Sustainable Futures for Veterinary Practice The Human Animal Bond and Bereavement David Foote BVSc, B.Mus PO Box 89 Randwick NSW 2031 The Nature of Grief It is essential for practitioners to have an understanding of the normal grief process in order to support bereaved clients in a healthy way. In a broad sense grief can occur as we deal with change and endings of various types throughout life. Grief for pet owners is about processing the intense feelings that arise before, during and after a loved pet dies. There are a number of important concepts to grasp when seeking to understand grief, many of which appear to be contrary to common knowledge or conventional wisdom. Grief is a natural process not an event Grief is a process that takes time traditionally society does not allow for the time it takes or acknowledge that the bereaved may need support on an ongoing basis. Standard workplace time off allowance for bereavement is 3 days nowhere near enough for many people. Grief is necessary for emotional healing Grief is like a raw emotional wound. While the bereaved will never forget the deceased, acceptance and emotional healing comes through experiencing and processing the powerful feelings over time. If the expression of grief is in some way limited, the healing time for recovery is prolonged. 1 It is not uncommon for clients experiencing grief around pet death to acknowledge a resurgence of grief from an earlier death, often a family member or another pet, and to further reveal that they did not allow themselves to feel their grief at the time. Grief is unique for each person. Every human being is unique, every animal is unique and each human animal relationship is unique. It follows that each person s grief is unique. Within the same family each person will have a different grieving process based on their personality, coping skills, personal grief history and the significance of the pet to them. There is no right or wrong way to grieve. Grief does not have a set time frame. It takes as long as it takes. Normal grief may last for weeks months or years depending on the significance of the deceased. The frequency of intense feelings gradually diminishes over time although the intensity may remain high when they do arise. Anniversaries, Christmas, birthdays and other special milestones usually reactivate grief. Based on my experience, early grief for pet owners lasts for up to three months although this is a generalisation. Often those around the bereaved grow impatient and frustrated with the passing of weeks if the bereaved person hasn t returned to normal. This can create a significant problem for the bereaved as they are usually emotionally vulnerable and can begin to feel ashamed of their grief.
The relationship continues The relationship with the deceased pet continues based on memories and feelings. It is important to acknowledge and support clients in this regard. For many clients it may be important to leave in place for a period of time or retain so-called transitional objects such as bedding, food bowls, collars or other mementos. Conventional wisdom says we should try to forget and find closure around the death of our loved ones. A more accurate and realistic description of a healthy grieving process is to come to acceptance of the death. Grief follows chaos theory. The process of grief is not a predictable sequential process as previously espoused decades ago. While there is a general trajectory of grief from early intense distress and emotional pain to acceptance and recovery, the stages of grief do not manifest discretely. 1 Grief is not validated well by others In general our society is not sensitive or informed about the grieving process or the needs of the bereaved. Bosses may not understand the need for time off. Friends often stay away or try to rationalize and shift the bereaved out of their uncomfortable feelings. This is principally because, generally speaking, we are not raised with any real knowledge of grief or taught how to grieve in a healthy open way. Consequently most people feel uncomfortable around the bereaved and are not sure how best to help. Grief is disenfranchised for pet owners. In general society does not strongly validate or support grief around the death of pets. Grieving clients can feel ashamed of their grief and too fearful to tell others how they are feeling or to ask for support. Although attitudes are shifting slowly unfortunately the attitude of It was only a dog is still pervasive. Life is changed forever. The unique pet and relationship cannot be replaced or substituted. Owners who seek early replacement of their pets are often seeking their old pet back again and/or some release from their painful feelings. Grief Reactions A persons individual grief reaction is affected by previous experiences of grief, learned attitudes and ways of coping from family of origin, depth of love, resilience, level of support, ability to get their needs met and the significance of the relationship with the deceased. 2 Shock and disbelief Shock and disbelief can be experienced with any death, but can be especially felt when the death is unexpected. Other emotions that may be experienced include being numb to feelings, feelings unable to be expressed, disconnection with the world around sense of it being surreal is this really happening, disorientation, cannot focus or retain information, denial, and questioning of the truth/diagnosis. Intense emotions
Other intense emotions that may be experienced include yearning, feelings of extreme sadness, guilt, anger, loneliness, isolation, frustration, regret, relief, hopelessness, helplessness and trying to find distractions from the intensity of grief. Owners may feel responsible for the death or the quality of death if only I d rung earlier he would have survived. Common during this phase are sleeping/eating disturbances, restlessness, exhaustion and loss of energy, physical pain and symptoms (sometimes related to those of deceased in humans) and stress. Some clients experience auditory and visual hallucinations of the deceased, which they usually find extremely upsetting and distressing. Grief and the deceased are foreground in client s thoughts and feelings appear to be all there is to life. Disorganisation and despair Clients may not function well, be introspective and find they can t relate well to others. They may find difficulty fulfilling normal roles in family or at work, feel aloneness even within relationship and really feel the absence of the deceased. They may still be preoccupied with death and may think about making big decisions such as moving house, changing career or ending a relationship. They may question the meaning of life and their life direction and purpose. Reorganisation and recovery. This stage involves the acceptance of the death and clients are able to focus energy back into normal life activities and experience pleasure again. They are able to have pleasant memories and experience humour as well as times of sadness. They return to normal role function and reintegrate their deceased animal into ongoing life. Grief and the deceased slowly move into the background. Risk Factors The following risk factors indicate the possibility that an individuals grieving process may be more complicated, difficult or protracted. Sudden death Traumatic witness i.e. see their pet die from trauma Preventability Euthanasia of a physically healthy animal Prolonged dying cancer, chronic disease Concurrent crisis Lack of social support (or inability to accept it) Unresolved past grief Death of the young Lack of reality i.e. not present at death and can t view body It may be that there is a combination of these factors. For instance an owner witnessing their dog being run over after accidentally leaving the gate open will have sudden death, traumatic witness and preventability as risk factors. Needs of the Bereaved
The task for the bereaved is to accommodate their grief into their ongoing life one day at a time. Not get over it or find closure. My clients routinely state that the biggest difficulty they encounter is the people around them saying unhelpful things or giving inappropriate or short-lived support. Reality Lack of reality is listed as a risk factor. Generally speaking people who are not present at the time of death or don t get the opportunity to view the body have greater difficulty accepting and comprehending that death has occurred. Permission Permission is required from self and others to work through the pain of grief and feel the feelings. To be able to talk and to feel - to just be as they are. Being upset, distraught and crying a lot does not mean someone is not coping - it means they are grieving. The difficulty for the bereaved is that it is difficult to find someone who can sit with them and hear them in their distress. Empathy What clients need is acceptance, non-judgmental listening and validation. Empathy is about acknowledging and trying to understand the other person s reality. When we are being empathetic we convey that we truly understand what is going on for the other person regardless of our own opinions or experience without trying to solve the situation or change the other person in any way..3 Sympathy is meant well but is based more on pity and tends to unintentionally create distance. Time The time frame for any individual is unknown. Based on my experience, early acute grief for pet owners lasts for up to 3 months although this is a generalisation. It is crucial to understand that it takes time for clients to undergo their grieving process and adjust to life without the deceased. Individuality Clients need permission from those around them to grieve in their own way and memorialise in their own way. Normalisation It is extremely helpful for clients to have some validation that what they are going through is normal even though they don t feel normal. They need to know that they are not going crazy. How You Can Help The task of the helper is to be empathetic to try to understand and comprehend what reality is like for the bereaved not to try to change the way they feel. Clients will feel better if they feel understood and have the opportunity to ventilate their grief in a safe, accepting environment. Veterinarians are not counsellors or psychologists and cannot be expected to fulfil those roles. However there is much that we can do to provide meaningful, compassionate support to our clients. It all depends on attitude, the ability to listen and the use of a few basic
communication skills. Here is how you can help meet the previously identified needs of grieving clients. Reality Gently encourage clients to be present at the death where it is an option. Offer them time before hand and time after so that they can say goodbye in the way they need to. Encourage the return of ashes and a ceremony as a ritual for marking and honoring the significance of their pet in their life. It is also helpful to use the correct language (i.e. dead or has died ) rather than the plethora of euphemisms traditionally used. Permission Talk openly with clients about the death and their thoughts and feelings to the extent that they are comfortable. Listen and validate their process and how difficult it is for them. Empathy Develop the ability to sit with clients in grief and distress and try not to fix them, cheer them up or rationalise them out of their feelings. Listen and give time - be genuinely present and attentive - may need to say nothing or very little. Use open questions i.e. questions that do not have a yes or no answer. How are you feeling today? Paraphrase I can hear that you re really struggling to come to terms with Toby s death Clarify if you need to What do you mean when you say you re feeling weird? Don t ignore, judge or categorise feelings. Stay with, accept and acknowledge feelings - they aren t right or wrong they just are. Time Be prepared to give it to them within practical limitations. A follow up phone call within 3 days is an excellent practice. Professional validation In certain circumstances it is helpful to use your position and knowledge to release clients from inappropriate feelings of guilt. Clients often blame themselves in part for having contributed in some way to their pet s death If only I d come in sooner he would have lived. Where it is obvious that they are assuming responsibility inappropriately it can be very helpful to reassure the client that it is not their fault and that you believe nothing they could have done would have made any difference. Normalisation Give out literature on grief. Reassure the client that what they are experiencing is to be expected and that it will pass.
It is good practice to offer clients the option of having support in the form of bereavement counseling from a relevant practitioner. Some clients will be severely affected by grief and may express suicidal thoughts or other worrying signs of an inability to cope. It is imperative that veterinarians advise and preferably help such clients to seek counseling support including the use of 24 hour crisis lines. References 1 Lagoni L, Butler C, Hetts S, The Human Animal Bond and Grief. Philadelphia: W.B.Saunders, 1994 2 Worden J W, Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner, New York: Springer Publishing Company, 1982 3 Zagdanski D, Stuck for Words: What to Say to Someone Who is Grieving. Melbourne, Hill of Content Publishing Co. 1994