Lori Montross, PhD., Director, Center for Grief Care & Education, San Diego Hospice
Related Story: Holidays A Bad Time For Those Who Grieve
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. All the ho, ho, ho of the holidays can be too much for some folks, producing a phenomenon we all know has the holiday blues! But when the Christmas season collides with real grief over the loss of a loved one or a serious illness, other people's holiday joy can be almost too much to bear. The counselors at San Diego hospice are reaching out to the community with advice for getting through this challenge. And my guests, doctor Lori Montross, director of the center for grief, care, and education at San Diego hospice. Welcome to the show.
MONTROSS: Thank you so much.
CAVANAUGH: May I call you Lori?
MONTROSS: Of course, yes.
CAVANAUGH: Now, I think many people have experienced that first holiday season without a loved one. Why is it that we tend to feel these losses most deeply during this time of year?
MONTROSS: We certainly have connections with our loved ones that can make cherished memories during the holidays. So the absence of them can become even more clear when the holidays have arrived and the loved ones are not there to perform some of the tasks or traditions that we normally had. So they were part of putting up, let's say, Christmas lights or creating a special dinner, and they were the cook that made the stuffing, those sorts of things that really are endearing in our live, and we notice when they're not there, particularly during the holidays.
CAVANAUGH: So you hear people say it doesn't even feel like the holidays without this particular person here. So it's -- is it can really can be a damper for people who are in the midst of everybody celebrating.
MONTROSS: It really is. And particularly sense holidays are touted as a time when we're with our families, we're with our loved ones, and socially there's an expectation that they're joyous and fun-filled, and for those people that have recently lost a loved one, that becomes so much more isolating, frankly. Then they feel like they're the only ones that must be experiencing that, and that's not the case.
CAVANAUGH: Can you recall an instance, a story of a person or something that comes to mind of someone you've counseled through the Christmas season? What kind of challenges they face?
MONTROSS: They certainly can face challenges now with the loss of their loved one, deciding which events they may or may not attend, and their role in those events. So for instance, if they were part of a couple and they attended the husband's work event or they attended some of the husband's friends' ceremonies, now there's a sense of how do you fit into all of that? Do I want to go? Do I not? And it can be quite emotionally draining, honestly. It can feel as though I don't fit in, and I'm tired, I'm not sure if I should go, and it can really become overwhelming.
CAVANAUGH: Is this then a good time to start new traditions for the holidays? Or is that too much to ask someone who's actually going through the grieving process?
MONTROSS: First and foremost, there's certainly an emphasis on thinking through what's best for you. Each person has an individual case. But we get that question quite a bit. Is it okay to make a new tradition? Because in some way, it might feel disrespectful to that loved one if you do something new. But we would encourage -- there are ways to create new traditions or new rituals that can be quite comforting. And you can tie your loved one into those new traditions. So for example, I worked with a woman whose husband had passed away, but he was an avid surfer, and he liked a particular portion of a beach. And so she donated a park bench on that beach. Now her new tradition is on Christmas morning, she goes to the park bench, and she sits and she thinks of him, and maybe even has that conversation with him, if you will, as she looks out into the ocean and so for her, that's a tradition that makes a great deal of sense, it's individualized, it's comforts, it reminds her of him. And additionally, it's even benefited the community.
CAVANAUGH: Right. And that's a way to incorporate someone who's no longer there into a holiday situation or into a new tradition as the family goes forward.
MONTROSS: Precisely. And there are a number of ways to do that. And thinking through what would be meaningful to you and from what you know of that loved one, what might be meaningful to them. So people may put a candle at a holiday table in honor of a loved one. They might make a donation to a charity in honor of that loved one, and do see in their name. So it's a nice way to say their name, have them acknowledged during that time which can bring a lot of solace.
CAVANAUGH: What about if a serious illness is involved? Obviously holiday gatherings that are taking place while a member of that family is seriously, possibly terminally ill, is going to foreshadow the death of that loved one, how does a family handle that?
MONTROSS: Again, thinking through what are the dynamics of each family and how do they interact, but it can be best to acknowledge what's present and the seriousness of that illness. And having conversations about that. We certainly at San Diego hospice advocate family meetings, times when communication between the family members is encouraged and is key. For them, simply saying things like this is a difficult time, I'm not quite sure how he should handle this, what do you think? It opens up a dialogue around it versus trying to not pay attention to the illness or to skim over it can somehow feel even worse, perhaps eve Moe shallow in that experience.
CAVANAUGH: I would imagine that the level of grief involved would change depending on who is not at the table. In other words, the difference in trying to get over the loss of a grandparent as opposed to a spouse, that would seem to me to need different levels of adapting.
MONTROSS: Uh-huh, uh-huh. And I think in fact that word is very appropriate, adapting. So depending on your connection with that person, and in trying to make the grieving process appropriate to that love connection. Sometimes that's difficult. We may be very, very close to a grandparent, and maybe that was the person that raised us throughout our life. And so helping other people understand that this is a very deep connection for me, someone I cared for, tremendously, and so I have much more grieving to do around this death than I might for other individuals in my past.
CAVANAUGH: That's interesting.
MONTROSS: Helping people understand that.
CAVANAUGH: So the idea of making any kind of a generalization about the kind of grief that you should feel about the loss of a person that you loved is just wrong. People should not assume that you might expect your grandparents to pass and therefore that wound would be there, but it wouldn't be something that would change your life in a sense, but it often can, is the point you're making.
MONTROSS: Precisely the point. And in fact I would advocate as much as possible, particularly since so many of us want to help either friends or family members who are grieving during this time and joining the holidays and we don't quite know how to broach that, asking questions in a way that doesn't assume either a tremendous amount of grief or not. So for instance my suggestion might be to approach, let's say, your friend Linda and say Lind AI'm thinking of you, I'm wondering how you're doing during this holiday especially since it is the first time without -- Bill. I'm wondering if I could help, and even offering some specific help to that friend or loved one and say, you know I'm particularly good at gift shopping. Can I run to the fashion valley mall for you, and I know just what to pick out, and offering tangible ways that you might be able to help, and opening that dialogue for them so they can tell you either yes, this is tremendously impacting me or maybe share with you how they're managing this process right now.
CAVANAUGH: That is such wonderful advice, but it's so hard for people to do.
MONTROSS: It is.
CAVANAUGH: We would just really rather not make that phone call or just not mention what we know is causing someone a great deal of grief and sadness.
MONTROSS: Right, right and so I think taking the approach of letting that person know you're thinking of them and that you're acknowledging this may be the first holiday without that loved one, and saying that loved one's name, and then listening at that point. Because letting them tell you how they're coping with it can be really healing and powerful, and it can create a connection simply by you allowing the conversation to happen. But you're absolutely right. We tend not to want to even start that conversation and dance around it. And that can make it more isolating for that person.
CAVANAUGH: R there sometimes that a person who is grieving should just withdraw from celebrations and holiday traditions entirely?
MONTROSS: Keeping in mind emotions consume energy, and so as best as possible, planning ahead for those situations and taking a priority of what do you feel like engaging in? And maybe that's different this year than it was last year. So keeping in mind whatever you do this holiday doesn't mean you have to do it every subsequent holiday. But taking a clear inentory of what makes sense for your time and energy this year, and evaluating how much energy you may realistically have, particularly if you can plan extra time both before and after to prepare yourself for conversations that may be difficult or even situations that are more draining than normal and then allowing yourself extra time to unwind afterward is really important. Again, you may feel more drained than you had in the past as you try to cope with this new landscape.
CAVANAUGH: I think that most people realize, and you've touched on it here that grief can sometimes result in physical problems. You can get very depressed, you can have feelings of being overwhelmed, you can make yourself sick actually. So people obviously should be very attuned to how they're physically responding to events and holiday traditions.
MONTROSS: Absolutely. The body has a great way of telling us when we have needs. So certainly doing the best that you can to take care of yourself. And noticing, I think one. The keys, if there are activities that you normally enjoyed a great deal that now you don't have the energy for, I think that's a clear sign that the grieving process is in need of being addressed. It's those times that we know, otherwise we would have wanted to complete that activity and been at that party.
CAVANAUGH: In your work at San Diego hospice, you deal with people who are very ill quite often.
CAVANAUGH: I'm wondering what kinds of holiday traditions or gatherings can give a person who is dealing with severe illness some kind of comfort.
MONTROSS: I think most traditions that would incorporate a level of story-telling, a person who's quite seriously ill might not be able to physically engage in other activities that they would have in the past. So they're not able to make the stuffing that they've done for years. I hear that a lot. There must be a number of great stuffing recipes.
[ LAUGHTER ]
MONTROSS: But they can't physically make the stuffing the way that they used to. But engage with that person around what's in the recipe, how did they come to find that recipe, how that recipe been passed down across generations, and allow that person to tell some of the stories of their life and what's behind that, I think is a great way to engage those loved ones even if they can't physically.
CAVANAUGH: That's wonderful advice again. Now, I'm wondering if someone is listening to this or they know of someone who is grappling with feelings of grief during the holidays, how do they reach out for help? I mentioned that San Diego hospice not only helps families of patients but also the community at large.
MONTROSS: Absolutely. We are considered community-owned, we're not for profit, and the design is to serve the community at large, even if your loved one has not been on hospice service. We still provide individual counseling, group counseling, support groups related to grief and Los, and we serve over 12,000 individuals annually. So we certainly have the capacity and are very interested in assisting people.
CAVANAUGH: And is there a charge for this service?
MONTROSS: Some are free and some are low-cost or sliding fee scale. So we really try to accommodate as many people as possible.
CAVANAUGH: Let me ask you, how do you and your grief counselors deal with this? You hear so many stories of loss, so many people going through these incredibly challenging experiences. What do you do for yourselves?
MONTROSS: We try our very best to take care of ourselves, and we have support groups within our own organization where we can support each other and meet on a regular basis so that we can debriefcase, confidentially of course. But ways they have impacted us interestingly, in both good and bad ways. In some ways the work is absolutely difficult. But there are some cases where it's extremely rewarding, and we're so honored to be a part of people's live when they have these very vulnerable situations. So it's also a time for us to share that with one another as well.
CAVANAUGH: What are the signs that you would look for and advise other people to look for for someone who is dealing with grief and loss, and they seem to really be getting into trouble? They are not handling this well. And as we know, this time of year can also be one of excess as well. So what are the signs that someone really should be looking for some help?
MONTROSS: So certainly as you mentioned what may appear to be increases in depression, ways to look for that again, activities they would have otherwise engaged in and you know they loved and enjoyed. Maybe they were a jogger and all of a sudden they're not jogging anymore, and the tennis shoes are sitting next to the door. It's a clear sign that something has shift forward that person. I would also look for any feelings of worthlessness, helplessness, if they're expressing to you a sense of things will never get better, and in some of their language there's a sense of I don't know if I'll ever get through this. And if there's any sort of occupational decrease; or if some ways their occupation or social interactions are being affected. Ways that just aren't normally them, and it's impacting their job or friends or family.
CAVANAUGH: And then you go to them and you say what?
MONTROSS: I would again say I'm concerned about you, I've noticed -- and if you can, attach it to what the behavior is that you're aware of. In the jogging case, I'd say Bob, I've noticed you haven't run for three weeks, and you used to run every day. I'm just concerned. Is there something I can help with or is there something going on?
CAVANAUGH: Always offering that help in some way. Is there some way I can assist you, something you'd like to tell me or something I can do for you?
MONTROSS: Absolutely. And letting them know that from your perspective, they don't quite seem themselves. And that you love them, and you want to be of assistance.
CAVANAUGH: What's your final word? What would you like to say to those who might be dealing with loss right now and who are perhaps thinking of reaching out for help?
MONTROSS: That they are not alone. And that San Diego hospice offers support to them. We have over 35 counselors that can talk with people individually, in groups, in families, and support groups that can really be a way to connect with other people who are dealing with these very same topics. It can be very normalizing.