Stages of Grieving--It's Not (Quite) So Simple

Keep in mind that it's very important to remember that the stages of grieving are not linear. This graphic represents what happens with many people’s grieving.

Someone may bounce from one stage to another and back again. And they may skip stages. They might even spend prolonged periods in one stage--and very short times in another. It's definitely not a one-way cycle, and it's going to look different for everyone. This is especially true in children who may have a delayed grieving process because when they're young they don't know anything else--and children tend to be very plastic, adapting to what they're given in life because they don't know what they don't know. However, as they grow older and are able to compare their own experiences with the experiences of others they are then able to classify their personal experiences as burdensome, unfair or something else.

 

Stigma - Don't Add To It!

One of the most crippling aspects of mental health with diabetes is stigma--and we need to combat that by empowering our patients.

Diabetes is a complex disease with many metabolic, genetic, autoimmune, and environmental factors present, some of which we may have an ability to impact. However, many of these are outside our direct ability to control. It’s important to focus on today and not on the past, and it’s important to make what healthy decisions you can for your patients and to give them permission to release past decisions. They cannot go back and change decisions, and to not hold themselves to an unacceptably high level of perfection.

Messages from Outside   You caused this. If you try hard enough.. Failed empathy (my grandma’s cat). Minimizing. A world of “NO”. Comparison and judgment. How to Combat Them   This is a complex disease, FOCUS on today. You can’t force physiology. Your emotional EQ is higher than others! NO LIMITS – just degrees of want. EVERYONE is a mess behind the camera!

 

The next message is that you can change things if you try hard enough. This is a very American concept. You can do anything if you’re willing to try hard enough. But the unfortunate truth is that this is not reality. You can try as hard as you want but you are never going to be 6 foot 7. You are also never going to have three eyes. There are just certain things that cannot be changed. So it’s not about how hard you try, it’s about how well you adapt and move forward. I always tell my patients that success in life is not dependent on never failing, it’s about how well you bounce back from failure.

The next stigmatizing message I call “failed empathy” or “my grandma’s cat”. Anyone who has ever given a diabetes diagnosis can share stories of failed empathy. This is where someone immediately responds to the diabetes diagnosis with, “Oh yeah, my grandma’s cat has diabetes. Or “my great uncle Joe had diabetes, and after he went blind and lost his legs he died in a nursing home”. These are all attempts by people to connect with the person with diabetes by referencing what they perceive as a shared experiential point—when, in fact, it’s belittling and demeaning, and is perceived as either equating the person’s diabetes diagnosis to that of a cat’s, or the inappropriateness of the Uncle Jerry story being discouraging and planting seeds of fear and condemnation.

 

To counter this, it’s important to encourage people with diabetes by reminding them of their emotional intelligence, or what is referred to as EQ. Let them know that their EQ is higher than those unknowingly hurting them--and that's precisely why they are hurt by this. Remind them that it isn't their job to advocate and educate everyone in their world, and that there will always be people saying these kinds of really ignorant things. Instruct them to just let it go and be encouraged by the fact that your diabetes has actually made them a better and more emotionally aware person.

And then there are the people who want to minimize the situation. They'll say things like "Well at least it isn't cancer"-- as if one terminal illness diagnosis is somehow scarier than another. Some outsiders will try to convince you that your diabetes isn't painful as the diabetes their grandfather had, when in reality there is no point in comparing pain from one person (or disease) to another. Diabetes can also bring with it the perception of a world of 'no'. That there are going to be foods you can’t eat, activities you can’t do, jobs you can’t do for a living, and things you can’t become in your life. We can combat that by making it very clear from the beginning of diagnosis and from then on that there are no limits with diabetes, there are just degrees of what you want.

And, of course, there is comparison and judgment. We live in a social media world where everyone’s on social media and it is full of perfectly airbrushed, filtered, posed, and timed images of the very best moments of people's lives. I encourage patients not to engage in that behavior and that if they were to post their A1C (no matter the number) they would get two responses. One saying they are a terrible person for allowing their A1C to get that high; the other saying it's amazing their A1C is that low. And there would be very few responses in between.

The key here is that we don't always have it together as clinicians and passing that along to your patients can be very uplifting to them. Encourage them to find the joy in their life and make the most of what they have.