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The spoon theory and grief

23/3/2022

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​The spoon theory was created by Christine Miserandino to explain to a friend about what it felt like to have the chronic illness lupus. She used it to describe how every task in a day requires a block of energy, be it physical or mental, and that she had to budget out those blocks across the day. She wrote it up as an essay for her blog.
 
"I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said 'Here you go, you have Lupus'… I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of spoons. But when you have to now plan your day, you need to know exactly how many spoons you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons…. I asked her to list off the tasks of her day, including the most simple. As she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon… I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your spoons are gone, they are gone."
 
Spoons and grief
The spoon theory was created for chronic illness, but it can also be used for the impact that grief has on your physical and mental spoon numbers. Early on in grief I was so tired that my bones hurt, which took away some of my physical spoons. I also had widow brain, which took away some of my mental spoons too. Creating a spoons graphic based on your own needs can be a useful exercise to help you understand what you need, and what you can do to look after yourself.
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What you can do
  • Be kind to yourself
  • Some days you might wake up with very few spoons – those are the days that you need to rest, both physically and mentally
  • Get to know your limitations
  • Prioritise the things that have to be done, the things that it would be useful to do, and the things that can be put off to another day
  • Schedule your day to meet the spoons you have – you may have more energy at different times of day
  • Accept that you may need to ask for help, and accept help when it's offered (I know it's hard)
  • Understand that, when you are low on mental spoons, physical spoons, or both, it's hard to make plans. And that you might need to change your plans at the last minute, too.
  • Pace yourself – if you have a busy day ahead, have a quiet day the day before if you can, and be prepared that you might need to rest the day after
  • Take breaks when you need them
  • Explain to people what you are going through – the spoon theory can help
  • Try to eat and sleep as well as you can, and consider adding in a basic multivitamin and multimineral if you're not eating well
  • Exercise when you can
 
Notes about spoons
  • Your numbers of spoons can change from day to day
  • Physical and mental spoon numbers can differ – gardening may be a high physical spoons activity but if you enjoy it, it might be low on mental spoons, or even help you to replenish your spoons
  • The number of spoons any activity takes will vary from person to person
  • Replenishing mental spoons differs for different people – for extroverts, spending time with people helps, and for introverts, spending time alone might be the right thing to do. I'm an ambivert with introvert leanings, and so I love being with people right up to the point that I suddenly need to be alone
  • The spoons lost in grief do come back, but your spoon numbers might drop on milestone dates or days when grief hits hard 
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Hints and tips for sleep

21/3/2022

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Lack of sleep can have an effect on our health – it's been linked to obesity, heart disease, memory loss, high blood pressure, diabetes and a less effective immune system. Not having enough sleep can leave you craving sugary, salty or carbohydrate-heavy food.

Lack of sleep has connections between depression and anxiety. It can even affect your balance.

Sleep can be so hard when you are grieving - your head is full of spinning thoughts and tough memories, and you may have nightmares. ​​Here are some hints and tips for improving sleep.
 
During the day
  • Get sunlight, or use bright daylight bulbs during the day to reinforce your circadian rhythm
  • Use the bed to sleep, not to work
  • Exercise during the day can help you sleep at night, by increasing sleep duration, deep sleep duration and fewer times waking up. Avoid strenuous exercise or competitive sport in the few hours before bed
  • People who eat a Mediterranean-style diet have a lower risk of insomnia, and are more likely to have a good night's sleep.
  • Avoid napping if possible
  • Try stopping smoking, as nicotine affects sleep
  • If you drink alcohol, try cutting it down, especially late at night – while it makes you feel sleepy, it disrupts later sleep
  • Try cutting down caffeine, especially later in the day
 
In the evening
  • Don't eat a heavy meal too close to bedtime
  • Avoid devices for half an hour to an hour before bedtime, and don't have TVs, computers or smartphones in the bedroom
  • Don't drink too many fluids before bedtime
  • Have a warm bath or shower, with lavender-based bubble baths, soaps, body washes and body lotion – there is some evidence that the scent of lavender does have an effect on sleep
 
Bedtime
  • Think about your sleep hygiene – have a target bedtime, and a fixed wake up time, even at the weekends
    • But if you really aren't sleepy, don't force yourself to go to bed
  • Dim the lights
  • Take half an hour to wind down – music, reading, stretches, yoga
  • Have a consistent pre-bed routine, such as cleaning teeth, putting on pyjamas
  • Make sure your mattress, pillow, duvet and bedding are comfortable
    • Mattress toppers add extra snuggliness
    • Wool mattresses, mattress toppers and duvets can help you regulate your temperature 
  • Weighted blankets may help with stress and anxiety
  • Keep your bedroom cooler than other rooms
  • Have blackout curtains or blinds
  • Block sounds with ear plugs, or drown them with white noise
  • Listen to low volume audio or music on a player that switches off automatically – Radio 4, radio 4 Extra, podcasts and Audible are all good options for audio, but make sure it's not too interesting or it will keep you awake!
    • The Calm app has meditation, music and stories designed to lull you to sleep
  • Use lavender oil or lavender-based pillow sprays,
  • Have a glass of warm milk – tryptophan can improve sleep and mood, and warm milk reminds me of being a little kid tucked up in bed
 
If you can't sleep
  • Try counting sequences
    • Count sheep
    • Count backwards from a hundred, starting again every time you make a mistake
    • Count the Fibonacci sequence
  • Try the cognitive shuffle
  • Try the 'military method' – relaxing each part of your body, and then making your mind blank
  • Try progressive muscle relaxation, where you tense each part of your body and then release the tension
  • Try slow breathing – it can help in sleeping as well as grounding
    • 7/11 breathing – breathe in for a count of seven, and breath out more slowly, to a count of eleven
    • Box or four-square breathing – breathe in for a count of four, hold for a count of four, breathe out for a count of four and hold for a count of four
    • Alternate nostril breathing – block your left nostril, and inhale and exhale through your right nostril, then block your right nostril, and inhale and exhale through your left nostril
    • 4-7-8 breathing – breathe in through your nose for a count of four, hold your breath for a count of seven, and then breathe out through your mouth for a count of eight
  • Try mindfulness or meditation
  • Distract yourself with imagery – visualise the route of a favourite walk, a childhood room, a wonderful beach or an amazing view. Bring in as many details as you can, including sounds, sights, views, textures, colours
  • Try sleep hypnosis – there are lots of sleep hypnosis audio tracks on YouTube
  • Tell yourself to stay awake…
  • If you can't sleep after 20 minutes, get up and do something calming in dim light, and then try again
 
If insomnia is making you so tired during the day that you can't work, care for yourself or others, or means that driving feels dangerous, talk to your doctor. There may be medications or therapy techniques that could help.

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Cooking and eating after loss

18/3/2022

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Cooking can feel like the last thing you want to do when you are grieving. Your appetite might be gone, and shopping and cooking for one, setting the table for one, and sitting down to eat alone just reminds you of what you have lost. You might simply not have enough energy to cook (spoon theory isn't just about chronic illness). In a world where everything is packed in two, or four, or huge multipacks, cooking for one can feel very wasteful, or make you feel trapped into eating the same thing every day for a week.
 
When you just can't face cooking
In the early days I didn't really want to eat much, and then if I did want to eat I certainly didn't want to cook. Remember at this time, eating anything is better than eating nothing, and now is not the time to be counting calories or stressing about dieting.

​There are quick and easy alternatives that get you through the bad days.
  • Smoothies are a good way to get protein, vitamins, fibre and your five a day. Plain yogurt provides protein and calcium, oats, coconut flour, nuts and seed add fibre, and fruit and veg add flavour and nutrients
  • Meal replacements, such as shakes, soups and bars are nutritionally complete
  • Tinned soup
  • Anything on toast – butter, marmite, beans, an egg, peanut butter
 
Recipe boxes and ready meals
Recipe boxes provide you with all the fresh ingredients you need, which takes the pressure of shopping away, and reduces waste. Hello Fresh and Mindful Chef provide one portion meals. Gousto recipe boxes serve two, but you can split what you make and have it the next day.

Potage, Cook and Wiltshire Farm Foods deliver single portion ready meals for the freezer (Wiltshire Farm Foods also does meals for special dietary needs) and Mindful Chef has a range of ready meals, soups and broths. Allplants and Planty deliver single portion vegan ready meals for the freezer.
Many of the plans have introductory offers, with reduced prices for the first few deliveries.
 
Keeping it simple
When you start to cook for yourself, keep it simple. That doesn't mean dull food, just food that can be made in single portions, prepared quickly and don't involve waste.
  • Jack Monroe's Tin Can Cook is a book of recipes that you can make straight from the cans on your shelf
  • One Dish Kitchen is a website of single serving recipes, and has a section of easy things to cook
  • Quick and easy meals for one, practical one person meals, and one-person cooking ideas that won't waste food
 
Learning to cook
Some people face living alone being unable to cook, or lacking confidence in their own abilities. And while all the television shows on cooking are great, they can make the whole process look really daunting. These resources are also useful for people looking for inspiration.
  • There are cookery schools in many towns and cities, and cookery classes at local colleges, which teach cooking from basic techniques to producing something amazing
  • Delia Smith's website has a whole section on learning to cook, with videos, guides and a glossary
  • Jack Monroe's website Cooking on a Bootstrap is packed full of simple and low-cost cooking ideas
  • GoodtoKnow has the 57 basic recipes that the site reckons 'everyone should know how to cook'
  • Felicity Cloake's Masterclass has a series of 'How to make' recipes that are broken down into steps
  • YouTube has a lot of cooking videos for beginners, including cook-along videos
  • Miranda Gardiner wrote Teaching Dad to Cook Flapjack, a collection of family recipes, when her mother died and her father didn't know how to cook
 
Gadgets
The two best things I bought for the kitchen were a soup maker and an air frier. My soup maker means that I can load it up with veg and stock and half an hour later I've got my five a day in a mug, with another portion for later. Some will also make smoothies, sauces and even jam.
My air frier is effectively a tiny fan oven, and means that I don't need to put the oven on when I'm cooking for one. As well as making awesome roasted vegetables, great baked potatoes (microwave them first and then finish them in the air fryer, nice crispy bacon and rather good chips, it's great for warming through bread rolls and yesterday's left-over slice of quiche.
 
Batch cooking
When you have the energy, and feel like a day in the kitchen, batch cooking means you can cook in larger batches but not be stuck eating the same thing every day. You'll also have a freezer full of ready meals made exactly to your taste.

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Bereavement support payment

14/3/2022

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You can get Bereavement Support Payments from the government. This is not a means tested payment, and is open to people whose husband, wife or civil partner died in the last 21 months, provided that the late partner paid National Insurance contributions for at least 25 weeks in one tax year, or if they died because of a work-related disease or accident. You will get £2,500 as an initial payment, and £100 a month.

Claiming within 3 months of the death means that you will get the full amount, but you can claim up to 21 months after their death. You can apply online, by phone or by post.
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Models of grief: Four phases of grief

9/3/2022

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Psychiatrist Colin Murray Parkes and psychologist John Bowlby came up with the four phases of grief model in the 1970s. This is a linear model of grief, like the four tasks of grief and the six R processes of mourning. The real experience of grief generally isn't linear though, and people as they grieve can cycle through different phases, or ping between them like a pinball machine.

Shock and numbness
After someone dies, whether it's sudden or expected, there is a period of numbness that perhaps helps us to survive the first few days, weeks or months. It's hard to accept the reality of the loss.

Yearning and searching
In the second phase, we long for our person to return. Our life is full of sadness, anger, anxiety and confusion. We can seem preoccupied.

Disorganisation and despair
Accepting our loss can leave us without energy, despairing and feeling hopeless, and can make us withdraw. Life feels like it will never get any better.
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Reorganisation and recovery
In the recovery phase, intense sadness starts to withdraw and we may be able to remember the person we lost with more positive feelings. Energy begins to return.

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Flashbacks and intrusive memories

3/3/2022

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 Just over four years ago, Tim died suddenly and unexpectedly next to me. I had to call 999, for only the second time in my life. The call handler dispatched the ambulance, and I pulled Tim onto the floor. The call handler talked me through CPR – I shouted 1-2-3-4 as I pressed down on his chest, and I can still feel in my bones the moments his ribs cracked.
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The paramedics arrived, and for a moment they thought they had restarted his heart – but no, he was gone. Tim's sudden death left me with dissociation, flashbacks, intrusive memories and nightmares, all symptoms of post-traumatic stress disorder (PTSD).

Flashbacks and intrusive memories
Flashbacks are moments where you feel that the trauma is actually taking place again, right here and right now. Intrusive memories are unwelcome thoughts and memories that push themselves into our mind.

Flashbacks and intrusive memories can be triggered by lots of things – a smell, a sound, something you see. I had a flashback in the middle of a conference when someone coughed, and it sounded just like Tim's last breath. I wanted to run but couldn't get out. I repeated under my breath 'that was then, and this is now'.

There is a brilliant video about intrusive memories from The Loss Foundation that explains more about why these happen.

Dreams and nightmares
There is a theory that dreams and nightmares are a way of our brains processing the events that we have been through, and storing our memories. If this is correct, it's not surprising that we have grief dreams. They're not always about our partners dying – I've had dreams about Tim coming back temporarily, about his death being a mistake, about him not dying at all but leaving me or me leaving him. Over time, the bad dreams do diminish, though they can pop back up after emotional moments or times of conflict. I do now have nice dreams about my parents, and about Tim. While I wake up sad, I think 'It was nice to see you again'.
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Dissasociation
When you disassociate, you can feel unreal, and disconnected from yourself or the world. You might feel that the world around you is a film that you are watching, or that you are watching your life as an outsider. You might blank out, not remember what you are doing, or feel like you are daydreaming. It can come with a feeling of numbness. While dissociation in PTSD is similar to depersonalisation-derealisation disorder, a dissociative disorder that I have had in a mild form since my mid-teens, it is linked to a specific traumatic event.

What to do
For flashbacks and intrusive memories, or after nightmares, telling yourself that it isn't real, and that the event is over, can help. Grounding techniques can also be useful.

If flashbacks, intrusive memories and nightmares become disabling, talking to someone can help. I saw an integrative psychotherapist who used techniques based on CRM (comprehensive resource model), and this made a huge difference for me. EMDR (eye movement desensitization and reprocessing) and CPT (cognitive processing therapy) are also used in PTSD. 

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    I was widowed at 50 when Tim, who I expected would be my happy-ever-after following a marriage break-up, died suddenly from heart failure linked to his type 2 diabetes. Though we'd known each other since our early 20s, we'd been married less than ten years. ​

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