Saturday, December 15, 2012

No Words for Such a Tragedy

Beginning yesterday, just after my previous post about my work with a child homicide survivor, my phone lines and emails have been chaotically inundated with fallout from the mass murders in Connecticut.

I want to say publicly: I have no answers for such trauma. I have no directives, no real consolation. What can one offer at a time like this?

I will not publicly bring people together in a formal way without the express permission of the families affected by this. In my humble opinion, to do so without their consent is an overstep that may not be appropriately sacred for such a horror.

What I can offer is that people take this time to understand what it means to be traumatically bereaved, for self and for other.

What I can offer is some wisdom that comes, not from the DSM or any other book or manual about how people should and shouldn't react in such a time of incomprehensible suffering, but from the wisdom of the ages and cultures and from the bereaved themselves, the initiates:

Be careful of the questions we ask.

Be mindful of how we speak of this to others and to our children.

Be aware of how we show up in the world because of this.

Be circumspect about the ways in which we publicly mourn and share information.

Be sensitive to the suffering of these families by honoring their privacy.

Be attentive to our own losses and how this type of trauma reignites our sense of vulnerability and grief.

And so, quietly, quietly, quietly...  this is my way to pause and honor the families and children who were murdered and assaulted in their schools in both Connecticut and in Nanping, China, both on the same unforgettably painful morning on opposite ends of the globe:

I will sit in meditation and prayer for them. I will light my candle for them and burn sage. I will set intentions of kindness and compassion while holding their pain. I will pay attention to my words, my deeds, and my thoughts.  I will hold them all in my heart, leaving space for whatever of my own emotions may rise and fall in the aftermath of the unspeakable. I will be still, for them.

Then, if and when the families are ready to speak about their losses, we will be there to embrace them with unconditional love and allow them - perhaps join them - to honor their children in the way they want, according to their own way... as those of you who have suffered this type of loss know, 
time alone does not heal, contrary to popular belief. And they will likely need much support in the coming weeks and months and years. A parent's grief is timeless.

For the providers who have contacted me around the world and want to know how to support bereaved parents, your full presence and civic love is the greatest offering of all.  Here are some words of wisdom, not intended to direct or command, but rather intended to get us thinking about the ways in which we care for others:

We invite you: We invite you not to:
Show them your unconditional love and support for as long as they need it, even years later.

Do ask, "How are you really doing?"

Do remember that you can't take away their pain, but you can share it and help them feel less alone.

Do let your genuine concern and care show.

Do call the child by his or her name.

Do treat the couple equally. Fathers need as much support as mothers.

Do be listen, to run errands, to drive, help with the other children, or whatever else seems needed at the time.

Do say you are sorry about what happened to their child and about their pain.

Do accept their moods whatever they may be, you are not there to judge. Be sensitive to shifting moods.

Do allow them to talk about the child that has died as much and as often as they want.

Do offer practical aid or just drop off meals at the front door (careful not to disturb them).

Do talk about the special, endearing qualities of the child.

Do give special attention to the child's brother and sister--at the funeral and in the months to come (they too are hurt and confused and in need of attention which their parents may not be able to give).

Do reassure the parents that they did everything they could, that the care the child received was the best possible.

Do put on your calendar the birth and death date of the child and remember the family the following year(s). Remembering with them is important. They will never forget.

Do extend invitations to them. But understand if they decline or change their minds at the last minute. Above all continue to call and visit.

Do send a personal note or letter or make a contribution to a charity that is meaningful to the family.

Do read literature from the real experts (parents themselves) about the grief process of a bereaved parent to help you understand.
Don't avoid them and don't be afraid to talk to the parents. They do not have a communicable disease- they are mourning.

Don't be afraid to ask about the deceased child and to share memories.

Don't think that the age of the child determines his or her value and impact.

Don't be afraid to touch those who are mourning, as it can often be more comforting than words.

Don't avoid them because you feel helpless or uncomfortable, or don't know what to say.

Don't change the subject when they mention their child.

Don't push the parents through the grieving process, it takes a long time to heal and they never forget.

Don't encourage the use of drugs or alcohol.

Don't ask them how they feel if you aren't willing to listen.

When in doubt, don't say anything. Just be present and listen to their pain with love and compassion, nonjudgmentally.

Don't say you know how they feel.

Don't tell them what they should- or shouldn't- feel or do.

Don't try to find something positive in the child's death.

Don't point out that they have their other other children.

Don't say that they can always have another child.

Don't suggest that they should be grateful fo their other children.

Avoid the following cliches:

"Be brave, don't cry."

"It was God's will" or "it was a blessing."

"It's time to get on with your life.
You have to life for him/her." or "He/She wouldn't want you to be sad."

"God needed another flower or angel (or whatever) in his garden."

"At least he/she wasn't older."

"You must be strong for your other children."

"You're doing so well." or "You're so strong!"

"You're young, you'll get over it."

"Time will heal." 

Friday, December 14, 2012

Touching the Holy

We have only one reality, and that is here and now. What we miss by our evasions will never return, but if we squander ourselves, then too we lose being. Each day is precious: 
a moment can be everything.
Karl Jaspers

A few months ago, I began working with a beautiful Native Gila woman whose six-year-old son was murdered last year. With her permission, I would like to share this spirit stick and sage wrap she made for me and a handmade owl icon, in recognition of our very sacred and painful grief work together.

And this is the spirit stick prayer in honor of her beloved son, J:

The Making

As my hands wrap this leather around the wood 
I remember your hand in mine
Fingers entwining with mine
And do you know, I would jump across to the other side if I could catch you?

These four directions to which I raise my hands
These clouds that I stare at, 
And the wind that brushes across my skin,
It must be you
And do you know, I would jump across to the other side if I could catch you?

I hear your voice in the water that rushes by
I see your reflection in the sun that shines in my eyes
The beauty of it all brings me to my knees
And do you know, I would jump across to the other side if I could catch you?

The moon is shining for you and the stars light up the sky
As I wrap your four directions into my soul
And do you know, I would jump across to the other side if I could catch you?

And this is her email to me:

My father- he taught me to make these...the wood has been buried in the earth by the river area on my Rez...I buried the wood shortly after J is Cottonwood... it's been buried for a year and now I have it with me...I need and want to pass it on -  this is what I need to do...I have an owl feather that I would like to attach to it...owl feathers are rare (the owl was not harmed) but there must be a reason that I have received this feather...we attach the feather of the bird of who will guide my son or who represents his spirit...and I thought of you Dr. C and your connection with the owl... it's the right way I believe for you to have it...maybe my son in my dream with you he telling me I can tell you everything... and it feels good to finally tell someone...thank you from my heart.

Wow.  I wept. For her, for her son, for the pain she feels, and for the connection we share in grief.

The true healing in the "I-Thou" relationship (Buber) cannot be contained in the pages of a book or in a manual or in numbers or digits assigned by outsiders.

"What we miss by our evasions" and when we "squander" with both self and other, "we lose being."

Thank you dear mother of J for inviting me on your journey. It is a journey I wish we never had to take.

Thank you for your willingness to entrust me with him and for your open, albeit shattered, heart.

*Our hearts go out to the families in Connecticut and in China whose beloved young children were murdered today.  The death of a child to homicide is an unspeakable, incomprehensible loss. We share in your sorrow, across the land, beyond the waters, and carried on the winds into eternity.*

Monday, December 3, 2012

The Death of Grief, the Birth of Mental Illness

For immediate release December 4, 2012

Dear MISS Foundation families, providers, and supporters,

We are saddened and disappointed by the recent announcement that the DSM-5 task force has finalized the decision to eliminate the bereavement exclusion from the Major Depressive Disorder diagnosis in the upcoming edition of the manual. This move will allow clinicians, including counselors, general physicians, social workers, and psychiatrists, to diagnose a major mental disorder in bereaved parents and other grieving individuals as early as two weeks following the death of a loved one should they meet the DSM-5’s criteria for depression. Importantly, many of you will recognize these criteria which include sadness, feelings of emptiness, crying, sleep and weight changes, guilt and regrets, and loss of interest or energy. Yet, all of these symptoms are quite common in grief, and particularly after the death of a baby or child which evokes enduring and intense reactions in parents.

This move has personal implications for the MISS Foundation. The DSM-5 change increases the likelihood that grief will be misdiagnosed as Major Depressive Disorder in the most vulnerable of all populations.1 The possibility exists that bereaved parents and other grievers will be mistakenly treated for a misdiagnosed mental disorder. Recent trends suggest that the most common form of treatment offered for this disorder is psychotropic medication.2-3 While some medications may be effective for some forms of depression,4 there is no sound evidence that they are effective for grief. Research shows that bereaved parents are already medicated earlier than can be justified by current evidence.5-6 We fear the DSM-5 change will exacerbate this trend and cause even more grieving individuals to be prescribed medication for symptoms which are actually a normative response, despite the lack of evidence to support this practice and a lack of information on how such medications may interfere with the grieving process.

The MISS Foundation has actively opposed this proposed change in DSM-5 and will continue to do so. You can read Dr. Joanne Cacciatore’s initial blog post which went viral in March of 2012 on this topic here.  The first open letter outlining our concerns sent to the American Psychiatric Association in March can be read here and another letter sent in April can be found here. Finally, in October the MISS Foundation issued a formal letter on behalf of the organization and can be viewed here. Finally, many links to research and articles about this issue can be found in this blog entry at the end.

We issue a caution to our families: We urge bereaved individuals to be informed about what this change could mean when seeking help from medical and mental health providers using DSM-5, scheduled to be published next year. Should you have concerns about the quality of medical/mental/emotional care you are being provided, please speak with experts who can help guide you. Get help somewhere, indeed.

Please be assured that many other parents are experiencing the same immense suffering and that you are not alone. Seek solace through skilled and highly trained providers who truly care for you and are willing to walk with you through your darkest times: providers who understand the death of a child as life’s worst tragedy and who will be truly present with and available to you. Seek solace through like others in support groups, online support, and through your community.  Seek solace in spirituality and nature and books that help you to cope as you travel this overwhelming road. Seek solace through self-care and compassion. Seek solace through others who are unconditionally loving whether that be your partner, family, children, animals, or your faith based community. Seek solace through contemplative practice such as prayer, meditation, and quiet time and also through action in service and kindness toward others.

We issue an ardent appeal to providers: The bereaved are a vulnerable population. Please, be mindful and conservative in the issuance of diagnoses and medication, and educate yourselves in evidence-based practices as well as culturally influenced interventions. Take personal responsibility to learn what is truly normal, not pathological, after a traumatic death. The DSM-5 gives you much power and influence over the life of another. Please do not take this responsibility to “do no harm” lightly.

Dr. Joanne Cacciatore, Founder                                           Kara Thieleman, MSW, PhD Student         
Karla Helbert, LPC, Facilitator                                              Dr. Melissa Flint, Clinical Psychologist                    
Jennifer Soos, MFT, Facilitator                                             Dr. Trish Wonch Hill, Policy Analyst
Barry Kluger, CEO                                                                 Kelli Montgomery, Executive Director
Yasaman Parsi, Grief Counselor                                          Rebecca Ong, MSW, Grief Counselor


1. Wakefield, J. C., & First, M. B. (2012). Validity of the bereavement exclusion to major depression: Does the empirical evidence support the proposal to eliminate the exclusion in DSM-5? World Psychiatry, 11(1), 3-10. doi:10.1016/j.wpsyc.2012.01.002
2. Mojtabai, R., & Olfson, M. (2008). National trends in psychotherapy by office-based psychiatrists. Archives of General Psychiatry, 65(8), 962-970. doi:10.1001/archpsyc.65.8.962
3. Olfson, M., & Marcus, S. C. (2010). National trends in outpatient psychotherapy. American Journal of Psychiatry, 167(2), 1456-1463. doi:10.1176/appi.ajp.2010.10040570
4. Kirsch I., Moore, T. J., Scoboria, A., & Nicholls, S. S. (2002). The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment, 5(1), 23a. doi:10.1037/1522-3736.5.1.523a
5. Cacciatore, J., Lacasse, J. R., Lietz, C., & McPherson, J. (In press). A parent’s TEARS: Primary results from the Traumatic Experiences and Resiliency Study. OMEGA.
6. Cacciatore, J., & Thieleman, K. (2012). Pharmacological treatment following traumatic bereavement: A case series. Journal of Loss and Trauma, 17(6), 557-579. doi:10.1080/15325024.2012.688699

Link to this article here. Please share far and wide with others.


The soul still sings in the darkness telling of the beauty she found there; and daring us not to think that because she passed through such tortures of anguish, doubt, dread, and horror, as has been said, she ran any the more danger of being lost in the night. Nay, in the darkness did she, rather, find herself.

--St. John, Dark Night of the Soul

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