The First Smile

The world breaks us all, 

and afterward some are stronger in those broken places.

Ernest Hemingway

I remember the day with piquant detail. The first smile after she died, cracking my cheeks, splitting my skull in two. I felt as if I'd committed an act of desecration, voyeurs witnessing my fait accompli. My dead child in her pink satin casket lay there lifeless. And I smiled. 

I do not recall who caused this act of irreverence- or what they said or did to prompt it. I only remember standing outside of myself in shame. Smiling is an act of the living. I was not alive; I certainly felt dead.  But the dead do not smile.  

I knew in that moment I was not one of the dead. No matter how much I beckoned, I knew Death would come on its own will.  I also knew that I was not amongst the real living. I existed in some liminal place between breath and stillness, extinction and existence, nether and numinous, and life and death.  I was broken, irreparably shattered.

For months, I wandered through the valley of the shadows as I vacillated between the world of the living and the world of the dead. I struggled to accept life's mediocrity, longed for my now fugitive naïveté, and wished for ailments of trivia instead of trauma.  

What glue could hold those broken places? What stitch would ensure proper healing? What concoction would purge me of the pain? Which God could heal my suffering and despair?

It would be many months before smiles would come again. But they came. Slowly and painfully. I did not want others to assure me that it was okay to smile and that I should move on and be happy in my life. This, I knew, would one day be my truth. But I was not ready yet. I needed pause. Her life and death were worthy of this interruption in my previously assumed entitlement to an untainted, joyous sojourn. Instead, I wanted others to accept my shame without judgment, to hold a place for my broken, sometimes irrational, state of mind. Often, they could not. Like a leper, raw grief frightened them. 

Nevertheless, I would not accept their platitudes or poisons. I rejected their attempts to tug me toward the future faster than I was ready. I refused to abandon my brokenness in exchange for cheap glue or careless stitching. I indulged in time and tears and tribulation. I became a seeker of healing that would endure, not healing that was shoddily constructed with plastic words, or pills, or even a magic wand, susceptible to rebreaking under the slightest pressure.

What I've realized over the past 14 years is that it was the very grief that frightened them- that raw grief which seeped from my broken places like blood spilling from a wound- that truly healed me. I have become stronger in my broken places.  And I am smiling again.

From the Gallows of Grief to Gratitude

There is nothing so whole as a broken heart.

Mendel of Kotzk

This quote reminds me of what I've learned during my grief journey. 

I've learned that in brokenness, there can be wholeness. In the darkness, there can be light. In egoism, there can be selflessness. In despair, there can be hope. In ungratefulness, there must, eventually, be gratitude. 

This isn't just psychobabble; for many, it is their survivalist reality. It is the only way that so many bereaved have moved beyond mere suspension.  Those who allow themselves to experience gratitude are often able to transcend their former place in the world. They not only become whole again, but they have reached a threshold of completeness they would never have known would it have not been for their confinement to the gallows.

These are individuals who, despite incapacitating trauma and turmoil, manage to find gratitude for the goodness in their lives. This is not a magical moment of epiphany for many of them. Rather, it evolves over time and with intense cognitive effort.  I believe that finding gratitude- even crumbs or morsels at first- requires emotional maturation, practice, and mindfulness. 

It requires us  to first focus on the self- to take personal responsibility for our own suffering. To acknowledge it. To tell and retell our story. To know ourselves well. It requires us to acknowledge that there is healing in our suffering. It requires that we silence our minds, respect our body's response to the grief, and be gentle with ourselves. It commands patience, intentionality, and commitment to the insufferable pain that radiates from the tips of our hair to the tips of our toes...the agony that causes every cell in our bodies to ache. It requires that we reach out for help from others, sometimes strangers, and that we accept the outreached hand with grace.

Then, when we are ready, we must move beyond the self. We must see the suffering of others. We must acknowledge the other's pain sans the fear of losing or diminishing our own suffering. We must be able to sit compassionately with another, abandoning for a moment our own grief's narcissistic exigence. We must  widen our circle of compassion for all beings suffering. We must see the world through others' eyes.  

We must recognize the acts of kindness, courage, and sacrifice that others have offered along our journey, and extend that droplet of hope to another. It requires that we honor even ill-fated attempts to comfort, and that we reconsider exchanging alienation, anger, and resentment for tolerance, empathy, and acceptance. We must seek gratitude daily, even for the 'small' things in life, like a dandelion dancing on the warm breeze, shadows playing in the park, or a fiery sun setting against a mountainous silhouette- or perhaps, a simple kind word of support from a friend...

Like threads in a garment, grief runs in and out of our daily lives from the instant of Death, one moment often indistinguishable from the next for many days and months. There is a time for this. There is a time to wallow in the mud, a time to pause for the entangling. The garment is unravelling and grief has patterned your life, against your will, in an unfamiliar mosaic.  Yet, gratitude can truly help us to heal from our suffering when the time is right to reconvene our lives. 

And when that time comes, consider your complaints and revisit your expectations. Take the time to fill your heart with gratitude. You can be grateful for what you have without taking away from that which you have lost. 

So, tell someone who has helped you how grateful you are for their presence in your life. Hug someone you love and tell them three things you admire about them. Write a letter or send a card to someone who is making a difference in your community. Leave an anonymous gift for a teacher, doctor, or other "carer". Reach out to another person in mourning.  Let gratitude hang in the shadows, parallel to your grief. It is not magic, but it is transformative. 

When we allow the experience of gratitude, the heart may still be broken but the heart is also most full, most whole, and most complete. Mendel of Kotzk also said, "Where is God to be found? In the place where He is given entry".  Where is gratitude to be found? It can be found in the very place where you have also given it entry. Grief and gratitude can coexist.

I dedicate this posting to our wonderful MISS Foundation moderators, volunteers, and facilitators.  For your commitment to helping others, I am so incredibly grateful.

Nobody and Everyone

Nobody knows everything
and everyone knows something.

In ancient mythology, the final apotheosis of a Taoist who had transformed his body into pure Yang occurred after 1000 years in this world. He attained hsien (immortality) through mysticism, restoring the purest energies possessed only by newborn infants at birth. Once satiated with mortal life, he "ascended to heaven in broad daylight."

According to the Tao, life and death are but one of the pairs of cyclical phases, such as day and night, summer and winter. Life and death are not opposing forces; they are merely two variables of the same reality, "arrested moments out of the flux" of the chaotic universe.


From the Tao Te Ching

All creatures under heaven are born from being;
Being is born from nonbeing.

The Way gave birth to unity,
Unity gave birth to duality,
Duality gave birth to trinity,
Trinity gave birth to the myriad creatures.

Treat well those who are good,
Also treat well those who are not good;
thus good is attained.
Be sincere to those who are sincere
Also be sincere to those who are not sincere;
thus sincerity is attained.

Everything has a beginning
which may be thought of as the mother...
Having realized the mother,
you thereby know her children,
Knowing her children
go back to abide with the mother.
To the end of your life, you will not be imperiled.

Observe others through your own person.
Observe others through your own family.
Observe others through your own village.
Observe other states through your own state
Observe all under heaven through all under heaven...

Undertake great tasks by approaching the simplicity in them.
Do great deeds by focusing on the small details.

Seek the unusual and creative, for there is greatness.

Guard the three treasures: compassion, frugality, and humility.

Realize that you do not know all; this is a virtue.
Not to realize that you do not understand is a defect...

The Way of heaven is impartial,
yet is always with the good person.

The Way is empty yet it never refills with use;
Bottomless, it is, like the forefather of the myriad creatures.
It files away sharp points, unravels tangles, diffuses light, mingles with the dust. Submerged it lies, seeming barely to subsist...

Attain utmost emptiness. Maintain utter stillness.

Synchronicity

“So when you are listening to somebody, completely, attentively, then you are listening not only to the words, but also to the feeling of what is being conveyed, 

to the whole of it,  not part of it.”

Jiddu Krishnamurti

I met a fascinating man today who approached me, interested in my work with the bereaved. It's amazing how, when you meet a kindred soul, you can listen and exchange for hours upon hours and never tire of the conversation because it is intentional, meaningful, and consequential. 

We spoke about life and loss, trauma and tribulation, reality and relationships, loving and listening.

Listen. Listen. Listen.  

Repeat the word, twenty times. Softer. Listen, listen, listen.

Listening to the other can have powerfully therapeutic effects. Holding a space for the other through silence.  Being fully present, all senses focused on the other, their moment of disclosure- be it filled with suffering, sorrow, despair, or joy- being that which Pine (1985) calls a prepared explorer into another person's life.  Gadamer says that the important thing is to "be aware of one's own bias so that the text may present itself in all its newness and assert its own truth."

Reik (1954) discussed listening with the "third ear."  This is psychoanalytic listening intent on intuition. It requires that full experience of presence with the other.  He says, "...in order to comprehend the unconscious of another, we must, at least for a moment, change ourselves into and become that person.  We only comprehend the spirit whom we resemble."  I might call this true, empathic connectedness.  Freud calls it "listening with evenly suspended attention."  The results can be astonishing- acknowledgement and validation of a person and their place in the world. Thank you, David.

What greater gift can you offer to another than intentionality, consequentiality, and meaning?

And I submit this: Offer this gift, also, to yourself. Listen to the thoughts and the emotions and the memories and the pain and the struggles and the fears and the sounds and the beauty of you.  

Do what you must do to become who you must become.

Traumatic Awakenings

To be alone is one of the greatest evils for a person.

William James

I've always appreciated James' idea of loneliness as a threat to the human being.  We don't give it much thought through the societal bedlam and over-scheduled lives.  Many of us are constantly surrounded by both people and stimuli- auditory, visual, olfactory.  Yet, is it possible to be lonely even when you are with others?  Is it possible to be woefully alone while surrounded by friends? I say, indeed, it is. In fact, I believe this state of existential loneliness happens often in societies where disingenuous, superficial relationships flourish in commonplace. We rarely pause long enough to build the types of authentic and circumspect relationships necessary to avert loneliness- Martin Buber's idea of the "I-Thou" relationship. More importantly, many rarely journey inward to build the most important relationship of all- the relationship with the self.  Loneliness is a way of life in 21st Century Western culture, and the cost may be far too high.

James Lynch, PhD, professor of psychiatry and author of the book, The Broken Heart, asserts that loneliness is one of the leading causes of premature death in society.  The idea that chemical perturbations- the evolution of cellular regulation- incites emotional responses such as love, anger, fear, and loneliness set the stage for modern medicine.  Lynch disagrees with the Cartesian model that the language of emotion is separate from the body. Instead, he posits, the somatic reaction to stress, or loneliness, or grief is the body's way of communicating its suffering.   He asserts that some physical illnesses- cellular dysphoria- occur as a direct result of our bodies' failure to connect with others - and frankly, our true selves: "Because we do tell people to hide their suffering, their vulnerability and loneliness, and so they also hide their beauty...when you wall off your capacity to feel pain, you also diminish your capacity to feel pleasure."

Lynch extrapolates the result: narcissism.  Narcissism, he counters, means no self, no authentic self. These are people who are most likely to suffer heart disease, high blood pressure, and other chronic illnesses according to Lynch.  They cannot feel, really feel, their feelings at all. They do not know themselves, and they have no boundaries between themselves and the world. Narcissists get stuck in their suffering because they are wholly incapable of seeking out meaning; the eventual result being deriving joy even amidst pain. These types of individuals- very lonely individuals- are the least likely to awaken after a trauma- the least likely to recognize that fulfillment and pathos coexist throughout the human experience. Lynch says he has the scientific evidence to back his postulations.  

And I would further ask: How can we be in a real relationship with another if we are not in real relationship, first, with ourselves?  The longest journey is the journey inward. It may begin in loneliness, but it will most certainly end in knowing the self better than ever.  And the reward for this may be the gain of genuine, sustaining relationships and connectedness that enable us to truly be with others- and ourselves- during our short time on this earth.

"Too many things are occurring for even a big heart to hold."

W.B. Yeats

(Art entitled "Loneliness" by Santosh Gupta)

Death Talk: Docs dodge honest conversations

Elisabeth Kubler-Ross began this fight in the 1960's; before her death, she told me how it frustrated her that some physicians- even psychiatrists- had not yet "gotten it"-that the dreaded "D" word was still relatively unspoken in the medical community.

Indeed, it is difficult for me to imagine that this battle still continues, that it is even a controversy at all. It illuminates three things for me- 1) the ever present paternalism still alive and well in medicine, 2) the reluctance to build the types of relationships wherein honest discussions about death can take place, and 3) our ongoing circumvention of death at all- as if not speaking of it will help extend life... An important article posted today from the AP:

CHICAGO, Illinois (AP) -- One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived. Eileen Mulligan's doctor told her upfront that there are no good treatment options left to try for her cancer. He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care.

"At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan, who now is making a "bucket list" -- things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., home. Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.

New research shows they are wrong.

Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

Convinced of such benefits and that patients have a right to know, the California Assembly just passed a bill to require that health care providers give complete answers to dying patients who ask about their options. The bill now goes to the state Senate. Some doctors' groups are fighting the bill, saying it interferes with medical practice. But at an American Society of Clinical Oncology conference in Chicago earlier this month, where the federally funded study was presented, the society's president said she was upset at its finding that most doctors were not having honest talks. "That is distressing if it's true. It says we have a lot of homework to do," said Dr. Nancy Davidson, a cancer specialist at Johns Hopkins University in Baltimore.

Doctors mistakenly fear that frank conversations will harm patients, said Barbara Coombs Lee, president of the advocacy group Compassionate Choices. "Boiled down, it's 'Talking about dying will kill you,' " she said. In reality, "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone. No one is willing to talk about it."

The new study is the first to look at what happens to patients if they are or are not asked what kind of care they'd like to receive if they were dying, said lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston. It involved 603 people in Massachusetts, New Hampshire, Connecticut and Texas. All had failed chemotherapy for advanced cancer and had life expectancies of less than a year. They were interviewed at the start of the study and are being followed until their deaths. Records were used to document their care.

Of the 323 who have died so far, those who had end-of-life talks were three times less likely to spend their final week in intensive care, four times less likely to be on breathing machines, and six times less likely to be resuscitated. About 7 percent of all patients in the study developed depression. Feeling nervous or worried was no more common among those who had end-of-life talks than those who did not.

That rings true, said Marshall, who is Mulligan's doctor at Georgetown University's Lombardi Comprehensive Cancer Center. Patients often are relieved, and can plan for a "good death" and make decisions, such as do-not-resuscitate orders. "It's sad, and it's not good news, but you can see the tension begin to fall" as soon as the patient and the family come to grips with a situation they may have suspected but were afraid to bring up, he said.

From an ethics point of view, "it's easy -- patients ought to know," said Dr. Anthony Lee Back of the Fred Hutchinson Cancer Center in Seattle. "Talking about prognosis is where the rubber meets the road. It's a make-or-break moment -- you earn that trust or you blow it," he told doctors at a training session at the cancer conference on how to break bad news. People react differently, though, said Dr. James Vredenburgh, a brain tumor specialist at Duke University.

"There are patients who want to talk about death and dying when I first meet them, before I ever treat them. There's other people who never will talk about it," he said. "Most patients know in their heart" that the situation is grim, "but people have an amazing capacity to deny or just keep fighting. For a majority of patients it's a relief to know and to just be able to talk about it," he said.

Sometimes it's doctors who have trouble accepting that the end is near, or think they've failed the patient unless they keep trying to beat the disease, said Dr. Otis Brawley, chief medical officer at the American Cancer Society. "I had seven patients die in one week once," Brawley said. "I actually had some personal regrets in some patients where I did not stop treatment and in retrospect, I think I should have." James Rogers, 67 of Durham, North Carolina, wants no such regrets. Diagnosed with advanced lung cancer last October, he had only one question for the doctor who recommended treatment. "I said 'Can you get rid of it?' She said 'no,' " and he decided to simply enjoy his final days with the help of the hospice staff at Duke. "I like being told what my health condition is. I don't like beating around the bush," he said. "We all have to die. I've had a very good life. Death is not something that was fearful to me."

Iterations of Freud

No one who, like me, conjures up the most evil of those half-tamed demons that inhabit the human breast, and seeks to wrestle with them, can expect to come through the struggle unscathed.  -- Sigmund Freud, Dora: An Analysis of a Case of Hysteria

Words have a magical power. They can bring either the greatest happiness or deepest despair; they can transfer knowledge from teacher to student; words enable the orator to sway his audience and dictate its decisions. Words are capable of arousing the strongest emotions and prompting all men's actions.   --Sigmund Freud, The Educator's Book 

Freud was an esoteric man, publicly vilified and maligned, and woefully misunderstood by his historic peers and subsequently in many circles of psychilluminati.   Born in Czechoslovakia in 1856,  he moved to Vienna when he was three years old.  His lived his entire life there and would have died there; but the beginning of WWII prompted his escape. He took refuge from the Nazis in 1938 in England and died the following year there.  Several years later, his sister died in a German concentration camp.

Freud was one of the intellectual elite who, by the time he finished middle school, spoke fluent Greek, Latin, German, Hebrew, French, English- and a little Italian and Spanish too. At age eight, Freud's favorite authors were Shakespeare and Goethe.  (Sidenote: It's nearly incomprehensible for me as a mother of three boys living in Westernized American culture...). In other words, from his earliest days, he was somewhat of a sociocognitive anachronism.  He was obsessive, meticulous, controlled, parsimonious, obstinate, rigid, and compulsive (SE, IX. 169). He existed in a vicissitudinous state of both credulity and skepticism. He was, indeed and in every way, extraordinary.

I have always been fascinated with Freud and other radical eccentrics and misanthropists. Like his early defectors, Jung, Adler, and Stekel, I also recognize Freud's cardinal flaw- overgeneralization and absolute determination to be unquestioningly right. I could not disagree more with his theory of mourning; that is, his idea of cathexis and decathexis- the necessity for mourners to sever bonds with their deceased in order to reinvest in living.  And, I won't recapitulate Freudian theory that has been scoured and devoured by 20th Century psychologists.  The Oedipus and Electra complexes and his idea of the death drive, and the ensuing mass hysteria around those postulations, are well-known- and still ridiculed- throughout the general public.   

Still, I believe him to be one of the greatest thinkers of the 20th Century. Freud contributed so much to what we know about the human psyche.  He taught us about neuroses and childhood development. He taught us the importance of maternal attachment and praise; and in fact, John Bowlby built much of his theoretical postulations on Freud's work.   He opened dialogue on dreams and symbology, and the unleashable power of the unconscious mind. He taught us about narcissism, melancholia, and identified what we now know today as posttraumatic stress disorder in combat soldiers during WWI (back then termed 'shell shock').  He gave us the Freudian slip and glimpses beneath the iceberg of consciousness: Freud left the world a powerful framework with which to understand ourselves- our true selves- psychoanalysis.  

One of my favorite, dark Freud books is Civilization and its Discontents. This manuscript is not for the faint-hearted. It is Freud at his most misanthropic, pessimistic-self.  The historical context of societal and personal events during the writing of the book is essential to consider: His daughter, Sophie, died in 1920. He was diagnosed, not surprisingly, with cancer in 1923, and later that year, his beloved grandson died. Then, the second world war began soon after and Jews were being slaughtered, and he began working on the epic book Civilization and its Discontents. Within two decades, he'd lived through two world wars, one in which his religious group was facing extermination; now faced his own mortality; and he lost his daughter and then his grandson to Death. Given the historical context, is it any wonder, then, this book is a literary augur of calamity?  

I believe every person should read at least two of Freud's books, if not for clinical purposes then for gain of political philosophy.  He is, after all, one of the great makers of our previous century.  And even in the darkest, dampest corners of his mind, Freud left room for the human spirit to succeed.  It's not an exaggerated or naive optimism. Rather, it requires maturation and responsibility: he calls upon people to become acquainted with themselves, to understand themselves. 

He says that knowing yourself will help both individuals and society remain open to the vast possibilities of human expression, those beyond the impulsive drives- the negatives- those beyond the failures. We need not be limited by our past; rather, we can live authentic lives when we know ourselves- when we are honest- and transform pain and aggression into beauty and peace.  

Id's a wonderful world, after all.

 

The Risk of Love

The most secure prisons are those we construct for ourselves.

Gordon Livingston, M.D.

How does one live in a world where children die? 

Living in 21st Century, relatively affluent American society we are unaccustomed to the idea that children die. Yet, there was a time, not long ago- and still true in many parts of the world, when many, many children died. Two dead children in a family of four was not the exception just 100 years ago, or more commonly five dead children in a family of ten.  But our worldview- our very expectations upon which we construct our futures- patently rejects the idea that our families can be swiftly shredded at Death's whim. Due to medical advances, sanitation improvements, and other accoutrements of modern life, most have become wholly unfamiliar with early death, both during infancy and childhood as well as early adulthood, in Western society.

In fact, many believe they can beat Death at His game. Many nonprofit organizations exist to eradicate Death. They are single-cause focused. They want to cure, prevent, heal, and prolong. All worthy causes, indeed. But Death is a formidable enemy who will not secede. We may cure cancer one day, or heal brain injuries, or prevent suicide or car crashes or stillbirth or SIDS...but Death will, for us all, come one day. We can only hope that He comes for the parents first, and then that He comes for parents at the end of their lives, and not prematurely.  We can only hope that for the rest of the world's children, too. Sadly, in a world of inequity and suffering, this is unlikely.  

That is why the MISS Foundation exists. Because since the beginning of man's time on this planet, children have died. And until man takes his final step on this earth, children will continue to die.   We can be imprisoned and paralyzed by fear, anxiety, grief, despair, and sadness. Our children's lives are certainly worthy of such psychological woes.  I think of the purgatorial state of the mother in the film "What Dreams May Come."  Her prison- one of her choosing- was painful for me to watch... it represented a familiar place to which I'd once condemned myself.  In a sense, perhaps, punishment to an austere life is the only justice a mother can give her dead child.

Perhaps not. 

Perhaps, instead, our penalty for outliving our children is the task of seeking connection in the midst of an imperfect world, reinventing ourselves in the midst of our child's ghost, rebirthing in the midst of suffering, or finding a way to love despite the pain. Love, Livingstone says, is the ultimate risk. When we cannot change the parts we wish were different, the unfairness and cruelty of life, we've only one  choice.  To live or die.  Yet, to surrender our existence would be to abandon all that is beautiful about our children who died. Indeed, he says, living after a traumatic death is both an act of will and an act of surrender. He speaks from very personal experience.

Livingstone is a bereaved parent twice. His eldest son completed at suicide, and his youngest, only 13, died of leukemia. How does one exist in a world where children die? I think, perhaps, through that for which we are willing to risk everything- love.

Trauma proliferation: God help us

For this is what we do. Put one foot forward and then the other... Add our little consequence to the tides of good and evil that flood and drain the world. Drag our shadowed crosses into the hope of another night. Push our brave hearts into the promise of a new day... for a truth other than our own. With longing: the pure, ineffable yearning to be saved. For so long as fate keeps waiting, we live on. God help us. God forgive us. We live on.

G. David Roberts, Shantaram

I'm presenting a paper this weekend (published by Omega Journal of Death & Dying) at a social stress conference, and I am listening to paper after paper of research on stressful life situations. And you know, there isn't anything that approaches the trauma of child death. Well, actually there is one... Depressed Affect and Historical Loss among Northern American Indigenous Adolescents.  This paper moved me, and I was intrigued by the idea of collective trauma in the context of child death across cultures and time.

Loss, of course, comes with his often-companion- trauma. Like Jung's collective unconscious, historical trauma is intergenerational, unconscious, and unrecognized.  According to Professor Maria Braveheart, historical trauma is the "cumulative emotional and psychological wounding over the life span and across generations, emanating from massive group trauma".  

This concept is a similar sociological construct as that suffered collectively by African Americans who were enslaved and their offspring, Jewish people as a result of the Holocaust, and Japanese Americans who were sequestered in California camps at the beginning of World War II.  It's the criminal result of colonized and coerced oppression versus voluntary immigration (ie, Italians and Irish).

American Indian families suffered immense losses at their core. Braveheart cited government-mandated boarding schools, wherein children were forcibly removed from their family homes, as a major factor in the historical trauma. Here she says, "gender roles and family relationships were impaired at the boarding schools, where the focus was on the European tradition of male-female relationships and not the Indian tradition of holding women and children sacred".  (I do so prefer this model...)

These boarding schools exacerbated the traumatic effects of familial separation by stripping the dignity and identities of the children, forbidding their language, sanctioning their ritual and religion. Grandchildren of the boarding schools suffer for the pains of the past through complex pathways; they suffer as a consequence of their own parents' suffering and subjugation.

Health ailments such as type II diabetes were common among American Indians, perhaps because of the dramatic changes in their natural diet; but perhaps also, at least in part, due to the extreme physiological stress.  Psychopathology of chronic stress and even incidental trauma is well documented in empiric studies and include shame, guilt, depression, anxiety, loss of control, low self-esteem, emotional numbing, anger, suicidal ideation, and somatic illnesse-mirrors grief in many ways.

That's on a massive, macro scale. How about individual families?  It makes me wonder about child death in families, and the intergenerational effects of trauma that we pass on to our children. It also incites curiosity about those children who were wounded by the distant past. For example, my mother's mother, was a Sicilian immigrant born just after the turn of the 20th Century. It was a time when many children died before their first birthday. In fact, some families withheld naming their children until post-1st-birthday to ensure they would live.  My grandmother had her first baby around 1931.  Her name was Josephine (1). Josephine died of pneumonia at two years of age.  Her next baby was born in 1933.  Her name was also Josephine (2). She died at around three months of age. My grandmother, fraught with the superstitions of a demon-filled world, believed that evil spirits took the baby because she forgot to pray. Her third baby was born in 1934. She named that baby Mary, believing that the name Josephine might be cursed.  Her fourth baby, born in 1936, she renamed, again, Josephine (3), the namesake of her dead sisters. This would be my mother.  My grandmother was a cold, detached woman. I never heard her express love- she rarely smiled- she was not warm or nurturing. In fact, by today's standards, she was physically and mentally abusive. I cannot help but wonder if her behaviors were manifestations and effects of those losses. And what about the effects on my own mother? How have those effects translated, mutated, and contributed to the nature of my own relationship with Josephine (3)?

Len Pearlin says that stress proliferation- or higher on the continuum, I'd posit, trauma proliferation- can occur three ways. One, through secondary means, or multiple issues that arise concomitant to a traumatic event. Two, it can occur through succession of stressors, such as serial events, interrelated domino effects of a traumatic incident.  And finally, there is well-documented empiric evidence to support the idea of the diffusion of traumatic stressors within a system, such as the family, a type of vicarious trauma contagion.  What is missing from this theory is intergenerationality of traumatic events, the series of historic events wherein an event triggers a response which triggers an event which triggers a response, and so on. What is missing is an examination of how trauma affects both the psychological and the neurocognitive state of a mother, let's say, and how those sometimes neurocidal changes impinge on the prefrontal cortices, limbic systems, and reptilian or paleomammalian regions (MacLean's triune brain theory) of her children's developing brains. It is something that, certainly, warrants further study.