There isn’t consensus in the scientific community about whether Kubler-Ross’ five stages of grief is rooted in empiricism. Although much vaunted in popular culture, if you’ve experienced grief and resolved it in your own way, you’ll know that grief is an organic process that is by no means neat or orderly. It’s deeply unique to each individual, and this article is designed to hopefully help you through whatever loss you have experienced in the recent past.
The five stages of grief, which Kubler-Ross first postulated that terminally ill patients experience are: Denial, Anger, Bargaining, Depression and Acceptance. Denial in this context encapsulates a perfectly normal response to a tragedy, and is exactly what you would imagine – it’s simply a refusal to believe that “this bad thing is happening to me”. After reality sets in, and the sobering realisation that the tragedy has occurred is impossible to ignore, Kubler-Ross observed that people often display frustration, which culminates in Anger. Once that Anger has dissipated, people often move on to Bargaining, which is the hope that they can somehow extricate themselves from their dire straits and obtain the balm of a different circumstance. Notwithstanding the success of the earlier bargain, Depression follows, which is self-explanatory. The final stage of Acceptance is the sanguine realisation that nothing will change their situation.
If you are currently going through your own grief and taken a step back to evaluate how you are processing it, you might have noticed some incongruencies between the model and your experience. That’s perfectly natural because there has been some criticism levelled at the Kubler-Ross model in that there is confusion over description and prescription. This means you shouldn’t take it as a rule, no, or feel inadequate or “bad” that you aren’t “properly” grieving. We hope that what follows in this article will provide you with some breathing room to let your grief take its own course, and helps you handle a tragedy with the right tools.
Grief is a loss. It’s your prerogative to define what grief is to you, and even something as banal as losing a cherished item from your childhood can precipitate feelings of loss. So, you shouldn’t wall up these feelings behind what society has proscribed as appropriate. We’re talking about you here, not anyone else. It bears repeating that your grief is unique because of a multitude of factors, for those of you who don’t want to accept that it is your right to give yourself the breadth to grieve – your upbringing, your culture, your faith, your parents, the list is endless. So give pause and slip into your own rhythm of grieving.
To help ensure that you do not slip into the common fallacies that can disrupt your grieving process, we’re going to list some of the pitfalls that ensnare people and prevent therapeutic processing of grief.
1) If you don’t show an outward display of grief such as crying, you aren’t “sad”
Just like the shortcomings of Kubler-Ross’ model, while crying is seen as a “socially acceptable” way of demonstrating sadness, it isn’t applicable to everyone. You may have been brought up to avoid tears at all costs, perhaps due to tough parenting or some childhood trauma, or you may not wish to “affect” others with your grief. No matter the reason, you should know that physiological responses to grief vary widely depending on your circumstances. Shock, numbness, anger, even hysterical laughter – just about anything is permissible in the initial, very private stages of your grief.
2) If you don’t “get over it” within an “acceptable timeframe”, you aren’t good enough
Although your family members or people in your community may react to and resolve their grief earlier than you, you need to know that it is by no means healthy to affect the fragility of such a process by introducing the pressures of comparison. Some people simply have better coping-skills than others or are more inured to unhealthy thought processes that hold them back from the therapeutic management of their grief.
3) You feel like you need to “protect” loved ones from your grief, so you turn inwards
We keep emphasizing that grief is individual to everyone – this should tell you that there is no circumscription to how you handle it. Even though it might feel selfish to display your feelings openly because you think less emotionally able loved ones shouldn’t have to deal with your pain, remember that there is nothing shameful about the old adage, “Shared joy is double, shared sorrow is halved”.
There are some simple coping mechanisms that you can use to help yourself through the process. Although the low mood is a given after the heartache of a tragedy or loss, and you might not feel willing or able to pick yourself up and carry on, remind yourself of the wisdom of eating and sleeping right. Drugs and drink might seem the most accessible ways to insulate yourself from poor mood, but these indulgences, in the long run, are hindrances to sustaining your mental well-being.
If you feel like the person you have lost needs to be remembered, you can do so in the solitude of creative expression, or you can choose to gather loved ones to laugh about cherished memories. If there’s one scenario where laughter in the face of loss is wholly acceptable – here it is! Whether communal or solitary, there are many ways you can raise someone up in loving memory – honouring them and helping yourselves.
Find solace in your old routines. If you’re hurting after the failure to gain acceptance into a school of your choice, it may help to remember all the things you did well before that gave your life meaning and structure. At the worst of times, it helps to fall back on old patterns if only to hang on to some stability.
Lastly, know that there is a difference between clinical depression and the normal response to grief. You should be aware of critical signs or symptoms in both yourself and your loved ones that may indicate depression. For example, if you notice that your loved one isn’t eating or sleeping properly after a long period of time, or is displaying reckless tendencies such as driving dangerously or overindulgence in addictions, it may be time to seek professional help. Although many people can get through grief without the help of a mental health professional, when it all gets too heavy to handle, you may consider seeking grief therapy. Some of our clinicians are specifically trained in grief therapy, such as Joachim Lee or Winifred Ling.
In an article titled “Drug syndicates get crafty as supply disrupted, prices spike”, Andrew da Roza, addictions therapist at Promises Healthcare, told Straits Times reporter Zaihan Mohamed Yusof that “anecdotally”, the costs of illegally imported prescription medication and illicit drugs have risen, “although supplies appear to be available”. Mr da Roza goes on to say that he has noticed that some drug addicts are managing withdrawal symptoms and cravings by substituting their drugs of choice with alcohol, new psychoactive substances and over-the-counter medication. The article also mentions that people may seek alternative methods to obtain illicit substances as supply chains are disrupted – such as turning to the Dark Web to get their needs fulfilled by mail.
It wrote that we (Promises) have seen a 25% increase in visits to the clinic “because people are having a harder time managing compulsive behaviours such as substance abuse, smoking and gambling during the circuit breaker period.”
If you are having trouble managing an addiction, you should know that Promises Healthcare has kept its doors open all through the pandemic in service of promoting mental health. Further, in keeping with social distancing measures, our clinic is also offeringteleconsultations in place of regular visits. Support groups have also moved meetings online, which are going ahead as scheduled – on platforms like Zoom instead of physical gatherings. Do contact us for more details.
At its most elemental level, people avoid the risk of failure for one simple reason – it hurts. Every single person has experienced failure. If you were to interpret failure by its definition in the dictionary, “the neglect or omission of expected or required action”, wouldn’t you, as a child, have stumbled along the way to achieving those long strident steps you take when strutting along the sidewalk? Yet, nobody feels ashamed of failing to learn to walk as a toddler. Why’s that? You could say that no-one in the right mind would expect that of a human child – we aren’t deer, or gazelles that need to shake off the afterbirth and walk – or risk predation. Our success as a species which put us at the top of the food chain negates that need. Fear is a function of the amygdala, yet failure isn’t. There’s a distinction here that we need to be mindful of. If you’re a parent or have access to YouTube, you’ve probably noticed that there’s an innocence in children that can be quite uplifting to watch, as they try multiple times to succeed at a simple task. They don’t puff their cheeks out and sigh in despair, or bury their heads in their hands. At most, they demonstrate frustration.
Shame is learned behaviour that children integrate into their developing moralities, either from being taught or through observation. Studies done on athletes have shown that perceived parental pressure (or pressure from authority figures) have deleterious effects on how sportspeople experience and interpret failure. Simply put, the fear of failure is a construct of how societies function. For some people, the avoidance of shame that failure brings weighs too heavily on them, and that is the crippling fear of failure. Dr Guy Finch puts this rather more succinctly: “fear of failure is essentially a fear of shame”. How then, do we begin to become more self-aware in the face of these deeply ingrained avoidance mechanisms to start building our best selves?
After all, overcoming fear of failure is all about reversing negative thought patterns, and Cognitive Behavioural Therapy (CBT) is designed to help you identify the underlying belief that causes a negative automatic thought (which in turn guides the feelings that come with it).
With the help of a qualified mental health professional, which can be anyone from a trained psychologist, psychotherapist or even psychiatrist, you can be empowered to break the circuit of the pervasive vicious cycle of negativity that prevents the unfettering of fear of failure’s heavy chains.
For instance, think of each deeply held criticism that you can’t let go of as a block in a Jenga game with your friends and the tower represents your thought life as a whole. Even though you’ve suffered through failure after failure, you can’t seem to jettison them from your psyche. Can you imagine a game of Jenga that doesn’t end in peals of laughter? It seems that some re-evaluation is needed to turn the way you handle each soul-sucking gut-punching failure from the darkness of your room. The grip of negativity steadying your trembling hand, an extension of your mind, putting each block up on autopilot because you believe you are not good enough. Instead, we suggest turning the lights on, invite someone you trust into your sanctum of despair, to play the game of Jenga with you. As you ease into their presence, you’ll begin to notice that the tower doesn’t look so intimidating anymore. It’s no longer just a congealed mess of all your shortcomings and toxic thinking, but a simpler thing that can be deconstructed. If each block represents a negative conviction you have about yourself that is too painful to touch, reach for the piece that looks more well-shorn and polished (which represents a perceived positive character trait or accomplishment that you hold dear). Put it back on top of your tower. It is yours, isn’t it? Or perhaps let your confidant handle that splintery block.
Of course, we all know that Jenga isn’t all laughter and grand gestures. There’s physical tension and the cogitation of making the right choice so the tower doesn’t crumble prematurely. Maybe you aren’t too good at Jenga. That’s fine. But if you start thinking of this special game of Jenga as a collaborative effort instead of a competitive one, you’ll start getting the picture. Who would you like to invite to collaboratively play a game of Jenga?
Sagar, S and Stoeber, J. Perfectionism, Fear of Failure, and Affective Responses to Success and Failure: The Central Role of Fear of Experiencing Shame and Embarrassment. Journal of Sport and Exercise Psychology, 2009, 31, pp 602-627.
Episode 7 of En Ullae S2 is a harrowing tale of Ramesh’ descent into utter despair due to his alcohol addiction. After the lilting trill of a happy alcohol buzz wears off, people in the throes of addiction often experience a sense of bitterness and desolation. It’s an artificial stimulant that when consumed, releases endorphins, neurotransmitters that promote a feeling of euphoria and help reduce stress.
Some instances of alcoholism are undergirded by an anxiety disorder, according to Dr Rajesh Jacob. He posits that people attempt to “treat” symptoms of anxiety by self-medicating with alcohol, ameliorating the discomfort of social situations through chemically induced disinhibition and happiness. They become chattier, and won’t choke during conversations – an alluring prospect for chronically anxious people.
Ramesh, now advanced in age, wistfully recounts how he fell into alcoholism. At 15, he and his friends would entertain themselves with drinks and idle chatter at a ‘kopitiam’, a Singaporean colloquialism for ‘coffee-shop’. Dr Jacob reminds us that despite being a stimulant, long term alcohol abuse invariably leads to depression or anxiety. Alcohol addiction can stem from a variety of factors – from the ‘angry, drunk father’ to early over-exposure to alcohol, and everything in between. Hassan Mansoor, a recovering alcoholic, confesses that his first foray into Bacchanal pleasure was during his secondary school years(junior high) for you Americans). He doesn’t remember the time with rose-tinted glasses, though – his adolescent years were marked by incessant violence, physical altercations and poor academic performance. He’d thought it made him look “cool”. Beer, whiskey, “Boon Kee Low”, “Paddy”, its name derived from its roots as a rice wine, and “Deer”. All of them cheap highs.
We’re then treated to a vignette in which a listless Ramesh, rake thin, gets into an argument with his doe-eyed girlfriend over whether wine should be drunk at lunch. Both of them are adamant that they hold the moral high ground – Ramesh, with his insistence that wine is “not hard liquor”, and Reena, with the awareness that his alcoholism is ruining not only their relationship but himself. We learn that the long-suffering Reena has tolerated Ramesh’s equivocations and excuses for four years, and she’s at the end of her tether.
(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep7/954631 ) Dr Jacob explains that genuine awareness of an alcohol problem can only legitimately come from within, and external criticism is met with a wall of anger and irritation. In the early stages of alcohol addiction, one usually does manage to induce some level of happiness. As the disease progresses, drinking no longer “feels good” and chemical dependence means that consumption is imperative to avoid withdrawals. Alcohol withdrawal symptoms include hand tremors, which can set in as quickly as 4 – 6 hours from the last drink, insomnia, anxiety, psychological cravings, palpitations and sweating. Alcohol addiction is a vicious cycle, according to Dr Jacob.
Most people suffering from alcohol addiction start off with social drinking, which isn’t a problem in itself. However, addiction is a chronic, progressive disease which Dr Jacob measures with three factors of varying severity: drink frequency, duration of drinking, and cravings. Ramesh admits that his family life and relationships suffered. Getting blackout drunk was a nightly affair, which left his wife paranoid of his infidelity, when in fact he was unconscious in a ditch somewhere. He wouldn’t remember the events leading up to the loss of consciousness, a form of anterograde amnesia. Eventually, his wife takes out a Personal Protection Order (PPO) against him, the Singaporean variant of a restraining order.
The spiral into full throttle addiction isn’t a pretty sight. Just being in the presence of his drinking buddies would catalyse a night of binge drinking, invariably followed by a hangover in the morning made all the more unbearable by guilt over the slow rot of his cherished relationships. Work performance suffered, many a medical certificate was sought, culminating in joblessness.
Dr Jacob explains that addiction leads to productivity impairments at work. A sure sign of dependence is the need for a drink in the morning to curb tremors and imbibe him with enough energy to perform as a barely functioning alcoholic. Day drinking and surreptitious alcohol breaks are common. When in active addiction, one’s happiness (in the form of craving relief) takes precedence over that of others, and empathy goes out the window. Ramesh is reduced to a pitiable state, cajoling once close friends to spot him the occasional tenner – in their eyes, he is reduced to a shadow of his former self. Now jobless and without an income, he burdens his children with the restitution of his loans – he is now too functionally impaired to perform any meaningful work. His wife is now the sole breadwinner, and the guilt in his voice is apparent, even today.
Ramesh only manages to stop drinking for some length of time at 48 due to chest pains. After a successful heart bypass, he turns to drink again. Then comes the second bypass, which he sullies with an infection brought on by his inveterate drinking. Alcohol and heart medication should not be taken together, but his addiction blinds him to a sanguine truth. It is only after last-ditch surgery is performed that he cultivates some restraint, managing to abstain from drink when he recuperates for a month in the hospital. He is 68 when he finally gets into recovery.
All manner of physical ailments accompanies alcohol addiction. “From the head to the feet”, Dr Jacob says. The brain is atrophied such that fits, falls, bleeding, subdural hematomas and dementia become common. Liver cirrhosis brings about jaundice and bloody stool. Peripheral neuropathy, a feeling of pins and needles in the hands and feet arises from damage to nerves outside the brain and spinal cord. Even sexual performance suffers. If diabetes is comorbid, the body becomes much poorer at sugar control.
Dr Jacob recommends a ‘biopsychosocial’ model for treating alcohol addiction. “Bio” refers to medical treatment in the form of total abstinence (detoxification) and medication. “Psychosocial” refers to psychological counselling to treat addiction, medication to reduce cravings, and therapy sessions with the family. In short, a treatment model that aims to target likely risk factors for relapse.
Nobody takes their first drink and thinks, “This’ll be the death of me”. Fortunately, if people suffering from alcohol addiction take a step back and consider their mind, their physical body, and their loved ones, and combined with proper support and therapy, recovery is possible.
Anger is a response most of us have when we feel our territory is being threatened. This is a primitive reaction from our days as cavemen (and cavewomen) when a wild animal was nearby! This reaction has not quite been removed by modern civilisation. When something threatens our security, the brain responds to it with a fight or flight reaction. The body releases adrenaline which causes changes in the body. The heart pumps faster, breathing gets faster, blood gets diverted to the legs and arms so we can run or fight back. The blood flow to the reasoning part of the brain is lessened so that thinking becomes difficult. Nowadays there are no saber tooth tigers coming out to attack us which require us to fight or flee. However the body’s response to a threat remains the same and, unless we find ways to discharge the energy or change our perceptions, the fight response will persist.
Powerless!! That’s the situation most people find themselves in at the moment during this Covid-19 Pandemic Circuit Breaker. From the home maker, who has to see her family all day long to the child who wants to have his friends over; teenagers who are restricted in their activities with peers to husbands who have to adjust to being at home with no break! Cabin fever is setting in and many are not coping well. Add to that mix an addiction that is running rampant in the household and you have a powder keg ready to blow!!!
What can family members do at this time to stay sane and not get embroiled in another power struggle or argument with the addict in the house. Anger that luxury during normal times is just magnified as all of us are forced to Stay Home. A simple request turns into a huge event; an innocent comment gets misinterpreted; and even demonstrations of concern become fuel for accusations of being manipulative or controlling. What to do??
Most family members of addicts or dysfunctional families (most of us can attest to being in this category), have resorted for a while now to manage, manoeuvre, save or guilt trip. This comes from a place of love and fear. However having time apart has always been a great diffuser of tension. Now faced with a Stay Home situation things can get stressful. Once free to go out, meet friends, go to the gym and pursue our life goals, we find ourselves having to don a mask and stay six feet away from each other, with frequent temperature checks thrown in! Yes we know it’s for our own good but just how do we go about removing that sense of irritation or frustration?? What’s wrong with me? I never used to get SO upset?? Being stuck at home we ‘step on the toes’ of others or they inadvertently step on ours.
So here are some possible ways to cope…..
1. Walk away and discharge the energy
Going for a walk, or a run and getting away from the source or trigger for our anger is one option. Moving away and giving vent to the energy is what we need to do. Digging in the garden, washing dishes, scrubbing the bathroom tiles or polishing the furniture is a great outlet for this energy. Shredding newspaper is another excellent technique. After which you could turn the strips into Papier Mache pulp and create an art project. One woman wrote that she would pull out weeds and imagine she was pulling out her husband’s hair! This is called Detaching.
2. Practice Deep Breathing and Self soothing
This taking in of deep breaths, helps bring more oxygen into the body and to the brain. Especially important is the frontal cortex where our reasoning happens. Improved brain function helps restore some calmer thinking. Follow this up with doing something good for yourself such as listening to some music you like, dancing, playing a game on your phone, doing a craft or even having a nap. Seld care is important when you have to deal with a loved one suffering from an addiction. We often say, “Put on your own oxygen mask before you attend to others.”
3. How Important Is It?
Ask yourself this question. After walking away and breathing for a bit, consider how the event figures in the larger scheme of things. Does this event require action right now or can it wait? Do I need to say what’s on my mind right now or can I pause and say it later. Often I ask myself these questions- Does it need to be said? Does it need to be said by me? Does it need to be said by me now?? By the time ive asked myself these questions, my good sense would have returned and I can leave it for another time.
4. Respond not react
After calming down, consider a way to communicate which is kind and thoughtful. Say what you mean, mean what you say, but don’t say it mean. I’ve heard this said by someone- “Try to say it in ten words or less!” Haha! Most of us have communication patterns that escalate tension! So, try this for a change.
Another great tool is the acronym – T.H.I.N.K. Before I speak I need to THINK.
Is what I’m saying Thoughtful, Honest, Intelligent, Necessary or Kind. If not take a piece of Masking tape and place it nearby. This helps as a reminder to keep my mouth shut.
When all else fails, go talk to someone you trust and let it out. A friend in need is a friend indeed. Or seek one of many support groups or counsellors to help you cope. Whatever the case, we are all in this together! So don’t suffer alone. There are many helplines and people available to support you such as the ones listed below.
I am a self-confessed introvert. And I’m also an addict.
I was recently cajoled into attending a Psychodrama session. I’d heard things about it – years earlier, my then significant other lauded the raw emotional exploration her sessions afforded her. I encouraged her, it was good for her. Personally though, I found the idea of a group session’s ability to evoke genuine emotion alien. It was the antithesis of who I was.
I had never enjoyed group sessions. I hated them. The introvert in me screamed (silently) in indignation at being forced into a room with my peers, lorded over by therapists who would extol the heaven-sent power of vulnerability, hanging it over the heads of us sullen detainees. They would espouse connectedness with others, openness. To me, these were just unattainable states of being that I could never actualise. The years wore on, and I plodded along, entwined with my precious, thorny, addictions. Prison, pricey rehabs abroad. I took care to never bring my real self along to the banal group therapies – I merely presented them with an alter-ego. Faking it to get along. Or “faking it to make it”, in the parlance of addicts like myself who would say or do anything to achieve a discharge.
I was living an entirely unremarkable life, losing friends and embarrassing myself.
Then, I experienced a seismic shift in circumstances. To represent it as merely ‘mandated’ would be to deny gravity to what had happened. I had run afoul of the law again, and paid my penance with a 9 month long “drug rehab”. I got out, and three months later I was a year clean. Still, I wasn’t happy. I had done no soul searching, nor had I even begun to scratch the surface of my addiction, always lurking in the shadows. Of course, a large part of my reticence towards accepting sincere nudges in the direction of help could be attributed to personal and moral failings. But why was I the person that I was? That’s when I decided to attend a psychodrama workshop at the urgings of my boss, a sweet girl whose genuine concern had initially confounded me. Why did I acquiesce? To understand myself, I guess. So, I went in with an open mind.
Psychodrama is about exploring internal conflicts, by acting out emotions and interpersonal interactions. I wasn’t inclined to be the center of attention just yet, so I left other enthusiastic participants to play the protagonists. The director, a bubbly personality whose sharp wit was tempered by insightful, genuine empathy, herded a roomful of clueless attendees with a deft hand, schooling us in psychodrama’s basic concepts. I made myself small in the corner and watched as our director doubled volunteers, acting out scenes from their lives, giving voice to their unconscious. Revelatory perspicacity was the order of these moments. I watched as they were mirrored, experiencing themselves from the outside, drawing from a nonjudgmental pool of collective consciousness. I watched as roles reversed – mothers became their daughters, and wives their husbands. All of them seemed edified, comforted, even. Misty eyes and rivulet strewn faces, sighing into closures when none previously seemed possible. There was a woman pained by a frightful trauma, her repressed malefaction she seemed so sure she had committed driving her to seek expiation from whom had ceased to be able to give her any. From the outside looking in, I was sure her wound was self-inflicted – we all knew this, but one’s own guilt is deeply personal, often insidious. As her situation percolated in my mind, so did my own guilt. I hadn’t wept when I learned of my father’s and sister’s departures, I hadn’t wept at their funerals, I hadn’t wept at their memorials. I hadn’t needed to, because I had my addiction. Now, without the pernicious warmth of substances, these losses became some therapeutic cynosure of a starting point. I had begun to understand myself, through others. The cynic in me finally realised why, across addiction recovery literature, syllabuses are almost invariably characterised by the motif of benefits accrued by group therapy. I think it owes something to the collective experience of humanity, that no matter your guilt or your shame, there are people out there who have lived congruent experiences. It may seem cloying and mawkish for me to say that no-one is truly alone, but it’s true.