Let's start by discarding the notion of a golden rule or a magic bullet -- each psyche, each grief and each death is unique. A normal grieving reaction in one case is not normal in another. Shirley Murphy, a University of Washington nursing professor, recalls the mother of a 17-year-old stabbing victim who could not have a knife in her house for six months after the murder. While that would be abnormal in some circumstances, she says, it was not in this case.

Often, parents of murdered children can't bring themselves to clean out the child's room, saying "you can't pack up your dreams in a box." Parents who force themselves to do that packing too soon, Murphy says, might be signaling a need for treatment.

Cultural roles greatly affect grieving. When Murphy offered group therapy to bereaved parents of murder and accident victims, she often heard, "I sure hope you can help my wife; she really needs this program." Even the younger men in her recent study (see "Parents' Evaluation..." in the bibliography), showed the effects of socialization, saying "they must protect their family."

Warning signs
When does grief bleed over into pathology? There's no hard-and-fast line indicating a need for professional help, but someone who still can't sleep six or eight months after the death may need it, Murphy says.

One major warning sign is a numbness, flatness, and "absolutely no feeling whatsoever," says Wisconsin grief counselor Judy Koeppl. At the other extreme, an inability to rise out of grief -- a pervasive, extended period of feeling low, with a tendency to isolate yourself, feeling hopeless, suicidal, or worthless -- may signal a slide into depression. In either case, professional intervention could be warranted.

Peer self-help groups come into play much earlier, where people who have survived a similar tragedy get together to talk, cry and remember. This experience gives what Murphy calls "normalization -- you begin to realize that you are not crazy... You feel the support of another who has experienced the exact same thing, and can see how other people are doing."

Information helps too
In a recent test of group therapy for parents of children killed by accidents, suicides or murders, Murphy added an informational component to the more traditional emotional support. Information covered topics like financial and legal issues, seeking support, understanding shifts in family roles, and coping with changes in the support network.

Her subjects, 261 bereaved parents contacted randomly from death certificates, ranked the information component just as highly as the emotional component. "People, especially men, told us they like the combination," Murphy says, "that it really helped to move from topic to topic. Otherwise, they tend to stay on the same thing over and over."

Emotional support groups are good, Murphy says (although they're not for everyone), but they can get stuck. "They keep focusing on the event [the death] rather than on how you can help another person get beyond it. They tend to take on a life of their own."