In a 2005 radio interview, Joan Didion—author of A Year of Magical Thinking, a memoir about her husband’s fatal heart attack and her daughter’s ultimately fatal septic shock—was asked what advice was most helpful to her during this painful time in her life. Her somewhat surprising answer: “Emily Post.” Post’s 1922 book, Etiquette in Society, in Business, in Politics, and at Home, offered guidance because, Didion explained, “Death was still up close, still in everybody’s house. Everybody was still expected to know how to deal with it … But at some point after that, we medicalized death. We put it in the hospital. And around the same time, we stopped being able to look it in the eye. We stopped knowing what to do or say.”
Grief comes to us all. We all lose the people and the things we love. In the painful abyss of grief, we are neither better nor worse than anyone else. We feel the vulnerability of our own essential humanness—our need for comfort and our terror of being alone—and recognize in others a shared humanity. We need to know that grieving takes many forms, and might not follow prescribed patterns. And we also need to know that pushing away the emotional reality of grief is not helpful. The medicalization of death that Didion talked about is just one form of denial. Others include keeping our grief private or trying to ‘movie on.’
In the West, at least, we are used to thinking of grief as a highly personal experience with a largely individual process for healing. Yet new insights into the psychology of grief show how it can link us together, in families, in communities, even within and between ethnic groups. Since grief can be a shared experience, it makes sense that working through grief with others, can be a first step on the road towards healing.
But in order to let grief help us, we need to acknowledge what happens—to us and to others—when we avoid or deny grief. That means looking individual mourning in the eye to understand how unresolved personal grief can have a wider interpersonal impact. Then, perhaps, we can begin to undo the patterns that perpetuate collective grief and step into a compassionate recognition that one person’s suffering affects us all.
Grief is a highly complex constellation of emotional, cognitive, behavioral, and physical symptoms that occurs in response to loss. Grief comes to us in many ways, through definitive deaths as well as through hidden and ambiguous sorrows, such as the loss of health or the denial of opportunity. It comes through our personal tragedies and through witnessing the tears of others.
Most of us are familiar with the feelings, thoughts, and behaviors that come with grief—sadness, anger, guilt, depression, withdrawal, trouble sleeping, lack of motivation, and self-destructiveness. Physical experiences can range from chills, diarrhea, and fatigue to tremors, nausea, and tightness of the chest. Scientists at Johns Hopkins have even identified what they call “broken heart syndrome,” a surge of adrenalin and other stress hormones caused by shocking and unexpected loss, which in some cases can mimic the symptoms of a heart attack.
Sigmund Freud was an early student of grief. His 1917 paper Mourning and Melancholy described the necessary task of accepting the loss of someone or something to which you were attached. According to Freud, it was only through facing the reality that this attachment is irrevocably gone that an individual can re-attach to another object of love, and learn to relate to life again.
Psychiatrist Elizabeth Kubler-Ross wrote about the five stages of grief in the now classic On Death and Dying, published in 1969. Kubler-Ross originally intended the five stages—denial, anger, bargaining, depression, and acceptance—to apply to the process of dying itself, but some researchers observed that the bereaved also experienced these stages. Though most grief experts no longer believe there is a single pattern of mourning, Kubler-Ross’s insights have become an integral part of our modern understanding of what we experience in response to loss.
Most grief workers recognize that accepting the reality of one’s loss, and working through the disturbing emotional maelstrom that ensues, are prerequisites for regaining a willingness to live and to love. And they emphasize the role of community reflection and support, whether that means sharing grief with a therapist, a family member, a friend, or an entire nation. They also agree on something else—that our resistance to grief makes things much more complicated than if we face grief head on.
According to Gary Laderman, author of Rest in Peace: A Cultural History of Death and the Funeral Home in Twentieth-Century America, the medicalization of death was a product of a number of scientific and cultural changes in the early 20th century, including a dramatic increase in the number of hospitals. From 1873 to 1923, the number of hospitals in the U.S. rose 3,800 percent, and medical facilities displaced the home as the place where most people became sick and died. In hospitals, death was increasingly regarded as a failure to solve the problem of illness. As a result, how we mourned changed as well. We were no longer in the privacy and protection of a familiar environment—the parlor of our own house—but in an impersonal setting under the watchful eyes of professionals.
The practice of embalming, which became standard in the funerary business around the turn of the 20th century, further dissociated us from death. Funerary directors, like doctors, became authority figures and took over the mourning process, while embalming changed how the body felt, looked, and smelled. “It’s amazing how we can block out the truth of death,” says Frank Ostaseski, who founded Zen Hospice in 1987 and the Metta Institute in 2004, which are based in Northern California and offer educational programs about death, dying, and mourning. . “If you are surrounded by a family or a culture that says, ‘Don’t talk or think about it,’ it can hinder our capacity to acknowledge the loss.”
Viewing the body of the deceased can be a powerful way to face the truth of loss. If we miss this step, we might be more likely to remain in denial. One study of data collected between 2003-2007 by a researcher at the Department of Forensic Medicine at the University of New South Wales, Australia, found that participants who did not view the body of their deceased loved one had significantly higher trauma symptoms than those who did view the body. At Zen Hospice in San Francisco, which offered end of life care to the dying, Ostaseski found ways innovative ways to help people face deat. “When I ran the Hospice,” he says,“I would invite the family in to help bathe the body of someone who died,” he says.. “Sometimes, they were very frightened. But, inevitably, they would come in, bathe, come in contact with the body and with the reality of the death. If we hide death, we hinder grief.”
Another way we hinder grief, according to Pauline Boss, professor emeritus at the University of Minnesota and author of Ambiguous Loss and other books on stress and loss, isthrough our cultural insistence on closure and mastery–the assumption that if we work hard enough we can accomplish anything.. To allow grief to proceed, she says, we often have to learn to live with ambiguity and our own powerlessness.
For over 30 years, Boss has studied and aided individuals and families facing types of loss that make closure impossible—a parent with Alzheimer’s who is both physically present and emotionally absent, a family member who goes missing and is never located, a kidnapped child who is never found, a loved one who is the victim of a natural disaster or terrorist attack in which the body is never recovered. Boss calls such instances “ambiguous loss.” Her research began in 1971 with the families of U.S. soldiers who were missing in action in Vietnam and Laos. She has also worked with the families of the victims of 9/11.
To facilitate the grieving process, Boss encourages people to change how they think and feel about uncertainty rather than to focus on finding the truth, which is often impossible in cases of ambiguous loss. “I encourage people to use paradoxical thinking and speaking,” she explains. “For example, use ‘both/and’ language. If you are married to a man who has Alzheimer’s disease, you might say, ‘I am both married and a widow.’ This loosens the bonds of certainty, and relieves the stress of needing things to be one way or another.”
Boss explains that mastery-oriented individuals–those who are used to successful effort-based achievement–have an especially hard time with the feelings of powerlessness that come with grief. She cites advising Microsoft employees, whose colleague was lost at sea in 2007. Despite a relentless search, they never found the body. “These were the brightest and most intelligent individuals,” Boss says. “They were used to solving problems. But no matter how hard they tried, they could not solve this problem. Many told me they found the ‘both/and’ language helpful. They learned to say, ‘We both did our best to find him and yet we couldn’t find him.’ This reduced guilt, allowing them to move forward without having an answer.”
When grief remains unprocessed- whether because of our denial, avoidance, or inability to work through our emotions – some people can fall into a state of perpetual mourning called “complicated grief.” Complicated grief can last for years, undermine any renewed engagement with life, and contribute to a wide range of health complications.
Estimates on how many people suffer from complicated grief vary from between 15% and 20% of those surviving a loss, according to Katherine Shear, professor of psychiatry at Columbia University School of Social Work. “We think people with a history of mood or anxiety disorders, a history of multiple losses, and a history of difficult relationships with early caregivers may be risk factors, as well as violent or untimely circumstances of death.” Shear says. “There are circumstances of loss that are egregious that are certainly more difficult to process.”. Signs of complicated grief can include disbelief about a loss, anger and bitterness, and a continual focus on—and an intense longing for—the deceased, and can potentially lead to major depression and anxiety. It can also increase the risk of heart disease, cancer, and high blood pressure as well as produce symptoms similar to those of post-traumatic stress disorder.
Studies carried out by a team of neurologists and psychiatrists at UCLA show that complicated grief can take on the characteristics of an almost addictive yearning. The UCLA researchers found that complicated grief turns on the nucleus accumbens, a part of the brain associated with feelings of reward and longing that is also active in people with addictions. The study involved 23 women, 11 with complicated grief and 12 with conventional grief. When shown pictures of their deceased loved ones, the brains of both groups of women showed activity in regions associated with feelings of physical and emotional pain. But the nucleus accumbens was active only in the women with complicated grief.
Researchers agree that complicated grief calls for different treatment and support methods than normal grief. Because it is often linked to trauma, treatments that help with post-traumatic stress disorder can be effective, such as retelling the story of the loss in a safe setting. In one study carried out by Shear and colleagues, complicated grief was effectively treated in part through “revisiting” exercises, in which sufferers recorded their stories and then listened to them later, which helps create a sense of positive connection with the deceased Complicated grief treatment also includes focusing on the future to help sufferers reengage with life.
Complicated grief can affect not just individuals but entire cultures when it is passed through generations. , The Encyclopedia of Multicultural Psychology defines “historical “grief” as “unresolved, dysfunctional grieving of historical losses that interferes with an individual’s well-being,” and links historical grief to historical trauma – “an inter-generationally transmitted cluster of trauma symptoms experienced by members of an ethnic group or community whose history includes severe and cataclysmic trauma, such as genocide.”
Psychoanalytic thinkers first developed theories about inter-generational grief during case studies involving the children of Holocaust survivors. The children showed symptoms similar to those of their parents, despite not having lived through the events themselves. One study found, for example, that the incidence of post-traumatic stress disorder among Holocaust descendants was 31%; among comparison groups, it was 15%. Similar patterns of inherited grief have been found among the children of African-Americans suffering the aftermath of slavery and Japanese-Americans interred at the beginning of World War II.
Maria Yellow Horse Brave Heart, an Oglala Lakota and associate professor of social work at Columbia University, has identified inter-generational grief and its effects among Native Americans. She cites the 1890 Wounded Knee massacre, in which hundreds of Lakota were killed and thrown into mass graves, the forced displacements, and the government-run boarding schools in which physical and sexual abuse were common as major factors in Native American historical trauma.
According to Brave Heart, the historical trauma suffered by Native Americans contributes to symptoms including grief, depression, anxiety, anger, low self-esteem, substance abuse, and other self-harming behaviors. The prevalence of post-traumatic stress disorder among Native Americans and Alaska Natives, for example, is 22%; for the general population, it is 8%. She also suggests that type II diabetes, common among Native Americans, can be explained in part by the stress hormones that the traumas induced. The extreme impact of these cumulative traumas made it near impossible to grieve each event fully, and ceremonies that could have helped individuals and communities grieve were also banned until the American Indian Religious Freedom Act of 1978.
The U.S. government established boarding schools for Native Americans in 1878 as part of a wide-spread policy of extinguishing indigenous culture. The imperative of the schools, as set forth by Captain Richard H. Pratt in a 1892 speech, was to “kill the Indian, save the man.”.. Tiokasin Ghosthorse experienced the schools first-hand. As a child from 1963 to 1969, Ghosthorse—a Lakota from the Cheyenne River reservation, and now produces and hosts the New York-based First Voices Indigenous Radio station—was forced to attend three different missionary boarding schools where he was routinely burned with cigarettes, beaten, and sexually abused. The effects of the abuse were made even worse, according to Ghosthorse, because his mother had also been a student at a boarding school but refused to discuss it. “Those experiences are passed on without us even knowing it,” he says. “It is still with all of us, even the young ones now, 130 years later, reverberating.”
For Ghosthorse, healing began in the late 1980s after )a failed suicide attempt. He wandered into a river in Washington State in the middle of winter, trying to drown himself in the freezing water. He walked out to a marker showing a 22-foot depth, but was confused when he arrived at the marker and was only in water up to his knees. Dazed, he climbed the riverbank and saw a sweatlodge, a traditional sacred space used in ceremony, in which he wrapped himself in cardboard and slept for four days. When he awoke, he felt a renewed commitment to healing, which has included re-connecting with his Lakota roots, language, and cultural traditions.
“It’s both important and ideal for educational and healing programs to have a strong Native cultural foundation” says Brave Heart, who founded the Takini Network, a collective of Native American health professionals, to help address historical grief in 1992 Takini Network workshops are led by Native Americans and include traditional ceremonies held in sacred spaces, such as the Black Hills of South Dakota, to emphasize the wisdom and healing power of Native American spirituality – “the first peoples of this nation” she says
Eckhart Tolle, a spiritual teacher from Germany, offers an esoteric description of how we are all connected through unresolved suffering: “The remnants of pain left behind by every strong negative emotion that is not fully faced, accepted, and then let go of join together to form an energy field that lives in the very cells of your body,” he writes in The New Earth. This “pain body,” as he calls it, is largely unconscious, living through individual and collective violence and, according to Tolle, is stronger in some groups—like Jews, African Americans, and Native Americans—and in some regions. Since the pain body is largely unconscious, the key to undoing these patterns is to become more conscious and present.
Sandra Ingerman, a shamanic practitioner for 25 years and author of six books on shamanism and healing, including Medicine for the Earth, suggests conscious acknowledgment is an important first step: “When we start becoming aware of a problem and begin to say, ‘We are part of this; this needs healing by all of us,’ we will be given ways to heal,” she says. “But it won’t appear until there is a conscious acknowledgement that we have not treated each other or the earth well.”
Jann Derrick, a Mohawk family therapist who founded the Four Winds Wellness and Education Center in British Columbia, had no idea how powerful acknowledgement could be until last year, when Canadian Prime Minister Stephen Harper apologized to Canada’s First Nations People for their treatment by the Canadian government.
Like Australia and the U.S., Canada placed First Nations children in missionary-run boarding schools to eradicate native culture and identity. The Canadian apology was made as part of a larger national effort that began ten years earlier, and included nearly $TK billion ($2 BILLION CANADIAN) in reparations for survivors of the school children and a variety of reconciliation projects. Hearings on individual abuses are still under way, and the hearings themselves are a way to acknowledge and heal the grief in a public setting. “After the government apology,” Derrick says, “someone said to me, ‘We can stop being angry now. They know what they have done. Now we need to learn to be parents again.’ There was a feeling we could leave this behind us and move forward.”
If acknowledgment is the first step towards healing, the next step is less clear – keeping with grief’s unpredictable nature. But most likely it will include bringing people together in ways that reflect our equal value and shared humanity.. s. Ingerman tells a simple story of traveling to Germany to give a workshop: “I’m Jewish, and I was always terrified of going to Germany. During one trip, I was part of a ceremony with a descendent of a Gestapo guard. Suddenly, I had the epiphany that we are all just people. The barrier between this woman and me was gone. I was never afraid of going to Germany after that.”
Uniting with others—even with former ‘enemies’—can help heal the grief of historical trauma. The non-profit To Reflect and Trust (TRT) was founded in 1992 by Dan Bar-on, a psychologist at Ben Gurion University in Israel, initially to bring together descendents of Nazi perpetrators and descendents of Holocaust survivors to share stories and develop understanding. Today, TRT has groups for South Africans, Northern Ireland’s Catholics and Protestants, and Israelis and Palestinians. Group meetingss are flexible in format, but are all built around the power of storytelling to help individuals work through their emotions and begin to heal.
Healing our personal grief, much less the historical grief of whole cultures, can seem like a daunting task. But denial only feeds grief’s fury, and prolongs our pain. Grief can be good, if we give it its proper place. “I was teaching in the rural northwest,” Frank Ostaseski recalls, “and a man present said, ‘Grief is like telephone poles!’ I asked him to explain, and he said: ‘I used to install telephone poles, and they can shake and sometimes they can fall. I told my partner that I would run if the pole started to fall. But he said, No, if it starts to fall, the safest thing to do is to head toward it and stand right up against it.’ With grief, the healing is always found in the middle of the suffering; the only safe place to be with both hands right on it.