Archives

The Healing Art of Writing Memoir or Fiction

 

Isak Dinesen, writer

Isak Dinesen, writer

“All sorrows can be borne if you put them into a story,” said Isak Dinesen, author of “Out of Africa,” and “Babette’s Feast.” This quote beautifully puts into words why I went to the Westport Writer’s Workshop last Saturday to teach a class called “The Healing Art of Writing.”  My goal? To help people who’ve experienced grief, loss, illness, abuse, violence, addiction, or other trauma try to turn those difficult emotional experiences into compelling fiction or memoir.  I decided to teach the class partly because I know that to do this is healing, since I drew upon my own traumatic experiences to create both a novel and now a memoir. I also journaled obsessively before conceiving my novel, “Saving Elijah,” and used pieces of that journal in writing the book, so I know from experience that expressive writing is healing.  But I’m also convinced that the discipline of creating a narrative or “story” out of the chaos of emotional experience is healing from the first draft to the last. I think most writers would to some extent agree.  I know Karen Blixen (Isak Dinesen) would.

Here a bit about why I think so, along with steps to help you see if this might be for you:

Expressive Writing Practice: Journaling

Begin by developing an expressive writing practice such as journaling, three or four times a week, for ten or more minutes a day.  Tons of research shows that just writing about trauma, loss, grief, or illness without any regard for the writing “product” has a healing effect and improves mental, emotional and physical well-being.  This is because traumatic or emotionally charged experience is stored in the right brain as all chaotic sensation with no logic or language. When you bring language or narrative to any emotional experience as you do when you write, you bring this experience, or perhaps the memory and associated emotions of the experience into the logical, analytical left brain.  This helps integrate the two and lessen emotional reactivity, a big part of healing. In doing therapy and facilitating workshops, I’ve even seen writing help to heal people who aren’t even particularly literate.

When you do expressive writing, knock the censor monkey off your shoulder, and express your feelings without thinking about the writing “product.”  Bring it up from your guts. Don’t think about grammar, form, or appropriateness.  Don’t worry that anyone will read what you’ve written. Banish all thoughts of I wouldn’t want anyone to see this, or This isn’t any good, or  My eighth grade teacher—or my mom—told me I stank as a writer. Also banish all thoughts like, Nothing I could ever write could communicate how I feel. Write as if you were going to burn it.  Don’t burn it though, since you’ll later find gems you can use to great effect when you write your memoir or fiction.

Even after you begin writing fiction or a memoir, begin each writing session with a few minutes of journaling or other form of expressive or free writing.

Expressive Writing Practice: Exercises

Take a “Write to Heal” workshop like the one I offer.  Many individuals, hospitals, and healing centers around the country are offering these now. In my workshop, I provide exercises to help people express themselves without regard for the writing “product,” or how a reader might react, who might read it, or who might or might not be interested in reading it.  Although sometimes write-to-heal writers produce beautiful writing, I facilitate these exercises primarily for their therapeutic value.  I take the therapist’s “stance” in this setting. I empathetically accept and embrace whatever is produced., there is no literary criticism, and I make no attempt to teach the “craft” of writing, let alone the art. Sharing is optional of course, but there is also some therapeutic value to being “witnessed” and to “witnessing.”

Also, do the exercises on this website, or the exercises in books like Natalie Goldberg’s “Writing Down the Bones,” Bonnie Goldberg’s “Room to Write,” or Julia Cameron’s “The Artist’s Way.” Again, make this a practice, several times a week.

Blogging: Is this expressive writing?

Nowadays many people blog episodically about their feelings and experiences around personal trauma, loss, or illness.  Blogging can of course be healing too, in the sense that all writing can be healing. However, I suspect most bloggers do at least some selecting and revising before they publish, and so blogging isn’t true expressive writing in which no attention is given to the product.  I hope so, because some blogs of this sort gain huge readerships.  Readers actually read ONLY because they feel moved, entertained, instructed, or compelled to READ ON; readers, even readers of emotional blogs, don’t take the therapist’s stance of empathy and compassion and acceptance of feelings whatever they are. (You can certainly see this in some comments.) Which means the blogger who has made no attempt to process or intellectualize experience, distance herself from it, and prepare it and herself for the reactions of others can find herself retraumatized as readers who don’t empathize with her feelings react to or criticize the writing.  I think publishing unprocessed emotional writing even in this confessional age can be VERY be psychologically risky. Oh my goodness, it was psychologically healing to give voice to my anger in my own journal after my son’s death, but publish that journal?  No way.

On the other hand, it is also true that no matter how many revisions and how much processing you do before you publish any piece of writing, readers are going to bring their biases, craziness, projections, interpretations, and misinterpretations to it.  David Sedaris put this brilliantly when he said:  “Writing gives you the illusion of control, and then you realize that it’s just an illusion, that people are going to bring their own stuff into it.  But even the “illusion” of control can be a good defense. Where would we all be without our illusions?

Write a memoir or fiction

Obviously not everyone can write a novel or a memoir, or would even want to, but the twenty women who came last Saturday to my class, each of whom has experienced trauma, illness, abuse, or loss, presented themselves as wanting to learn how to turn their experiences into stories in the literary form of fiction or memoir.  I treated them like writers.

Yes, it’s hard to speak candidly to someone who’s experienced something awful that lies at the pit of her soul and who lives and breathes this thing every day.  It’s hard to tell someone who’s gotten used to simply writing her feelings that there might be a more effective way to present them to help readers want to hear them. First of all, she’s been writing and knows how healing it feels to write, which is probably one of the reasons she’s decided she wants to bring her writing into literary form. Another is that she feels she has something important to share with others, some lesson learned, some hurdle crossed.  (Therein, of course, may lie the arc or even the plot of her story.  How DID she overcome that awful thing?)

I think some, although certainly not all writing teachers would find it hard to tell someone who, for example, is writing about the profound and devastating experience of losing a child that some of her words don’t compel the reader to turn the page, don’t communicate effectively, confuse, or even turn the reader off.  I am of course sensitive to this, but I am tough-minded too because I know that learning craft and bringing it to your writing helps you intellectualize and separate from traumatic experience in a very unique way.

I know that even if feedback at first feels hurtful or invalidating, it’s actually the opposite.   A reader or teacher who offers honest feedback actually validates your experience by showing she cares enough about it to help you express it more effectively, say by helping you learn the components of a scene, or by pointing out that you’ve “told” something rather than “shown” it.

And I know that every time you hear and tolerate criticism about what you have written about your trauma, and every time you decide (using your analytical left brain) to accept or reject that criticism, you distance yourself from the emotion of that trauma.

“Kill your babies,” Faulkner said about writers and their words, and the would-be memoir or fiction writer must learn to tolerate hearing that she must kill some of her babies. (You should pardon the pun.)

Yes, it’s a long grueling process, but…

  • We heal as we learn and apply writing “craft,” which after all is a discipline that comes out of left brain thinking.
  • We heal each time we rewrite or revise, because when we rewrite we rethink, re-remember, and re-imagine our experience, memories, even our whole life. Psychology and neuroscience have proposed many different models of memory, but one truth is: We do not remember our experiences, we only remember our last retrieval of our memory of our experiences.  As we gather our short and long term memories to write a memoir or fiction, we revise those memories to fit them into the emotional arc (or plot) we are creating.  Often this is a new vision of ourself as hero rather than victim in our own life story.
  • We heal each time we turn chaotic emotional experiences into work that fits within an accepted literary form, uses language in an evocative way, has narrative drive, and a beginning, a middle, and an end. Doing all this involves intellectual, logical left brain thinking and tamps down emotional right brain thinking.  No one wants to read about a victim, or at least not a victim all the way through.
  • We heal as we learn to self-observe, as we discipline ourselves to make the hard choices about which elements of lived experience to include or exclude, and how best to organize and express material in order to compel readers to READ ON.

The End of Words

The massacre of babies with bushmasters

are words that shame the lips, stun the tongue into silence,

1592099245

end words,

send language,

or even the very idea

of language,

raining down

into the holy place

inside the dark forever of

a parent’s soul,

forever divided

between this and that,

then and now,

a rupture so wide and deep

that words

drop into the void.

How can you speak

when you hear such words?

Can you ask questions?

Who is at war with

whom?

How does that sorrow

break?

What does it take to make

the whole world

tremble?

And what of the millions

who only buy more bushmasters

in the wake of those words?

Where are the words that can speak of that?

Those words even silence the rain.

Writing To Heal – December 4th Stamford JCC

Looking forward to facilitating…

JConnect_October2-1-1Writing to Heal: A workshop for people who’ve suffered grief, loss, trauma, or illness Tuesday, December 4th 7:30 PM Stamford JCC, 1035 Newfield Avenue,Stamford

No previous writing experience necessary. Free and open to the community. For more information or to register for the workshop, please contact Eve Moskowitz, JFS Director of Clinical Services at 203-921-4161 ext. 122 or email at emoskowitz@ctjfs.org

OR JUST COME!!!!

                                                                 *        *       *

Shining a Light on Grief: Carole Geithner’s novel, “If Only”

Carole Geithner’s novel, “If Only”

I was honored last night to be part of a panel discussion, “Shining a Light on Grief,” with Carole Geithner, author of “If Only,” a young adult novel I thought was enchanting. I’d recommend Carole’s book to anyone, young or old. I’d especially recommend it to bereaved young people, and those who want to learn more in order to help a bereaved friend.  Some may find a novel like this more helpful than even a “how-to” book because it organically teaches what, and what not to do and say. “Showing” (as in a novel) is always more effective than “telling.” (as in a “how to”)

Carole’s a professor and social worker who works with the bereaved, and she said she wrote the book, at least in part, to help her deal with her own experience of grief.  As Bruised Muse readers know, I too wrote a novel inspired by my grief, “Saving Elijah.”  I inscribed a copy for Carole. She and I have a lot in common, it seems, both in our professional interests and in our understanding of the power of writing to heal.  (We may also have some personal things in common, since both of us are social work types married to successful businessmen. Okay, so maybe that’s a stretch, since Carole happens to be married to the US Treasury Secretary.)

Carole Geithner

Anyway, Carole is lovely and calm and knowledgeable and reassuring (all good things for a social worker), and her book is wise and accomplished and real.  It brings to life and gives voice to a believable thirteen-year-old named Corinna as she makes her way through the very difficult first year of aching loss and grief after the cancer death of her mother, Sophie.  In scene after scene, often with humor, Carole believably, enjoyably, and instructively depicts many of the situations and dilemmas you encounter after the death of someone you love. As a writer I particularly admired the scene in which Sophie is listening to a private conversation between her father and her aunt about her mother.  I was also struck by the range of experiences Carole managed to get into the book.  This includes everything from the feeling that nothing is normal and you’ve arrived on an unknown planet called Planet Grief, to the need to create new rituals, to the natural attraction to people who’ve experienced similar situations or just know how to “be with” you, to all the strange and hurtful things people say to you.

What is helpful/What isn’t

Carole has put into the novel wonderful examples of what’s helpful, which fit with my own suggestions:  Be present.  Be humble.  Be patient.  Observe. Reflect.  Give witness. Allow silence.  Don’t judge. Don’t try to fix it.  Accept.  Listen.

As for what to say, “I’m sorry” is fine, or even, “I don’t know what to say.” Some people are instinctively gifted at compassion-giving, while others need instruction.  It takes commitment and stamina to sit with the truly bereaved.

Carole also put in quite a few examples that nicely fall into the categories I’ve described for all the people who mean well but say the wrong things, including: babblers (Let’s talk on and on—about anything else); advice givers (It’s time to clean out the room…start dating again…get over it…); platitude-offerers/pain-minimizers (God must have wanted him…he’s in a better place…you did everything you could); pseudo-empathizers (I know just how you feel); lesson-learners (Everything happens for a reason…life is short…) and last and worst, abandoners.

I experienced most of these myself and I see them echoed over and over in the experience of others, so much so that at one point I was thinking of writing a book called: The Ten Worst Things to Say.  The key is: Don’t say anything that de-legitimizes whatever the bereaved might be feeling.

The evening was jointly sponsored by the Jewish Family Service, Jewish Community Center, The Den for Grieving Children, Family Centers, and the Center for Hope.  I have associations, one way or another, with all of these wonderful institutions in the community.

The audience included many professionals who work with the bereaved, and quite of few bereaved too.  I was thankful for some wonderful questions, such as this one (I’m paraphrasing):  “I understand it’s really hard to know what to say when people ask you how many children you have.”  Yes, indeed, this is always a loaded question. It’s one of the many real dilemmas of grief, particularly at first.  If someone asks how many and you leave out the dead child, you might feel as if you’re betraying that child. But if you include that dead child you might then be forced to answer the follow up questions, which might lead you (and the asker) where you might not want to go.  It’s always awful to find yourself suddenly talking about your most profound pain to a stranger who was simply making conversation, or even actually breaking down in tears in the cheese aisle.  There’s also the concern that you might ruin someone’s day.  Anyway, eventually most bereaved people figure out and make peace with how they want to handle this dilemma, which is one that’s going to be with them for the rest of life.  It’s a case by case decision.  It gets easier with time.

I hope the newly bereaved who were brave enough to come felt supported and cared for.  I admit that while I wasn’t surprised I was a bit disappointed by the lack of attendance by more non-professionals perhaps looking for information on how to help a friend. I guess I’m so comfortable with this topic, and with offering compassion to the suffering that I forget how much most people really just want to avoid it.

Here’s the link to Carole Geithner’s website, which has some great resources about grief in addition to info about the book.

Compassion Roundup, Part I: Who cares if your surgeon is a jerk?

Huckabee at the Republican National Convention

A few weeks ago, Mike Huckabee, making a medical analogy about the alarmingly jerky Mitt Romney, told Howard Kurtz of the Daily Beast: ““The sicker the patient, the less important is bedside manner.  If you’ve just been diagnosed with a brain tumor, you honestly don’t care if your neurosurgeon is a jerk.”  Now I admit that Mike Huckabee is a personable, often funny, natural, and authentic guy, sort of the un-Romney, even though I disagree with him on nearly every political idea he ever expressed including this one.  I disagree with this one so much that it’s been stuck in my head for the last three weeks. Reason? My own personal experience with jerky doctors

Most commentators, including Gail Collins of the New York Times, commented on the weird “damning with faint praise” aspect of that quote, since presumably Huckabee meant to praise (if faintly) our Presidential candiate, who has proven himself even more jerky this week by among other things commenting on an ongoing violent international crisis before knowing the facts, and by suggesting that a statement put out by the American Embassy in Cairo condemning a hate film undermined American values.  Coming from a man who would be President in a highly dangerous, complicated, and non-black-and-white world, this was so misguided and jerky in so many ways that I can’t possibly mention them all in a blog in which I want to comment on Huckabee’s medical analogy.  So for the moment, I’ll simply wonder why Romney, or anyone, thinks it’s not an American value to ALWAYS condemn hate speech, counsel calm, tolerance and compassion, and support the forces of tolerance, understanding, and compassion in every situation and society.  To me this is among the highest of human values.  More about that in my next blog.

So back to Huckabee’s analogy. After endlessly fussing I’ve finally shipped off my memoir, “How I Lost My Bellybutton and Other Naked Survival Stories, to my adorable new literary agent.  While I’ve met many amazing and wonderful doctors during all my medical woes, the memoir details my experiences with some incredibly jerky doctors, including my late son Michael’s neurologist and the surgeon I call only “Plastic Man” whom I encountered during my breast cancer experience.  I think their jerkiness made them less rather than more skilled, that’s for sure.  I won’t talk about the neurologist here, but Plastic Man was jerky mainly because he lacked compassion, and I suffered mightily at his hands, not because he isn’t or wasn’t a skilled cutter. I assume he is, he certainly has a good reputation on that score. But bedside manner? The man was rude, stiff, abrupt, aloof, childish, petulant, and defensive, and became even more so when I developed an infection and became quite sick.  As I detail in my memoir, his jerkiness may have increased because he was afraid of being sued.  This doesn’t excuse it, of course, and in any case research shows that doctors who tend to the doctor/patient relationship lessen their risk of being sued. This makes perfect sense, of course, since people tend to give back what they receive.  The most important thing is, he made my situation even worse than it probably had to be, thereby affecting his skill not just as a cutter but as a physician, who after all should be a healer.  I say this not just because I was terrified and needed reassurance when I was so weak and sick and vulnerable, but because if that surgeon had LISTENED to me, his patient, as a good compassionate, non-jerky physician would do, he might well have been able to spare me all or at least some of that suffering, both mental AND physical.

So I say yes, I guess I’d prefer a jerky surgeon who’s a skilled cutter to a compassionate, non-jerky surgeon who isn’t a skilled cutter, but like almost all things in life it isn’t (or shouldn’t be) an either-or, black-and-white choice.  Why wouldn’t we want physicians—and politicians, and filmmakers, and everyone else–to think of having compassion for the weak (ie non jerkiness), as an important part of their skill and to be BOTH compassionate AND skilled?  As Gandhi and others have said, “The measure of a civilization is in how it treats its weakest and most vulnerable members.” Substitute the word “doctor” for “civilization” and “patient” for “member,” and I think you see how this applies to the medical situation on which Huckabee is commenting, in my view utterly incorrectly.

So here’s a survival tip I learned the hard way.  I put it in my (hopefully soon-to-be published) memoir, “How I Lost My Bellybutton, And Other Naked Survival Stories”:

Survival Tip #17:  Compassion and empathy aren’t luxuries for a doctor, they’re prerequisites. Especially if things go wrong or you’re really suffering and really need compassion and empathy. So if you have a choice, find one who has some.

Mr. Huckabee, I know your analogy was meant to suggest that Mr. Romney has the skill to fix the economy, thereby lifting all weak boats in the trickle-down sense, but I think that the weaker and more vulnerable the patient (or the citizen, for that matter), the more I need and want to be tended to with compassion rather than jerkiness.

My novel, “Saving Elijah,” is now available on Kindle!

Wow!  It’s been twelve years since Putnam published SAVING ELIJAH, my novel “inspired” by the loss of my son.  It’s now available in a KINDLE edition through Amazon, and RIGHT NOW, for a limited time, Amazon is offering it FREE if you’re an Amazon Prime member.  Otherwise it’s just $3.99.  My blood, sweat, and tears for only $3.99!  And what do you get?  Terror and sorrow, poignancy and inspiration, I hope.  That’s a lot for free, and even for $3.99. Click HERE for the Amazon link to get the book, and if you happen to read it and like it, please leave a review there.  For reasons I don’t exactly understand, the reviews for the print edition of the book don’t automatically get transferred to the new Kindle edition.  This, of course, is one of the many things about this life that I don’t understand.

Here are a few of those rave reviews:

“Stunning, spellbinding, cracking with suspense, dark humor and provocative questions. A compelling page-turner that meditates, with honesty and insight, on the nature of parental love and responsibility.”  (Publisher’s Weekly, notable review)

Ambitious, imaginative, and beautifully done. (Wall Street Journal)

Fascinating, skillful, a fiercely compelling read. (Glamour)

Misguided religion: My heart and soul to Etan Patz’s parents

I almost lost my breakfast this morning upon reading in today’s New York Times that a man named Pedro Hernandez, who confessed to police last week to murdering six-year-old Etan Patz thirty-three years ago, also confessed to some relatives and to a charismatic Christian group thirty years ago.  I can’t even imagine how Etan’s parents feel.

This “Christian” group apparently encouraged (or maybe still encourages) participants to “feel the Holy Spirit and unburden themselves of guilt for their sins.” The  Times further describes the charismatic Christian gathering in Camden that Mr. Hernandez attended 30 years ago a “free-for-all of admissions of guilt, sometimes shocking.”  Furthermore, the article says, the “groups grow hardened and numb to hearing them,” and that one Mr. Rivera explained it by saying that it wasn’t his “place”  to tell because the confession wasn’t made to him alone, one-on-one, but to the group.

This is probably an accurate expression of Mr. Rivera’s own psychological rationalization.  But wow.  That is some religion. Defenders of religion often try to say that we need religion to instill morality, and manage to ascribe this kind of immorality to zealots of “other” religions, but how do we find the morality in any philosophy that would encourage silence and rationalization in the face of such a confession?  How do we reconcile an ethic that finds the “Holy Spirit” powerful enough and sufficient to relieve the guilt of a child murderer?  Or that puts protected confession above any feeling of empathy for the parents of that murdered little boy?  How do we cope with a religion that puts so called “faith” above a proper, conscience-guided sense of right and wrong?  Examples abound of religion–all religions, in history and currently–encouraging blind adherence to zealotry and faith, and/or protection of a misguided, entrenched hierarchy over the development of a moral conscience that can distinguish right from wrong, but really, this all still all reminds me of Eichmann’s Nuremberg defense that he was ” just following orders.”

One has to wonder what other confessions these people heard.   Isn’t there a priest somewhere who understands and can distinguish right from wrong, and could have advised these people?

My heart and soul goes out to Etan’s parents.

McSweeney’s, Geraldo, and Trayvon

I’ve received letters from all over the world on my piece of rhetoric (otherwise known as a rant) in McSweeney’s about the misuse of the word “closure.” Some complimented my literary craft (which is nice), some came from people in the bereavement field, some from parents.   I’ll post one or two of these letters soon; meanwhile here’s the link:

http://www.mcsweeneys.net/articles/an-open-letter-to-the-radio-lady-who-said-we-should-find-closure

And speaking of “closure,” so far I haven’t heard anyone mention it in relation to the terrible death in Florida of Trayvon Martin, though no doubt some misguided soul will do so in the coming days.  Over the weekend, however, I heard Geraldo Rivera say, “the hoodie is as much responsible for Trayvon Martin’s death as Zimmerman is.”  Wow.  Similar to the “he raped her because she was dressed provocatively” defense, the argument may be a new low in an already bottom-scraping America, when someone with actual access to airwaves can get away with making an excuse like that for what really does appear to be a murder of a beautiful, unarmed seventeen year old boy walking down the street carrying some Skittles and an iced tea by an armed neighborhood watch “volunteer.”  What happened for the idea of “freedom” these same people are always crowing about? Would that be freedom for everyone except those who want to wear hoodies?

According to the LA TIMES (and many other news sources): George Zimmerman, whose fatal shooting of an unarmed teenager has sparked nationwide protests over alleged racial profiling, had thought the entire incident would “blow over,” a friend said Sunday. The story goes on to make the claim that Joe Oliver, a ten year friend of Zimmerman, make the claim that he had never seen any indication Zimmerman, 28,  is racist.  Now Zimmerman is hiding amid death threats and demands for his arrest.  I wouldn’t support death threats for anyone, but demands for his arrest? Absolutely.

“Walking while black” is a much, much better explanation for this outrageous act by Zimmerman, no matter what his friend says, and how sad for the loving parents of all the young black children in American, that they still, constantly have to worry about their children in a country that continues to be a terribly racist place, even WITH a black President.  I have sat with bereaved parents black and white; their tears and pain are exactly the same.

And here’s another important point in this matter.  It’s as difficult to even know what’s in people’s hearts, let alone to legislate what should be in their hearts.  It’s for a court to determine whether this guy is or isn’t racist, and this is or isn’t a bias crime, and yet, unbelievably, because of the so called stand-your-ground law, which took effect in Florida in 2005, police could not arrest Zimmerman.  Shame.  Shame.

Well,  we DO know this.  Research has shown that access to the means to commit deadly violence is the best possible predictor of deadly violence.  For example, if you have a gun in the house, it’s more likely that someone (usually NOT an intruder) will be shot and killed, or even that someone will commit suicide successfully.  In view of this and the proliferation of senseless shootings in this country, it seems to me that the gun lobby has become far, far too powerful, scary powerful, and that the narcissistic, gun-crazed, irresponsible climate it has promoted and created and nurtured in the last thirty years is as much responsible for the shooting of this young boy as anything.  How else can you explain the passage of a law like the stand your ground law,  which permits people to use deadly force not only inside the home but on the street if they feel threatened?  People feel threatened by all kinds of things, real and imagined.  If you put a gun in every hand, as some in the gun lobby are pushing for, there will be more blood and death than there would be if you didn’t. A Priori. Why do we keep passing legislation that makes it more likely, rather than less, that this kind of thing will happen?

What is wrong in America?

Offending the bereaved: Thoughts on the controversy around the upcoming DSM V proposed “grief guidelines”

Michael Max Dorf, a month or so before.

Who would have ever thought there could be a controversy around grief?

In the last few months, in my other (non-writing) life as a therapist, I have heard the devastating stories of several people seriously traumatized by their past contacts with the mental health system, people with a lasting legacy of pain from being (probably wrongly) prescribed powerful psychiatric drugs or placed against their will on a terrifying psych ward. I’m definitely not a conspiracy theorist, one who says things like “everything happens for a reason,” or assigns existential “meaning” to every happening, and so I’m sure it’s pure coincidence that I’ve heard so many stories like this lately. I obviously recognize that many dedicated people in the field are doing work that manages to be both life-saving and compassionate, yet these awful stories also underscore the need for folks setting the parameters in the field–the task force considering changes in the upcoming edition of the “bible” for clinicians, the Diagnostic and Statistical Manual (so-called “DSM V) to the various “diagnoses” around grief–to at least try to get it right.  It seems to me that those of us working in the field who are honored every day to do this work, to witness people’s deepest pain, have a duty to at least speak out when it appears that a grave and possibly for some folks dangerous injustice is being contemplated.

Partly because of the experience I mention above, and partly as a response to a wonderful “Open Letter to to the DSM Task Force” posted by Dr. Joanne Cacciatore on her own website (which I’m linking to here) , I’d like to add my own voice to all those professionals and offended bereaved people weighing in on this disturbing and upsetting controversy.

As readers of this blog surely know, I too lost lost a child, my son, Michael, who died in 1994, and I’ve been living with, and thinking, studying, and writing about grief ever since. (Let me assure the reader that I’ve also done lots of other things, including recover my sense of humor.)  My writing inspired by this includes a highly acclaimed novel, “Saving Elijah,”  published by Putnam in June, 2000.  After that I (eventually) went back to grad school to get a second masters degree in social work, mostly in order to work with the bereaved, even though I already knew from experience what one bereaved human being needs from another human being.  More recently I’ve been working on a kind of memoir, which I’m calling, “Excerpts: Complicated Grief.”  Included in the memoir is a recounting of the day I first heard in grad school that we were to label grief that lasts longer than two months (now according to all accounts of the upcoming DSM V apparently further reduced to two weeks) as pathology, call it “complicated,” call it a “disorder.”  Even twelve years after my son’s death, this felt like an accusation.  How could it not?  How could they not see that this is damaging to the very people it purports to “help?” It was as if feeling the terrible sorrow I had felt, sometimes even still felt (still sometimes feel now), wasn’t “normal.” Yet I knew full well that it was “normal,” both from my own experience and from talking to scores, even hundreds of other bereaved parents.

I’ve written the memoir in the second person, and it moves backward from the present to the day of the loss, in an attempt to show how grief can (while still being “normal”) reverberate throughout every corridor of a life, sometimes louder, sometimes softer, sometimes as a source of wisdom, sometimes as source of pain or anxiety, but always present.

It opens on what would have been my son’s 21st birthday.

October 22, 2011, seventeen years after. Stand at the dryer, slap in wet clothes, try to form an image of a strapping young man turning twenty-one today.  See only a sturdy toddler.   Like a failed magic trick.

Go to the cemetery, brush away leaves, place stones on the brass and marble marker. Stand in the thick, humid air.  Say Kaddish,  forget the last part.  Try to remember Michael but conjure up only bones in a tomb, shreds of boy and turtle, earthworms, fecund soil.  Say the word fecund aloud, the hard k sound rattling the teeth. Remember your husband falling into the grave. Wonder why you  come.  Get back into your car pursing your lips as if tasting something moldy. Think of old metaphors, new similes. Grief always comes alone to a child’s grave. Grief is no longer a thundering, hissing monster.  Grief is hollow now, like the blunt thud of rock on stone…….

The core problem comes in my view from the pathologizing of the normal human emotion of grief by calling it any kind of a disorder. And so whether you call it an “adjustment disorder related to bereavement,” and give it one year before you dial it up into an even more serious “disorder,” or whether it becomes “major depressive disorder” at two months, or at two weeks, seems to me secondary to the fact that it is called a disorder in the first place.

A child’s death?   At two weeks you’re still in shock. You’re just getting started at two months. Maybe. Actually, it seems to me that it would actually be “abnormal” for a parent who lost a child to not feel overwhelmed and debilitated by sorrow (and to experience many of the attendant symptoms that echo but are not the same as those for depression) at two months out, let alone two weeks out. I would venture to say this is probably true even at one year.  I remember visiting a friend of my mother’s who at age 100 was still talking about her fifteen-year-old son’s death in a car accident fifty years before as if it had happened that day. Personally, I would still call hers “normal” grief. And so the learned people figuring out the DSM seem to have had it backwards all along, and now seem to be doubling down on having it backwards.

I certainly agree that what people who have suffered loss need is (as Dr. Joanne says), human connection, caring, and compassion, or as the Lancet said: Time, Compassion, Remembrance, Empathy.  I believe it’s an insult to think that a pill could be any kind of substitute for that. I remember a good, well meaning friend wanted me to take medication, but even though I was suffering mightily, walking around in my bathrobe (not only figuratively) for three years, I somehow knew that it would do no good at all to try and mask the symptoms, because a certain amount of tears needed to be shed.  Luckily no clinician suggested medication.  I’m not sure what I would have done, given my state of mind, if one had.  The idea that we can “medicate” away the pain of grief isn’t about the bereaved, it’s about those who are uncomfortable with being witness to pain. As Rumi says,

We are pain and what cures pain, both. We are the sweet cold water and the jar that pours. I want to hold you close like a lute, so that we can cry out with loving. Would you rather throw stones at a mirror? I am your mirror and here are the stones.

In other words, the healing from the pain is in the pain.  So it is.

My favorite definition of compassion is the Buddhist one: “Willingness to be close to suffering.”  That’s what I do, what all of us who want to help do, we open our hearts to someone’s suffering.  We witness.  We don’t try to fix it.   I always say: Be present. Be humble. Be patient. Observe. Reflect. Allow silence. Don’t judge. Accept. Listen

It seems to me that this isn’t only about the pharmaceutical industry, it’s even more about the insurance industry, which seems to be in the business of not paying for whatever it can possibly get out of. (And not just in the area of grief.)  In this case the insurance industry seems to want to get out of any paying for anything other than that which has medication as the first line of treatment, and which labels grief a “mental illness,” or a “disorder” of some kind (an outcome that can stay in a person’s record forever, with terrible, terrible consequences).

It’s a sickening conundrum, it puts people who want to provide support for the bereaved who seek it in a terrible position, and of course it puts the bereaved in an even worse position.  Aren’t we trying to help them?  Surely we are. And one of the things we must do to help them is “normalize” what they’re feeling.  Yes, I wailed at the top of my lungs in a hospital room, but so would you.

As clinicians, we have the “V” bereavement code, but insurance generally doesn’t pay for treatment if you use this as a diagnosis. To receive payment from insurance, it has to be a “disorder.” And so to get insurance to cover our effort to help people make their way through grief, we are actually forced to call it some kind of disorder, even when we know it isn’t.  (This is, by the way, actually true for many situations, for example anger management.  Insurance won’t pay for people looking for help with “anger issues” unless you slap on a some kind of a “disorder” label.

Some, no doubt, will think I’m a hopeless idealist, or a radical left winger for believing that Americans, the “richest” country on earth, ought to provide universal health care that enables people to get the health care they need, no matter what their financial or job situation.  I don’t care.  I still must speak the truth as I see it.  And there simply ought to not only be health care for all, there should be some other terminology that acknowledges the debilitating nature of what I’ve called “big time grief,” and also provides coverage for people to get the proper, compassionate psychological support they need in difficult times.

All of us can be hopeful that the outcry from the grief community around this issue will, like the outcry to de-pathologize homosexuality in the 1970s, result in a de-pathologization of grief.  From a practical standpoint, under our current disaster of a health insurance system, we are required to diagnose some kind of “disorder” or there is no insurance coverage for clinical services.  In the absence of a complete rethinking of the whole system (oh, for such an outcome!; let’s just hope the misguided politicians won’t succeed in their threat to repeal the so-called “Obamacare” coverage for everyone), we can only hope that whatever happens, good clinicians (and particularly psychiatrists with their ready-meds) recognize that the DSM is at best an imperfect guide, and can tell the difference between grief and either adjustment “disorder,” or major depressive “disorder,” whatever must be recorded as a diagnosis to get coverage.

I invite you to share your grief story as a comment.

Surviving 9/11: A few thoughts after the anniversary

On Sunday for a while I watched the reading of the names at Ground Zero. It brought up my own recollections of that day, of course.  We lived directly on Long Island Sound at that time, and had an amazing, unique view across the water to the lower half of Manhattan Island. That day was so clear you could practically see the windows in the Towers, which rose in the distance like a number eleven on steroids.

We were building our home at the time, living in a cottage on the property.  That morning, fifteen or so men, mostly of Portuguese ethnicity, were putting on the roof shingles.  I was in the cottage watching the Today Show when they cut to the scene.  Katie Couric said, “A small plane has crashed into the World Trade Center.”  Didn’t even vaguely look like a small plane to me.  How could Katie even say that with a straight face?

In the first of many reality checks of the day, I went outside to affirm that what I was seeing on television was actually happening, or maybe vice versa.  Indeed it was real; you could see the first tower burning across the Sound, smoke rising up into the sky in a huge dark plume that already dwarfed both towers.  The fifteen Portuguese roofers were standing on the plywood up there, transfixed.  And silent, except they had a radio going, a newscast, I think–in Portuguese.  A few of them looked at me, maybe wondering if they should continue.  I didn’t know.  I went back into the house just in time to see the second Tower hit. I began to make my check-in-with-family phone calls.

When the first tower fell, I happened to be outside looking at the actual view, and it seemed like a disappearing act from that 20ish mile distance. One moment, two buildings; the next, one.

An hour or so later, our neighbor across the street came over, distraught.  His wife was working at the time in Tower 2, 84th floor, and he hadn’t heard from her. (She did manage to make her way down, though lost many of her colleagues, and this couple went to memorial services for months.).

All day long, strangers kept stopping by the house just to just stand and witness the thing from our vantage point, the plume of thick dark smoke spreading like a halo over Manhattan.

Ten years later, as I listened to all those people read the names of their dead, I couldn’t help thinking of my own loss, though it had nothing to do with 9/11. (How could I help it when James Taylor played a song I used to sing to my toddler son, You Can Close Your Eyes?) It seems to me that the reading of names stems from a deeply human, universal need to bring the dead back into the world of the living. I know I feel grateful when someone mentions my son or speaks his name. And too, I found it deeply moving to hear each person offer their personal thoughts, prayers, and feelings, which seemed mostly unscripted and authentic to me. So rare nowadays. Everywhere we turn, we find ourselves inundated by so much that is packaged and canned that it seems we have been unalterably changed as a people, possibly unable to identify what should be obviously false. Maybe Katie Couric unquestioningly repeating what she had been told, that a small plane had hit the tower, was some kind of watershed 1984 moment.

In the aftermath of all this, the Bruised Muse would like to express a thought or two about our survival not as individuals who’ve suffered loss, but as a country. Get ready, since this is a rant.

A few days ago a report came out that the United States of America had spent 3.3 TRILLION dollars (that’s Trillion with a T) on the two main wars we’ve engaged in since 9/11. Supposedly, we went to these wars because of 9/11, the Bush Administration touting the idea that we had to be on a war footing. Yet most if not all of the ACTUAL victories against the terrorists, before and after 9/11, have been either special ops or police work.

  • Whatever the reason the Bush Administration wanted the Iraq war–maybe Rumsfeld wanted to test his new war toys or theory, or Bush the younger wanted revenge–it should be clear now to anyone with any critical thinking skills at all that the war was scandalously, monumentally unnecessary. It amazes me that all these years later, no one has been called to pay for the lies they told to convince the country to support that total bait and switch operation.  Worse, that Administration was so effective in telling their lies that many American citizens, voting citizens, apparently STILL believe there was some relationship between Al Queada and Saddam Hussein. The only problem with democracy is that anyone can vote.  Which of course is also its main strength. Yet a huge problem now, in my view, is that our population has become so gullible as a result of ever more sophisticated packaging and canning (ie marketing/pr) that in the absence of a skeptical press (not a polarized press, but a skeptical one), Americans who can’t or won’t educate themselves can STILL vote.
  • And then there’s Afghanistan, which I supported in the beginning, although I thought they should have put more money and special ops personnel into cornering Bin Laden at Bora Bora, which they would have if they hadn’t been set on their Iraq bait and switch. But it’s TEN YEARS LATER, and I recently heard a NY TIMES reporter on NPR ((than God for NPR and the NY TIMES, what’s left of it) that things are worse than ever there. Consider the attack just today on the US embassy there.

I mention all this because, I’ll say it again, WE HAVE NOW SPENT 3.3 TRILLION. Isn’t THIS a HUGE part of the reason we’re now bankrupt?  Are we so lost that rather than speaking the truth about why we’re bankrupt, we have a group of politicians of apparently growing influence proposing (and the people BUYING) that the way out of bankruptcy is to give more money to the richest of us, cut programs that give food to babies, take the people who’ve just gotten health coverage off again, and roll back all the regulatory progress we’ve made in the last fifty years?

THIS will save the country? What country? Do they really think that unregulated corporations interested only in profit will police themselves?  Do they REALLY want to be poisoned by the water, air, food? Or maybe they LIKE the idea of seeing another Triangle Shirt Factory fire?

It’s bad enough that a miserable creature like Ann Coulter can get away with saying on national television that the she’d never seen so many enjoying their husband’s deaths as the 9/11 widows; my guess is she’d actually revel in seeing little girls jump out of windows (as long as they’re liberals jumping).

But my goodness, where are we as a country when they can call a moderate like Obama a SOCIALIST and so many believe it, share it, like it, tweet it?

And when on a nationally televised debate of so-called mainstream Republican candidates, all except one says he (or she) doesn’t believe in climate change or evolutionary science. Which of course, means non-belief in every interconnected branch of science too, from archeology to zoology?

And when on the same debate the moderator asks the leading candidate if we should let a thirty year old uninsured person die because he doesn’t have health care, and the candidate says “Yes.” AND THE AUDIENCE GOES WILD IN SUPPORT.

Well, calling Barack Obama a socialist is truly laughable, but these people are, plain and simple, extremists, and they seem to me to want the country to go back to a time when the people gathered in the town square to watch the hanging. They’re all saying they’re scared of Obama, they want their country back.  Is THIS their country? A country that cheers on the idea of letting a 30 year old die because he doesn’t have or can’t get insurance?

Honestly, we should ALL shudder at the thought of someone like Rick Perry (or Sarah Palin or Michele Bachman) as President. These people, for all their patriotic blathering, don’t even seem to believe in democracy, they seem to support some kind of fundamentalist, anti-intellectual, anti-science theocracy. I’ve been reading Eric Larsen’s book: In the Garden of the Beasts. In Hitler’s Germany, the takeover of a government and a people was gradual and insidious.  Demagogues start by subtly whipping up underlying biases and fears, and then offering easy answers that people cling to to allay those fears. And no one notices the true implication of what’s happening until until it’s too late. This should chill the blood.  Electing some of these people could easily turn us into those who attacked us.

Okay, I’m done now.