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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

Surviving Fire (or perhaps Survival by Fire)

Okay, so that last blog with the frying pan WAS a little bit snarky, despite my promises that there would be no snark on this blog.  Well, maybe just a little.  (At the moment, I’m refraining from any snark related to the pathetic, destructive path on which our country has embarked.)

In this post I want to call to Bruised Muse readers’ attention the work of Megan Smith-Harris, who once (many moons ago) took one of my creative writing workshops. She wrote to tell me what she’s up to and boy was I impressed and moved.  She’s directing and producing documentary films, some of which have been on the WE network.  Here’s the link from her documentary called: TRIAL BY FIRE: LIVES RE-FORGED.  Wow!  These are stories of amazing resilience and courage by people who’ve suffered unimaginably, burn patients who are permanently disfigured and yet find the way to cope and move on.

Here’s the promo copy from the website: “TRIAL BY FIRE: “Lives Re-Forged is a feature length documentary about burn survivors–ordinary people who were in the wrong place at the wrong time. The film follows their journeys as they navigate the challenging physical and emotional obstacles toward recovery, reclaiming first their lives and then their dreams.”

I’m constantly impressed at the similarity of reactions in people who survive horrible tragedies and traumas. No matter what the particulars, you hear people talk about a certain deepening of compassion, understanding, gratitude, and appreciation for life.

Here’s a quote from one of the subjects of TRIAL BY FIRE, JR Martinez, a former soldier in Iraq:

“April 5 2003 was my rebirth. Because I literally was reborn…I had to do everything over again but I learned it in such a deeper way, in a way I was more connected to life and people and adversity and it was a blessing. I feel like the fire completely re-forged my life.”

Wow. Wow. Wow.  To watch the trailer go the Trial by Fire website.

Bruised Muse Publication News – Open to Hope: Inspirational Stories of Healing After Loss

Open To Hope: Inspirational Stories of Healing After Loss Fran’s piece, “Growing through Grief,” is one of the articles in the just published book, “Open to Hope: Inspirational Stories of Healing After Loss,” edited by mother and daughter psychologists and grief gurus, Gloria Horsley and Heidi Horsley. Yes, folks, this is an actual book with covers and pages and printed words that you can order through Amazon or on the Open to Hope (www.opentohope.com) site.  My piece is about the need to tell our story to an empathic listener, the self absorbing nature of grief, and how we can take the first steps toward moving forward when we begin to recognize how self absorbed we’ve become.

If you’ve suffered loss, or know someone who’s suffering, this book is the perfect gift. And while the cynic in me still feels slightly embarrassed at all things purporting to be “inspirational,” I have to say that this is NOT chicken soup. By the way, the cynic in me doesn’t even shut up about my OWN memoir, “Grief in the Raw, How I Lost My Bellybutton, And Other Naked Survival Stories,” which I hope is inspirational, moving, AND funny. It’s the funny part in the book helps the cynic part in me mostly shut up.

Survival in books: Emma Donoghue’s haunting novel, ROOM

The Bruised Muse has long been a fan of writer, Emma Donoghue. I loved and admired her novel, Slammerkin.  I was completely unprepared for ROOM. I had resisted reading this one for a long time, since I’d heard that the novel was about a kidnapped woman and her child held captive in an 11×11 cell.  I don’t generally read formulaic suspense novels any more, particularly creepy serial killer ones, and this sounded to me like a typical suspense plot.  I also wondered how a novel written in the voice of a five-year-old could possibly have anything to teach me, or even hold my interest all the way though. Boy, was I misguided.  ROOM has been haunting my dreams.  ROOM has intruded on my thoughts. ROOM makes me want to weep with envy at the author’s artistry and accomplishment. ROOM has even renewed my hope (well, a small bit of hope) that we can as a species survive. ROOM IS JUST BRILLIANT. BRILLIANT. BRILLIANT.

I’m often puzzled at the commercial success of many so-called “literary” novels I see on the bestseller list.  I wonder, What is it about this particular book that so very MANY people connect with? Why this book, and not that book?   What is this one’s magic?  What theme does this novel consider that resonates with so many people right now?  And why didn’t the book I read last week and found far more interesting, well written, engaging, or brilliant connect with enough others to make it too, or even instead of this one?

No one needs to read stories about made-up characters, of course, so it seems to me that (leaving Oprah aside) a novel succeeds commercially because millions of people recommend it, one by one (or social network by social network). That is, when one reader feels so moved that, without any reason at all (other than perhaps generosity), he or she will say to a friend, “You’ve got to read this. This is important. This will teach you something about life.” Multiply that formula by millions and you have a bestseller, in this case possibly even a classic.

ROOM is that rare book whose success is completely right and understandable. Unique, artful, poignant, authentic in its voice and characters, and beautifully, brilliantly written without flourishes or writerly self-consciousness, ROOM grabs you from the first minute and refuses to let go. Yet many (well, some) books do all that.

ROOM’S wisdom comes upon you slowly, like the light of a sunrise. In telling the story from the child’s point of view, Donoghue protects us from the horror, just as Ma protects her child. In focusing so tightly on the relationship between this devoted and inventive mother and this boy, by observing so clearly every single object and moment in its character’s 11 x 11 world, ROOM manages to illuminate the entire World.

I think ROOM connects with so many because it speaks to a certain planetary zeitgeist.  Everywhere on earth, things seem to be spiraling out of control, and Donoghue has written an unexpectedly hopeful book that speaks to human resilience in adversity, our capacity to survive. ROOM comments powerfully on our culture of gluttony, and profoundly teaches us about the nature and meaning of reality, how we construct our realities.

ROOM is also, of course, about the bond between mother and child. Most psychologists agree that failure to form a bond of attachment with at least one human being in the very early years can have devastating lifelong consequences. In my social work practice, I see many people who seem so damaged by early neglect, parental cruelty, selfishness or narcissism, and/or simple bad mothering/fathering, that it almost seems nearly impossible to effect repairs. ROOM forces you to note (and believe) that this remarkable woman, though she lives in constant personal terror, is managing to save her son by simply using her own good sense, subjugating her own needs to the needs of her child, and making the best of what she has for the sake of her child. And by saving her child, she also saves herself. And the hooked reader can’t help wonder about what will happen to Jack and Ma, even after that last powerful scene. The Bruised Muse has faith that what Ma has done will, in psychological terms, will be, “good enough.” How extraordinary. To wonder what will happen to made-up characters. Now THAT’S suspense. And suspense is another reason the book succeeds. By adhering broadly to the outline of a creepy suspense novel, yet being completely without creep, ROOM draws in the reader looking for “suspense,” but effectively turns the genre inside out.

The Bruised Muse also found that ROOM has aroused her long suppressed desire to write fiction again. (Wait. No. Don’t.  Push it away. Don’t be a fool.)

Surviving Optimism

Certain members of my family (who shall remain nameless) always accuse me of being “pessimistic,” while I believe I’m simply a realist. Well, according to neuro-imaging researcher Tali Sharot, author of a new book called “The Optimism Bias: A Tour of the Irrationally Positive Brain,” discussed in the New York Times today, most human beings inaccurately predict most outcomes in life because our brains are hard wired to be unrealistically optimistic. I haven’t read Dr. Sharot’s book yet, but I suspect this may have something to do with the fact that in order to live our lives we have to psychologically and neurologically set aside the existentially depressing fact that we’re all going to end up as wormfood. In any case, our neurons efficiently encode unexpectedly good information, but fail to incorporate information that is unexpectedly bad. For example most people believe they will be highly successful when the odds are against that outcome. Underestimating risk also makes us less likely to practice safe sex, save for retirement, buy insurance, or undergo medical screenings. It is of course not surprising that those of us who realistically predict outcomes tend to be mildly depressed.

I’m wondering how this relates to my own clinical observation that the experience of actual trauma seems to subsume the optimism bias in making the traumatized more emotionally reactive, and more often than not changes the worldview of the traumatized toward a more pessimistic, anxiety-ridden, depressed view of the future. Or is this altered view that traumatized people exhibit merely realistic, a kind of adjustment to the “natural” optimism bias? Given the growing amount of trauma in the world, this seems to me like an important issue that may affect our ability to move forward as a species.

What do you think?

Writing for Survival: Fran on She Writes.com

I wrote the following piece on writing and my new book for a great writerly website called, shewrites.  As usual I’m out there with honesty.


I’ve just completed a memoir in essays I’m calling “How I Lost My Bellybutton and Other Naked Survival Stories,” in which I try to make sense of the ridiculous amount of “tsuris” I’ve had in my fifty-seven years. As I begin sending it out into a publishing world that’s become quite weird, I’m feeling surprisingly Buddhist. Of course I want to entertain, illuminate, and move others with published work, but finding and telling my own story in my authentic voice, sometimes using my (recovered) sense of humor, has helped me accept that I actually write to survive. Writing is my solace, therapy, coping tool, refuge, calming mechanism, path to healing, and way to make sense of life.

So what have I survived? Well, who’s counting, but just for starters we’re talking a husband’s brain tumor (1 time), the same husband’s cancer (2 times), my own miscarriages (3 times), breast cancer and a mastectomy whose aftermath nearly killed me (1 time, so far), a brother who thinks he’s the Angel of Philadelphia from the Bible (He’s not unlovable, but 1 deluded brother is plenty), and familial mental illness that I realize now pervaded every corner of our house in the Philadelphia suburbs, however in denial my father was. (3 mad aunts, 2 depressed parents).

None of it comes even close to the 1994 death of my three-year-old son, Michael. Surviving that is, I believe, one of the two greatest accomplishments of my life.

My relationship with writing has been explosive and fickle, beginning when I wrote to cope as a teenager, secretly. Like a junkie who keeps going into rehab, only to relapse every time, I’ve stopped when I lost focus on process, suffered rejection, envied another writer’s talent or success, had to abandon a project that didn’t work out, didn’t realize that everything you do, even that which fails or hurts, can teach.
I’ve even condemned and ridiculed my Muse without mercy, beaten the poor thing over the head until she shuts down, rebels, abandons me, or even hits back. Here’s a Survival Tip She-writers might find useful:

Survival Tip #1: Do not beat your muse. She’s sensitive, and doesn’t respond well to bullying. Who does?

Even during my most successful period, when I had multiple book deals, foreign translations, a German best seller, film options, nice sales, great reviews, I kept beating my Muse for not being better. I kept trying to quit.

And then came December 7th, 1993, my version of Pearl Harbor Day, the day my son had a seizure. My husband and I rushed him to a Hospital, but we arrived with our baggage in Hell.

At the time of my son’s death I had a two-book contract that I tried to fulfill by frantically finishing the second book in a few weeks. What a sight I must have been, pounding on the computer, a wild-eyed zombie—in a bathrobe, since I hardly ever got dressed. The editor rejected that violent mess of a book, and I lost my deal.

Was I thinking I could plow through such a loss, or maybe put off grief until later? This kind of grief makes you insane. And in my insanity, I stopped writing again, just when I needed it most.

I spent the next three years walking around wearing only my bathrobe and my grief, only vaguely aware of my daughter and husband, like floaters in my field of vision. People suggested I write a journal, but I became enraged at anyone who presumed to tell me how to cope. One desperate day three years later, I scrawled the words “Help me” over and over in a notebook until they dissolved into unrecognizable strokes. Eventually I turned that journal into my unconventional third novel, “Saving Elijah.” Writing that book saved my life. Even so, when my next novel didn’t sell to a publisher, I gave up writing again.  Here’s another tip:

Survival Tip #2: Rejection and failure come with the territory. Art is subjective and interactive. 

I went back to school for social work, and now have a clinical practice I love. I also facilitate “write to heal” workshops. And writing eventually lured me back, first poetry to cope with the trauma of sitting with other people’s trauma, and then after surviving the breast cancer (barely), I started the bellybutton essay, to which I added Other Naked Survival Stories, including several about my son, what Hell is like, how I escaped it. The book is part memoir, part self help, with 70 or so Survival Tips based on all I’ve learned about psychology, resilience, and coping with emotional pain. Writing the tips—the real ones and even the bits of schtick I threw in for fun—was instructive for me, and I hope will be for readers, too. Here are a few tips more for writers that aren’t in the book:

Survival Tip #3: Banish all self-censorship, whether you’re “writing-for-healing,” or writing a first draft.

Survival Tip #4: Draw blood. This is the (oddly) healing part. Corollary: It helps to examine and unpack your psychological baggage when you’re forced to deal with trauma in your life, and/or when working with it in your writing.

Survival Tip #5: Learn craft. Learn more. Craft (and even art) comes with practice and study, and with a willingness to write and rewrite, examine and reexamine the material (along with your mind and heart) to shape it so it resonates emotionally with other readers. Corollary for Older Writers: Do not be dismayed that on the Internet, your writing is called “content.” Fuss with it anyway. Writers fuss because they care about each word.

Survival Tip #6: Learn to distinguish between criticism or honest reaction, and snark. Criticism can help you in your work. Snark is about the person giving it. Corollary: Don’t become overly fond of your words, but learn to stand your ground on the words that work.

Survival Tip #7: Tell the truth. Or your truth, anyway. But don’t expect to be thanked. Corollary: To tell your truth, find your authentic voice.

Survival Tip #8: Count your blessings. One blessing is that you have the gift of writing to see you through this life.

Semi-reformed cynic that I am, I feel blessed to have been able to use my writing to see myself as a survivor, rather than as victim of emotional (not to mention physical) suffering. I’ll be thrilled if readers find my new book moving, wise, funny, and (God forbid) inspirational, but whatever happens out there in the big bad publishing world, I know that I can no sooner give up writing than give up my nose. I’m definitely keeping my nose, since I no longer have a bellybutton. As for how, exactly, I lost my bellybutton, that, Sister Survivors, is a long story, which I hope you’ll read about in the memoir.

Writing Prompt: Here’s an idea I explored in my novel, “Saving Elijah.” I recommend it for anyone who’s suffered trauma, loss, illness, or emotional pain. (That would be just about everyone!) With all the creativity and imagination in She-Writes-Land, I trust we’ll see some interesting results. Post and tag your efforts so we can all enjoy them.
Imagine a scene in which you (or a character) meet God, or God’s emissary. Place the scene in any era: the 1950’s or 1500’s, the future, now. Any locale: France, Detroit, your kitchen, the New York Stock Exchange, a dusty road. Dress God in any guise: someone meaningful from your (or the character’s) past, a dead father, a purple angel or demon, a crooked old man. Now write the scene, with dialogue. You might (but don’t have to) start with your character imploring to God, “Why me?”
Why me, indeed.