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Rituals to Navigate Unwanted Change

It’s tempting to erase a broken past, but the goal of a well-designed ritual is not to remove a painful past, which would only serve to reinforce denial or other “flighting” behaviors.

Soul Injury, Moral Injury

Rituals to Navigate Unwanted Change

by Deborah Grassman

It’s tempting to erase a broken past, but the goal of a well-designed ritual is not to remove a painful past, which would only serve to reinforce denial or other “flighting” behaviors. The goal is to develop a different relationship to the past and instill confidence that the participant(s) can reckon with the past by using it to give their future new meaning. It encourages participants to redeem their suffering with new insight from lessons learned. As a result, their destiny is reshaped.

The stages of ritual also correspond to how we interpret time: past, present, and future. The first stage of a ritual (separation phase) reflects a new willingness to abide with the past, acknowledging the specific brokenness that was incurred. The next stage (transition) highlights the present, where a releasing of the past is done and there is a reckoning with the uncertainty and ambiguities of the present. The last stage of integration expresses a decision that beholds hope for a different future.

Therapeutic Rituals for Professional Change

I have used rituals professionally when difficult transitions were needed. When our oncology unit developed the hospice program, we didn’t anticipate the strife and division it would cause the staff. Creation of new programs with different patients upset the usual pattern of care. Tension and arguments ensued as staff coped with the change. Staff were reluctant to let go of their identity as oncology nurses and expand into the identity of oncology and hospice nurses. The new identity was necessary for the unit to function successfully.

I designed a therapeutic ritual to promote the inward changes needed to incorporate the larger identity that was needed. During the separation stage of the ritual, each staff member recalled a cherished memory, said good-bye to “the good old days,” and acknowledged the difficulty and pain of doing so. Each proclaimed a desire to grow into a new identity that included hospice nursing. Each brought spiritual readings and songs that reflected letting go and saying good-bye. During the transition stage, the anxiety of journeying into unfamiliar territory was acknowledged. Songs and readings that reflected a willingness to stay open to the uncertainty were articulated as well as a willingness to suffer required changes. Each person acknowledged the difficulty of changing and identified something they needed to do to make the transition into hospice nursing. A circle was formed with each person lighting a candle, saying, “A heart that is willing to suffer is a light to the world.” The integration stage included receiving a small footprints pin with the words, “Know that your journey is sacred and that your footprints are holy.” Songs that appealed to the hope of living from our larger selves were sung; a final blessing dispensed.

There were many tears during this ceremony. There was also much change because there was no longer a need to fight or resist. Problems still arose, but they were dealt with openly and with understanding. I subsequently modified the ritual and used it at the conclusion of each “Living and Dying Healed” course I teach.

Therapeutic Rituals Surrounding Illness and Death

Rituals are enacted at time of death on our Hospice unit. These rituals are especially important in our under-ritualized, death-denying, “we-don’t-need-a-funeral” culture. A flag quilt replaces the blanket on the bed while family has time with their loved one’s body. The body is then transported to the morgue under the flag quilt. As the body passes down the hallway, people often turn toward the passing guerney and pay respect with a salute. The patient is also honored with a rose and footprint with his/her name and date of death placed on the empty bed. The six-inch footprints are made by staff from baked dough. When the dough hardens, it is painted. These footprints honor the veteran and also highlight their separation from us. Other patients see the footprint and anticipate that they, too, will be remembered and treated with respect. This footprint also acts as a trigger in the environment for them to anticipate and prepare for their own deaths. The footprint remains on the bed until another patient comes to occupy the bed. Then it’s moved to a wall in the hallway that depicts a rainbowed road with the inscription, “Together we walk, one step at a time.” The wall with all the collected footprints acts as another trigger in the environment for death preparation. In November, the footprint is moved to a holiday tree and later given back to the family members at a holiday bereavement program.

Another important ritual occurs with the family at time of death. After a loved one’s death, an electric candle is lit with the family. The pain they are feeling is acknowledged. The courage to let go is affirmed. Family members are encouraged to tell a few of their favorite stories about their loved one. Each is then asked to write a message to their loved one on the back of the patient’s namecard, one more opportunity to address “unfinished business.” The card is placed on a stand in front of the candle. A prayer or reading that offers hope and support for continuing without the loved one is provided. Marianne Williamson’s book of spiritual prayers, Illuminata, is often used. It has one section devoted to prayers for use in therapeutic rituals. A pin with three footprints is then pinned on each person with staff providing a message of hope. “One footprint is yours. One footprint is your loved one’s. The third footprint represents all the people who are willing to help you walk this painful part of your journey. May each time you see these footprints, you know you are not alone. May you have the courage to ask for help when you need it.” As modern culture continues to devalue grief, as mourning is shortened from months to days, and as funeral services are eliminated, this ritual becomes increasingly valued.

We use ritualized formats that incorporate the three stages of change for several bereavement events. On Memorial Day, we use a ritualized format to provide bereavement care at a picnic. We hold a Memorial service every four months to honor all the veterans who died in the Medical Center. Pat developed the following ceremony that has been particularly effective:

(Pat) “When I look at all of you here today, I feel very grateful both for this opportunity to honor your loved ones and to be able to share with you in your grief journey.  Gerald May, an authority on grief said that, “although grief may be the single greatest pain you will experience in a lifetime, it is a pure expression of love.”

“Love in our culture is frequently depicted as warm summer days at the beach without bugs or blowing sand.  You all know that love is much more than that.  In the circle of life, love is experienced as joy and happiness at times, familiarity and routine at other times, and painful bumps in the road at still other times.  Each of these needs forces your love to resiliently change shape to accommodate. Sometimes these adjustments come so fluidly and imperceptibly that we hardly notice.”

“At the close of the circle of life however, the transformation of love to grief is profound.  This hospice team is privileged to walk with many of you as your loved one’s circle reaches completion.  We are there as the very stuffing of the heart begins to pour out and the transformation begins.” 

(I begin to turn the heart inside out, spilling out denial, anger, jealousy, and guilt)  “Feelings we don’t want to feel begin to spill over as we fight the inevitable.  Finally at the moment of death, the heart strings which are so entwined with one another are tugged and tugged until the heart that is left behind is turned inside out.  Love has changed form to grief.”  (I hold the inside out heart with it’s strings dangling for all to see.)

“I have spoken with many of you since the deaths of your loved ones.  You describe the many symptoms that you are experiencing.  You question your very sanity.  There are many symptoms of grief.” (The final stuffing to leave the heart contains the physical, emotional, and spiritual symptoms of grief.  I discuss each.)

“Ok, your love is turned inside out, your tears are beautiful expressions of the love, and you are not crazy.  But now, how do we adjust to the world without our loved one in it?  How do we deal with this pain and loneliness?  What will help you get through?  Who can help?” (The healing tools have been distributed in advance to staff and volunteers in the audience. When I say “who can help”, they begin to bring helpful tools like grief groups, tears, friends, etc. which I discuss while they place stuffing back into the heart.  Some of the things they bring (drugs, isolation, denying feelings) do not fit in the heart and actually prevent any of the healing components from getting through.  Eventually, the heart regains its shape, it does not look the same, but it looks like a “Heart”)


Denial – “This can’t be happening!”

Anger- “Why is this happening?!?”

Jealousy – “Why can’t my life be like ________?”

Guilt – “If only ______, this would not be happening.”


Spiritual – doubt or anger at God

Emotional – depression, panic, anxiety, hallucinations,

suicidal thoughts.

Physical – Pain, insomnia, forgetfulness, restlessness,

lack of concentration, confusion

Describe when these things are normal and when they are not.


Goodbye – it’s never too late to say goodbye. We say goodbye to the

physical presence, not the love.

S.T.U.G.s – Sudden, Temporary, Upsurges of Grief

Healing Grief Groups – free at most hospices

Gracious Receiver- people want to help, let them, tell them what

you need.

Tears – The only bad tears are the ones you do not shed. Healing

Anniversary/Holidays – hard to get through.  Make a plan.

Memorial Services – come together with others to honor/share pain

Laughter – heals

Forgiveness – never too late to forgive.  Letter writing.

Rest – emotional surgery

Prayer and God – crying in church

Small pleasures – sunsets, candles, flowers

Good and bad days – let yourself feel good when you can

Friends and family – double edge sword (choose who can help)

Precious memories – those that hurt the most at first may be most

comforting later.


Isolation – OK to be alone, but people need people

Denying feelings – “we weren’t close” can’t heal what we can’t feel

Drugs/Alcohol – prevents healing, keeps us stuck in grief.

Closing (Pat): “Grief will be different for each of you.  It will take as long as it needs to take.  It is work!  Perhaps the goal of the work can be a tribute.  The greatest tribute we can give a deceased loved one, a full and happy life. You will never forget your loved one.  A Native American medicine man once said, “If the dead be truly dead, why should they still be walking in my heart.”  Love is resilient.  Love transcends death and the love you shared will live on with you forever.”


The Grief Recovery group also uses rituals to process grief. Bereaved group members finger paint a picture that reminds them of their loved one. One by one, they light a candle and explain the picture to the group. They also tell their loved one whatever they want them to know or they speak any unfinished business. Then they blow the candle out, while being affirmed that they can meet the challenges of a new world without their loved one in it.

When employees die, especially if it’s an unexpected death that leaves unfinished business, I meet with the employees on that unit. A candle is lit, and a memorial card with the person’s name and date of death is given to each person. They write their good-byes on it during the opening separation stage. During the transition phase, a picture of the deceased or some other object is passed and each person recalls a story about the deceased person. In the integration phase, each person identifies one quality of the deceased they are willing to let inspire them.


Talking Stick-A Native American Healing Forum

Learn how Native American tradition of a Talking Stick can help others speak honestly and listen without pretense or judgmenet.

Healing , Rituals, Myths, Ceremonies , Soul Injury, Moral Injury

Talking Stick-A Native American Healing Forum

When they come to powwow, Native Americans pass a “talking stick” to everyone gathered within the circle. About a foot long, it is often adorned with beads and feathers. Two rules are observed: only the person holding the stick at that moment can speak, everyone else must listen; whatever that person says while holding the stick has to be truthful, no pretenses or coverups.

I recognized the power of this format to elicit deeper and more meaningful stories that can emanate from the hero within. The format also levels the playing field, equalizing the power for all participants regardless of position; no voice dominates, and no voice is excluded.

At our first meeting, we didn’t have a stick. A smooth, black rock was on the table, so we used that. It became our touchstone. I added two rules of my own: “We are free to pass the rock without speaking; no apology needed. Also, we must resist the urge to give advice or philosophize. Instead, we each tell a personal story or experience about the topic.”
Monthly sessions usually start by asking if anyone is seeking counsel. Someone identifies a need, and the touchstone is passed. Sessions have included multiple themes. One staff member spoke of a family death, and the rest of us responded with our own stories of recovering from a death or loss.

Another time a nurse said she was feeling “lost,” which elicited stories when others felt lost and uncertain. One nurse said she was having difficulties with a family member’s alcohol usage; the rest of us responded with our own stories of how alcohol had wounded people we loved.
An adult son moving back into a parent’s home prompted story-telling of lifestyle changes and boundary setting with older children.
One session responded to the need of a staff member whose young adult son had stopped any contact with her. All responded with stories of children (sometimes themselves) rebelling against parents. One staff member noted changes in health as she aged, realizing that she might need to consider retirement. The rock was passed to gather stories about our own experiences of aging and illness. It is not unusual for various aspects of Soul Injury to surface.

Sometimes the sessions might involve confrontation. Marie privately confronted Jane about Jane’s anger. Jane was surprised, expressing little insight into its cause. In a subsequent pass-the-rock session, Jane asked for stories about how the rest of us fight or flight anger. As a result, she realized that she camouflaged her anger with chaos and drama. Her journey to meet her shadowed anger is now depicted with a graphic on our Old Rugged Path. It shows a woman sternly pointing her finger, saying: “Hello anger. I’ve tried every way I know to ignore you. I prefer to get dramatic instead, saying I was ‘ruined.’ I’m reclaiming my power now. I wasn’t ruined. I was angry. I can say it instead of being defeated by it. Hello anger. You’re my new friend.”

We don’t always talk about personal issues. Sessions might address conflicting feelings about taking care of a difficult patient: “What inside me keeps me from loving this patient? What keeps me from responding graciously? What button is this patient pushing inside me and why?” Once there was a general climate of grouchiness on the unit. Staff chose to address it by inventing a “grouchiness scale.” Zero was mellow and 10 was irritable and grouchy. Then each of us was asked to address this further: “I’m a ____ right now. What I need to do to lower that number by one is ______.” Sometimes questions focus on issues our patients struggle with: “A time when I hid behind my stoic wall when it would have been better for me to come out is ________ ;” We also did “A time when I let my feelings misguide me rather than applying stoicism so I could accomplish my goal was _______.” And, of course the question we ask all our patients is most important to ask ourselves: “If I died today, what would be left unsaid or undone.”

Sometimes we work too hard; play gets stuffed in our shadow. That’s when we start a session with: “A story that always makes me laugh.” By the time we’ve all had our moment with the rock, we’re usually laughing so hard we have to choose between holding our bellies or wiping away the tears.

There has been little overstepping of boundaries. Self-controlled disclosure creates an atmosphere for safe and comfortable sharing. I’m thankful that Native Americans understood the wisdom of this powerful and meaningful forum for connecting and growing together, drawing out deeper insights from within.

The touchstone has collected hundreds of stories over the years. Wisdom is found in stories because stories have value beyond facts or biographical information. “The story is not told to lift you up, to make you feel better, or to entertain you. The story is meant to take the spirit into a descent to find something that is lost or missing and to bring it back to consciousness again,” writes Clarissa Pinkola Estes. She’s right. Stories are healing; they restore wholeness to our fractured selves. They help us find ourselves. There’s always room for each of us in a story, even though it’s someone else’s story. It reminds me of something I read: “We comfort others not from the foundation of our superior faith, but from the commonality of our mutual struggles.” A good story almost always has a “mutual struggle” that connects each of us in the “common-unity” of the community.

Insight: Veteran Bereavement Letter

Sometimes, providing the Veteran perspective can provide healing for bereaved families of veterans.

Forgiveness, Guilt, Shame , Grief, loss, Transitions , Healing , Soul Injury, Moral Injury , Veterans, First Responders

Insight: Veteran Bereavement Letter

by Deborah Grassman

Ben, a friend of mine, was a World War II veteran. Over time, I came to see how stoicism, PTSD, and Soul Injuries had impacted his life. When Ben died, I met his five adult children, all of whom lived out of state. I could see that some of them felt distant from their father. I could also see that they really didn’t grasp the importance and relevance that the military had in shaping their father’s life and their own lives. I wrote them a letter to offer insight that might provide a healing perspective for how the effects of the military had impacted them. Later, I learned from Ben’s wife that this letter helped their children to better understand their father. It also helped one daughter to stop blaming herself for her father’s emotionally-distant treatment of her in her childhood, causing an insidious Soul Injury

This is the letter:

Dear Susan, Greg, Jane, Paul, and Amy,

As I came away from the funeral service last night, I was left with a desire to share my own story about your Dad. I have known your Dad for the past 10 years as part of our church community. He started a small group in his home, and we have been meeting monthly since that time. Your Dad was careful to say in the first meeting that this would not be the kind of meeting where people “spill their guts,” and your Dad kept his word about that for five years. One night, however, your Dad started talking about the death of your sister. As he spoke, it became apparent that the death of this daughter at age five had been deeply disturbing, though he had never let himself grieve. Instead, he had boxed up his pain, hoping it would go away. Now, 40 years later, here it was again. This time though, he let himself feel his pain. He told of his despair over losing a child at that tender age, and he let himself cry. He was embarrassed at first, but soon the emotion gave way to the sobs of tears he had held back so long. Your Mom said it was the first time she’d ever seen him cry. I think your Dad was a little different after that day. A part of his heart was unlocked and his sharing became more open, his feelings expressed more freely.

I also think of your Dad at our 4th of July party. We did a tribute to the veterans for the freedom we were celebrating that day. I called the three veterans who were at the party to the front of the group and seated them in places of honor. Then we sang God Bless America and saluted them, which meant a lot to your Dad. Your Dad sacrificed a lot for his country. He bore a lot of physical and emotional scars from the war. Those scars are what I thought of last night when I saw the flag draped across his coffin.

I learned more about your Dad’s struggles after the war when I visited him in the hospital last week. He wasn’t taking any painkillers for his pain. He said he wouldn’t have anything to do with morphine. Then, he told me the story of how he had become addicted to it with his injuries during the war. He said that there weren’t facilities during wartime for fixing the injury. Instead, he said the soldiers were “doped up” until medical services could be provided. After being on morphine for many months, he got hooked on it. After his injuries were repaired and healed, he continued on the morphine. He told me about a time when he beat up a pharmacist friend of his to get more. He said that was about the “stupidest” thing he ever did and was deeply ashamed, but it served as the wake-up call to kick his habit. He kicked it the only way he knew how. He went off into a cabin in the woods. He stayed there by himself and sweated it out. Your Dad said it was pure hell. He sat with a loaded gun to his head and his finger on the trigger for many of those days. I think it was a combination of will power on your Dad’s part, defiance toward his father, and faith in God that kept him from pulling that trigger. At any rate, as I listened to your Dad’s story, my respect for him deepened. I had a greater appreciation of his stoicism. I had a deeper sense of who he was and why he was.

Your Dad had a hard life. And I think these last 10 years after he retired enabled him to let the grizzly bear in him fade and the tender teddy bear emerge. These were years when your Dad softened with age so that insight and wisdom grew, and pride and introversion faded, years that softened the blows in life that your Dad had to face and the hardness that it took for him to face them. My hope is that through his death, you will have a deeper sense of his life, a deeper sense of his love for you, and a deeper sense of yourselves.


You can receive free pamphlets from your closest Dignity Memorial funeral home. Use them to educate Veterans’ families. You can also download the pamphlets below by clicking on them.

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Bereavement Care for Veterans and Their Families

Sometimes, military culture can complicate the grieving process for the families of veterans who have died. This article by Pat McGuire explores those challenges.

Caregiving , End-of-Life Care, Hospice , Forgiveness, Guilt, Shame , Grief, loss, Transitions , Healing , Rituals, Myths, Ceremonies , Soul Injury, Moral Injury , Veterans, First Responders

Bereavement Care for Veterans and Their Families

by Patricia McGuire
Veterans and their families need the same things non-veterans and their families need when a loss is experienced: comfort, sympathy, emotional support of friends and family, knowledge, coping skills, time, and healing. The military culture, however, can create special grief needs as well. Complicating bereavement matters further, Soul Injuries tend to surface at the end of life for the entire family.
Stoicism, while a needed quality for an operative military, can be a hindrance in grief. Stoicism may cause grief to be hidden behind a silent or angry facade, cavalier humor, an attitude of bravado, or an “I’m fine” wall of denial. Stoicism not only affects veterans, it can affect whole family systems. One woman spoke of her friend who was married to a career Marine. She described the woman’s stoicism: “She is as much a Marine as he is. When her mother died, she was expected to grieve quickly and return to normal functioning in short order. She did.” Twenty years later, however, her mother’s death was reactivated when her husband died. This time, I gave her permission and encouragement to grieve and to take the time she needed to grieve both of these losses.
In addition to stoicism, “career-military” family systems may present special considerations. The family may have lived in numerous places for short periods of time, and this impacts family in several different ways. For example, at one veteran’s deathbed, his adult daughter identified for the first time where her bitterness for her father had begun: “It was the five different first grades I went to.” Because staff had been trained in veteran-specific issues, his daughter made this discovery as part of her anticipatory grief. She had the opportunity to work through this issue and the wall it had created before her father died. I acknowledged the patriotism and sacrifice that her entire family had made, which allowed the daughter to change her relationship to her past. This change helped her let go of some of her anger and open up to her father in a new way. Her grief after his death was facilitated by acknowledging the ways that this early loss affected her life and her perception of her father, which helped her deal with those losses prior to her father’s death.
Another issue which may arise with career-military families is that when there is a death or major loss, the family may find themselves far away from their family and support system. Because military families have not established roots, there may not be a network of support that facilitates effective grieving. On the other hand, because of these frequent moves, families of veterans may readily reach out for support because they have learned how to ask for help and form new bonds quickly. A Greek war bride from World War II cried at her husband’s death bed: “I have no family, what am I going to do?” I anticipated the possibility of complicated grief due to lack of support. An hour later, however, I found her in the hospice kitchen, with five lifelong friends from the Officers’ Wives Club. It was every bit a supportive family, just a different kind. Conversely, a young Vietnamese wife who barely spoke English said: “We did everything together. We are each other’s world.” This veteran’s isolation excluded everyone except his wife, leaving her unprepared for his death. She was at high risk for complications of grief and required extensive support to find her way materially and emotionally after his death.
Consider a third young American bride living in Germany while her husband served in Afghanistan. He was due to return in time for the birth of their first child. Unfortunately, the young woman went into labor early and their child was delivered stillborn. She was far from home, family, and anything familiar as she struggled with her overwhelming grief. Her husband returned to her as soon as possible, which in this case was a week later. He was grieving the loss of their child, feeling like he deserted his platoon, and struggling with symptoms of Posttraumatic Stress Disorder (PTSD). She was grieving the loss of their baby, the loss of innocence that she saw in her husband, and changes within her own body. This couple required intensive support as they faced their changed world. Their return to home was delayed due to legal issues related to transporting their child’s remains from one country to another. Plans had to shift to assist her parents to travel to Germany. This whole family system needed extensive support due to the complexity of the situation.
In her book, Peace at Last: Stories of Hope and Healing for Veterans and Their Families, Deborah Grassman explores the impact of military service on veterans at the end of life. She offers insight into some of the possible effects of combat on veterans and their families. Providing the book for family members to read helps them better understand the military influence on their loved one, their family, and themselves. This enhanced understanding can facilitate peaceful life closure and more effective grief recovery.
Veterans may gain a deeper appreciation of life by surviving combat and recognizing each day as a gift. Others may superficially integrate their experiences and carry on with their pre-war lives after returning from war. A third group may be changed by their combat experience and be unable to effectively cope. These latter two groups’ coping styles may adversely affect the family. Veterans in the last category may have struggled for years with bouts of depression, anger, nightmares, or from being overly protective or controlling. The veteran may have coped by using drugs and alcohol, or might have isolated himself in order to feel safe. Families living in this environment may have been abandoned, abused, or developed dysfunctional coping mechanisms to deal with these behaviors. This kind of lifestyle might precipitate divorce, creating multiple families by the time the veteran comes to the end of life. A common saying among Vietnam vets that overly simplifies this issue is, “Most veterans with PTSD have been married three times.” There may be three different sets of children at a veteran’s death bed. Perhaps their first family was abandoned when the veteran first returned home from war and he was unable to reconnect with them. These children may be angry. When the veteran remarried and started a second family, these children may have lived with abuse, drugs and alcohol, and developed dysfunctional coping mechanisms. After a second divorce, the veteran may have gotten into an addiction recovery program, as well as received help for his PTSD. A third marriage is often to someone who already has children. These children may reap the benefit of the veteran’s recovery and think their stepfather is very special. Imagine this veteran’s death bed with all of these family members present! Providing support for all of these family members with a wide range of forgiveness, estrangement, and anger issues creates a highly-charged environment for needed therapeutic work in order to facilitate some resolution. I strive to keep my heart open to all of these different family members and recognize each of the particular losses and relationships with this veteran. The past cannot be changed, but new understanding can help to change their relationships to the past.
When there are multiple families, judgments about one another are often passed. Guilt, shame, and blame are often the fuel that has been used to avoid the pain of the underlying loss of healthy relationships. This can negatively impact decisions that need to be made as the veteran is approaching the end of life. For example, the person who is legally able to make the decisions for the veteran may be someone from whom the veteran has been estranged. The current significant others of the veteran may find themselves disenfranchised at the time of the death, funeral, and burial. Another common contention after the death of a veteran with this kind of multiple-family constellation is: “Who gets the flag?” There is one flag provided for each veteran, yet there may be more than one person who feels that they deserve it. In these situations, it can be helpful to work with the VA’s office of Decedent Affairs, also known as the Details Clerk, to arrange for the provision of more than one flag.
Presentation of the flag in a respectful manner is of the utmost importance. Because many families today choose cremation, there may or may not be a funeral or memorial. In these cases there is not a formal presentation of the tri-corner flag to the next of kin. One VA nurse saw a family leaving the details office after their loved one’s death with a flag in a small rectangular box. He was upset by this “indignity” and called the team together to find a way to correct it. The solution was found when the Korean War Veterans Service Organization (VSO) agreed to use this need as an opportunity. The VSO provided education to a local Boy Scout troop about proper flag etiquette and flag folding. The Boy Scouts now meet bi-monthly with the VSO to fold flags. Together, they have maintained a supply of folded flags for that VA facility. The flag is now formally presented in a dignified way to the family at the time of death.
Other family members might have anger or bitterness about their veteran not getting a medal, service-connected disability, or pension. These feelings can interfere with effective grieving: “Dad was wounded in combat and he never received his Purple Heart. They lost his records.” This veteran and his entire family had chafed over this injustice for many years. After his father’s death, one son doggedly pursued his father’s records until the Purple Heart was awarded posthumously. This act helped the family begin to move through their grief. In a similar situation in which the Purple Heart could not be obtained, Deborah Grassman, their nurse practitioner, made a “purple heart,” ceremonially pinning it on the veteran while citing the heroic deeds that he had done. The bereaved family survey subsequently identified this act as extremely meaningful.
If PTSD is identified for the first time as a veteran is dying, the impact on family needs to be factored into their bereavement needs. Some family members feel relief: “I’m so glad to know it has a name. I knew something was wrong but I didn’t know what. Now this makes sense.” Other family members might feel guilty: “I wish I would’ve realized this sooner, I would have_________ (listened more carefully, gotten him help, been more patient and understanding, etc.)”
If the veteran had PTSD, physical or mental disability, or long-term illness prior to the death, the family member may be exhausted from providing care; they may not have the energy to grieve. In her book Chronic Sorrow: A Living Loss, Susan Roos (2002) writes about “significant losses with no foreseeable end” in the context of children with disabilities. Veterans and their families may share a similar experience. This may lead to frequent periods of sadness with no stable periods to allow time for grief and adjustment.
The family may have financial concerns near the end of life. For example, if the family has been supported by the veteran’s disability check, they may want extensive futile care because they do not know how they will survive without the veteran’s check. They may have provided care for the veteran for years and thus been unable to maintain work outside the home. It is important to acknowledge the reality of this practical consideration and recognize that the family’s questions about money may not indicate a lack of love, but instead may be a first step in providing the practical groundwork for their future welfare and their ability to grieve. Providing social work services can help the family with financial strategies and resources. The veteran may also be concerned about the financial plight of their family after he or she dies. This concern might cause the veteran to fight death so the disability check continues. One veteran lived for 40 years as a quadriplegic in a VA nursing home. He said, “My job is to stay alive as long as I can so my wife will have the money to raise our kids.” When he died, his family spoke of “growing up at the VA,” and there were as many staff mourners as family at the memorial service. Many such families have provided care and support for their loved one for years with little or no recognition. Acknowledgment of their patriotism and a word of gratitude for the sacrifices they have made may bring tears to their eyes. Those tears often represent the internal healing that is taking place. We developed a ritual that recognizes the family members who have been caring for veterans by pinning them with a small patriotic angel dressed in red, white, and blue. The family is thanked for their sacrifices and service to America by providing care and support to their veteran. A small card is given to them so they will remember the meaning behind the pinning. The card reads: “Caregivers are important too! Because we know you have also paid a price for our freedom, we honor you with this pin. It’s our way of acknowledging the many ways you’ve been impacted by the military and also the many ways you have provided care to our veteran. We are grateful.” (Go to “resources” tab for information about how to obtain pins).
Caregivers are 93% female. Most caregivers are spouses (72%) and parents (12%) (National Alliance for Caregiving, 2012). Today, there are more services for family caregivers than ever before. All VA medical centers now have Caregiver Support Coordinators (Johnson, 2012). They are experts on caregiver issues and are knowledgeable about VA and non-VA resources. They manage a menu of options to support veterans including in-home care service, respite care, needed equipment, home and automobile modification, peer support, and caregiver support groups. The VA also runs an interactive website for caregivers ( The Primary Family Caregiver Benefits include a stipend (post-9/11) paid directly to the caregiver, which is centrally funded and managed. The caregiver may be eligible for health insurance through CHAMPVA (a health benefits program through VA), travel, lodging, and mental health services through VA or by contract. This kind of support allows veterans and their families to have more time and energy for their bereavement and emotional needs.
In addition to needing support when a veteran is facing illness and death, family members may also need help in understanding a veteran’s response to loss. A veteran’s inability to grieve someone’s death might be due to their fear of unresolved grief from comrades who died in combat, and this fear can sometimes cause the veteran to detach from grief. This was true for a veteran and father of four whose youngest son was killed in a hit-and-run motor vehicle accident. The veteran went through the formalities of identifying the body, arranging the funeral, and receiving the outpouring of support from his community; yet he remained impassive throughout the process. His wife and family were appalled at his lack of emotion. When the veteran came in for counseling, he reported being on a convoy in Vietnam 40 years earlier. One of the trucks hit a young Vietnamese boy. It was a dangerous area and they were under orders not to stop. This veteran was devastated by seeing this innocent boy left presumably dead and unattended. When his own son died in a similar manner, he could not allow himself to feel the grief for his own son until he had acknowledged the loss and grief of the parents of the Vietnamese boy. The latter was the focus of the bereavement intervention.
Another young soldier serving in Iraq was notified of his grandfather’s death; the Red Cross was prepared to bring him home for the funeral. The soldier declined to leave his troop, and the family was very upset with his decision. As bereavement counselor, I discussed with the family their son’s need for stoicism so he could face war every day. If he came home for the funeral, he may have felt that he had deserted his troop. He could also be opening himself up to an emotional bungee jump, bouncing from his feelings of his grandfather’s loss which could also trigger grief over deaths he was seeing in war, only to have to go right back into war two weeks later. Thus, the bereavement intervention did not focus on trying to convince the grandson of the need to return home, but rather on helping the family choose to validate the young soldier’s choice. Intervention also focused on planning a family gathering when the young soldier was home again and emotionally able to participate in working through his grief for both his grandfather and his fallen comrades.

Supporting Veteran Grief
As part of a focus on comprehensive care, unresolved bereavement needs of veterans need to be assessed when they are being treated for physical and mental health issues, homelessness, substance abuse, and PTSD. These needs can best be addressed by a clinician who has been sensitized to the special needs of veterans. In 2003, Wounded Warriors: Their Last Battle, a presentation developed by Deborah Grassman, was produced by the National Hospice and Palliative Care Organization (NHPCO) and distributed widely throughout both the hospice and VA communities. Her presentation sensitizes clinicians, veterans, and their families to issues that may otherwise be overlooked or misunderstood. (Click on “resources” on this website to view the updated version). The same stoicism that allows veterans to be the helpers of the world may prevent them from reaching out for help or support. Messages of “big boys and girls don’t cry” were learned as children and reinforced in the military. This message needs to be reframed by clinicians. When a veteran is talking about the pain of loss and attempting to hold back the tears, they can be reminded of the courage it takes to allow their feelings to show. It may be helpful to sit beside rather than in front of the veteran to allow emotional privacy. Alternatively, the clinician might bow their head and sit quietly when tears escape from behind a stoic wall. I let veterans know that tears are a normal reaction to pain and are welcome. I have a picture in the bereavement office of a face with a beautiful tear running down it. I ask veterans who struggle to externalize tears to study it and tell me what it elicits for them. The picture acts as a reminder of the beauty of grief expressed. I also use a prescription pad and “prescribe” crying in the shower, in the car, or wherever the veteran feels safe. Some veterans are more comfortable with humor and respond well to being told that I get a bonus if they cry. Everyone grieves in their own way, so there are not always tears. The gender differences between men and women have been studied for years and many men are more likely to express their grief by doing something active: planting a tree, building a memorial, or organizing a fundraiser for a needy veteran family. Tears may or may not be part of their grief journey (Doka and Martin, 2010; Golden, 2010).
In caring for veterans with PTSD, it is important to know that they may not trust easily. My initial efforts need to focus on gaining their trust. This can make something as simple as scheduling an appointment difficult. For example, when a veteran is identified for bereavement counseling, a telephone call is used to make contact. Not unusually, there is no answer and a message is left encouraging a call back. When this is unsuccessful, a second call is made and again a message is left. If the call is not returned, a condolence note is mailed to the home. Persistence often pays off at this point and the veteran may reconnoiter and peek into the bereavement office a few times. If I pass muster and seem trustworthy, the veteran will schedule an appointment to address his or her grief issues. A basic premise of passing muster is the understanding that “we serve those who first served us.” Veterans need to know that I am aware that veterans are trained warriors; they need to know that I value their service and recognize that freedom is not free.
These issues may also be apparent when a veteran is diagnosed with a terminal disease. The veteran may not want anyone “to see me weak.” They may go so far as to say, “When I can’t take care of myself, I’ll just go off into the woods to die.” I met one such veteran during his several admissions to the hospital through his illness. My interventions focused on encouraging him to be a gracious receiver. I educated him about Dame Cicely Saunders, founder of the modern hospice movement around the world, and what she said at a conference a few years before her death. Using a wheelchair for ambulation, she stated, “I used to think that being a giver was the most important thing. Now that I need help myself, I realize that being a gracious receiver is the most important thing.” He was encouraged to see how helpful his gracious receiving could be for him and for his comrades. As his illness progressed, he was able to make healthier decisions about his care. The veteran allowed his friends in the “Vietnam Brotherhood” to participate in his care and ultimately his death. Many of these men had only witnessed violent or mutilating deaths in the past. In combat there was no time to mourn the deaths of comrades. This veteran made a courageous choice to allow the brotherhood to come together as a group to grieve while they provided care and support to their dying comrade. They were dressed in their Vietnam Brotherhood jackets; many had long hair, ponytails, and tattoos. Although their tough exteriors were intimidating, they provided tender physical comfort by repositioning the veteran, giving him drinks of water and food, and even participating in circles of prayer. By relying on their camaraderie and overcoming their fear of vulnerability, they created a dignified death for their comrade and a new concept about death for themselves.
The Commander of a local chapter of the Korean War Veterans Service Organization (VSO) was asked about the impact of combat on the members. His eyes clouded over: “We all have PTSD to some degree. It’s just a matter of what we do with it.” He spoke of some members who self-medicated with alcohol, but of many others who channeled their pain into contributing to the community. Honor guards are one of the services this chapter provides. They are frequently at the local VA cemetery to honor their newly fallen comrades by providing military honors, an interment ceremony, and the presentation of the flag to the next of kin. He acknowledged that when he participates in these events, he is attending to his own bereavement needs by honoring the buddies he lost in service so long ago.
As many as 30,000 veterans live in State Veteran Homes and there are many other long-term care facilities caring for veterans. These settings can provide an opportunity to address unresolved grief from fallen comrades decades earlier.
One State Veterans Home in Ohio provides such a service. This was developed when Deborah and I were providing clinical consultation services to the staff so they would better understand how to care for the unique needs of veterans as they die. Deborah asked a Vietnam Veteran, “Is there anything from the war that might still be troubling you now?” The veteran, hardly able to talk due to severe COPD, nodded his head. Then he said, “My brother and I both went to Vietnam, but I was the only one who came back.” Tears slowly ebbed down his cheeks while Deborah and I waited in calm silence. Then, he added: “I didn’t even get to go to his funeral.”
We explained that we could design a ceremony to honor his brother and create space for his grief. We explained the value of unmasking unresolved grief. The veteran’s face visibly lightened and he eagerly participated in the designing of the service. Deborah and I then realized the gaping wound in many of the veterans at the State Veterans Home, so we invited all of them to the service to mourn their comrades fallen during battle. About 25 showed up! We also addressed the guilt that some of them felt — survivor’s guilt, guilt of killing other people, guilt of things done or not done. This launched a program called the Fallen Comrades Ceremony that has been done throughout the country for veterans of all ages and eras.

Veterans Need to Mourn the Deaths of Their Comrades
The source of the gaping hole in our society caused by the aftermath of war is unmourned loss and unforgiven guilt/shame from the deaths of comrades killed in war. The hole this leaves in surviving comrades’ hearts continues to exert its influence throughout their lives until the deaths are acknowledged, honored, mourned, and redeemed. We believe that our civilian society has a responsibility to help heal the Soul Injuries of our nation after war. Soul Injury ceremonies can help restore wholeness to our broken nation; we struggle together to heal the wounds of war.
Opus Peace has developed a Fallen Comrades Ceremony. The resultant service can be a model for other organizations to provide so that our nation can be healed of this gaping wound. If you would like to help heal our nation of the aftermath of war, please consider sponsoring a community event that invites combat veterans to come mourn their fallen brethren. Contact us and we will come help you. Don’t miss this opportunity to heal the aftermath of war in your community. Throughout the United States, there are Fallen Comrades ceremonies taking place. These can be healing to both veterans and their families.
Most VA Medical Centers offer memorial services honoring the veterans who died in their facility annually. These services should be formatted in a ritualized ceremony that acknowledge and promote effective grieving and the ceremony should have a military context. Many VAs provide bereavement ceremonies or events to provide support for the veterans and their families for Memorial Day, Veterans Day, Fourth of July, and other holidays. Community hospices and other long-term care facilities should be encouraged to participate in these events or to hold their own veteran-centric programs.

Active-duty Deaths
The military culture influences both veterans and their families. They may face issues that do not impact the general population. This is also true of veterans and families of loved ones dying on active duty; however, hospice services are not provided to families prior to an active military death. Bereavement care to the surviving family members should follow the above guidelines coupled with standard bereavement guidelines that focus on sudden and violent death.
There are two organizations that are uniquely equipped to provide bereavement counseling and support to active duty personnel, their families, and extended families: Vet Centers and Tragedy Assistance Program for Survivors (TAPS). Vet Centers provide individual, group, and family counseling to all veterans who served in any combat zone. Services are also available for their family members. TAPS is a national non-profit organization that offers extensive peer-to-peer support and education about traumatic death and the active duty military’s specific grief needs. Some hospices partner with these agencies to provide services. Other hospices partner with the Red Cross to offer bereavement services for active military deaths. It is important that Hospice staff receive specialized training in order to perform this task.

You can receive free pamphlets from your closest Dignity Memorial funeral home. Use them to educate Veterans’ families. You can also download the pamphlets below by clicking on them.

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Forgiveness: Changing our Relationship to the Past

Reestablish peace in your world through the art of forgiveness.

Forgiveness, Guilt, Shame , Healing , PTSD, Trauma , Soul Injury, Moral Injury

Forgiveness: Changing our Relationship to the Past

by Deborah Grassman

The process that precipitates pervasive inner peace is forgiveness. Unforgiven guilt and shame often culminates in the creation of a Soul Injury.

Although seldom recognized, forgiveness is one of the keys for living in the “now.” I have to forgive every disappointment and interruption that interferes with my experience of the moment. Every time I am told, “No” by God, another person, or life itself, I have to actively forgive the world for things not going the way I had hoped. Then I can reencounter the ever-present now; I reestablish peace in my world. I call this my journey from “Oh no!” to “Oh well…”.

One time, I asked my mother, “Who is your best friend?” She replied, “Whomever I’m with at the moment.” I liked that answer. I hope I can live out that wisdom. Similarly, I hope that I can answer the question, “What’s your favorite thing to do?” with “Whatever I’m doing right now.” Then, I’ll know that I’m living in the now, and the key for doing so is forgiveness; I will be able to forgive the world for everything that is not “now.”

Forgiveness can have very practical applications. I jog along a two-mile rural road. Trash litters the edge of the road, corrupting its beauty. I frequently complained about the litter with a tightness in my jaw and neck as I did so. Then I realized that I had a choice: I could forgive the litter for being there and enjoy the landscape anyway, or I could pick up the litter. I decided on the latter. My garbage bag in hand, I picked up each can and wrapper. Initially, I was thinking mean thoughts about the litterers. Then, I realized that I was littering my mind with resentment, robbing me of “now-ness.” I switched to blessing each litterer, and actually had great fun on the rest of my clean-up adventure. Forgiveness is like that; it transforms moments so I can live in the vitality of the now.

Desmond is a Vietnam veteran who knew how to maintain peace in the now. During a Quality of Life meeting with him, our team acknowledged his military service, which he appreciated. “’Nam vets never got their due,” he told us. We offered an apology for the way he had been treated when he returned from the war. When asked how he was doing spiritually, he told us, “I’m good in that department because I always keep my feet wiped.” He explained that some people don’t keep their “feet wiped” on a daily basis. Instead, dirt accumulates, surfacing as they approach death, which was the case with Jim.

Jim was a World War II vet. He was weak with a cancer that would take his life in a few days. After I introduced myself and we spoke quietly for several minutes about hospice care, I asked him if there was anything from the war that might still be troubling him. He said there was, but he was too ashamed to say it out loud. Motioning me to come down close to him, he whispered, “Do you have any idea how many men I’ve killed?”

I shook my head, remaining silent, steadily meeting his gaze with my own. He continued.

“Do you have any idea how many throats I’ve slit?”

Again I shook my head. The image was grim, and I felt my eyes begin to tear. Jim was tearful too. We sat silently together, sharing his suffering. No words needed to be said. This was a sacred moment that words would only corrupt.

After several minutes, I asked, “Would it be meaningful if I said a prayer asking for forgiveness?”
He nodded. I placed my hand on Jim’s chest, anchoring his flighty, anxious energy with the security of my relaxed palm. My prayer, like any praying I do with patients, reflected no particular religion. “Dear God: This man comes before you acknowledging the pain he has caused others. He has killed; he has maimed. He hurts with the pain of knowing what he did. He hurts with the pain of humanity. He comes before you now asking for forgiveness. He needs your mercy to restore his integrity. He comes before you saying, ‘Forgive me for the wrongs I have committed.’ Dear God, help him feel your saving grace. Restore this man to wholeness so he can come home to you soon. Amen.”

Jim kept his eyes closed for a moment, tears streaming down from unopened lids. Then he opened his eyes and smiled gratefully; his new sense of peace was almost palpable. It was a reminder to me of just how heavy guilt weighs.

The reason I prayed for Jim with my hand on his chest is because anxious energy usually rises. Think about when you get excited. Your voice usually gets higher; energy gets flighty. You might place your hand on your chest or near your throat, unconsciously anchoring yourself. A calm, centered person’s energy usually resides lower and deeper. If a calm person places his or her hand on an un-calm person’s sternum, it can often help this person feel secure, more weighted, less anxious. I often sit with my dying patients with my hand on their chest. I teach their loved ones to do the same (see Anchoring Heart Technique under Tools.)

‘Lub Dub’: The Sound of Peace within a Community

When “lub dub” is lacking, missing, or abused, then conditions are ripe for precipitating a Soul Injury.

Caregiving , Healing , Soul Injury, Moral Injury , Spirituality

‘Lub Dub’: The Sound of Peace within a Community

by Pat McGuire
“Since the human heart is never completely born, love is the continuous birth of creativity within and between us.”

~ O’Donohue, Anam Cara: Spiritual Wisdom from the Celtic World)

The first sound any of us hear in this world is the steady “lub dub” of our mother’s heartbeat. Throughout our lives, if we are lucky, there is a great deal of touch from nurturing family members, friends, and pets. This keeps us connected to the “lub dub” of our humanity and also to “the heart that is never completely born.” This is the significance of the eternal, ubiquitous “lub dub.” When “lub dub” is lacking, missing, or abused, then conditions are ripe for precipitating a Soul Injury.

When we are confronted with losses or disappointments of any kind, our primal sense of connectedness is reduced. I have had the opportunity to facilitate many groups throughout my career as a bereavement coordinator providing Family support, cancer support, grief support, addiction recovery, and facilitating The Hero Within book communities. No matter the purpose of the group, one of the basic needs of the attendees is a sense of connection. Coming together with others with the same issues can be very healing. However, these groups generally fill one hour of a week and the need for connection has no such limit. These feelings of disconnection are felt most intensely in the middle of the night.

At the ending of the group meetings, through consensus of the group, we end in a circle. Holding hands, each person says whatever is on their heart. It struck me more and more how strong the energy pulsing from hand to hand was when we were encircled in this way. I called this to the attention of the groups. I reminded them that even when we were not holding hands, our hearts continued to ”lub dub” together. I asked them to remember that when they were home alone at three o’clock in the morning, they could reconnect with the group by feeling their own pulse. The message of the “lub dub” is: “We all have to do this life ourselves, but we do not have to do it alone.” The groups responded well to this intervention, often saying that during chaotic times, “It brings me peace.”

I have also responded to this intervention, but in an even larger way. Just thinking about the great lub-dub of this universe draws me into my center where I am the birther and the birthee. When I open myself to the lub-dub among people, the energy in the room changes; we are no longer separate entities, but rather one entity of shared humanity; it’s a communal abiding spirit. This is the value of community: common unity. Creating small communities restores personal wholeness, TOGETHER.
I was lucky. I came by this naturally. I was born into a family with 13 children. Although there were some serious disadvantages with being part of so many, there was also a distinct advantage: I learned how to be part of a thriving community that took care of each other — we lub-dubbed together; we restored personal wholeness together. Now, my parents and two of my siblings have died. Several years ago, I left my hometown and many of my siblings in New Jersey to move to Florida. I found myself longing for the lub-dub missing from my heart. It was painful; it was lonely. It wasn’t until I transferred to the hospice unit that I again discovered my community heart.

Deborah Grassman was my boss. She had built a thriving community of hospice staff who loved and respected each other in a communal way. My pulse quickened as I was welcomed, supported, and grew into this new environment. Mainly, I felt safe. Deborah did not allow bitching and back-biting; instead, she showed us how to open up to our hostilities so we could own them and use them for personal growth.

Now, I am partnering with Deborah to create healing communities everywhere. I have started three Hero Within book communities in just the past three months. I call it lub-dubbing, and I am seeing healing transformations right before my eyes. It is, indeed, exciting to witness.

When I tried to explain lub-dubbing to Deborah, she said: “Sounds like you are experiencing what the Beatles sang about: ‘I am you and you are me and we are all together.”
“Yeah. Something like that,” I told her.

Aging: A Soul → to Sole → to Soul Journey

As we age, we complete the tasks of individuation; we start letting go of our sole self and gradually start opening up to our soul self.

Aging, Chronic Illness, Stress , End-of-Life Care, Hospice , Soul Injury, Moral Injury

Aging: A Soul → to Sole → to Soul Journey

by Deborah Grassman
“It takes a lot of courage to grow old,” my 90-year-old mother said the last few decades of her life. “Aging is not for sissies,” I’ve heard others say. Indeed, it is so. Rather than cultivating courage, however, we often resist aging – even deny its personal existence.
Could it be possible that aging might have something that we need? What are we missing by not valuing aging? Are we too arrogant or too controlling to think that aging might have something to teach us? Why would we want to be anything other than who we are (which includes the age that we are)?
Conceptually, I describe aging as a Soul → to Sole → to Soul journey. Our soul is born into this world to embark upon what psychologists call an “individuation process,” which manifests as the unique individual that we are. As we age, we complete the tasks of individuation; we start letting go of our sole self and gradually start opening up to our soul self.
The Soul-Sole-Soul process is described much more scientifically in healthcare literature, most notably by Erik Erikson (1,2). Most healthcare professionals have studied Erikson’s developmental tasks for aging. He says that there are maturational crises or critical decision points that require attention and mastery in order for successful aging to occur. They are:
· 0-18 months:Trust vs. Mistrust
· 18 months-3 years: Autonomy vs. Shame
· 3-5 years of age: Initiative vs. Guilt
· 6-12 years old: Industry vs. Inferiority
· 12-18 years old: Identity vs. Role confusion
· 18-35 years old: Intimacy/solidarity vs. Isolation
· Middle age: 35-55: Generativity vs. Self absorption or Stagnation
· Older age:55+: Ego Integrity vs. Despair
It is the last two categories (middle and older ages) that are surrounded with fear and ignorance. Healthcare providers working in pediatrics are well versed in the first five categories. Programs designed for toddlers are vastly different than those designed for school-age children. But something happens after adulthood is reached. The developmental tasks seem to fade from healthcare providers’ practices. At best, the general principles of Erikson are known by clinicians, but most geriatric programs evidently don’t take the principles seriously because the concepts are often ignored. For example, Erikson writes about the value of helping elderly people face the fear of death so that they can gain “ego integrity.” Contemplating death and “the meaning of life” can bring fuel for the soul, expanding consciousness as elderly people face numerous challenges in their lives. Yet, geriatric centers and healthcare facilities seldom have classes on aging and dying; instead, classes focus on fitness, clubs, games, and interests from the past. These are important activities, but the topic of aging and death is also important. Yet, it is seldom broached, much less discussed and contemplated. Personally, I think we miss a lot when this “let’s don’t talk about dying” approach is taken, and in some ways, it’s even more than that. To not have programs that integrate death contemplation and exit strategies could be considered a form of abandonment since research and developmental models (like Erikson’s) demonstrate the value.
I cite my mother’s experience living in an Adult Living Facility (ALF). The ALF staff took good care of Mom. She was bathed twice a week, had numerous activities to choose from, and ate good food in a beautiful dining room. She seldom complained about the many ills she had but rather focused on the gratitude she felt for her many blessings. Over the last six months of her life, I noted that she was sleeping more, losing interest in participating in activities, eating poorly, incontinent, and losing weight. She was treated for depression with no change; I surmised that she probably had a cancer, which later turned out to be the case. The ALF staff had a different idea. They called her doctor and got an order for physical therapy.
“I don’t want to go,” Mom told me.
“It’s your life Mom. If you don’t want to go, tell them ‘no’.” Mom worried about staff getting mad at her if she didn’t go and so she went.
One day, I entered Mom’s room unbeknownst to her or the Physical Therapist. I stood at the doorway witnessing their conversation.
“I’m too tired to go,” Mom complained to him.
“You’re not going to get stronger if you don’t get out of that bed,” the therapist said nicely.
“But I don’t care if I get stronger. I just want to sleep,” Mom argued.
“You can sleep after you do your exercises,” he countered.
I intervened to protect my mother’s interests. “It’s okay,” I told the therapist. “Mom is nearing the end of her life. She doesn’t need therapy. If she wants to sleep, let her sleep. We’re in a mode now of just respecting what she wants.” Then I turned to Mom, “Mom, you don’t have to do anything that you don’t want to do.”
“I keep telling them that, but they don’t listen,” she said.
Her therapy didn’t stop until I called Medicare myself and told them not to pay for it.
I don’t want to imply that the staff were insensitive or incompetent. Their intentions were good. They typify the current geriatric culture with its exclusive focus on rehab and activities. It seems odd that helping people confront death and reckon with its unseemly ramifications is commonly excluded within geriatric communities. Rather than having programs that help people reckon with their approaching death, the focus is on distracting them from death, pretending that death isn’t happening. For example, I always enjoyed sitting on the front porch in the rocking chairs with the residents at my mother’s ALF.
Mom and I are on rocking on the porch swing. “You remember Florence?” Mom asked me.
Yes, I had spoken with her many times in the hallways and dining room.
“She went to the hospital and never came back. I asked what happened to her and the nurse said they’re not allowed to talk to us about other patients. We didn’t find out that she died until we saw her obituary in the paper.”
I could only sigh with my mother at the disrespect that she felt — not only for Florence, but for her own needs to know, honor, and grieve.
Another resident sitting nearby chimed in: “When you die, there’s no public acknowledgment,” he said mater-of-factly. “We’ve been living together and helping each other for years, and one of us dies, and everything goes on as if nothing happened.”
Even the deterioration of aging is squelched. One resident told me how anytime they try to talk about how bad they feel or how hard it is to get through the day, that the staff try to cheer them up and talk them out of their difficulties. “They don’t want to hear us complain.”
I’m thankful that Mom and I had many talks about her death on that porch. She told me about a few things she wanted to do before she died, and we were able to accomplish those. We planned her funeral and I reassured her that her body would be flown back to Indiana and buried with my father. However, even these meaningful conversations were discouraged. Overhearing us, a nurse said, “Don’t be talking like that. You’re going to live another 10 years.”
“Oh, I hope not!” Mom laughed. “Ninety years is long enough!”
Opus Peace focuses on aging and transitions – not by fearing or denying it. We also don’t take the other extreme: ie., looking at aging and dying by only focusing on the positive virtues of aging. Rather, Opus Peace seeks to cultivate honesty, courage, and humility to navigate the later years because these years can be difficult! Let’s look at middle age first.
Middle Age invites us to summon the courage to stop clinging to who we were and open up to who we are. Then, we no longer cling to fame or fortune or the appearance of youth. We are transformed by relinquishing the old ego attachments and affirming our deepening descent into the mystery of the soul. We move from sole to soul and gain our freedom. This is not an easy process. It is normal to feel distress as we age with the undoing of all we have labored to secure. That’s why aging is not for SISSIES!
There is a saying in Hospice: “Those who grieve well, heal well.” This is a paradoxical truth that initially seems counterintuitive. But, grief is the normal, natural emotion that accompanies loss and change. Grief allows us to let go so we can move forward rather than “stagnate” as Erikson called it. So grief is not a destructive process as many think. In fact, it’s just the opposite: it’s a creative process that allows us to be re-formed and opened to something new that will better fit the changing circumstances. So, healthy aging during the middle years usually involves getting honest with the losses we are experiencing and allowing ourselves to humbly grieve the changes so we can open up to who we are becoming rather than clinging to who we used to be.
Older age (55+ according to Erikson) means that the horizon is no longer obscure. Bodily reminders start creeping in to remind us of our destiny. Ultimately, INTEGRITY means getting honest about the reality of approaching death. No matter how much we medically advance technologically, death is still a mystery and good travelers are able to open up to the uncertainty of it with a growing wisdom that the world is broad and doesn’t revolve around us. We start accepting death as the completion of life. Despair, on the other hand, is more narrowly focused around fear of the past (“Was the trip here on Earth worth it?” or “I wish I would have done ______ {regret}) or the future (“What is going to happen to my loved ones after I go” or “I don’t want to let go of what I know to go into the uncertainty of the “great beyond.”) Narrow focus can also be disguised as rather arrogantly denying existing fears or covering them over by pretending that there’s no uncertainty in death. Running or hiding from our fear of death can lead to despair. I have seen it many times in the 10,000 people that I’ve been with as they’ve faced death. At the same time, I will tell you that most of these people were able to reckon with their fears by allowing death to humble them. As one patient told me: “Now, while I’m dying, is no time to be lying to myself.” I applauded his wisdom. And in the space of just a few short days, he mounted the courage to open up to the peace that awaited him beyond his fears.
Carl Jung said that the pain of aging is with those who “content themselves with inadequate or wrong answers to the questions of life.” Aging wisely means asking ourselves tough questions that require non-superficial answers. If we’re honest with ourselves, we discover that much of our thinking and frustration centers on clinging to who we used to be. The questions we ask ourselves are:
· Which facelift surgeon should I use?
· How many pounds can I bench press?
· How can I maintain power and authority?
· What love-object do I need to find?
· How can I stay fixated on what I used to be?
Jung would want us to ask questions that can only be answered beyond our ego-self:
· What HONESTLY empowers me (job, status, muscles, boobs, trophy wife, etc.)?
· What happens when erotic success or social status no longer count?
· Why am I ashamed of the age I am, realizing that it is part of who I am?
· Why have I let commercials brainwash and control how I feel about myself?
· Am I willing to regain my NOW life (which includes the age I am NOW)?
The truth is we have allowed modern advertising to dictate who we are rather than allowing our own imprinted destiny to unfold with grace and dignity. Viktor Frankl puts it this way: “Today’s society is characterized by achievement orientation, and consequently it adores people who are successful and happy and, in particular, it adores the young.” (3)
We allow money and temporary materialism to take us away from the eternal. This leads to ignoring our soul. We cover it up so we can “Buy our product so you don’t have to be you.” This is an archetypal form of prostitution: we sell our current-aged self and buy a younger version of ourselves, losing ourselves in the process. When we stop being unfaithful to ourselves, then we can allow the natural urge to age unfold. This produces luminosity and liberation.
If aging is so fearful that we have to deny it, then it has a lot of power over us. Paradoxically, we then miss the very gift that aging brings; we are robbed of our own Self. In our western culture, the premise is that materialism, narcissism, hedonism will make us happy, yet, it leads to emotional/spiritual bankruptcy. In a society that is afraid of loss, aging and death will appear as the enemy to be conquered. Aging is viewed as a poison that we’re forced to drink. The question then becomes: Is it possible that if aging is a poison, that it might be a healing poison?
In my Aging workshops, I often have participants meet their Interior Elder. I even have their Elder write them a letter. Here’s the letter my Elder wrote me:
Dear Deborah,
I first met you 61 years ago. I was so far away that you could barely see me, yet I was in every beat of that tiny little heart that so bravely decided to come into this world to meet me.
You are no longer so far away. As I have called your name with the lub-dub of each heart beat, you have drawn closer. You sit at my knees now. I long to gaze fully into your eyes, but sometimes you turn your gaze away from my loving arms that await your return to my bosom – a buxom bosom that yearns to hold you and suckle you with breasts filled with the milk of life.
Each day, you are looking more and more like me. You don’t like that do you? You are ashamed of me. You didn’t think I knew that did you? Well, I do, and it hurts each time you hide me or curse me when you look in the mirror or groan with the ache in your bones. Deborah, I am the destiny you were born to fulfill. Do not be afraid of me. Do not be ashamed of me. Every time you say you are “lucky” that you don’t have gray hair, you are turning me away. Whether you know it or not, you need me, and when I come to the hairs of your very head, I hope you won’t cover me up or color me away, but that you will REJOICE and wear me proudly. If you will do that, I can hold you even more tenderly than I already am. Yes, you do have wrinkles. This should be no surprise to you. Yet, you act surprised to see them each and every day. When you pull the loose skin up from the sides of your face to erase the grooves I’ve so lovingly placed there, you make me feel very sad. Not for me, but for you. You see, Deborah, you lose your power when you do that. Yes. You are running away from the very thing that gives you strength and wisdom.
Deborah, it was I who carried you through treacherous days. It was I who suckled you at my breast during the night and gave you dreams to guide your way back home. Deborah, it was I who stood strong by your heart to assure that it would not become crusted over with bitterness.
You are about to launch Opus Peace to help bring peace to the Soul of this broken world. Deborah, I have a secret to tell you about that. You are not going to be its CEO… I AM! So, call on me when you are scared, weary, or feint of heart.
Welcome home! It’s about time that you finally acknowledged me as your roommate.
With love,
Your Soul’s Crone
1. Erikson, E. H. (1959). Identity and the life cycle: Selected papers. Psychological Issues
2. Erikson, E. H., & Erikson, J. M. (1998). The life cycle completed (extended version). WW Norton & Company.
3. Frankl, V. (1988). The Will to Meaning. NY: Penguin Books.

Other concepts about aging like this one are in Deborah Grassman’s book, The Hero Within: Redeeming the Destiny We Were Born to Fulfill.