Doing the Work of Grief Care
I’ve started writing this on day 217 of the ongoing genocide against the Palestinian people. I am in the sun, outside the spiritual care tent at the People’s Circle for Palestine, the student-led encampment occupying the University of Toronto campus. Myself and a number of other seminary students from U of T are taking shifts to provide interfaith chaplaincy care to those camping here. The People’s Circle demands that the university, complicit in genocide through its financial holdings in the State of Israel and possibly in weapons manufacturing, disclose, divest and renounce. This makeshift camp - complete with counselling tents, a kitchen, medical care, meeting spaces and sanitation protocols - is propelled by the conviction that justice will be found. The Palestinian people will return to their homelands, and those martyred by Israel will be remembered, dignified, and honoured.
I am well aware that my role here is not to remove grief or sorrow. Had I come here with that goal, I would fail. Not only would l I fail, I would disrespect the sanctity and importance of that grief having no conclusion. Grief is not meant to be moved through; grief is not a process. Grief instead is the reflection of attachment, meaning and often (but not always) love, found in the absence of loss. It is the embodiment of connection straining across worlds, across time, and through change. It is necessary, enduring, eternal. Not only can I not remove this from people - I don’t want to.
I’ve been meaning to write a sort of manifesto about my approach to grief care for a while, and sitting here outside the spiritual care tent space seems an auspicious time to do so. This manifesto is informed by the past 6 years doing grief care in social work spaces, in grassroots movements, and in mutual aid. It’s written from a non-clinical framework for anyone who finds themselves walking with loss, although it is largely informed by my focus providing care after stigmatized and disenfranchised human deaths. It is not meant to be a definitive guide, framework or paradigm - prescriptive approaches to doing this work with others is really the antithesis of what I hope to emphasize. Just as relationships are complex, contextual, non-dual and nuanced, so too is grief.
Moving Beyond Grief Pop-Psychology
Four-ish years ago, in the fall of 2020 after lengthy lockdowns worsened the quality of the illicit drug supply, I was approached to train the volunteer team from E.S.N. (Encampment Support Network) in Toronto in grief and loss care. These volunteers were regularly encountering the deaths of encampment residents, and also often supporting residents in their own personal experiences of loss. I’d been working in bereavement care for a few years at this point, and having trained volunteers, social service providers and funeral industry workers had a well-rounded knowledge of grief and loss theory. Despite this, I felt dismayed by the task of making any meaningful contribution to the skillsets of these volunteers given the massive and constant waves of death attributed to the overdose & drug poisoning crisis. Mainstream and pop psychology understandings were not only not applicable, but would likely do harm to both grievers and care providers. Before even attempting to answer how we do grief care, I decided that we first need to define what grief is - both as individuals and as a culture.
These pop psychology understandings of grief processes I found myself disillusioned with usually come in the form of what theorists call “Stage and Phase” models. The original model - theorized by Elisabeth Kübler-Ross, a Swiss-American psychiatrist who specialized in hospice care - argues for 5 total stages: denial, anger, bargaining, depression, acceptance. Kübler-Ross’ 5 Stages are entrenched in the western psyche as the gold standard of grief work, so much so that I have worked with numerous counselling clients that measure their own grief journey against this standard, even to the point of feeling concerned that they’ve not progressed through the stages fast enough. To this dismay I will usually point out that that the five stage model has actually been misappropriated: it was not coined to describe the journey of grieving a death or loss - Kubler-Ross theorized these stages to describe the experience of hospice patients who were preparing for their own deaths. It was posited as a finite journey because the griever in question would soon come to the end of their life, and thus the end of this emotional process.
Those representing the posthumous Kübler-Ross legacy now argue that the model is transferable to the experience of grieving the loss of someone, something, somewhere - and is not meant to be linear. There’s more stage and phase models beyond these 5 - David Kessler’s addition of a 6th stage (meaning-making), Warden’s Four Tasks of Mourning, Rando’s 6 “R”s of Mourning. My goal here is not to condemn this model entirely, but to instead suggest that stage and phase models are not the end-all-be-all - and introduce another way of conceptualizing what grief is. This stage and phase paradigm has repeatedly failed people I’ve worked with (as well as myself), and yet it continues to dominate the western mindset and encourage an understanding of grief likewise as a finite process. But what happens when the griever in question continues to live? How are we to explain the reality that most grievers will note their grief does not end - and more so, how are we to embrace that?
These models all envision the task of grieving as a process to move through, in which we confront a loss, experience a range of associated emotions, and then engage in some variety of internal or external (decided largely by gender socialization) emotional labour or endeavour that brings us to a point of completion. Stage and Phase models tell us that at some point, contingent on the success of this emotional labour, we will make it to the end of our grief. The sorrow will subside, our anger will dissipate, we will put the lid on this particular grief experience and file it away in the closet our losses go to be forgotten. But, of course, it doesn’t really work like this. The pain of loss may lift, recede or become easier to live with, but our grief is enduring, because grief is the tint that attachment takes after loss. For many of us, this attachment is one of love, and so the resulting grief is coloured by longing. But it is also possible to have an attachment to what was lost that is complex, hard, fucked up, and painful - and therefore our grief will also reflect this reality. For this reason, I avoid language like “loved one” to refer to the deceased before I understand the nature and complexity of the relationship, and am also wary of platitudes like “grief is love with no place to go” - at least when stated as a generalization.
Grief as Relationship
If grief is not a process, what is it? Again, I want to emphasize that prescriptive approaches are really what’s gotten us into this cultural bind, and so do not want to replace one rigid paradigm with another. But if we are going to engage with grief - both our own, and that of others as a helper, we need some sort of understanding of what the hell it is. Building from the understanding that grief is a “relationship we enter into” (from the work of now-closed Toronto non-profit Being Here, Human) I conceptualize the task of doing grief care as assisting others in finding their own right relationship to their grief. By “right” relationship I do not mean right or wrong - much the opposite. “Right” means intentional, contextual, thoughtful and individual. It draws largely from harm reduction paradigms that advocate for autonomy and agency in how one approaches and engages with something difficult (substance use largely, but applicable to many hard things we are in relationship with). One person’s right relationship may be different from another’s, dependant on internal emotional capacity, external supports, and risk and protective factors. This paradigm understands that forced engagement - much like forced abstinence approaches to addiction care - do much more harm than good, and so does not move people into deeper relationship with grief when it is untenable. The goal of this approach is not resolution like stage and phase models allege, but instead intentionality and engagement. Where stage and phase models seek to neutralize grief, right relationship encourages us to build the emotional muscle to sustain a manageable relationship with it. Not to get rid of it, but to learn to live with it. The way in which we do that is up to us, and dependent on the many factors specific to our personal and cultural context.
Also central to this model is the importance of non-stigmatizing approaches to what I call non-normative and unsanctioned grief. These expressions and experiences of grief are those that the dominant culture labels unacceptable and illegitimate, and which it punishes when they manifest. Examples of non-normative and unsanctioned grief include expressions of aggression and violence, high or low emotionality that runs counter to accepted gender roles, non-mainstream ritual or remembrance services different than the cultural norm (although Celebrations of Life have become much more widely accepted), expressing anger, disappointment or relief about the loss, risky or chaotic substance use/sex, and other stigmatized coping mechanisms. Just as harm reduction paradigms for substance use understand high risk, chaotic use as a coping mechanism and work to decrease stigma and moralization of this behaviour, right relationship models of grief care understand that what dominant culture would likewise admonish as “unhealthy” grief processes are deserving of the same understanding. Where harm reduction emphasizes “meeting people where they’re at”, so too does this approach to grief care. Our role is not to move someone into a process or stage of change they are not willingly moving toward - and we should be vigilant to avoid doing this. We are instead looking to collaboratively strategize about how one might come into their own current right relationship: to destigmatize ways in which people feel they are doing grief “wrong”, to reduce harms where they arise, and to assist in building that emotional muscle that will allow for intentional relationship with grief.
The Work of Grief Care
There’s an endless number of ways that we might assist people in finding their own right relationship with grief - any skill or approach to integrating difficult experiences that has worked for someone previously can be repurposed here. I outline a general methodology that can be helpful in breaking down what the work of grief care may look like - this is not a exhaustive list, and I encourage you to draft your own framework utilizing the paradigms, tools and modalities you work from.
Sustaining and Stabilizing: Basic needs are grief needs, and very little in the realm of emotional processing and integration can be accomplished when these are not met. Housing, income and food security, access to quality healthcare (including harm reduction supports), and a supportive social network are all components of grief care.
Witnessing: Our role is not to fix, neutralize or heal. Disenfranchised grief (those forms of grief not seen as legitimate or worthy of attention and care) must be enfranchised. We do this by witnessing - by emphasizing the gravity and weight of the experience. I suggest that caregivers regularly reflect on and take stock of areas where the impulse to fix, rather than to witness, arises.
Framing: The ways that we conceptualize what grief is vary from person to person. Before engaging in the how of what grief care will look like, we have to first let our clients explore what grief is. Are they working from a stage and phase model, a relationship model, or something else? How does that inform what our work together will look like?
Destigmatizing: I’ve worked with plenty of clients that get stuck thinking they’re doing grief wrong. This often looks like feeling they’re not “progressing” fast enough through a stage and phase process, or comparing their journey to an internalized cultural standard. It’s important to clarify here that I don’t work from a model that envisions there’s no wrong way to do grief - I believe that avoidance and suppression of grief are significant and wide-spread problems, and have likewise seen the ways that suppressive behaviours such as chaotic substance use block the work of intentionality and engagement with our grief. The work of coming into right relationship is therefore the work of feeling our grief - I do not believe there is a way around this. The work of destigmatizing then is push back, from a trauma-informed lens, against shame-based narratives around why avoidance and suppression of grief happen in the first place - not to say that we needn’t worry about them at all.
Engaging Skills: Grief does not require a separate set of skills to integrate. Much of what we do as care providers is assisting in inventorying and encouraging existing skill sets that can be repurposed for this task. Everyone on a grief journey has previous experience with loss, sorrow, and change - our job is sometimes as simple as invoking the skills already within a person.
Ritualizing: While this may not be an interest for all clients, there’s plenty of research showing that rituals are deeply impactful ways to process and integrate grief. Some clients may have existing spiritual or social rituals to turn to, others may be interested in creating something specific to this particular loss. Research specifically shows that bespoke ritual is more impactful than rote participation in something pre-existing. I envision ritualizing as a process compatible with animistic, theistic, agnostic and atheist understandings of the world - it’s a meaning-making process, and meaning can be found in each of those paradigms.
This is far from an exhaustive list of what my approach has been, but hopefully acts as a framework from which you can develop the methodology best suited to your communities. Grief care is often envisioned as a highly specialized form of mental health support that only those with formal training dare approach, but the reality could not be further from the truth: grief care is the realm of all living beings, because it’s the one experience we are guaranteed to share. Supporting people through death, change, and loss is our birthright, and I see it as belonging to the realm of mutual aid before formalized healthcare or counselling. What I provide to my people today is what I will also need in future. Loss will come for all of us, and therefore has profound potential to unite if choose to let it.