Fantastic article in The New Yorker on grief and trauma counseling. I have quite a bit to say about this but not a lot of time at the moment.
The article discusses, with the context of September 11, the trend of grief counseling – grief counselors rushing to the scene of the trauma, to de-brief those who witnessed it, to try to head off any debilitating Post Traumatic Stress Disorder.
There was a WONDERFUL essay in The New York Times about a year ago – which I did print out – I’ll have to dig it up out of my files to quote from it – but it was called “In Praise of Repression”. The title certainly caught my eye, because I, like so many others, have been taught, by our culture more than anything else, that repression of anything is bad. Unhealthy.
The author, cannot remember her name, said something like, “In the immediate wake of September 11, there were 5 grief counselors for every traumatized person. That image alone is something I am going to need to repress.”
In the last couple of years – I would say since September 11 – I have come to the conclusion that repression of terrible events is not only NOT bad, but it can be the psyche’s way of healing itself. This is not always the case, and there are certainly some people who become so debilitated by their trauma that they can no longer function, they start drinking heavily, they abandon their families, whatever. They are unaccustomed to having strong emotions of any kind, and so they freak out. But in the New York Times piece – follow-up had been done a year later, with many of the survivors of the catastrophe, and they found that those people who successfully “repressed”, who did not continuously re-live that day, were the ones who had a high quality of life, who had survived psychologically. People re-committed themselves to their families, people became workaholics, people played golf like maniacs. These are coping mechanisms, yes, but they are coping mechanisms on the side of LIFE. What good does it do to keep talking about it, keep reliving it?
Dredging up the pain, re-living memories (especially very soon after the event) is not only not helpful, but can be quite damaging.
Read the article in The New Yorker – I thought it was incredible. I’ll have more to say about it, when I have time.
I read a similar piece about returning soldiers from WW’s I and II – these soldiers had no interest or intention of “talking” about the horror they had lived through, and many wives had never even heard any stories. I know my mother found photographs my grandfather had taken while liberating concentration camps – when he discovered her looking at them he burned the photos and they never discussed it again. I’m sad for the lost history, but I know that my grandfather had found a hidden place for his pain and a focus on his blessings.
Bets-
Beautiful point! Thank you!
A couple years ago I did a show where I played a woman whose child died. I did a lot of reading on the topic, a lot of research. Elizabeth Kubler-Ross wrote a wrenching book about the death of children. It was hugely helpful to me. One of the things which outraged her about the common practice in hospitals is – that when a mother begins to freak out with her grief – when a mother (or father, I suppose) really FEELS her grief and rage at her child being lost – it is common practice to give the mother a sedative.
It is only because her grief and her rage makes her difficult to deal with for hospital personnel.
Kubler-Ross was a militant on stopping that practice. Grief should be experienced, and fully.
To go crazy with grief is a NATURAL response to enormous loss. Cutting off that process is harmful. Big emotions are not bad – some things are not meant to be responded to in a calm and rational way.
I read somewhere that during the Civil War, what we now call “post-traumatic stress disoreder” was known as “soldier’s heart.” The latter phrase seems to me a much more human and empathetic one.
David –
AbsoLUTEly. Thanks for that.
I agree that in many cases, a certain amount of repression can be an important coping mechanism. Like anything else, too much repression can be a bad thing and can lead to later problems. On the issue of debriefing, trying to force someone to talk about a traumatic event soon after it’s happened is definitely a lousy idea. Neither is it wise to go too far in the other direction, and make people feel like there’s something wrong with them if they do need to talk to a counselor. It’s just that those who do need that sort of help will probably be a minority of the total affected by a tragedy.
I’d like to ask one of these people how human beings coped before our society was able to devote resources to employing people as grief counselors.
Because we seemed to do it fairly well before they came along.
Well, Bill – one comment on your comment. Psychosis and trauma always existed, and people didn’t always do “fairly well” – but there were other more primitive words for such things as clinical depression (brought on by excessive grief, an inability to move past a terrible event), or schizophrenia, or whatever. They called it Demonic possession, or witchcraft. Plenty of people probably spent their entire lives locked up in horrific insane asylums, when now a little Prozac or Lithium means they lead productive lives out in society.
I’m not against psychiatry, really. I was in therapy for about 7 years. But I definitely agree with the experts in the article who talk about the benefits of “cognitive-therapy” as opposed to deep Freudian analysis.
And I am completely against the so-called benefits of “re-living” traumas. Extensive studies now show that that does far more damage than good. I liked the point of view of one of the anti-debreifers in the article, who says that – some of these de-briefers merely see signs of “tears” as healing. So if someone has a breakdown, it is seen as the first step towards mental health.
that’s crazy to me.
Trauma is trauma. People will heal themselves in time.
And one other thing (and this is the other essay that eventually I want to write, when I have time): We put too high a premium on “fixing” ourselves. This is the cult of psychiatry. Anything which doesn’t fit in with the norm (anger, depression, nervous tics, whatever) must be FIXED.
Cognitive-therapy does not focus on fixing events in the past, does not focus on dredging up life events, in the hopes that eventually the memory will not hurt.
painful memories will always hurt us, although the intensity of the pain changes. Cognitive therapy focuses on the story we continuously tell ourselves, when bad things happen to us. And by changing that STORY (ie: “I’m a loser” or “nothing ever works out for me” or “I am doomed”) we can actually change how we perceive terrible events.
A whole different approach, which I like much better.
But again – have to put all of this into an essay. Too much to say here!!
Oh, and one other thing –
See, this all has to go into the essay:
long ago, there was more space for, as my friend Betsy calls it, “grief and praise”. If you lost your entire family in a fire, you were not expected that you would be able to bounce back, get back to work, join normal life. You wore black for an entire year. The community took care of you, understanding that no one would be able to do a THING for quite some time after a catastrophe.
Now – people’s freakin’ fathers die and they get to take the weekend off.
That is fucking CRAZY if you ask me, and causes a lot of the problems we see now.
If it is your custom that you wear black for an entire year after you lose your spouse – it gives your heart room to cope, it gives you space to grieve. You can’t skip over that stuff.
half of these de-briefing counseling sessions after September 11 were held so that the “productivity of the work place” would not be disrupted.
i find that a bit despicable.
Damn good question Bill. Why do I have the sneaking suspicion that grief counseling in some aspects is a racket of sort, selling folks something they don’t realy need?
I think the trend, now, of having “grief counselors” race to the scene of a disaster is definitely a racket.
In that New Yorker article, they talked about how firefighters and cops volunteered to be “peer counselors” to any of their co-workers who were freaking out. And how effective that was – because they spoke to them not from the language of mental health, which is … annoying, to say the least, but in a common sense way, like, “You probably should stay away from alcohol the entire time you’re working down at Ground Zero – Because it ends up depressing you.”
That is helpful advice, something you can DO.
But there’s all this scary stuff about “false memories” too – how this “dredging up” of memories can actually implant false memories into people’s heads – People who DIDN’T see bodies falling suddenly remembered that they DID see bodies falling – and so their panic gets worse.
And in this way – the “counselling” business gets to continue on, making millions of dollars.
But again – I do not want to suggest that therapy is always a racket. I got a lot out of it. And there are cases where people’s grief debilitates them, and they can no longer feed their kids, or pay their bills, whatever. But in that case, I would say that dredging up painful memories would be the last thing needed. i would say a mild anti-depressant, so that the person can catch up on sleep, and get their appetites back.
Treat the SYMPTOMS. That is all you can do.
Half of depression is exacerbating symptoms. You can’t sleep. You’re depressed. The more sleep-deprived you become, the more depressed you get. If you could just have a little sleeping pill, and get some shut-eye – then maybe the most severe symptoms of depression would subside.
I know of what I speak.
I would say that with what Sheila said about taking the weekend off for a death, society has created a perfect setting for the birth of the counseling racket. How often do we stop to help a disabled driver or go beyond the obligatory casserole when a neighbor is in crisis. I look to my mother as a role model because some friends of hers are in crisis now (early 40’s,husband,father of teens, with cancer) – She and some of her friends have each taken a day to go and feed the family, help with homework and do whatever needs to be done. This “day” will come every week until this family is able to stand up and face the world again, with or without this very sick man. Of course this is a complicated subject with enabling and those who take advantage of good people – but that is another conversation! I just like to hope (idealist that I am) that when we help eachother, the need (or perceived need) for paid help is lessened.
The mention of mourning clothes reminds me that Queen Victoria wore black for the rest of her life after Prince Albert died. That may sound extreme, and well, it is, but it’s certainly no more “insane” than, as you said, going back to work a few days after the death of a parent.
I Googled and found the text of the article here:
http://maillist.linuxmednews.org/pipermail/mednews/2003-February/000313.html
It’s called “Repress Yourself” by Lauren Slater. I kept a copy of it and at the bottom it says:
Lauren Slater is the author of ”Opening Skinner’s Box: Great Psychological Experiments of the 20th Century,” to be published by W.W. Norton in 2004.
Julia –
Wow! Thank you! (I forget about Google sometimes, I admit it.) That article really changed how I looked at things … I became very pro-repression. :)
I will be writing more on this – It’s a topic that obviously interests me.
Betsy-
I could not agree more with your statement. I mean, think about our weekend in New York! I found that time together with you, me, and Beth far more healing and life-affirming than any therapy session.
But yes – it is a complicated issue, and obviously there are many sides to it.
Some people truly do need professional help. But I don’t think people grieving loss are those people. Grief is normal. In whatever form it takes, even if it’s alarming to those not experiencing it.
I agree – in a world where every living thing dies – there is grief!
I find this an interesting topic from the evolutionary point of view. How did our ancestors cope with grief 100,000 years ago? Probably in much the way we do in the absence of grief counselors – leaning on friends and family. I would venture that the frequency of traumatic loss was far more than that experienced by “us” today – and it wouldn’t have been adaptive for the species if individuals became emotionally incapacitated for long. Sociobiologists may point to the therapeutic role of the group and they would probably be correct. Today we don’t see much of the extended family living together in close quarters. For kids to move next to their parents and siblings is unusual in the West. This fragmentation may be part of what fuels the grief counselor niche.
On the other hand, living with or next to your parents may generate the need for a different sort of counseling… The Ray Barone syndrome…
Sheila,
My comments were primarily directed at grief counselors. I didn’t mean to make it sound as if I dismissed our current understanding of mental illness. Most people will be able to deal with tragedy, and it was the grief counselors for everyone racket I was dismissing.
Bill –
Thanks. I wanted to make sure that I, myself, was clear too on what I was saying here. It seems to me to be pretty obvious that “grief counselors”, especially post-crisis trauma counselors, are a little bit bogus. And in a way, they DEPEND on the crisis staying a crisis – otherwise they lose their livelihood.