GriefPerspectives | The "Grammar" of Bereavement

It has been a LONG time since I learned the process of “diagramming sentences.” English majors and adults of my generation (oldies, as my kids say) recall this laborious task in elementary and perhaps junior high school. Though I never particularly enjoyed grammar, the science of language, I even took a course in college creatively entitled “Transformational Grammar;” I must have lost a bet at class registration time or something equally sinister; I cannot think of a good reason now to explain why I would have subjected myself to such torture.

But for all the pain inflicted by grammar teachers over the years, I am generally grateful I learned to diagram sentences. That simple process helped me learn the differences between nouns, verbs, adjectives, adverbs, direct objects, gerunds, and a host of other language conventions, though I do not always now recall how they differ. But here is another thing we all learned as we discovered how to speak, write, and use our chosen language: punctuation. We learned the differences between periods, commas, question marks, and other marks that speak to the reader about how to interpret the text.

In a series of workshops on dealing with grief after drug overdose deaths earlier this month, I suggested that bereavement has a lot in common with the grammar we all learned as kids. When a 93-year old dies after a brief illness and her family has the opportunity to be with her and bid her goodbye, that “sentence” ends in a period. Perhaps when a 19-year old dies in a car crash, that sentence is punctuated with an exclamation point. But it seems to me when death comes by suicide or drug overdose, the sentence of life is most frequently punctuated by a question mark.

I do not mean to disparage the value of good punctuation. Knowing whether the sentence I am reading is a declarative sentence or an inquiry makes a lot of difference in its meaning. But in the final analysis, the nouns, verbs, adverbs, and adjectives of the sentence lend that sentence its meaning and its color. The death and the circumstances surrounding it are just the punctuation marks; they are not the “nouns and verbs” that describe life’s real meaning and color.

When through our own use of therapeutic questions we invite bereaved individuals to share the story of the deceased, to paint in the corners of the life story, we are helping our patients, clients, constituents, and friends to move beyond the circumstances of the death and its cause. Instead, we relish in the good-natured humor, generosity, friendship, compassion, loyalty, and selflessness that are the qualities so often described by family members and friends in the aftermath of a death.

When we gather at funerals and memorial services, I do not suggest that we ignore the circumstances of the death and that we only talk about life; frankly, that is one of the umpteen reasons I so seriously object to the whole notion of renaming funerals the euphemistic “Celebration of Life,” especially when the death was particularly tragic. I feel that such language choice tries, as we say in Texas, to paint lipstick on the pig.

Rather, those who lead such services of honor must engage the family in developing an appropriate narrative to share, a story that neither shrouds the truth nor ignores its painful reality. I have begun my remarks at such gatherings by suggesting something like, “We have gathered with deeply broken hearts, filled with far more questions than answers. Knowing those answers does not lessen our grief but it is human to grapple with the ‘hows’ and ‘whys’ of experiences like these.” I believe this is far more honest than the oft-heard notion of “not crying at my funeral.”

But the cause of death is not the end of the story; it is merely the punctuation mark at the end of the sentence. In funerals, support groups, individual psychotherapy, and caring interactions with bereaved friends, I suggest that we also think deliberately about how to engage in conversation about the character, the values and virtues exhibited in the life of the deceased. Surely every person who has ever lived has contributed something powerful and positive to the world; most people have exhibited a catalog of goodness we can honor in the face of their death.

In the Christian New Testament, James writes in his letter, “Every good thing bestowed and every perfect gift is from above, coming down from the Father of lights, with whom there is no variation, or shifting shadow” (James 1:17, NASB). In my theology, the life of every person is a gift opened in the lives of those who loved him. As we interact with bereaved families and their communities, it behooves us to honor the character qualities of those to whom we say goodbye in death. In my work with individuals and families, I have found that I frequently have to elicit these virtues, these character qualities, these descriptive labels of who their loved ones have been in the lives of those who love them. I ask bereaved individuals to describe to me the character of their loved one, to talk about the ways he or she impacted lives and the world. Usually, it requires no more prompting than that for the stories and the character words to begin flowing.

Perhaps the 26-year old son, the person perhaps described by his parents as a “lost soul” cared deeply for animals and even made a place in his home for stray dogs. Frequently, I hear these searching individuals described as one who “would give you the shirt off his back,” a clear indication of a life of gratitude. Maybe this woman had a contagious smile and a joyous sense of humor in spite of the pain she carried in her life. The final act of a person who died by suicide or the descent into addiction that describes recent years in the life of the one who died by drug overdose, are not the sum total of their lives; they are simply an obnoxiously loud part of the story.

In enumerable ways, we hear such words. Sometimes, we hear the stories that depict real life examples of these qualities. When hearing such stories, I frequently say, “Wow, it sounds like your dad was a man of compassion for others” or “Gosh, it seems your sister was a woman who lived a life of respect for people.” Family members will correct us when we get it wrong, but most often in my experience, they respond with yet another example of the quality I have labeled: “Yeah, that is right. Another time, she…” This recollection of stories and the character values that underpin them is what I call remembering and it is a fundamental way we help ourselves integrate the death of a loved one into the rest of our lives (Hoy, 2016).

Frankly, hearing some of these descriptions about the recently-dead sadden me; I often wonder how often the deceased heard these words of affirmation during his or her frequently-tortured life. Nevertheless, when we interact in the aftermath of death, the honoring of this life means regardless of how the sentence was punctuated, this person had value, was loved, and likely loved others. And when our own death approaches, may we be remembered more for the qualities of our lives—the nouns, verbs, adverbs, and adjectives—than we are for the way our own sentences are punctuated.

References.

Hoy, W.G. (2016). Bereavement groups and the role of social support: Integrating theory, research, and practice. New York, NY: Routledge.

The Author: For more than three decades, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide effective care. After a career in congregation, hospice, and educational resource practice, he now holds a full-time teaching appointment as Clinical Professor of Medical Humanities at Baylor University in Waco, Texas where he has taught since 2012. His most recent book is Bereavement Groups and the Role of Social Support: Bridging Theory, Research, and Practice (Routledge, 2016).

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Research that Matters

Templeton, L., Valentine, C., McKell, J., Ford, A., Velleman, R., Walter, T., . . . Hollywood, J. (2017). Bereavement following a fatal overdose: The experiences of adults in England and Scotland. Drugs: Education, Prevention and Policy, 24(1), 58-66. doi:10.3109/09687637.2015.1127328

Especially across North America and Europe, the numbers of individuals dying in overdose of addictive drugs has climbed exponentially over the last couple of decades. In the United States, for example, opioid overdose deaths were six times higher in 2017 than in 1999. Public health leaders appropriately call the issue an epidemic.

In the present study, Templeton and colleagues conducted interviews with family members of 30 individuals who died by drug overdose in recent years to ascertain how families cope with such losses in the months and years after the death. With only one exception, the deceased loved ones were male and they ranged in age from 17 to 43 at the time of their death. Some of the parents recalled stories of their loved ones’ deaths from as long ago as nearly 20 years.

Qualitative studies such as this one are not intended to generalize statistical findings to larger populations; on the basis of such interviews, we do not suggest that “x% of parents bereaved by drug overdose believe y.” Instead, the value of such studies is that they reveal finely-nuanced themes that larger population studies simply cannot uncover; to effectively survey (sample) a large group, we have to know what questions to ask and qualitative, interview studies such as this one help us formulate such questions. In surveys, we simply do not know to ask questions about experiences unknown to the researchers.

One of the interesting findings in the present study was that for about one-third of the family members interviewed, the fatal overdose had not been the first overdose. Some family members discussed their grief before the loved one actually died: “The day I found out he was on drugs was the day that part of me died,” was the way it was expressed by one mother whose 32-year old son died a year before the interviews (p. 61).

Several factors were found to complicate grief for the bereaved families but one particularly interesting finding was that in half of the deaths, another person or group was believed to have been involved at the death scene. In some cases, parent grief was intensified by the awareness someone had an opportunity to intervene and did not. And of course several parents are tortured by their own sense of failure to prevent the death or even the addictive behavior that eventually caused the death: “What did I do wrong; I must have been a horrible mum” was the tortured sentiment expressed by a mother whose 28-year old son died a dozen years before the interview (p. 62).

Family members reported that the investigative process and their experiences with law enforcement and medical staff was largely negative. Several reported being made to feel like “second class citizens” because of the way their loved one died but noted how refreshing was the rare experience of sensing real compassion from caregivers (p. 63). Reinforcing a main point in the preceding article, “The ‘Grammar’ of Bereavement,” one mother whose 32-year old son died reported, “He was a wonderful son, brother, uncle, grandson, a very special human being, not just a drug addict. I hated the stigmatized thing of it” (p. 64).

The relational ambivalence frequently present for parents and other family members in addiction clearly shone through these interviews. One mother who found her son had been dead for some time raised the question of how she would have responded if she had found her son with resuscitation a possibility, especially in light of having performed CPR after several previous overdoses. Another mom reported, “Sometimes (I) would look at him and wonder will I phone the ambulance this time” (p. 64).

What is clear from this study is that the population of family members bereaved by the overdose death of a loved one is in need of intentional support, especially in light of the way these losses are marginalized and the bereaved stigmatized by the death’s circumstances. But they also reveal another fact well-known to those of us who care for the bereaved and that is they relish the opportunity to tell their story. The challenge for all of us in these deaths and in all deaths is for us to develop the same qualities apparently possessed by these researchers—to develop hearts with ears on them.