Understanding Grief

Summary

Podcast Summary: Am I Doing It Wrong? – Episode: Understanding Grief

Introduction

In the November 7, 2024 episode of Am I Doing It Wrong?, hosted by Noah Michelson of HuffPost, the conversation pivots to a profoundly human experience: grief. Typically co-hosted by Raj Punjabi-Johnson, Raj is absent for this episode as the topic of grief is a personal trigger for her. Instead, Lindsay Holmes, Senior Wellness Editor at HuffPost, joins Noah to navigate the complex landscape of grief alongside esteemed expert Dr. Catherine Shear.

Defining Grief

The episode kicks off with a heartfelt introduction where both hosts share their personal losses, setting a compassionate tone for the discussion. At [03:55], Dr. Catherine Shear, Marion E. Kenworthy Professor of Psychiatry at Columbia University and founding director of the Center for Prolonged Grief, joins the conversation.

What is Grief?

• Dr. Shear's Definition: At [04:07], Dr. Shear clarifies that grief is fundamentally "the response to loss." She emphasizes its multifaceted nature, highlighting that grief encompasses a wide range of emotions and experiences unique to each individual and each loss.

• Unique Aspects of Grief: At [07:46], Dr. Shear distinguishes grief from general sadness by focusing on elements like yearning, longing, and the persistent presence of memories related to the lost individual. She introduces the concept of "sadi," a Portuguese term meaning "the presence of absence," capturing the duality of feeling both the presence and absence of the loved one.

Manifestations of Grief

• Emotional Spectrum: At [06:24], Lindsay Holmes brings up the varied emotional responses to grief—anger, denial, and emptiness being common alongside sadness. Dr. Shear concurs, noting that while sadness is prevalent, it's the unique longing and preoccupying thoughts that set grief apart.

• Physical Symptoms: At [12:00], Dr. Shear outlines the physical manifestations of grief, such as gastrointestinal issues, appetite loss, sleep disturbances, and general bodily discomfort. Noah Michelson shares his personal experience of feeling a "physical void in my chest" when grieving his father, underscoring the somatic aspect of grief.

Normal vs. Complicated Grief

• Adaptive Process: At [18:14], Dr. Shear explains that there isn't a strict timeline for grieving. Instead, the focus is on adapting to a new reality post-loss, which involves accepting the permanence of the loss and gradually restoring one's capacity for well-being.

• Signs of Prolonged Grief: At [25:21], the conversation shifts to recognizing when grief might be complicating one's life. Dr. Shear highlights that prolonged grief keeps the individual stuck in a state of yearning and disconnection, impeding the ability to reconnect with others and engage with life fully.

Handling Unexpected Grief Triggers

• Honoring Anniversaries and Random Moments: At [27:09], Lindsay Holmes shares her experience of grief resurfacing unexpectedly, such as during anniversaries. Dr. Shear advises honoring these moments by allowing oneself to feel and commemorating the loved one in meaningful ways, such as spending quiet time or engaging in activities that celebrate their memory.

Supporting Others Through Grief

• What Not to Say: At [32:32], Dr. Shear emphasizes avoiding phrases aimed at making the grieving person "feel better," as they often inadvertently shut down the grieving process. Instead, she advocates for being present and allowing the person to share their memories and emotions without judgment.

• Effective Support Strategies: At [49:27], Dr. Shear advises showing support through actions tailored to the griever's needs, such as bringing food, helping with tasks, or simply being there to listen. Understanding that the grieving person's capacity for reciprocity is diminished during this time is crucial for providing meaningful support.

Debunking the Five Stages of Grief

• Critique of Popular Models: At [44:10], Dr. Shear critiques the widely recognized five stages of grief (denial, anger, bargaining, depression, acceptance), noting the lack of empirical evidence supporting their linear progression. However, she acknowledges their popularity stems from offering a comforting framework for understanding the tumultuous experience of grief.

Medical Interventions in Grief

• Role of Antidepressants: At [46:55], Dr. Shear discusses the limited efficacy of antidepressants in treating grief specifically. While they may alleviate associated depressive or anxiety symptoms, grief itself is best addressed through specialized grief therapy rather than medication alone.

Takeaways

In the episode's concluding segment, Better in Five, the hosts summarize key insights:

1. Grief as a Response to Loss: Grief encompasses a wide range of emotions and is fundamentally a reaction to losing something or someone significant ([51:18]).

2. Diverse Manifestations: Grief can manifest both psychologically and physically, varying greatly among individuals ([51:28]).

3. Acceptance as a Pathway: Accepting the reality of the loss is crucial for beginning to process grief ([51:34]).

4. Avoid "Fixing" Grief: Attempting to make someone feel better can hinder their grieving process ([51:41]).

5. Celebrate Memories: Talking about the deceased helps keep their memory alive and can be therapeutic ([51:47]).

Personal Reflections

Lindsay Holmes and Noah Michelson share their personal reflections on grappling with grief, reinforcing the episode's message that there is no "right" way to grieve. Lindsay admits to previously shaming herself for not reacting as expected, while Noah discusses the evolving nature of his grief over time, including the distress of losing memories of his late father.

Conclusion

The episode wraps up with a reaffirmation of empathy and understanding, encouraging listeners to honor their own grief and support others without imposing predefined notions of how grief should be experienced. The hosts invite listeners to share their thoughts and experiences, fostering a community of shared understanding and compassion.

Notable Quotes

• Dr. Catherine Shear [04:12]: "Grief is the response to loss. It's a simple definition that belies the complexity and variability of grief."

• Dr. Shear [07:46]: "The heart of grief, which makes it unique, is yearning and longing and preoccupying thoughts and memories of the person who died."

• Dr. Shear [25:54]: "If grief keeps yearning and longing at the center stage in your mind, you can't really connect with other people."

• Dr. Shear [33:12]: "You cannot make grief better. But you can share it and be there for them."

• Dr. Shear [38:15]: "Sharing stories is something that people always appreciate. They really always appreciate that."

Final Thoughts

"Understanding Grief" serves as a compassionate guide for anyone navigating the tumultuous waters of loss. By debunking myths, acknowledging the multifaceted nature of grief, and offering practical advice for both the grieving and their supporters, this episode provides valuable insights into embracing and processing one of life's most challenging emotions.

Transcript

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[Noah Michelson]

Foreign hi, I'm Noah Michelson, head of HuffPost Personal.

[Lindsay Holmes]

And I'm Lindsay Holmes, the senior wellness editor at HuffPost.

[Noah Michelson]

Welcome to AM I Doing It Wrong? The show that explores the all too human anxieties we have about trying to get our lives right. Okay, before we get going, no, your ears are not deceiving you. Raj is not here today, and that's because we're going to be talking about grief. And that's a topic that triggers her and actually a lot of other people. So before we did this episode, she said at this point in her life she's just not functionally able to handle talking about this. And she really wanted me to specifically tell you that it's okay to opt out on something if it's going to deter your mental wellness journey. And she is right. So I'm glad she's not doing this and I'm also glad that she'll be back next week. In the meantime, I'm really excited because the show is in very capable hands. We've got Lindsay Holmes, you Might remember her from our getting ready for bed episode last fall. And she's here. Lindsay, welcome.

[Lindsay Holmes]

Hi. Thanks so much for having me.

[Noah Michelson]

Of course. Let's get going. What are your thoughts on grief, and do you think that you or other people are doing it wrong?

[Lindsay Holmes]

I don't think there's a wrong way to do grief, but I'm eager to dive into this topic for so many reasons. I've covered grief a lot in my work at HuffPost, and I've also personally been affected by it. I've lost people incredibly close to me, including recently. My grandmother passed last year, and another family member passed shortly after her. So I'm anxious to do this episode. How do you feel about it?

[Noah Michelson]

Yeah, same. I lost my dad, and I lost my best friend to pancreatic cancer a couple years ago as well. And so grief is. I'm not gonna say grief is a friend of mine, but grief is a constant in my life. And so I would love to talk to someone who actually has been studying this for a long time. And that person is the incredible Dr. Catherine Scheer. She is the Marion E. Kenworthy professor of Psychiatry at Columbia University and the founding director of the center for Prolonged Grief at the Columbia School of Social Work.

[Lindsay Holmes]

Let's do it.

[Noah Michelson]

Dr. Shear, thank you for being here with us.

[Dr. Catherine Shear]

Thank you for having me.

[Noah Michelson]

So let's just start with the big question. What is grief? How do you define grief? How do we define grief?

[Dr. Catherine Shear]

Okay, that's three questions.

[Noah Michelson]

You're right.

[Dr. Catherine Shear]

And there are three different answers, actually. Okay, so we'll save the last what is grief? To the end. Because I think in. In a way, that's really important question to ask. But how do I define it? And how do you define it, or how do people define it? That's a very interesting question. And it's really what most people mean when they say, what is grief? They really mean, what do we mean when we say it? And that was a question I asked when I first started this work and I started thinking about it, I started reading about it. And what I found out very quickly is that there are a lot of different definitions. People define it. If you Google grief, for example, you get really dozens of different answers for what is grief? If you go to the dictionary, that's another interesting exercise because different dictionaries define it slightly differently. That's one thing. But they. They generally define it as a form of sorrow, deep sorrow.

[Noah Michelson]

Right.

[Dr. Catherine Shear]

But then if you look up deep sorrow, they define it as basically like grief. I mean, it gets. It gets very Tautological sadness, you know, whatever. And in order to do this work, I had to figure out how I was going to define it.

[Noah Michelson]

Right.

[Dr. Catherine Shear]

And the answer to that is, and it was kind of in the grief literature, the bereavement literature when I started this work, is that grief is the response to loss. It's a simple definition, actually, that belies the complexity and the variability of grief. So really, to say that it's the response to loss doesn't exactly tell you that much because the response to loss is complex, multifaceted, variable, and actually unique to each and every person, but also each loss that each person has. So, you know, any person who loses more than one person in their life will experience grief differently for those two losses.

[Noah Michelson]

I really like that too, because it feels like it is. It's like an umbrella for all of these different responses. Because I don't know that maybe sadness is not always the first reaction or the most prominent reaction.

[Lindsay Holmes]

Right. And it might not come, like you said, right away, or it might not come at all. And instead you might experience something like anger or denial or anything like that too. I'm curious about that spectrum of emotion that you might experience when you have grief and what that can look like for a person. And is there, I guess, a normal reaction? Probably not. But is there a normal reaction and what is kind of a sign that it might not be so normal?

[Dr. Catherine Shear]

Right. And so the direct answer to your question is that grief can be many emotions and really any emotion, any emotion at all. And for most people, sooner or later it is. Almost everybody does feel at some point sadness and anger and also guilt and self blame and just really almost any emotion you can think of. However, I guess what I want to add here is that at the heart of grief, which makes it kind of unique, is not the sadness. Sadness doesn't make it unique. What makes grief unique is yearning and longing and preoccupying thoughts and memories of the person who died. So it isn't really, you know, the dictionary kind of gets that wrong about what's unique about it.

[Noah Michelson]

Right. That's so interesting. I guess I'd never thought about it exactly that way, but yeah, you can be sad for a lot of reasons. You can be sad because you lost your job or something like that. But when you lose someone, nostalgia is not the right word, but sort of having these memories and these attachments and these longings for what is no longer there or what, what won't be there in the future, that does feel like a very unique experience.

[Lindsay Holmes]

Would you say it's Almost like a withdrawal. Speaking from my own experience with grief, I just feel this, like, intense, like you said, longing, but also an emptiness that's more like a withdrawal feeling where it's just like, how do I fill this space? How do I not feel this emptiness that I have? And I haven't really ever heard anyone describe it as a withdrawal, but that's kind of what it sounds like when we're talking about it right now.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

Yeah. You know, there's the word sadi. It's a. I'm actually. I'm not pronouncing it correctly, but it's a Portuguese word, and it means the presence of absence.

[Noah Michelson]

Oh, interesting.

[Dr. Catherine Shear]

Or the absence. It's kind of a palindromic idea because it's the presence of absence in the absence of presence. And I think it describes the experience of loss really well.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

Of loss of someone close.

[Noah Michelson]

We often think of grief being related to death, losing someone. But talk to us a little bit about different ways that we can grieve or different things that we can grieve or things that you've seen people grieve in private practice or research. Why else would it manifest itself?

[Dr. Catherine Shear]

Right. I mean, if we define grief, as I was suggesting, as the response to loss, then we're talking about loss and loss of something. It really isn't any loss. It's the loss of something that means something to us, someone or something. And my work has almost exclusively focused on the loss of a close person, a close attachment. But really the brain. We know the brain is parsimonious. And so we do the same, more or less the same kind of thing for anything else that anyone or anything else that we lose in a way other than death or things that we lose as opposed to people. And so we have a very similar kind of. I want to come back to another way to answer this question or to ask the question, really, because I think it's very important in terms of understanding how grief changes over time. When you say, what is grief? We've been talking about what is the experience of grief, basically. But you can also ask what's happening to a person's mind and body when someone dies. We're going to talk about it that way. And to answer that question, you kind of have to. It's kind of puzzling why the absence of something can cause such a huge reaction. So you kind of have to say, well, then what is it exactly that you've lost? And when I finished my psychiatry residency, I did a fellowship with someone named Myron Hofer, who was studying maternal infant attachment in actually in rodents, but he was, you know, he was really interested in that question of what is it? What exactly is a close attachment? And what's come out of that over the years is that there's a whole lot of evidence from non human studies as well as human studies that people we love help us regulate all kinds of functions in our bodies. So they affect how we think and how we feel in ways that we're not aware of, as well as ways that we are. And also the way our, you know, our physical body regulation, heart rate, immune system, even our genetics, there's some evidence that there's. There's epigenetics involved. And so they, they have all these kind of deep effects on us that we don't even know. They affect how, for example, we perceive the world. So if you lose someone like that, your whole body is going to respond.

[Noah Michelson]

Right, right.

[Dr. Catherine Shear]

So you can then go back to think of grief as the response to just a whole range of different sort of individual losses, so to speak. And the experience of grief emerges from that. So what's important about that is that it tells us what it is we have to do in a way, what has to change for that response to change. So we, we basically have to adapt ourselves to a world that is that world of absence.

[Noah Michelson]

Right. And it is physiological. Right. Or it can be. So what are some of the symptoms, the physical symptoms that, that people experience when they're in deep grief?

[Dr. Catherine Shear]

Well, they can, you know, it can be any gi symptoms that people can lose their appetite, they can have trouble sleeping very often, have trouble slee. They. They can experience various kinds of bodily feeling of discomfort from all the different. Just your body being kind of not well regulated.

[Noah Michelson]

Yeah. I mean, when I lost my dad or even, you know, I was doing, I guess, sort of anticipatory grief as well when he was dying. And I did feel like I had a physical void in my chest or a hollowness or emptiness that I couldn't fill up. And I don't know exactly what that was, but I was experiencing that grief physically.

[Dr. Catherine Shear]

Right? Yeah, yeah, I think that's very common, actually.

[Noah Michelson]

It's awful. Yeah. Let's take a quick break and we'll be right back.

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Welcome back to Am I Doing It Wrong?

[Lindsay Holmes]

I mean, there is no timeline, obviously, on grief, and we can talk more about this too, but is there a specific period of time, I guess, that mental health professionals would say is a time period where people should address that with someone professionally, or what's kind of like the process if someone is going through grief and they're thinking like, okay, maybe it's time for me to talk to someone else about this, what kind of timeline would you suggest for them to do that?

[Dr. Catherine Shear]

So there really, as you said, there really isn't a timeline for that per se. However, what we all have to do is we have to start to kind of come to terms with a new reality. And really the loss of someone close changes everything. It changes our inner experience of the world, changes the way we see ourselves and how we feel about ourselves and how we see the world from our perspective. And it also changes people around us. It really changes the world, changes often our social role. It affects other people. And those other people are likely, some of them are likely to be people that we interact with. And so that's going to be a change. So there's a lot of different stresses that we have to deal with. So we do that, but then we also. Everybody has to start to realign themselves to live in this world of absence that we were talking about before. So that's that withdrawal at first that you don't know where you are in a way. And so you have to figure out where you are in a sense. And your body and mind, outside of your awareness, has to figure all that out too. So you have to kind of live through a period of time during which you adapt to the loss. Which means two things really, that you accept this reality, the fact that this person is gone and not coming back, because that's one of the things people really experience is like that really strong feeling of disbelief.

[Lindsay Holmes]

Right, right.

[Dr. Catherine Shear]

That feeling maybe never goes completely away, or it takes a really long time to go completely away, but it lessens a lot over, you know, over the first, let's say roughly six months to a year, sometime within. Sometimes it happens quicker than that. So you have to accept that reality and accept the reality of your grief also. Which gets us back to grief. Because the biggest thing about grief is, is that you want to let it be what it is. And that doesn't mean that you have to be highly emotional whenever you feel like it. I mean, you might, that might be fine, it depends. But you can manage emotions. There are various ways we can learn to regulate emotions at the time. But to say that you shouldn't be grieving so much or that you should grieve more than you are, that doesn't make any sense. Because your body and your mind have a reaction that's very natural to this loss and that's what it is then. The other part though is you also have to restore your own capacity for well being because that grief kind of undermines that. It takes you Again, that withdrawal apart from the world, you don't see yourself in the future. As I was thinking about what is grief over the years, one of the words that I thought really describes it is disconnection. The feeling of disconnection from yourself, from the person, obviously from your past, from your future, from other people. And you kind of. You have to find a way to overcome that. That has to do with kind of reconnecting with yourself and with other people that you still care about or the world that you still care about. So what happens to some people is that they get caught up in some of what are very natural responses also. Like, if only, you know, your dad had gone to the doctor earlier. I mean, it's that kind of thing, you know, it's called counterfactual thinking in psychology. And it's actually one of the things we do very naturally whenever something happens that we don't like, that is we think is bad, we automatically start thinking backwards. You know, we start imagining alternative scenarios, and they can be better or worse scenarios. So they can be, you know, if only something had happened, he wouldn't have died, or it could have been a lot worse. He could have died in some way that he was in a lot more pain or whatever. So we do both. And what's interesting is most bereaved people do it, at least some of the. It's called upward counterfactual thinking, which is when you imagine a better way. And that, of course, is not so good if you're trying to come to terms with a reality. So you're kind of telling yourself an alternative reality. And that can kind of slow down the process of accepting that reality.

[Noah Michelson]

Right?

[Dr. Catherine Shear]

Same thing with, like, wanting to avoid reminders that the person's gone. You're not wanting to go to places that you went to with them because you get triggered, you know, and you don't like that, that's fine. You know, I mean, it's good to. It's really important in grief to let yourself do exactly what you guys were talking about, which is to let those feelings come when they come, and also let yourself set them aside. It's okay not to grieve at the funeral. Also, it's okay not to be emotional or not to feel emotions. If that process of both experiencing the grief and also setting it aside, if either one of those is too extreme, that can kind of slow down the process of coming to terms with it, adapting to the world in a new way, whatever language you want to use around that. But that's the process by which the experience of the loss actually changes. And as it changes, then your reaction to that's another way of saying that your response is going to change. And what's going to happen to most people over time is that it settles down. The grief will still be activated sometimes can be activated very strongly by certain kinds of reminders or calendar days that are specific reminders, those kinds of things. That's very natural also for years and years afterwards sometimes. And then you can not have that for a while. And then one Christmas or one birthday or something suddenly is really impactful again. But the basic idea is that it does quiet down. Except for some people it doesn't. And it's mostly because of this kind of the kinds of things that. That we do, like imagining alternative scenarios or avoiding things that just kind of get too much of a foothold. They sort of take too much center stage. It's not exactly wrong, but it is something that will slow down.

[Noah Michelson]

Okay.

[Dr. Catherine Shear]

And then what happens is that grief, yearning and longing and the need for the person and all the emotions and the preoccupying thoughts and memories of the person stay center stage in your mind. And so you can't really do anything else. You can't connect with other people. Just always on your mind and always highly emotional. And that's what we mean. So it's not really completely different than any other kind of grief, but it is stopping your life. That's what, that's what got it, how you can recognize it.

[Noah Michelson]

And that's why it isn't necessarily a certain duration of time.

[Dr. Catherine Shear]

Right.

[Noah Michelson]

But it's more about if you're able to start living again, re acclimate to the world. That would be a signal that you needed maybe more help than you're getting. Yeah, interesting.

[Lindsay Holmes]

What's your advice for people? You mentioned, you know, how that grief might come at a later time or an anniversary or something like that that, you know, might catch them off guard. I recently lost someone about a year and a half ago. And when it happened, we were kind of expecting it. It obviously didn't make it any less painful. But I had that experience where I didn't necessarily have the overwhelming reaction I thought I was going to have. And then a few months ago it hit me out of nowhere and it really caught me off guard. So. And I imagine that that's something that's going to continue for a long time for me and it could happen with other people too. What's your advice or what are your thoughts about those moments when grief really catches you off guard? Whether it's an anniversary or just a random time in life, what can someone do in that moment to kind of accept it and then either move through it or honor it or do something to kind of help in that specific situation?

[Dr. Catherine Shear]

I mean, I think you just described it. I mean, really just honoring it and letting it be. If it is an anniversary reaction, then sometimes you can plan for it. You can plan that as a time to honor the person. I mean, long before I started this work, I was working with someone. We were setting up our on call schedule and she said, I'm fine with whatever you want to do, but there's a week in October when I'm not going to be able to cover anything ever. And I said, okay. She said, don't you want to know why? So anyway, I said, okay, why? And she said, well, my mother died on this day. And I've learned that the best thing for me to do is to just take that week off every year. It doesn't always bother me too much, but what I do is I spend time honoring her and taking care of myself, you know, going to a spa and what she did, but, you know, something or just spending some quiet time and doing something she liked to do. So that's another kind of thing you can do. If I thought that was interesting, my.

[Noah Michelson]

Mom does the same thing. So my mom and dad were together for 35 years. Loves of their lives, like the kind of thing out of a movie where one of them would walk in the room and the other one's eyes would still light up 35 years later. And so my mom, you know, it's been 17 years since my dad passed, but like, she, you know, she's doing. She's a trooper, she's doing well. But there are still those moments, especially their anniversary, which is in August. And she does. She takes three days off the date and the two days before and after, and she goes up to our family's cabin by herself and just spends that time by herself and sort of honoring that day. I don't even check in with her on that actual day because I know that that's her day. And we talk about it before or after, but I think it's really good for her, you know, and it's just her way of getting through it. And I, at first it worried me a little bit when she did it, and now I'm like, no, this is just how she deals with it.

[Dr. Catherine Shear]

Yeah, I think those kinds of things are perfectly reasonable. And you know, the fact that you worried about it, I think we shouldn't worry about it. You know, we need to get to a place where we understand that we need to do these things.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

And that actually goes. You know, I actually lost. Recently lost my best friend for a really long time. And you know, at first. And you know, so if it's a friend, you know, not every, that's another thing people don't necessarily understand. And, but you know, and first I was going to. I said, well, you know, I can still think and talk and you know, I wasn't like overwhelmed. It was another expected death. And so the first day when I was going to go back to work, it was like a weekend. And so I. I realized that there was no way that I could do that. So instead I. I spent like two days just looking at old pictures and not necessarily, you know, just honoring her, remembering our time together, all of that. And it felt so. I mean, it just felt necessary, let's put it that way. And, and then, you know, and then I was able to kind of refocus. I mean, it's still, it's still, it's still there. Like, I think it's Lindsay, like what you were saying. Yeah, yeah.

[Lindsay Holmes]

It'll be with you in some way or another. But if you find a beautiful way to, to honor your feelings and the person, I think that that's all you can really probably ask for and for.

[Dr. Catherine Shear]

When you, when you, when it catches you off guard and you haven't had that beautiful way of honoring them. Just to practice self compassion, you know, to really give yourself a lot of leeway and not be self critical. Not worry about whether you're doing it right.

[Noah Michelson]

Yeah. One of the things I found the hardest. I don't know if you both have experienced this though, is that I have started to lose parts of my dad. Like I can't remember what his voice sounds like anymore. And that's very hard for me. And so there's a grief in that too. There's this weird. It's almost like a passive grief now that it's been so many years. I'm not actively crying every day thinking about him, but there are moments and I worry about not. I worry about losing him again in a way. And that's a kind of grief too.

[Dr. Catherine Shear]

Yeah, I mean, I think we forget the sound of someone's voice pretty quickly, actually. You may be noticing that more now. But one thing you should know is that you can't lose your dad. He's part of you. He's physically, literally part of you. And he's helped shaped You. Anyone we're close to helps shape us during the period of time we're with them. And we can't take that away. Even if we wanted to, we can't. So I think maybe that would be a way to think about it. That the concreteness of them. Yes. It's gone. And it's another manifestation of the fact of that presence of absence. And that's always going to be painful. I think it is.

[Noah Michelson]

Right. Oh, it's like I'm getting free therapy today. I love it.

[Lindsay Holmes]

I was just going to say that seems like the perfect thing to say to someone. And then I also want to ask, what are some things, in your opinion, that you shouldn't say to someone who is going through grief? Because sometimes I. I mean, I'm sure other people have experienced this too. I don't really know what to say in the moment, and I worry that I'm making it worse for someone.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

Yeah. I mean, I think. I think the first thing to remember about this is that you cannot make it better. Right. And so we all want so much to make it better. I mean, that's. That's part of why we're. We care about that question. Right. We're trying so hard to make it better. And the fact is you can't. But what you can do is you can share it and you can be there, and you can be, you know, your time and your real interest is what you can do for them. And anything that tries to make it better is probably, you know, that if you. If you. Is probably not such a good idea.

[Lindsay Holmes]

Yeah.

[Dr. Catherine Shear]

In the sense. You know, we call it in. In psychology, sometimes call it writing reflex. We try to, like, especially when someone's emotional in front of us. We are natural, you know, we want to kind of like, take care of them.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

And make it better and make it stop. And that's really not necessarily what they want. Right. I mean, that's what we were. We don't necessarily want to stop crying. We don't.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

And we don't want people around us to feel uncomfortable either. And so you're signaling that you're feeling uncomfortable. And we. We do feel uncomfortable around people who are very emotional, but we don't have to. We can manage that ourselves.

[Lindsay Holmes]

Right.

[Dr. Catherine Shear]

If that makes sense.

[Lindsay Holmes]

Yeah.

[Noah Michelson]

Let's take a quick break, and we'll be right back.

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[Lindsay Holmes]

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[Noah Michelson]

Welcome back to Am I Doing It Wrong? It's interesting because I've had so many people write essays about grief from my other job at HuffPost. And so what so many people have said, and I think I felt this way too, is that a lot of people in their lives didn't know what to say, but also didn't want to talk about the person who had passed because they didn't want to make that person feel bad. But what actually happens is that we want to talk about that person.

[Lindsay Holmes]

Exactly.

[Noah Michelson]

When I get to talk about my dad, it's like he's here again, you know? But I think people are afraid to do that. So I think maybe I'd love to hear your thoughts on that. But it seems like, take the lead from the person who's grieving.

[Dr. Catherine Shear]

Absolutely. But that's such an important point, and I should have made it.

[Noah Michelson]

Well, now you're gonna pay me. No, but say more about that.

[Dr. Catherine Shear]

Yeah. I mean, because sharing stories is something that people always appreciate. They really always appreciate that. And so I think that not being afraid to talk about the person, even if they cry, even it might make you cry. But that is something that is very important.

[Noah Michelson]

And that's the thing, too. With my mom, when my dad first passed, we would talk about my dad, and she would cry and cry, but she would say, like, don't stop talking about him. I'm gonna cry. This is gonna be my reaction. But I wanna hear your memories. I wanna hear, you know, conjure him, bring him into the room. And so I think also, the more disconnected we get, the more that we are using AI and we're online, the less human interactions we have. I think we forget. And I think it's scary when we see someone being really human in front of us, and we don't want to do that, you know? And so it's like an impulse that we've tamped down but that we should probably lean into.

[Dr. Catherine Shear]

Yeah. Yes.

[Lindsay Holmes]

The emotion is so important whether. Whether or not it makes you comfortable as the person who is sitting there witnessing it. I feel like the emotion that the person who's grieving expresses is just a manifestation of what they're going through. And I think that that's so important for people to lean into when it comes out.

[Noah Michelson]

Yeah. Maybe this is like an uncouth question after everything we've said already. And, you know, Lindsay asked about, if you are witnessing someone grieving, is there something you can say or do that that maybe isn't great, but are there mistakes that people themselves make when they're grieving? Is there a way to grieve wrong, or are you just gonna tell us that, like, there is no wrong way to grieve?

[Dr. Catherine Shear]

Yeah, I'm gonna tell you there's no wrong way to grieve. And I think it's a very important message because people do worry about it, and it takes them away. If you're judging something, you know, if you're thinking about something, you're not in it. Right. It's a way that gets you a little bit out of it, and we don't want that. And you're feeling what you're feeling for a reason, you know, and even as I said, the counterfactual. If we. If we think about those alternative scenarios. One of the things that I learned a lot from grief counselors, that's one of the ways that I learned about grief. And one of the things that grief counselors told me early on is that they said, why are you focusing on that? Those thoughts? You can really talk to someone. You can learn things about. People can learn from those. We call them pause points. This one grief counselor told me. And I thought, wow, that makes so much sense. It's not that even those things that can get in the way, we don't want to tell you not to have them. You can get there with a therapist if you need to, but you might learn a lot from having those thoughts.

[Noah Michelson]

Interesting, right? By having those thoughts, it can be a way to deal with them, maybe, or deal with what's going on.

[Dr. Catherine Shear]

It can be a way of taking you away from it, because it does do that. It sort of lets you have some respite from the pain, which you need. And we definitely. You need those periods of respite. So it does that because you're imagining a whole different way it could have happened. But it also. It also brings up things that you're worried about, about your own self. You know, a lot of times it does that. So, you know, like, why didn't I do this? And then if you. If you stay there. Well, why didn't you? You know, then you. You can kind of, like, unravel that. You. Well, I didn't. Because I had absolutely no idea that it was a problem.

[Noah Michelson]

Right.

[Dr. Catherine Shear]

And then you can, you know, and then it really subsides. Whereas if you were just not thinking about it, if you try not to think about something.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

Then you can't do that. And also, one of the things we know you probably Know this too, is the more you try not to think about something, the more. Absolutely the more intense to come back.

[Noah Michelson]

Yes.

[Lindsay Holmes]

We may not be grieving wrong, necessarily. But I am curious, are there some not so obvious signs of grief that people might not recognize is grief coming out? I know we spoke about anger and some of those feelings that you might have following a loss, but I'm curious if there is something that might be kind of surprising for people to hear, is actually potentially a manifestation of grief, whether that's physical or emotional.

[Dr. Catherine Shear]

It's true that almost anything can be grief. I mean, grief can show up as almost anything. But maybe numbness, you know, maybe numbness and just sort of being. Seeming really distant or disconnected, withdrawn, like you use, you know, that those people don't generally think of grief as being that, I think. I don't know. I mean, they think of it being high emotionality more so.

[Lindsay Holmes]

Yeah, that is true. I mean, I've definitely had experiences where I've felt numb or I've actually turned that sort of into productivity where I'm not really feeling any sort of emotion. But I'm cleaning the kitchen, I'm going around getting people drinks if they're, you know, after the funeral. Stuff like that, where it's just like trying to be helpful or productive and kind of using that energy to do something. And I think looking back on that time period in my life, like, that was definitely an expression of grief in its own way, too, because it was just taking what I was feeling and just acting on it. And that's the way that I knew how to act on it in that.

[Dr. Catherine Shear]

Moment and kind of setting it aside psychologically setting it aside, focusing on passing out the drinks or whatever, and which gives you some respite, which is part of the process of learning to live with the loss. I mean, it's part of it, which is if we say grief is the response to the loss, then it's part of the response to the loss. So it's grief.

[Lindsay Holmes]

Right, Right.

[Noah Michelson]

And maybe that got you through that moment and then you could, like you said, a respite, and then you could deal with the grief later.

[Lindsay Holmes]

Right.

[Noah Michelson]

I like that idea that. I like the idea that none of it is potentially bad.

[Dr. Catherine Shear]

Yeah.

[Noah Michelson]

It could all be serving a purpose at different times.

[Lindsay Holmes]

Right.

[Noah Michelson]

What are your thoughts on the five stages of grief? We hear a lot about that from what I can tell. Actually wasn't even. Wasn't created for grief, per se. So tell us a little bit about that. And is there anything that's useful from that. That method or that dynamic.

[Dr. Catherine Shear]

Well, I mean, it's wildly popular, both in professional circles as well. And so there must be a reason for that. Right. And I, I think. I mean, I've wondered about it because there's absolutely no evidence that there are five stages of grief. Only five stages. 25, 30 or 70, I don't know. But also that they follow any kind of expected stages like that. But. So why is it so popular? And I think it has to do with the fact that the whole experience of grief is so unfamiliar and, and discon. Discombobulating and disorienting, that if. If you tell someone, okay, don't worry, you're just going to go through certain. Yes, you're. It feels terrible right now. But then there's another stage.

[Noah Michelson]

Right?

[Dr. Catherine Shear]

There's another stage that. So the, the what the stages are, per se, it's not so much. But the fact of the stages, I think, is what's appealing.

[Noah Michelson]

Yes.

[Dr. Catherine Shear]

And helpful. It is helpful, I think, for people to know something about what they're experiencing. That's one way that, you know, it's less disconcerting.

[Lindsay Holmes]

Yeah. It feels prescriptive. It feels like, okay, this is kind of a blueprint for what you could potentially go through, and I think that might be comforting.

[Noah Michelson]

I like looking at it that way. It's like instead of going through the haunted house where things are jumping out at you and you're in the dark and you don't know what's coming, the lights are on and you can see what's ahead of you. Maybe. But I also like the idea that these are just some of the things that you might feel and it might not be in this order. It's going to give me a little something, like you said, Lindsay, a blueprint maybe, to think about. But don't expect that it's going to be exactly this. That doesn't seem helpful either. Right.

[Dr. Catherine Shear]

And I think, you know, if it helps you, if it feels like it helps, that's great, as long as you don't benchmark yourself to it. You know, you don't say, well, wait a minute, you know, I should be transitioning from whatever I'm feeling right now. And maybe I am angry. I should be transitioning to depression pretty soon.

[Lindsay Holmes]

Yeah, there's a lot of shoulding in that. And I feel like that's something that a lot of people get caught up in when they're going through grief, is I should be feeling a certain way, I should be acting a certain way. I should have moved on by now. What would you say to people who. Who are feeling that way? Maybe they're listening to this now and they're feeling like they should be able to move on. Maybe they should be having a different reaction. What would you say to someone who is going through that?

[Dr. Catherine Shear]

I respectfully disagree.

[Noah Michelson]

I love that.

[Lindsay Holmes]

Yeah.

[Noah Michelson]

Are antidepressants or anti anxiety medications ever something that you are using or that people should think about using? We talk about them a lot on this show and we always say, you know, you should be seeing, obviously seeing a medical professional and not something that you play fast and loose with. But is that something that would help with something like prolonged grief?

[Dr. Catherine Shear]

Well, we did a study to ask that question.

[Noah Michelson]

Yeah.

[Dr. Catherine Shear]

We did not document any effect. We were unable to document any effect. That's a longer conversation. If there is an effect on grief, it's minimal, at least grief as measured as we measure it for what we used to call complicated grief, the way that we measure grief, it doesn't. However, it does help depression. If you have depressive symptoms, it helps the depressive symptoms. And I don't think we really measured anxiety symptoms, but, you know, antidepressants do help anxiety symptoms, and so probably it would be helpful for that too. So you can have one of the things that loss also does that we didn't talk about. It isn't only grief that can be activated by a loss. If you have a major depressive disorder, a propensity to experience, you know, really depressive episodes or panic attacks or panic disorder, or really almost any physical or mental illness, it's a huge stressor. Losses are huge stressors, and they are associated with the onset of just about any mental disorder that you can think of. I collaborated with a colleague at the School of Public Health at Columbia, Carrie Keys, who published a paper, I don't know, five or seven, 10 years ago about analyzing some epidemiologic data that really clearly shows that. So, yes, I mean, my colleagues and I who did the study, we are all psychiatrists and we all treat people and we all have used antidepressants in addition to grief therapy. You need the grief therapy for the grief. That's pretty clear.

[Noah Michelson]

Right.

[Dr. Catherine Shear]

But they can sometimes be helpful.

[Lindsay Holmes]

So a lot of people who are listening right now may not be grieving, but they know someone who is, or they might experience it in the future. How can we best support people who are grieving right now? What are some things that we can do to show the people in our lives who are grieving that we care for them, that we're there for them, all of that.

[Dr. Catherine Shear]

I mean, I think the main thing is to exactly what you just said. Show them that we are there for them. And how we do that, it kind of depends on our relationship with them and them taking our lead from them. So sometimes it is doing things for them. Taking their kids to dance lessons, whatever it is, or bringing them food. A lot of times people do bring food, but that can be appreciated. But not doing it just as an automaton, but being there with them, at least to talk to them as you deliver the food, if not to share it with them. So being there with them, I think that's the main thing, both physically but also being present, taking time so you're not rushing off to some other place. And also, I guess another thing that might be important to say about this is that, that people who are grieving are not available for their other friendships in the same way that they usually are. And so there's not the usual kind of reciprocity that we just naturally expect. It's not there. And so understanding that and knowing that it's not going to last forever, that's not. That doesn't mean your whole relationship with them has changed. But right now it's more up to you to be that caregiving person.

[Noah Michelson]

I love that. I think that that's so important. Yeah, this has been wonderful. I don't love talking about grief. I think that's part of the problem, is that we don't talk about it enough. But I think that this was such a sort of embracing conversation about it. So thank you for being here.

[Lindsay Holmes]

Thank you so much.

[Dr. Catherine Shear]

Thank you for having me.

[Noah Michelson]

It's time for better in five. These are your top five takeaways from this episode. Number one, grief can be a lot of things, but Dr. Shear defines it as a reaction to loss.

[Lindsay Holmes]

Number two, grief can manifest in psychological and physical ways and it can be different for everyone.

[Noah Michelson]

Number three, one of the most important ways to move through grief begins with accepting it, so then you can begin to process it.

[Lindsay Holmes]

Number four, one of the things Dr. Shear advises not to do if someone you know is grieving is trying to make it better for them.

[Noah Michelson]

And number five, talking about the person who passed can be a healing way to grieve and keep their memory alive. All right, Lynn.

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[Noah Michelson]

So have you been doing grief wrong?

[Lindsay Holmes]

As we've learned, I don't think there's a wrong way to be doing grief. I do think that I've shamed myself for not reacting a certain way when I've been experiencing grief. I think that if I could go back, I would allow myself to be more accepting of whatever emotion I was experiencing in that moment. And I've learned today that grief can really manifest differently for different people and in different circumstances. I've reacted one way to a person passing and a different way to someone else. And whatever you're feeling is okay. And I think that that was my biggest less today.

[Noah Michelson]

So often on the show it's about being giving people permission to do things or to feel things. And this is another one of those episodes where it's like. Like you said, it's just, there isn't a wrong way to do it. I think the wrong way to do it is not letting yourself feel whatever you're feeling and making yourself feel bad because it doesn't line up with the, quote, unquote, five stages of grief.

[Lindsay Holmes]

Right.

[Noah Michelson]

And that's what I loved about this episode, is just talking to Dr. Shear and hearing her say, like, it's this very general thing. It's a reaction to loss. And that's gonna show up in so many different ways at so many different points. And, like, I'm still grieving my dad, and it's been 17 years. It's different than it was. I always tell people, especially people who are just going through, you know, the beginning, the days after, it doesn't get easy, but it gets easier. And I think that that's the thing that I hope people take away from this, is that it's. There isn't a wrong way to do it, but you can do it in a better way, maybe. Or you can give yourself that permission.

[Lindsay Holmes]

Absolutely.

[Noah Michelson]

Anyway, until next time, as long as there are things to get wrong, we're going to be right here to help you do them better. Bye.

[Lindsay Holmes]

Bye.

[Noah Michelson]

Do you have something you think you're doing wrong? Email [e-mail] and let us know.