeen days after my own. Upon learning this, there was an immediate and uncontrollable urge to "compare" my experiences with hers. As I read the articles, though, I realized that such comparisons are folly. I knew this, but, well, my autonomic brain is also a product of an industrialized civilization.
Anyway, aside from writing my usual grief stricken posts Here instead of There, my plan is to react, explicitly and in writing, to what I read as I browse the literature. I'm not promising that I'll write any more often than I'm presently writing Over There. Reading and writing about death and grief isn't all I'm doing. But, I thought it would be handy and helpful (for me) to separate this aspect of my journaling from the other aspects. I may be adding books and articles, which I'll catalog here, of course. I may not read every single word of every single book. Primarily, at the moment, I don't expect to read either #3 or #4 in their entirely.
One last note: The search engine for this section hasn't been set up or linked, yet. It will, soon, but at the moment it's not.
My current plan is to write all my grief stuff, from here on out, in this area. That doesn't mean my main journal will stagnate. I continue to have a lot to write about caregiving and other aspects of my mother's and my journey. Those will continue to be posted in my main area. It just seems as though I'm ready to section off my grief, I guess that's the best way to put it, to make a distinction between my grieving and the rest of my life. I can't say what this indicates about my emotional state...for the time being I'll let others, if they are so inclined, speculate on that.
Currently, these are the books I've either checked out of the library or already have that I intend to read over the next few weeks to months. I'm placing them in the order in which I intend to read them, although I've already begun reading three of them at once and one is already read but is in the stack for rereading:
- A Grief Observed by C. S. Lewis
- How to Survive the Loss of a Love by Colgrove, Bloomfield & McWilliams
- Treatment of Complicated Mourning by Therese A. Rando
- On Grief and Grieving by Elisabeth Kubler-Ross & David Kessler
- Nothing to Be Frightened of by Julian Barnes [which I own and have already read once]
- The Year of Magical Thinking by Joan Didion [which I own and have placed last, saving it for dessert]
As I read through the series of articles I was intrigued by some of the concepts: finding a metaphor for death; mention of the Texas Revised Inventory of Grief, which I looked up and which amused me because it submits grief to an industrial-civilized test; the question of whether The Dying One accepts her or his Death. As well, I was attracted to the series because O'Rourke's mother died just seventeen days after my own. Upon learning this, there was an immediate and uncontrollable urge to "compare" my experiences with hers. As I read the articles, though, I realized that such comparisons are folly. I knew this, but, well, my autonomic brain is also a product of an industrialized civilization.
Anyway, aside from writing my usual grief stricken posts Here instead of There, my plan is to react, explicitly and in writing, to what I read as I browse the literature. I'm not promising that I'll write any more often than I'm presently writing Over There. Reading and writing about death and grief isn't all I'm doing. But, I thought it would be handy and helpful (for me) to separate this aspect of my journaling from the other aspects. I may be adding books and articles, which I'll catalog here, of course. I may not read every single word of every single book. Primarily, at the moment, I don't expect to read either #3 or #4 in their entirely.
One last note: The search engine for this section hasn't been set up or linked, yet. It will, soon, but at the moment it's not.
Labels: Grief Literature, Introduction, Slate, TRIG
To Begin: Hearts is Trump
I've referred to myself in my main journal, at least a couple of times, I think, most recently here, as experiencing a broken heart resulting from the death of my mother on December 8, 2008. Serendipitously, on April 18, 2009, through a USA network TV rerun of a 2007 episode of House I watched entitled Words and Deeds [click here for an interesting review containing a "ridiculous" check of this episode and a brief rundown of fairly reliable (inasmuch as can be had at present, anyway) information regarding the diagnosis discussed in the program], I was treated to some intriguing information on Broken Heart Syndrome (sometimes abbreviated as BHS). Despite the maddening antics of the episode, the information contained was curious enough to prompt me to further exploration.
What we are now calling "Broken Heart Syndrome" has gathered centuries of anecdotal information: A widowed spouse, usually elderly, dying within a year of the deceased spouse is primary. There are tons of other examples, some of which don't involve death of survivors to someone deceased, but do involve prolonged grief and marked changes in sufferers' outlooks and lives. Often, as cited here, the condition involves physical pain in the chest region (it hasn't with me). Study of the condition as it might be related to physiological (vs. metaphorical) heart problems began only recently, in the 1990s, in Japan. This link, misnamed as it is (the condition "can be" but is not necessarily fatal), discusses in fairly good depth the Rhode Island Takotsubo Cardiomyopathy Registry as it was used to study this complaint. This link directs to an article published a year after the previously mentioned study commenced that gives an accurate overview of the condition and the questions that arise from considering it.
I was surprised to discover from the House episode that broken hearts are currently more than an emotional consideration and have become the subject of respectable scientific study. There is a bit of conversation in the above mentioned episode that was especially shocking (pun intended) regarding a treatment decision made that was specific to the suffering character's situation. The dialogue, below, taken from the show (all spelling follows CC spelling) traces the decision and, as well, gives what is currently considered a decent, though not thorough, explanation of the physiology of BHS:
The popularity of twists such as these is the reason I stopped watching House much earlier last year. I'd begun an obsession with the show when it was mentioned to me by an online acquaintance while my mother was in the hospital and rehab last spring. I sought it out and became almost immediately hooked for a period of a few weeks, until it dawned on me that the fictional arrogance portrayed (chiefly through Dr. House) in the show was mimicking the real arrogance I was, daily, fighting in every medical staff with whom I had to work as I advocated for my mother's health. Instead of calming me, watching the show was working me up to fever pitch every night before retiring.
Be that as it may, when Jessica Knapp posted about a House character's death at her website, after watching that episode in arrears I became, again, entranced with the show. I'm not sure why and an explanation doesn't yet matter enough to me to seek one. I still find the show maddening and frustrating. The issue of broken hearts becoming a medical syndrome, though, well, I can't quite let go of this, considering my recent use of the label. I think it's interesting, and probably worthwhile, that, as a species, we are attempting to study broken hearts from an objective, physiological point of view. Although the research doesn't yet conclusively indicate whether, when or why they are fatal, certainly, broken hearts are life changing. I'm not one to campaign for a cure for, or even the medical eradication of the physiology that accompanies broken hearts. Although the condition I'm labeling as my own broken heart is extremely uncomfortable and is, indeed, changing my attitudes toward life and, thus, I expect, will change my life, I'm not sorry it's happening and I'm not keen to avoid the condition. I hope, and think, that, eventually, living with my broken heart will reveal new ways of perceiving and approaching life that will be much more compatible with who I am, now, and will be much more effective and life-enhancing.
There was a time, immediately after my mother died, when I hurt so much, emotionally, that I confided to one of my sisters that, at least for a few weeks after everyone left, I hoped that family members would set up a schedule of checking on me daily by phone to make sure that I remained alive. I worried, I told her, based on all that anecdotal evidence I mentioned previously in this post (evidence with which I doubt any of us escapes familiarity, a familiarity which begins when we are young, before we are able to understand the concept of the effects of a broken heart), that, without ulterior intention I might die of a broken heart. My extended family did, indeed, set up such a schedule, including a back-up plan in case one of them happened to call when I was out, which set a time limit on lack of answering or responding, after which local police would be called. The plan played out for about three weeks. After that, I reported that it no longer was necessary. I'm sure I was right about that.
The abandonment of the plan, though, doesn't mean that I am not continuing to experience a damaged and confused metaphorical heart. I can't say whether I am also (or ever was) experiencing a physical heart that is besieged by the physiological properties of a broken heart, but I seem to be healthy and have no reason to go to a doctor, so my guess is that, if I was ever in any physiological danger from my metaphorical heart break, I am no longer. Stress isn't ipso facto deleterious. In this case, I consider whatever stress my continuing "heart condition" is causing to be advantageous. It's prompting me to work through it. No, it's not easy. Yes, sometimes I vacation, putting the work aside to revel in life's pleasantries. I prefer, though, sometimes even relish, working it...considering the alternatives, at least those I am sure would apply to me.
One of the aspects of BHS that was briefly mentioned in the show and, as well, on a few of the sites to which I've previously linked in this post, is that middle-aged women seem to be a primary demographic within the category of sufferers of BHS. This makes sense to me. Menopause changes a woman's physiology in ways that remove protection from the heart and colors a woman's perception of the world so distinctly that it upsets mental apple carts all over the place. Creating and adjusting to a post-menopausal world view, as well as adjusting to physiological changes, continues after one finishes menopause and ushers in years of what Margaret Mead termed "post-menopausal zest". Stack a death on top of this process and the weight is probably enough to break even a sturdy heart. However, this oddity, which hasn't yet been medically explained, does not account for what has always been anecdotal wisdom and, according to at least one study, is a matter of scientific observation: That when a spouse dies, a widower is almost three times as likely to experience "excess mortality" (dying because one's spouse has died) than is a widow. It's interesting to note that conventional wisdom often connects this observation with the idea that, overall, women are better at taking personal care of themselves than men because husbands typically depend on their wives to not only prompt them to but to perform personal care for them; thus, women are more likely to survive after the death of a spouse than are men. This scientifically observable phenomenon is often what is conventionally referred to as death by broken heart. I wonder, though, if it wouldn't be more appropriate to refer to excess mortality in widowered husbands as due to broken lives.
I can't say that I don't understand people who die after the death of an intimate. From what I've experienced since my mother's death I feel bound to report that such fantasies don't emerge only from the sense of life devastation that follows the death of an intimate and the desire to physically dive into that devastation, complete it, so to speak. I've also experienced a haunting quality to being "left behind" which involves a need to know "where" the deceased "is"; to want to follow her in order to remain in touch with her; an agony in having to surrender the actuality, the presence of a relationship, to Death; all of which have caused me, at times, since Mom's death, to wish that I would die, not in order to really die, but to follow, and know, and once again be in real time touch with her. I understand how it would be very hard to resist this desire if one is perennially prone to thoughts of suicide or very ill or very old and perceives her or himself to be close to death aside from the deceased's stark absence. I can also report, though, that when one isn't suicidal or perceives oneself to be close, for whatever reason, to the end of one's life, when one, I think, too, isn't experiencing complicated grief (which I wondered, for awhile, if I was experiencing but have satisfied myself that I am not, at least not at this point), it is possible, hard, yes, but possible, to resist realizing The Follow Fantasy. It is, in fact, a bit more seductive to continue trudging through the devastation of one's heart in order to see, just to see, if something else, something interesting and vital, can be resurrected from the debris of Death's toppling. For me, on a day to day basis, this, alone, is a good enough reason to continue plodding from morning, to noon, to evening, to night, and not merely hope but expect to rise, again, another day.
For others, it's not. I wouldn't be surprised to discover that none among these others expected to find themselves of the "not" sort. Maybe, one day, in reaction to a death, I might find myself "notting" away...thus, my heart wonders about these others.
What we are now calling "Broken Heart Syndrome" has gathered centuries of anecdotal information: A widowed spouse, usually elderly, dying within a year of the deceased spouse is primary. There are tons of other examples, some of which don't involve death of survivors to someone deceased, but do involve prolonged grief and marked changes in sufferers' outlooks and lives. Often, as cited here, the condition involves physical pain in the chest region (it hasn't with me). Study of the condition as it might be related to physiological (vs. metaphorical) heart problems began only recently, in the 1990s, in Japan. This link, misnamed as it is (the condition "can be" but is not necessarily fatal), discusses in fairly good depth the Rhode Island Takotsubo Cardiomyopathy Registry as it was used to study this complaint. This link directs to an article published a year after the previously mentioned study commenced that gives an accurate overview of the condition and the questions that arise from considering it.
I was surprised to discover from the House episode that broken hearts are currently more than an emotional consideration and have become the subject of respectable scientific study. There is a bit of conversation in the above mentioned episode that was especially shocking (pun intended) regarding a treatment decision made that was specific to the suffering character's situation. The dialogue, below, taken from the show (all spelling follows CC spelling) traces the decision and, as well, gives what is currently considered a decent, though not thorough, explanation of the physiology of BHS:
Cameron: Broken Heart Syndrome. He's in love and it's killing him.In the episode, through a bizarre twist, after the electroshock is applied it is discovered that the suffering character's broken heart isn't based on reality but on a delusion which is evidence of a condition which hasn't been adequately diagnosed or treated. Oops!
Foreman: Thought that only happened to 80 year old widows.
Cameron: Thanks to his menopause and estrogen level, he basically is an old woman. BHS is an acute physical response to an emotional experience. Stress triggers a flood of catecholamines...
Chase: That's a plain old stress cardiomyopathy, not a heart attack.
Cameron: But if you're too worried about your job to get it treated, they can devolve into full on heart attacks. You think this is a coincidence this started when Amy got engaged?
House: No, I don't. But now that you know the why, what are you going to do to stop the how?
Foreman: We've already put him on beta blockers and nitroglycerin. No effect.
Cameron: We need to put him on anti-depressants.
House: Not if you're right. Anti-depressants would inhibit his autonomic nervous system which would only speed up the heart attacks.
Chase: We could try propylthiouracil, slow down his metabolic rate.
House: Thyroid effect would only weaken the heart.
Foreman: The only other option is blood thinners.
House: This is not a fat guy with plaque-filled arteries and a swollen heart. He's a guy whose brain is trying to kill his heart.
Chase: So, buy him a girlfriend. Make him happy.
Cameron: That might make you happy. The only thing that'll make him happy is Amy.
Chase: So, keep him away from her.
Cameron: He has a myocardial infarction every time she walks in the room. What do you think will happen to his heart when you tell him he can never see her again?
Chase: He needs a shrink.
Foreman: Chase's idea is as good as any, because, short of frying his brain and wiping Amy out, he's screwed.
House: We need Cuddy.
Foreman: Why?
House: So you can tell her why you need to fry a guy's brain.
Cuddy: They guy's heart isn't working and you want to shock his brain.
House: Electroshock therapy is the only way to erase his memories of Amy and stop the brain's chemical attacks on the heart.
Cuddy: This isn't 1940. The problem can be controlled with anti-depressants.
House: Cameron?
Cameron: Anti-depressants would inhibit his autonomic nervous system. Speed up the attacks.
House: LMNO, PTU, blood thinners, none of them will solve his problem. The man's got a real life Harlequin romance in his head. We're gonna pull out the 1940 playbook. Bilateral electrodes, high stimulus sine-wave intensity. Turning that dial all the way to 11. It's basic brain chemistry. We interrupt the protein synthesis, altering the neuro-transmitter system. End results, no memories, no Amy, no problem.
The popularity of twists such as these is the reason I stopped watching House much earlier last year. I'd begun an obsession with the show when it was mentioned to me by an online acquaintance while my mother was in the hospital and rehab last spring. I sought it out and became almost immediately hooked for a period of a few weeks, until it dawned on me that the fictional arrogance portrayed (chiefly through Dr. House) in the show was mimicking the real arrogance I was, daily, fighting in every medical staff with whom I had to work as I advocated for my mother's health. Instead of calming me, watching the show was working me up to fever pitch every night before retiring.
Be that as it may, when Jessica Knapp posted about a House character's death at her website, after watching that episode in arrears I became, again, entranced with the show. I'm not sure why and an explanation doesn't yet matter enough to me to seek one. I still find the show maddening and frustrating. The issue of broken hearts becoming a medical syndrome, though, well, I can't quite let go of this, considering my recent use of the label. I think it's interesting, and probably worthwhile, that, as a species, we are attempting to study broken hearts from an objective, physiological point of view. Although the research doesn't yet conclusively indicate whether, when or why they are fatal, certainly, broken hearts are life changing. I'm not one to campaign for a cure for, or even the medical eradication of the physiology that accompanies broken hearts. Although the condition I'm labeling as my own broken heart is extremely uncomfortable and is, indeed, changing my attitudes toward life and, thus, I expect, will change my life, I'm not sorry it's happening and I'm not keen to avoid the condition. I hope, and think, that, eventually, living with my broken heart will reveal new ways of perceiving and approaching life that will be much more compatible with who I am, now, and will be much more effective and life-enhancing.
There was a time, immediately after my mother died, when I hurt so much, emotionally, that I confided to one of my sisters that, at least for a few weeks after everyone left, I hoped that family members would set up a schedule of checking on me daily by phone to make sure that I remained alive. I worried, I told her, based on all that anecdotal evidence I mentioned previously in this post (evidence with which I doubt any of us escapes familiarity, a familiarity which begins when we are young, before we are able to understand the concept of the effects of a broken heart), that, without ulterior intention I might die of a broken heart. My extended family did, indeed, set up such a schedule, including a back-up plan in case one of them happened to call when I was out, which set a time limit on lack of answering or responding, after which local police would be called. The plan played out for about three weeks. After that, I reported that it no longer was necessary. I'm sure I was right about that.
The abandonment of the plan, though, doesn't mean that I am not continuing to experience a damaged and confused metaphorical heart. I can't say whether I am also (or ever was) experiencing a physical heart that is besieged by the physiological properties of a broken heart, but I seem to be healthy and have no reason to go to a doctor, so my guess is that, if I was ever in any physiological danger from my metaphorical heart break, I am no longer. Stress isn't ipso facto deleterious. In this case, I consider whatever stress my continuing "heart condition" is causing to be advantageous. It's prompting me to work through it. No, it's not easy. Yes, sometimes I vacation, putting the work aside to revel in life's pleasantries. I prefer, though, sometimes even relish, working it...considering the alternatives, at least those I am sure would apply to me.
One of the aspects of BHS that was briefly mentioned in the show and, as well, on a few of the sites to which I've previously linked in this post, is that middle-aged women seem to be a primary demographic within the category of sufferers of BHS. This makes sense to me. Menopause changes a woman's physiology in ways that remove protection from the heart and colors a woman's perception of the world so distinctly that it upsets mental apple carts all over the place. Creating and adjusting to a post-menopausal world view, as well as adjusting to physiological changes, continues after one finishes menopause and ushers in years of what Margaret Mead termed "post-menopausal zest". Stack a death on top of this process and the weight is probably enough to break even a sturdy heart. However, this oddity, which hasn't yet been medically explained, does not account for what has always been anecdotal wisdom and, according to at least one study, is a matter of scientific observation: That when a spouse dies, a widower is almost three times as likely to experience "excess mortality" (dying because one's spouse has died) than is a widow. It's interesting to note that conventional wisdom often connects this observation with the idea that, overall, women are better at taking personal care of themselves than men because husbands typically depend on their wives to not only prompt them to but to perform personal care for them; thus, women are more likely to survive after the death of a spouse than are men. This scientifically observable phenomenon is often what is conventionally referred to as death by broken heart. I wonder, though, if it wouldn't be more appropriate to refer to excess mortality in widowered husbands as due to broken lives.
I can't say that I don't understand people who die after the death of an intimate. From what I've experienced since my mother's death I feel bound to report that such fantasies don't emerge only from the sense of life devastation that follows the death of an intimate and the desire to physically dive into that devastation, complete it, so to speak. I've also experienced a haunting quality to being "left behind" which involves a need to know "where" the deceased "is"; to want to follow her in order to remain in touch with her; an agony in having to surrender the actuality, the presence of a relationship, to Death; all of which have caused me, at times, since Mom's death, to wish that I would die, not in order to really die, but to follow, and know, and once again be in real time touch with her. I understand how it would be very hard to resist this desire if one is perennially prone to thoughts of suicide or very ill or very old and perceives her or himself to be close to death aside from the deceased's stark absence. I can also report, though, that when one isn't suicidal or perceives oneself to be close, for whatever reason, to the end of one's life, when one, I think, too, isn't experiencing complicated grief (which I wondered, for awhile, if I was experiencing but have satisfied myself that I am not, at least not at this point), it is possible, hard, yes, but possible, to resist realizing The Follow Fantasy. It is, in fact, a bit more seductive to continue trudging through the devastation of one's heart in order to see, just to see, if something else, something interesting and vital, can be resurrected from the debris of Death's toppling. For me, on a day to day basis, this, alone, is a good enough reason to continue plodding from morning, to noon, to evening, to night, and not merely hope but expect to rise, again, another day.
For others, it's not. I wouldn't be surprised to discover that none among these others expected to find themselves of the "not" sort. Maybe, one day, in reaction to a death, I might find myself "notting" away...thus, my heart wonders about these others.
Labels: Broken Heart Syndrome, Complicated Grief
