On June 9, 1975, Roselda Katz Cole died of cancer. When her daughter Diane recalls that time -- still as painfully close as a thought -- she speaks of the devastation of losing the guide to her future as well as a friend with whom she shared great joy.
Soon after her mother's death, Ms. Cole decided to heal in fresh surroundings, leaving her home in Baltimore for a new job in Washington. Restless, searching, the 23-year-old woman filled her empty hours by gobbling up anthologies of poetry and
listening again and again to the Brahms horn trio. She took up jogging. She wrote down everything she could remember about her mother's life.
Ms. Cole's "After Great Pain: A New Life Emerges" (Summit Books, $20) confronts her passage through her mother's illness and the aftermath of her death as well as the subsequent griefs of her own miscarriage and infertility. Anyone who suffers a great loss, she writes, begins a journey which can be unpredictable, bewildering, irrational and fiercely personal.
"Loss will make you feel out of sync, out of step with the other people around you," she says. "When you're mourning someone, you go about daily life with a sense of heightened reality, the sense of 'What does it mean to me to be doing these mundane little shopping errands when I have lost someone so important in my life?' "
Although each person's grieving is as unique as his fingerprints, the grief-stricken share so many similar experiences that some researchers believe grieving is "wired" into the brain circuitry to help humans through their losses.
Feelings such as denial, anger, guilt and ambivalence surface so predictably that grieving could be called a syndrome in its own right, says Dr. Mark Komrad, an attending psychiatrist at the Sheppard and Enoch Pratt Hospital and instructor in psychiatry at Johns Hopkins Hospital.
Anxiety often accompanies sadness. Some common physical aspects include stomach disorders, headaches, a rapid heart rate and sweaty palms, decreased appetite, increased urination, blurred vision, decreased memory and a loss of interest in usual things.
Intrusive reminiscences of the dead can seem to dominate the survivors' mental lives. These intense memory periods can come in waves, Dr. Komrad says, "washing over you and washing back in a way that may continue for years."
Survivors often believe they see loved ones on the foot of the bed or hear them calling from the next room. Ms. Cole remembers many inner conversations with her mother. She dreamed her mother told her that she wasn't really dead.
"These were ways in which I was trying to continue our relationship, to figure out 'How can I live without the mother who gave me life? How could I grapple with life without her?' " Ms. Cole recalls from her present home in New York. "Mom and I were particularly close, we were each other's confidantes. The dreams were comforting. Some were so vivid, I would wake up and say,'This wasn't a dream!' because I wished so strongly that Mom would be there.
"It is a very powerful thought to remain together in memory, if not in reality. To somehow find a way to continue our time together."
Ambivalence about the dead person can also strike forcefully. Loss creates a cacophony of emotions, including anger.
"All the things you've felt about somebody are going to come back more intensified," says Dr. Komrad. "Some people feel it's disloyal or sacrilegious to feel anger. And those emotions can lead to guilt which allows grief to go underground. Mixed feelings are very, very normal. One needs to honor all the feelings, even the negative ones."
He says blocking grief can build up a reservoir of emotional pain that can begin to spill out years later.
"This is very true for people who have lost loved ones in early childhood and whose parents didn't know how to encourage the grieving experience. Those people were left bewildered and half aggrieved and can experience future losses with unexpected power. Sometimes a relatively minor thing, like a loss of a job or the move of your therapist, can bring back that kind of stymied grief reaction."
Children grieve differently from adults, says Dr. Peter Hartman, a psychiatrist and instructor in the department of family medicine at the University of Maryland School of Medicine.
"If the parent of a 6-year-old dies, he'll cry and feel sad for a while and then a couple of hours later he'll play jump rope with the kids. Children do their crying or feeling anxious in chunks of time. But they do have a capacity to understand about death and shouldn't be given misleading statements like 'Daddy has gone away.' Daddy has died and won't be back. We should let them know that.
"Letting children go to the funeral is a good idea to the extent that they feel comfortable. . . . To keep them out of the whole process is more frightening to them than not."
He says resolving grief requires public, as well as private, expression.
"Although funerals cost a lot of money -- perhaps too much money -- it's psychologically important to have some public mourning process. The whole purpose of publicly displaying your sadness is to have something concrete to mark the event. You also need to talk about it and express whatever feelings you have in relation to that loss."
He points out that there is no formal system for publicly expressing grief for miscarriages and stillborn births, events which haunt many women for the rest of their lives.
"People are always saying: 'You should put the past behind you; keep a stiff upper lip.' And you try to tell that to yourself, too. But you can fool yourself only so long," says Ms. Cole, who suffered an ectopic pregnancy as well as a miscarriage.
"Traditionally women are much better at mobilizing their grief support systems than men are," says Dr. Komrad. "Men may find it harder to mobilize supports or do so in a way that has some intimacy to it. A man might more easily give you a stereotyped platitude, such as 'Well, these things happen. You do what you can with life.' A woman might more easily burst into tears and share with you how sad she's feeling."
And what happens to grief two years down the road? Or 10?
"A specific detail will trigger sadness out of the blue," Ms. Cole says. "We don't get over a loss, we learn to live with it. It becomes a fact in your life, like a job in your resume. If you've been married to someone who has been ill and died, that's a very important fact in your life. You can't forget that. Nor should you be expected to."
"When someone dies, the charge of the healthy mind is to feel the sadness . . . without something dying inside of us, as well," Dr. Komrad said.
Support groups for the bereaved
Here are a few support groups for those who have lost family members. Check with local hospices for others:
* Compassionate Friends, Inc., for those who have lost children. A 24-hour Baltimore hot line refers people to groups in other counties. (410) 321-7053.
* Family Bereavement Center, for families who have lost loved ones to homicide. Tuesdays at 6 p.m., Department of Education, 200 E. North Ave., entrance on Guilford Avenue. (410) 396-7351.
* Baltimore Cancer Support Group, for widows/widowers who have lost spouses to cancer. St. Peter's Lutheran Church, 7910 Belair Road. Call for meeting times. (410) 668-1762.
* Bereavement Outreach Center, for adults who have lost loved ones. St. Agnes Hospital, 900 Caton Ave. (410) 368-2840.
* Me Too, for bereaved children. Stella Maris Hospice, 2300 Dulaney Valley Road. (410) 252-4500, Ext. 287.
* Seasons, for families and loved ones of people who committed suicide. Spangler Hall of St. Paul's Church, 1609 Kurtz Ave., in Lutherville. Meetings at 8 p.m. on the third Tuesday of every month. (410) 882-2937.