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How do our brains handle grief? | Mary-Frances O'Connor | TEDxUArizona

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Pre-Owned Healing After Loss:: Daily Meditations for Working Through Grief (Paperback) 0380773384 9780380773381 - Walmart.com

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Review

“An enormous gift―transformative, compassionate, and wise. These simple and brilliant teachings will open your mind and free your spirit and your heart.” ―Jack Kornfield, PhD, author of A Path with Heart
“Internal Family Systems (IFS) therapy, and the understanding that we all contain valuable parts that are forced into extreme roles to deal with pain and disappointment, has been one of the great advances in trauma therapy. Understanding the role they have played in our survival and being able to unburden the original traumas leads to self-compassion and inner harmony. The notion that all of our parts are welcome is truly revolutionary and opens up a path to self-acceptance and self-leadership. IFS is one of the cornerstones of effective and lasting trauma therapy.” ―
Bessel van der Kolk, MD, author of The Body Keeps the Score
“In this trim and highly readable volume, Dr. Richard Schwartz articulates and deftly illustrates his Internal Family Systems model, one of the most innovative, intuitive, comprehensive, and transformational therapies to have emerged in the present century.” ―
Gabor Maté, MD, author of In the Realm of Hungry Ghosts: Close Encounters with Addiction
“With our culture abuzz about the importance of self-love, world peace, spiritual awakening, and healing, few seem to offer the ‘how.’ How do we love parts of ourselves that hurt ourselves or others? How do we resolve our inner conflicts so we can participate in healing a divided world? How do we awaken to the divine within ourselves without bypassing our humanity? How do we heal trauma―and the chronic physical and mental illnesses it can cause? Without the how, we wind up feeling helpless to live in alignment with the core values and desire for optimal health that most of us espouse. Well, wait no longer. This book offers the ‘hows’ we've all been waiting for, sensible solutions that help you open your heart to even your most destructive ‘parts’ so that your divine Self can extend compassion to them while leading the way to wholeness. Internal Family Systems is a total game changer. I'm not exaggerating when I say this may be the most transformational book you'll ever read.” ―
Lissa Rankin, MD, New York Times bestselling author of Mind Over Medicine
“Since Freud, therapy has referenced and worked with the psyche as having parts, but Richard Schwartz has raised the concept to a magisterial art form. His claim that all parts, no matter how misguided, serve a purpose and should be met with compassion rather than antagonism is little short of a revolution.
No Bad Parts is, I believe, his clearest, most comprehensive, and most inspiring manifesto. Anyone interested in IFS, indeed anyone interested in a happier, less conflicted life, should devour this life-changing, pioneering work.” ―Terry Real, author of The New Rules of Marriage
“Internal Family Systems offers a highly effective, hopeful, and uplifting paradigm for understanding and healing wounds that is revolutionizing psychotherapy. In this well-written book, Richard Schwartz offers the basics of IFS, a series of exercises to help you learn to relate in an open and compassionate way to all―even your most dreaded and extreme―inner parts, and the fascinating spiritual implications of IFS. This approach will change everything about how you relate to yourself and to others!” ―
Diane Poole Heller, PhD, author of The Power of Attachment
“Do you want to be wiser, more compassionate, at peace with yourself, and more deeply connected to others? This book will show you how. Drawing on decades of clinical experience and contemplative practice, Dr. Schwartz offers a powerful, practical, step-by-step approach to healing past injuries and uncovering our innate capacity for love, clarity, warmth, and sanity. It’s a must-read for anyone wanting to live a richer, freer, more joyous and connected life.” ―
Ronald D. Siegel, PsyD, assistant professor of psychology, part time, Harvard Medical School, and author of The Mindfulness Solution: Everyday Practices for Everyday Problems

About the Author

Richard C. Schwartz, PhD, is the creator of Internal Family Systems, a highly effective, evidence-based therapeutic model that de-pathologizes the multi-part personality. His IFS Institute offers training for professionals and the general public. Formerly an associate professor in the Department of Psychiatry at the University of Illinois at Chicago and later at Northwestern University, he is currently on the faculty of Harvard Medical School. He has published five books and is a sought-after presenter. For more, visit ifs-institute.com.

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No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model

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No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model [Schwartz Ph.D., Richard, Morissette, Alanis] on Amazon.com. *FREE* shipping on qualifying offers. No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model

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Remote across the entire US - live support provided to any family referred, navigating the early days of a loss.

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Remote across the US, including Chicago - live support provided to any family referred that is looking for support after a sudden loss.

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Nick Cave - Loss, Yearning, Transcendence | The On Being Project

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[ music: " Into My Arms" by Nick Cave and the Bad Seeds]

Krista Tippett: Here are some experiences to which Nick Cave gives voice and song as exquisitely as anyone with whom I've ever spoken: the universal human conditions of yearning, and of loss; a spirituality of rigor; and the transcendent and moral dimensions of what music is trying to say.

This Australian musician, writer, and actor first made a name in the wild world of '80s post-punk and later with Nick Cave and the Bad Seeds. He also underwent public struggles with addiction and rehab.

[ music: " Into My Arms" by Nick Cave and the Bad Seeds]

Since the accidental death of his 15-year-old son, Arthur, in 2015, and a few years later the death of his eldest child, Jethro, he has entered yet another transfigured era. He's co-created a gorgeous book called Faith, Hope and Carnage, and become a frank and eloquent interlocutor on grief to the many who write him on his blog called The Red Hand Files.

[ music: "Lavender Fields" by Nick Cave & Warren Ellis]

As a human and a songwriter, Nick Cave is an embodiment of a life examined and evolved.

[ music: "Lavender Fields" by Nick Cave & Warren Ellis]

Nick and I, as it turns out, crossed orbits in the divided Berlin of the 1980s, though we were clearly having very different night life experiences. Now, with both of us a few decades older, he came to see me in the On Being studio in Minneapolis, and I am beyond thrilled to share Nick Cave's voice in words and song with you.

I'm Krista Tippett, and this is On Being.

[ music: "Lavender Fields" by Nick Cave & Warren Ellis]

Tippett: So, a question that I start most of my interviews with is just wondering about whether there was a religious or spiritual background to your childhood, however you would see that now or define it now.

Nick Cave: Yeah, in many ways - My parents went to church every Sunday, but I don't think they were religious and I don't think that they believed in God, but it was a small town essentially, and that's just what you did. I ended up singing in the choir for a couple of years, 10 to 12, and was quite fascinated by that. I enjoyed listening to the stories from the Bible.

I was different than the other kids who just hated that stuff. I actually liked Sunday school, for example. But I also feel I had, when I look back, a kind of weird over-interest - or I was weirdly drawn toward the figure of Christ, I would say, from a very early age; I just found the story fascinating. Way before matters of whether God existed or anything like that, there was just something about this story that I found very strange. I still do find it very strange, actually. Based around this sort of tortured individual, literally, and I just found that compelling in some way. And I relate to it, too.

Tippett: Say some more about that.

Cave: Well, these days I relate to it more because there's a sense, especially in the scene of Christ in the garden praying and a God that had withdrawn his favor. I relate to that. I find that a compelling story and very beautiful, too, and very human. The sense of yearning, the sense of being tethered to the earth but reaching beyond ourselves in some kind of way is the story, I think, of everyone in a way.

Tippett: I was going to say that the word "yearning," you just used the word "yearning" and it surfaces again and again. It feels like a really central - not just a concept or a word, but an experience.

Cave: For me?

Tippett: Yeah, for you. In life and in the life of faith.

Cave: Yeah. I don't think I'm alone there. I think that most people have that feeling and a kind of lostness, I would say. An incompleteness and the need for something beyond ourselves to make sense of things. That's how I've really felt since my first child died. And that yearning feels to me a kind of universal condition, based on a universal feeling of loss, shall we say. Does that make sense?

Tippett: Yeah, it does. It's such a wonderful, evocative word. I feel like the way you talk about it is really - it's a theological notion and I feel like we could go down a rabbit hole. Is it when Augustine says "our hearts are restless," right? It's another word, it's your word for "our hearts are restless until they rest in thee."

Cave: Yeah, that's right. It feels to me that loss is our universal state as human beings. I disagree with the sort of "grief club" and the club no one wants to join. I think humanity itself is that club and that we are all feeling these senses of loss, whether it's directly personal, it's bred into us, that sense of yearning. And that's not a failure. It's a condition. To have these feelings, that we're being intellectually dishonest or all these other arguments against these essential feelings. It is our condition. And I think that if we're honest with ourselves, most people feel this way: a sense of lostness about things and a need for something beyond that. That's my defense of religion, I guess. [ laughs]

Tippett: Well, my most elemental definition of spiritual life at its best is that it is about befriending reality. That it helps us befriend reality, which means...

Cave: You mean the way things are?

Tippett: ...Yes. Which means befriending the bedrock fact of loss, this condition, just what you described. And so this book, Faith, Hope, and Carnage, really grew out of a conversation. And it was during the pandemic, right?

Cave: Yeah, it began - Yes, it was. Right at the beginning of the pandemic, weirdly enough.

Tippett: One thing that strikes me is I feel like the whole world, the ground was shaking beneath all of our feet. And Western society in particular actually doesn't have a very reality-based view, kind of resists this notion that loss is part of the human condition.

Cave: It ends up being a defensive position to hold because -

Tippett: And then brittle when things don't -

Cave: Brittle?

Tippett: Brittle, yes...

Cave: Brittle, yeah.

Tippett: ...when things don't go well.

Cave: Yeah. Yes. I mean, there's personal loss and the sort of obliterating effects of grief, if you actually lose someone, if a parent loses a child, for example, or you lose - Where the loss of someone dear to you impacts on you terribly, and it becomes this obliterating thing.

But I think that there's also, as you say, a kind of underlying bedrock within humanity, too, of a historical and personal loss that exists. This, to me, this is our condition. This is the common binding condition of what it is to be.

And in that respect, I don't think the common thread that runs through humanity is greed or power or these sorts of notions. It is this binding agent of loss. That, to me, is the thing that makes me able to look at anybody and feel connected to them, regardless of who they are. And I think there's a power in that that isn't really recognized.

Tippett: That's so interesting. I think a lot about how fear and hate and violence are two sides. That behind what we see as violent, the manifestation of violence is fear metastasized. And what you're saying also is what we look at -

Cave: That fear is behind the -

Tippett: Yeah. At the root of. And this idea that it's actually this lostness, this sense of loss or fear of loss that is behind greed. And what manifests, what shows itself as -

Cave: And it's the way we deal with that. It can be enormously creative and create extremely beautiful things, but it can also be the other way. We can become resentful, we can become completely concerned with our own inward situation. So it's not necessarily - Loss is a kind of opportunity that can go either way, I think.

[ music: "Waiting for You" by Nick Cave and the Bad Seeds]

Tippett: At the beginning of this book, there's this line from Isaiah: "A little child shall lead them." And for you, the death of your son, Arthur - Well, I want to say it this way. I want to use, also again, a theological word. I feel like in his death, as in his life, he transfigured you.

Cave: Yeah. Look, for me, what happened to me is that I just rolled along with life. I had some kids. I loved the kids very much, and life just rolled along as it did. It didn't have actually the dimension that it has now. And the death of Arthur - two of my sons have died, but the first one to die was Arthur - that had an obliterating effect on me and Susie. Not on our relationship, but individually.

It just drew us down a path of which we had no control whatsoever. It was not an ordered stroll through the stages that we're supposed to go through when we grieve or anything else. It was an obliterating mess. It was a mess. I could see what happened with Susie, it happened in front of my eyes.

Tippett: That's Arthur's mother, your wife?

Cave: Pardon?

Tippett: Your wife, Arthur's mother. Yeah.

Cave: My wife, Susie, sorry, yes. And Arthur's mother. An essential change in her condition of being, of what life was to her. It was extraordinary thing to see. It simply happened to her. It wasn't a matter of strength, it was just this thing that happened to her. I think the same thing happened to me. It was an enormous, defiant, creative energy that took Susie from being a regular woman that lost her child - was utterly obliterated by that - sort of rise out of that within a relatively short time - it's not that she's in any way out of it, or that there's ever been any closure - but to this defiant, dynamic force that came out of that. It was an extraordinary thing to see and incredibly helpful and inspiring to me, too.

I think that there was a sort of zeal attached to grief, of seeing the world in a completely different way. I don't see the world in the same way as I did before. It's much more complex than I thought and much more fragile. And this creates a different feeling towards people in general. I found, anyway. I hear that a lot, that grief and empathy are very much connected, in the same way as loss and love are very much connected, too. And that the common energy running through life is loss, but you can translate that into love too, quite easily. They're very, very much connected. And that comes around from an understanding of just how fragile and vulnerable and precarious the nature of life seems to be.

Tippett: There's something that you said in the book, and I think you're talking about this, but I'd like to hear a little bit more. So: grief makes demands on us.

Cave: Yeah. Yeah. I felt - What I'm doing now, this podcast, this conversation, for example, it's not something that I chose to do, in a sense.

Tippett: Right. Right.

Cave: Or where I am now with things, it's not something that was part of a master plan or something. Things just changed, and I found myself in this weird situation. I was quite happy being a musician and talking to Rolling Stone and Mojo [ laughter] about the latest record, or whatever. I was quite happy doing that. And in some way too, I think a lot of my fans were quite happy that that's what I was doing. [ laughter]

This thing that's happened, everyone's had to deal with in some way. There's this beautiful creative madness that goes on with grief where you simply don't know what you're doing, and you think you know what you're doing at the time, but you look back and think, "What was I thinking back then?"

For example, very early on, I decided to do a tour, go on tour and stand on stage and talk about this and ask questions and people could stand up. And people said, "What are you doing?" And I said, "It just felt like something I needed to do." But when I look back on it now, it was a strange thing for me to attempt to do. It was a kind of disorder about things that allowed me to just - It was like it didn't matter what I did, I just went and did whatever I felt like doing. It's a strange thing. I don't know if that makes any sense.

Tippett: It does. It does. There's mystery in this. And for you, this experience of grief, and an experience of God, or of what religion might be, are also intertwined in that way. Do you know this language of thin places and Celtic spirituality, that there are thin places and thin times where the veil between...

Cave: Oh yeah, I do know. Yeah. Yeah.

Tippett: ...heaven and earth, the temporal and the eternal, is worn thin?. It feels to me like that's an image also for what kept coming through to me in how these dimensions of experience, of mystery, of being human came together in you.

Cave: I think in the book, I called it "the impossible realm" or something like that, or it was something that I felt very strongly - I still feel strongly too at times - that there was a positioning of oneself, where I felt deeply connected to those that had passed on. Because it wasn't just Arthur, and then Jethro died, but also other people, too.

Tippett: You lost your mother and -

Cave: Yeah, and I lost my father earlier on.

Tippett: Right. Yes.

Cave: I still feel this sense of otherness about things, that it's not the imagination and it's not dreams or the imagination. There's just a way of being where I feel more connected to this other side, which is maybe that thinness you're talking about. Certainly, you become exercised. So much of your time, when you're grieving, is spent right up against loss and death and the one that you've missed, and absence and disappearance and all of this sort of stuff, incompleteness, these things, you're just crushed up against this feeling. And maybe that's the thinness of the veil, that dimension feels to sort of leak into your life in some way.

Tippett: Yeah. Here's something you said in the book. "Perhaps grief can be seen as a kind of exalted state where..." - here's the part - "...the person who is grieving is the closest they will ever be to the fundamental essence of things," which is a very mysterious statement to make.

Cave: Yeah.

Tippett: And there's also the mystery that what we're talking about exalts some people and crushes others, right?

Cave: That's for sure. That's for sure. Yeah, it's a beautiful way of putting it actually. You either turn around and look at the world and look at people in it or you don't, and you just look inward and you gaze into the absence of that person. That's like the abyss that you look into, it's an absence. And I understand that impulse. There's even a kind of deification of that one that is no longer with us, that's extremely dangerous. There's all these feelings of - that there's some sort of betrayal about moving on in your life.

Tippett: Yeah. Right. Right.

Cave: That there's some honor in just staying with the person who's passed on.

Tippett: And even of remaining faithful to the love that you had for them.

Cave: Yeah. Yeah, that's right. I think you can do both. You can move on and you can do things. I think you can turn your attention on to the world and in your own small way help other people in that respect, or help the world in some respect, whilst remaining true to the one that you lost. It's not a zero-sum game. There's no - I guess moving on is the wrong term, and the idea of closure is the wrong term.

Tippett: Yeah, I think that word is becoming discredited, even in psychology.

Cave: Okay, I'm glad to hear it. [ laughs] Also, acceptance, I find, is not an ideal term either, because that, to me, feels like a returning to the way things were before. And I don't think you do. I think, in fact, we just grow in magnitude that's predicated on those we lose. It's an amazing thing. I say this with a huge amount of caution, obviously, because I'd love it to be the way it was, actually, and just have my children, obviously, right?

Tippett: Yes.

Cave: But having said that, one feels an enormous and new capacity to love, I think. One can feel that way.

[ music: "Ghosteen" by Nick Cave and the Bad Seeds]

Tippett: There's a phrase that comes up in the book, of "spiritual acceptance," and you talk about poetic truth or metaphorical truth, that when something is true enough, it's of real practical benefit. All of these things we're talking about are in the realm of there being no definitive, right? There's nothing to point at that is resolution or -

Cave: These are abstractions and-

Tippett: Right. Right.

Cave: In that respect, it's extraordinarily difficult to argue your corner about these sorts of things against so-called rational, empirical truths about things. They have all the big guns. You just have a feeling or a softly spoken notion about these sorts of things. So, in a way, I've given up trying to - I think everyone who has the religious inclinations - I prefer to use the word religious rather than spiritual myself, but...

Tippett: Yeah. What did you say? "Religion is spirituality with rigor."

Cave: Yeah, I just...

Tippett: I like that.

Cave: ...feel it's like a little - it's asking something of us rather than, yeah, we're all spiritual creatures, which of course we are. I'm more traditional too, in the sense that I find an acute feeling of the mystery of these matters in church. I know a lot of people have felt that it's better to release God from the church and all of that stuff. I have found, in the last year or so, that this is a place that - I've actually found a church in the U.K., which I won't mention which one it is because I just want to go there privately, that is cut off from the world. It feels no need to address the problems of the world. It's a place that you go that it's so beautiful. The singing is so beautiful. The music, the organ player's off the charts, this character, in regard to just the pure drama of the narrative that plays out in the church service. It blows away my basic skeptical nature in a heartbeat. It allows me the permission to be deeply connected to those people that I've lost. That's what it's about, essentially.

By the time it gets to the communion it's unbelievably moving, this service. In fact, this church has got a reputation of being the church for atheists, because it's so beautiful that anyone can just feel these sorts of things.

Tippett: There's the phrase, "spiritual, but not religious." Something that I think is also coming back is "religious, but not spiritual," which is what you...

Cave: Yeah, this is what...

Tippett: ...represent.

Cave: It's when I'm in a church that doesn't know what it wants to do, where all my skepticism about whether God exists or, "What the hell am I doing in this place," and all of that sort of stuff comes rushing in. I become personally embarrassed to be in this place. And so there's something to be said for the sort of deeply, for all its flaws and all the rest of it, obviously, this sort of deeply traditional way of going about religion or navigating religion.

Tippett: Yes. And you might say, just referring back to something you said a minute ago, it's religious institutions engaging in that conversation with rationality, defensively, and then losing the ground I stand on. And yet, just to go back to where we started, that what you learn in the thick of life is the limits of rationality. That this rational way of being that thinks and insists that we can plan everything, and that in fact we won't again and again be obliterated by things that happened to us. It's actually...

Cave: Well I don't want to go into

Tippett: ...it's not reality.

Cave: I don't want to go into a church to draw closer to the rational things in life.

Tippett: Right. Here's something you said that I actually think would be very refreshing for a lot of people to hear. You said, this is again, in that dialogue with the rational, "Religion is a crutch, and a much-needed one."

Cave: Right. Yeah. Well that's true. And I have a lot of sympathy for people who use religion in that way. And I find it difficult to tolerate the argument that comes around kicking the crutches out from under people, but with their rationality. Because we need these things.

Tippett: Yeah, the reality is -

Cave: This is beyond whether God exists and stuff. But these matters. Now I have my own views that ebb and flow about that sort of thing. But at the same time, I'm not simply talking about that religion is useful in some rational way either. There's some other thing that's going on in religion that's more important than that. But it is useful also that it does ameliorate that need to some degree of yearning that we're talking about, or at least there's something that we can reach toward.

[ music: "Hollywood" by Nick Cave and the Bad Seeds]

Tippett: So let's talk about the mystery of music and songwriting. [ laughter] I actually wanted to read you a poem. Would you like that? A Mary Oliver poem.

Cave: Who wrote this?

Tippett: Mary Oliver.

Cave: Oh, okay.

Tippett: Do you know her?

Cave: Yeah, yeah.

Tippett: Yeah.

I was enjoying everything: the rain, the path
wherever it was taking me, the earth roots
beginning to stir.
I didn't intend to start thinking about God,
it just happened.
How God, or the gods, are invisible,
quite understandable.
But holiness is visible, entirely.
It's wonderful to walk along like that,
thought not the usual intention to reach an answer
but merely drifting.
Like clouds that only seem weightless
but of course are not.
Are really important.
I mean, terribly important.
Not decoration by any means.
By next week the violets will be blooming.
Anyway, this was my delicious walk in the rain.
What was it actually about?

Think about what it is that music is trying to say.
It was something like that.
"Drifting" by Mary Oliver. Reprinted by the permission of The Charlotte Sheedy Literary Agency as agent for the author. Copyright © 2014, 2017 by Mary Oliver with permission of Bill Reichblum.
Cave: Okay. Well, that's lovely.

[ laughter]

Tippett: So: "what music is trying to say." What does that evoke for you?

Cave: Well, okay, so...

Tippett: Of course the point of the poem is that you can't sum that up, but I'm just curious about where Nick Cave's mind goes.

Cave: Well you can't really sum that up, but I can give it a go. And my feelings about this have changed, too, over the years. But it feels to me that music in itself, I would say, has a moral dimension. That it's essentially good. That it works to improve matters. And that's how I go about concerts these days. And it's not me in particular, but any musician. In fact, playing any kind of music can do something to improve matters. There's that.

And then there is of course, the sort of transcendent element, too, the communal element, the sort of outpouring, intaking, the sort of circular thing that goes on with an audience of love.

Tippett: Yeah. The way we now know that music actually syncs up breath and heartbeats, and it's -

Cave: You mean communally?

Tippett: Yeah, communally. Yeah.

Cave: Yeah, that's right. I mean, my concerts these days get quite wild in that respect. [ laughs] And that's why I spend so much time right up the front with the audience, because I can see them better. But to look into the face of a person that's having a transcendent experience. It's quite something, and especially en masse. I find that each time I'm playing and doing a concert, I feel that I'm doing something to help rehabilitate the world, or it's a remedy for the world in some kind of way. And I don't mean that in a high-blown kind of way...

Tippett: No, no. I know.

Cave: ...in fact, to me, it's like a small act of kindness too, in the way that we all have the opportunity to do. But there is also a mysterious and transcendent element to music.

Tippett: So I have to ask you -

Cave: That was an incredibly confused answer.

Tippett: No, it wasn't at all. It was very clear. It was very clear. But I do have to ask, The Birthday Party band, which you were part of in your earlier life, which was at one point called "the most violent band in the world," which I think was promotional. Is that...

Cave: It's quite close to it.

Tippett: ...is that also true even of that music?

Cave: Yeah, I think that we were always attempting in our way to find something that was - Yeah, yeah. Do I think it's transcendent? Yes, I do. And very much so. And even though what I'm singing about is deeply problematic back then, I would say - to use that terrible word - even still I think it has this potential for doing good. And I just think we were looking for it in a different way. We were young and finding that sort of transcendent impulse in chaos. I didn't look at things in that way at that time, but I can see that quite clearly.

Maybe my attitude at the time as a young teenage - I was a drug addicted young guy - that I had a kind of jaundiced, contemptuous view of the world. And that was the sort of default setting of my view of humanity. It was extreme, but it was also the way a lot of young people see the world, and in many ways from their perspective, quite rightly so.

Tippett: Here's something you said in the book: "You only need ten songs, ten beautiful and breath-taking accidents to make up a record. You have to be patient and alert to the little miracles nestled in the ordinary."

Cave: Okay. [ laughs] Yeah, well, to get onto that, I mean, those ten songs, it seems kind of easy to do. But actually to get ten songs, to get ten miracles - of which, actually, only maybe three of them are actually miraculous and the other ones felt like they were at the time. But for me personally, it takes an enormous amount of - I have a particular kind of bizarre sort of work ethic where I get up and I sit down at nine o'clock in the morning and I start writing and I finish at 5:30, and I do it within office hours. And I try not to think creatively after that. If I have a muse, it has to keep office hours with me. Or my muse makes me keep office hours or something like that.

But essentially, every day, when I write a record I elect the day that I'm going to start writing it. I haven't written anything for a couple of years. And I start to write a new record. And to arrive at those ten little miracles is actually extraordinarily difficult and full of all sorts of rather embarrassing kind of anxieties that my wife...

Tippett: Well that's writing, that's the creative process.

Cave: ...rolls her eyes at, and I'm like, "It's not coming, darling. It's not coming."

Tippett: Yeah.

Cave: She's quite funny about that sort of thing. Not at all sympathetic. [ laughs]

Tippett: Something else that you speak about is improvisation, which I feel like is such an important - is something that a musician can speak about, but actually it's a life experience.

Cave: Yeah, it is. It is.

Tippett: So just a couple of things that you said, I'd love to - that improvisation is an act of acute vulnerability. And this I love, "the nature of improvisation is the coming together of two people with love - and a certain dissonance."

Cave: Yeah. Well, that's certainly the case with me and the guy I improvise with, Warren. It's quite an extraordinary thing, and it's a place where our relationship ignites and in quite a magical way. And I mean, we found that this is just a way we can write together, where you're in the company of someone else - I don't want to throw things out, it might be that two and two or more are gathered together or something like that. [ laughter] Is it two or three? I can't remember.

Tippett: I think it's two or three.

Cave: Two or three...

Tippett: Yeah.

Cave: ...are gathered together.

Tippett: I like that, yeah.

Cave: I am in your midst. That there's something that certainly goes on in that respect.

Tippett: There's a mystery to it.

Cave: Yeah, there is a mystery to it that we don't talk about, we just do it. It's an extraordinary thing because something happens where it makes conversation and these sorts of things meaningless. So we just create, then we sit and have lunch together and barely speak, and then we go in and do this stuff. So it's this relationship that we have that's extremely strong around this act of improvisation.

Tippett: I love that you also say "with love," right? That there's -

Cave: Yeah, yeah. Yes. It is an act of love. For each other as well

Tippett: And some of the energy of what transpires, certainly, is nourished by that, also, by that.

Cave: Yeah.

Tippett: And I mean just, there's this mysterious thing also about the Skeleton Tree album that it seemed to be that you released it right after Arthur's death, but it felt like an album that was -

Cave: Well, it was all written and recorded before he died.

Tippett: Written and recorded, and then even when people write about it, they write about it as the album you created after his death.

Cave: Yeah.

Tippett: And in fact, it was - you've talked about it - it was kind of foretelling the future in this -

Cave: I just feel essentially that songs seem to know more about what's going on than you do. I don't want to make too much of that you listen to it, and there's these things that you can - It's not like a kind of Beatles album that if you play it backwards, that speaks in tongues or something like that. There's just something about that record that I felt had a dark energy of a particular kind that I felt extremely uncomfortable about. Especially after my son died, because we then had to go into the studio and mix it. And these songs seemed to be speaking deeply into that in a very disconcerting way at the time. I find that to be quite a difficult record to listen to. Not that I really listen to my own stuff, but that record in particular.

The record after that, Ghosteen, is something that's directly - it's essentially made, certainly when I was making it I was attempting, in some way, to reach out to Arthur. In what way I'm not quite sure.

This is a strange thing to talk about. I find it very difficult to articulate. But at the time to somehow attempt to, well, it was to ask forgiveness in some kind of way for what had happened with Arthur.

Tippett: Of him?

Cave: In the sense that I had sort of residual feelings of guilt and these sorts of things that I think parents tend to do if they've lost a child.

Tippett: Mm-hmm.

Cave: And to sort of help his condition, that was the thing that was going through my mind at the time. And to do something other than just burying him. And I love that record Ghosteen, because I think we managed to do something that was very beautiful in that respect.

[ music: "Ghosteen" by Nick Cave and the Bad Seeds]

Tippett: It's kind of a mythical narrative, almost. But you said it "became an imagined world where Arthur could be."

Cave: Yeah. Yeah, that's a lovely way to put it. [ laughter]

Tippett: Good job. You said, he's running around inside the songs.

Cave: Oh, did I say that?

Tippett: Yeah, it's in the book. But did you feel that when you were writing it, or was it after you had produced it?

Cave: No, I felt that - there were lots that were going on when I was making that record. There was a desperation that was going on behind the record, and just to make sense of things. And that record, weirdly, went some way of making sense of something; that I could do something tangible in his, not just in his memory, but for him as a sort of - it's too difficult for me to - but for him. To somehow help his spiritual condition, even though I know that that sounds sort of crazy, at the time it didn't.

Tippett: It doesn't sound crazy unless you think there's nothing, no such thing as mystery.

Cave: Yeah, okay, okay.

Tippett: Right.

Cave: Well, at the time of making that, I mean, I don't know about these matters.

Tippett: Right, and no one does.

Cave: And so I can't argue one way or other about those sorts of things. But we have intuitions and I think that they were highly - at the time I was very responsive to that sort of thing.

Tippett: And in that, somewhere you talked about, you said songs have an essential self. And there's this song, the track on that album, "Ghosteen Speaks."

Cave: Yeah.

Tippett: And then there's also the Seven Psalms you've done, right?

Cave: Yeah.

Tippett: There's almost a way in which, and with the "Ghosteen Speaks," you said that that one just condensed into a mantra, condensed into a prayer.

Cave: Yeah.

Tippett: There's a liturgical quality to some of the music you do now, which seems to me, it makes sense as a reflection of the fullness of this experience that you've been having, of being alive in these last years.

Cave: The "Ghosteen Speaks" started as a massive thing, and it just kept getting smaller and smaller until I think it's pretty much, "I am beside you. Look for me." That's essentially what it is over and over again.

[ music: "Ghosteen Speaks" by Nick Cave and the Bad Seeds]

Cave: That song is essentially from his point of view, that "I am beside you."

Tippett: That he is beside you.

Cave: Yeah. "Look for me."

Tippett: Yes.

[ music: "Ghosteen Speaks" by Nick Cave and the Bad Seeds]

Cave: As with a lot of our improvised material, it is improvised over chordal patterns that I don't know exactly what's going on, because we're playing together at the same time. And so these words sometimes feel like they come from other places. It certainly did at the time.

[ music: "Ghosteen Speaks" by Nick Cave and the Bad Seeds]

Tippett: This feels to me like it - wrapping back around to the limits of the rational and how hard it is to speak of the mysterious - but you said, I love this, but you said, "There is no problem of evil. There is only a problem of good."

Cave: It's the audacity of the world to continue to be beautiful and continue to be good in times of deep suffering. That's how I saw the world. It was sort of not paying me any attention. It was just carrying on, being systemically gorgeous. [ laughter] And how dare it? But there you have it.

I get letters, too, from people who write into The Red Hand Files, who are furious with the way I talk about these sorts of things. "How can you?" They're so ruined by loss, and they see that I'm sort of putting a positive spin on their agony.

And I understand that, too. But I think it's not just me, I think it's everything that's happening around them, that life goes on and the sun still rises, and the birds sit in the trees and all the rest of it. And there feels like it's almost an act of kind of cosmic betrayal for this to be going on.

Tippett: Right.

Cave: Because people are suffering so deeply. And that's one thing I try and say is that - because we've already spoken about this - but the temptation is to cling on to that absence. To sort of fold yourself around the lack of something, rather than turning yourself out and looking at the world in that kind of way and coming to terms with that. It's dangerous. It can become like a hardening of the soul around this disappearance of something. And that's not good. I try not to tell people what to do about things, but that's one thing I think that grieving people need to be careful about.

Tippett: Mm-hmm. I think we've touched on this, or I just want to kind of land here also, that we live in this age where the pandemic was an extraordinary experience. The pain of that is still with us, the rupture of that is still with us. We really did have a collective, have had a collective moment of loss. And then this phrase: ecological grief. We are all experiencing rupture in this beautiful planet, that is, which we are of, not in. And so I feel like there is - sorry, go on.

Cave: Do you think that - did you feel that the pandemic offered us an opportunity?

Tippett: I did.

Cave: And that we squandered that opportunity, or that we -?

Tippett: I have felt that. I guess I try to take a longer view of time and say that it might still happen, and that it's happening, perhaps, in ways that are hard to chart.

Cave: Yeah, exactly, beautifully put. And I feel that too, in some kind of way. Even though the world ruptured further, it wasn't a great bringing together in any way.

Tippett: No, no.

Cave: I think it has sort of focused some people's needs in a different way.

Tippett: Right.

Cave: It's a difficult thing to talk about. But I've just noticed with people that they feel more attentive to things, spiritual matters...

Tippett: I'm feeling that, too.

Cave: ...for want of a better word.

Tippett: No, that people are really ready to go to places.

Cave: I never use that word, by the way. [ laughs]

Tippett: No, I don't either. I don't either. But that word itself used to be anathema.

Cave: Yeah.

Tippett: And not in this unrigorous way that you and I - [ laughs]

Cave: Yes, yes. I meant to say this, that five years ago if I'd sat down at the dinner table and talked about going to church, I'd be laughed out of the room, essentially. I don't know, maybe you sit around with different people. But these days there is a weird kind of curiosity around those sorts of things, that it's not seen in the same way. And there might be a whole lot of different reasons. But I feel that the pandemic and the other things that you're talking about, too, are igniting these concerns in people, in some people.

Tippett: I mean, you had this lovely sentence in the book also, you said you perceived a - I love this image - a "subterranean undertow of concern and connectivity...towards a more empathic and enhanced existence." And I experienced that too. It's not the whole picture...

Cave: It's not the whole picture.

Tippett: ...it's not what gets reported, but it seems to be quietly rising up.

Cave: Well, I think that goes back to what we were talking about at the start, the recognition of our common condition, which is loss. Now, I know a lot of people will react very badly to that. But on top of that, there's all sorts of other things that are going on within, but I think that that is the sort of bedrock that we recognized on some level.

Tippett: I really do see you as a poet. Do you see yourself as a poet, as a songwriter?

Cave: Not really.

Tippett: Not really?

Cave: [ laughs] Well, I don't. I'm still kind of - I feel I'm a songwriter.

Tippett: Yeah.

Cave: When people say, "I think you're a poet," it often feels like they're suggesting that, for some reason, poetry is an elevated form of songwriting. And I'm very proud to be a songwriter.

Tippett: Oh, I think they're the same thing, right? Aren't they just the same thing?

Cave: Yeah. Well, I guess -

Tippett: I think songs are the primary way that humans alive today imbibe poetry without realizing, perhaps thinking that poetry isn't part of their lives.

Cave: My father was an English literature teacher, and he had his views on what poetry was and what poetry wasn't. [ laughs]

Tippett: He probably wouldn't have agreed with Bob Dylan getting the Nobel.

Cave: Well, I don't know, but he certainly didn't - he saw Shakespeare sitting up there at the top of everything. And I still very much hear him sort of gnashing his teeth whenever I talk about this sort of thing.

Tippett: So this song, "Anthropocene," though, to me seems -

Cave: It's actually "Anthrocene," I did a sort of bastardization of the -

Tippett: Oh, I thought it was misspelled.

Cave: No, no, it's not.

Tippett: I thought it was being misspelled. I went through and spell corrected it "Anthrocene." [ laughs]

Cave: No, no, no. It's actually called "Anthrocene."

Tippett: Would you entertain the idea of reading this? No?

Cave: I wouldn't like to read that one because I don't think the lyrics are very good, as a poem.

Tippett: Well, can I just read the last two lines that feel that they speak to our world now?

Cave: Okay. Go on, go for it.

Tippett: "Here they come now! Here they come, pulling you away
There are powers at play more forceful than we
Come over here and sit down and say a short prayer
A prayer to the air! To the air that we breathe!
And the astonishing rise of the Anthrocene
Come on now! Come on now
Hold your breath while you say
It's a long way back and I'm begging you please
To come home now. Come home now
I heard you've been out looking for something to love
Close your eyes, little world, and brace yourself."

Cave: Oh yeah. That's pretty good, right?

Tippett: It's pretty good.

Cave: Wow. What a great song. [ laughs]

Tippett: You want to read those last, will you read it?

Cave: Okay. Okay.

"Here they come now! Here they come, pulling you away
There are powers at play more forceful than we
Come over here and sit down and say a short prayer
A prayer to the air! To the air that we breathe!
And the astonishing rise of the Anthrocene
Come on now! Come on now!
Hold your breath while you say
It's a long way back and I'm begging you please
To come home now. Come home now
[I've] heard you've been out looking for something to love
Close your eyes, little world, and brace yourself."

[ music: "Anthrocene" by Nick Cave and the Bad Seeds]

Cave: Well, that's awesome.

Tippett: It's awesome. Thank you so much. Thank you so much for what you do and how you've opened yourself to being present to everybody else with what you carry, and for making your trip to our studio. Thank you so much.

Cave: Yeah, I've really enjoyed it. It's lovely, lovely. Thank you very much.

Tippett: Yeah, it's been beautiful.

[ music: "Galleon Ship" by Nick Cave and the Bad Seeds]

Nick Cave is the songwriter and lead singer of Nick Cave and The Bad Seeds. Their albums include Ghosteen, Skeleton Tree, and Push The Sky Away. His recent albums with frequent collaborator Warren Ellis include Seven Psalms and Carnage. His book, which takes the form of an electric conversation with journalist Seán O'Hagan, is Faith, Hope and Carnage. Nick frequently writes, and answers questions from his fans, on the website, The Red Hand Files.

[ music: "Eventide" by Gautam Srikishan]

The On Being Project is: Chris Heagle, Laurén Drommerhausen, Eddie Gonzalez, Lilian Vo, Lucas Johnson, Suzette Burley, Zack Rose, Colleen Scheck, Julie Siple, Gretchen Honnold, Pádraig Ó Tuama, Gautam Srikishan, April Adamson, Ashley Her, Amy Chatelaine, Cameron Mussar, Kayla Edwards, Tiffany Champion, Juliette Dallas-Feeney, Annisa Hale, and Andrea Prevost.

Special, special thanks to AWAL, BMG and Kobalt Music Group for permission to use the music in this episode.

And to Penguin Press, for permission to read Mary Oliver's poem, "Drifting," which is published in the collection, Devotions: The Selected Poems of Mary Oliver.

On Being is an independent nonprofit production of The On Being Project. We are located on Dakota land. Our lovely theme music is provided and composed by Zoë Keating. Our closing music was composed by Gautam Srikishan. And the last voice that you hear singing at the end of our show is Cameron Kinghorn.

Our funding partners include:

The Hearthland Foundation. Helping to build a more just, equitable and connected America - one creative act at a time.

The Fetzer Institute, supporting a movement of organizations applying spiritual solutions to society's toughest problems. Find them at fetzer.org.

Kalliopeia Foundation. Dedicated to cultivating the connections between ecology, culture, and spirituality. Supporting initiatives and organizations that uphold sacred relationships with the living Earth. Learn more at kalliopeia.org.

The Osprey Foundation - a catalyst for empowered, healthy, and fulfilled lives.

And the Lilly Endowment, an Indianapolis-based, private family foundation dedicated to its founders' interests in religion, community development, and education.

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Nick Cave - Loss, Yearning, Transcendence | The On Being Project

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On the universal human conditions of yearning and of loss; a spirituality of rigor - and the morality and transcendence that music is about.

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Moving away from the idea that grief is a problem that needs to be "fixed," Speaking Grief validates the experience of grievers and guides those wishing to support them. There is no "right" way to grieve. By sharing diverse representations of bereavement, Speaking Grief illustrates that grief is a universal, yet individual experience.

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Finding the Words: Working Through Profound Loss with Hope and Purpose

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A powerful account of one father's journey through unimaginable grief, offering readers a new vision for how to more actively and fully mourn profound loss.provides powerful advice for processing pain and being there for those who are. By bravely sharing his journey through the unimaginable, Colin will bring hope to so many."

"After loss, one of the most common responses is "There are no words." But often times, words are what people who are grieving need the most. When silence is replaced with empathy and support, we help others heal. In his new book Finding the Words , Colin Campbell
-Sheryl Sandberg, Founder, LeanIn.org and OptionB.org

When Colin Campbell's two teenage children were killed by a drunk driver, Campbell was thrown headlong into a grief so deep he felt he might lose his mind. He found much of the common wisdom about coping with loss-including the ideas that grieving is a private and mysterious process and that the pain is so great that "there are no words"-to be unhelpful. Drawing on what he learned from his own journey, Campbell offers an alternative path for processing pain that is active and vocal and truly honors loved ones lost.
Full of practical advice on how to survive in the aftermath of loss, Finding the Words teaches readers how to actively reach out to their community, perform mourning rituals, and find ways to express their grief, so they can live more fully while also holding their loved ones close. Campbell shines a light on a path forward through the darkness of grief.

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Finding the Words: Working Through Profound Loss with Hope and Purpose

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Finding the Words: Working Through Profound Loss with Hope and Purpose [Campbell, Colin] on Amazon.com. *FREE* shipping on qualifying offers. Finding the Words: Working Through Profound Loss with Hope and Purpose

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Restorative Retelling for Violent Deaths (Manual)

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Restorative Retelling for Violent Deaths (Manual)

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https://www.vmfh.org/content/dam/vmfhorg/pdf/legacy-vm/workfiles/Manual_Accommodation_Violent_Dying.pdf

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Portland Institute for Loss and Transition (Bob Neimeyer & Others)

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Portland Institute for Loss and Transition (Bob Neimeyer & Others)

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https://www.portlandinstitute.org/

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Founded in 2001 by Karen Ross, LCSW, this group was formerly hosted on Yahoo Groups until 2019. It is an e-mailing list that provides an invaluable resource for Chicago area fully credentialed psychotherapists (LCSWs, LCPCs, LMFTs, PsyDs, PhDs, MDs) who are interested in networking, providing referrals and sharing opportunities in the Chicagoland community.***YOU MUST INDICATE YOUR FULL NAME & CREDENTIALS WHEN REQUESTING MEMBERSHIP***

GROUP GUIDELINES:
1. All internet communication is not protected, but we strive to uphold strict confidentiality and professionalism while remaining positive and supportive in our interactions with each other. 2. Identify yourself with a first and last name and credentials on ALL messages. It's your cyber business card! 3. Do not forward any of our emails to non-members. For sending referrals, "cut & paste" names and phone numbers but NOT email addresses (unless given persmission by the person who owns the email address). 4. Stay on-topic and do not start new posts using someone else's subject line. 5. Go off-list to discuss details of posts that are confidential or unrelated to other members. "Backchanneled" and "off-list" are requests that you email individual members directly--do not respond to the entire list. 6. No flaming (negatives about another person) or spamming. 7. For specific referral requests, please reply only to the person who made the request rather than the entire list. 8. Refrain from sending "Thank you, John" and "I agree, Jane" emails to the entire list. It clogs inboxes. Send those emails directly to the person you wish to address. 9. If you're receiving more listserv messages than you'd like, consider subscribing to the DIGEST or NO EMAIL service (the latter is where you check your messages at your leisure from the site). When you request a referral, be sure to say the location in the subject line.

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Founded in 2001 by Karen Ross, LCSW, this group was formerly hosted on Yahoo Groups until 2019. It is an e-mailing list that provides an invaluable resource for Chicago area fully credentialed psychotherapists (LCSWs, LCPCs, LMFTs, PsyDs, PhDs, MDs) who are interested in networking, providing referrals and sharing opportunities in the Chicagoland community.

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Chicago Creative Arts Therapy Network - Facebook Group

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Chicago Creative Arts Therapy Network - Facebook Group

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I am a member of this group on facebook - happy to post in here if you are looking for specific creative arts therapists

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Yevhenii Monastyrskyi was an undergraduate at the University of Luhansk, in the Donbas region of eastern Ukraine, when war broke out in 2014. One day, on his way home from a coffee shop with friends, he says, they were approached by Russian soldiers in an SUV. Without much explanation, Monastyrskyi told me, he and his friends were detained in the basement of a local government building. They were all released days later; Monastyrskyi had convinced his captors that he was no threat as a student, even though he had collaborated with Ukrainian authorities. A few months later, he left for western Ukraine, to begin his graduate studies at a different university.

Monastyrskyi hasn't returned home ever since. Later that year, Ukraine granted limited self-rule to Russian-backed separatists in Luhansk, and Monastyrskyi's activist history protesting the occupation made any return to the city he grew up in feel too risky to fathom. His home had fundamentally changed. "After 2014, I felt I lost the ground under my feet," Monastyrskyi, now a graduate student in history at Yale, told me. His emotions were akin to mourning, putting him in a constant state of longing. He couldn't even go back when his grandmothers died in 2015 and 2019, respectively. Shortly before the recent Russian invasion of Ukraine, Luhansk was one of two separatist territories whose independence was recognized by Vladimir Putin. Monastyrskyi's sorrow has morphed into anger.

Some psychologists might say that Monastyrskyi is experiencing migratory grief. Every person who leaves their country of origin-exiles, refugees, international students, migrant workers-experiences loss. Many have to memorialize family gatherings, languages spoken without self-consciousness, positions of respect in a community-essentially, an emotional belonging. Grief is a natural response.
Read: I can't stop watching a livestream of Kyiv
But not all migratory grief is exactly alike. People like Monastyrskyi who emigrate from countries that have undergone severe political changes can feel that their home has irreversibly transformed. They grieve not merely their severance from a homeland, but the demise of a place as they knew it. Natalie Cruz, a psychologist at Children's Hospital Los Angeles who regularly works with migrant families, told me that the mourning is qualitatively different for those who uproot their life for asylum or due to political upheaval. "We're entering the space of traumatic grief," Cruz said. "There's more of a fear, versus the sadness, the yearning."

I spoke with people from Ukraine, Afghanistan, and Hong Kong-all places whose recent political upheavals, in different ways, have rendered them almost unrecognizable. I wanted to know: How does it feel to know that you can't go home?

Few of my interviewees had heard of the term migratory grief, but the notion seemed to strike a chord. It was as if a label had finally been put on a constellation of ghoulish emotions each has felt. Yet I heard a wide array of reactions to the loss, from acceptance of a national fate to frustration with a country's aggressors, from fear of going back to eagerness of someday returning.

Justin Cheung works in San Francisco's tech industry but grew up in Hong Kong, coming to the United States for college. He always saw himself returning one day-the Bay Area was a temporary location. "I'm just here to get work experience," he told me. "My soul is happier back in Hong Kong or in Asia." However, a draconian national-security law was passed in mid-2020, press freedoms have been curtailed, and political figures have been imprisoned, causing a mass exodus from the city. ​After bouts of denial and anger, Cheung's acute pain has ossified into resignation. "It feels like a point where you can't turn back," Cheung said. If he were to go back to Hong Kong-which he still might-he doesn't think that his day-to-day life would feel too different from how it was when he previously lived there. But he'd notice the loss of the city's former values and its sense of "intellectual safety," Cheung told me by email. Even while abroad, he said, he feels less free to speak what's on his mind.
Read: ​​Moving back home isn't just a fallback plan
Cheung's story in some way speaks to the uniqueness of migratory grief. Some psychologists argue that many of its feelings have parallels in the aftermath of a loved one's death: a sense of helplessness, displaced anger, and an idealization of what one has lost. But Joseba Achotegui, a psychiatrist and professor at the University of Barcelona, told me that unlike grieving a person, the loss of one's country can feel more symbolic and ill-defined-the intangible disappearance of language, culture, social status. It's partially similar to other ambiguous losses, such as a kidnapped child or a missing soldier. The process of separation is recurring, Achotegui said, because the country of origin still exists, constantly reminding the migrant of their loss. Migratory grief can also be a disenfranchised grief, one in which the griever's feelings might be dismissed because society doesn't understand them.

For some people, the barriers to ever returning home are significant. The Afghan music scholar and educator Ahmad Naser Sarmast-who spoke with me from Lisbon, Portugal-has lived in exile twice. In 1994, when Afghanistan was going through a civil war, he was granted asylum in Australia, where he received a doctoral degree in music. After the ousting of the Taliban, he returned home in 2008 to found the Afghanistan National Institute of Music, a coed school teaching both Afghan and Western music. After last year's takeover by the Taliban, he fled again, with many of his staff and students, fearing for their lives. (At one point, he was targeted in a suicide bombing that killed one person and injured more than 10.) "We lost a generation," Sarmast told me. "There was a generation dreaming about a better Afghanistan ... With the return of the Taliban, it's again the loss of dreams, the loss of opportunities, the loss of hope." In exile, Sarmast and his students hope to spread Afghan music to a larger community outside the country. Their grief is ever present. But "the past is the past," Sarmast said. "I'm always focusing on the future."

Hope, too, is part of the grieving process. It stems not from clinging to a lost past or shedding its significance completely, but from fusing who you once were with gratitude for a new chapter in life. Sarmast repeatedly told me how his exile, though painful, has been an opportunity to reinvent himself. By choosing to pursue a Ph.D. in Australia, he connected his home country's musical tradition with new credentials that helped him establish his institute.

Sarmast's hopefulness was echoed by Olesya Pokorna, a psychiatrist in San Francisco who was born and raised in Odesa, Ukraine. Pokorna moved to California with her family about two decades ago and hasn't visited Ukraine since. Initially, she thought it would be too hard to visit home and then return to the U.S., a place where she can't effortlessly speak the native language and has to be hypervigilant so as not to commit a cultural faux pas. In recent years, she finally felt ready to return to Ukraine, but then the pandemic hit, and then the war.

The physical destruction of her country has intensified Pokorna's grief. The places where she spent her youth might no longer exist, she told me. But if anything, the conflict has emboldened her Ukrainian identity. "Bearing witness to all this suffering but also unparalleled unity and self-sacrifice helped integrate my 'Ukrainian self' and my 'American self,'" Pokorna said in an email. "I feel a renewed and deeper connection to my roots." She has become progressively more comfortable expressing this hybrid identity. For example, she recently started wearing her vyshyvankas -traditional embroidered shirts-at social occasions. "In the not so distant past, displaying this vulnerable part of my identity so openly would cause me a lot of discomfort about looking 'too foreign' and 'out of place,'" Pokorna said. "These days, I'm feeling proud and somehow more at peace with myself." Rather than the end of her country as she knows it, she feels like she is witnessing the beginning of a new national consciousness among Ukrainians.

Extinguishing the memory of losing one's country is nearly impossible. But that is not the point of grieving. As we grieve, we learn to define our new emotional equilibrium in terms of gains as well as losses: the end of a dear way of life, but also the growth of new facets of oneself. Joan Didion once wrote, "I think we are well advised to keep on nodding terms with the people we used to be, whether we find them attractive company or not." Perhaps this is what eventually awaits those who experience migratory grief: the ability to see one's former life not as a pentimento, crudely painted over by the present, but as part of a diptych, in which a past self sits more comfortably beside the new.

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When You No Longer Recognize Your Home Country

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Yevhenii Monastyrskyi was an undergraduate at the University of Luhansk, in the Donbas region of eastern Ukraine, when war broke out in 2014. One day, on his way home from a coffee shop with friends, he says, they were approached by Russian soldiers in an SUV.

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 Favorite Thing (quote, meme, sharable item)

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 Favorite Thing (quote, meme, sharable item)

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PDF version

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Helping children heal from the mental scars of COVID

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Unresolved grief is just one aspect of how COVID-19 has created widespread mental health suffering - a second pandemic, as it were. Particularly affected are children: More than 140,000 of them have lost a parent or a caregiver. Correspondent Susan Spencer looks at some of the psychological scars from COVID, and what steps are being taken to address them.

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December 9, 2021, Washington, D.C. The COVID-19 pandemic has been the single deadliest acute public health crisis in American history. More than 760,000 Americans have died in 22 short months, many leaving behind children who have lost a caretaker, role model, and provider. Today, COVID Collaborative and Social Policy Analytics released a report estimating that 167,082 children - roughly one of every 450 - in the United States lost a parent or other caregiver in the home to COVID-19, and offering a roadmap to support and provide for these children in their most vulnerable moments.

Non-White children lost caregiving adults at higher rates than their White peers, with American Indian and Alaska Native and Native Hawaiian and Pacific Islander children experiencing the highest rate of loss at nearly four times that of White children. Black and Hispanic children experienced more than twice the rate of loss of White children. Youth in every state experienced loss, but California, Florida, Georgia, New York, and Texas accounted for half of total caregiver loss from COVID-19. Seventy percent of caregiver loss affected those 13 and younger. Half of COVID-bereaved children (83,798) were elementary and middle-school age (5-13 years old) and 20 percent (34,150) were from birth to 4 years old.

"As the nation looks to recover from the COVID-19 pandemic, there is an urgent need to address the crisis of children left behind," said John Bridgeland, Co-Founder and CEO of COVID Collaborative. "For these children, their whole sky has fallen, and supporting them through this trauma must be a top priority. Today's report is a rallying cry for the nation to help the children who have lost parents and other caregivers to COVID-19."

"The children most likely to lose a caregiver to COVID-19 are also most likely to have faced previous adversities that hinder their ability to cope and show resilience," said Dan Treglia, co-author of the report and Associate Professor of Practice at the University of Pennsylvania. "They are dealing with personal tragedies in the midst of national uncertainty, stress, and turmoil, and leaders face a responsibility to support COVID-bereaved children and their remaining caregivers to maximize their chances of resilience and success."

Children and adolescents depend on their caregivers for financial, emotional, and developmental support, and the death of a parent or caregiver can hinder a child's development and success for the rest of their lives. The impacts of losing one or both parents can include anxiety, depression, PTSD, substance abuse, suicide, poor academic outcomes, increased rates of high school dropout, economic turmoil, and general instability.

Policymakers, educators, nonprofits, and the private sector can take steps to help children and youth to address their grief and trauma. The report outlines recommendations, including evidence-based policies, programs, and practices to address grief and trauma. The report recommends: concerted efforts within schools, health care, and faith-based communities to identify and connect children and families to supports; a COVID-Bereaved Children's Fund; expanding access to high-quality early childhood programming and social and emotional learning in schools; structured mentoring, peer support, and grief camps; expansion of mental health care; and executive action from the federal government to support these children now.

"The consequences of losing a parent can persist throughout a child's lifetime," said Governors Dirk Kempthorne and Deval Patrick, Co-Chairs of COVID Collaborative, in a joint statement. "As a compassionate nation, America must provide the support these children need during this time of great challenge."

The report, Hidden Pain: Children Who Lost a Parent or Caregiver to COVID-19 and What the Nation Can Do to Help Them is available on COVIDCollaborative.us.

Statements of Support from Partners

Juliet K. Choi, President & CEO of the Asian & Pacific Islander American Health Forum
"COVID-19 has taken a gut-wrenching toll on our country, including the loss of so many parents and caregivers of children. This loss has disproportionately affected communities of color, including Native Hawaiian, Pacific Islander, and Asian American communities. We urge our nation to act, in unity, to ensure these children and their families have the support they so desperately need, now and in the years to come."
Dante Desiderio, Executive Director of the National Congress of American Indians
"The heartbreaking truth is that American Indian and Alaska Native children have the highest rates of caregiver loss in the nation stemming from the COVID-19 pandemic. We need a comprehensive effort to support these children and their families as they work to navigate such difficult times."

Derrick Johnson, President & CEO of the NAACP
"COVID-19 has disproportionately affected communities of color. One of the most serious consequences has been the loss of a parent or other in-home caregiver for so many children in these communities who often lack the resources and support to respond."

Janet Murguia, CEO of UnidosUS
"This alarming report shows that Black and Hispanic children are more than twice as likely to have lost a parent or caregiver due to the pandemic. The consequences of these losses are devastating and can last for a lifetime. It is critically important for them and for our country's future to support a comprehensive response that will help restore their social, economic, and emotional health and well-being as quickly as possible."

Gary Edson, President of COVID Collaborative
"COVID-19 has unnecessarily divided us at a time when this crisis should have united us. Lending a helping hand to the children who have lost parents, grandparents and other caregivers is a moral imperative that can knit our nation back together in a common enterprise."

Chi Kim, President & CEO of Pure Edge and board member of CASEL
"We have spent years working to advance the social and emotional development of children. The COVID pandemic has devastated families and taken so many lives, including parents and caregivers, away from their children. We need to redouble our efforts in the nation's schools to teach and foster those very strategies to help heal the heart and develop tools to flourish."

Annette March-Grier, President & Co-Founder of Roberta's House
"We are working with children and families every day who have experienced trauma and loss, including children who lost a parent or other caregiver to COVID. Children and teens have been greatly impacted from so much loss and are at risk psychologically, physically and spiritually. America needs to come together to support this vulnerable population that represents so much potential for the future."

Heather Nesle, President of the New York Life Foundation
"We have worked for well over a decade to provide bereavement support to children and families. And we know from our recent survey that parents say they need more support on this subject, particularly from schools. So we are strongly behind a public-private effort to expand proven strategies and services to help these children build a better future."

Karen Niemi, President & CEO of CASEL
"We are working across many states and school districts to help students acquire the very skills they will need to do better in school, work and life. These skills are also invaluable in helping students cope with grief and trauma, including loss caused by the COVID-19 pandemic."

Francie Schnipke Richards, Vice President of Social Responsibility and The Allstate Foundation
"It's critical that our nation prioritizes equitable access to evidenced-based social-emotional support for youth. Social and emotional learning can help youth in many ways: from facing the trauma of losing a parent or caregiver, supporting mental health needs and resilience through pandemic recovery, to strengthening youth confidence, leadership and relationship skills for years to come."
David Shapiro, CEO of MENTOR
"MENTOR and the mentoring field are proud to join COVID Collaborative in placing healing and resilience at the center of our nation's response to the trauma and loss faced by too many young people as a result of the pandemic. Nothing will replace a parent or caregiver, but we must do all we can to take on these complicated and long-term challenges including providing the personalized and proven response of positive and enduring mentoring relationships for young people left in the turbulent wake of loss. We will work diligently in a combined effort toward the goals of coping, healing and thriving by fulfilling the promise of human connection at a time and in circumstances when our young people need it most."

Timothy P,. Shriver, Chairman, Special Olympics and UNITE
"In the midst of unspeakable grief from the COVID-19 pandemic, those who have experienced painful losses are looking to all of us for strength, solidarity, and love. In these moments where so many children grieve, it is our great privilege as families, friends and citizens to support them in their sadness and strengthen them in their recovery."

Caryl M. Stern, Executive Director of Walton Family Foundation
"The past two years have called upon so many Americans to summon courage, resilience and determination in the face of tragic loss from the pandemic. The loss of so many parents and other caregivers is devastating to hundreds of thousands of children and families. We know our nation will summon the will to act."

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Hidden Pain: Children Who Lost a Parent or Caregiver to COVID-19 and What the Nation Can Do To Help Them | COVID Collaborative

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December 9, 2021, Washington, D.C. The COVID-19 pandemic has been the single deadliest acute public health crisis in American history. More than 760,000 Americans have died in 22 short months, many leaving behind children who have lost a caretaker, role model, and provider.

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The latest edition of the DSM-5, sometimes known as "psychiatry's bible," includes a controversial new diagnosis: prolonged grief disorder.

Holly Prigerson, a professor of sociology in medicine, has worked to include prolonged grief as a classified, diagnosable psychiatric disorder. Credit... Hiroko Masuike/The New York Times

After more than a decade of argument, psychiatry's most powerful body in the United States added a new disorder this week to its diagnostic manual: prolonged grief.

The decision marks an end to a long debate within the field of mental health, steering researchers and clinicians to view intense grief as a target for medical treatment, at a moment when many Americans are overwhelmed by loss.

The new diagnosis, prolonged grief disorder, was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.

Its inclusion in the Diagnostic and Statistical Manual of Mental Disorders means that clinicians can now bill insurance companies for treating people for the condition.

It will most likely open a stream of funding for research into treatments - naltrexone, a drug used to help treat addiction, is currently in clinical trials as a form of grief therapy - and set off a competition for approval of medicines by the Food and Drug Administration.

Since the 1990s, a number of researchers have argued that intense forms of grief should be classified as a mental illness, saying that society tends to accept the suffering of bereaved people as natural and that it fails to steer them toward treatment that could help.

A diagnosis, they hope, will allow clinicians to aid a part of the population that has, throughout history, withdrawn into isolation after terrible losses.

"They were the widows who wore black for the rest of their lives, who withdrew from social contacts and lived the rest of their lives in memory of the husband or wife who they had lost," said Dr. Paul S. Appelbaum, who is chair of the steering committee overseeing revisions to the fifth edition of the D.S.M.

"They were the parents who never got over it, and that was how we talked about them," he said. "Colloquially, we would say they never got over the loss of that child."

Throughout that time, critics of the idea have argued vigorously against categorizing grief as a mental disorder, saying that the designation risks pathologizing a fundamental aspect of the human experience.

They warn that there will be false positives - grieving people told by doctors that they have mental illnesses when they are actually emerging, slowly but naturally, from their losses.

And they fear grief will be seen as a growth market by drug companies that will try to persuade the public that they need medical treatment to emerge from mourning.

"I completely, utterly disagree that grief is a mental illness," said Joanne Cacciatore, an associate professor of social work at Arizona State University who has published widely on grief, and who operates the Selah Carefarm, a retreat for bereaved people.

"When someone who is a quote-unquote expert tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions," Dr. Cacciatore said. "To me, that is an incredibly dangerous move, and short sighted."

"I completely, utterly disagree that grief is a mental illness," said Joanne Cacciatore, an associate professor of social work at Arizona State University who operates the Selah Carefarm, a retreat for bereaved people. Credit... Adriana Zehbrauskas for The New York Times

The origins of the new diagnosis can be traced back to the 1990s, when Holly G. Prigerson, a psychiatric epidemiologist, was studying a group of patients in late life, gathering data on the effectiveness of depression treatment.

She noticed something odd: In many cases, patients were responding well to antidepressant medications, but their grief, as measured by a standard inventory of questions, was unaffected, remaining stubbornly high. When she pointed this out to psychiatrists on the team, they showed little interest.

"Grief is normal," she recalls being told. "We're psychiatrists, and we don't worry about grief. We worry about depression and anxiety." Her response was, "Well, how do you know that's not a problem?"

Dr. Prigerson set about gathering data. Many symptoms of intense grief, like "yearning and pining and craving," were distinct from depression, she concluded, and predicted bad outcomes like high blood pressure and suicidal ideation.

Her research showed that for most people, symptoms of grief peaked in the six months after the death. A group of outliers - she estimates it at 4 percent of bereaved individuals - remained "stuck and miserable," she said, and would continue to struggle with mood, functioning and sleep over the long term.

"You're not getting another soul mate and you're kind of eking out your days," she said.

In 2010, when the American Psychiatric Association proposed expanding the definition of depression to include grieving people, it provoked a backlash, feeding into a broader critique that mental health professionals were overdiagnosing and overmedicating patients.

"You've got to understand that clinicians want diagnoses so they can categorize people coming through the door and get reimbursement," said Jerome C. Wakefield, a professor of social work at New York University. "That is a huge pressure on the D.S.M."

Still, researchers kept working on grief, increasingly viewing it as distinct from depression and more closely related to stress disorders, like post-traumatic stress disorder. Among them was Dr. M. Katherine Shear, a psychiatry professor at Columbia University, who developed a 16-week program of psychotherapy that draws heavily on exposure techniques used for victims of trauma.

By 2016, data from clinical trials showed that Dr. Shear's therapy had good results for patients suffering from intense grief, and that it outperformed antidepressants and other depression therapies. Those findings bolstered the argument for including the new diagnosis in the manual, said Dr. Appelbaum, who is chair of the committee in charge of revisions to the manual.

In 2019, Dr. Appelbaum convened a group that included Dr. Shear, of Columbia, and Dr. Prigerson, now a professor at Weill Cornell Medical College, to agree on criteria that would distinguish normal grief from the disorder.

The most sensitive question of all was this: How long is prolonged?

Though both teams of researchers felt that they could identify the disorder six months after a bereavement, the A.P.A. "begged and pleaded" to define the syndrome more conservatively - a year after death - to avoid a public backlash, Dr. Prigerson said.

"I have to say that they were kind of politically smart about that," she added.The concern was that the public was "going to be outraged, because everyone feels because they still feel some grief - even if it's their grandmother at six months, they are still missing them," she said. "It just seems like you're pathologizing love."

Measured at the year mark, she said, the criteria should apply to around 4 percent of bereaved people.

The new diagnosis, published this week in the manual's revised edition, is a breakthrough for those who have argued, for years, that intensely grieving people need tailored treatment.

"It's kind of like the bar mitzvah of diagnoses," said Dr. Kenneth S. Kendler, a professor of psychiatry at Virginia Commonwealth University who has played an important role in the last three editions of the diagnostic manual.

"It's sort of an official blessing in the world," he said. "If we were on the planetary committee of the American Astronomical Society deciding what is a planet or not - this one's in, and Pluto we kicked out."

If the diagnosis comes into common use, it is likely to popularize Dr. Shear's treatment and also give rise to a range of new ones, including drug treatments and online interventions.

Dr. Shear said it was difficult to predict what treatments would emerge.

" I don't really have any idea, because I don't know when the last time there was a really brand-new diagnosis," she said.

She added, "I really am in favor of anything that helps people, honestly."

Dr. M. Katherine Shear, a psychiatry professor at Columbia University and a founding director of the Center for Prolonged Grief, has been studying the condition since 1995. Credit... Yana Paskova for The New York Times

Amy Cuzzola-Kern, 54, said Dr. Shear's treatment helped her break out of a terrible loop.

Three years earlier, her brother had died suddenly in his sleep of a heart attack. Ms. Cuzzola-Kern found herself compulsively replaying the days and hours leading up to his death, wondering whether she should have noticed he was unwell or nudged him to go to the emergency room.

She had withdrawn from social life and had trouble sleeping through the night. Though she had begun a course of antidepressants and seen two therapists, nothing seemed to be working.

"I was in such a state of protest - this can't be, this is a dream," she said. "I felt like I was living in a suspended reality."

She entered Dr. Shear's 16-session program, called prolonged grief disorder therapy. In sessions with a therapist, she would narrate her recollection of the day that she learned her brother had died - a painful process, but one that gradually drained the horror out of the memory. By the end, she said, she had accepted the fact of his death.

The diagnosis, she said, mattered only because it was a gateway to the proper treatment.

"Am I ashamed or embarrassed? Do I feel pathological? No," she said. "I needed professional help."

Yet, others interviewed said they were wary of any expectation that grief should lift in a particular period of time.

"We would never put a time frame around when someone should or shouldn't feel that they have moved forward," said Catrina Clemens, who oversees the victim services department of Mothers Against Drunk Driving, which provides services to bereaved relatives and friends. The organization encourages bereaved people to seek mental health care, but has no role in diagnosis, said a spokesperson.

Filipp Brunshteyn, whose 3-year-old daughter died after an automobile accident in 2016, said grieving people could be set back by the message that their response was dysfunctional.

"Anything we inject into this journey that says, 'that's not normal,' that could cause more harm than good," he said. "You are already dealing with someone very vulnerable, and they need validation."

To set a year as a point for diagnosis is "arbitrary and kind of cruel," said Ann Hood, whose memoir, "Comfort: A Journey Through Grief," describes the death of her 5-year-old daughter from a strep infection. Her own experience, she said, was "full of peaks and valleys and surprises."

The first time Ms. Hood walked into her daughter Grace's room after her death, she saw a pair of ballet tights lying in a tangle on the floor where the little girl had dropped them. She screamed. "Not the kind of scream that comes from fright," she later wrote, "but the kind that comes from the deepest grief imaginable."

She slammed the door, left the room untouched and eventually turned off the heat to that part of the house. At the one-year mark, a well-meaning friend told her it was time to clear out the room - "nothing worse than a shrine," he told her - but she ignored him.

Then one morning, three years after Grace's death, Ms. Hood woke up and returned to the room. She sorted her daughter's clothes and toys into plastic bins, emptied the bureau and closet and lined up her little shoes at the top of the stairs.

To this day, she is not sure how she got from one point to the other. "All of a sudden, you look up," she said, "and a few years have gone by, and you're back in the world."

# data[].attributes.attachment_link.title
How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer.

# data[].attributes.attachment_link.description
The latest edition of the DSM-5, sometimes known as "psychiatry's bible," includes a controversial new diagnosis: prolonged grief disorder. After more than a decade of argument, psychiatry's most powerful body in the United States added a new disorder this week to its diagnostic manual: prolonged grief.

# data[].attributes.attachment_link.readable_text
The latest edition of the DSM-5, sometimes known as "psychiatry's bible," includes a controversial new diagnosis: prolonged grief disorder.

Holly Prigerson, a professor of sociology in medicine, has worked to include prolonged grief as a classified, diagnosable psychiatric disorder. Credit... Hiroko Masuike/The New York Times

After more than a decade of argument, psychiatry's most powerful body in the United States added a new disorder this week to its diagnostic manual: prolonged grief.

The decision marks an end to a long debate within the field of mental health, steering researchers and clinicians to view intense grief as a target for medical treatment, at a moment when many Americans are overwhelmed by loss.

The new diagnosis, prolonged grief disorder, was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.

Its inclusion in the Diagnostic and Statistical Manual of Mental Disorders means that clinicians can now bill insurance companies for treating people for the condition.

It will most likely open a stream of funding for research into treatments - naltrexone, a drug used to help treat addiction, is currently in clinical trials as a form of grief therapy - and set off a competition for approval of medicines by the Food and Drug Administration.

Since the 1990s, a number of researchers have argued that intense forms of grief should be classified as a mental illness, saying that society tends to accept the suffering of bereaved people as natural and that it fails to steer them toward treatment that could help.

A diagnosis, they hope, will allow clinicians to aid a part of the population that has, throughout history, withdrawn into isolation after terrible losses.

"They were the widows who wore black for the rest of their lives, who withdrew from social contacts and lived the rest of their lives in memory of the husband or wife who they had lost," said Dr. Paul S. Appelbaum, who is chair of the steering committee overseeing revisions to the fifth edition of the D.S.M.

"They were the parents who never got over it, and that was how we talked about them," he said. "Colloquially, we would say they never got over the loss of that child."

Throughout that time, critics of the idea have argued vigorously against categorizing grief as a mental disorder, saying that the designation risks pathologizing a fundamental aspect of the human experience.

They warn that there will be false positives - grieving people told by doctors that they have mental illnesses when they are actually emerging, slowly but naturally, from their losses.

And they fear grief will be seen as a growth market by drug companies that will try to persuade the public that they need medical treatment to emerge from mourning.

"I completely, utterly disagree that grief is a mental illness," said Joanne Cacciatore, an associate professor of social work at Arizona State University who has published widely on grief, and who operates the Selah Carefarm, a retreat for bereaved people.

"When someone who is a quote-unquote expert tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions," Dr. Cacciatore said. "To me, that is an incredibly dangerous move, and short sighted."

"I completely, utterly disagree that grief is a mental illness," said Joanne Cacciatore, an associate professor of social work at Arizona State University who operates the Selah Carefarm, a retreat for bereaved people. Credit... Adriana Zehbrauskas for The New York Times

The origins of the new diagnosis can be traced back to the 1990s, when Holly G. Prigerson, a psychiatric epidemiologist, was studying a group of patients in late life, gathering data on the effectiveness of depression treatment.

She noticed something odd: In many cases, patients were responding well to antidepressant medications, but their grief, as measured by a standard inventory of questions, was unaffected, remaining stubbornly high. When she pointed this out to psychiatrists on the team, they showed little interest.

"Grief is normal," she recalls being told. "We're psychiatrists, and we don't worry about grief. We worry about depression and anxiety." Her response was, "Well, how do you know that's not a problem?"

Dr. Prigerson set about gathering data. Many symptoms of intense grief, like "yearning and pining and craving," were distinct from depression, she concluded, and predicted bad outcomes like high blood pressure and suicidal ideation.

Her research showed that for most people, symptoms of grief peaked in the six months after the death. A group of outliers - she estimates it at 4 percent of bereaved individuals - remained "stuck and miserable," she said, and would continue to struggle with mood, functioning and sleep over the long term.

"You're not getting another soul mate and you're kind of eking out your days," she said.

In 2010, when the American Psychiatric Association proposed expanding the definition of depression to include grieving people, it provoked a backlash, feeding into a broader critique that mental health professionals were overdiagnosing and overmedicating patients.

"You've got to understand that clinicians want diagnoses so they can categorize people coming through the door and get reimbursement," said Jerome C. Wakefield, a professor of social work at New York University. "That is a huge pressure on the D.S.M."

Still, researchers kept working on grief, increasingly viewing it as distinct from depression and more closely related to stress disorders, like post-traumatic stress disorder. Among them was Dr. M. Katherine Shear, a psychiatry professor at Columbia University, who developed a 16-week program of psychotherapy that draws heavily on exposure techniques used for victims of trauma.

By 2016, data from clinical trials showed that Dr. Shear's therapy had good results for patients suffering from intense grief, and that it outperformed antidepressants and other depression therapies. Those findings bolstered the argument for including the new diagnosis in the manual, said Dr. Appelbaum, who is chair of the committee in charge of revisions to the manual.

In 2019, Dr. Appelbaum convened a group that included Dr. Shear, of Columbia, and Dr. Prigerson, now a professor at Weill Cornell Medical College, to agree on criteria that would distinguish normal grief from the disorder.

The most sensitive question of all was this: How long is prolonged?

Though both teams of researchers felt that they could identify the disorder six months after a bereavement, the A.P.A. "begged and pleaded" to define the syndrome more conservatively - a year after death - to avoid a public backlash, Dr. Prigerson said.

"I have to say that they were kind of politically smart about that," she added.The concern was that the public was "going to be outraged, because everyone feels because they still feel some grief - even if it's their grandmother at six months, they are still missing them," she said. "It just seems like you're pathologizing love."

Measured at the year mark, she said, the criteria should apply to around 4 percent of bereaved people.

The new diagnosis, published this week in the manual's revised edition, is a breakthrough for those who have argued, for years, that intensely grieving people need tailored treatment.

"It's kind of like the bar mitzvah of diagnoses," said Dr. Kenneth S. Kendler, a professor of psychiatry at Virginia Commonwealth University who has played an important role in the last three editions of the diagnostic manual.

"It's sort of an official blessing in the world," he said. "If we were on the planetary committee of the American Astronomical Society deciding what is a planet or not - this one's in, and Pluto we kicked out."

If the diagnosis comes into common use, it is likely to popularize Dr. Shear's treatment and also give rise to a range of new ones, including drug treatments and online interventions.

Dr. Shear said it was difficult to predict what treatments would emerge.

" I don't really have any idea, because I don't know when the last time there was a really brand-new diagnosis," she said.

She added, "I really am in favor of anything that helps people, honestly."

Dr. M. Katherine Shear, a psychiatry professor at Columbia University and a founding director of the Center for Prolonged Grief, has been studying the condition since 1995. Credit... Yana Paskova for The New York Times

Amy Cuzzola-Kern, 54, said Dr. Shear's treatment helped her break out of a terrible loop.

Three years earlier, her brother had died suddenly in his sleep of a heart attack. Ms. Cuzzola-Kern found herself compulsively replaying the days and hours leading up to his death, wondering whether she should have noticed he was unwell or nudged him to go to the emergency room.

She had withdrawn from social life and had trouble sleeping through the night. Though she had begun a course of antidepressants and seen two therapists, nothing seemed to be working.

"I was in such a state of protest - this can't be, this is a dream," she said. "I felt like I was living in a suspended reality."

She entered Dr. Shear's 16-session program, called prolonged grief disorder therapy. In sessions with a therapist, she would narrate her recollection of the day that she learned her brother had died - a painful process, but one that gradually drained the horror out of the memory. By the end, she said, she had accepted the fact of his death.

The diagnosis, she said, mattered only because it was a gateway to the proper treatment.

"Am I ashamed or embarrassed? Do I feel pathological? No," she said. "I needed professional help."

Yet, others interviewed said they were wary of any expectation that grief should lift in a particular period of time.

"We would never put a time frame around when someone should or shouldn't feel that they have moved forward," said Catrina Clemens, who oversees the victim services department of Mothers Against Drunk Driving, which provides services to bereaved relatives and friends. The organization encourages bereaved people to seek mental health care, but has no role in diagnosis, said a spokesperson.

Filipp Brunshteyn, whose 3-year-old daughter died after an automobile accident in 2016, said grieving people could be set back by the message that their response was dysfunctional.

"Anything we inject into this journey that says, 'that's not normal,' that could cause more harm than good," he said. "You are already dealing with someone very vulnerable, and they need validation."

To set a year as a point for diagnosis is "arbitrary and kind of cruel," said Ann Hood, whose memoir, "Comfort: A Journey Through Grief," describes the death of her 5-year-old daughter from a strep infection. Her own experience, she said, was "full of peaks and valleys and surprises."

The first time Ms. Hood walked into her daughter Grace's room after her death, she saw a pair of ballet tights lying in a tangle on the floor where the little girl had dropped them. She screamed. "Not the kind of scream that comes from fright," she later wrote, "but the kind that comes from the deepest grief imaginable."

She slammed the door, left the room untouched and eventually turned off the heat to that part of the house. At the one-year mark, a well-meaning friend told her it was time to clear out the room - "nothing worse than a shrine," he told her - but she ignored him.

Then one morning, three years after Grace's death, Ms. Hood woke up and returned to the room. She sorted her daughter's clothes and toys into plastic bins, emptied the bureau and closet and lined up her little shoes at the top of the stairs.

To this day, she is not sure how she got from one point to the other. "All of a sudden, you look up," she said, "and a few years have gone by, and you're back in the world."

# data[].attributes.attachment_link.title
How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer.

# data[].attributes.attachment_link.description
The latest edition of the DSM-5, sometimes known as "psychiatry's bible," includes a controversial new diagnosis: prolonged grief disorder. After more than a decade of argument, psychiatry's most powerful body in the United States added a new disorder this week to its diagnostic manual: prolonged grief.

# data[].attributes.attachment_link.readable_text
Affiliations

¹ Cornell Center for Research on End-of-Live Care, Weill Cornell Medicine, New York, NY, USA.

² Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.

³ Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.

⁴ ARQ Research, ARQ National Psychotrauma Centre, Diemen, The Netherlands.

⁵ Department of Experimental Psychology, University of Oxford, Oxford, UK.

⁶ Department of Radiology, Weill Cornell Medicine, New York, NY, USA.

Free PMC article

Free PMC article

Affiliations

¹ Cornell Center for Research on End-of-Live Care, Weill Cornell Medicine, New York, NY, USA.

² Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.

³ Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.

⁴ ARQ Research, ARQ National Psychotrauma Centre, Diemen, The Netherlands.

⁵ Department of Experimental Psychology, University of Oxford, Oxford, UK.

⁶ Department of Radiology, Weill Cornell Medicine, New York, NY, USA.

Abstract

Although the concept of pathological grief dates back at least as far as Freud's "Mourning and Melancholia", there has been opposition to its recognition as a distinct mental disorder. Resistance has been overcome by evidence demonstrating that distinctive symptoms of prolonged grief disorder (PGD) - an attachment disturbance featuring yearning for the deceased, loss of meaning and identity disruption - can endure, prove distressing and disabling, and require targeted treatment. In acknowledgement of this evidence, the American Psychiatric Association Assembly has recently voted to include PGD as a new mental disorder in the DSM-5-TR. We tested the validity of the new DSM criteria for PGD and of an adapted version of our PG-13 scale, the PG-13-Revised (PG-13-R), designed to map onto these criteria, using data from investigations conducted at Yale University (N=270), Utrecht University (N=163) and Oxford University (N=239). Baseline assessments were performed at 12-24 months post-loss; follow-up assessments took place 5.3-12.0 months later. Results indicated that the PG-13-R grief symptoms represent a unidimensional construct, with high degrees of internal consistency (Cronbach's alpha = 0.83, 0.90 and 0.93, for Yale, Utrecht and Oxford, respectively). The DSM PGD diagnosis was distinct from post-traumatic stress disorder (phi=0.12), major depressive disorder (phi=0.25) and generalized anxiety disorder (phi=0.26) at baseline. Temporal stability was remarkable for this diagnosis (r=0.86, p<0.001). Kappa agreement between a PG-13-R threshold symptom summary score of 30 and the DSM symptom criterion for PGD was 0.70-0.89 across the datasets. Both the DSM PGD diagnosis and the PG-13-R symptom summary score at baseline were significantly associated (p<0.05) with symptoms and diagnoses of major depressive disorder, post-traumatic stress disorder and/or generalized anxiety disorder, suicidal ideation, worse quality of life and functional impairments at baseline and at follow-up, in the Yale, Utrecht and Oxford datasets. Overall, the DSM-5-TR criteria for PGD and the PG-13-R both proved reliable and valid measures for the classification of bereaved individuals with maladaptive grief responses.

Keywords: DSM-5-TR; ICD-11; PG-13-R; Prolonged grief disorder; bereavement; pathological grief; post-traumatic stress disorder.

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Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale - PubMed

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Although the concept of pathological grief dates back at least as far as Freud's "Mourning and Melancholia", there has been opposition to its recognition as a distinct mental disorder. Resistance has been overcome by evidence demonstrating that distinctive symptoms of prolonged grief disorder (PGD) ...

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With the United States surpassing 727,000 deaths from covid-19, the disease caused by the coronavirus, millions have been left grieving the losses of their loved ones. As a psychologist, I bear witness to the emotional and physical pain, sadness, anger, fear, isolation and struggle of those who mourn. They often feel as if there is a wall between them and the rest of the world, like our accelerated, progress- and positivity-centered society does not allow for grieving and honoring the deceased.

The pandemic has made things worse, with relatives barred from supporting the dying, and religious and cultural mourning rituals disrupted or impossible. "In the current environment, we are likely to see more people whose grief doesn't lessen with time, and whose intense suffering disrupts their ability to function," said Holly G. Prigerson, professor of sociology in medicine at Weill Cornell Medicine in New York City and a co-author of " Bereavement: Studies of Grief in Adult Life."

How to Grieve During a Pandemic

Prigerson's studies over the past three decades, along with other research from the United States, the United Kingdom, the Netherlands and Australia, among others, have led to the inclusion of a new disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - the main guide for diagnosing mental health problems. The American Psychiatric Association recently announced that prolonged grief disorder (PGD) will be added to the newest version of the manual, DSM-5-TR.

Here is what you need to know about prolonged grief disorder.

What is prolonged grief disorder?

Grief is a natural human reaction to the death of a loved one. It tends to come in waves, often triggered by internal or external reminders of the loss, which is why anniversaries or holidays can be particularly difficult. It is also idiosyncratic, hence the maxim that there is no one right way to grieve. For some people, talking a lot about the deceased is healing, while others benefit from more interior mourning.

Although most people have a hard time after a death, over time, they are able to accept the loss, find meaning in life without the deceased and reintegrate into society. They find new ways to love and work.

"But for a small but significant group of people, grief doesn't resolve. It is ongoing, pervasive, intense and debilitating," said Katherine Shear, professor of psychiatry at the School of Social Work and founding director of the Center for Complicated Grief at Columbia University. "This is what we call prolonged grief disorder."

PGD can be diagnosed no sooner than one year after the death of a loved one, and it is defined by a daily, intense yearning for the deceased or a preoccupation with thoughts or memories of them. Additional symptoms - three of which are required for a diagnosis - are identity confusion, disbelief, avoidance of reminders of the loss, intense emotional pain, difficulty engaging with others and with life, emotional numbness, feeling that life is meaningless, and intense loneliness.

Although PGD is newly designated as a disorder, similar conditions have been documented and investigated for many years, usually called " complicated grief."

Why is it important to recognize prolonged grief disorder?

About 1 in 10 people who have lost someone struggle with PGD. Until now, many of them might have wondered what was wrong with them and whether they could get better. "People ask us, 'Am I going crazy?' all the time, and having PGD recognized will validate their suffering and show them there are others suffering in a similar way," said Natalia Skritskaya, a clinical psychologist and associate research scientist at Columbia's Center for Complicated Grief.

When birthdays, songs, other things can spark grief long after a loved one's death

Although PGD shares some symptoms with depression and post-traumatic stress disorder, it is "neurobiologically and epidemiologically different," Prigerson said. "It has a distinct pattern of symptoms and different treatments."

PGD puts people at higher risk for medical problems (cancer, high blood pressure, heart or immunological issues), other mental health disorders, disability, hospitalization and suicide. The DSM classification will help health-care professionals identify those who suffer from PGD, so they can properly help them.

All the while, we need to be careful not to pathologize grief. "We run a risk of stigmatizing the grieving, reducing their dignity and medicalizing the natural process," said Allen Frances, a professor andchairman emeritus of the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine and the author of " Saving Normal." "Some practitioners, especially in primary care after a 10-minute visit, might overuse the new label, over-diagnose and overprescribe."

So, always ask questions and advocate for yourself or your loved ones if you feel as if medical providers are not taking time to listen and understand.

What makes people more susceptible to PGD?

Research has identified several factors that complicate grief. If you were very dependent on the deceased for practical or emotional needs, or if your world revolved around them, the loss can be hard to process. On the other hand, difficulty remembering positive traits of the deceased can also prolong grief.

"Sudden and traumatic deaths, and deaths by suicide, are more likely to lead to complicated grief," Skritskaya said. "If the grieving person is dealing with multiple losses, poor social support, has a lot of stress in their life, or a history of psychological disorders or prior trauma - those are risk factors, too."

Also likely to worsen grief: chronically avoiding thinking about the loss and getting stuck in a ruminative cycle of asking why this has happened to you or wondering whether you could have done something different. Judging oneself for experiencing negative emotions related to grief is not helpful either.

What are the treatments?

Treatments for complicated grief have been investigated since the late 1990s and practiced for much longer. "Research showed that neither antidepressants nor standard depression-focused therapy are very effective for complicated grief," Shear said. "That's why we developed complicated grief treatment."

Shear's integrative treatment helps patients understand and accept grief, manage emotions, strengthen relationships, create a coherent story of the death, live with reminders and feel connected with people who died, and begin to see a promise in the future. It was shown to help a majority of people with PGD.

Robert Neimeyer, professor emeritus of psychology at the University of Memphis, director of the Portland Institute for Loss and Transition and co-editor of " Grief and Bereavement in Contemporary Society," finds that the most important goals of complicated grief therapy are to develop a narrative of what happened, to revise and re-create one's relationship with the loved one, and to reinvent oneself. "After loss, we need to reconstruct life meaning and find a way to reinvest in living," he said.

'Pandemic grief' proves especially devastating and complex for many in mourning, health experts say

A 2014 Australian study found that grief-focused cognitive behavior therapy helped those with PGD. The therapy included noticing thinking traps that get us mired deeper in grief, gradually approaching previously avoided situations that had reminders of loss, and scheduling social and other enjoyable activities. A version of this treatment that also focused on recurrent vivid recounting of how the loved one died was particularly effective.

And I have found that, in situations in which PGD is related to guilt, regret or a sense of unfinished business with the deceased, writing a letter or having an imagined conversation with the lost loved one can be a powerful aspect of treatment.

While psychotherapy is a first-line treatment for PGD, antidepressants can be helpful with the depression that often accompanies complicated grief. Grief support groups are also recommended, especially when they involve mourners with similar grief stories.

Finally, the websites of Columbia's Center for Complicated Grief and Cornell's Center for Research on End-of-Life Care provide assessment, education, self-help and other resources for dealing with grief and PGD.
Jelena Kecmanovic is the founding director of the Arlington/DC Behavior Therapy Institute and an adjunct professor of psychology at Georgetown University. Find her @DrKPsychologist.

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Prolonged grief disorder recognized as official diagnosis. Here's what to know about chronic mourning.

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Also known as complicated grief, prolonged grief disorder affects 1 in 10 mourners and is defined by a daily, intense yearning for the deceased a year or longer after their death.

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Finding Our Way website developed by Wan Jou (Lavender) She at Weill Cornell Medicine

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Call to Action

While knowledge of the ten core principles is a critical first step to becoming grief-informed, we must recognize that knowledge is most impactful when it is put into action. It is time that we as a nation take a stand and acknowledge grief for what it truly is: a natural and normal response to loss that is interwoven into a sociocultural context. Grief is not an experience that needs to be "silenced," "treated," or "pathologized." Grief, and all the many complications it imposes on the griever, is an experience that needs and deserves understanding, support, and community.

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Dougy Center for Grieving Children & Families | Portland, OR

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While knowledge of the ten core principles is a critical first step to becoming grief-informed, we must recognize that knowledge is most impactful when it is put into action. It is time that we as a nation take a stand and acknowledge grief for what it truly is: a natural and normal response to loss that is interwoven into a sociocultural context.

# data[].attributes.attachment_link.description
Finding Our Way website developed by Wan Jou (Lavender) She at Weill Cornell Medicine

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I believe in the inherent power each person possesses to make positive changes in his or her life. I utilize a strengths based, nonjudgmental approach with my clients. I believe in providing a safe, private and supportive space for my clients to freely explore experiences and themes in their life that may cause them pain or stress. I have experienced time and again the power of therapy to truly help people, and I am passionate about the work I do.

I have over 15 years of experience in the field. I began my career as a perinatal social worker, but also have additional expertise working with individuals and families dealing with aging and chronic illness. My areas of clinical interest include grief and loss, adjustment to illness, aging, depression, anxiety, pregnancy, childbirth and parenting.

I am proud to be a part of the practice at Nancy Eschbach, LCSW and Associates. My office is located in downtown Des Plaines which is readily accessible to interstates 294 and 90.

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Courtney Bowles, Clinical Social Work/Therapist, Des Plaines, IL, 60016 | Psychology Today

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Courtney Bowles, Clinical Social Work/Therapist, Des Plaines, IL, 60016, (847) 807-1182, I believe in the inherent power each person possesses to make positive changes in his or her life. I utilize a strengths based, nonjudgmental approach with my clients.

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Nancy Eschbach, LCSW and Associates, LLC offers an array of services for individuals, couples and professionals including psychotherapy, training and consultation.

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In response to COVID-19/Coronavirus, we are now offering telehealth psychotherapy sessions which are covered by most insurance plans. Please call 847.877.3970 for information and to set up an appointment.

Not sure if therapy is right for you? Call for a free 15 minute consultation to help you decide. 847.877.3970

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Nancy Eschbach, LCSW and Associates, LLC offers an array of services for individuals, couples and professionals including psychotherapy, training and consultation. ​ In response to COVID-19/Coronavirus, we are now offering telehealth psychotherapy sessions which are covered by most insurance plans. Please call 847.877.3970 for information and to set up an appointment.

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Segment Transcript

IRA FLATOW: This is Science Friday. I'm Ira Flatow. Being a human can be a wonderful thing. We're social creatures. We crave strong bonds with family and friends.

Those relationships can be the most rewarding part of life, but having strong relationships also means experiencing loss. Grief is one of the hardest things we go through in life. If you've lost a loved one, you know that feeling. It can be an overwhelming sadness and heartache that reaches deeply into the very core of your being.

To understand why we feel the way we do when we grieve, the logical place to turn to is our brain. A new book explores the neuroscience angle to this profound human experience. The author is my guest, Mary-Frances O'Connor, PhD, author of The Grieving Brain, based in Tucson, Arizona. Welcome to Science Friday.

MARY-FRANCES O'CONNOR: It's so nice to be here, Ira.

IRA FLATOW: It's so nice to have you. Let's start with some of the wordplay here, if I might. I'm inclined to use the words "grief" and "grieving" interchangeably, but they're actually different experiences, correct?

MARY-FRANCES O'CONNOR: That's right. I have found this to be really helpful in studying grief and grieving. Grief is that wave that just knocks you off your feet, where grieving is how the feeling of grief changes over time without ever going away.

So what I mean by that is that grief is a natural response to loss. And if I open a drawer, I come across a- my mom's signature, say, for example, 20 years after she's died, I may still dissolve into tears on that day. And yet I know that that feeling of grief is maybe more familiar. And so it's not the same as it was 20 years earlier. But if we're expecting that we're not going to feel grief anymore, we may start to wonder if we're actually getting any better, or if we're adapting the way people are expecting us to.

IRA FLATOW: You said when you study grief. How long have you been studying grief? And what do you mean by studying grief?

MARY-FRANCES O'CONNOR: I have been studying grief for a good 22 years now. I started in graduate school, because fMRI technology was brand new back then, and I was absolutely intrigued. So after my dissertation, we brought people back and put them in the neuro-imaging scanner for the very first study of grief from a neuroscience perspective.

IRA FLATOW: So this was groundbreaking stuff then.

MARY-FRANCES O'CONNOR: Yes. The American Journal of Psychiatry thought it was, at least.

IRA FLATOW: Well, when you put them in the scanner, what do you ask of them?

MARY-FRANCES O'CONNOR: We really struggled with, you know, how do you evoke something as deeply intense and personal as grief in such sterile, sort of hospital-like environment? And what we came up with was what people do pretty naturally. If they're going to tell you about someone who has been the love of their life, they often open a photo album and show you photos.

And so we scanned photos individuals brought us and took words from the stories they told us about their loss, and projected those onto goggles that people were wearing in the scanner. So we literally had images of what their brain was reacting to when they were each looking at individual photos of their loved lost one, which was a little unusual at the time. Usually, we'd try to have standardized stimuli across everyone. But it is such a personal experience, that felt important.

IRA FLATOW: Please, can you share with us what you've learned? Tell us what is going on in the brain when you look at those pictures, or when we lose a loved one.

MARY-FRANCES O'CONNOR: You know, one of the things we realized is that grief is really complex. So it actually involves a bunch of different things that the brain is doing all at the same time. And those include things you might expect, like memory and even things like being able to take someone else's perspective. So encoding of sort of the self and the other. But other things as well, even things like regulating our heart rate and so forth.

IRA FLATOW: You've just described how you show pictures to people who are getting their brain scan. And that must dredge up memories, correct? What's going on in their brain about these memories?

MARY-FRANCES O'CONNOR: Well, one of the interesting things is the brain is very complex. And we can actually be using two streams of information at the same time. So you're absolutely right. One aspect is memory. We're thinking about times we spent with the loved one, maybe even seeing the loved one decline over time or being there when they passed away or getting that phone call to tell us that they have died.

But interestingly, we also have to think about the bond. So in the human brain, there is a bond created when we come to be a parent, or we become a spouse. That bond is very strong and comes along with some beliefs. And one of these beliefs we have is, that person is going to be there for us. No matter what, that person is there.

What that leads to is these two streams of information. On the one hand, you know that they're gone. But on the other hand, it sort of feels like they're going to walk through the door again. And so that can be very confusing for people. I think it takes a long time for the brain to be able to predict, no, I'm not really going to see this person again, and all the emotions and what that means that comes along with it.

IRA FLATOW: So does that mean that in the brain, the brain cells have to physically rewire themselves for the new reality?

MARY-FRANCES O'CONNOR: That's exactly right. So even in simple things, say in a mouse, if you put him in a box every day and he sees some blue LEGO item, after a number of days, if you take the LEGO out, and you put him back in the box, there is still a ghost trace of that block. Because the rat is expecting it, there are neurons that fire when he is in the area where that block should be. Now, this persists for a number of days, but imagine, for a life that is so intersected with another person- everything we do and think and plan is involved with this other person- the brain literally has to create new wiring to understand what's happening.

IRA FLATOW: And that takes time.

MARY-FRANCES O'CONNOR: It does take time. It turns out that time is one of the most important things. But actually, experience is another important thing. Something we sometimes see is that people have a lot of difficulty with grief and start avoiding situations or conversations or even people that remind them of the loved one because it's quite painful. But it turns out that kind of avoiding doesn't give our brain a chance to learn the new reality.

IRA FLATOW: Yeah. Grief can feel like such a physical event.

MARY-FRANCES O'CONNOR: Yeah.

IRA FLATOW: Can't it?

MARY-FRANCES O'CONNOR: It really can. I think it is a physical event, in part because it's physically happening in your brain. Usually when we say that, of course, we're referring to the bodily feelings.

But really, those changes- for example, some work by Zoe Donaldson at University of Colorado Boulder shows that there are specific neurons in rodents that pair bond- some of you will have heard of them- called voles. There are specific neurons that are activated just when that vole is approaching their one and only. And the number of neurons increases as that bond gets stronger. And so if you think about, then, all the things that have to happen in order to be able to predict this person isn't going to be back and understand what that means, it's pretty complicated, and really is a physical process.

IRA FLATOW: Yeah. Yeah, you talk in your book, also, about how grief can actually cause physical ailments.

MARY-FRANCES O'CONNOR: Well, the term "the broken heart phenomenon" is something we think of as a metaphor, or we think about that in terms of sort of a poetic way to put what we're feeling. But we actually know from epidemiological research that it is true that when a person has lost their spouse, their own risk of mortality goes up. For men, it goes up twice as high than their married counterpart for the first six months. And it goes up in women as well, not quite as high.

And so we know that that connection is a lot about physiological regulation. Being with our loved ones is extremely rewarding, and it feels safe. And so our physiology really has to live in what feels like an unsafe world for a while, and try and figure out how to come back to homeostasis.

IRA FLATOW: Yeah, because we know that losing a loved one can be very traumatic.

MARY-FRANCES O'CONNOR: Yes.

IRA FLATOW: Do trauma and grief overlap?

MARY-FRANCES O'CONNOR: We used to think that grief and depression were the same thing. And sometimes we even thought grief and PTSD might be the same thing, depending on how the loved one died. But some work by Richard Bryant at the University of New South Wales in Australia did neuro-imaging scans of people who had a severe form of grieving, and it actually looked different from PTSD and from major depressive disorder in the brain, recruiting different parts of the brain, recruiting the orbitofrontal cortex when people who had this severe grief looked at pictures of people with sad faces. So knowing that there are some biological differences, or neurobiological differences, really reinforces what we see clinically, that PTSD and grief- they are different.

IRA FLATOW: That is interesting. You say in your book that many people who lose a loved one turn to religion to help them understand what has happened and where their loved one may have gone. Is there science that backs up this connection?

MARY-FRANCES O'CONNOR: I think, you know, as a neuroscientist, it isn't so much that I'm trying to figure out if religious beliefs are true, but rather, what does it do for us if we have religious beliefs? So on the one hand, we know often being a religious person comes along with having a religious community. And we know social support is really important. And we can see that in studies.

The other thing that sometimes happens for folks, though, is that they get into a lot of concerns about guilt, sometimes even feeling that they are being punished for what has happened. And this can be really problematic for people in trying to understand the meaning of what they're going through.

IRA FLATOW: We have to take a break, but when we come back, more about how our brain processes grief with author Mary-Frances O'Connor.

This is Science Friday. I'm Ira Flatow. A brief programming note- the spring season of the Science Friday Book Club is about to begin. Starting February 25, we're reading Sarah Stewart Johnson's The Sirens of Mars. It's all about the search for life on the Red Planet. If you want to read with us, go to sciencefriday.com/bookclub. You can sign up for our newsletter, join our community space, and even read an excerpt of the book. That's sciencefriday.com/bookclub.

If you're just joining us, I'm speaking with author and neuroscientist Mary-Frances O'Connor about how our brains process grief. Her new book, The Grieving Brain, is out now. Are there medications designed to alleviate or help people cope with grief?

MARY-FRANCES O'CONNOR: This is a very important question. And I would say that at this point, we do not have medications. In fact, one of the things that we know is that, as I said before, major depressive disorder and even severe forms of grieving are different things. This was really neatly, sort of elegantly, explored in a study by Kathy Shear at Columbia University, where they did treatment for a severe type of grieving called prolonged grief disorder. And they also looked to see if they had major depressive disorder.

So in one case, they were given just psychotherapy targeted for grief. And then they were either given an antidepressant or not given an antidepressant. What they discovered was antidepressants were very helpful if the person had comorbid depression. We saw their depressive symptoms remit. But the antidepressant did not actually have an impact on those feelings of yearning and wishing that the person was back. That type of emotional pain was not actually helped by the antidepressant. And that was very helpful, again, in helping us distinguish between these difficult experiences.

IRA FLATOW: Do you suspect, though, that when someone is grieving, and it's quite obvious how much they're suffering, that somebody- a psychiatrist or their physician- may prescribe an antidepressant just to give them something when they don't actually need it?

MARY-FRANCES O'CONNOR: This is a bit of a challenge. I think there hasn't been a lot of education in medical schools- frankly, in psychology training, either- about grief. It really is in its infancy. And so often, because, just as you say, doctors are empathic- they see this person, they want to give them something- sometimes they will prescribe an antidepressant, even sometimes when the patient says, I don't really feel depressed.

But the other problem is that a lot of people who are grieving have difficulty sleeping. And so a doctor will often prescribe a sleep medication. What we know about that is the difficulty sleeping that comes with bereavement is a temporary situation. It is incredibly difficult, but it is also temporary.

And those sleep medications tend not to work well in the long run. And yet people tend to stay on them, sometimes because coming off of them is difficult. So it's more important to think about, for example, cognitive behavioral therapy for insomnia, what we call CBTI, which is a way of thinking about supporting the natural sleep cycle through behavioral means and enabling that person to get back into a rhythm naturally so that in the long term, they don't have these sleep difficulties.

IRA FLATOW: Now, your book was written pre-COVID, but it's very timely for right now, I would imagine. So how much grief is happening in the world because of this virus? I mean, has this pandemic changed how you look at grief in some ways?

MARY-FRANCES O'CONNOR: It has in some ways. I think there's been a lot of discussion about grief. But what we know from evidence in the United States, some modeling done by some sociologists demonstrated that for every person who has died, there are about nine loved ones who remain, who are survivors. So if you think about, we're getting close to a million people who have died of COVID, that's 9 million people who are acutely grieving. And-

IRA FLATOW: And that's just in our country.

MARY-FRANCES O'CONNOR: And that's just in our country. So one of the difficulties is just understanding what it means to have such a large number of people, but also, who are all going through it at the same time. Usually, when we're losing a loved one, we have people around us who aren't going through that experience that we can kind of lean on. And now we have a pretty unusual situation where, I mean, let's face it, we're dealing with a lot of types of grief, but even if we focused only on bereavement, we're dealing with a lot of deaths.

And for me, it isn't just, what does that grief feel like, or how many people have it? But as a grief researcher, my interest is partly in, why might the pandemic circumstances be harder for people who are grieving? And the thing I said before about, the brain relies on this stream of information where we've maybe seen the person decline, we may have been there at the bedside when they passed away, we went to a funeral or a memorial service- many of those circumstances have really changed because of social distancing.

And so as I'm doing research right now, I'm talking with people who- you know, the 70-year-old woman who dropped off her fairly healthy husband who had a cough at the ER, and was having some trouble breathing, and then, because we're not allowed to be in the hospital with them, the next thing she knew, he was actually- she was being told that he had died. And that's a very unusual circumstance, for us not to be present. People who have loved ones in long-term care experience this as well. And I think the problem is that it doesn't give our brain a chance to understand what's happening as we're going through the experience.

IRA FLATOW: Yes. That, I'm sure, has happened many times, unfortunately. And as you say, we're experiencing what feels like a group grief event with COVID. Do you think this might change us as a species?

MARY-FRANCES O'CONNOR: It's an interesting question. Certainly, in the sense of a species, grief is such a universal experience. And even pandemics, right, mass casualties- we certainly, as a species, have faced difficult situations before. And we can look to some of those for important ways that people have coped.

I think it's unusual in a cultural way. Part of what we sometimes forget is that bereavement is a health disparity, right? So 65% of all the children experiencing COVID-associated loss of a caregiver are of a racial or ethnic minority.

And this has always actually been true. Black Americans become widowed at much younger ages. Work by Debra Umberson down at UT Austin showed that between the ages of 65 and 74, 25% of Black Americans are widowed compared with only 15% of white Americans. And so bereavement isn't affecting everyone equally. If we're thinking at a kind of public health level, we have to really make sure that the response is targeted in the way that it will do the most help.

IRA FLATOW: If there are people who are listening and who are grieving, what do you recommend they do to lessen the pain or help them move on or find help?

MARY-FRANCES O'CONNOR: This is a very challenging time for people. I think it's confusing. The grief experience is not often what people are expecting. There's a lot of anger, often, or just the intrusive thoughts. You can't sort of stop thinking about it.

Much of that is actually pretty normal. And people often have the desire to talk about their experience, to try to put into words what it means to know that you're not going to retire with this person that you had planned to do that forever. So I actually recommend reaching out and talking with the people around you, especially people who may have had their own grief experience. Often, there's a level of empathy there that- it can be more difficult for people who don't have the same lived experience. So reaching out and talking with people.

And also, if people are experiencing things like feeling life isn't worth living, or feeling they can't get through the day without drinking a large amount of alcohol, these are really signs that it is important to reach out for professional help, as well, because this is a temporary situation. And although it doesn't feel like it in the moment, it will change over time. And we want to support a person who's in that immediate part of grieving in order to help them get onto that sort of healing grieving trajectory.

IRA FLATOW: You know, the news is filled almost every day with someone else suffering a violent death, whether it's from gunshots, whether it's from murders, whatever. Is there a special kind of grief that these people, the relatives and the loved ones of these people, go through that needs a special kind of treatment or counseling?

MARY-FRANCES O'CONNOR: We sometimes refer to this as traumatic grief, meaning that the situation itself that led to the death was a traumatic situation. And we know that violent deaths and unexpected deaths can be more problematic as people are trying to understand what has happened and what it means for their life. Often, people who've experienced a traumatic death experience more grief symptoms.

But often, also, it comes with other things as well. Sometimes there is what we might call survivor's guilt. So depending on what the situation was, the sort of question to oneself of, why did I live when this other person did not? And that can be complicating as you're trying to come to terms with what has happened and then learn how to sort of restore a meaningful life.

IRA FLATOW: What research would you like to see on grief and grieving in the future? And if I gave you- I'm going to give you the SciFri blank check question. Maybe you've heard it before. If I had a blank check, which I don't have it, to give you for spending on buying anything you'd like, on the kind of research you'd like to see done that hasn't been done, how would you spend it?

MARY-FRANCES O'CONNOR: You know, I think there are even some really basic questions that we don't know. One is that we have a number of studies now on grief, that single snapshot in time across a number of people. What we don't have a lot of research on is actually grieving, so looking at the same person, putting the same person in the MRI scanner numerous times across that changing experience and seeing, what does it look like in the brain when people are coming to terms with what has happened, restoring a meaningful life?

And the second question I would want to know at the same time- we don't actually know if people who are psychologically having a lot of difficulty adjusting are the same people who are having a lot of difficulty medically adjusting. So we don't actually know yet- because these tend to be different groups of people studying them- we don't actually know if the changes physiologically are related to the changes in the brain and in the mind. And so I'd love to see more integrated work over time with people.

IRA FLATOW: When you say medically adjusting, what do you mean by that?

MARY-FRANCES O'CONNOR: Well, this gets a little bit back to what I was saying about the broken heart phenomenon earlier. What we know is that acutely- and this is true even in animal pair bonds. Some work by Oliver Bosch at University of Regensburg in Germany has shown that when a bond is formed, it's almost like cocking a gun, so that as soon as there is separation, cortisol goes up, or the animal version of cortisol. Cortisol goes up in humans upon separation and remains high.

So think about that moment when you lose your kid in the mall, and you can't find them- that utter panic, right? Or think about when a husband even goes on a trip out of town, and you feel awful, right? As soon as that separation happens, we know there are these physiological changes.

And we're still really trying to understand, in human beings, for whom do those changes happen most? Is that related to how they feel emotionally? And then, are there things that we can do to help sort of support the body as it deals with this stress hormone imbalance in order to improve their experience and even improve their medical situation in that initial period of grief?

IRA FLATOW: Talking with Mary-Frances O'Connor, PhD, author of The Grieving Brain, on Science Friday from WNYC Studios. You told me earlier that you've been studying grief for over 20 years. Does it get to you, studying grief?

MARY-FRANCES O'CONNOR: This is a really common question for me. You know, I teach an undergraduate Psychology of Death and Loss course, so 150 undergrads who say the word "death" probably more in that 14 weeks than they ever have in their life. And they often say to me, you know, I feel like you're too happy to be teaching this class.

And I tell them the thing for me is, the reason I'm happy is because I really understand the suffering. And so I have found a way in my own life, from the death of my mother when I was in my mid-20s and then the death of my father not so many years ago. I know what that suffering is like. And for me, it has helped me to find a lot of meaning in life, to know that working with that one student to help them understand something is really rewarding because this is all the time we got.

So I think the surprising thing is, for people who have found meaning, it can be very powerful. And that is sort of an unexpected side to grieving.

IRA FLATOW: Well, that's about all the time we've got. Mary-Frances, thank you for taking time to be with us and for this terrific book that you've written.

MARY-FRANCES O'CONNOR: Thank you so much, Ira, for bringing this conversation to the radio.

IRA FLATOW: Mary-Frances O'Connor, author of The Grieving Brain. She's based in Tucson. And if you're interested in learning more about this topic, you can read an excerpt from the book on our website, sciencefriday.com/grievingbrain.
Copyright © 2022 Science Friday Initiative. All rights reserved. Science Friday transcripts are produced on a tight deadline by 3Play Media. Fidelity to the original aired/published audio or video file might vary, and text might be updated or amended in the future. For the authoritative record of Science Friday's programming, please visit the original aired/published recording. For terms of use and more information, visit our policies pages at http://www.sciencefriday.com/about/policies/

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Segment Transcript IRA FLATOW: This is Science Friday. I'm Ira Flatow. Being a human can be a wonderful thing. We're social creatures. We crave strong bonds with family and friends. Those relationships can be the most rewarding part of life, but having strong relationships also means experiencing loss.

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Krista Tippett, host: When I interviewed the psychiatrist Bessel van der Kolk for the first time, his book was about to be published. And I described him as "an innovator in treating the effects of overwhelming experiences on people and society" - what we call trauma, when we encounter it in life and in the news. So I have needed to catch up with him in a time unlike any other in my life, in which we are living through one vast, overwhelming experience after the other, and The Body Keeps the Score has become one of the most widely read books in the pandemic world. His knowledge is so very practically helpful - a distinctively illuminating perspective towards meeting what is happening in our world and inside each of us.

I'm Krista Tippett, and this is On Being.

[ music: "Seven League Boots" by Zoë Keating]

Bessel van der Kolk has been a leading researcher of traumatic stress since it first became a diagnosis. That was in the wake of the Vietnam War, and from there, it was identified and studied in other parts of the population. We take off, this hour, from some of my original conversation with him, laying out intricacies of his insights into the human brain and body and strategies for transmuting trauma that logic and language cannot reach. In the second half, I pick up with Bessel van der Kolk to mine that wisdom for 2021. He was born in the Netherlands. His own father spent time as a religious prisoner in a German concentration camp during World War II.

I always start my conversations with this question, whoever I'm speaking with. I'm just wondering, was there a religious or spiritual background to your childhood?

van der Kolk: Yeah, a multiplicity: my parents were fundamentalist Christians, in some good and some not-so-good ways, and as an adolescent, I spent a fair amount of time in a monastery in France called Taizé.

Tippett: Oh, you did? Oh, interesting. So you went to Taizé just ...

van der Kolk: Because I loved the music.

Tippett: This field you're in, of trauma, traumatic stress, nowadays this language is everywhere, right? This language of trauma and traumatic stress has made its way into culture, movie, TV scripts, the news, public policy discussions. I've read a few different accounts of how you stumbled into this field. How do you trace the beginnings of your research into traumatic stress?

van der Kolk: Well, it starts in a very pedestrian way, I mean, coming from a generation that it was generally recommended that people have their own heads examined, which I think is sort of a good idea if you try to help other people. So psychoanalysis was the way to do that, back then, and the only program that paid for that was the VA. So I went to work for the VA for the same reason that soldiers go to the VA, namely, to get their benefits package.

Tippett: And this was in the 1970s, is that right?

van der Kolk: It was in the 1970s, yeah. And like many of my colleagues, I was just there to - as a step in my career. And then the very first person I saw was a Vietnam veteran who had terrible nightmares. I happened to have studied nightmares up to that point, and I'd done some sleep studies on that, and I knew a little bit how to treat it, so I gave him some medicines to make the nightmares go away. And two weeks later, he came back, and I said, "So how did the medicines work?" And he said, "I did not take your medicines, because I realized I need to have my nightmares because I need to be a living memorial to my friends who died in Vietnam."

And that statement was the opening of my fascination about how people become living testimonials for things that no longer exist, but they need to hold it in their hearts and minds and bodies and brains. And the loyalty to the dead, the loyalty to what was, just blew me away.

And the veterans really touched me very deeply, both for what they had done, how ashamed they were about what they had done, how they went in idealistically, how they came back broken, how they relied on their comrades, and they reminded me, I think, of the uncles and my father, who I grew up with in the Netherlands after the Second World War. So it resonated with me.

Tippett: And at that time, I believe there was no formal connection made between military service and problems after discharge, right? This diagnosis hadn't happened?

van der Kolk: Well, it comes and goes, you know? I became quite interested in the history of how Western culture has looked at trauma. And people were very aware of it in the 1880s and after the Civil War, and during the First World War and during the Second World War. And then, in between, it gets forgotten. And so the way - the time that I got into the field happened to be a time of ignorance again. These things come and go.

Tippett: After the Vietnam War. And my understanding from your writing is that this diagnosis of PTSD, the term we use now, came about because of post-Vietnam War advocacy.

van der Kolk: Yeah, absolutely. And so later on I became aware of all sorts of colleagues who had been working with abused kids and rape victims, and they had been trying to get a diagnosis in. And that group was too small to have any political clout. And it's really the Vietnam veterans that brought this in, and the power of the large numbers of psychiatrists and patients at the VA. That was strong enough to make it an issue and a diagnosis.

Tippett: So I think that language you used a moment ago, about that first veteran you spoke with, that he was a living testimonial to his memories and to something that had happened, which no longer was happening but utterly defined him, is a good way in to how you define trauma. And so I'd like to spend a moment on that. I mean, start with me. How do you describe what this is - trauma - as you deal with it, as you study it, as you treat it?

van der Kolk: Well, what I think happens is that people have terrible experiences. And we all do. And we are a very resilient species. So if we are around people who love us, trust us, take care of us, nurture us when we are down, most people do pretty well with even very horrendous events. But particularly traumas that occur at the hands of people who are supposed to take care of you, if you're not allowed to feel what you feel, know what you know, your mind cannot integrate what goes on, and you can get stuck on the situation. So the social context in which it occurs is fantastically important.

Tippett: Something that's very interesting to me in how you talk about trauma, the experience of trauma, what it is, is how the nature of memory is distorted; that memories are never precise recollections, but that in general, as we move through the world, memories become integrated and transformed into stories that help us make sense, but that in the case of traumatic memories, they're not integrated. And they're not even really remembered, as much as they're relived.

van der Kolk: That's correct. That's actually a very old observation; you know, it was made extensively in the 1890s already, by various people, including Freud, and that's really what you see when you see traumatized people. Now, these days, now that trauma is a popular subject, people say, "Tell me about your trauma." But the nature of our trauma is that you actually have no recollection for it as a story, in a way. Many victims, over time, get to tell a story to explain why they are so messed up, but the nature of a traumatic experience is that the brain doesn't allow a story to be created. And here, you have an interesting paradox - that it's normal to distort your memories. Like, I'm one out of five kids. When we have a family reunion, we all tell stories about our own childhood. And everybody always listens to everybody else's stories; says, "Did you grow up in the same family as I did?"

Tippett: [ laughs] Right, there are five versions of every story.

van der Kolk: Right, right, there's all these very, very different versions, and they barely ever overlap. So people create their own realities, in a way. What is so extraordinary about trauma is that these images or sounds or physical sensations don't change over time. So people who have been molested as kids continue to see the wallpaper of the room in which they were molested. Or when they examine all these priest-abuse victims, they keep seeing the silhouette of the priest standing in the door of the bathroom and stuff like that. And so it's these images, these sounds that don't get changed.

So it's normal to change. My old teacher, George Vaillant, did a study that you may have heard about. It's called the Grant Study. And from 1939 to 1942, they followed the classes at Harvard, every five years [ Editor's note: The study followed participants from the Harvard classes of 1939-1944], and it's going on to this day. Most of them went off to war in 1942, and almost all of them came back in 1945, and they were interviewed. And then they have interviews in 1989, 1990, 1991. [ Editor's note: Questionnaires were administered every two years, and interviews were conducted every five years. Learn more about the methodology here.] And it turns out that the people who did not develop PTSD, which is the vast majority, tell very different stories, let's say, in 1990 than back in 1945, and so it now is a glorious experience, and it was a growth experience, and how cool it was, how close they were to people, and how patriotic they felt. And it's all sort of cleaned up.

Tippett: Right. But it's become a coherent narrative.

van der Kolk: But it's very coherent, and it's a nice story, and it's good to listen to it, and the relatives have all heard it a million times, because we make happy stories in our mind.

People who got traumatized continue to have the same story in 1990 as they told back in 1945. And so they cannot transform it. So if you treat people, when we treat people, you see the narrative change, and people start introducing new elements. I compare it very much to what happens when people dream. Maybe dreaming is very central here, actually, in that the natural way in which we deal with difficult stuff is we go to sleep and we dream, and next day we feel better. It's very striking, how we get upset and say, "I'm going to move to Florida, bummer day in Boston in the winter." And the next morning, you wake up, and you shovel out your car, and everything's fine. And so sleep is a very important way in which we restore ourselves, and that process of that restoration that occurs during REM sleep, dream sleep, is probably an important factor in why traumatic memories do not get integrated.

Tippett: And also, that gets at the fact that it's not just cognitive, right? It's not just a story that you could tell - I mean, it may eventually become a story, but that it's body memory. Or it's a neural net of memory. It's not just about words that you can formulate.

van der Kolk: Yeah. It's amazing to me what a hard time many people I know have with that, that this is not about something you think or something you figure out. This is about your body, your organism having been reset to interpret the world as a terrifying place, and yourself as being unsafe. And it has nothing to do with cognition, with - you can say to people, You shouldn't feel that way, or, You're not a bad person, or, It wasn't your fault. And people say, I know that, but I feel that it is.

It was very striking, in our yoga study - because we see yoga as one important thing that helps people who've been traumatized, because they get back into their bodies - how hard it was for people to, even during the most blissful part of the yoga practice, called Shavasana, what a hard time traumatized people had at that moment, to just feel relaxed and safe and feel totally enveloped with goodness. The sense of goodness and safety disappears out of your body, basically.

Tippett: I want to talk about yoga in a minute. That's really - and I mean, as you said, people were talking about this in the late 19th century. Freud talked about it, and I guess his phrase was "hysteria." But something that you seemed to have noticed early on is that traditional therapy was ignoring this sensate dimension of these experiences and trying to reduce it to talk therapy, which absolutely didn't fit with the experience.

van der Kolk: Right. There's a few people here and there in the last 150 years who do it, people noticed the somatic dimension of it, but by and large, I think psychology training really breeds attention to the body out of people - even medical training. It's amazing. Psychiatrists just don't pay much attention to sensate experience at all. Antonio Damasio, in his books, The Feeling of What Happens and books like that, really talks about our core experience of ourselves is a somatic experience and that the function of the brain is to take care of the body. But it's a minority voice. It's a small voice.

Tippett: But it seems to me that what we're learning from brain imaging is bearing out these kinds of observations. I mean, what are we learning? Is any of this surprising to you?

van der Kolk: What we see is that the parts of the brain that help people to think clearly and to observe things clearly really get interfered with by trauma and that the imprint of trauma is in areas of the brain that really have no access to cognition. So it's in an area called the periaqueductal gray, which has something to do with the sort of total safety of the body. The amygdala, of course, which is the smoke detector, alarm bell system of the brain, that's where the trauma lands, and trauma makes that part of the brain hypersensitive or renders it totally insensitive.

Tippett: And the Broca's area?

van der Kolk: Well, in our study and some others, I mean, for me, that was really the great finding early on, is that when people are into their trauma, Broca's area shuts down. And that is something that almost everybody has experienced. When you get really upset with your partner or your kid, suddenly you take leave of your senses, and you say horrible things to that person, and afterwards, you say, "Oh, I didn't mean to say that." Well, the reason why you said it is because Broca's area, which is sort of the part of your brain that helps you to say reasonable things and to understand things and articulate them, shuts down. So when people really become very upset, that whole capacity to put things into words in an articulate way disappears.

And for me, that is a very important finding, because it helped me to realize that if people need to overcome the trauma, we need to also find methods that bypass what they call the tyranny of language.

Tippett: Right - don't ask to be verbal; to verbalize it.

van der Kolk: Or to be reasonable. [ laughs]

van der Kolk: I think trauma is not about being reasonable or to be verbal or to be articulate.

[ music: "Third" by Hiatus]

Tippett: I'm Krista Tippett, and this is On Being, today with psychiatrist Bessel van der Kolk, on trauma, the body, and 2021.
[music: "Third" by Hiatus]
So it seems like there are all these impulses that we have that we're working with all the time that get so out of whack, with trauma. So I've understood that it's not just that we have memories and that we process them in different ways, but also, that we are constantly rationalizing, that we have this impulse to rationalize. But then, when people are traumatized, they are actually - they also have this impulse to rationalize, and then become unable to grasp the irrelevance of that memory and that feeling to the present moment.

van der Kolk: So we have these two different parts of our brain, and they're really quite separate. So we have our animal brain that makes you go to sleep and makes us hungry and makes us turned on to other human beings in a sexual way, stuff like that. And then we have our rational brain that makes you get along with other people in a civilized way. These two are not all that connected to each other. And so, the more upset you are, you shut down your rational part of your brain.

When you look at the political discourse, everybody can rationalize what they believe in and talk endlessly about why what they believe is the right thing to do, while your emotional responses are totally at variance with seemingly rational behaviors. We can talk till we're blue in the face, but if our primitive part of our brain perceives something in a particular way, it's almost impossible to talk ourselves out of it, which, of course, makes verbal psychotherapy also extremely difficult, because that part of the brain is so very hard to access.

Tippett: We're pretty fascinating creatures, aren't we? [ laughs]

van der Kolk: Fascinating, disturbing, glorious, all those things. [ laughs]

Tippett: All those things, all at once. So I do want to talk about yoga now, which is something very important to me, as well. It's something I've discovered in the last five or six years. And how did you get interested? How did you discover yoga and then make that part of this kind of work?

van der Kolk: We actually got into yoga in a very strange way. We learned that there is a way of measuring the integrity of your reptilian brain, i.e., how the very most primitive part of your brain deals with arousal. And you can measure that with something called heart rate variability, and that tells you something about how your breath and your heart are in sync with each other.

And it turns out that the calmer people are and the more mindful people are, the higher their heart rate variability is.

And then we were doing that on some traumatized people, and we noticed that they had lousy heart rate variability. And then I thought, so how can we change peoples' heart rate variability?

Tippett: And is this something you'd naturally be aware of, or not? You wouldn't know if it was in sync or out of sync?

van der Kolk: No, but you can measure it, and it's fairly easy to measure it; like there are apps for your iPhone on which you can measure them. But of course, we do it in a more sophisticated way. And so we found this very abnormal heart rate variability in traumatized people. And then we heard that there were 17,000 yoga sites that claimed that yoga changed heart rate variability. And a few days later, some yoga teachers walked by our clinic and said, "Hey, do you think you can use us for some project?" And I said, "We sure can. We'd love to see if yoga changes heart rate variability." And this whole yoga thing also fit very well with the increasing recognition that traumatized people cut off their relationship to their bodies.

And I have to give a little bit of background here. Way back, already, in 1872, Charles Darwin wrote a book about emotions in which he talks about how emotions are expressed in things like heartbreak and gut-wrenching experience. So you feel things in your body. And then it became obvious that if people are in a constant state of heartbreak and gut-wrench, they do everything to shut down those feelings in their body. One way of doing it is taking drugs and alcohol, and the other thing is that you can just shut down your emotional awareness of your body. And so a very large number of traumatized people who we see - I'd say the majority of the people we treat at the trauma center and in my practice - have very cut off relationships to their bodies. They may not feel what's happening in their bodies. They may not register what goes on with them. And so what became very clear is that we needed to help people, for them to feel safe feeling the sensations in their bodies, to start having a relationship with the life of their organism, as I like to call it.

And so a combination of events really led us into exploring yoga for that. And yoga turned out to be a very wonderful method for traumatized people to activate exactly the areas of consciousness, areas of the brain, the areas of your mind that you need in order to regain ownership over yourself. I don't think that yoga would be the only way to do it or think, if you only do yoga, that you can totally take care of it, but yoga, to my mind, is an important component of an overall healing program. And again, not only yoga; you could do maybe martial arts or qigong - but something that engages your body in a very mindful and purposeful way, with a lot of attention to breathing, in particular, resets some critical brain areas that get very disturbed by trauma.

Tippett: Do you also have a yoga practice?

van der Kolk: I also have a yoga practice. I do. Not enough, of course. None of us ever does enough, but I try to start every day with a yoga practice.

Tippett: Now, did I read somewhere that you also found that your heart rate variability was not in sync and was not robust enough?

van der Kolk: [ laughs] I like to keep quiet about it. That's true, that's true.

Tippett: [ laughs] And do you know if yoga has helped your ...

van der Kolk: Yeah, I have a nice, even heart rate variability now.

Tippett: I wonder if you have ever heard of somebody named Matthew Sanford, who I've had on my program. He's actually -

van der Kolk: No.

Tippett: He's a very renowned yoga teacher. He's been paraplegic since he was 13. And he had no memory of the accident in which he was disabled, and his body remembered it. He talks about body memory. It's the same thing you say, this imprint that trauma has, not just on your mind. And the other thing that he's doing recently is actually working with veterans, and also working with young women suffering from anorexia, and understanding, also, that although that seems to be so much an obsession with the body, they are really in a traumatic relationship with their own bodies.

van der Kolk: Absolutely.

Tippett: And some of the things he's doing, which he actually did for me - I did a class with him - like just putting these very comforting weights on certain muscles, and so you feel sunk into your body, in a way. And I don't know, I just was thinking - I've been thinking about this as I've been reading about your research.

van der Kolk: Huh. It sounds very sympathetic and very right. And the sense of the experiences, of feeling weight and feeling your substance ...

Tippett: Yes, feeling your substance, which is bigger than just feeling a weight on your muscles, isn't it? I mean, it's ...

van der Kolk: Yeah. Really feeling your body move, and the life inside of yourself, is critical. And personally, for example, when people ask me, So, what sort of treatments have you explored? - I always explore every treatment that I explore for other people - what's been most helpful for me has been rolfing.

Tippett: Has been what?

van der Kolk: Rolfing. Rolfing is called after Ida Rolf. It's very deep tissue work where people sort of tear your muscles from your fascia, with the idea that, at a certain moment, your body comes to be contracted in a way that you habitually hold yourself. So your body sort of takes on a certain posture. And the idea of rolfing is that you really open up all these connections and make the body flexible again in a very deep way.

I had asthma as a kid. I was very sickly as a kid, because I was part of the group in the Netherlands - I mean, in the final year of the war in the Netherlands, during which I was born, about 100,000 kids died from starvation, and I was a very sickly kid. And I think I carried it in my body for a long time. And rolfing helped me to overcome that, actually. So I now, my body became flexible and multipotential again.

And for my patients, I always recommend that they see somebody who helps them to really feel their body, experience their body, open up to their bodies. And I refer people always, to craniosacral work or Feldenkrais. And I think those are all very important components about becoming a healthy person.

Tippett: But they're not that easy to find. They're still kind of around the edges, Feldenkrais and craniosacral.

van der Kolk: Yep, they are.

Tippett: Isn't it strange how, in Western culture, in a field like psychotherapy - or even, I see this a lot in religion, in Western culture, we turn these things into these chin-up experiences. We separated ourselves. We divided ourselves. I see this - I mean, yoga is everywhere now, right? And people are discovering all kinds of ways, as you say; there are all kinds of other ways to reunite ourselves. But ...

van der Kolk: But it's true. Western culture is astoundingly disembodied, and uniquely so. The way I like to say is that we basically come from a post-alcoholic culture. If you feel bad, just take a swig or take a pill. And the notion that you can do things to change the harmony inside of yourself is just not something that we teach in schools and in our culture, in our churches, in our religious practices. And of course, if you look at religions around the world, they always start with dancing, moving, singing ...

Tippett: Movement, yeah, crying, laughing.

van der Kolk: ... physical experiences. And then, the more respectable people become, the more stiff they become, somehow.

[ music: "Scene of the Sunrise" by Miaou]

Tippett: After a short break, I catch up with Bessel van der Kolk in November 2021.

[ music: "Scene of the Sunrise" by Miaou]

I'm Krista Tippett, and this is On Being. The psychiatrist Bessel van der Kolk's work on the brain, the body, and the human reaction to overwhelming experience that we call trauma has met its moment. We've been hearing foundational insights from my first interview with him, when his now-famous book, The Body Keeps the Score, was just about to be published. For this second half, I caught up with him again to look at this moment through the unique lens of his training and perspective.

So it's wonderful to be able to have a new conversation with you now, in a world that has changed so radically from what, you know, if anyone had tried to describe this to us when we spoke years ago, that this is what 2021 would hold -

van der Kolk: Yeah, we're still sort of flabbergasted by these recent developments, and the world is a completely different place now and no longer a place that is trustworthy, in a way. The world is much more unsafe and unclear, and we don't know who's on our side, who's not on our side, who's telling the truth, who's not telling the truth - it's a very radical disintegration of something.

Tippett: Well, so some of the things that you notice through your work with trauma or - you know, the animal brain and the rational brain - you know, what you said to me those years ago is, the more upset you are, you shut down your rational part of your brain.

van der Kolk: That's right.

Tippett: And we've pretty much, to a person, been really upset now for a long time, right? [ laughs] I mean, some of us, some of us have had firmer, steadier ground beneath our feet, but, you know, I've thought about this protracted uncertainty, which our bodies do not do well with. And our animal brains do not - it wreaks havoc with our animal brains, right? I've almost felt like that is, again, maybe perhaps not trauma, but traumatizing. I don't know.

van der Kolk: It is something. I'm not ready to put it in the category of trauma, which is a radical transformation.

It's interesting - since I wrote my book and since I talked to you, I'm much more in touch, although we touched on it last time we talked, also, about the power of feeling taken care of and feeling believed, and that it's possible to survive just about anything, as long as you have - the people who are important to you are on your side. People believe you, and people are there for you, and if things get too much, people say, "I'll cook tonight. I'll take care of you."

And that synchronicity between us and other people is much at the core of resistance through trauma, and makes us very vulnerable to become much more overwhelmed by all kind of stuff. It's very much - I put it more in my notion about attachments and our monkey nature, which is that we are meant to live in troops and fleece each other and run from branch to branch and just do stuff together. And it's also essential primate nature of us that's getting assaulted right now.

And that's different from trauma. It's another dimension. They have to do with each other, but it's not so specific. You know, the nice thing about trauma, if there's such a thing as a nice thing about trauma, is that you can process the memory and leave it behind. If a particular thing happens, you can help the mind and the brain to say, Yes, it happened, but it happened a long time ago.

And right now we are living in a world that nothing belongs to the past. And it sort of keeps coming up and keeps coming up. And our political situation is just terrifying. People cannot get it together to say, let's take care of ourselves.

Tippett: I was thinking about this notion of memory and what you know through trauma, and how - the primacy of that. I remember you tell this story, you described a veteran as a "living testimonial to his memories" - to something that had happened, which was no longer happening but utterly defined him, as kind of a visual definition of trauma, but then also how what you also know is that what happens when health comes, or restoration, is that memories become integrated and transformed into stories that help us make sense.

But I wonder, is it possible to help tend and steward the formation of those memories that will help make sense? Are there techniques for that that we could be turning to now, communally and individually?

van der Kolk: The way that people overcome events of the past is to be still enough and have an alternative experience, so they can say, Oh, right; now I feel different, and that's different from when I saw my best friends getting killed or whatever - that you viscerally know the difference; say, That is a terrible moment in my life, when I was 18 years old or four years old, whatever.

But it's only if you have an experience of being different, of, I am safe now; my body feels relaxed now. And I think this ongoing, low-level threat that we all live right now -

Tippett: Yeah, we're not getting there. We're not getting there.

van der Kolk: No, so I think that people with prior history of trauma have a much harder time right now. There's a tremendous increase in domestic violence and in child abuse, of people not feeling safe with each other anymore and not being able to do the sort of things that makes your body feel safe, like going to the movies, [ laughs] - very simple stuff, you know, standing on line to get an ice cream - just that sort of - how we move rhythmically, with other people.

Tippett: That creaturely experience that you're describing.

van der Kolk: And most people choose to live in the context of other people. Very few people move to shacks and turn out to be all by themselves. That's not our natural state.

Tippett: I think something you just said about - oh gosh, my pandemic brain just clicked in. [ laughs] OK, what did you - you said - oh yeah. You just mentioned the people who have prior trauma. When an experience like this comes along, those things surface again, right? So then you have these multiple layers. I just feel like that is important for people to know.

van der Kolk: Yeah, and these things -it's not the memories, it's the reactions, the embodied trauma that you still live in your body. You're more likely to get triggered into being really angry or being upset or shutting down. I think any relationship that actually survives right now, with the pandemic - of having nobody else to talk to and being in the same place all the time, putting up with your own fragility, idiosyncrasies - takes an enormous amount of psychological power, actually, to maintain peace and thoughtfulness when you're just locked up with somebody.

Tippett: I think it is fascinating that, for you, the trauma discussion, or the insights of this for our time, have as much to do with the political, social, kind of civic container that we're in as with the virus, the illness, the death, the ecological rupture, the racial rupture. But for you, it's - somehow, what's driving all of that to a deeper level of what you might call trauma, for certain people and for us communally, is, are the structures of our life together.

van der Kolk: Right, and that very resonates with my clinical work. The vast majority of people who I see, and I've seen over the years, are traumatized within their own social context, by people who were supposed to love them and look after them. And the great hurt, actually, is not the event itself, but the fact that nobody is standing up for you, and nobody comes to your help, and nobody says, "That's just terrible," and nobody gives you justice. The issue of people needing to know that justice will be done or fairness will be happening is terribly important for all of us, to survive in the networks that we live in. And if you can't trust the network around you anymore, it gets to be very bad.

Tippett: That's so -

van der Kolk: And of course, the upside of this whole thing is also that, under extreme conditions, people start feeling very close together. And so part of what I've seen, also in medical settings, again, is that people who have worked together to take care of COVID patients are very tight with each other and very supportive of each other. Of course, that's always part of what happens, that the network closes in around you to make you all survive.

And I think many of us have also experienced that in our personal friendship network, where somehow I feel more warmth towards my friends than I was aware of before. I'm more happy, when I see a familiar face of people I've spent time with, than I've ever appreciated before.

Tippett: Yeah, I've had that experience, too, and of some friendships just radically deepened, and not necessarily the ones I would've expected to be radically deepened.

van der Kolk: Right. We all say negative things about Zooming and stuff, but you know, my family was very deeply affected by the pandemic in 1918, 1919. It was devastating. And I think about them all the time. They didn't have Zooms. They didn't have telephones. They couldn't stay in touch with people. And I think about how much worse it must have been for people back there - and I know, because my parents were very, very hurt people, as a consequence - and how great it is that I speak to my friends in Australia once a week, and I speak to my friends in San Francisco every other week. And there's still that capacity to see each other's faces and to still have your heart open to people around you. So let's not say all negative things about Zoom, because it has made a tremendous difference for the better, also.
[music: "Frontiers" by Floratone]
Tippett: I'm Krista Tippett, and this is On Being, today with psychiatrist Bessel van der Kolk, on trauma, the body, and 2021.
[music: "Frontiers" by Floratone]
You know, one thing I said in the script for the show we did before is, I - this was at the top of the show. I said, "A conversation with this psychiatrist is a surprisingly joyful thing," [ laughs] because I feel like you always have held that, that when you are speaking of trauma, you're also investigating resilience, right? You're investigating what can be redemptive, and the complexity of memory and our need for others, and how our brains take care of our bodies. I wonder, are there nuances of things you already knew about human beings and our bodies and our minds that, both being a - [ laughs] an involuntary participant in this pandemic world, but also observing it as you have, in working with patients, are there ways in which your understanding of things and the work you do has been nuanced and illuminated by this experience?

van der Kolk: Yeah, you know, a very big part of my endeavors over the past few years has been in psychedelic therapy. So that's sort of gone together with the whole pandemic. And those experiences have been in person, particularly after people have been vaccinated and they're very careful with each other. And it brought home in such a profound way that it's not in our cognition; that we need to - we're able to go very deep inside of ourselves, if we feel safe with the people around us.

Let me tell you about an experience I had recently. As part of my psychedelic world, I have to take psychedelics, myself, and it's legal, actually, for me to do so. And ...

Tippett: Because you're working therapeutically, with the ...

van der Kolk: Yeah, and because I have a license, actually, to do research. In my last podcast with you, I mentioned how I was this very sickly child - actually, I just listened to it again - and how I had no memory of the imprint of that. In my last experience, actually, I experienced in a very deep way what that little boy went through, who was starving and his mom was not there for him. And I had a tremendous sense of compassion for, oh my God, what that little boy went through. And the people around me were also extremely attuned. And it sort of took care of something so subliminal inside of myself that I think it's produced quite a significant transformation inside myself, in terms of that I don't feel deprived. I don't feel that there's a deficit anymore.

So as all this is going on, I'm also part of the world that's exploring very deep phenomena, human phenomena, that really, we have an enormous amount of presence. And you know, you always ask about spirituality. Now, if anything gets you in touch with the cosmic dimensions of ourselves, then it is these medications, these drugs that really do open ourselves to the mystery of the universe, and we end up feeling at once utterly insignificant and utterly precious at the same time.

So it's very curious, in the middle of all this, this really tough world that we live in, we're also discovering some new avenues that are like, wow, this has enormous potential to make a difference. I'm also very worried that it will be misused and, at the end, do harm again for people. But the potential certainly is there.

Tippett: I'm worried - I mean, I'm worried that it will not, it will only, that it will be more of an elite thing, you know. I'm worried that we have certain kinds of drugs that are ruining lives and killing people, and then these drugs. But I agree with you, also, that - and I think I was going to point at what you just pointed at - that it's a dramatic, it's just a dramatic, kind of, it's almost like, psychedelically dramatic age to be in, on every front. And there are so many things happening like this. There are these breakthroughs of us understanding how we can be more conscious, how we can be human in a way that is not on display, globally, politically or societally. And yet we are making these breakthroughs at the very same time, and that's the time we inhabit, too.

van der Kolk: Yeah, and, you know, people ask me, what do you think will happen? It's like, you know, after the First World War and the first pandemic, the world went crazy and we had flappers and drinking and bars and it just became this super frivolous world. After the Second World War, the world completely changed and started social democracies and social security and medical care for everybody. And so different disasters give very different, have different long-term outcomes, and we see all these things right now happening, of amazing breakthroughs. Like a friend of mine has survived lung cancer now for eight years, because of immunotherapy. That's completely untreatable, a few years ago. And stuff like that keeps happening. At the same time, our mother planet is dying, and we're killing it. And it's just, we know so much, and we are so stupid at the same time.

Tippett: Right. [ laughs] Yeah. I mean, I do feel that - when you and I first began speaking, you said you haven't really understood why everybody's reading your book or what effect it's having. I do think that there's a power to unleash compassion that maybe - you know, compassion doesn't yell, and it doesn't make headlines, and it's not screaming on social media. But I think when you help people understand what's happening inside their bodies and how wild that is, right - [ laughs]

van der Kolk: Yeah, but that's, again, the world they live in. I see people do amazing things all the time, you know?

Tippett: Right. And I think if they, if you start to understand what's going on inside you, and you realize that's going on inside other people ...

van der Kolk: That's right.

Tippett: ... that there's something in that that has a restorative force.

van der Kolk: Yeah. I think you touch on a very important thing that actually came out of our MDMA study. You know, it's a great thing about doing research. Things pop up, sometimes, that you didn't expect. And the big thing that came up was self-compassion. And the thing about being hurt is that when you feel hurt, you always hate yourself for getting hurt: I wasn't strong enough. I didn't resist enough. I didn't fight back. I didn't whatever. There's this deep sense of hating yourself for allowing whatever bad happened to you.

And we see that dissolve, in our current study. And once you don't hate yourself anymore, you don't project it onto other people any longer. And so projection is always a big issue. You know, we see it in politics all the time. The part of me that's unacceptable, I put on you.

What I am fascinated by is the question you ask, is - all this good and evil goes together. It's terribly important, and we know, I know people who do hula dancing in maximum security prisons. I know people who do vipassana meditation. I know people who do Shakespeare theater in prison systems and other systems. And there is so much creativity that's happening, actually. But it doesn't make the headlines. And so it's a very good question, is how do we highlight the many amazing things that are happening? And I keep being impressed how our culture, this strange American culture, still is a feeding ground for very creative ideas that keep coming up. And ...

Tippett: Yeah. Well, you're doing your part in that, and I'm -

van der Kolk: And you sure are, too. [ laughs]

Tippett: [ laughs] Well, thank you. It means a lot from you. And yeah, I appreciate you out there, and I'm really glad to have a chance to touch base again.

van der Kolk: Well, I hope that a year from now we actually have a better sense of putting all these weird pieces together, because it's - we all are living a very confusing world right now, something that we have never faced before in living memory. And whew, I hope we'll be clearer, a year from now.

Tippett: OK, well, let's hold on to that hope and make a plan to speak when we can talk about all the resilience and restoration that we've been doing.

van der Kolk: OK.
[music: "Enjoy the Calm" by Drew Barefoot]
Tippett: Bessel van der Kolk is the founder and medical director of the Trauma Research Foundation, in Brookline, Massachusetts. He's also a professor of psychiatry at Boston University Medical School. His books include Traumatic Stress: The Effects of Overwhelming Experience on the Mind, Body, and Society and The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
[music: "Trifle (Consoles Because a Trifle Troubles)" by Infradig]
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Bessel van der Kolk - Trauma, the Body, and 2021 | The On Being Project

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Krista Tippett, host: When I interviewed the psychiatrist Bessel van der Kolk for the first time, his book was about to be published. And I described him as "an innovator in treating the effects of overwhelming experiences on people and society" - what we call trauma, when we encounter it in life and in the news.

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Sean Pratt (Narrator), Bessel A. van der Kolk (Author), Penguin Audio (Publisher) & 0 more

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The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

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Amazon.com: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (Audible Audio Edition): Sean Pratt, Bessel A. van der Kolk, Penguin Audio: Audible Books & Originals

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It Didn't Start with You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle

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It Didn't Start with You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle - Kindle edition by Wolynn, Mark. Download it once and read it on your Kindle device, PC, phones or tablets.

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Mary-Frances O'Connor, Ph.D. - The Grieving Brain: How We Learn from Love and Loss

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Amazon.com: Widowish: A Memoir eBook : Gould, Melissa: Kindle Store

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Several days before Christmas 2003, John Gregory Dunne and Joan Didion saw their only daughter, Quintana, fall ill with what seemed at first flu, then pneumonia, then complete septic shock. She was put into an induced coma and placed on life support. Days later-the night before New Year's Eve-the Dunnes were just sitting down to dinner after visiting the hospital when John Gregory Dunne suffered a massive and fatal coronary. In a second, this close, symbiotic partnership of forty years was over. Four weeks later, their daughter pulled through. Two months after that, arriving at LAX, she collapsed and underwent six hours of brain surgery at UCLA Medical Center to relieve a massive hematoma.

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The Year of Magical Thinking [Didion, Joan] on Amazon.com. *FREE* shipping on qualifying offers. The Year of Magical Thinking

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Loss of a loved one is something everyone experiences, but we have had little scientific perspective on this universal experience. Renowned grief expert, neuroscientist, and psychologist Mary-Frances O'Connor shares groundbreaking discoveries about what happens in our brain when we grieve, providing a new paradigm for understanding love, loss, and learning. In this interview she also discusses her upcoming book, "The Grieving Brain: The Surprising Science of How We Learn from Love and Loss."

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Loss of a loved one is something everyone experiences, but we have had little scientific perspective on this universal experience. Renowned grief expert, neuroscientist, and psychologist Mary-Frances O'Connor shares groundbreaking discoveries about what happens in our brain when we grieve, providing a new paradigm for understanding love, loss, and learning.

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Health, Mental Health, and Social Services | Pillars Community Health

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Find links to our main services including health, mental health, domestic violence, child care, and more.

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For children - Sheilah A. Doyle Foundation

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For children - Sheilah A. Doyle Foundation

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The Sheilah A. Doyle Foundation is a 501(c)3 non-profit organization that provides support and assistance to children ages 7-17 whose parent, legal guardian, or sibling fell victim to homicide. Through our bereavement camp and our college scholarship program, we believe that we can transform a child's tragedy into a bright future.

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The Sheilah A. Doyle Foundation is a 501(c)3 non-profit organization that provides support and assistance to children ages 7-17 whose parent, legal guardian, or sibling fell victim to homicide. Through our bereavement camp and our college scholarship program, we believe that we can transform a child's tragedy into a bright future.

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GriefShare is a grief recovery support group where you can find help and healing for the hurt of losing a loved one.

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The Mission of Fox Valley Hands of Hope is to provide compassionate guidance and support for the grieving, at no cost to clients.

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Fox Valley Hands of Hope Home Page. Quality Grief Support at no cost to clients. Group programs, individual counseling, and family programs.

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Willow House is a non-profit, social service organization whose sole mission is to support children, families, schools & communities who are coping with grief.

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If you are a member (or a friend) of a family that has suffered the death of a child, The Compassionate Friends is here to help you and provide support for the family. Feel free to contact TCF's National Office at 877-969-0010 or nationaloffice@compassionatefriends.org if you need assistance in finding a local Chapter or you have any other questions.

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Click on the Chapter name to view additional Chapter contact information and meeting times.

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Chapter Meeting Locator - Compassionate Friends

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If you are a member (or a friend) of a family that has suffered the death of a child, The Compassionate Friends is here to help you and provide support for the family. Feel free to contact TCF's National Office at 877-969-0010 or nationaloffice@compassionatefriends.org if you need assistance in finding a local Chapter or you have any other questions.