By Amanda Stern
I was all set to publish a different piece for this week. But, it didn't feel right not to address the massacre last week at the elementary school in Uvalde, Texas, and the grief many of us are grappling with.
I have not fully processed my feelings of rage and helplessness. Still, I can offer a transcription of a profound conversation I had about grief with *Dr. Mary-Frances O' Connor, a scientist, and psychologist who has pioneered the field of grief research in the U.S. We spoke two hours before we'd learned about the shooting at Robb Elementary School.
(Dr. O' Connor contributed to getting "Prolonged Grief Disorder" listed in the DSM, which has proven quite controversial.)
O'Connor recently published The Grieving Brain: The Surprising Science of How We Learn from Love and Loss, an examination of grief from the brain's point of view.
This book has helped so many who are grasping to make sense of loss, and I recommend it now, hoping that it will offer insights, solace, or even answers.
*full bio at the end.
I APOLOGIZE IN ADVANCE FOR THE LENGTH OF THIS PARTICULAR POST. It's hard to edit things out when everything feels essential.
AS = Amanda Stern
MOC = Mary-Frances O’Connor
I’ve transcribed the conversation between us, lightly editing for clarity and (believe it or not—length.)
The original conversation can be seen here if that's preferable:
A CONVERSATION ABOUT GRIEF AND GRIEVING with DR. MARY-FRANCES O' CONNOR
AS: Hi there, Dr. O'Connor, thank you so much for for joining me here on StreamYard, where faces are flipped and everyone's disconcerted.
(*StreamYard is a third-party app I sometimes use for live streaming conversations and they don’t mirror your face, it's flipped—very upsetting for some people’s faces!)
MOC: It's so nice of you to have me. Just call me Mary-Frances.
AS: Okay, will do! So, you're a clinical psychologist and a scientist?
MOC: Yes, that's right. Clinical psychologist by training and then researcher and neuroscience as well.
AS: Me too.
Kidding.
You also run the Grief Loss and Social Stress Lab, whose acronym is GLASS, in Arizona.
MOC: Yes. University of Arizona.
AS: Your profession has been to help shape the direction of the field of grief research. Is that accurate?
MOC: Yeah, I would say that's accurate. By studying and producing knowledge, and understanding what people are going through, part of the role is also to say, what are some of the important questions? And then how would we go about asking those and answering them?
AS: And how do you decide what the important questions are?
MOC: That's a great question. It happens with lots of different influences. This is one of the reasons that it's so important that grief research has kind of reached a critical mass.
When I was first starting out, people were like, Oh, you're the grief researcher. And now it's like, Oh, you're in the grief research field! which is a really different place for us to be as a society, because you have lots of different perspectives from people weighing in on the important questions.
AS: And how big is the grief research field?
MOC: It's still very, very small. There aren't many of us who really devote our whole career, or whole research program to studying grief, even if there are people who've maybe done a study or two because they also study older adults, or they study loneliness or depression.
There aren't that many of us, but we're an international group, which is also really exciting.
We're able to think about grief and grieving in terms of different cultures and different points in history. And, how do we understand that all together?
AS: I mean, it's really incredible–you're one of the essential people in the grief field, you're really helping to bring a conversation that we don't have, into the public arena and to the general public.
It's a big question, but I do want to ask why you think we don't talk about death in our culture. We treat it like it's contagious, which it is–to a degree, but what is this phenomenon? Can you help us understand that a bit?
MOC: You know, I think it stems from a few different places.
I think death is really hard to talk about. Death is very anxiety provoking, and to really talk about grief, you ultimately end up having some kind of conversation about death, and people aren't usually prepared to feel those big emotions that come along with that fear and terror, but I would say as well, we are a society that has become more and more diverse.
We're not all Protestant anymore, for example. We don't all have the same perspective on what happens.
This means that a lot of our rituals have changed, and our ways of understanding. So, there can be fewer points of connection there. But also, we have the residual Puritan influence.
I think there are lots of reasons, but I would say, honestly, that it has changed so much in the past 20 years. Even in the past five years, so many more of these conversations are happening.
Part of writing the book, genuinely, was that I realized there was research going on that wasn't getting into the hands of people who could actually apply it to their own life.
AS: We all need it, just like we all need to learn about emotion.
They should be teaching classes on how to live and how to be a human being in school, and they should also be teaching classes on death and dying. [I meant in high school, but didn't manage to make that clear]
I think maybe you froze.
So, we just lost Mary-Frances during a conversation about loss…
WE ARE INTERRUPTED BY THE MOST ANXIETY-PRODUCING OF ALL LIVE-ONLINE OCCURRENCES....The frozen guest. I remove Mary-Frances, and she returns.
AS: [Cont’d] You’re back! Phew. Okay. I was just saying that we don't teach kids how to live or what it means to be a human being, and part of that is teaching death.
MOC: I do teach a psychology of death and loss class.
AS: I know, and I really want to take it!
Here's my other big question. Is grief an emotion?
MOC: Ah, that is a great question.
I think of grief as the natural response to loss, often the loss of a loved one.
But the response actually happens in lots of different channels, right? So, emotion is certainly one of them. We think of that most often when we think of grief, but even those emotions encompass sadness, and also guilt and anger and anxiety and yearning....There’s a whole range of emotions that are all part of grief.
But in addition, there are thoughts that come along with it, all those thoughts keep running through your head or intruding on your day-to-day life. And there's also what we would call physiological reactions: your body also reacts to the death of a loved one; your heart rate tends to go up a little bit, and your blood pressure tends to go up a little bit–especially at first.
It's a full body, full mind response.
AS: I was really surprised to learn that emotion doesn't activate the amygdala, which–for those who don’t know–is known as the fear center; it’s the little almond-shaped nugget on both sides of our brain that process emotion.
And, apparently, grief does not travel there.
MOC: it's interesting, none of my studies have ever shown activation in that region.
There is a more recent study that's come out that shows some activation in the amygdala.
Part of it is what we’re asking people to do when they're in the scanner. They bring photos of the person who has died and when they’re lying in the MRI scanner, they look at the photos.
We’re watching what brain activation is happening as they're looking at the photo.
The amygdala has to do with lots of different emotions, especially around threat and fear. And while we often have anxiety when we experience grief, the moment of that wave of grief is very often associated with sadness and yearning.
And so, I think, if we looked at people who had a lot of anxiety, and they were grieving, we might see more of it. I think there's still a lot of research to be done.
AS: I know everyone's going to read this book coming from their own personal perspective and wanting answers to the questions that are driving their lives.
And my life has been driven since infant-hood by panic attacks and separation anxiety. I grew up with an anxiety disorder, and when people ask about it, I often say that I have spent my life grieving, because that's what it feels like.
And so, I was really interested in learning about all the separate emotions that feel like grief, but aren't grief.
MOC: I think of it this way: First, you have a bond.
When you fall in love with your spouse, or you fall in love with your child–your baby, you create this bond in the brain, and it's like a physical thing in your brain–the way that proteins are folded, and neurons are connected.
And then if that person dies, you have this loss experience, and what's important about that to me is that having loss means a lot of things, it can mean sadness, but it can also mean anxiety and guilt.
They're all a part of loss.
Do you know what I mean? And so that's why it's so varied. But I would say also that there is an element of it that's a lot like panic.
In fact, one of the neuroscientists who studied separation in animals, he called it the Grief-Panic System. And if you think about it this way, once you're bonded to someone, like… you're in the grocery store, and you turn around and your toddler is not next to the cart.
That absolute panic of separation, that is one part of the system, right? The whole goal is to keep you with your loved ones, because they're so important to us.
Once you form that “we” and then you are separated from them, that panic is a very natural part of the reaction to that separation, and in the case of a death, then that reaction to a loss.
AS: Yeah. You know, in your book you ask this question, or people ask this question: Why does grief hurt? Or why does it last so longer?
Which, on its face, sounds like a preposterous question. But if you really think about it, you're like, wait–that’s really fascinating.
You talk about virtual mapping in the brain and I was hoping you could talk about that and explain that to people.
The reason that grieving takes so long is the grieving is a form of learning. And your brain literally has to update every single prediction to predict their absence instead of their presence. And it takes a long time for you to understand what that means.
MOC: In evolution, once we got to social mammals, like human beings are, we had this problem we had to deal with. We need our loved ones as much as we need food and water, right? An infant does not survive if there is not someone caring for it all the time.
And spouses do not function well in the world, unless they know where each other are. So the problem that we faced then was, how do you keep track of other human beings that move around?
And in fact, we want them, we need them to go search for food, or go to work in the morning. So, we need to have this flexibility where there is both the ability to be separated, and also the deep knowledge that you'll be back together again.
And so we spend a lot of time mapping where our loved ones are. If I say to you right now, "Do you know where your boyfriend or girlfriend is?" You could probably figure out pretty quickly how to get to them.
We spend a lot of time updating that information.
So here's the problem…
Yearning is supposed to bring us back together. That's how the system is supposed to work. When a loved one dies, the solution your brain has is to go get them.
But that solution doesn't work anymore.
It's not actually that they're lost.
There's nothing wrong with the map, it's that the map doesn't exist anymore.
And that is very disorienting for a person.
The reason that grieving takes so long is that grieving is a form of learning. And your brain literally has to update every single prediction to predict their absence instead of their presence. And it takes a long time for you to understand what that means.
AS: Yeah, that makes so much sense. You give an example in the book, and it's so minor, but it's so powerful.
I'm going to bungle it, but it's something about getting up in the middle of the night to go to the bathroom, and as you’re walking you automatically shift your body to allow for the chair you know is right there, but one night the chair’s not there.
Your body is automatically shifting to make space for the thing that has always been there, and suddenly it’s gone; yet, your body is still performing as though it still exists.
MOC: It’s fascinating to think that you can respond to the absence of something.
Like there’s no physical chair there, but it used to be there, and so you're actually reacting to its absence. I think it’s a great analogy.
AS: Yeah, I do too. How do you measure absence? What’s happening in the brain due to absence? I have no idea. Is there an answer to that?
MOC: We have a lot of different ways of getting at it.
Some neuroscientists actually study animals that pair bond, that mate for life. And so, it's an even more interesting question.
I mean, at least when you're doing human research, you can ask “How much have you been yearning for this person?”
Or:
“Do you feel like part of yourself is missing?”
We can at least ask those questions.
But for animal researchers, they can't even ask those questions. And yet, we see these stress responses that look like grief in these pair-bonded animals.
They do other things that I think are really interesting, like, looking to see when a pair-bonded animal, whose partner has died, when are they willing to interact with another possible partner?
Or, how hard would they work to get back to the loved one they've been separated from, the mate they've been separated from, because that willingness to do difficult things in order to have the reward of being with your loved one, is a kind of yearning, isn't it?
It's kind of a quantitative measure of how much you're yearning to be with them.
AS: You also talked about the difference between grief and grieving, which I think would be really helpful for people to understand.
MOC: I found this to be very useful. As I was doing research, I realized, “Wait, what is it exactly that I'm studying?” And that led me to really make the distinction, and then I realized it helped other people too.
So, here's the distinction. Grief is the response. It's that wave that overtakes you where you feel sadness or anxiety, but it's in the moment. That wave comes and eventually it recedes.
Grieving on the other hand, is the way that grief changes over time, without ever going away.
And so what I mean by that is, initially, when we are in that first acute grief point, those waves just keep coming, right? It's like you just can't get away from them.
And over weeks and months and years, those waves of grief come less frequently. And they're often a little bit less intense than they were. And so, we know, that there are these changes, or the waves begin to feel more familiar, right?
The first 100 times you have this wave of grief, you think, oh my god, I'm not gonna get through this moment.
But the 101st time you sort of start to feel like, okay, I really hate this, but I do recognize it. And maybe to some degree, you start to even know how you might comfort yourself in those moments.
So it's that change over time that is grieving. And you can have moments of grief decades after you've lost someone.
My sister is engaged, for example, and I know on her wedding day, we are going to feel grief, because my parents aren't there. There's nothing wrong with our grieving.
It's just in that moment, you're very aware of their loss, of their absence. And so we will have waves of grief. It doesn't mean there's any problem with the grieving that's happened up to that point.
AS: So grieving itself is the process, the trajectory, and grief is the momentary expression.
MOC: That's right.
AS: In the book, you talk about the three dimensions: here, now, and close. Can you explain what this means?
MOC: When we are little, when we're infants even, we have to be physically touching our caregiver to know that they're there, right?
We don't have the brain capacity to know much beyond what’s in our immediate presence. As a child develops, they come to understand that mom or dad–even when they're not visible to me–they still exist, they still care, they still love me, they're going to come back.
So even when they're not in the room, or even when they have gone to the grocery store, they're going to come back so that here and now we sort of develop this virtual world where we understand they're out there somewhere. Right?
I think the easiest way to think about this dimension is how we talk about it in regular life where I might say, “So how close are you and your sister?”
The answer to that has you assessing the closeness dimension. Well, what's so interesting is it turns out that the brain is using these different dimensions to map where our loved ones are.
So, we might know they're on a trip, and that's the here dimension–they're not here. But we know when they're coming home, right? So that's the now dimension.
But It feels very different when they're on a trip, and you had an argument the night before they left.
Or if you had a great dinner the night before they left and you feel really close with them. So that is another dimension that we are always assessing. How can I trust when they’ll be back and what it will be like when we're together?
AS: Is the brain simply unable to process the concept that a person is just no longer on the face of this earth?
MOC: Well, this is the amazing thing about the brain. I mean, the brain is just a miraculous organ.
It is true that we keep this attachment belief–they are out there somewhere for us, they are our one and only. We can have that stream of information at the same time as we actually have other streams of information.
We can call on the memory of being there, at the bedside, you know, when our loved one was dying, or getting that terrible phone call, right?
There are multiple streams of information and they don't fit together. They don't make sense, right? And so, I think, that's part of what takes so long and is so upsetting is that things just don't make sense for a long time.
And you can even hear people say it, when they say, “Look, I know that he's died, but it just feels like he's gonna walk through the door again.” Like you know the reality, your brain is aware, and at the same time that's the feeling.
AS: You mention in the book that the brain has trouble when there’s a violation in the congruence of things. I’m fumbling this, but you know what I’m referencing?
MOC: Yes, it's the prediction error.
I use the example in the book: You know, if you wake up thousands and thousands of days next to your wife, the first morning that you wake up, and she's not there next to you, it's not actually a very good prediction that she's died, right?
Like, it takes your brain a long time and a lot of experiences to believe that she's actually not there. To predict when you wake up in the morning that she's not alive, takes a long time.
And I think part of the reason this is useful for people, I hope it's useful for people, is because that gives us a little bit of self-compassion, for one thing–why is this taking so long? And why do I feel kind of crazy, you know? I still think I see my loved one, or I feel them. I think it makes sense why this happens, and you're not crazy.
But I think there's another reason, and that is when a loved one dies, we often start to avoid things that remind us of their death.
We might avoid particular conversations, or we drive out of our way to avoid the hospital where we spent all that time with them while they were dying, or we avoid certain people, right?
Oh, I can't go out with my couple friends, because I'll just feel so awkward without my husband, and it'll just make me feel terrible the whole time I'm there. And that is understandable, and avoidance is part of the process.
It's stressful to grieve. And it's okay to take a break. It's okay to just pretend this isn't happening for a minute. But the brain really needs experience in order to learn; to learn that this is what the world is like now, even though it’s painful.
When we avoid a lot, or for a very long time, or sometimes there's just a specific thing we're avoiding, it often keeps us stuck in not living in the present moment.
We're not really living in reality right now. And often, ironically, people find that when they confront that thing that they're avoiding, and they have those waves of grief, it’s actually not as terrible as the effort they put into avoiding and it enables them to kind of engage in their life in a fuller way.
AS: You made a really important–I mean, you've made like 10,000 really important points in the book–but one of them is that avoidance doesn't necessarily take the form of a physical action.
Many people avoid by ruminating and then they get stuck in this cycle of negative thinking. Your point is that ruminating is a form of avoidance. And I would love to hear a little bit more about that.
MOC: You know this sounds kind of weird when you first hear it, and there's some really great research studies that led us to really understand how this works.
Something that's more familiar to people, is the Woulda, Shoulda, Coulda. So that loop that you get into: If only the doctor would have ordered that test, or If I had gotten them to the hospital sooner....
The trouble with all that ruminating is that there is no answer.
There are an infinite number of possibilities. But the other thing is those stories that we are telling, that virtual reality we're living in, those stories all end in: “and then my loved one would have lived.” But, of course, they didn't live.
And so, in a weird sort of way, as you're letting that set of thoughts just go round and round or you revisit them, it isn't actually helping you to understand what reality is like now that they're gone.
A gentleman I knew whose son had died by suicide described it to me as, “Eventually I realized I couldn't go through the questions by finding answers. I had to figure out how to go around the questions.”
Her [Kubler-Ross] ideas became a prescription for grieving instead of a description of grieving. That became problematic because people thought: “Oh, I'm doing it wrong.” But there is no wrong. It’s all normal. It’s just your reaction.
AS: Yeah, I think this is such an important point for people to really take in. Sometimes the “Woulda, Shoulda, Coulda” is a tactic we’re using to avoid what we really need to face.
MOC: I think in those moments we can ask ourselves “Am I stuck in the thoughts? Or is it somehow a feeling?”
I think when you're telling the story of what happened, and you're telling it exactly the same way you've told it dozens and dozens of times, it's just thoughts, right, but it's not really connected to the emotional experience, to the feeling in my body. When you connect the telling to the feeling in your body, that’s the present moment.
You can tell all sorts of stories, but you can be in the present moment telling those stories.
The present moment is where there's a lot of pain and suffering, but it's also the only place that we have love and connection and compassion too.
AS: I want to talk for a minute about Elisabeth Kubler-Ross and some of the damaging aftereffects of her model of grieving. Can you talk about who she was, what you did, and what happened?
MOC: I have a ton of respect for Dr. Elisabeth Kubler-Ross. She was a psychiatrist when not a lot of women were psychiatrists, and she had a tough time in the academic world.
She did what all good scientists do at the beginning when they're studying something, which was she described what she was looking at in great detail. She had this revolutionary idea that you could talk to people about their grief, and you could ask them what they were thinking and feeling.
She made very clear descriptions for the world of what that feels like. It feels like depression, it feels like anger, it feels like numbness, it feels like acceptance. If we think of it, what she was describing were moments.
That's all well and good, and she was very accurate in her descriptions, but she wasn't necessarily describing grieving.
Because of her descriptions this idea developed that there was a linear process, stages you go through that happen in a sequence, and once you’ve gone through the sequence, once you go through anger, or acceptance, you’ll never feel those things again.
Her ideas became a prescription for grieving instead of a description of grieving. That became problematic because people thought: “Oh, I'm doing it wrong.”
But there is no wrong.
It’s all normal.
It’s just your reaction.
And when someone thinks “Oh, I haven't gone through the stages in this order” or: “I never experienced anger so I guess I'm not done grieving.”
Those things end up being damaging because people think there’s something wrong with them if they haven’t “grieved right.”
Now we have a more scientific understanding where we've been able to measure people over time, so we're looking at their grieving.
AS: Do you think that that is partly why there’s this idea that grief is something to get over, or to move on from? As though life will eventually just reassemble back how it was before the death?
MOC: Yeah, that's right. I think some of it is, when you are in the middle of acute grief, when it has just happened, and it is fresh, and it is painful, you want to believe that it's gonna end, right?
And I think we tell each other a story as though you go through this difficult process, this quest, and then at the end of it, you're done. And I think it can feel reassuring until that's not how it actually works, and then it doesn't feel reassuring at all because you feel like there's something wrong with you.
I think it is better to think about grief as being always present when you're aware of the loss. But as you restore a meaningful life, you're just not going to have as many moments where you're overtaken by grief, and you will get better at managing that feeling for yourself, you'll come to recognize, “Oh, I'm a person in the world who might be overcome with grief at any time, and I've learned how to jump into and out of that puddle.”
I think sometimes, there's such a belief that there's an end; that there's closure.
Sometimes when I'm working with medical residents, I describe it this way: I say, “Okay, so let me ask you the question: 'When did you get over your wedding day?'"
That doesn't make any sense! What do you mean? It doesn't make sense to ask when did you get over the death of your child, or the death of your spouse, or the death of your mom.
It's an event that changes us forever. Right?
AS: Right. Yeah. You also make this point that the person that you're bonded to, that you have an attachment to actually changes your brain and becomes a part of the structure of your brain.
And therefore, after they're gone, they are a part of you, and in the grieving process having a new relationship with what existed between the two of you is part of the work of continuing to be alive without them. Maintaining a relationship.
MOC: It's so interesting. I was talking with a woman who was thinking about dating again, and she said, you know, the part that's so funny is, I have different conversations with my husband in my head. Ones I wouldn’t have had before, because he didn't know me as a person who had grieved the death of a spouse.
So, I'm still having conversations with him, but I'm having those conversations as a person who has deep knowledge of mortality and loss. And I still know how he would react to me.
So those conversations are still useful to her. And even thinking about dating again, it's not like he goes away. Like, he's still in her brain. And so she's able to, to talk with him at some level.
Now, not everyone has conversations. Some people do. For some people, it's more of a feeling or a sense of, I'm carrying on their values. You know, like, I want to be the best daughter I could be in the world, even though my mom has died.
And what it means to be a good daughter is X, Y, and Z. And so I'm doing those things because she would be proud, right? So it doesn't have to be a conversation. But for a lot of people it is.
AS: I've had a dog for 10 years now. And I can't tell you the amount of times people have stopped me on the street to tell me about the death of their dog.
For the longest time, I was like, "Why is this happening? I don't want to hear about dog death. Why can't people stop telling me?" But of course, it didn't stop. It seemed like every time I passed someone on the street, they'd just yell out after me, "My dog died!"
It was so awful. But then, not long ago, after one of my many terrifying flashes of life after my dog dies, I understood. I totally got it.
After my dog dies, I will want everyone to know about her. I will want to talk about her all the time. I’ll want everyone to know of her.
I realized that's what people are doing by telling me about their dead animals. Instead of racing away because I don't want to hear about it, I should thank them and ask them to tell me more.
MOC: People who are grieving will often say, ”I'd love it if people around me would use their name.”
Because for us, we’re still carrying them, we're carrying the absence of them. And while no one else can see them, it makes them no less an important part of who we are.
When someone says their name it's like the person is so much more alive, right? You're kind of unveiling that absence that you're always carrying around.
AS: Can you tell us what complicated grief is?
MOC: Complicated Grief is actually an older term. We now call it Prolonged Grief Disorder and it's recognized by the APA.
I like the term complicated grief, and here's why: If you think of grief as a natural response to loss, then it's sort of like, if you break your leg, you're not actually doing something to knit those cells back together, right?
Sometimes when I'm working with medical residents, I describe it this way: I say, “Okay, so let me ask you the question, When did you get over your wedding day?” That doesn't make any sense! What do you mean? It doesn't make sense to ask when did you get over the death of your child, or the death of your spouse, of the death of your mom? It's an event that changes us forever.
If your body is doing that, naturally, it is restoring itself. And you might support the process, right?
You use a cast or use crutches or whatever. But your body is going to sort of naturally adapt. But the trouble is sometimes there are complications.
You can get an infection, for example, or there's a second break. In those circumstances, it can be helpful to have a professional go in and help fix some things to help get you back on the healing trajectory.
But, Prolonged Grief Disorder is when a very small proportion of people don't see a change over time.
Remember how I was saying that usually, over weeks and months and years, you get a decline in the frequency and intensity of these waves of grief?
Well, there's this really small group of people, maybe 1 in 10, maybe 1 in 20, who when you can look at their data and those waves of grief, you see that they haven’t changed over time, over months, over a year.
Those are the moments where we think, okay, for most people it feels different now than it did right after the loss, and then for a small group of people it doesn't feel different, and they're not able to get dinner on the table, or they're not able to get their kids' shoes on to get them out to school, or they can't finish a project at work, or whatever it is.
It's really preventing them from living. And so, for those people, what we know, through research, is that there are targeted psychotherapies that can help to get them back on that natural trajectory.
So not taking their grief away, that's not going to happen, but teaching them skills and helping give them the support and courage to engage in some of the things they've been avoiding, to deal with some of the thoughts that are rolling around in their head, and to really learn the flexibility of jumping into and out of the puddle again, so that they can have grief, and they can also live a meaningful life.
So that’s where the term comes from.
AS: I found it so important. I just had never heard of it. And it made so much sense. Sort of like the difference between having typical anxiety and having an anxiety disorder.
MOC: Yeah, absolutely. Right. So we can have sadness, and even profound sadness, and it's not the same as depression. Right?
I was one of the people who tried to get Prolonged Grief Disorder to be recognized by the American Psychiatric Association.
The reason is the only way to get insurance to cover things is to be able to diagnose it.
Now, it's not the only reason to create a recognition of what's going on for people, but it also means that now that there is an awareness of a severe and problematic aspect of grieving, it means that we're all going to get training on what regular grief is like.
Historically, there has been no training. As you become a psychiatrist, a psychologist, a counselor, there's been no training on what grief is like and how it should evolve and what to look out for.
Now we will have to have those trainings, we will have to have Continuing Ed, and this to me, hopefully, will make a big difference in the long run.
The other thing I should say, just real quick, is that hospice is a benefit that is covered by Medicare.
And a lot of people don't know that hospices have to provide 13 months of grief support. Hospices do an amazing job of providing grief support.
But what people don't often realize is, even if your loved one didn't die in that hospice, you can still reach out for support from your local hospitals.
And so it is often the case that you can attend bereavement support groups, or educational programs about grieving.
And so I recommend that people reach out to their local hospices, especially nonprofit hospices, and ones who’ve been around for a long time, there are a lot of really recent hospices, but those older hospitals often have really amazing support.
But what people don't often realize is, even if your loved one didn't die in that hospice, you can still reach out for support from your local hospitals. And so it is often the case that you can attend bereavement support groups, or educational programs about grieving.
AS: Is Prolonged Grief Disorder now recognized in the DSM?
MOC: It is, yes. As of March of 2022. There are a lot of people who are worried that we're going to pathologize typical grief. And I worry about that too, you know, but I don't think it's a reason not to recognize these people, given that we have specific therapy to help them.
AS: I want to ask one last question. One that I think will be most helpful to people. You teach your students how to have conversations with their friends who are talking about ending their lives.
What is it that you teach them? What is it that you tell them to do, or say? I think that would be really helpful for people to know.
MOC: It is so important. I tell them to say “I sense that you are having a really hard time, and I want to know if you've been thinking about hurting yourself, or even if you've been thinking of ending your life." Just saying that is so critically important, and here's the reason why.
Usually, when people are contemplating ending their lives, they get into a very black and white mindset. There are only two options: Either I can live with the pain that I'm experiencing every day, for the rest of my life, or I can end my life.
And that's all they can see. And very often they feel very alone, very isolated. So, if a person can say to them, “I see you, I see how hard things are for you right now.” It goes a little bit further to feeling less alone. Right?
Now, the fear of having that conversation is what do I do next? What if they say “yes” and this is part of why it's so important if you're having this conversation, to have the suicide hotline number with you.
It doesn't have to be the person who is thinking about hurting themselves who calls the hotline, you can also call the hotline and ask for advice.
So you have people who can support you in this. But often it's really just about having the conversation. And the conversation is also, “I want you to know that I'm here, and I want you to get some help, because I think the resources that you usually have are just not enough right now, and I want to be here as we access those resources.”
Or another way of approaching it is just to say “I am here with you." You don't have to solve all the problems. You just have to say “I see you; I hear you. And I can see a future where these are not the only two options. I know that you can't see that future, but I can see that future. And together we're going to find a way to get there. This is a permanent solution to a temporary problem.”
Just being real, being vulnerable and honest, and saying I see you hurting, it goes a long, long way.
AS: I think that is exceptionally valuable information and advice for people. I love the idea of a friend being the one to call the suicide hotline.
I don’t think people would normally think of that. Thank you so much for not just the book, but for everything that you've done for your community and the larger community. It's just, it's amazing.
And it's so inspiring. And I really appreciate you. And I'll link to your book, when I share this talk.
MOC: Thank you for bringing this conversation to people. It's so important that we're having these discussions.
END
It's been a profoundly hard past few years (well, six years) and these past two weeks have been emotionally agonizing. I hope this conversation about grief and grieving was helpful; that it gives you the incentive to buy the book, and learn how to talk about grief with friends and family. Perhaps, talking about grief in public will begin to make death more tangible, relatable, and real. And perhaps that realness will permeate our culture in a necessary wave of realization that life has value, and when it ends, it is never, ever returning.
Until next week, I remain…
Amanda
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