Friday, April 11, 2014

Thursday's Therapy - Only a Few Really Know...

Are good Child-Loss Grief and Trauma Therapists as Rare as this 
Rare Flower, the "Red Middlemist camellia"
Let's Hope Not. There are only Two (2) of these in the world!

Thursday's Therapy

Only a Few Really Know...

featuring words from

Social Worker and Grieving Mother,

Dr. Joanne Cacciatore

Snapshots of thoughts from a well-known Grief and Trauma researcher and therapist who is also a Grieving Mother, Dr. Joanne Cacciatore, in how she approaches Healthy Grief and Mourning care and treatment for Child-Loss Parents:

The healing from the pain is in the pain. 

…(F)or either state- grief or depression- a pill is a poor substitute (and according to Kirsch et al (2008) not any more efficacious than a well-placed placebo) for human connection, caring, and compassion.  Quite poor actually.  We can never derive what we need during suffering from a pill or a bottle. What we desperately need in our world is a willing witness to our suffering, someone who will join us with full presence and mindfulness. 

The Lancet editorial captured, beautifully, what it means to be a consummate psychiatrist for the bereaved: time, compassion, remembrance, and empathy.

In fact the word psychiatry comes from two Greek (ψυχιατρική) words: psykhe meaning mind and iatreia meaning healing and caring. In French, the literal translation of psychiatry is a "healing of the soul." 

A pill will never heal the soul of a person in mourning. 

Brief, laconic treatments, as the great psychiatrist, Irvin Yalom says, are not best practice for patients. Rather, they are best practice for managed care systems and the psychotropic medication industry which insist on rapid cures for the incurable and place more value on profits than people and relationships.

I don't heal people. I help them be with what is true. 
The healing comes from that.

-Robert Hall, M.D.

Being with what is true hurts. It hurts a great deal. And it takes time to unfold into its own change. Yet, psychiatrists have capitulated to an antithetical system of caring which Yalom calls "inexpensive and perforce, brief, superficial, and insubstantial" and "rather, specializing in psychopharmacological based laconic interventions". (sic) Similarly, Sigmund Freud warned against furor sanandi, the rage to cure. Modern psychiatrists  have, more recently, sounded that same alarm only to fall on intransigent ears and hearts. 


What do I do to help those suffering traumatic death? I have no magic wand, or pill, or words. I am, however, willing to join a person in the abyss and sit with the suffering non judgmentally, without urging him or her toward healing before healing's time has come. I radically accept whatever emotional state presents, even if it means we spend two hours on the floor in silence except for the visceral moaning or sobbing, the primal longing for a person's beloved dead.

It has become appallingly clear that 
our technology has surpassed our humanity.  

-Albert Einstein

We should not, ethically or morally, medicalize grief.  To do so is to medicalize love.  We rarely mourn for that which we do not love. I can only begin to imagine what the sages, and mystics, and shamans of the past might think of a society which does so.  Seems hardly human at all.


Some also assert that the ability to receive consolation is one of the markers between depression and grief. 
(My Note: In her next statements, Joanne is alerting us, Be careful whom you choose for a therapist to help you with your Child-Loss Grief and Trauma:)  
I have some questions about this purported consoling: What is the quality of the consolation? Who is consoling and how? How do we ensure a bereaved person gets before a "skilled clinician"? 
(My note: Joanne continues warning about inappropriate therapists' attitudes toward, and treatments for, our grief:) 
What about shame? Guilt? Anger? Trust? Platitudes? Insensitive others? Community? How do those play a role? Far too many variables to operationalize this process, in my opinion.

Just as despair can come only from one human being to another, 
hope, too, can be given to one only by another.

-Elie Wiesel

The word compassion comes from the roots com  meaning "together" and pati meaning "to suffer". Roshi Joan Halifax says that "compassion is a tenderness of heart in response to suffering".  With compassion in my heart, let me introduce you to some families who have given their permission to share their stories for the purposes of this statement. They are a part of our very sad and grieving-without-bounds community which puts no time limits on an interminable grief, and in my commitment to caring for them, I continue to suffer with them and beside them. These are the people I see everyday, all day long for 16 years, and this is their insufferable 
(My Note: I am choosing NOT to add these families' stories in today's blog post. Their stories may be triggering; rather, I just want to you see what a good therapist's heart is toward our Lifelong struggle with Child-Loss Grief and Trauma.)


(My Note: After describing these families' losses, Joanne goes on to summarize, still adding helpful quotes along the way. 
Joanne then reacts to the psychological system seemingly needing to pathologize grief and not address it as a normal reaction to abnormal circumstances.)

Everyone is an 'expert' in grief until it is he who has it.

-William Shakespeare

Do you - any of you - have the answers these families seek? Can you cure them? Surely, I cannot. And I will not participate in any ruse to do so.  What manual tells you what to do to "console" Shawn, Maya, Katie, Amy, Ashley, Sandie and Mark? Are you, Dr. DSM, prepared to sit before one of these parents two weeks after their unspeakable horrors and tell them they are depressed? And do you actually believe that?

It's relatively easy to entertain multiple possibilities of truth 
and right action if one remains 
a spectator on the sidelines.

-Helen Merrell Lynd

(My Note: the next paragraph describes some violent scenes; please skip this paragraph if you fear being triggered.)

Or what about other parents with whom I've worked?  One whose three children and husband died in a fire? Or one whose 17-year-old daughter was raped and murdered? Or the woman whose two young children were murdered by their father? 

Shall I send them off to a psychiatrist to diagnose them with a disease? 

There's only one disease expressed in that equation and it isn't on the part of the bereaved. The entire system is a mirror image- a projection, of its own illness and intolerance, denial and delusion. Truly, we live in an insane world when spouses and children and parents, like those above, and other grievers around the world can be diagnosed with Major Depressive Disorder- a mental illness- two weeks following a traumatic death at the behest of someone who has no notion of the reality of their experiences. This feels like the apogee of hubris, exorbitant arrogance.  Too much knowledge and absolutely no wisdom. Too much death avoidance and not enough willingness to approach the ineffable. I see this played out often when I speak of my work and watch others recoil. But - of all the helping professionals- shouldn't a provider of mental health "care" be highly trained and well-prepared to deal with trauma and death?

And, tell me why is it that mourners cannot get help at any time they need it?

If it is because insurance companies refuse to pay for grief counseling then our obligation is to oppose the establishment and not acquiesce to a caustic and fallacious taxonomy which further harms the most vulnerable.

If we are going to cure anything, let's remedy the systemic apathy in an institutional pedagogy unfit to cultivate mindful healers and the insurance providers whose myopic understanding of the human condition, tempered against economic avarice, limits their ability for circumspect.

And why is our ability or willingness to help, as a society, based on time? What makes us think that the two-week bereavement exclusion will allow someone to seek help and that not having such an exclusion will preclude such help? Grief counseling or therapy with a competent provider may help some. But also, what about the role of faith communities? Indigenous healers? Friends? Colleagues? Nonprofits and self-help groups? Neighbors? Even strangers?  We are enabling an environment of human apathy - abdicating our responsibilities to one another and foisting it onto a system -a machinistic system- asking this system to care deeply when it cannot. Instead of abnegating our moral duty to fellow human beings, we should be fostering a society of individuals who care about and for one another. Person-to-person, as in Buber's (1932) concept of I and Thou, Ich and Du.

I am done with great things and great institutions and great success. I am for those tiny, molecular moral forces that work from individual to individual, creeping through the crannies of the world, like so many rootlets, or like the capillary oozing of water which, if given time, will rend the hardest monuments of pride. 
-William James

There are many who can help those who are grieving whether the help is sought weeks, months, or even years following a death.  I once saw a woman whose newborn died in 1967 and she had, in her own words, "tried to bury the pain and the truth" with her baby.  More than thirty years later, she wanted to be able to "die in peace" and so she sought help in confronting the pain that she had deflected for so many years.  Healing communities offer opportunity for deep and meaningful human connection and solidarity. And, thus, for this woman the MISS Foundation was there for her, and provided a place of comfort and solace. 

We need not feign mental illness and disease for mourners to seek and receive the kind of help which truly helps.

Never apologize for your feelings. 
When you do so, you apologize for the truth.

-Benjamin Disraeli

I can have no part in this diagnostic charade.  Rather, I will go on, in the spirit of compassion, suffering with the other, in the best way that I can. Ethically, I cannot and will not violate what I know to be real and true and sane and human.

This implacable grief is a result of unyielding love.  If we wish, as a society, to truly help those suffering in the aftermath of loss, then we must make the move toward collective compassionate and open hearts. Systems of "care", HMOs, hospitals, and evidence-based practice manuals will not help heal others.

You cannot rush your way through grief. 
Grief unfolds with the same
 exquisite timing as the rose, 
left to blossom on its own time, 
until the colors slowly fade 
and the petals fall away
 of their own accord.

-Margaret Brownley

I posit a universal axiom based on reason, and truth, and the wisdom of the ages…:

Only people and relationships and moments of deep connection will help heal the hearts of the bereaved.

So, to the DSM committee, should you have chosen to read this missive, what these families experience, hundreds of thousands every year, is not ordinary grief, nor is it Major Depressive Disorder. 

This is extraordinary grief as a result of extraordinary circumstances

Contrary to your postulations about grief being like many other losses, in general, I can assure you that this is, actually, quite different from other conditions of the human experience. Please, see clearly the truth that lies before you.

The mere title of 'doctor' is no criterion; a real doctor is one who is a true servant.


As for me, I will continue to reassure the families with whom I work that their beloved child is worthy of each and every tear.

Thank you to Dr. Joanne Cacciatore for her compassionate heart, and her willingness to share that compassionate heart with us, and with other Child-Loss Grievers.

Blessings to you all!

Dr. Cacciatore's complete Blog Post from which I drew today's excerpts:


No comments:

Post a Comment