Like many single thirtysomethings, Elly Trickett had been through her share of dead-end relationships. So in February 2002, when Trickett, then 30, flew from New York City to Houston to meet David Monroe, a man she'd gotten to know through an online forum for public relations executives, she was hopeful but cautious.
"I figured we'd hang out and have fun, nothing more," Trickett says. Unexpectedly, sparks flew. "I loved everything about him — his broad swimmer's shoulders, his huge smile, his Southern accent," she says. "The two of us fell madly in love almost immediately."
After 18 months of phone calls and visits, David moved to New York. "We were so happy to be in the same place," Trickett says. "Every day felt like a gift knowing he was close by. I figured this was it. We'd be together for the rest of our lives."
Then, in July 2004, nearly a year after they'd moved in together, the two were riding the subway to work when David almost blacked out. He insisted he didn't need to go to the hospital, but Trickett wasn't taking any chances; he'd been born with one kidney, which later failed, and had gotten a transplant from his uncle when he was in his 20s. What if this was related?
Doctors confirmed that David's kidney had indeed failed and said he needed immediate dialysis. "It was surreal," Trickett says. "One minute we were having a normal day; a few hours later, we were talking about transplants." They reconfigured their schedules to accommodate David's new three-day-a-week dialysis regimen. "It was hard, but he'd been through this before and it turned out fine," she says. The couple even planned a visit to London for David's upcoming 32nd birthday, after locating a dialysis clinic there. "I had a feeling he might propose during the trip, so I was especially looking forward to it," Trickett says.
The weekend before the trip, David flew to Houston to visit his family. On Sunday, Trickett got a call from his mother: He had collapsed and was in the hospital. A half hour later, his sister called, sobbing. David had died, she told Trickett, but not of kidney failure (months later, they discovered he'd had an aneurysm). "I went cold and kept screaming, 'No!'" she recalls. "I was looking at a photo of him on my bookshelf and thinking, We've fixed everything else. We can fix this, too. My mind simply rejected the idea that he was dead."
Dazed, she called her mother and a few close friends, then crawled into bed around 1 A.M. "I didn't think I'd get to sleep, but I had a very vivid dream: I was lying in a field looking at the stars, and there was one bright star with a ladder down to Earth. David was in that star, smiling and reaching out to me," she says. "When I woke up, I felt comforted, and I was more able to accept the fact that he was really gone."
Even so, the days and weeks that followed were unbearable. "For the first few days, I cried almost constantly, and for two or three months, I had terrible gastrointestinal problems and I couldn't eat much. I lost 14 pounds," Trickett says. Nine days after David's death, she returned to work, worried she wouldn't be able to concentrate. "It turned out to be a blessing because it kept me busy," she says. Still, there were times she felt as if a vital part of her had been ripped away. "The person I was supposed to spend my life with was suddenly gone. To say I felt empty doesn't even begin to describe it. There was not nothing left; there was less than nothing."
A loss that everyone will experience
Each year, approximately 2.5 million people in this country die, leaving behind an average of five close bereaved friends and family members. Yet how people heal from the death of a loved one has remained largely unexamined since the most well-known book on the subject, Elisabeth Kübler-Ross's On Death and Dying (Scribner), was published in 1969. Kübler-Ross's theories continue to shape the way many experts believe grieving typically progresses, in five separate, successive stages: denial, anger, bargaining, depression and acceptance.
More recent research, however, suggests that for most people, grieving is rarely a straight passage through discrete phases ending in healing. Rather, it tends to occur in fits and starts, sometimes quickly, sometimes over a number of years. The way it unfolds varies dramatically, too, depending on whom you've lost and the nature of your relationship.
Perhaps more surprising, research suggests that whomever a person is grieving for —a well-loved parent, spouse, friend or child — human beings are surprisingly resilient. In a study of more than 300 mourners who had lost a spouse to natural causes, Holly Prigerson, Ph.D., director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston, discovered that while nearly all people go through a very rough period where they cry, long for the loved one, have difficulty eating and can't concentrate, 85 percent start feeling somewhat better in about six months. Even more hopeful, there are steps everyone can take to help the recovery process along, regardless of whom you're missing.
A new view of grieving
Like life itself, grief isn't something that unfolds neatly, starting on cue with denial and continuing until the mourner reaches the final stage — accepting that the person is gone. In her two-year study of mourners, Prigerson found that rather than denial or anger, most mourners feel an acute sense of yearning and sadness throughout that fades as time passes. "There's no orderly progression of Kübler-Ross's hypothetical phases," Prigerson confirms. "It's more accurate to say that the emotions associated with grief exist simultaneously, then slowly decline as feelings of acceptance rise," she explains.
Moreover, grief isn't something people simply recover from, like the flu. Experts now say that even those who regain their footing relatively swiftly may be struck by pangs of loss and sadness for years. A 2004 study in Psychological Medicine comparing 449 parents who had lost a child to cancer with 457 nonbereaved parents found that the risk for anxiety and depression was still high for mourning parents up to six years after a child's death; beyond that, it dropped to levels similar to those of nongrievers. "Fifteen percent of mourners struggle mightily to accept the loss, obsessing about their loved one and grappling with deep sadness or anger for a year or longer," Prigerson says.
Instead of encouraging those mired in depression to "get over it," experts now view such intense and prolonged yearning as a sign of a condition known as complicated grief. Some psychologists are trying a novel type of therapy to break the cycle of sorrow: Among other things, a therapist asks the mourner to describe her loved one's death; the patient then takes a tape of the session and listens to it at home, over and over, the aim being to gradually help the grieving person accept it. When researchers tested the approach on 95 people with complicated grief, 51 percent responded well compared with only 28 percent of people in traditional psychotherapy, the more common method. "Some people told us that when they listened to the tape, they finally believed their loved one was truly gone," says the study author, Katherine Shear, M.D., the Marion E. Kenworthy professor of psychiatry at Columbia University School of Social Work in New York City.
A bond with the beyond
Another shift in the way psychologists think about grief is that instead of viewing bereavement solely as a process of letting go, experts now contend that it's equally important to create a new relationship with the deceased. This need to form a "continuing bond" is less well accepted in our get-over-it culture, but it's increasingly seen as essential to healing.
"Grief isn't only about mourning — it's about restructuring your identity and life after someone you love has died," Prigerson says. Rather than squelching their sadness and emotions, "the central challenge for mourners is to move from loving someone who is present to loving them even though they're absent," adds Thomas Attig, Ph.D., author of The Heart of Grief: Death and the Search for Lasting Love (Oxford University Press). "Lots of people talk about closure, but that's a fantasy. Death ends a life, but it doesn't end the relationship."
Tanya Lord, 40, of Nashua, New Hampshire, was nearly incapacitated for more than a year after her 41/2-year-old, Noah, asphyxiated on blood following a tonsillectomy in 1999. "After he died, I wore the same clothes for a week and prayed I'd go crazy so I didn't have to deal with the pain," she says. Because she'd been a stay-at-home mom and Noah was her only child, she lost more than a son; she says she lost her sense of self, too.
"My life had been about Noah, feeding and bathing him, taking him to playgroups. When he was gone, I remember watching cars and people outside our window, thinking, Don't they understand the world has come to an end? I had nowhere to go and nothing to do and few people to turn to because other parents don't want to talk about a child's death. It's too scary."
'They don't understand the guilt'
It wasn't until she went to a support group for bereaved parents six weeks after Noah's death that she found the empathy and understanding that sustains her to this day. "Those meetings became the place I could say, 'I like to lie down in the spot in our family room where Noah died so I feel closer to him,' and people wouldn't look at me as if I was crazy," she says. "A few months after you lose a child, people start encouraging you to move on. They don't understand the guilt when you begin to be happy again, because it feels as if you're forgetting your child."
Yet people who laugh while talking about a deceased loved one may experience less anger and distress and enjoy better social relations than their more somber peers, according to a 1997 study from the University of California at Berkeley and the Catholic University of America in Washington, D.C. "It's understandable that mourners feel guilty when they laugh in the days after someone dies, but laughter reduces stress; it's a sign of healthy coping," says study coauthor George Bonanno, Ph.D.
Of course, giving in to grief can be comforting as well. "There are times I feel an attack of sadness coming on and I figure, well, if I'm going to be upset I might as well do it properly," Trickett says. "So I'll pull out old photo albums or David's letters and cry myself insane. Giving myself the opportunity to lose it is very healing. Afterward, I feel like I can get on with things again."
Memory, Attig confirms, is the place the relationship resides and can thrive. "The world is full of reminders of the person — the foods they liked, their favorite chair," he says. "At first, these may seem too painful to think about. But if you reach through the pain and let your mind go there, memories can be a comfort; they make it feel as if the separation isn't as final."
Lord says she began healing when she realized she could keep the memory of Noah alive yet still be engaged in and enjoy life. She and her husband talk about their son often and even bake a cake for his birthday every year. "Most people would think that's going overboard," she says. "But it's important to us to honor the day Noah was born, even if he's not here to share it."
Dealing with unexpected emotions
Facing the past doesn't feel comfortable for everyone. Emily Voelker, 30, has only recently started untangling the complex feelings she tried to ignore after her older brother committed suicide more than a decade ago. "I pushed the grief deep inside," she says. "I went to college soon after it happened; no one knew me, so it was easy not to tell anyone."
But in the intervening years, Voelker realized that her grief was seeping to the surface in other ways. "I'd get irritated easily, like bursting into tears if I locked my keys in the car," she recalls. "I'd get into screaming matches with my mother." So she started seeing a psychologist to help her open the vault where she'd stored all her complicated emotions about her sibling. "With suicide, there are so many elements — guilt, anger, the stigma," she says. "You say 'cancer,' and people at least get it. You say 'suicide,' and they draw in their breath; they're more shocked than sympathetic. I quickly learned from experience how tough it is to talk about, so I stopped doing it."
Voelker's reaction may be common among certain types of mourners. "Sudden, violent or traumatic deaths are frightening for everyone. Many times people in the griever's family and community don't know what to say or do to help the individual, and may pull away as a result," points out John Jordan, Ph.D., a psychologist in private practice in Wellesley, Massachusetts. "As a result, certain types of mourners-parents who have lost children and relatives of suicide or homicide victims-may need outside assistance, whether counseling or a support group."
Surprisingly, other types of mourners may not benefit from professional help: A 2003 report by the Center for the Advancement of Health in Washington, D.C., finds that grief counseling (one-on-one or in a group) doesn't necessarily reduce symptoms in most adults experiencing normal grief.
Finding meaning in loss
Indeed, for many people, it's not therapy but spirituality that provides a natural context for connecting with those they've lost. A study in the British Medical Journal of 135 relatives and close friends of patients in hospice care found that those with stronger beliefs felt more resolved in their grief 14 months after the death than nonbelievers did. "When bad things happen, the mind tries to cope with the emotions by interpreting the event in a way that's understandable, say, by telling themselves that the deceased is now at peace," according to W. Richard Walker, Ph.D., professor of psychology at Winston-Salem State University in North Carolina.
Similarly, many people console themselves by actively transforming a death into something larger. When Mary K. Talbot, 44, of Barrington, Rhode Island, lost her first baby, Lucas, for no discernible medical reason shortly after his birth, she was devastated. But she and her husband immediately threw themselves into raising money for the neonatal intensive care unit at the neighborhood hospital, among other projects. "I wanted Lucas's life to have some greater meaning," she says.
For her part, two years after Noah died, Lord and her husband adopted two boys from Russia-a move that was, in part, inspired by Noah himself. "Ultimately, I didn't want my child's legacy to be this broken, damaged mother," she says. "I realized that I could do a better job of honoring his memory by living my life fully, rather than letting myself be consumed by grief."
Part of grieving, Attig says, is returning to and rediscovering the things about your old life that still work and give you a sense of purpose — your close relationships, your career, your passions. "But many people find and make new connections in ways that wouldn't have occurred to them before the loss," he says. "At first, it seems impossible that you'll ever feel anything but pain. But people can and do grow positively through the experience."
Elly Trickett says her inner strength and resilience have surprised her. "About two months after David died, I had to take a business trip to Atlanta, and that was the first day I didn't have a big cry," she recalls. On New Year's Eve of that year, Trickett swapped her waterproof mascara for regular, a milestone, she says. And in another symbolic gesture, she bought herself an opal ring, David's birthstone. The inscription on the simple gold band reads My darling Texan: We both loved more. "The two of us used to find silly, wonderful ways to prove that each of us loved the other person more; with this, neither one of us gets the last word," she says.
As it turns out, a few months after David died, Trickett met someone online. They started seeing each other on weekends, and to her utter astonishment, she fell in love. "Sean is an amazing, compassionate man," she says. "He wanted to be with me even though he knew I was still in love with David. Instead of trying to take my mind off the grief, he was simply there for me." Within a year, the couple moved in together; in November 2006, the two were married.
"My life isn't perfect now," acknowledges Trickett, whose grief still ambushes her at unexpected moments. "I'll notice the leaves changing color or see the first snow and feel overwhelmed by the idea that David isn't here to enjoy it," she says. Still, although Trickett says she will never get over losing him, "I know he would have wanted me to be happy. When I lost David, I thought my life was over. Now, I have so much to look forward to."