Beware of Strangers

To love means to open ourselves to the negative as well as the positive-- to grief, sorrow, and disappointment as well as to joy, fulfillment, and thus an intensity of consciousness that before we did not know was possible.

Rollo May

Throughout human history, there has been a tendency to fear the unknown. On a macro level, this fear has fueled oppression such as religious intolerance where, for example, during the Dark Ages, countless women were drowned or burned at the state as "witches." Fear of the unknown has incited wars between tribes, hatred between countries, and violence between groups. 

But fear is not merely a societal sarcoma that may manifest in subjugation and massacre; rather, evolutionarily speaking, it is a the most primal and visceral- and necessary- of human emotions. Fear keeps us safe from predators and protects us from endangering our lives. 

If there is a knock on the door, I ask, "Who is it?" in an attempt to familiarize myself so that I feel secure, to ameliorate my fears and keep myself safe from potential harm. The focus of some neophobias is on people, while others fear new experiences, places, or even driving a different path to work. But fear can also hinder social creatures like humans. Fearing people can incite stereotyping and prejudice. The fear of traveling to new places can stunt ethnological appreciation and wisdom. Even driving the same path to the workplace everyday can be inhibitive: What more interesting landmarks might you notice by taking a different path? So, what do we miss by our fears and subsequent evasions of the unfamililar?  

Grief was, at one time, an unfamiliar stranger. My primal response to him was terror and crippling fear. He controlled my thoughts, and I saw the world through his eyes, not my own. Panicked, I could not look this intruder in the eyes. I was paralyzed. I was certain that if my gaze met his, the abyss would, as Nietzsche said, stare back at me and overtake me. Like an ominous stranger at my door, I did not want to invite grief inside my home. I wanted to leave him out in the cold darkness of night where he belonged. 

What I didn't realize then was that this stranger was a part of me now, inexplicably linked by experience. By leaving him outside in the darkness, he became the monster in my dark closet that would haunt me when my mind was still. And unwittingly, I made a decision in 1995 to surrender to that which I most feared. Part of that psychological relinquishment required that I accept grief out of the darkness and into my home.  We sat down together and sipped tea. We walked together. We sat on the back swing and watched the sunset.  I came to know and understand this part of me that felt so foreign, and I began to slowly see the value in the unfamiliar that he brought into my life.  He became more predictable and I feared him less. His roar softened and he did not need to yell for my attention any longer. We gazed into one another's eyes and I survived the facing. 

I can honestly say that now grief, mostly, is my friend and an accepted, not feared, part of me. Now, I trust him to lead me into those places where, as May said, I can truly experience the pain, believing that beauty will soon follow, and knowing that I will experience the intensity of consciousness that far transcends the merely ordinary.

Remembering the Dead: Thoughts from Kierkegaard

"In relationship to one dead you have criterion whereby you can test yourself... it is one's duty to love [those] we do not see...we cannot be set aside because death separates them from us, for duty is eternal."

Søren Kierkegaard

I spent today reading Kierkegaard's "Works of Love". Specifically, a piece called 'the work of love in remembering one dead' whereby he asserts that actively remembering our dead is an act of duty that epitomizes the most unselfish, freest, and most faithful love. Perhaps, it brought me so easily to tears because it is that time of year when my heart, like brittle blown glass, is more fragile than robust. Or, perhaps, it resonated because his words offered marrow to my own philosophy and dutiful practice.

Kierkegaard asserts that the work of love in remembering one who is dead is a work of the most unselfish love. It is unrequited, for the dead can never reciprocate:

"O, if one were accustomed to truly love unselfishly, one would certainly remember the dead differently from the way one usually does after the first period, frequently rather than brief, in which one loves the dead inordinately enough with cries and clamour."

And the work of love in remembering the dead is a work of the freest love. There is no coercion nor compulsion to continue loving the dead. It is an act of authenticity and freewill, not an act of demand or obligation. To remember one dead is intentional and quite different than simply not forgetting soon after the death. It withstands the test of time:

"With respect to one dead... nothing is coercive at all. On the other hand, the loving memory of one dead has to protect itself against...new impressions to expel the memory, and it has to protect itself against time...Time has a dangerous power; in time is is so easy to make a beginning again and thereby to forget...In the meantime, the multiplicity of life's demands beckons to one, the living beckon to one and say: come to us, we will take care of you. One who is dead, however, cannot beckon."

Finally, the work of love in remembering the dead is a work of the most faithful love. It requires unwavering and enduring devotion, for neither affection, nor love, nor strength, nor kindness can be returned from one who is dead. Our dead do nothing to hold on to us; still, in remembering our dead, we love disinterestedly, freely, and faithfully. We hold a place in our lives for their psychological presence. This work of love in remembering the dead is faithful because our dead cannot compel steadfastness of our covenant to remember- the one we made at the moment of death when we vow emphatically, "I will never forget.". Rather, our dead remain passive and unchanged, unable to hold us accountable for fulfilling our promise to remember:

"Little by little, as the dead crumbles away, the memory crumbles away between the fingers and one does not know what becomes of it...if love still abides, it is most faithful."

As I finished reading this piece, tears filled my eyes. I felt vindicated in some small way, as if the world who had so long misunderstood my seemingly strange, unceasing allegiance to my dead child was woefully misguided in its assumptions. The love I hold for her in my heart and the space I allow for her in my life is an act of unselfishness, freewill, and faithfulness. This sounds much more palatable than psychopathologizing the bereaved who choose to remember their dead. And in so doing, I have been better able to learn, grow, endure, and mostly to love all those around me:

"If you love one dead, then remember him lovingly, and learn from him, precisely as one who is dead; learn the kindness of thought, the definiteness in expression, the strength in unchangeableness, the pride in life which you would not be able to learn as well from any human being, even the most highly gifted...Remember one dead and learn in just this way to love the living disinterestedly, freely, faithfully... Remember one who is dead, and in addition to the blessing which is inseparable from this work of love, you will also have the best guidance to understanding life; that it is one's duty to love the men we do not see, but also those we do see."

Sagan: Chaos and Order

You must have chaos within you 

in order to give birth 

to a dancing star.

Frederich Nietzsche

The universe, filled with nebulae, black holes, and the mysteries of time and space, was begotten from atomic chaos. Billions of years ago, all space, matter, and energy in our known universe was contained in a "volume less than one-trillionth the size of a needle point" or about the size of a single atom (deGrasse Tyson, 2004). This preplanetary pandemonium would impregnate our mother in this massive cosmos - Earth's solar system. Out of this frenetic and violent chaos, would come life, order, and beauty. These are key principles of physics and astrophysics: supernovas that outshine entire galaxies are born from massive stellar explosions, their remnants capable of forming ominous black holes or neutron stars and pulsars that are up to eight times larger than our sun; and the untempered chaos of a seemingly libertine universe gives rise to the magnificence of the cosmos.

On July 27, 1994, my own universe imploded when my baby died. I've found myself present with sadness and absent words this July, as I have been during the past 14 voyages of the Earth about its star between June and August. My grief feels like the fledgling cosmos. Chaotic, disordered, confused, violently out of control. Still, I take comfort in reflecting on the genesis of our macrocosm. 

Grief, like our universe, is often indescribable; it is elusive, creviced, and wordless. There exist within it many great mysteries, places unexplored and unknowable given the ephemerality of time. One pithy moment of grief gives rise to a new precipice, like a pulsar in my own universe of loss. I'm sitting quietly with this idea, and I'm reminded of Nietzsche's notion that order will come of the chaos, meaning of the confusion, and that I can, indeed, have my dancing star amidst it all.  Caret initio et fine.

RIP Carl...

November 9, 1934   to   December 20, 1996

A Cry Unheard

Seeking to forget makes exile all the longer; the secret of redemption lies in remembrance.

Richard von Weizsaecker

I picked up a new book last week on the recommendation of a colleague: A Cry Unheard: The Medical Consequences of Loneliness by James J. Lynch. I only wish I'd had this book in hand when I conducted my own research on the effects of social support on women after the death of a baby.  This seminal book is filled with clinical research on the dangers of social isolation, including the effects on the body and health.  Lynch captured data demonstrating the devastating health consequences of shame, anxiety, anger, and fear that was unrecognized, undetected, and most importantly, unheard.  I think this fact, for me, was the most important. It wasn't that the emotions themselves were "bad" or "negative" as contemporary theorists might imply. It was that the person experiencing them, and others too, did not acknowledge the emotions that created the problematic outcomes.  They were abandoned- both by others, and also by themselves.

In sum, he found that such social disenfranchisement can lead to fluctuations in blood pressure and respiration, depressed immune functioning, heart disease, hypertension, and a host of other physiological maladies. He notes that: "Those lacking social support, those who live alone, those who struggle with chronic loneliness, those who lose a loved one, all exhibit sharply increased risks of dying prematurely."

I've posted a great deal about narcissism, grief, and finding gratitude- and how, when the time is right, there is an imperative to move beyond our own suffering and see the suffering of the other.  There are some bereaved who may never move to that space where they are willing, thus able, to do that. Lynch calls this the "black hole". He says:  "Like black holes in space, such individuals absorb all light and all objects around them while emitting nothing back. Nothing escapes their...emptiness."

Conversely, he recommends looking "out into the world beyond the confines of your own skin...listening to a bird sing can lower blood pressure...gazing at the stars" too. "Listening to one's fellow (hu)man in dialogue can lower blood pressure."  Basically, moving beyond the necessary narcissism of early grief.

Lynch believes that "dialogue is the elixir of life and chronic loneliness its lethal poison". But what about the dialogue often aimed at bereaved parents? You know- those promptings to "move on", "God has a plan for you", "at least it wasn't one of the older ones", "you can have more", "everything happen for a reason", "time heals all wounds", and "aren't you done grieving yet"s?  Lynch said that dialogue can also be used to create distance, that it can be used to manipulate. He asserts that "empty language suppresses hope...and is spoken from outside our own hearts...(where) human dialogue is ruptured, destroyed, or reduced to a living hell" when abused in this way.  He termed it toxic talk, and far too many bereaved parents have experienced a litany of such dialogue.

I deeply appreciated Lynch's honest explorations as a medical doctor, professor, and human being.  It confirmed that the bereaved should be sensitive to their own needs; and then, when ready, actively engage in moving beyond the self.  The (temporarily) non-bereaved should engage in dialogue that is comforting and from the heart. They should not seek to cure or heal or absolve. Rather, they should seek only to be with the suffering. They should use words with great care and intention, for it is easy to destroy a fragile other with a few, seemingly benign, syllables. 

Allow them to remember, and invite them warmly back from exile.

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.

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.

Barefoot walkabout

Today was glorious.  I woke up to perfect Sedona weather, the sun raying, birds singing, and Brewer Trail beckoning. Ingrid and I started up the trail with another friend.

Brewer Trail leads to a special place I call big rock, one of the best panoramics in town, and is about two miles straight toward the big sky.  We met a Native American man at the top of big rock, and a few brave meditative types. I wondered how many relationships healed there, and how many ideas were born there, how much reverie and introspect were discovered on this big, red rock. I wondered how many feet of different lands once stood there, and how many ancient, indigenous voices had spoken there. It's a holy place, that big rock.  The journey to big rock was filled with friendly discussions with Ingrid about life, and men, and work, and aspirations, and grief, and hope, and disappointments.

The journey back down big rock would be very different than the journey toward big rock. While I was on standing big rock, overlooking the herculean geological majesty of Sedona, I experienced a moment of perspicuity.  I decided I would walk all the way down the mountain barefoot on the rocky trail, my feet touching the ground.  

I climbed down big rock barefooted, and I felt different immediately. The direct contact from my skin to the sharp edges of the rocks and earth sent stinging sensations to my brain. Tiny rocks that had just gone unnoticed under my feet now pierced my soles, and I found myself navigating the trail with greater mindfulness of every step. I found myself in the moment, truly in each moment, not deviating from planning the next step. I had to avoid stepping on yet more cactus needles or, worse, into a hungry ant hill. "Ouch, ouch, ouch, ouch, OUCHHHH!"

For nearly two miles, I walked, and walked, and walked, feet to the burning earth, feeling every sensation. It was a ritualistic exercise in mindfulness and focus, my barefoot walkabout from Sedona's big rock.

It could have been just an impulsive oddity in which I'd chosen to engage. I could have missed the lesson of this walkabout. But I learned something from my trek down the mountain. I learned that I am stronger and more tenacious than I thought, and I that I can tolerate discomfort in exchange for the promise of learning. It affirmed that mindfulness is an important part of walking through life- awareness of surroundings and respect for the moment. I learned that I can navigate pain but not avoid it. I can adjust for rocks in the trail, and I can adjust for the barriers in life but that they are there, unavoidably, and I will face them. 

This impulsive ritual felt good- even through the pain- and I was glad to have taken something profound away from my hike. So I plan to continue the barefoot walkabout when I want to practice mindfulness. The soles of my feet will surely callus over time, but not before being sore and blistered during the process. I cannot reach the lesson without first having accepted the pain. Ah, such is life.

Getting Through the Human Experience

To be alone is one of the greatest evils.

William James

Psychopharmaceuticals are plentiful here in the United States as a way to help individuals cope with  psychic angst.  Pharmaceuticals are marketed as a means to help anyone who is bereft with depression, PTSD, personality disorders, anxiety, PMS, menopause, postpartum-related depression, mood disorders, dysthymic conditions, and even grief.  

A high number of bereaved parents, in my experience mostly mothers, are also prescribed anti-depressants. For some, these pharmaceutical remedies can bring equilibrium to a person who is fraught with debilitating mental illnesses.  Yet, are we pathologizing normal, albeit painful, human experiences of suffering?

Indeed for others, according to Dr. Elio Frattaroli and psychiatrists critical of the overuse of prescriptions, SSRIs are being used as a shortcut to healing, the McDonald's treatment plan of the 21st Century- the comfortable numbing of a society.  We are afraid to feel suffering.  We are uncertain of our own strengths to cope with loss. We do not know how much we can- and should- rely on one another to help us through the human experience.

Interestingly, while SSRIs can help some selective patients with legitimate mental disorders, there are also long-lasting effects of SSRI use. Researchers at the University of Ottawa have discovered a correlation between stillbirth and other negative birth outcomes and SSRIs.   While other studies have demonstrated inefficacy of some SSRIs, even in the case of the severely depressed wherein SSRIs were no more efficacious than a placebo. In some cases, it's worse than we realize. SSRIs were identified to increase violent thoughts toward self or others, including suicidal thoughts. The FDA has warned of these dangers at least twice; yet so many people remain enslaved in a cycle of medication and remedication.

I am not an expert in the use of psychopharmaceuticals for the severely depressed.  

I do, however, know that there are voluminous studies on the benefits of human connectedness, social support, and compassionate others.  Being connected with and supported by others helps women have healthier babies with higher Apgar scores. It helps women cope with the stress and angst of breast cancer. It reduces the effects of postpartum depression.  It helps the homeless and mentally ill.  It even helps accelerate recovery from a myocardial infarction (heart attack).

We are a society of aloneness, a society afraid of really experiencing our own emotions and the feelings of others. Many are emotionally bankrupt, while others are depleted of the most basic of human empathy. We are rushed, hurried, and harried. We do not have time for pause, or reflection, or grief- we have not scheduled suffering into our calendars. Our lives are consumed and constricted by things that are not real- Hollywood gossip, Blackberries and Palm Pilots, parties, Prada shoes, and consumerism. We are so diverted from what really matters that we hardly recognize that which is real- even real relationships. So few of us really have time for authentic relationships- the types of friendships in which we can entrust our pain and suffering. And it takes a tremendous amount of psychic energy to maintain the fraudulence of empty lives.  Is it any wonder so many in Western society face the types of existential crises that cry out for meaning and purpose and connection?

There is no substitute for human relationships. In the absence of meaningful connections to others, we will not survive as a species nor as individuals. We need one another to help us through suffering. We need guidance through the human experience. The answers do not lie in a bottle or in a pill or in distractions or in diversions. Our salvation from suffering, what will save us from the darkness, is the hope, love, empathy, and compassion we offer and receive from one another. It is the only way through the human experience.

Have you come to that Red Sea place in your life 

where there is no way out but through?

Merritt Malloy

Primum non nocere, prosum beneficum

When my daughter died in 1994, I heard nothing from the hospital staff after our discharge. Instead, I returned to my home where grief had taken residence, and I was left alone.  No social worker or nurse attended to my needs. No pastor or clergy offered aid. No physician called to check on our family. No cards were sent from the medical staff. Nothing. Just the silence of apathy and death, now camped next to my bedstand.

In 1999, five years later, our dog, Bandit, died.  The veterinarian and his staff were gentle, kind, and empathic. They called that same day to check on us and express their sympathy.  And four days later, we received this card in the mail:

To Bandit's Family

Our thoughts are with you, 

when sometimes the hurt is too big for words. 

We are so sorry for the loss of Bandit. 

I know you loved him and that he will be missed. 

Roger William DMV and staff

I was, frankly, both awed and angered.  How is it that years earlier, I had not received this type of care and compassion upon the death of my child?  What gives?

The ethos of primum non nocere, first do no harm, has been a guiding principle of medicine since the mid-nineteenth century.   This axiom quickly becomes familiar to med school students as they endeavor toward epistemic gain and become introduced to the micro-culture of medicine.

But is a postmodern detached, passive interpretation of this canon enough? Do we stop at first, or is there an imperative to do more?And should physicians strive for better than merely doing no harm? Why not strive toward beneficence?

A recent article published in the journal Academic Medicine (Newton, Barber, Clardy, Cleveland, & O'Sullivan, 2008) titled "Is There Hardening of the Heart During Medical School? Physician-Patient Relationship"  explored vicarious empathy during medical education. 

They found that "empathy significantly decreased during medical education (P < .001), especially after the first and third years". The authors concluded that diminished vicarious or emotionally driven empathy occurs after the first year and after the third, clinical years of medical education when students “were seeing patients they had, presumably, looked forward to helping.”

Interestingly, another study conducted by Jean Decety, Professor in Psychology and Yawei Cheng of the Institute of Neuroscience found that physicians unconsciously learn to turn-off the center of the brain that initiates empathic responses. In their 2008 article,  “Expertise Modulates the Perception of Pain in Others,” published in Current Biology, they note that physicians "have learned through their training and practice to keep a detached perspective; without such a mechanism, performing their practice could be overwhelming or distressing, and as a consequence impair their ability to be of assistance to their patients”.

Based on their current and previous research, Decety and Chang affirmed that these physicians are unique: their neural circuitry, which normally registers pain when one person sees another person in pain, experiences no activity during such an exercise. The response in this circuit, which includes the anterior insula, periaqueducal gray, and anterior cingulate cortex, is automatic and likely represents evolutionary panic responses in order to respond to danger. Unlike the control group, the sample group of physicians did experience an increase in the frontal areas of the brain- the medial and superior prefrontal cortices and right tempororparietal junction, where emotions are regulated and cognitive control occurs.  This unconscious training of the brain can incite emotional detachment, which some argue helps physicians avoid their own high levels of personal distress that may incite a host of psychological problems.

But is there a middle ground wherein a physician- or a nurse, social worker, therapist or other helper- can engage in empathy while maintaing important, self-preserving boundaries?  This is an important area for further social and neuro scientific research. For example, we should explore whether or not empathic traits actually do expedite vicarious trauma or perhaps burn out.  In other words, does compassionate and empathic care, in fact, "impair [physicians'] ability to be of assistance to their patients"? We should explore the positive, insulating benefits of relational mutuality for patients, their families, and the physicians as well.  These types of studies may provide more answers to many unaddressed questions about the nature of human relationships during distress.

As a clinician who has helped bereaved parents for thirteen years, many of whom have experienced trauma beyond any normal range of experiences, I would assert that, indeed, we can engage in this way. In fact, I'd go as far as to assert that there is no other way in which to experience authentic, meaningful, and healing human interaction.  It moves beyond the acquiescence of first, do no harm and prompts an imperative to then do good.  How to reach this place is complicated and I cannot teach it in a few words electronically scribbled on these pages.  It takes willingness to learn, and requires an abandonment of academic arrogance and the assumption of humility. They are lessons hard learned. But it is what I teach because it is that in which I believe. It is what I know to be true.  

And I think it is because I do go there with people, because I have trained my brain to remain responsive to and not allow flight during those fearful times, that I have been able to listen to thousands upon thousands of stories of trauma and loss, to watch hundreds of children die in the arms of their parents. 

I have allowed the germination of those meaningful relationships, and I have tried to nurture interconnectedness, even through the vicarious pain and angst.  I am nearly certain that if I'd tried to protect myself, sequestering my heart from these experiences, and not invited those empathic relational interactions, I would have suffered from caregiver burnout long ago.  And, oh what I'd have lost would be far greater than that which I've gained.  

Ref: Academic Medicine. 83(3):244-249, March 2008.
Newton, Bruce W. PhD; Barber, Laurie MD; Clardy, James MD; Cleveland, Elton MD; O'Sullivan, Patricia EdD

Secrets and the Place for Exceptional Memories

Grief colors my world. It is the lens through which I view most everything. I was cleaning out my drawer this morning and came across a note written by a then-seven-year-old boy in love with his mother. The note read:

This is to you mom.

I love you more than life itself.

You are the best mom ever

and when I say ever
I mean ever
!!!!!!!!!!!!!!!!!!!!!!!!

Josh had written me this note, folded in into a tiny pocket that contained a photograph of us together that he'd found in an old album. Most every mother I know would save such a tender memento. Many would have a special place in their homes for such exceptional things for their children's children, so that in two decades they can narrate each treasure, reconstruct and reminisce a childhood past.

Most mothers do not know what I know. They do not know the secret.

So, I took the sweet note and put it into a large storage box, my place for exceptional memories, that holds my children's cherished nuggets. And while exploring amongst the many things in my place of memories, I realized that I saved more than the average mother. I even saved the word "love" scrawled on a tiny corner of a paper napkin, with a red, quasi-heart shape drawn by Josh at age three with a backward "L" and an "E" that resembled his age at the time. I saved every tooth. Every photograph. Every expression of love and every piece of art. I stockpile and hoard memories like a bereaved mother.

I do not save only for their future. I save also for the what ifs; that one in twenty-thousandth chance that I will lose one of my other children to death. It seems unfair to live in constant awareness of life's fragility. I wish I did not know the secret. I wish I'd never been shown. Yet, I do know. I am aware, and I cannot feign ignorance.

I know that you do not forgive yourself easily when a child dies.

I know that no alcohol, no pill, no distractions, and no book can cure the pain.

I know that children can and do die, and that Death is a cruel and unforgiving victor.

I know that there are no guarantees, and that control is an illusion.

I know that good, competent mothers sometimes lose their children, while unloving, neglectful "mothers" sometimes get to keep theirs.

I know that one day, one year, ten years, twenty years, and fifty years is never enough time with your child.

I know that there is no accepted trade, nothing you can barter, to renegotiate your child back to life, not even offering yourself instead.

I know the secret that life goes on, but not really.

So day-by-day, I seek to live in the moment. I feel compelled to save, cherish, hold, adore, and express, wanting no regrets that accompany not saying that which needed saying and not having enough memories. After all, what's a grieving mother to do with such a burdening secret, such a recondite reality? That is, allow it to help me love more profoundly and surrender to the awareness that each moment, every breath, may be the last.