It’s easy to see why some seniors can fall into deep depression and decide life may not be worth living anymore. They may have lost a spouse, family members, children, friends or perhaps their mobility and health.
Sometimes depression may come softly, slowly stealing the seniors’ enthusiasm for life and isolating themselves from others while struggling alone with all sorts of depressive emotions.
New therapies have emerged that can help seniors deal with emotional issues that even they may not know they have. Talk therapy is one method of treatment that’s making amazing pathways to help seniors re-evaluate their present situation and find ways to deal with it.
How Talk Therapy for Seniors Works
Mental health social workers, psychiatrists and psychologists are become adept at helping seniors revamp their lives with the help of talk therapy. This type of therapy is designed to get the seniors to confront their negative thoughts and mood swings and develop new ones that can stave off bouts of depression that plague them in future years.
Some seniors that are dealing with depression today may be part of the generation that didn’t put much stock into therapy or counseling. They think of it as ‘spilling their guts’ to a person they don’t know and who doesn’t really know them. It’s embarrassing and a stigma that they want to avoid at all costs.
During a senior’s younger years, most have likely never entered a therapist’s office. Now, however, they’re recognizing that some of their problems might be easier to handle if they talk to a professional about ways to deal with them.
Since Medicare pays for therapy and psychiatric assessment, there’s no viable reason for a senior not to have an evaluation from a professional. Seniors are realizing that their time is more limited than it was and that they need to make the most of whatever years they have left.
Talk therapy is a good place to start when dealing with a senior’s depression and negative thoughts. If the patient is in full blown clinical depression, antidepressants may be in order – or some other type of lifestyle change such as diet and exercise.
Talking to someone neutral — especially a trained professional — about personal problems and fears can’t hurt and will likely give the senior a new perspective on life so they can become open to changes and new opportunities that present themselves in later years.
Claustrophobia is a form of anxiety disorder, in which an irrational fear of having no escape or being closed-in can lead to a panic attack.
It is considered a specific phobia according to the Diagnostic and Statistical Manual 5 (DSM-5).
Triggers may include being inside an elevator, a small room without any windows, or even being on an airplane.
Some people have reported that wearing tight-necked clothing can provoke feelings of claustrophobia.
Fast facts on claustrophobia:
Here are some key points about claustrophobia. More detail is in the main article.
Claustrophobia affects some people when they are in a small space.
It can lead to feelings of panic.
Causes may include conditioning and genetic factors.
A variety of tips and treatments may help people overcome their fear.
What is claustrophobia?
Claustrophobia is the fear of a closed-in place from which escape would be difficult or impossible.
The word claustrophobia comes from the Latin word claustrum which means “a closed-in place,” and the Greek word, phobos meaning “fear.”
People with claustrophobia will go to great lengths to avoid small spaces and situations that trigger their panic and anxiety.
They may avoid places like the subway and prefer to take the stairs rather than an elevator, even if many floors are involved.
Up to 5 percent of Americans may experience claustrophobia.
A psychologist or psychiatrist will ask the patient about their symptoms.
A diagnosis of claustrophobia may emerge during a consultation about another anxiety-related issue.
The psychologist will:
ask for a description of the symptoms and what triggers them
try to establish how severe the symptoms are
rule out other types of anxiety disorder
To establish some details, the doctor may use:
a claustrophobia questionnaire to help identify the cause of anxiety
a claustrophobia scale to help establish the levels of anxiety
For a specific phobia to be diagnosed, certain criteria need to be met.
a persistent unreasonable or excessive fear caused by the presence or anticipation of a specific situation
anxiety response when exposed to the stimulus, possibly a panic attack in adults, or, in children, a tantrum, clinging, crying or freezing
a recognition by adult patients that their fear is out of proportion to the perceived threat or danger
employing measures to avoid the feared object or situation, or a tendency to face the experiences but with distress or anxiety
the person’s reaction, anticipation or avoidance interferes with everyday life and relationships or causes significant distress
the phobia has persisted for some time, usually 6 months or longer
symptoms cannot be attributed to another mental condition, such as obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD)
Claustrophobia is an anxiety disorder. Symptoms usually appear during childhood or adolescence.
Being in or thinking about being in a confined space can trigger fears of not being able to breathe properly, running out of oxygen, and distress at being restricted.
When anxiety levels reach a certain level, the person may start to experience: sweating and chills
accelerated heart rate and high blood pressure
dizziness, fainting, and lightheadedness
hyperventilation, or “over breathing”
shaking or trembling and a sense of “butterflies” in the stomach
a choking sensation
tightness in the chest, chest pain, and difficulty breathing
an urge to use the bathroom
confusion or disorientation
fear of harm or illness
It is not necessarily the small spaces that trigger the anxiety, but the fear of what can happen to the person if confined to that area.
This is why the person fears running out of oxygen.
Examples of small spaces that could trigger anxiety are: Claustrophobia trapped.
Claustrophobia can stem from a feeling of being trapped, and what could happen if they stayed confined to that area.
elevators or changing rooms in stores
tunnels, basements, or cellars
trains and subway trains
cars, especially those with central locking
some medical facilities, such as MRI scanners
small rooms, locked rooms, or rooms with windows that do not open
checking the exits and staying near them when entering a room
feeling anxious when all the doors are closed
staying near the door in a crowded party or gathering
avoiding driving or traveling as a passenger when traffic is likely to be congested
using the stairs instead of the elevator, even if this is difficult and uncomfortable
Claustrophobia involves a fear of being restricted or confined to one area, so, having to wait in line at a checkout may also cause it in some people.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) can be used to reduce the frequency and potency of the fear reaction’s triggers.
Following a diagnosis, the psychologist may recommend one or more of the following treatment options.
Cognitive behavioral therapy (CBT): The aim is to retrain the patient’s mind so that they no longer feel threatened by the places they fear.
It may involve slowly exposing the patient to small spaces and helping them deal with their fear and anxiety.
Having to face the situation that causes the fear may deter people from seeking treatment.
Observing others: Seeing others interact with the source of fear may reassure the patient.
Drug therapy: Antidepressants and relaxants can help manage symptoms, but will not solve the underlying problem.
Relaxation and visualization exercises: Taking deep breaths, meditating and doing muscle-relaxing exercises can help deal with negative thoughts and anxiety.
Alternative or complementary medicine: Some supplements and natural products, for example, lavender oil or a “rescue remedy,” may help patients manage panic and anxiety.
Treatment often lasts around 10 weeks, with sessions twice a week. With appropriate treatment, it is possible to overcome claustrophobia.
Tips for coping
Strategies that can help people cope with claustrophobia include:
staying put if an attack happens. If driving, this may include pulling over to the side of the road and waiting till symptoms have passed.
Reminding yourself that the frightening thoughts and feelings will pass
trying to focus on something that is not threatening, for example, the time passing or other people
Breathing slowly and deeply, counting to three on each breath
challenging the fear by reminding yourself that it is not real
visualizing positive outcomes and images
Longer-term strategies may include joining a yoga class, working out an exercise program, or booking an aromatherapy massage, to help cope with stress.
In this video, Stella Lourency, Assistant Professor of Psychology at Emory University, explains that people with higher levels of claustrophobic fear tend to underestimate distances.
Past or childhood experience is often the trigger that causes a person to associate small spaces with a sense of panic or imminent danger.
Experiences that can have this effect may include:
being trapped or kept in a confined place, by accident or on purpose
being abused or bullied as a child
getting separated from parents or friends when in a crowded area
having a parent with claustrophobia
The trauma experienced at that time will affect the person’s ability to cope with a similar situation rationally in future. This is known as classic conditioning.
The person’s mind is believed to link the small space or confined area with the feeling of being in danger. The body then reacts accordingly, or in a way that seems logical.
Classic conditioning can also be inherited from parents or peers. If a parent, for example, has a fear of being close in, the child may observe their behavior and develop the same fears.
Possible genetic or physical factors
Other theories that may explain claustrophobia include:
Having a smaller amygdala: This is the part of the brain that controls how the body processes fear.
Genetic factors: A dormant evolutionary survival mechanism causes reactions that are no longer needed in today’s world.
Mouse studies have indicated that a single gene may cause some individuals to have a greater degree of “resident-intruder stress.”
One group of researchers has suggested that people who experience claustrophobia perceive things as being nearer than they are, and that this triggers a defense mechanism.
A new study by patient safety researchers shows common medical errors may be the third leading cause of death in the U.S., after heart disease and cancer. (Deirdra O’Regan/The Washington Post)
Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient-safety researchers provides some context.
Their analysis, published in the BMJ on Tuesday, shows that “medical errors” in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s.
Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another.
“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said.
The issue of patient safety has been a hot topic in recent years, but it wasn’t always that way. In 1999, an Institute of Medicine report calling preventable medical errors an “epidemic” shocked the medical establishment and led to significant debate about what could be done.
The IOM, based on one study, estimated deaths because of medical errors as high as 98,000 a year. Makary’s research involves a more comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 to 2008. His calculation of 251,000 deaths equates to nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.
Makary said he and co-author Michael Daniel, also from Johns Hopkins, conducted the analysis to shed more light on a problem that many hospitals and health-care facilities try to avoid talking about.
Although all providers extol patient safety and highlight the various safety committees and protocols they have in place, few provide the public with specifics on actual cases of harm due to mistakes. Moreover, the Centers for Disease Control and Prevention doesn’t require reporting of errors in the data it collects about deaths through billing codes, making it hard to see what’s going on at the national level.
The CDC should update its vital statistics reporting requirements so that physicians must report whether there was any error that led to a preventable death, Makary said.
“We all know how common it is,” he said. “We also know how infrequently it’s openly discussed.”
Kenneth Sands, who directs health-care quality at Beth Israel Deaconess Medical Center, an affiliate of Harvard Medical School, said that the surprising thing about medical errors is the limited change that has taken place since the IOM report came out. Only hospital-acquired infections have shown improvement. “The overall numbers haven’t changed, and that’s discouraging and alarming,” he said.
Sands, who was not involved in the study published in the BMJ, formerly known as the British Medical Journal, said that one of the main barriers is the tremendous diversity and complexity in the way health care is delivered.
Consumer Reports recently investigated California licensing records and found that many doctors who were still practicing were on probation for serious violations of patient safety.
“There has just been a higher degree of tolerance for variability in practice than you would see in other industries,” he explained. When passengers get on a plane, there’s a standard way attendants move around, talk to them and prepare them for flight, Sands said, yet such standardization isn’t seen at hospitals. That makes it tricky to figure out where errors are occurring and how to fix them. The government should work with institutions to try to find ways improve on this situation, he said.
Makary also used an airplane analogy in describing how he thinks hospitals should approach errors, referencing what the Federal Aviation Administration does in its accident investigations.
“Measuring the problem is the absolute first step,” he said. “Hospitals are currently investigating deaths where medical error could have been a cause, but they are underresourced. What we need to do is study patterns nationally.”
He said that in the aviation community every pilot in the world learns from investigations and that the results are disseminated widely.
CONTENT FROM THE CLEVELAND CLINIC
Why empathy matters in healthcare
More hospitals are putting patient comfort and wellbeing at the forefront of their operations—from staff hires to building design to team structure.
“When a plane crashes, we don’t say this is confidential proprietary information the airline company owns. We consider this part of public safety. Hospitals should be held to the same standards,” Makary said.
Frederick van Pelt, a doctor who works for the Chartis Group, a health-care consultancy, said another element of harm that is often overlooked is the number of severe patient injuries resulting from medical error.
“Some estimates would put this number at 40 times the death rate,” van Pelt said. “Again, this gets buried in the daily exposure that care providers have around patients who are suffering or in pain that is to be expected following procedures.”
EPIC-id+ offers the advantages of an Engraved Emergency ID along with three digital pages of your most critical medical information on a waterproof USB. EMS, firefighters and police are trained to look for emergency ID bands. When first responders read your engraved ID and connect EPIC-id to their on-board computers, they immediately have your medical and contact information available in both a physical and digital format.
Digital emergency forms come pre-loaded on EPIC-id, making it simple to input your personal medical information and make updates as often as necessary. No software to download. No subscriptions to pay.
Easy for First Responders
EMS, firefighters and police are trained to look for emergency ID bands. When professional first responders read your engraved tag and connect EPIC-id to their on-board computers to access your medical information, you have the benefit of having your medical information available in both a physical and digital format.
Want to ask questions about V.I.P ? Call Ashley’s Voice Outreach – 615-673-2221
When Someone You Know Is Touched By Crime
Whenever a crime occurs, many people are affected — the victim, family members, friends and the entire community. The latest national statistics show that one out of four families in the United States will be touched by violent crime every year. Moved by the very real suffering of the people who make up these alarming figures, the Nashville Police Department developed the Victim Intervention Program as a way to help restore a sense of peace and balance to lives torn apart by violent crime.
The mission of the Victim Intervention Program of the Metropolitan Nashville Police Department is to provide mental health services and criminal justice system advocacy whenever individuals, families, and/or the community are affected by violent crime. All services are free, confidential, and provided in an environment which supports cultural diversity: with respect to race, religion, creed, and sexual orientation.
Help Is Here
The Victim Intervention Program (VIP) was first launched in 1975 as a crisis counseling and victim advocacy program. VIP was founded on the idea that anyone who endures a trauma as a result of a criminal act should be offered free and immediate crisis intervention and follow up counseling. Staffed by mental health professionals, VIP is available to victims, their families, and other individuals in crisis who come in contact with the police department. Anyone victimized by a crime who wants counseling or court advocacy is eligible for services. A victim’s decision about prosecution does not affect eligibility.
A Wide Range of Services
As the number of violent crimes has continued to climb, the Victim Intervention Program has added services to fill a growing need. A professional and compassionate staff provides:
A 24-hour on call service to victims and citizens involved in crimes reported to the police department.
Professional counseling services to individuals, family members and others affected by crime and traumatic police related events. Support groups for victim populations are provided at various times throughout the year and referral services when appropriate.
Critical Incedent Debriefings
Group crisis intervention provided upon request when businesses, schools, or other groups are affected by violence.
Guidance, support, clarification and explanation throughout police and court proceedings.
Consultation and Training
A series of lectures and workshops for community groups and professionals that help to increase awareness and understanding of victimization issues and crisis intervention.
Information and Referral
Coordination and communication among physical and mental healthcare practitioners, social service agencies and the criminal justice system.
It’s Your Call
The main goal of the Victim Intervention Program is to help individuals and their loved ones reclaim a sense of health and well-being in the aftermath of a crisis. If you or someone you know is the victim of a crime, please call the appropriate number listed below.
You may have heard this one, but I find that it doesn’t hurt to be reminded of it every once in a while. First let me tell you the story, and then we can talk about it.
Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions.
Off in the distance, the old man noticed a small boy approaching. As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea. The boy came closer still and the man called out, “Good morning! May I ask what it is that you are doing?”
The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”
The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”
The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”
adapted from The Star Thrower, by Loren Eiseley (1907 – 1977)
We all have the opportunity to help create positive change, but if you’re like me, you sometimes find yourself thinking, “I’m already really busy, and how much of a difference can I really make?” I think this is especially true when we’re talking about addressing massive social problems like tackling world hunger or finding a cure for cancer, but it pops up all of the time in our everyday lives, as well. So when I catch myself thinking that way, it helps to remember this story. You might not be able to change the entire world, but at least you can change a small part of it, for someone.
They say that one of the most common reasons we procrastinate is because we see the challenge before us as overwhelming, and that a good way to counter that is to break the big challenge down into smaller pieces and then take those one at a time–like one starfish at a time. And to that one starfish, it can make a world of difference.
“A single, ordinary person still can make a difference – and single, ordinary people are doing precisely that every day.”
— Chris Bohjalian, Vermont-based author and speaker
Applies to promethazine: oral elixir, oral syrup, oral tablet
Note: This page contains side effects data for the generic drug promethazine. It is possible that some of the dosage forms included below may not apply to the brand name Phenergan.
How does Phenergan work?
It blocks the effects of the naturally occurring chemical histamine in your body. Phenergan is used to treat allergy symptoms such as itching, runny nose, sneezing, itchy or watery eyes, hives, and itchy skin rashes. Phenergan also prevents motion sickness, and treats nausea and vomiting or pain after surgery.
As well as its needed effects, promethazine (the active ingredient contained in Phenergan) may cause unwanted side effects that require medical attention.
Stop taking promethazine and get emergency help immediately if any of the following effects occur:
Rare – Symptoms of neuroleptic malignant syndrome; two or more occur together; most of these effects do not require emergency medical attention if they occur alone
difficult or unusually fast breathing
fast heartbeat or irregular pulse
high or low (irregular) blood pressure
loss of bladder control
severe muscle stiffness
unusually pale skin
unusual tiredness or weakness
Claritin-D® – Official Site
Relieve Your Allergies & Congestion. Try Non-Drowsy Claritin-D® Today. Claritin.com/Congestion-Relief
Major Side Effects
If any of the following side effects occur while taking promethazine, check with your doctor immediately:
Incidence not known:
Abdominal or stomach pain
black, tarry stools
blood in urine or stools
chest pain or discomfort
confusion as to time, place, or person
cough or hoarseness
decreased awareness or responsiveness
difficulty or troubled breathing
fast, pounding, or irregular heartbeat or pulse
fever with or without chills
fixed position of eye
heavier menstrual periods
holding false beliefs that cannot be changed by fact
increased or decreased blood pressure
irregular, fast or slow, or shallow breathing
large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
lightheadedness, dizziness, or fainting
loss of appetite
loss of bladder control
lower back or side pain
mimicry of speech or movements
painful or difficult urination
pale or blue lips, fingernails, or skin
peculiar postures or movements, mannerisms or grimacing
pinpoint red spots on skin
seeing, hearing, or feeling things that are not there
severe muscle stiffness
shortness of breath
slow or irregular heartbeat
sores, ulcers, or white spots on lips or in mouth
sticking out of tongue
tightness in chest
uncontrolled twisting movements of neck
unpleasant breath odor
unusual bleeding or bruising
unusual excitement, nervousness, or restlessness
unusual tiredness or weakness
vomiting of blood
yellow eyes or skin
Symptoms of overdose:
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
excessive muscle tone
feeling of warmth
feeling sad or empty
lack of appetite
loss of interest or pleasure
muscle tension or tightness
pupils of eyes large and not moving or responding to light
redness of the face, neck, arms and occasionally, upper chest
shakiness and unsteady walk
unsteadiness, trembling, or other problems with muscle control or coordination
Minor Side Effects
Some promethazine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:
Incidence not known:
blistering, crusting, irritation, itching, or reddening of skin
continuing ringing or buzzing or other unexplained noise in ears
Nervous system side effects have been reported the most frequently. These have included excessive sedation, drowsiness, fatigue, paradoxical excitation, confusion, disorientation, tremors, convulsive seizures, and decreased motor coordination. Extrapyramidal effects (including oculogyric crises, torticollis and tongue protrusion), encephalitic symptoms, convulsions, and psychosis have been rarely reported.[Ref]
Neuroleptic malignant syndrome has been rarely observed during treatment with promethazine (the active ingredient contained in Phenergan) It usually occurs within the first 30 days after exposure to neuroleptics.[Ref]
Fever, altered consciousness, labile blood pressure, autonomic dysfunction, and muscle rigidity are the hallmarks of the neuroleptic malignant syndrome. The neuroleptic malignant syndrome is associated with a case fatality rate ranging from 5% to 20%. Immediate discontinuation of promethazine and intensive monitoring and supportive care are indicated.[Ref]
Local side effects have been associated with the inadvertent intraarterial injection of promethazine (the active ingredient contained in Phenergan) which carries a high risk of distal necrosis and frequently requires amputation of the affected limb. Subcutaneous injection has more rarely caused chemical irritation and necrosis.[Ref]
Respiratory side effects have rarely included respiratory depression and arrest, especially with parenteral administration of promethazine (the active ingredient contained in Phenergan) Equipment for resuscitation should be available when parenteral promethazine is used. Asthma and nasal stuffiness have also been reported.[Ref]
Gastrointestinal side effects have included nausea, vomiting, and dry mouth.[Ref]
Hypersensitivity side effects have included rare reports of rash, pruritus, hypotension, photosensitivity, and tachycardia.[Ref]
Hematologic side effects have included rare cases of neutropenia. Leukopenia, thrombocytopenia, thrombocytopenic purpura, and agranulocytosis have also been reported.[Ref]
Cardiovascular side effects have rarely included tachycardia, bradycardia, and increased or decreased blood pressure. Prolongation of the QT interval, heart block, and malignant arrhythmias have been reported in association with other phenothiazines.[Ref]
Immunologic side effects have included rare reports of a systemic lupus erythematosus syndrome.[Ref]
Developing Formal Guidelines for the Diagnosis and Treatment of CVS in Adults
When CVSA was founded in 1993, it was thought that CVS was a condition of childhood and adolescence. Now we know that adults also suffer from CVS. There is CVS that begins in childhood and may extend into adulthood and adult onset CVS. As so many adults can attest, the condition causes untold suffering and disability, and often leads to family, school, and career upheaval.
With children’s guidelines already in place thanks to CVSA fundraising and our strong medical team, we are embarking on a partnership project that will help adult sufferers around the world. Partnering with the American Neurogastroenterology and Motility Society (ANMS) www.motilitysociety.org, a strong medical committee of ten medical professionals has been formed to develop guidelines for the diagnosis and treatment of CVS in adults. When completed, these guidelines will help doctors and ER personnel around the world understand how to diagnose and treat adult CVS patients more effectively.
Developing medical guidelines is a rigorous and expensive process, estimated to take two years. This is where you come in. CVSA is actively seeking financial sponsorship for this project through our membership and beyond. You can be part of this long overdue work of CVSA, the product of which will reach people still suffering in isolation with CVS. Please consider sending in a donation through our website.
When a loved one dies, there are plenty of decisions that will have to be made by his or her family. A potentially overwhelming number, in fact. It is a sad fact of the nursing profession that one of the most dreaded duties that a caretaker will have to perform is to ask the following question: “Which funeral home would you like us to call to make arrangements for the body?” That question carries with it a ton (actually several tons) of stress and grief that can come pouring upon a family member who has lost his or her beloved. And it just the first of a string of important decisions that must be made – often within a half hour or less. This article aims to help families be ready for that question and all the others that will follow it over the course of the next few days (or even weeks).
The easy way to make Funeral Decisions:
The best and easiest way to make funeral decisions is to take the time to plan things well in advance. Experts in a variety of fields — from psychology to financial planning to, of course, funeral planning — will all tell you that elders in a family owe it to their own piece of mind (as well of that of their loved ones) to make sure their final arrangements are planned, down to the very last detail and very last dollar, well before the time of need. And the experts all go on to say that it’s never too early to make these arrangements. Though people in their 20s rarely can be found to consider, and communicate, what should happen to their remains in the event of an untimely death, doing so can be a healthy experience. It is a practice of good stewardship to write one’s wishes and plans in detail and store the document in a very secure place known to several in the family. The very first sentence of this document would do well to answer the question that no nurse will ask out of eagerness: which funeral home should we call.
How to Decide who should make the Funeral Decisions:
But, even in the case in which a funeral has been planned in advance of need, there will still be at least a few details left uncovered. The deceased may have thoroughly explained his or her desire to be cremated or burried, or what to do with the cremation ashes, to scattering the ashes across various part of the state in which he lived or to have a water or ocean ash scattering. But, at the same time, she might have likely neglected to say which exactly which relatives should be mentioned by name in the obituary, or who should be asked to be a pall bearer at the open casket service he requested.
The questions, nevertheless, must be answered by someone.
The best way to do this is to organize an emergency family meeting (via telephone or video conference call, if need be) within 12-24 hours after a death. Whoever takes the lead in arranging the meeting should be prepared to also be selected the family’s spokesperson in dealing with the professionals who will be helping plan the funeral. But this person should not presume this selection in advance of the meeting. The most important item of business in this meeting would be to achieve a consensus about just who has the authority to speak for the family. In most cases, this authority need not necessarily be in writing, but, in the event a family has a history of litigiousness or even just a history of fairly routine strife, it might not be a bad idea to ask all present to sign a statement of some sort. A simple one or two sentence page will probably suffice in all but the most contentious of cases.
Establishing a Consensus:
Once a spokesperson has been selected, it then becomes his or her responsibility to be a democratic leader, taking all opinions and ideas into consideration before making any final decision. It is important for this leader to remember that his or her selection is not necessarily a license to plan things his way. Such an attitude could be detrimental to the long term healing of grief for many family members who have entrusted him or her to speak for them.
Consensus must always be the goal.
What to do in the event of Major Disagreements:
In the event of major disagreements over how to make funeral decisions for a loved one, the leader who has been selected as spokesperson for the family should consider adopting a humble spirit for the sake of harmony and consensus. That’s what any good leader would do, in fact.
A case in point:
One woman in Texas was selected as the family spokesperson after the death of her husband who had left conflicting instructions regarding his choice of burial versus cremation. Being a frugal woman, the wife’s first inclination was to simply have her husband quickly cremated and ask various family members to scatter portions of them over various parts of the United States in the coming months. This had been the wish of her recently departed brother-in-law, and her husband had always seemed glad for the opportunity to participate in that type of memorial. And besides, this decision was going to save thousands of dollars off the cost of her husband’s memorial service, a ceremony that, it was clear, she would be paying for almost entirely.
When the woman mentioned these plans to family members, she immediately began to sense that several were uncomfortable with it. For emotional reasons, these family members gradually expressed to her over the next day or so that they preferred to have their beloved relative buried in a traditional grave marked with a headstone that they could come and visit many times over the course of the rest of their lives.
The woman knew that honoring these desires would add thousands of dollars to her expenses, and it went against her spirit of economy and frugality.
But she conceded anyway.
Allowing this emotional blessing to her fellow family members who loved her husband as much as she did was simply the right thing to do, she decided.
Consensus, in the end, was worth much more than frugality. And that is often the case, families find, when they get down to the business of making funeral decisions.
You may find yourself feeling angry:Legend has it that one evening an elderly Cherokee told his grandson about a battle that goes on inside every one of us. The battle, he said, is between two wolves. One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego. The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith. His grandson thought about this for a moment, then asked his grandfather, “Which wolf wins?” His grandfather simply replied, “The one you feed.”
Although anger is commonly identified as one of the so-called Stages of Grief, we now recognize that grief does not occur in easily defined stages, and anger is not always a part of everyone’s experience. Better to think of anger as a state (the circumstances or condition in which you may find yourself at any given time) rather than a stage (one of several sequential phases you may be in, as you work your way toward an end).
What is more, many mourners report not feeling angry at all. Nevertheless, there are times in your grief journey when you’re frustrated and hurting, and it’s only natural to lash out and look for someone to blame. Being angry is a way of channeling energy, of making some sense of the pain. When you are protesting an unjust loss, you may have every right to be angry. Even if you know your anger isn’t logical or justified, you can’t always help how you feel. Emotions aren’t always rational and logical. Feelings are neither right or wrong, good or bad. They just are. And for some of us, being angry may be preferable to feeling the underlying hurt and pain of loss.
at yourself for what you did or failed to do, whether it is real or imagined.
at your loved one for dying and abandoning you.
at a surviving family member for not being the one who died.
at medical or nursing staff who expressed little or no sympathy during your loved one’s illness or death.
at the doctors or the health care system for failing to save your loved one.
at the situation which suddenly rendered you helpless and powerless, when all this time you thought you were in control of your life.
at fate or at God for letting your loved one get sick and die.
at life because it isn’t fair.
at the rest of the world because life goes on as if nothing’s happened, while all your dreams are shattered and your life’s been turned upside down.
at others who have not lost what you have lost, who aren’t suffering; who are more fortunate than you and don’t even see it or appreciate it; who cannot understand what you are going through; who will go back to their lives as usual.
at others for being happy (part of a couple, part of an intact family) when you are not.
Anger is a powerful emotion that can be frightening. But feeling angry doesn’t necessarily imply that you will lose control or take your anger out unfairly on others. Before you can get through it, let go of the intense emotions attached to it and move on, your anger must be admitted, felt and expressed, if only to yourself. When you simply acknowledge feelings of anger to yourself or a trusted other without actually doing anything about them, no harm is done, to you or anyone else. On the other hand, if anger is suppressed and held on to, eventually you may erupt like a volcano, internalize it and take it out on yourself (in the form of depression or anxiety), or misdirect it toward innocent others such as family, friends and colleagues.
Suggestions for Coping with Anger
Recognize what you were taught about anger as a child and how that may affect the way you experience and deal with anger now.
Seek to understand what’s driving your anger, resentment or disappointment. Examine whatever expectations you had of others that were not met. What did you expect that did not happen? Were your expectations reasonable? Were others capable of doing what you expected?
Discover ways to discharge the energy of anger in appropriate, non-destructive ways that will bring no harm to yourself, to others or to property. Find a safe place, space, activity and time where you can let your anger out through: