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Creativity and Healing: Let The Little One Inside You Sing

Physicians, medical students, psychologists, poets, and other helpers, healers, and writers interested in the healing power of writing hugging a giant Cypress tree at the “Healing Art of Writing” conference in San Rafael, California, July 18, 2012. The guy in the light print green shirt looking away is the gifted John Fox, author of one of my favorite books on this subject, “Poetic Medicine.”

Why do we feel so satisfied when we engage our creativity?    Why is singing, writing a play, cooking a wonderful meal, designing a building or outfit, composing a song or sonata, capturing a particular moment in a photograph, or coming up with a new idea, method, or a way of looking at things in the brainstorming session at work so fulfilling?  Why does using our imagination feel so wonderful? Why does making the metaphor that perfectly describes something by comparing it to something else feel so gratifying?  Why do people make art anyway?  Why do people write?

A man is struggling to go on after losing someone he loves.  A beloved wife.  I ask him to try a simple writing exercise, and he runs with it.  He is not a “poet,” but he produces poetry, beautiful and true.  He has turned pain into beauty, and he finds the process satisfying, cathartic, healing.

Or take my own experience.  I was already a writer when I lost my son in 1994, and yet afterward I simply refused to write for a number of years.  I refused because writing was what I did before, and that life seemed over.  But the problem was I was cutting off my most available path to self-healing: my writing, my own creativity.   It was only out of sheer desperation that I began writing again three years later.  It turned out that the process of writing (my novel, Saving Elijah) was the very thing that helped me free myself from the prison and the merciless solitude of my sorrow.  Writing that book saved my life.  Everything I write now contributes in some way to my own self-healing process.

And it isn’t the applause we might crave at the end of our creative process that drives us, or that heals us.  It’s the process itself.  A writing mentor of mine always says, “Writing is a process, not an event.” This is, of course, true of all creative acts.  If you’re worrying about how what you’re doing will be received, your desire for acclaim, or your fear of rejection, you simply aren’t in the process.

I was recently honored and thrilled to be a part of an extraordinary gathering in San Rafael, California called The Healing Art of Writing.  The conference drew physicians, medical students,  psychologists, social workers, poets, a musician or two, and other helpers, healers, artists, and writers interested in the healing power of creative expression, in this case writing.  Just being in the presence of so many people accessing their own creativity or learning to facilitate creativity in others to heal was incredibly moving and healing.

Why is the creative process so healing?  I’m convinced that when we engage in creative expression–through writing, art, coming up with that new idea, or in whatever way we can–we feel healed because we have moved back into or toward our original state of creative bliss, a state from which we gradually separated in response to the reality of life and the demands of a sometimes harsh world.

Consider my grand daughter.  She’s two, and her creative spirit is still completely pure.   Every moment of every day she is deep into her own creative process, she lives in a wellspring of pure joy at her own imagination and creativity. When she walks down the street, she doesn’t just walk, she claps, dances, or skips, and she sings or tells herself a story at the top of her little lungs.  Her song might be one she’s making up or one my daughter taught her, and her story might be about the moon and stars, or Elmo, or a purple cow.  She doesn’t care that cows are black and white, in her mind and creative imagination they can also be purple. Everyone on the street smiles, as if to acknowledge how adorable she is, maybe to share in the knowledge that children are such creative little souls who unlike the rest of us can live so in the moment, so in the creative process, unconcerned with outcome.  Watch my granddaughter now as she becomes angry and has a tantrum when you tell her to do something other than the incredibly creative thing she is doing at this very moment.  She doesn’t care that you might be trying to save her life when you insist she stop clapping and hold your hand because you’re going to cross the busy street. All she knows is that you’ve interrupted her creative process, her joyous in-the-moment creativity.

You can see the effect this kind of interruption has as a child gets older.  Few ten or fourteen-year-olds would skip and dance down the street singing at the top of their lungs, for fear of the outcome, the rejection.

A loving, nurturing, encouraging environment in childhood supports a person’s ability to appropriately access his or her own creativity as a source of self-healing. I always feel so sad when I sit with people who were subjected to a non-nurturing, restrictive, neglectful, abusive, traumatic, or rigid environment that stifled their once-brilliant creativity, and even made them lose their ability to connect back to it as a way of self-healing. Some are virtually paralyzed by self-condemnation, just as I was after my son died.  Some cannot even begin imagine their lives differently.  They continue to think the condemning thoughts and feel the hurtful feelings others have foisted upon them, a process that destroys rather than creates.

So remember that no matter what field you’re in, or where you are in your life, or what trauma you’ve experienced, you always have the power to connect to your original state of creative bliss, and even use the process of creating as a way of self-healing  That little child is still in there, singing blissfully at the top of her lungs.  All you have to do is find her.

Next post: Ways to find her.

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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)

Just Ask Me: Letter from a worried mother who worries me

Children "learn" what we model for them.

Dear Bruised Muse readers, I’m posting this email series between me and “T,” because, although I found her response to some of my recent writing kind of lovely and sweet (if somewhat misguided), I also found our exchange quite thought provoking and worrying.  In my anger management classes, I’ve heard people express similar “spare the rod, spoil the child” ideas.  “T” has given me permission to post this anonymously, and I hope readers will find it interesting too.  

Dear Ms. Dorf,

I have no idea how I started reading about you, but somehow I stumbled across two posts written by you in one day. One was on McSweeney’s site (Open Letter to the Radio Lady) and one was on your own site about bereavement. As I write this, I sit here with a gigantic lump in my throat and tears in my eyes. I cannot breathe. Nothing I can say about the loss of your son can sound anything other than trite and simplistic. I cannot offer you condolences that mean anything, I do not know you, I did not know your son. Please bear with me. I am aware that what I am about to write is not entirely appropriate and may even stray over the border-line of “this woman needs help.”

I have a son. I remember waiting, almost with baited breath, until he turned seven months old. For me, at that time, that was the magic number. Once he was seven months old, nothing could possibly happen to him. Of course, as soon as he turned seven months old the magic number became 12 months. And then 15 months. And so on… He is now 26 months old. I cannot imagine my life without him. I do not want to. The thing is, ever since I became a mother, stories about children, ANY children, affect me almost as if they were my own. Happy stories make me tear up in joy, and think of ways I could somehow transfer that joy to my son’s life. Sad stories make me cry to the point of depression, and then I just want to encase him in a bubble and protect him forever. I do not know if this is ‘normal’. I know that this is MY ‘normal’.

My own childhood was complicated and abusive. I spend every day caught in a tailspin of endless second-guessing, analysing, terrified of somehow unknowingly abusing my son.

I wanted to write to you because I want to give you a hug. I really do. I want to give Michael a hug and tell him he has an amazing mom. Who, even after spending 21 years in a cycle of grief that I cannot even begin to comprehend, managed to reach out over hundreds and thousands of miles to a complete stranger and touch her life, and maybe even save it.  

I don’t know what it is about your story about Michael and dealing with the tragedy that has prompted this email to you. I know that even on the worst of my days, what I go through is nothing compared to what you deal with on a daily basis. And that puts a lot of things into perspective for me.

I apologize if any of this has offended you. If nothing else, please re-read the part in bold and delete the rest. I’m not the best at explaining what’s going on in my head and heart.

Thank you for sharing your story.

BIG hugs,

T

* * *

Dear T.

Thanks for reaching out.  I’m so glad you find me, and my resilience, and my writing inspiring.  I’m glad you feel I’ve been able to touch your life, although I would deny that a stranger (or anyone) can “save” it.  Only you can do that.

I think you may misunderstand my writing to some degree, perhaps because I’m sometimes able to take on the “voice” of bereavement, which only means it’s effective writing, not that I’m still suffering and need condolence, although I certainly thank you anyway.  Let me assure you I haven’t spent 21 years in a “cycle of grief.”  (Or even 17 years, since my son died when he was three and a half in 1994.)  Even though my loss is always with me, one way or another, I have a full, rich, happy life.  Much of my healing has been and remains in my writing.  I have found some sort of meaning in the loss, partly by starting (with my husband) a program for toddlers with special needs in memory of our son, partly by becoming a more compassionate person, and partly by studying, training, and making myself available to help others look at their pain, trauma, whatever they struggle with. One of my special gifts is to be able to help people articulate their story through writing, although I use other techniques as well, like more traditional talk therapy.

I’m not offended by your letter, but I am worried about you and your son.  I do see that you may be suffering. Of course you want to protect your son.  Every mother does.  But it does sounds to me as if you have a whole lot of debilitating fear and anxiety around your son’s safety and well-being that may come from some childhood issues you haven’t dealt with.  How difficult for you to “spend every day caught in a tailspin of endless second-guessing, analyzing, and being terrified of somehow unknowingly abusing your son.”

Here are two options:

1. With your permission, I can post your letter on my blog anonymously, maybe give a little fuller answer.  That would be interesting for my blog, maybe for you too.  However, no quick answer could possibly tackle what you’ve described.

2. Much more importantly, have you ever talked to a therapist or other counselor?   Or perhaps, if you like to write, we could figure out a way for me to help you articulate your story in writing, which might help you work through some of your pain, anxiety, and issues related to the trauma of growing up in an abusive home.  Or perhaps there’s someone in your area? Really, I recommend you do some sort of therapeutic work.

Best,

Fran Dorf

*******

Hi Ms. Dorf,

Thank you for replying to my email. To be honest, my email may have sounded a tad dramatic. A little background – my hubby has been out of town for the past couple of weeks on work, I’m exhausted with looking after my son and trying to work from home (I’m a web designer) and the day I read your posts I was just wrecked. I was extremely affected by your writing, and the loss of your son upset me greatly. Your writing moved me – and I am amazed by your strength and resilience. And to build on that by being a therapist and helping others  is truly inspiring.

Of course you can post my letter on your blog, but please do remove my son’s name as well as my own.

I think maybe I did misunderstand your post. I was thinking about the closure one, how someone who has lost a child cannot really get closure, but I think you were saying that it is possible to move on without HAVING to have closure? Is this closer to the mark?

I saw a psychologist when I was younger, (I think I was fifteen or so) and because of the way I was then, I basically manipulated her into thinking I was okay with the abuse (also because I wasn’t entirely sure she wasn’t sharing everything with my mom). My issues stem from my mother, with whom I have a very complicated relationship – I love her to bits but am so incredibly angry with her for what she did to me and my brother during our childhood. I cannot confront her about this, because she has blacked it out (she was on a cocktail of pills at the time) and because she had her own issues. I come from an Indian background where going against your parents is sort of out of the question, let alone confronting them on any level. The abuse we endured was physical (beatings) and emotional (she would sometimes make us hit her or say things like, ‘if you do this it means you don’t love me’ – this being stupid things like walking on cracks in the sidewalk).

I’ve seen a counselor more recently which has helped quite a bit. My husband and I started seeing him after I found some emails that indicated that my husband was having an emotional relationship with another woman. This started a year or so after our son was born and devastated me – I was already quite depressed from PPS, and my husband and I decided to see a counselor together. I also sought help in single sessions for my anger management (I lash out verbally when I’m angry, which is part of the problem between my hubby and I). I would have liked to have continued with these sessions but we moved to a different city. There is no English-speaking counsellor here, and the psychiatrists/psychologists all charge upwards of 150 euros an hour which I cannot afford. We live in Germany by the way. My husband is Irish and I’m Indian.

About the tailspin: I make it a point to not hit my son in anger, EVER. If I get that mad or frustrated I leave the room for a bit. When he does get smacked he gets smacked on the hand, and it’s usually the third strike rule. However, at the end of the day, I find myself analysing and picking apart my behaviour to make sure I haven’t abused him. Of course, I may well be doing it all wrong (God knows, my mom probably thought she was doing the right thing at the time) and not knowing it. What keeps me sane is my son’s behaviour. He is a cheerful, adventurous and gentle little boy, and his caregivers at the play group he goes to just love him to bits. So I take that as encouragement that I’m on the right track. I try not to let my anxiety spill over into his life.

Good grief, I really have rambled on, haven’t I? In short, I have good days and bad days, on the bad days I think of people like you, and a couple of other writers and it snaps me out of my funk. In essence, that is what I wanted to tell you.

Thank you again for your kind words.

All the best,

T.

******

Dear T.

You do sound as if you’ve had a lot to deal with in your life. I’m very glad you got some counseling and feel that it has helped.  I’m very sorry you feel counseling is too expensive now; perhaps there’s a public clinic that would cost less but still provide you with the treatment and support you may need.  Or maybe you can find a good clinician who’s willing to take a reduced fee.

It’s great that you walk away from your son when you’re feeling angry.  This is what we call taking a “timeout,” and it’s a great practice for anger control.

Now obviously there are cultural differences in the world around child rearing, but I can’t let this go without saying that I do not believe in spanking children no matter what they do, either hitting them on the buttocks, the face, the arm, the hands, or any other way.   Here are a few other of many reasons.  (Much of this is taken from here (www.naturalchild.org/) and here (http://www.askdrsears.com):

1. Children learn what parents model for them. Dr. Sears tells the  classic story about the mother who believed in spanking as a necessary part of discipline until one day she observed her three- year-old daughter hitting her one-year-old son. When confronted, her daughter said, “I’m just playing mommy.” This mother never spanked another child. Hitting children teaches them to become hitters themselves. Witness your own situation. Your mother beat you and now you hit your child and worry about abusing him.

2. Spanking demonstrates that it’s all right for people to hit people, and especially for big people to hit little people, and stronger people to hit weaker people, and you solve a problem with a good swat. A child whose behavior is controlled by spanking is likely to carry on this mode of interaction into other relationships with siblings and peers, and eventually a spouse and offspring.

3. Research supports a direct correlation between corporal punishment in childhood and aggressive or violent behavior in the teenage and adult years. Virtually all of the most dangerous criminals were regularly threatened and punished in childhood. It is nature’s plan that children learn attitudes and behaviors through observation and imitation of their parents’ actions, for good or ill. Thus it is the responsibility of parents to set an example of empathy and wisdom.

4. Punishment distracts children from learning how to resolve conflict in an effective and humane way.  A punished child becomes preoccupied with feelings of anger and fantasies of revenge, and is thus deprived of the opportunity to learn more effective methods of solving the problem at hand. Thus, a punished child learns little about how to handle or prevent similar situations in the future.

5. Punishment disrupts the parent and child bond, as it is not human nature to feel loving toward someone who hurts us. The true spirit of cooperation which every parent desires can arise only through a strong bond based on mutual feelings of love and respect. Punishment, even when it appears to work, can produce only superficially good behavior based on fear, which can only take place until the child is old enough to resist. In contrast, cooperation based on respect will last permanently, bringing many years of mutual happiness as the child and parent grow older.

6. Many parents never learned in their own childhood that there are positive ways of relating to children. When punishment does not accomplish the desired goals, and if the parent is unaware of alternative methods, punishment can escalate to more frequent and dangerous actions against the child.

7. Anger and frustration which cannot be safely expressed by a child become stored inside; angry teenagers do not fall from the sky. Anger that has been accumulating for many years can come as a shock to parents whose child now feels strong enough to express this rage. Punishment may appear to produce “good behavior” in the early years, but always at a high price, paid by parents and by society as a whole, as the child enters adolescence and early adulthood.

On hitting a child’s hand, Dr. Sears says: How tempting it is to slap those daring little hands! Many parents do it without thinking, but consider the consequences. Maria Montessori, one of the earliest opponents of slapping children’s hands, believed that children’s hands are tools for exploring, an extension of the child’s natural curiosity. Slapping them sends a powerful negative message.  Psychologists studied a group of sixteen fourteen-month-olds playing with their mothers. When one group of toddlers tried to grab a forbidden object, they received a slap on the hand; the other group of toddlers did not receive physical punishment. In follow-up studies of these children seven months later, the punished babies were found to be less skilled at exploring their environment. Better to separate the child from the object or supervise his exploration and leave little hands unhurt.

And furthermore, Dr. Sears says, Hitting Devalues the parent: Parents who spank-control or otherwise abusively punish their children often feel devalued themselves because deep down they don’t feel right about their way of discipline. Often they spank (or yell) in desperation because they don’t know what else to do, but afterward feel more powerless when they find it doesn’t work. As one mother who dropped spanking from her correction list put it, “I won the battle, but lost the war. My child now fears me, and I feel I’ve lost something precious.”

“T,” I’m sure you have a wonderful son, but it seems to me that you and your son both would be much better off if you made a serious effort to figure out the ways your childhood is still affecting you, emotionally disengage your childhood trauma from your current life, and learn other, more effective, less putative or damaging methods to deal with your son.

On the matter of closure, I think you’re much closer to accuracy with the statement that we can move on WITHOUT having to find closure.  Closer still would be the statement that instead of looking for “closure” on a loss, we can try to find meaning in the loss.  This however, does not mean that we should go around telling the seriously bereaved that they should find meaning, which could well be offensive to them.  Rather, we should allow people the space and time to take their own journey and discover what they need to discover.  We can see the proof that people do eventually find, or try to find meaning in loss in the way they so often take up causes related to the lost one, find ways to honor the lost one.  For example, Candy Lightner creates the organization MADD. (Mother’s Against Drunk Driving.)  The Dorfs start a program for toddlers with special needs called Jumpstart in memory of their son.  Another family plants a tree, or starts a local giveaway of bicycle helmets in memory of their son who was fatally injured when he fell off his bicycle.

Thank you again for sharing your story, T, and I hope you’ll consider what I’ve said about learning other ways than hitting to deal with your son. Do it for your son, in memory of my son. While I don’t think I’d call hand-slapping “abusive,” I think there are much better ways to deal with your beautiful little boy.  How about a timeout for him?  Or a system of positive reinforcement.  So, for example, if he listens to mommy three times he gets a star, if he gets three stars, he gets something (little) he wants.

I wish you both the best, and I stand by my original suggestion that you get some counseling, individual rather than couple.

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.

Short Take: Surviving the Wiseass Kid

So last night I was helping out my friend Tony D’Amelio, with his brilliant scholarship program for local teens going to college, Dollars For Scholars. (For info go to:  www.dollarsforscholars.org)  I had volunteered to be on the “Scholarship Committee.”  We (the committee head and I) had gone to our local JCC, where a bunch of teens and their parents had come to hear a panel talk about getting into college.  Standing at the table, we were ready with our brochures and our pitch as the kids and parents exited the college meeting.  Basically we were just trying to give them information about the program, how to apply for the scholarships, the website, etc.  Most of them were thrilled to hear, signed up for the email list, and took info on the program.

Except one.

I rounded up this particular boy and his Mom and gave them my shpiel, as enthusiastically and coherently as I could.

Mom turned to her son and said, “Why don’t we sign up?”

The boy shrugged and started to walk away.

Undaunted, I continued my pitch. “It’s based on need and merit….”

To which the kid replied, “I have no merit.”

(His mother was not amused, but what could she do?  She gave me a helpless look and followed him out the door.)

See now, that’s the kind of thing I probably would have have said at that age, wiseass that I was. Cynicism as self-protection.

Just Ask Me Advice: Help! I Can’t Stand my Family at the Holidays

Reposted by  — from The Daily Muse, November 23, 2011 — 1 Comment
Help! I Can't Stand my Family at the Holidays

Dear Fran,

As Thanksgiving approaches, I find myself once again stressed and sick at the thought of traveling home. I’m kind of the black sheep of my family, and don’t feel like I fit in anymore, if I ever did. The biggest issue is my brother, who’s ten years older than I, and his wife, who hs a knee jerk opinion about everything, from politics to how children should be raised.  Plus, their 13-year-old daughter is a total brat.

Truthfully, my brother is a brat too, but in my father’s eyes he can do no wrong.  Both of them played college football, and we have always had a kind of male-oriented household.  While my younger brother is thinking about going to law school after college, my older brother has joined my father’s business, and the two of them live in their own world in which only their opinions and needs count.  Even though I went to a good college and now have a great husband and career, they all act like that was just expected and truly don’t seem to care.

With barely a break for dinner, they will spend Thanksgiving ay immersed in whtever football game is on, drinking beer and hollering at the TV.  Last year my neice sat in a corner, texting on her phone, ignoring the constant nagging of her mother.

Worst of all, my father and older brother kind of pick on my husband because he’s not a sports guy.  My husband tries to fit in, and always feels oblgated to join the rest of them in the football thing.  Inevitably, my mother and I end up alone in the kitchen doing the dishes, and my mother quietly complains about how unhappy she is with my father.

As I grow older, I find it harder to find common ground and even have a decent conversation, let alone avoid any judgment or squabbling because of the crude way they talk, sometimes even calling people racist or sexist names.  I envy my friends and even the holiday movies full of families gathered around dinner tables happily feasting, and enjoying being together after moths apart, when all I feel is embarrassed, disgusted, and stressed.

Alone

****************************************

Dear Alone,

Let me begin by saying that I sympathize. I too grew up in a family in which my father favored my older brother, and I felt dead last in a field of two. It took a very long time to understand how this has impacted my life, my choices, and my emotional stability. In the long term, I suggest you go to therapy or undertake an honest self-analysis to try to understand how this has potentially impacted you.

But here’s my advice for the short term: First of all, stop being embarrassed and envious of all those “happy” families. Truth is, every family out there has its own unique imperfections. Things can look pretty good from the outside, but the ideal family dynamic is not something I have seen in reality very often. And I’d say that most families have at least one member who isn’t all that happy to be home, or thinks she doesn’t fit in, or feels like some kind of black sheep.

I also want to dissuade you of the notion that there is anything wrong with being the proverbial black sheep; it sounds to me as if you’re lucky you got out of there! Now I admit I’m not a football fan, but given the evidence showing as much as a 22% rise in domestic violence calls to the police on Thanksgiving Day, I can’t help mentioning here the disgust I have with the whole “drunk and hollering” milieu.

Try this: Meditate to calm down. Look at Thanksgiving as a kind of yearly sociological experiment. Talk to your husband about your feelings and frustrations, listen as he explains his, and support him in doing what makes him feel comfortable. During the weekend, observe carefully, learn from everyone’s behavior (including your own), and become stronger in your convictions.

Be grateful for all the wonderful things in your life, and maybe even suggest that everyone in the family take a turn before the meal saying what they’re grateful for. Also try to focus on the family members with whom you do, or could, have positive relationships. Continue to be there for your mother, and be kind to her—it sounds to me as if she has a lot of regrets. Foster your relationship with your younger brother, who sounds thoughtful and approachable, and reach out to your niece, who, despite her aloofness, may be a struggling young girl who could benefit from your influence in her life. Perhaps bring her a little gift, maybe a puzzle or a game you could play together. Plus, your husband might be grateful for the escape from the rest of the family and join in.

While keeping in mind that you aren’t going to change anyone, steer clear of any political debates. I would, however, draw the line at sexist and racist name-calling. Say you don’t appreciate that kind of negativity and ask them to stop.

And finally, if being with your family at the holidays really pains you, it might be time to consider avoiding it altogether. Consider spending next Thanksgiving with your husband’s family or on a vacation with just the two of you. You can’t choose your family, but you can choose how you react to them—and how much time you spend with them.

Best of luck,

Fran

Have a question for Fran? Email advice@thedailymuse.com

Photo courtesy of Stephanie Wesolowski.

“Just Ask Me” Advice #4: How to Help a Friend with cancer

Help! How Do I Help a Friend with Cancer?

Help! How Do I Help a Friend With Cancer?

Dear Fran,

A close friend of mine was diagnosed with breast cancer a few weeks ago. She’s had surgery and will be undergoing radiation and chemotherapy. The doctors say her prognosis looks good, but she has had to drop out of her grad school program for the semester.

We were all absolutely devastated when we heard the news, and it’s been the most difficult thing I could imagine for her and her family. She has been inconsolably depressed, crying all the time, and so angry that her life as she knows it is over. It is so not fair that this happened to such a wonderful person—and all I want to do is make her feel even a tiny bit better.

Our friends have tried everything we can think of—spending days at the hospital, crying with her, talking, bringing games, watching movies, and more. But nothing has helped—even the good news from the doctors that we got last week. I can’t even begin to imagine the pain she’s going through, so I am at a loss as to what else I could say or do that might help even a tiny bit.

How can I help her?

A Friend

Dear Friend:

I am moved by your question. It sounds as if you are a caring, concerned friend who’s doing everything possible to alleviate your friend’s suffering.

Unfortunately, there is nothing you can say or do to magically make things better or to wish her disease away. Your friend is mourning a very grave loss. Calling cancer a loss may surprise you, but a young woman being treated for breast cancer, even breast cancer she’s probably going to survive, is dealing with significant life losses, including loss of health, loss of innocence, loss of safety, (perceived) loss of sexuality, and (at least temporarily) loss of cherished dreams and ambitions.

Your friend is on a journey and needs time to process this profound life experience. All you can offer is your companionship and deepest compassion. The Buddhist definition of compassion is the nearest I’ve come to truly understanding how to handle situations like yours:

“Compassion is willingness to be close to suffering.”

Being close to her suffering means being patient with her feelings, not trying to change them. Continue to visit and when you do, encourage her to express her emotions, and always validate their legitimacy, even if they’re scary or make you feel vulnerable or uncomfortable. Don’t pretend to understand her pain; it is hers and hers alone. And when she’s opening up to you, don’t try to distract her unless she’s begging for news from the outside world or a change in topic.

Also refrain from optimistic assurances—they may come across as empty or invalidating and may further anger or depress her. Don’t, for example, try to reassure her that she can go back to school next year, or even that all will eventually go back to “normal.” Her process might take her somewhere else entirely, and her “normal” may be altered permanently, too.

All that being said, there are some ways you can help her move forward:

  1. Bring her a beautiful journal in which to record her experiences and feelings. She can keep this private, of course, but the writing process itself is wonderfully beneficial. Or direct her to a website like www.caringbridge.org, where cancer patients can write an ongoing journal, share their experiences with a community of concerned friends, and receive support.
  2. Encourage her to participate in a support group with other young women facing breast cancer or other health crises. Individual therapy with a social worker or psychologist might also help. Check out the resources in her area or community, or ask her hospital for helpful and therapeutic resources.
  3. Put together a care package of meditation tapes, green or white teas, a heating pad, aromatherapy candles, books (the young and amazing Kris Carr has a few), tissues, stationery—anything that may be comforting and relaxing to her.
  4. Bring her a book about the breast cancer experience, either a memoir or an instructional book on how to get through it. Hearing from someone else who has been through what she’s dealing with might be incredibly comforting, and help her feel that she’s not so alone.

Finally, keep doing what you’re doing. Be present and humble. Observe and reflect. Allow silence, and don’t judge. No matter how she’s dealing with this, accept her, listen to her, and love her.

Let me end with a life survival tip, which I offer in the most sincere and open way. After I lost my son, I spent years raging at the whole universe, to no avail—except to learn that the universe is 100% indifferent to what seems fair. Knowing this tidbit helped me later, when I received my own breast cancer diagnosis.

I offer this tip to help you prepare yourself for the vicissitudes of life, and to encourage you to be grateful for each moment and every day. To help you help your friend as she begins this journey. And to state a bottom-line truth that is nonnegotiable and endlessly unforgiving:

Survival Tip #1: Life is not fair.

Your friend is learning this truth, and I encourage you to learn it, too. And I wish you both good luck and good health.

Fran

Have a question for Fran? Email advice@thedailymuse.com