The first and necessary step of grief is discovering what you have lost. The next step is discovering what is left. What is possible.
Although scholars have written much about animal-assisted therapy’s (AAT’s) benefits and techniques, few in the field have studied the loss of a therapy animal and its effect on the lives of patients and practitioners. AAT is a happy kind of therapy. In the care of thoughtful people and appropriate animals it can transform the lives of those who receive it and of those who practice it. Each party to the therapy enhances the effect on the others, giving the method an intensity and power that other systems may not achieve. Even observers and those who simply read about the approach are touched. For these very reasons, thinking of the day when the three-way relationship must end can be extraordinarily painful.
The author has been working in the field of animal loss since 1982, when she began practicing social work at the Animal Medical Center in New York City. When she started, there was almost nothing written on the topic. It became clear almost immediately that much of the standard literature on bereavement did not apply to pet loss, at least pet loss as found in a big urban veterinary teaching hospital.
Over time patterns emerged. The reasons people gave to explain why this loss was worse than others fell in three general areas: The role of this pet in their life, the way in which the pet died, and what else was going on at the time. Many of these patterns fit the relationship among practitioner, therapy animal and patient/recipient/consumer. Other issues affecting the experience of loss in these situations are different than those with pets. This chapter will help professionals assess anyone experiencing the loss of an important animal and suggest ways of easing the pain.
In the last 40 years, research has fleshed out a feeling that nature lovers have long held: interacting with animals helps people heal from a variety of ills. The pairing of scholarly investigation and clinical practice has driven our understanding of human/animal interaction, but it has also been a field in which ordinary people contribute. Animals may be family pets accompanied to the nursing home by friendly visitors, wild birds arriving solo to a feeder outside the windows of a hospice or highly trained horses working with skilled professionals to help a young woman with cerebral palsy develop muscle strength. All the people involved—professionals, handlers, consumers and observers—can become attached to the animals. That means everyone involved can suffer when these animals retire, disappear or die. As professionals in the field we need to recognize the potential for grief in a wide group of people. We must consider all that is lost when contact ends and learn to help clients, coworkers and ourselves get through the process in a way that strengthens each person.
21.2 Scholarly research
Other chapters in this book provide comprehensive reviews of evidence that contact with animals is good for people. This chapter contains a sample of that research, which illustrates some of the benefits to different populations. Those who care for therapy animals run the risk of losing the benefits if the animal dies or is lost in some other way.
Human/animal bond research often looks at how pet contact or animal-assisted therapy helps a specific population improve social contact or mental health. Numerous studies show that elderly people socialize more or have improved quality of life when pets are present (Fick, 1993; Johnson and Meadows, 2002; Kaiser et al., 2002; Mahalskie et al., 1988; McCabe et al., 2002; Raina et al., 1999; Rogers et al., 1993). The effect of dogs on social interactions is particularly strong (McNicholas and Collis, 2000; Rossbach and Wilson, 1992).
Other studies have shown that pet contact can attract or even break through to psychiatric patients (Barker and Dawson, 1998; Berget et al., 2008; Corson et al., 1975; Holcomb and Meacham, 1989) Some prison studies have shown positive effects when incarcerated individuals care for or train animals (Katcher et al., 1989; Lee, 1984; Moneymaker and Strimple, 1991). Several research efforts have looked at how assistance animals and pets help children with disabilities and adolescents in foster care enhance social relationships (Gonski, 1985; Mader et al., 1989; Martin and Farnum, 2002).
A second area of research has focused on physical health benefits, primarily on cardiovascular functioning. An early study finds that pet ownership is a strong predictor of survival after a heart attack. In that study, benefits are not limited to dog owners (Friedmann et al., 1980). A later study of people with severe heart arrhythmias, who had already had a heart attack, finds that having a dog improves survival, though there is no difference in the physiologic profiles of pet owners and non-pet owners. In other words, dog owners do not survive just because they were healthier in the first place (Friedmann and Thomas, 1995). Recently, a Minnesota study of 4,435 people finds that living with a cat, presently or in the past, is associated with a significantly reduced risk of death from cardiovascular disease, including stroke (Qureshi et al., 2009). Other research and practice experience demonstrating improved health is discussed later in the chapter.
21.3 Understanding loss
In many ways, the loss of a therapy animal is like losing any other important person or pet—it hurts. The ways in which it hurts depend on many factors: What role did the loved one play in your life? How did the loved one die? What other experiences in your life influence your response?
While cultures create beliefs and rituals to help mourners process the loss of human relationships, the loss of important non-humans is often ignored. In 1978, clinical support for pet loss began at the University of Pennsylvania when the dean of the School of Social Work recognized that clients at the veterinary hospital were showing the same signs of grief that she recognized from her work in human loss. Her work led to the hiring of Jamie Quackenbush, a doctoral student from Michigan, to support bereaved pet lovers (Quackenbush, 1981; Ryder and Romasco, 1981). Academic recognition began in March 1981, when New York City’s Animal Medical Center and Foundation of Thanatology held a three-day conference on Pet Loss and Human Emotion (Kay et al., 1988). Since then, many veterinary colleges have developed counseling programs that include support for clients, instruction for students, community outreach and scholarly studies. Few if any programs exist specifically to support the friends and caretakers of therapy animals.
21.4 Loss of a special animal
21.4.1 Loss of a pet
Our knowledge about pet loss comes largely from clinical practice and from a few research studies. Many books have been written to help bereaved pet lovers. Lago and Kotch-Jantzer alert planners to the need for community programs to help both sides of the pet loss dyad: the impact of pet death on older adults and the effect of caretaker death on the fate of pets (1988). Cohen and Fudin outline the need for support from parents and professionals at the time of euthanasia (Cohen, 1985; Fudin and Cohen, 1988). Adams et al. (2000) highlight the harmful effects of a lack of understanding from friends and family. Field et al. (2009) have refined the concept of attachment in evaluating pet loss. Dunn et al. (2005) detail how to set up a pet loss support group.
Grief is not just for those who live with pets: people grieve for animals that do not even belong to them. Neighbors become fond of each other’s pets (Casciato, 2010) and visitors grow attached to particular residents of the local zoo (Fire at the Philadelphia Zoo, 1995; Zongker, 2010). Animals in trouble, such as endangered birds that have been raised or rehabilitated for later return to the wild, can capture the attention of a nation (Zongker, 2010; Zoo condors to be released in Andes, 1997). Caretakers who work closely with such animals may be heartbroken when they are transferred or euthanized (Egan, 1999; Film star holds funeral for water buffalo, 2001; San Diego Zoo to euthanize pioneering monkey, 2003; Szita, 1988).
A few quotations from and about mourners serve to show that living with someone is not essential to loving someone. Any loss, including death, can hit hard and last a long time.
Casper was a longhaired tuxedo cat who became famous for catching the bus every day from his home town into Plymouth, England: After he died in a hit and run accident, many who had been captivated by his story expressed their sorrow. “The bus service, First Devon and Cornwall, said it was ‘devastated’ by the cat’s death…The website for local newspaper The Herald said it had received tributes from around the world” (Casciato, 2010).
A woman at the farewell party for a Washington, DC panda said before his return to China, “I love Tai Shan so much, I don’t know how I’m going to handle it” (Zongker, 2010).
Actor Bin Banloerit explained why his fellow cast member deserved a three-day funeral in the Buddhist tradition: “He could not just die like other regular water buffaloes because he had done so much for the movie” (Film star holds funeral, 2001).
A San Diego Zoo representative’s account of reactions to the impending euthanasia of a twenty-three-year-old endangered monkey whose willingness to take insulin injections for his diabetes helped children overcome their own fears—“Everyone from the welders who made his cage to zoo regulars have stopped by to say their goodbyes…‘It will be a regular trip to the hospital,’ Killmar said, her voice breaking. ‘He just won’t come back’” (San Diego Zoo, 2003).
21.4.2 Role of the animal
Many therapy animals begin as pets/family members. Seeing the effect that their friendly, well-behaved cat, dog or bunny has on others, pet lovers begin to think about how to make the most of the therapeutic properties their animal companion already has. They join an animal-assisted activity program and visit nursing home residents or train as a volunteer with a group that certifies animals for a range of therapeutic work. Other people begin when they are already established in a career. Licensed in one of the helping professions, such as social work or physical therapy, they decide to incorporate domestic animals in their work. Though we think of therapy animals primarily as partners in healing, these roles developed for pet relationships apply equally to them.
Companion—Most Americans choose pets for companionship, and much of animal-assisted therapy works for the same reason: Humans relax around calm animals, which allows them to stretch physically, mentally, and emotionally.
Protector—Both urban dwellers and rural folk keep pets for protection. While many people tend to think only of dogs in this role, other pet lovers say their cats, birds and even bunnies alert them to sounds outside. Losing a pet leaves these people feeling vulnerable. While those receiving animal-assisted therapy may not feel unprotected, those who live with the animal co-therapist have a strong connection and may experience loss as ripping away a line of defense.
Assistant—People with physical disabilities often use the terms “assistance” or “service” animal, while those who have animal companions for mental health and cognitive support tend to describe the dog, cat, rabbit or monkey as a “therapy” animal. Losing such a helper adds additional burdens beyond emotional ones. Those who depend on non-human support may become housebound from fear or slip back into the self absorption of autism. In addition, no matter how hard the person is grieving, he or she must acquire a new helper even before the pain has subsided.
Trophy—For some people an important part of any possession is its rarity. Though many cringe at the notion of animals as property, they may still enjoy being seen with a beautiful horse or unusual cat. For both professionals and volunteers, training a therapy dog to meet certification standards or taking a llama for a walk enhances self-esteem, which loss may shatter.
Bridge—Research and common sense demonstrate that friendly animals help humans bridge gaps of age, class and familiarity. Loss of a therapy animal can mean no more trips to the corral, no more reading sessions with the dog, no more chats about cats in the nursing home recreation room. In losing the animal, these participants in animal-assisted therapy lose their connection to other people.
Family member—The feeling that one is in a family relationship reaches far beyond legal and genetic ties. Both the caretaker with whom a therapy animal lives and those receiving help may feel a specific animal is part of their family (Cohen, 2002). Loss of that tie can be devastating, in some cases causing greater pain than the death of human family.
Significant other—For many people an animal companion can be the most important emotional tie in their lives. The handler often lives as well as works with a therapy animal, meaning the person’s life and professional identity are intertwined with this other being.
In the case of therapy animals, another factor in their role in the lives of clients depends on the kind of animal and the nature of the intervention. For example, interacting with dolphins can relieve depression (Antonioli and Reveley, 2005). Dolphins are large animals that one meets in unfamiliar surroundings—large bodies of water. While dolphin programs may be an expensive treatment for mild depression, the setting and symbolism—being in the water eye-to-eye with highly intelligent “wild” creatures—make it a circumstance that will not be duplicated by any other approach, including other kinds of animal-assisted therapy.
Another different remedy involving animals and water is placing a fish tank in the dining room of an Alzheimer’s disease (AD) facility. Gazing at the fish increases the appetite of AD patients, or at least their willingness to keep eating, leading to health-protective weight gain (Edwards and Beck, 2002). Unlike swimming with dolphins there is no physical contact or one-on-one relationship, but there is a physical effect, as well as an individual response.
21.5 Manner of loss
A second part of the loss experience is the way in which the loved one leaves or dies. The truth is, there is no easy way to lose a loved one, but some separations are more painful than others. For example, when a therapy animal retires, those left behind can enjoy thinking that the animal is enjoying his days in the sun. They imagine that Shep, the dog that visited them during their frequent hospital stays, is frolicking in the grass, and that they might meet again one day. The parting might be sad, but with it comes pleasure and hope.
Separation also comes from the actual loss of the animal. Although therapy animals are usually well supervised, volunteer therapy animals can slip out a door and become inadvertently lost. A therapist might move away or close down the program, taking one’s favorite four-footed companion along. In these cases, the client or recipient loses contact without the buffering knowledge that the animal is happy and possibly available for a future reunion. The client and perhaps the therapist have no control over whether they can maintain contact with the therapy animal.
Separations through illness or death are difficult to bear. When a therapy animal becomes seriously ill, those who depend on it may cycle through a series of feelings, such as shock, fear, pain, and waiting to see whether the animal will survive the treatment and return to its role as healer. If the animal makes it through but can no longer work, both handler and consumer feel relieved that at least the animal is alive. If the animal does not survive, some individuals will find that their pain eases more rapidly because on some level, the mind began to work through the reality of impending loss. For other people, the idea that an animal who contributed to the health and well-being of many others might have suffered is a torment.
Sudden death carries its own agony, because there is no time to prepare. Life was good, and now it is unrecognizable. In severe cases, the shock is so great that it constitutes a trauma, an emotional wound that may last months or years. The unexpected death of a spouse puts a great strain on the survivor, a strain that family, friends and health care providers often underestimate (Rodger et al., 2006–2007; Wortman and Silver, 1989). Sudden death leads to greater depression in widowed individuals (Burton et al., 2006).
Losing a special animal without warning stuns survivors. In the author’s experience, while many people feel surprised by the death of a loved one no matter how long they have been ill, the shock that follows sudden loss seems to last longer.
Whether it is a protection from dealing with our own fears of death or whether we just see human beings as responsible for whatever happens to them, we tend to blame people, at least a little, for their misfortunes. We told them to exercise and to quit smoking, but they did not listen. Now look what has happened. In the case of companion animals, which are seen as innocent and dependent (Bulcroft and Albert, 1987; Perin, 1986), caretakers often feel responsible in some way. They should have known the food was tainted, prevented the cat from ripping open the window screen, argued with the veterinarian about surgery or looked up from writing the Great American Novel long enough to notice the dog was losing weight. Some who lose a pet or therapy animal will feel deep guilt that may never quite resolve.
21.5.1 Life experiences (nine stories)
A third way of understanding what the loss of a therapy animal might mean depends on a person’s life experiences before and during work with the animal. The author has found that nine stories told by clients often suggest that an individual will have difficulty when a particular pet dies or disappears. These stories, or accounts of the human’s life, affect the experience of losing therapy animals as well.
Other loss—No one can endure repeated blows from life without staggering. Often a special animal helps buffer the ups and downs of life, so when that support disappears, someone who has suffered other losses, especially recent ones, may feel as though the ground has dropped out from under them.
Time spent with pet—Those who both live and work with an animal may become closer as many aspects of life intertwine. Neither the human therapist nor the recipient can go to the office and forget about the empty leash that now hangs by the front door. In addition, the author’s research shows that for urban pet lovers the sheer number of hours spent together correlates closely with scores on the Poresky Human-Animal Bonding Scale (Cohen, 2002; Poresky et al., 1987).
Rescue—Rescue can go in either direction. A stroller who scoops a discarded kitten from the garbage may feel especially connected to that animal. Similarly, an alcoholic who feels that his dog kept him from going under completely may feel that the dog rescued him. Therapy animals are designed to improve the health and functioning of people who may feel rescued from a life of social and physical hardship, perhaps even financial downturns.
Mistake—While many mourners feel regret after the death of a loved one, those who care for animal companions may feel especially responsible because they see domestic animals as innocent and dependent. If, in addition, the person can point to an apparent mistake—picking the “wrong” pet sitter, accidentally injuring a pet—anguish can overwhelm a rational appraisal of what went wrong.
Live alone—Someone who lives with only one other person or pet shares meals, activities, and even sleeps with the same companion. Years of shared routines can contribute to having all their emotional eggs in one basket.
First pet/last pet—In modern urban life many young adults get their first pet with no childhood animal care experience to guide them. Losing a pet may be their first experience with the death of someone close. They have no bereavement skills to fall back on. Animal caretakers at the other end of life may not want another 20-year commitment to a new animal. Even if they are willing to take on the responsibility, their new living arrangements may make the keeping of pets or other animals impossible. Land needed for large therapy animals, like llamas, is sold, co-op apartment boards change their rules, forbidding pet keeping. The first serious loss in someone’s life and the last, if it carries no hope of finding a new love, can be especially hard to bear.
Shared life events—At times the most consistent relationship in one’s life is an animal companion. Birds and horses may stay for decades. Cats and dogs see their caretakers through several love affairs, at least one romantic partnership, and jobs/apartments/and hair styles too numerous to mention. Whether a person and pet volunteer in a reading program or work side by side in therapeutic riding, the level of mutual understanding is high and the number of shared experiences rivals that of any other family member. Consumers of animal-assisted therapy also share life-changing events with four-footed catalysts. When a therapy animal dies or retires, caretaker and client lose a witness to history, a trusted companion who “knew them when.”
Tie to another—An animal companion can gain special significance when a person associates that Siamese cat, parrot or pony with someone who is no longer part of their lives. Inheriting Mom’s dog allows one to keep a piece of the past alive.
Identification with animal companion—People identify with animals because of similar physical characteristics and life circumstances. The author’s clients have said they felt they and their pet were bachelors together, that they were both arthritic old ladies or that they shared a love of pizza and nature programs on television. The shared experience may involve a challenge, such as surviving cancer or abuse. In the Animal Medical Center’s animal-assisted activity program, Pet Outreach, some of the most effective therapy animals have been missing a leg or part of an ear. Their unspoken message is that even those who look different can be productive and loveable. Depending on the depth of the identification, the loss of an animal can frighten someone who feels their lives are similar.