UD prof heads national association for death education

8:57 a.m., Aug. 13, 2004--Madeline Lambrecht, director of the College of Health and Nursing Sciences Division of Special Programs, recently became president of the Association for Death Education and Counseling (ADEC). ADEC is an international professional organization, with 1,800 members from 14 countries, dedicated to promoting excellence in death education, care of the dying, and bereavement counseling and support. Its membership includes educators, nurses, clergy, hospice personnel, physicians, social workers, psychologists, funeral directors and staff, philosophers, mental health professionals and others.

Lambrecht, nurse, professor and specialist in the field of death education and bereavement counseling, said appropriate help for the dying and their loved ones can ease the pain of bereavement.

Q: Recently, you became president of ADEC, an organization that certifies people to practice in the field of thanatology. What is thanatology?

A: ADEC is the oldest interdisciplinary organization in the field of dying, death and bereavement. Its certification assures that an individual has demonstrated mastery of thanatology, the study of everything related to dying, death and bereavement.

Q: Do you have a goal for your term as president of ADEC?

A: I'm honored to serve as ADEC's president and am committed to the growth of the organization both in the U.S. and abroad. We have much to learn from each other and to share with each other. My special project for the year is called the Ambassador Book Project, and I've asked all ADEC members to donate thanatology-related books to individuals and groups in underserved areas, as well as to groups abroad, to increase understanding about dying, death and bereavement. Our goal is to distribute 1,000 books around the globe this year. If anyone reading this knows of a group or organization that is without resources to make such purchases, please contact me at (302) 831-4549 or e-mail me at [madeline@udel.edu].

Q: Is there a difference in the way thanatologists counsel people of different ethnic or religious backgrounds?

A: When counseling individuals who have experienced a loss, many factors are taken into consideration including the client's religious or spiritual beliefs and practices, as well as his or her cultural background. We always need to remember, however, that each person's grief experience is unique and may not "fit" with the textbook description of beliefs and practices of a specific group.

Also, we know that loss often alters one's personal belief system, temporarily or permanently, and thus, religious or spiritual rituals may not provide the same comfort as in the past. Too often we call for the clergy or rabbi without checking to see if this is an appropriate action.

Q: Can anyone really ease the pain of someone who has lost a loved one or is it just a matter of time?

A: No one can take away the pain felt by the bereaved. However, we can do much to support them during this very difficult time. Our first inclination is to stop their tears, to help them think of happier times but this is not really helpful. We act this way because of our own discomfort at seeing someone else in obvious pain.

What we can do is simply offer our presence sitting beside them, listening, calling frequently on the phone. Allowing them to "tell their story" is a way of helping them face the reality of the loss and begin the adjustment process. If we cut off their efforts to weep, to rage at the unfairness of the death, to retell their story, we do them a great disservice because this postpones their grief.

Notice that I did not speak of "resolving" their grief. There is a saying, "once bereaved, always bereaved." This means that we always carry our losses with us. They hurt less over time but are always present. We revisit them many times—on happy occasions, when we experience new losses or unexpectedly for no apparent reason, when we least expect to be remembering loved ones. We call the latter grief attacks. They come unbidden and pass quickly but can be very unsettling if one doesn't understand that this is normal.

Q: Do family dynamics change after the death of a family member?

A: Family dynamics change anytime there is a change in the family system. We speak mainly of the primary loss, the death itself, often forgetting the secondary losses such as role changes, financial issues, social relationships, etc.

For example, Tim's dad recently died due to the rupture of a brain aneurysm. Tim, age 11, is one of two children. His sister is 18-years old. She had planned to go away to college this year but took a local job instead to help her mother with the bills. She works 11 p.m. to 7 a.m., so she is home when her brother gets home from school. Her role shifted from being the college-age daughter going away to school to that of "second" mother to her brother and secondary family breadwinner. These changes add to the stress of the primary loss and need to be identified and worked through.

Q: Is there a difference in the way we grieve and in how we should be comforted when someone has been taken suddenly?

A: There is often the belief that an expected death is "easier" because one has time to prepare, to say goodbye. As an example, some would say that a spouse whose husband died at age 82 after 51 years of marriage should be thankful for all their years together and, while sad, should be expecting this at his age. This reflects the youth-oriented emphasis of our society. Wouldn't one think that the more time spent together, the harder the separation? Just because advanced age brings death doesn't mean that it hurts less.

A recent example of expected death was that of former President Ronald Reagan. In this instance, his wife had already experienced his death once before—the loss of the man she married to Alzheimer's, and then lost him again to pneumonia. As we all saw via the media, it wasn't any easier to bear.

With respect to sudden loss, it can overwhelm the survivors and often means the intrusion of the press and legal system if it is a suicide or homicide. We certainly have seen much traumatic death in the past several years and know that it carries with it the increased possibility of complicated grieving.

In a "normal" death, whatever that may be, we can expect the grief process to extend over several years even though the intense pain will subside much sooner and the person will be readjusting to the world without the loved one. In sudden death, grief is often complicated by the missed opportunity to say goodbye, unfinished business (things done or undone, said or unsaid), legal involvement, and in some cases, the horrendous act itself.

Consider the families of those killed in Iraq and survivors of 9/11 who must face everyday the possibility that they'll read another story about their loved one or see his/her face or body flashed on the TV screen. Clearly, these individuals may need professional help in addition to the support of family, friends and colleagues. However, I want to emphasize that not all need professional help even in these circumstances.

Q: How can thanatologists be of help those who are dying?

A: We can help the dying by helping them to live each day to the
fullest. The gift of your presence is the greatest gift you can offer to
the dying. Take time to stop by for a short visit, telephone, e-mail,
write a letter, run an errand. Too often we avoid the dying because we have no idea of what to say or do. Just be yourself. Take your cue from the individual. The dying enjoy a good joke as well as the rest of us.

If they bring up issues related to their illness and possible death, don't interrupt, just listen. If you try to change the subject, you may have closed the door for good. If they ask for your thoughts, share them but don't try to tell them what to do.

It's sad that we wait until someone is dying to talk about quality of life. I believe we should make quality of life an everyday issue. Life comes with no guarantees so take time to enjoy a beautiful sunset, the dewdrop on a late blooming rose, a cardinal sitting on the bird feeder, the waves breaking near the beach, a baby's smile.

Q: Society treats the death of a friend as something less traumatic than that of a family member. Is that a correct assumption or can the death of a friend be as devastating?

A: The death of a friend can certainly be as devastating or more than the death of a family member. We live in a society in which the grieving rules are based on blood ties.

For many years, clinicians were seeing clients whose grief was unrecognized and unsupported because their relationship with the deceased—gay/lesbian, extramarital, friend, neighbor, colleague—did not fall within societal criteria. In some cases, the survivors—young children, the aged, the mentally challenged—were thought incapable of grieving. In other cases, such as abortion, pet loss, surrogate motherhood, etc., society did not recognize the loss as significant. Survivors were at risk of experiencing disenfranchised grief, meaning that they fell outside society's criteria for legitimate grievers. Friends are clearly in this category.

Q: Is there a difference in the way we grieve and in how we should be comforted when someone has been taken violently or has committed suicide?

A: Today we know that other factors such as the type of death also contribute to the possibility of disenfranchised grief. For example, survivors of suicide often avoid any public services for their loved one and may be very hesitant to tell others what occurred. Such behavior means that they get less support at the very time they need it most.

Q: Is it important that a person be in control of his or her life until the end?

A: One of the greatest problems we face is lack of information about dying, death and bereavement. Too often people suffer alone believing that what they are feeling and experiencing hasn't happened to others. If we can introduce information about the life cycle, including death, into the school curricula, individuals will be much better informed by adulthood. Unfortunately, parents are often unable to discuss such issues with their children. However, there are many fine children's books that could serve as the basis for ongoing discussion. I recently prepared a book purchase list containing books for children from 3-12-years old.

Often, parents ask me if young children should attend funerals, and I tell them that it should be the child's choice, but they first need to offer a simple explanation of what to expect. They should never be forced to participate. Including children helps them to feel part of the family and to begin to understand death as a part of life. Many funeral homes have staff who are professional counselors to help families with such issues.

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