Grief

Guest Dr. Deb Bernstein (drdebbernstein.com) endured the loss of her young brother, her young romantic love and most recently both her mother and father.  As a clinical psychologist she has specialized in grief through research and through her 35 year private practice in Warwick, NY.  

In this episode Dr. Deb and I discuss the following and more:  

•  The many and varied symptoms of acute grief and how long it lasts
•  How our relationship with the deceased affects our grief, such as when we have mixed feelings about them
•  How Elizabeth Kubler-Ross apologized about how her “Stages of Grief” were misconstrued
•  How to respond to a grieving friend
•  Strategies for coping

Some books and authors we brought up in our conversation include: 

When the Bough Breaks:  Forever After the Death of a Son or Daughter  by Judith R. Bernstein, Ph.D.

Grief Counseling and Grief Therapy, Fifth Edition:  A Handbook for the Mental Health Practitioner  by J. William Worden PhD

The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss by George A. Bonanno Ph.D.

Transcript

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SPEAKER_02 0:04

To love learning. To laugh. To love. To be loved. To see beauty. To understand.

SPEAKER_00 0:13

To bring grace to the things that matter most.

SPEAKER_02 0:17

This is Psychology America with Dr. Alexandra. Welcome to my show. For every life stage, we have questions. Let's enhance our lives together as we explore the things that matter most. This episode is dedicated to Ginny's House, a nonprofit which helps abuse children for free, 100% for free, with no insurance hassle. To learn more, visit gennieshouse.org. Today, it's my pleasure to have a guest, Deb Bernstein, and we are going to talk about a difficult topic, and it's about grief. Deb, thank you for being here. Can you please introduce yourself to listeners?

SPEAKER_01 1:09

So I am uh Dr. Deborah Bernstein. I'm a clinical psychologist in private practice in my little town of Warwick, New York. And I've been Dr. Deb, as I'm called locally, for 35 years. Mm-hmm. So the way that this episode came about, I was hosting a dinner for some colleagues and students of mine and my husband's over the summer. And one of them was Alexandra, who has become a dear beloved friend. And we were having a barbecue, and she was telling me that there had been a loss in her family recently. And she was surprised at how deeply it had affected her. Yeah. And because I have had extensive experience with bereavement, both professional and personal, I talked with her about it for a while. And she asked me to come on the podcast. That's right. And talk about it some more. So here we are.

SPEAKER_02 2:21

Yeah. I felt like you really understood. I really wanted to come to that dinner, but it was hard for me. And I noticed that I had withdrawn a little bit, like I sat a little bit in the corner when we were outside, and I needed to. I needed to be away. I wanted to be there, but I was still in pain.

SPEAKER_01 2:42

Yeah, you were really not yourself. Although once we started talking about what you were going through, you came alive again.

SPEAKER_02 2:49

So the pain I was feeling was about my stepbrother Marco, who died last June. And my stepdad and I, and we're very close, his name is Bob. We've talked about this, and we decided that we're not going to keep it a secret that he died of an opioid overdose. So that is what I was dealing with.

SPEAKER_01 3:12

He was only 31. So here's an interesting question that I'm going to ask you that I didn't even think about at the time, because when you sent me a list of topics you wanted to talk about tonight, one of them was disenfranchised grief, which, as much as I'm a grief expert and I have been for a lot of years, I had no idea what that was. And I called up my daughter and she said she thought that it was the grief that disenfranchised people in the population are feeling now. And I said, hmm, that's interesting. And I looked it up, and in fact, it wasn't. Disenfranchised grief is grief that isn't generally recognized. Like when you lose a pet, you don't get to have a day off from work, you don't get to have a funeral. And yet that grief can be just as profound as anything else. So I found out just from Googling it that one really common form of disenfranchised grief is if your loved one committed suicide. That the culture is kind of judgy about that sort of thing. And that kind of loss, it's not that it isn't recognized, but it's not recognized in the same way.

SPEAKER_02 4:27

I think what happens is that it's still not acceptable. It's um there's some judgment about it. So some people are afraid to talk about it. So then you can't talk as much about your grief if you're afraid to talk about it. So an example would be someone who dies of AIDS.

SPEAKER_03 4:46

Right.

SPEAKER_02 4:46

And yeah, like you're mentioning, um, suicides, overdose. It's there's an element of shame where the person grieving feels like they have to shut up about it or keep it a secret. And then that just holds you back.

SPEAKER_01 5:02

Right.

SPEAKER_02 5:02

Yeah.

SPEAKER_01 5:03

So I really commend you for making the decision, both you and Bob.

SPEAKER_02 5:07

Yeah.

SPEAKER_01 5:08

To really be open about it. And then you can get a little bit more of the support that you need, which is so important.

SPEAKER_02 5:14

That's right. And the way Bob is looking at it is that people need to know about this epidemic in the United States. Absolutely. Yeah. And I reached out to Bob and I said, Would you mind writing me about how it's been for you? It's been about five months because Marco died in June, and he wrote me a very touching letter. And I'm gonna read parts of it on this episode. So I'm gonna read about what it was like for him in the first month. He writes The first month for me included acute physical and emotional pain. At times I thought I couldn't cope. The anxiety and panic could be overwhelming. I'm a person who presents options, finds solutions, and fixes things. He's a lawyer. The reality that I could not fix the loss of my son was devastating. I thought I would go crazy. The acute pain has mostly passed, but the sadness and sorrow have not.

SPEAKER_01 6:23

And the sadness and sorrow never will. So one of the things I shared with you that night was that my first area of research when I was in graduate school was on parental loss. And little did I know when I did that research when I was 22 years old and presented it widely that within the next five years, I would watch my fiance's parents and my own parents lose their sons. So I had the academic research. I spent a lot of time with a lot of bereaved parents. And then I watched my loved ones' parents and my own parents go through that very incredibly devastating experience that I think is probably the worst thing a human being can endure, the loss of a child.

SPEAKER_02 7:14

I always say that to my patients. I don't think there's a greater pain than the other. I don't think there is. Yeah.

SPEAKER_01 7:20

And, you know, it there were times in history that it was a lot more common than it is now. Yes. But it's a devastating, devastating human experience. And my mother, five years after the cancer death of my brother, wrote a book called When the Bow Breaks, Forever After the Loss of a Son or a Daughter. Oh, that is still available on Amazon. They actually released it in e-book form. And I get word all the time that it is the book for bereaved parents. And she wound up helping a lot of people. It was a very hard book for her to write. Wow. And she actually couldn't write the first chapter. She called me up and she said, I can't do it. And I wrote it for her. You did? You wrote the first chapter of that book. And it's pretty, she pretty much used it verbatim. What happened for her was that she was, my mother was also a psychologist. Both of my parents were psychologists. And she was trying to be professional. And she was avoiding telling her own story. And she needed to tell it. So I told it for her. And then she was able to go with it. And it's a profoundly comforting book for bereaved parents because they get to see they're not crazy. Yeah. And that their experiences are quote unquote normal. And that can be stabilizing in the midst of the terrible, terrible pain that they're in.

SPEAKER_02 9:08

I thought it might be helpful to list some of the symptoms of grief. Would you mind if I read some of the symptoms of grief? Go for it. Okay. So I got this from William Warden's book, Grief Counseling and Grief Therapy. And I want to mention something that he mentioned in the book. And it's a word in German that captures a concept that we don't have in English. And I'm very familiar with that because there are words in Portuguese that capture an entire concept that I can't say it in one word in English. So this word is called schmirz. Okay. I never heard of this. Yeah, it's what it means is physical pain combined with emotional pain or sorrow. Oh gosh, what a great word. Of course, there should be a word for that. Absolutely. Yes. But we don't have that in English. So there it is.

SPEAKER_01 10:06

Because when you're really emotionally unwell, your whole self is unwell.

SPEAKER_02 10:10

And it's also physical. Right. It's tangible, yeah. So here are some of the symptoms of grief. Okay. Hollowness in the stomach, tightness in the chest, tightness in the throat, oversensitivity to noise, a sense of depersonalization as if nothing's real, shortness of breath, weakness in the muscles, lack of energy, dry mouth, trouble concentrating, forgetting things, confusion, restless hyperactivity, treasuring objects that belong to the deceased, social withdrawal from friends, loss of interest in the outside world, sleep disturbance, undereating, absent mindedness, and distraction.

SPEAKER_01 11:00

Okay, I'm gonna add a couple. Okay. These are from my own experiences in profound, horrific traumatic grief. That is grief that's sudden, unexpected, and horrible. Yes. Feeling like you can't get enough air. Like no matter how deeply you breathe, you have a hunger for air, not being able to breathe right, and not being able to regulate your temperature.

SPEAKER_02 11:26

Temperature. That goes to what we were saying about how physical it is. Yep.

SPEAKER_01 11:31

And I've also had this experience, I guess derealization is probably the right description for it, but I'm gonna elaborate on that. Okay. I've had this experience when I was either in the midst of preparing for a death, right? You know, someone is dying and you're sitting some sort of a vigil. Yeah. Or right after a death. That if you're out in the world and you're going through this profound experience and you look around you and you see other people living their normal lives, you feel almost as if you're in a bubble. And the rest of the world is on the other side of some sort of membrane that you're separated from. I think that's what you were feeling.

SPEAKER_02 12:20

Depersonalization. Um or derealization. Yeah. Feeling like you're not really there, or or you're separated. You've felt you've experienced that.

SPEAKER_01 12:30

Absolutely. Very profoundly. Yeah. So one of the terrible losses that I had in my life was when I was 23, the man that I had been in a deep romantic relationship with for five years. We were planning on spending our lives together, went into surgery for a hot appendix and never woke up. Lived four years in a coma before he died. And so during those first weeks that he was in a coma, I spent in that state. Now I was also sleep deprived. Uh I was away from home because we were on a trip at the time. We were up in Vermont. So all happened away from home. So I was basically living in the hospital lounge, wearing surgical scrubs, going into the ICU for 15 minutes every hour around the clock. So I was sleep deprived. I was traumatized. I was terrified. I was in deep grief. And there were times that I would leave the hospital to run some errand or get something to eat, and I would have this experience that I was just in a completely different world from everyone else. And since that time, when I've had other losses, such as the death of my brother or when he was terribly, terribly sick, I've gone back into that state.

SPEAKER_02 14:04

So it was familiar. Right. You knew that was the grief. Right. Um, I also didn't mention that numbing can be a reaction. And what I read about the research regarding numbing is that that's okay too.

SPEAKER_01 14:18

Absolutely. So what we're talking about here really is acute grief. Yeah, right after it happens. Right. And acute grief and quote unquote chronic grief or long-standing grief are really very different. Yes. So those states where your body and mind are deeply affected generally don't last that long. How long do they usually last? It's very variable. It depends on all sorts of factors, including your relationship with the person that you lost and your own physiology and your own mental health, and so many factors that I couldn't even elaborate. But I would say generally a couple of weeks. Oh, okay. The the most painful part. The part where you're affected every second, day and night.

SPEAKER_02 15:16

I read that there are some things that can complicate grief or make it more difficult to pull out of. And I'd like to mention some of those things and I'd love to hear your thoughts on them. Sure. One of the things that can get in the way is ambivalence about the person that died. Now, when you say get in the way, what do you mean? Of healthy, normal grieving. Okay. So if there was conflict with the person who died, or you have very mixed feelings about the person that died, that can complicate grief.

SPEAKER_01 15:54

So I'm gonna use myself as an example. Okay. So this past year, I lost both of my parents. And I would say my relationship with my parents was complicated. Okay. And to complicate already complicated relationships, their declines were protracted, difficult, painful, and burdensome. Taking care of them in the last couple of years of their life was brutal. There was a lot of relief when each of them died. And I have to say, I would have, if I weren't as knowledgeable about grief as I am, worried that I wasn't sad enough. Because truth was, I wasn't that sad. I was free in some ways for the first time in my life.

SPEAKER_02 16:57

Thank you for sharing that. That is something that a lot of people feel. Right. And but then they will feel guilt about it. That's right. If they feel a sense of freedom when someone dies, maybe it was an abusive person. That's right. They might feel emancipated with their death, but then what happens next is guilt. Like, why do I feel this way? Right.

SPEAKER_01 17:19

So you were gonna ask me about the five stages of grief. And here is where I am going to comment on that. Let me hear.

SPEAKER_02 17:27

That was supposed to be my first question. I know. It didn't. But I wanted to make sure we covered it.

SPEAKER_01 17:32

So the five stages of grief come from Elizabeth Kubleross, who was a researcher in the 60s. And best I can tell, she was the first person who really got a lot of attention for talking about the grieving process. The interesting thing that most people don't know is that Kubler Ross's research was not, in fact, with bereaved people. Her research was based on her studies of people who were terminally ill. Do you know that?

SPEAKER_02 18:01

It was themselves before they died. That's right. Not the people around them. Right. And it had nothing to do with grief.

SPEAKER_01 18:09

They weren't dead. They hadn't lost anybody. They were dying. Right. It's a really difficult. I mean, it's not completely different, but it's a pretty different situation, right? It is. What you go through when you're dying as opposed to when you lose somebody you love. Pretty different. So her stages were based on terminally ill people. And she never meant for that to become a Bible that everybody for decades afterwards would use as a standard of what we're supposed to do when we lose someone we love. And as a matter of fact, before she died, she apologized. She felt bad. Who did she apologize to? The public. She felt bad that people misconstrued her writing to mean that there were predictable stages that you had to go through, or else there was something wrong with you. Because she knew that grief is incredibly variable, that it really has to do with your relationship with the person who died, the kind of person you are before your loss, and all sorts of things about your situation, your psychology, your physiology, your culture. So many contextual factors. That's what everyone talks about. And everybody believes that if you don't do those in order and get them right, something terrible's gonna happen and you're gonna have to go back and do it over. And there is no evidence for any of that.

SPEAKER_02 19:43

My stepdad wrote about that in his letter. He said, everyone seems to do it differently. Right.

SPEAKER_01 19:49

But even therapists think that if you do too much denial and you're not sad enough, it's gonna come back and bite you somehow. And you better go into therapy and talk about how sad you are. And you know what happens if you make a person do that? No, it messes them up. They're likely to get more dissipating. No, they were really sad. They'll manufacture sadness for you. It takes away their well-being. The vast majority of You're gonna have them move their spotlight to sad thoughts. That's right. Exactly. You're gonna create depression. The vast majority of people, according to George Bonanno, who is the current expert on grief, do just fine. They have an acute phase of grief in which they're in all kinds of distress, and then they go back to normal functioning. And if we don't mess with them and we don't tell them they're doing it wrong, the vast majority of us are wired for loss. It's part of life, and we integrate it. That's hopeful. So today's experts don't recommend that people automatically get therapy when they're grieving. Only need therapy is if their distress is persistent and they can't handle it.

SPEAKER_02 21:13

Right. Beyond a certain time.

SPEAKER_01 21:15

Right.

SPEAKER_02 21:16

Like beyond one year.

SPEAKER_01 21:18

Well, I mean, if you've lost a child, by the end of a year, you don't you're only just even beginning to deal, to process.

SPEAKER_02 21:27

It depends on the loss. I was talking to a lady who lives on my street. I took my children out for Halloween a few nights ago. And you get to see all the neighbors on the street that you may not see often. And her husband died a few years ago, and she is still in a lot of pain, but much of it is because she was so dependent on him.

SPEAKER_01 21:54

That is a really special case. And research tells us that people who are really Really dependent on a loved one who dies are really at risk for going into a chronic state of grief and really having a hard time managing their lives.

SPEAKER_02 22:10

He did everything for her. Right. He did all the bills. He took care of the house. And she's great at work. But as she put it, he took really good care of her. Right. But then she didn't know how to do any of it. And he'd be like, Honey, can I show you what we do with the bills? And she'd always say, Tomorrow. Yeah.

SPEAKER_01 22:30

Yeah. That's a really, really important example. Yeah. So we should all beware. We have to stand on our own two feet. Yeah. We can love our loved ones, but yeah, being too dependent is never a good idea. Contrasting that with one of my oldest and dearest friends who was my college roommate. Yeah. Prior to turning 60, which we have both just done, she buried her second husband. Ooh. First husband died 10 years ago. And she recovered from that terrible, terrible loss after 25 years of marriage. Fell deeply in love again, remarried. And six years later, he got pancreas cancer. Got incredibly sick incredibly fast. And on almost exactly within two weeks of the 10th anniversary of her first husband's death, she buried her second husband.

SPEAKER_02 23:29

Oh my goodness.

SPEAKER_01 23:30

And then just celebrated her 60th birthday last week. Her dear friends took her out on a cruise around Manhattan where she laughed and cried and ate and drank and reminded herself that she's still alive.

SPEAKER_02 23:44

So is she doing okay? She's doing okay. And you said contrary to your friend. Why did you say contrary? Because she's she didn't become overly dependent. Oh, okay. As an example of a widow. Yeah.

SPEAKER_01 23:57

Well, she wasn't overly dependent on either one of them. Oh, okay. Yes. She was somebody who was really able to pick herself up. And she's kind of shrugging her shoulders, like, well, this seems to be my journey. Tough. But even she, we had an interesting text exchange in preparation for my doing this interview with you. Someone sent her something suggesting that she really needed to be out doing things and with people more. It was a piece of writing. I don't know whether it would be worth my reading to you. As a way to cope. Sharing grief allows us to ease our burden by letting someone else help carry it. This helps us process our own inner thoughts and feelings through a filter of a trusted and beloved someone. So this person, this writer, was making a point that we really need to reach out and get support actively from other people, which I more or less agree with. But she was saying this to my friend, whose name is also Deb, at a time that Deb was feeling like what she really needed was to be left alone. And Deb had really had sent an email out to me and all of her other friends saying, I really need to be my myself for a while. When I'm ready to be together and connect, I'll let you know. Don't worry. And when I got that message from her, I said, Good for you. You have been through hell. Do what you need to do. Well, first she sent it to me and she asked me my reaction. So the other person's email ends by sharing our hopes and fears, joys and pains with another person, we accept the universe's gifts of wisdom and loving care. And so she felt like she was being admonished to be more outward and to spend more time with other people than she really felt like doing. So she asked me for my response, and this is what I wrote to her. This is so on point, though I think there's also good reason deeply grieving people often isolate. When you're in so much pain, you're in another world. And the majority of people you encounter are wearing the quote veil of protection that separates them from the stark connection to loss and mortality that the grieving person lacks. The veiled person can be made anxious by being near the pain and rawness of grief. And that causes them to say stupid, insensitive things like, it was God's will, or at least her suffering is over, or you're lucky to have had him as long as you did. When you're already wanting to be in bed under the covers, hearing the insensitive things that people say can be doubly hard and can send the bereaved back into isolation. So I think we need to respect both the need for connection and the need for space, which, like anguish and laughter, come in waves. I've watched you do just that. Honor your need to rest, to be alone, and follow your own heart, to reach out when you feel up to it. And that's what she did. And a couple weeks later, I got an email from her saying, I want to come and see you and stay over at your house. And I want you to feed me, and I want us to go out walking, and I want to go out kayaking. And I said, You go, girl. And I was not crazy about the fact that one of her other friends was subtly shaming her for saying, I need some time alone. Because she had clarity about what she needed.

SPEAKER_02 28:14

I read that in the acute phase of grief, it's very normal to want to be alone and to withdraw. Yeah. But you brought up a word, which I'm so glad you brought it up, and that is active. Now, active coping works better than passive coping.

SPEAKER_03 28:33

Right.

SPEAKER_02 28:33

And I have a quote here that I want to bring up from William Warden from the book that I really enjoyed about grief. And he said this the oft-repeated phrase, time heals, holds only a partial truth. Healing comes from what the grieving person does with the time. And I know that that can vary about how someone copes, but actively coping is better than passive coping. I'm not sure I agree with that.

SPEAKER_01 29:06

I could give you a run for your money. Well, let me hear. So in this last year, I've had a lot of adjusting to do, including I've had to adjust to really having an empty nest again, losing both of my parents after very, very difficult, protracted illnesses. Both of them had cancers, both of them had Parkinson's, their deaths were really difficult, dealing with turning 60. Yeah. I needed a lot of downtime. Sometimes I just sat and did nothing. Sometimes I walked in the woods and did nothing. It wasn't really active. I wasn't solving any problems. I wasn't doing breath work. I wasn't doing meditation. I did those things too. But sometimes I just needed to withdraw and isolate. And I think that was pretty healing.

SPEAKER_02 30:10

Well, I wonder if this is a matter of semantics, because I think what William Warden meant by active coping and passive coping was more um the way that you think about it cognitively or the way that you frame it.

SPEAKER_01 30:26

So I'm gonna substitute the word intentional.

SPEAKER_02 30:29

Perfect.

SPEAKER_01 30:30

I like the word intentional. That's better intentional and unintentional.

SPEAKER_02 30:34

Because you were walking through the woods, and what he meant by that was the way that you're thinking about it. So, okay, an example he gave was someone who says there is nothing that I can do about it, they're the ones who don't cope as well as those who would think about how do I reframe my life in a new way without this beloved person. Right. So that's active.

SPEAKER_01 31:03

Right.

SPEAKER_02 31:04

Okay. Or intentional. Intentional.

SPEAKER_01 31:07

Right.

SPEAKER_02 31:09

In grief, folks will sometimes direct anger at someone else and blame them in a sense. They'll release the anger or the grief will create anxiety. And then from the anxiety, they'll direct it into anger at a person. Right. And I talked about this in a podcast I have about scapegoating. I'm wondering what your thoughts are on that.

SPEAKER_01 31:40

So when you, when we were preparing for this and you sent me a list of the things you wanted to talk about, this was one of them. And when I read it, I thought, I have no idea what she's talking about. I'm gonna tell her not to ask me about this. And then in the middle of the night, I woke up and I realized, oh, wait a minute. I know exactly why Alex, what, what Alexander was talking about, because it happened to me. I got scapegoated and blamed for my beloved's death. You mean the 23-year-old? So when I told you about what happened, it was the surgical accident. Yes. There actually were people to blame. Right. The people who did the anesthesia wrong, the people who didn't save his life when he stopped breathing. His parents, his mother confided in me several years later, blamed me because I took him to that hospital. And they said that they really couldn't deal with being in touch with me anymore because they were so angry with me for bringing him to that hospital. To the wrong hospital in their eyes. Right. Well, that I was the one who invited him on the trip in the first place. So they blamed me for bringing him there to his death. And they realized that it wasn't rational. Yeah. But it affected the way they treated me. And it was incredibly painful. So yeah, that happens.

SPEAKER_02 33:11

It does happen. And I think it can be easier psychologically for groups to sort of target someone and say, and just release the anger on that person. They're dealing with so much, with the grieving. Right. So I know that you've talked about how the stages don't make sense for those that are what's important about the stages is not that they're not accurate.

SPEAKER_01 33:37

Certainly denial, anger, what she calls bargaining, which is trying to make it not true, depression, and acceptance are all states of being that can absolutely happen and often do happen when people are grieving. What's troubling is that professionals and lay people alike have believed that they have to happen in order. Right. And they all have to happen in order for grief to be, quote unquote, healthy or quote unquote normal. And that's not true. So we need to pathology we need to avoid pathologizing departures from the stages. It's not that the stages don't exist, they're not really stages.

SPEAKER_02 34:29

Yeah. I'd like to share with you William Warden's ideas about tasks versus stages. I liked it. And this way he he sees the grieving person as more in charge, not so helpless. And they are acceptance, processing, processing the pain of grief and adjusting to a world without the deceased, finding a way to remember the deceased.

SPEAKER_01 35:02

That turns out to be super important to continue to hold a relationship with the person that you loved who died. That's a very important research tells us that's a really important factor in how well people do.

SPEAKER_02 35:18

Yeah, let's talk about that because it seems to be something that if uh the healthiest response is to keep that in balance, meaning there is something called mummifying. And that is when someone you make a shrine, you don't clean out the room. Yeah, the room remains intact. Right. They don't remove any of their clothing, right? And that's called mummifying, and that's unhealthy. Right. Whereas removing your home of anything, any object that reminds you of that person is also unhealthy because that's a form of denial. Right. So objects and what we do with their objects in balance.

SPEAKER_01 35:59

It's sort of symbolic of what you do. So one of the things that we've done over the years, because I, for example, lost my brother before I had my kids, I wanted my kids to know their uncle, even though they weren't gonna have an active relationship with him. Yeah. So I kept some of his stuff. I have some of his stuff, which I've shared with my kids. I've I have pictures around the house and I've tell and I tell them stories. How old was he when he died? When he died, he was 26 and I was 28. Okay. So go on. So and I had Meg, my first child, when I was 31. So three years after he died. Yeah. So twice a year on the anniversary of his death and on his birthday, we have special dinner and just maybe drink a toast to him or just mention him. It's a day that we pay attention to. It's not a huge deal. I don't wail and cry and fall apart all these years later, but just a sweet way of paying tribute and keeping him a part of my life. That's lovely. It is very sweet. I believe in those kinds of rituals. And I think the research tells us that they're healthy and helpful. You know, some people will go to a cemetery or scatter ashes or write letters. Everybody's got their rituals.

SPEAKER_02 37:29

If they have not had some sort of morning ritual, which is happening a lot more frequently, that folks are not having funerals or any kind of ritual. I think not having that at the beginning might make it harder for people to accept.

SPEAKER_01 37:46

Yeah, I think it is important to gather and to have support. I tell you about my mother's memorial. No. We actually did two memorials. We did a memorial while my father was still alive. We did a memorial right after my mom died that was lovely down at my sister's. And then after my dad died two months later, we did a memorial for both of them. But after she died, she was a wonderful quilter. She made this. Oh. And my sister had a bunch of her quilts. I had a bunch of her quilts, and she had kept a bunch of her quilts. And so my brother-in-law strung all of the quilts on lines around my sister's garden, around her pool. And it was just incredible to have them all flying in the in the wind as we pay tribute to her. That is lovely. It really was. Yeah. It's beautiful. She would have loved it.

SPEAKER_02 38:42

Yeah, it can be even just like you're saying, writing a letter to the loved one if you haven't had a ritual or putting a flower in a river in remembrance of them.

SPEAKER_01 38:54

Yeah, or even just talking to them or about them.

SPEAKER_02 38:57

Yeah.

SPEAKER_01 38:58

Telling stories. Very important and helpful.

SPEAKER_02 39:02

A patient of mine has had extended mourning about her father, and she decided to start running a 5K on his behalf.

SPEAKER_01 39:14

Oh.

SPEAKER_02 39:14

And that was very healing for her to just release it into the 5K to prepare for it and run it and to think about him the whole time that she did it. Oh, so sweet.

SPEAKER_01 39:25

Yeah. I love that.

SPEAKER_02 39:26

And the last task that he talked about is embarking on the rest of your life while remembering the deceased.

SPEAKER_03 39:36

Mm-hmm.

SPEAKER_02 39:37

So it means if you're not completing that task, it means you're not living anymore, so to speak. It's choosing to live, it's choosing to love again. Esther Perell, do you know who Esther Perell is?

SPEAKER_01 39:50

Yes. Yes. She talks a lot about the difference between living and thriving, right? She watched her parents, who were Holocaust survivors, embrace life and thrive. And she watched a lot of other survivors just stay alive. And they really were emotionally dead. Her parents danced and partied and traveled, and they really embraced life after the terrible, terrible losses and traumas that they had been through.

SPEAKER_02 40:28

I thought that it might also be helpful to listeners to hear about Therese Rando's six activities and processes that are important in adapting to loss. And what I like about it is that it includes alliteration. It all starts with Rs. Okay. Right? So it goes like this recognize the loss, react to the separation, remember and re-experience, relinquish attachments and assumptions, readjust to a new world, and reinvest in new activities and new relationships. I like it.

SPEAKER_01 41:09

You like it? Yeah. I I really think that the only thing that I would want to tweak would be all of that is helpful and good. But if you miss one or you decide not to do them, all of your friends and loved ones should not be worried about you and tell you you're doing it wrong.

SPEAKER_02 41:31

Yeah. I think that's a great takeaway from speaking with you. Right?

SPEAKER_01 41:35

We have all sorts of suggestions and all sorts of things that can be helpful and great, but the last thing any of us needs is for therapists, friends, relatives to tell you you're doing it wrong.

SPEAKER_02 41:50

What do you recommend as healthy ways to cope with grief, with loss?

SPEAKER_01 41:56

So I don't think there is a clear set of things that I would say that will work for everybody, but some general guidelines. You want to really take excellent care of your mind and your body because it's an incredible stress, especially at the beginning. So to the degree that you can, that you're able, get plenty of rest. Try to sleep, even if it's difficult, and sometimes it will be. Try to nourish yourself. And again, at the beginning, you might not feel like eating, but it's important. Get some exercise. Any of life's challenges can really be helped by being in your body and using your body. We already talked about this, paying attention to when you need to be with people and when you need to be alone. And that can really vary from minute to minute, hour to hour, day to day. There are going to be times that you feel like you cannot stand to be alone. And there are going to be times that you feel like if you have people around you for one more minute, you're going to scream. Find a way to respect your own rhythms and ask for what you need from the people who are around you. Be clear about what you're feeling, what you need, and give yourself the gift of being able, to the extent that you can to get what it is that you want and what feels comforting. Do the things within reason that make you feel good. I'm not talking about massive amounts of drugs and alcohol, but thank you for mentioning that. Yeah, people can fall back on those things. And of course, you want to be careful about that. But doing the things that you love to do, if you have hobbies, if you have activities that are comforting to you.

SPEAKER_02 44:01

Do those things. We were mentioning about uh treasured objects, and my stepdad has taken Marco's guitar and he's really thrown himself into learning the guitar and getting much better.

SPEAKER_01 44:15

That kind of thing is perfect. I think it's a wonderful way to cope. Art, poetry, and try to remember what it is. You know, for me, in the many, many years after I lost the two young men in my life, I felt an extra responsibility to live for them, to do the things that they would have wanted to have done if they'd have been here. So my brother was a great skier. And even though I didn't love skiing that much, I made sure to go skiing once every winter, that kind of thing, to keep them alive by doing the things that they loved and being in the stream of life as much as you really can bring yourself to.

SPEAKER_02 45:00

It's keeping their memory in those ways, but also living again. Exactly. Let me ask you this. How do you know when you're out of the worst phase of it?

SPEAKER_01 45:13

That's a great question.

SPEAKER_02 45:14

I don't know if you do. Is it do you think it's important? I think it's helpful to know. Like, because I think for most people, there's going to be a beginning and a middle and an end of the worst of it.

SPEAKER_01 45:27

So I'm going to go off in another direction. I think that for any adjustment that we have to make in life, including loss, initially there might be a time that we really need to focus on just handling what's going on. And that ultimately and gradually we return to full functioning. Now, that doesn't mean that we feel exactly the same that we did before the thing happened, because probably that's never going to happen, right? Right. If you lose a loved one, your life is never going to be the same as it was when that loved one was there. It never will. But if you're healthy and if you're managing, you're going to return to full functioning, which means that you're engaged in the stream of life. Doesn't have to be the same life, but it's being engaged in life. In the new normal, whatever that is. I don't know that it's useful or helpful or necessary to have benchmarks beyond that. That ultimately you want to embrace life and be living life and invested and engaged in it.

SPEAKER_02 46:46

I think that's an excellent way to close. How can listeners find you, Deb?

SPEAKER_01 46:53

Um, my website, dr debernstein.com, has all my contact information.

SPEAKER_02 46:58

And now we're off to honeynut squash, correct? Correct. What are you doing with it again?

SPEAKER_01 47:05

Um, or occhiati pasta with leeks, honey nut squash, blue cheese, and hazelnuts.

SPEAKER_02 47:14

Thank you for cooking an amazing meal as you always do. Thank you, Deb. Cheers. And thanks for coming on the show. My pleasure.

SPEAKER_00 47:22

If you enjoyed this episode of Psychology America with Dr. Alexandra, show your support by leaving an awesome rating on iTunes. If you'd like to share your comments or ideas about this podcast, follow us on Facebook under Psychology America. Lastly, Dr. Alexandra has written an inspiring children's book entitled There's Always Hope, a story about overcoming, which is beautifully illustrated by Brianna Giasulo. There's Always Hope, a story about overcoming, teaches children about finding joy and gratitude, even when things don't go exactly as planned, and can be found at Psychologyamerica.com or Amazon.com