In the February 1, 2010,
The New Yorker, Meghan O'Rourke asks if there is a better way to be bereaved. O'Rourke frames her piece around Elisabeth Kubler-Ross, the Swiss psychiatrist, who in 1964 started lecturing on death. "Death, [Kubler-Ross] felt, had been exiled from medicine."
Her argument was that patients often knew that they were dying, and preferred to have others acknowledge their situation: “The patient is in the process of losing everything and everybody he loves. If he is allowed to express his sorrow he will find a final acceptance much easier.” And she posited that the dying underwent five stages: denial, anger, bargaining, depression, and acceptance.
I've been in grief therapy for more than three years. I'm not as hung up (or put off) by the grief stages as others. I understand them as useful metaphors. In my therapy, Dr. Gail Giacalone, talked about 7 stages--the first three of which are shock, confused thinking, emotional tumult. I'm paraphrasing. I was taught that these three phases can occur on top of each other--which my experience confirms. I don't recall what the other 4 stages are any more.
O'Rourke writes:
Today, Kübler-Ross’s theory is taken as the definitive account of how we grieve. It pervades pop culture—the opening episodes of this season’s “Grey’s Anatomy” were structured around the five stages—and it shapes our interactions with the bereaved.
Scientists have found that grief, like fear, is a stress reaction, attended by deep physiological changes. Levels of stress hormones like cortisol increase. Sleep patterns are disrupted. The immune system is weakened. Mourners may experience loss of appetite, palpitations, even hallucinations. They sometimes imagine that the deceased has appeared to them, in the form of a bird, say, or a cat. It is not unusual for a mourner to talk out loud—to cry out—to a lost one, in an elevator, or while walking the dog.
Additional studies suggest that grief comes in waves, welling up and dominating your emotional life, then subsiding, only to recur. As George A. Bonanno, a clinical psychologist at Columbia University, writes in “The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss” (Basic; $25.95), “When we look more closely at the emotional experiences of bereaved people over time, the level of fluctuation is nothing short of spectacular.” This oscillation, he theorizes, offers relief from the stress grief creates. “Sorrow . . . turns out to be
not a state but a process,” C. S. Lewis wrote in 1961. “It needs not a map but a history.”
This "grief comes in waves" idea was very useful to me. When I saw the six, nine foot swells cresting, it was useful for me to know that it would pass, recede. When you body surf you lose if you fight the water. You can't possibly be strong enough to stop it. It was equally useful for me to know the wave would come again.
O'Rourke continues:
To say that grief recurs is not to say that it necessarily cripples.
Even Bonanno, trying to offer a neutral clinical description of grief, betrays how deeply he has bought into the muscle-through-it idea when he describes a patient who let sad feelings “bubble up” only when she could “afford to.” Many mourners experience grief as a kind of isolation—one that is exacerbated by the fact that one’s peers, neighbors, and co-workers may not really want to know how you are. We’ve adopted a sort of “ask, don’t tell” policy. The question “How are you?” is an expression of concern, but mourners quickly figure out that it shouldn’t be mistaken for
an actual inquiry.
Another thing Dr. Giacalone made sure I understood: "Bill, no one walks in your shoes," "everyone grieves in their own way, in their own time." Some people would be good at showing sympathy, others would be awful. Some wouldn't be able to engage at all. In my case, some close friends took more than a year to get past the cliche. There are others, even today, who haven't spoken to me. I know the silent ones were hurting, may still hurt.
Meanwhile, the American Psychiatric Association is considering adding “complicated grief” to the fifth edition of its DSM (the Diagnostic and Statistical Manual of Mental Disorders). Certainly, some mourners need more than the loving support of friends and family. But making a disease of grief may be another sign of a huge, and potentially pernicious, shift that took place in the West over the past century—what we might call the privatization of grief.
This is a topic I would love to discuss with O'Rourke. I want to make sure we know what is the forest and what are the trees. Grief therapy is useful. If having a code for it in the DSM helps medical insurance cover it, that is good. That is not the same thing as making it a disease. Well-baby visits are covered by insurance. Getting your teeth cleaned every six months is covered. There should be mechanisms in place to encourage preventative care.
The other point O'Rourke is making in the quote above, and probably the one more important to her, is the "privatization of grief." Here I agree. Community, friends, family are very important. Even as the bereaved is wanting isolation, and is pushing people away, it is still a comfort to know there are people in the next room. One of the more special things friends did for me was to bring me dinners for months afterwards.
Even a good death is seldom good for the survivors .... In [Emily Dickinson's] poem “
I Measure Every Grief I Meet,” the speaker’s curiosity about other people’s grief is a way of conveying how heavy her own is:
I wonder if It weighs like Mine—
Or has an Easier size.
I wonder if They bore it long—
Or did it just begin—
I could not tell the Date of Mine—
It feels so old a pain—
I wonder if it hurts to live—
And if They have to try—
And whether—could They choose between—
It would not be—to die.
Listen to
O'Rourke talk about her piece with
The New Yorker's Blake Eskin:
Libby read Naomi Shihab Nye's poem,
Kindness, at Jack's memorial service. Here's a link to
Kindness from Garrison Kieller's
Writers Almanac on NPR. I've excerpted this:
Then it is only kindness that makes sense anymore,
only kindness that ties your shoes
and sends you out into the day to mail letters and purchase bread,
only kindness that raises its head
from the crowd of the world to say
it is I you have been looking for,
and then goes with you everywhere
like a shadow or a friend.
I have to say I don't like Kieller's voice reading the poem, so you can skip that.