Bereavement

I’m up and it’s only 2:30 a.m., happen to catch a glimpse of myself in the mirror. In a shiva house the mirrors are covered, for the most part, for that first week of mourning following the passing of a first degree relative. There are all kinds of superstitious reasons, frankly I’m not interested in them. All I know is that one of the towels fell off the bathroom mirror and there I am, looking at me, and it isn’t pretty.

Has it aged me, losing my father? Or should we say, wizened me. Both right. It is a new experience, not at all like I thought it would be. It feels as if I’ve been hit in the back of the head with a baseball bat, still, over a week later, and that I’m in some kind of daze. It is surreal, detached.

We call it Bereavement, a V code, V62.82. Thankfully I have very few of the symptoms that distinguish bereavement from Major Depressive Episode. I haven’t got the guilt over what I didn’t do, no morbid preoccupation with death, no marked psychomotor retardation (although driving has been a little scary, haven't quite got the coordination back). No hallucinations, although my dreams, really scary.

And sure, it’s hard to sleep, and it is very early in the morning. I throw on a heavy FBI sweatshirt, one that my youngest son bought on his senior trip to Washington, DC, take a tour downstairs to the kitchen. I haven’t been home in a few days, have stayed overnight with my mom. It is traditional to choose a site for visitation, so my brother and I, without ever discussing it, have been at her home for the week, receiving visitors.

It is the flip of being a therapist, ideally. Being a therapist is all listening, or 80% listening, 20% feedback. Being a mourner, in my tradition, is talking or sitting quietly, but the mourner is the initiator. You don't impose your stuff on a mourner. Visitors come to sit with you for seven days, keep you company. It's about consolation, paying condolences.

You talk about whatever you want to talk about, so if you don’t want to discuss your father you don’t have to. But this is your chance, so to speak, to honor his memory, to publicize his goodness, his life experience.

We learn about life from the obituaries, at a certain age, and the eulogies.

I'm sitting near the toy box, see toys on top, not inside, remember putting them there, picking them up from the living room. My daughter and son came in for the funeral of their grandfather, one with an almost toddler, and after they left I didn’t want to put it all away. I look at the toys and it feels as if the visit was years ago.

I make a stab at reading from a novel, American Wife, by Curtis Sittenfeld, a wonderful treatment of Laura and George Bush, but can’t concentrate. There are a few newspapers on the table, but the words don’t penetrate. Something about winter Olympics and bobsleds. And of course, Tiger Woods. I think, I should blog about Tiger. Then I think, I should blog about my father.

He buried my brother 40 years ago to the day of his death. Isn't that amazing? Someone says to FD, Sometimes you get a glimpse of how things are actually run. It's not all random.

Here are some of the things I said at the funeral:

My father was such a complicated man that I can’t tell you if he would want me to make you cry, or not. I think not, because he was such a social guy. He would be happy to see such a nice crowd.

He simply had this magnanimous warmth, he greeted everyone as if he’d been waiting all week for you to stop by. Always someone knocking at the front door window, the telephone always ringing. Almost always for my Dad.

Last Wednesday morning, we're in the ER. He's in terrible pain. They put a gown on him, hook him up to an IV, his clothes are in a plastic bag. He’s on oxygen.

“You never saw me like this,” he says to me, for the hundredth time since he’s been so ill. This has been his mantra for months, now, “You never saw me like this.”

Every day it surprises him, embarrasses him that he’s weak, short of breath, and he’s embarrassed about it. Like many men of his generation who did not experience the hunger of the concentration camps, being physically weak is unfathomable. It isn’t who we are, he would say, for he encouraged us to take good care of ourselves, always. You eat right, lots of garlic, you sleep right. Your body cooperates. He has to remind me; this isn’t him.

And I tell him that it’s okay. I know who he is.

A story: Kovel, Poland: the end of the Russio-Poland War, 1920. Bands of marauding Cossacks, White Russians; they're raiding towns everywhere, especially the ones with Jews. They pillage and rape and kill babies with their bayonets, toss them into the air.

My grandfather is running an errand, probably buying something for the farm. My grandmother is in bed nursing my infant father. A gang of these animals bursts in on her. They see my grandmother, a beautiful woman, probably all of twenty, nursing. One says something, probably in Russian, to the others. They argue, banter back and forth. They stare at her, they look at my father, they look at one another. The toughest one says something. They shrug. And they leave.

My grandfather returns from the store, he hears what has happened, and he packs a few things, takes this little family to the forest at the outskirts of town for as long as it takes until the hooligans move on to another.

But you know, a small town family, they’re always waiting for another gang of Cossacks.

Probably in response to my grandmother’s fears, and being the oldest son, my father takes the protector role in life when he can, which is how I see him as a kid, watchful. Bigger than life, really. I’m a naturally fearful person, irrationally afraid of home invaders, as you know. But if he's home, I'm not afraid.

There are too many stories, a blog is just a blog. Okay, just a little more.

Things not everyone knows:

He was charitable, he couldn’t say no, especially not if people asked him for something directly. A total softy, if you looked my father in the eye, respected him for who he was, he would give you the universe if he could find a way. And honestly, he believed he owned that, too, that the world was created for him.

Which is how we’re supposed to think.

He would teach that it’s what’s inside that counts, not what you have. It’s not acquiring things, it’s living that counts, living fully. This in the heart of of the suburbs, a very material world.

The world is not going to be the same, not for a lot of people, without my father.

therapydoc

How to Save a Life

Caveat: This may make you feel bad. If you know someone who killed himself, or herself, and you feel badly about your part in it somehow, get therapy. Or talk to someone about it. You matter, too, and despite what you might think after reading what I write below, you probably couldn't have helped that person, probably could not have saved a life. It's one of those things, best to take yourself off the hook.

One night last week FD said to me, "We should make a shiva call tonight."

Someone who sits shiva has lost a parent, sibling, or child, a member of the  family of origin. From burial to "getting up" from shiva, friends have a week to stop by and sit together with the mourners, console. Or they can call on the phone, if the mourners are out of town. My parents call it a condolence call.

I felt badly for not being on board, but it had been a long day. I just didn't want to sit anymore, not with anyone. I wanted to eat some dinner, make a few calls, work on taxes, try walking a little on the treadmill, see if I could ride a bit on the stationary bike. I told FD I had a break the next day and intended to visit our friend then, maybe do some shopping afterward. Did he want to come along then, skip tonight?

Call me before you leave, he said.

So I did, and he went along. We visited someone who had lost his father, a dear man in his eighties. Our friend talked about his mother, alone now and missing her spouse, what that must be like, missing him for what will be the rest of her life. To her, this man in his eighties died prematurely.

Sad but a relatively easy shiva call, as shiva calls go. No one lives forever, children should outlive their parents. There's a certain order that makes life just a little easier to take, sometimes.

After the visit we grocery-shopped and had some lunch. I dropped FD off at his office and started back towards mine.

Then I heard the song. I'd heard this song maybe three or four times before, and each time would think, Catchy, but what's he's saying? Is the refrain really, how to save a life? Is this song about suicide? It sounds like the lead singer is blaming himself, this mournful, plaintive voice in the band, the one full of regret.

But honestly, all due respect, words run together for me and I don't want to think this. I'm on my way to work thinking, how to save a God knows what, flashing on that first patient and  wondering where am I going with this woman. Is my treatment plan on target? One false move. . . No room for mistakes.

I’m an aquarist and have had a bad fish week, lost three, one to an attempted homicide. The bat fish didn't make it through the mauling. A trigger mistook him for a leaf, perhaps. The clowns died of broken hearts, in sympathy, no idea. They just couldn't smile anymore.

But these are people.

I get to the office early and log onto YouTube, because there's really nothing to worry about with that first patient and I know this, truly the job is in hand, the work's been done. We're in middle phase, putting together a few pieces, not resuscitating anything, anyone.

And there it is, the music video, obviously a hit, a clear winner, it pops right up. Many others boast videos "with lyrics." So apparently I am not the only one who didn't get them on the radio. Once you know the words, like everything else, meanings are clear as rain.

Where have I been? Why haven't my kids told me about this? Don't they know I need this stuff? It's like oxygen for me, a song like this. I print out the lyrics, then watch the video maybe five times, mesmerized.

Fray, the band, won't let me embed it on my blog, so readers must find it themselves or follow a link.  With their permission, here are the lyrics.

How To Save A Life:
Step one you say we need to talk
He walks you say sit down it's just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you've told him all along
And pray to God he hears you
And pray to God he hears you

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you've followed
He will do one of two things
He will admit to everything
Or he'll say he's just not the same
And you'll begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life
How to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to
Save a life

A critical thinker would watch the video and say, so emotionally manipulative. These are actors, hired to look sad, to draw attention to a problem affecting youth today, but there is no way that any of them would really want to die, would voluntarily take their lives.

But the truth could be otherwise. Although these are actors, they are representative. There is an ennui that affects young people, like old people, a psychic pain that affects the leaders of tomorrow, and I see them in my office and we talk and talk and talk, and there was a time, when I was young, that I would be on the phone all night with them. I knew so little back then.

More aggressive, I haven't done that in a long time. Not only are youth at risk, of course. Anyone who has lost everything, which is easy to do, is at risk—middle-aged men and women who have no savings, no jobs, fathers, mothers, grandfathers, grandmothers, the old and the young have angst, suicidal wishes. We know them.

Along comes one, distressed, withdrawn, glassy-eyed, a friend of any age, who has changed. And let's say you have this chance, somehow, to stay, to help this friend through one night in particular, one awful night. It is a horrible position, to have to do that, to make that choice. And with grown men, it's not as if anyone is asking you to stay and hold hands, not usually.

Maybe you know. He’s not going home to anyone. He’s isolated. In a book you are reading you learn that isolated people are at higher risk. It is sometimes easier if there are friends, family around. Living with someone is better than living alone; the support is built in, not that this always helps. People can be in the next room and not be there, not be very much help at all. They may even be a part of the problem.

Thus as a real friend, you have to stay to save a life, as Fray tells us. You may have to call someone else, explain why you'll be late, maybe why you'll be out all night. Mention that you might need some assistance, too.

But you have to stay, and you might have to stay up all night.

You never want to be in charge of someone's life, it's not a great position, it's not usually what we sign up for when we say, I'll be your friend. But sometimes, by staying, we make it a little easier for a friend in trouble to hold on. Stay just a little longer, until you have a chance to bring in bigger shoulders.

It can be hard hanging in there with someone who is seemingly smiling politely back at you. (Lyrics like these strike a familiar chord. We've seen this smile). You can't politely look right on through, go your own way. To be trite, you may not pass this way again.

Between the lines of fear and blame. You begin to wonder why you came.

Except you shouldn’t wonder, because your fear is nothing compared to his, and no one, really, is to blame. Depression happens and is obviously the domain of the therapists, the professionals—doctors. We have the tools. Sometimes all we need, however, is some unknown actor to play a quiet understudy role, to be a stand in for a few hours, keep our patient alive, watch him and don’t let him let that impulsive, senseless act happen. Get through the night and then find help, the bigger guns, to fight your friend's depression. Tell someone, a parent, a primary care doctor. A cop.

Anyone can sense a death wish, you know, feel that Spidey sense tingling. It is a scary feeling, sensing a death wish, because we have no control, none over the actions of others. Intimate information, insider knowledge direct from the mouths of our suicidal friends will haunt us if the act is consummated.

Like isolation, seeing self-destructive behavior is insider information. If a friend has been hurting himself, or has been hurting for a long time, drinking and drugging without any thoughts about tomorrow, then the direction of his mood won't spontaneously lift, the negativity won't fly away, not without medical intervention. That is when we have to seek help, can’t wait around for tomorrow. It is too dangerous a cocktail, negative thoughts mixed with accessibility, the accessibility of drugs, alcohol, bullets, ropes, blades. We can't walk away the truth of our violent world. We have what to fear, old Yiddish expression.

So scary, and we’re so powerless, You wonder why you came. So you go.

When we don’t, when we reach out, they punish us. This is how they make us feel, depressed people, like we're useless and powerless, like we can't help them. Why bother? This is how they feel, useless and powerless, failures, better off dead, not worth bothering about. It is called projection, and a sensitive friend feels what is in the heart of another, this feeling that there may be, truly, nothing that can be done.

Such a trap, and so wrong! Over-rated, powerlessness, hopelessness. Push help, find those friendly cost-effective social service people at the local mental health agency, the professionals. They’ll think of something. That is the rational way of seeing despair. The social scientists can't treat everything, not every time, but God knows, they can treat depression, and more often than not, win the battle.

Someone has to stay rational, unafraid, and above all, hopeful. You, the friend, perhaps the lover, sister, brother, parent, spouse, are elected. Maybe it won't work, maybe you will lose this person in the end, but you don't really know that, do you? So you can't run away, that's for sure, hoping that in the morning your friend will be okay.

You can't stay right if he turns left. This is the projected abandonment he is hoping for, you validating his worthlessness with your leave-taking. Don't fall for these words, I'm okay, go home. Be sure someone else is on call. Or stay.

This is not to say a person should be manipulated to stay by suicide threats designed to control the relationship. This is entirely different, a typically borderline personality modus operandi, and it is not an easy call to make. One in five with this disorder do kill themselves. But threats are threats, and as such need to be taken to a higher court. There is a fine line between dependency and despondency, but sensing you are walking that line, it is best to get out of the helper/rescue role.

It is too big for you. It is too big for most of us. That is why such people are so lonely.

Oh, so much to say. Why did I start?

Because so many people, after a suicide, say, I knew.

I tell people to talk openly about it, about this idea that most of us have had, at least once in our lives, that life is too tough, that we wouldn't mind finishing it. And they should discuss meaning, why choosing life is the better alternative, because there is meaning. It is our job to find it.

Having the discussion doesn’t make it your job to find meaning for your friend, the one who wants to die. It is the job of professionals. But you can play with it. It is a wonderful, rich, very intimate conversation we're talking about, and as such can be therapeutic. Therapists have no corner on these conversations. We do tell people that a suicide is permission to the generations to come that it is okay to throw their lives away. And if you do happen to help a friend find meaning, if together you find that elusive raison d’etre, within the throes of discussing depression, you are amazing, both of you are, and should consider this profession.

Oh, but we aren’t finished. In the process of this philosophical discussion, should your friend mention a suicide plan, then this is a heads up, don't take it lightly. There is real risk. Your friend is capable, armed, can exact a suicide. Now is the time to phone for help. More drama now, less later.

You can and should call parents, if there are any, and they are around. Real friends know how to find them, aren't afraid of these people, the ones who birthed a suicidal buddy, who brought a suicidal friend into the world. It is possible that these people hold the key to something very elemental to your friend's survival.

If there are no relatives nearby, then you may be the closest relative right now. You don’t want to lose him, but he can be such a burden, sometimes we give up. If it were our child with a fever, we wouldn’t give up. This is a child with a fever.

Where did I go wrong, I lost a friend. Somewhere along in the bitterness.

Whose bitterness? Suicide is an angry act, a vitriolic act. At some point there's energy, enough to make it so, that decision, the one that spells relief. It takes a lot of psychic energy. The decision to do it can be invigorating. So we watch people when they say they're feeling better, watch them more closely. We're thinking, the energy is available, the time is now. He's going to go left. There's so much energy in the bitterness and anger. Toxic stuff.

Let him know that you know best. Cause after all you do know best

All you know is there’s something really wrong here. Even we, the professionals, the ones who know, don't give advice. We listen. We teach from experience and we do it gently, if we do it at all. All we know is we find death repulsive. Our friend does not.

When your Spidey sense says, You're not getting through, this person is going to try it again, it is time to call for reinforcements. I've had kids never see me again because I forced a hospitalization.

Enough. It is a blogger’s prerogative to ramble on, but you get the idea. You know the symptoms to look out for, the loss of interest in the usual pleasurable activities, not caring about school or work, not caring about hygiene, expressing hopelessness and helplessness, giving away possessions, revealing a suicide plan.

You don't want to be an armchair therapist, here, not a self-appointed therapist, certainly don’t want to beat on someone's short-comings, not ever. Like Fray warns us in the song, we don't tell a person what he doesn't want to hear.

Our unconditional love and support? It might feel good, but it might not, won’t necessarily save anyone’s life and doesn't take the place of professional help. It is all we have to offer, however, when someone won’t get help. The real kicker is that people can fool the healthcare professionals. As soon as they’re released, they overdose or shoot a bullet through their heads.

When they have had help and given up, it is the worst. We have to reinforce that therapists are a dime a dozen. Try another.

Meanwhile, scheduling is impossible, and there are no appointments and your friend is taking his feelings into his own hands, dosing out his own medicine, not caring if it helps or not. And you're there and you can tell, he's too drugged up, or he's drinking too much, that this isn't good.

So you call 911.

And there, you've saved a life.

You don't have to wonder about any of it, you don't have to wonder why you came, why you stayed. The un-timeliness is what we're talking about, the premature death, the one we want to avoid, no different in its importance than the one we talked about earlier, the octogenarian who still died prematurely, at least according to his wife.

We want to save a life at any age. That's why we stay. We—you—are a part of it.

therapydoc

The Shiva

I always get a little paralyzed here. Probably most people do.

You might know that shiva refers to the seven days of mourning that follow a close relative's funeral. Such a mourner, in Jewish tradition, sits at home, refrains from work and withdraws from the usual affairs of life; but takes visitors, dozens, sometimes, at a time.

Friends and relatives in a community come to visit during the week, even if they're not particularly close to the mourners. Sometimes the shiva is shorter than the traditional seven days. It may last only three days, maybe only one, depending upon the custom. But no matter how long, visitors serve to soften the intensity of the loss; the presence of visitors fills the void. For a little while.

It should be easy to make a visit like this one. A person isn't really required to say anything. All a person has to do is be there, take a seat and listen. In the more observant homes, the people sitting shiva are seated on low chairs, their blouse torn just a little; they face others, those who are not in mourning, who are seated across from them.

Usually someone's talking, not necessarily about the person who passed away, either. It's not unusual to hear people talk about anything but the person who has passed away. And that's okay if that's okay with the person(s) in mourning. Sometimes, as a mourner, you just know that it's going to be a very long week, so you're fine with the light motif, the banter that gives you a break.

It happens to be the three weeks,* an unlucky time for the Jewish people, so when someone passes away during this season we sort of look at one another and say, It's a three weeks thing, and everyone gets it.

But when it's cancer that takes a life during the three weeks, I always go, Nah, it's cancer. And everyone gets that, too. We know that many presentations of the disease are curable, and the survivors, the soldiers, are our heroes. But occasionally, it's not a winning battle, and the fallen become our sacrifice and we respect them even more.

So today I wanted to make a condolence call, but did everything in my power not to go, did an admirable job of sabotaging my time. I found an old chandelier in the basement and since I had a couple of hours to spare, decided that this would be a good time to wash the crystals, even though the thing has so many broken pieces it should probably go to Salvation Army and will.

After about an hour, though, I took the walk over to the shiva house. Slowly. I felt terrible that I hadn't visited her when she was sick. I've known she was sick for almost a decade. I'd walk by her house on any given day and sometimes she'd be sitting outside on a chair and we'd talk for awhile, maybe ten, fifteen minutes, just chew the fat about nonsense. She would ask about my kids; she remembered them, had taught them some twenty years ago.

But I never went in. You know what I mean. I never took that second step of going inside when she wasn't well enough to sit outside.

And boy, I'm so sorry about this. I feel so badly.

Earlier this morning I caught FD for just a second before he went to work, took him by surprise, made him face me as I shouted, "I just hate myself for not visiting her when she was sick!"

He totally understood and shook his head. "I know, I know, me, too. What was wrong with us?"

"We'll you're always visiting sick people. You're in the hospital and they're sick, or they manage to find you if you don't find them. It has to be a lesson for me, is all. This sort of thing just makes me feel like garbage. Had the chance. Let it pass. It'll never be there again. Gone."

I had ten years to do that, visit.

When my daughter heard about the death she said, "How could that happen? Wait a minute! You don't mean this! She was so young! She couldn't be much older than you, right?"

She was sick a long time, dear. Age has nothing to do with it.

So I shuffle along, finally walk through her door. Immediately I sense the atmosphere is light. My neighbor/friend's mother, the woman who has just lost her daughter, looks up at me, catches my eye as I get my bearings. She smiles a smile of confused recognition, one that says,

I'm sure we've met. Who are you?

We have never met. She has other people sitting with her, talking to her. I can see the mourner I know the best, my neighbor's husband, with a chair open right in front of him. He smiles, happy to see me. I sit with him and we talk awhile about how things used to be.

It's funny. We, the visitors, are only there because a person used to be there. A person used to be a part of the way things used to be, but isn't any more. And yet we're talking about grocery stores that are no longer, toy stores that have relocated, and how people used to be so nice in a snowstorm.

And then he inserts her. He says, "She told me that I had to fight her parking ticket for her because I didn't move the car in that storm, so of course I did, I fought it and won, and it's a good thing I did."

And there she is. And I feel better. The light motif is still light, but it's more meaningful.

At some point I see his daughters, young married women with young children, and I talk to them. They're very much about talking about their mother and their loss, and how we must, we simply must find a cure for breast cancer. Someone mentions Mike Dewey, the Texan who has offered $1 billion dollars to anyone who finds a cure. I feel the time slipping away, know I have to get to work, so I say the magic condolence formula that we say to mourners** and ask the younger women, "Where's your grandmother?"

I'm asking about the woman who caught my eye when I walked in the door. She has vacated her seat. I want to meet her, to tell her how much I admired her daughter, how I'll miss her, too. They tell me, "Try the kitchen."

Where else?

So I head there, to the kitchen, and sure enough, the elderly woman with that certain spark, that glint, smiles when she sees me. I recognize the spark because her daughter had it too, that quick way of creating humor, a way of making things light, happy. Humor is communicated through the eyes of these people, the ones with the sparkle in their eyes.

I introduce myself. I say I'm So and So's niece. Everyone knows my aunt in this community, there weren't that many Orthodox families in town when my mother, my aunt, and this woman were girls. Chicago has grown, but the native Orthodox all know one another.

"You looked familiar! I knew I knew you," she exclaims. "And now I know why! You have the family resemblance."

I don't want to disappoint her. I look like my father's side. But it's okay. We shmooze awhile, standing in the kitchen.

"And how did you get this?" I ask, pointing to a sling on her arm. "It's very stylish, but still."

She's coy, lowers her voice, the twinkle is blinding. She says, "Well, I'll tell you the truth. I just. . .I just wasn't getting enough attention on Thursday (the day of the funeral) so I tripped and made them take me to the hospital. I think it was brilliant." She's smiling the smile that caught the canary, making this our little not-so-private joke, and it is, it is really, really funny.

"You go to a lot of trouble for attention. You could go pro."

"I know," she says proudly. "And look! It worked!"

"Except," I correct her, "that you're stuck with a lot of pain for who knows how long."***

"Four weeks, the doctor says. It could hurt for four weeks. I'll need a lot of attention."

"Four weeks if you're lucky!" I cry. "It could go on for six weeks, eight weeks!"

"I told them! I told them this!" she exclaims upon hearing my prognosis, triumphant. "I told them it could go on for eight weeks. Come. Come with me. You have to tell them." She takes me by the elbow, guides me back to the living room where they're sitting shiva.

"Tell them!" she commands, for all to hear, pointing in the direction of her daughter, the only daughter left, the only mourner I've yet to meet. There's a small crowd of women sitting around her but I introduce myself, tell the only daughter left that I'm sorry about her sister.

"Tell her!" the matriarch insists. "Tell her how long it could take for this arm to heal!" She's having a ball. She loves this.

"Are you a doctor?" asks her daughter.

"Not a medical doctor. A PhD."

"That's fine. Even better," the daughter affirms, going along with the script. "So tell me, doctor, how long will my mother need this sling?"

I shake my head gravely. "I don't know. It could be very, very bad. Could be six to eight weeks. Maybe more. Could be years."

No one's got a straight face here, but boy, I'm trying. I shrug. "I would keep a good eye on her if I were you," I say, looking up and to the right, clearly deep in thought.

Then I tell over the condolence blessing to the only daughter left, kiss my new friend and say it again, and leave, always amazed at how these things go.

therapydoc

* You can read more about the three weeks on the Cirque du Soleil post, there are links at the end from bloggers who know the rules.

** It's in Hebrew and basically says The place of all comfort should comfort you among the mourners within the gates of Jerusalem. Some prefer to say simply, We should meet at simchas, happy occasions, or You should know no more sorrow, like that's possible, but it's a blessing, basically. All positive shoulds, you should, are blessings in this religion, or can be.

***for who knows how long is a Jewish way of marking time that goes on and on, as it does.

Other bloggers who have posted on shiva include:

Amy Kronish writing about Shiva the movie (who knew?) directed by Ronit and Shlomi Elkabetz

Patti, not religious at all, but still sitting virtual shiva at Live to Lounge writes about having lost her brother very recently. If you're very sensitive, you may not want to gaze at the banner, nude art alert, consider yourself warned. But say hello, wish her well. Why not?

Oaxaca is interested in comparating religions over at the Bed and Breakfast.

Vesom Sechel , kind of serious, but okay, this is a serious subject, generally, that is.

Can You Cry Too Many Tears?

This will be a long one. Settle back and relax.

Today is the holiday that the Jewish people (those who observe it) dread for three weeks. Some people dread it all year long. FD says there should be a holiday that everyone dreads.

I'm not sure I follow his logic, but ours is certainly the religion for everything.

Tisha B'Av, the 9th day of the Hebrew month of Av, is a day that marks destruction. Like every holiday there are certain laws to observe. The law specifically associated with this holiday is about tears. Crying.

You're supposed to make yourself cry and get in touch with the loss of the Holy Temples of Jerusalem, built and destroyed by conquering nations. We lost the first in 586 BCE, two thousand, twelve hundred years ago, to the Babylonians who desecrated the holy walls and holy vessels; the second in 70 AD to the Romans who seconded the motion.

We grieve the martyrdom of people of other eras (think Spanish Inquisition, for one) who died rather than convert, and we remember every pogrom, especially the Holocaust.

Our history is full of tears.

On Tisha b'Av we get in touch with the loss of holy land and what are thought to be the dwelling places of the Old Mighty. (That's how my grandfather referred to Him. ) When we're in Israel we say that prayers are a local call. The Jews trace a relationship and ownership to the holy places of Israel to Biblical times, fifteen hundred to two thousand years B.C.E.

In any case, a huge mosque sits atop the spot that Jacob wrestled with an angel and won but walked away, limping.

This is also where his grandfather Abraham said to the Old Mighty, "Sure, you want my son, you can have my son, my only son from this particularly incredible mother, Sarah, my helper, my friend, my companion, the woman who has grown old with me. "

The midrash (an explanation, also a few thousand years old) tells us that Isaac was no baby at the time he was offered as a sacrifice per the Old Mighty's request. Sarah, when she heard about the possibility that Abraham would do this, had a heart attack, probably at the age of 103. We think Isaac was thirteen years old at the time.

Bound, his father readying himself with a knife for slaughter, Isaac looked up at the sky and the Old Mighty opened up the heavens so that His young servant alone could see beyond the stars. The tears of the on-looking angels fell into his eyes, which is the reason Isaac is said to have been near-sighted for the rest of his life. Most of his descendants are, too.

Anyway, the angels cried and the Old Mighty had mercy and crying is a theme in our culture.

I believe I told you that my mother said, "Cry, it feels good, it's good to get them out." I'm sure she said it in Yiddish, too, but I've forgotten the Yiddish.

And I've told you that there is not an infinite number of tears. Eventually you will stop. If you need to cry, cry. At least I don't think there's an infinite number of tears. I could be wrong. Has anyone done the research on this? I don't think so.

The rabbis say, Cry, for sobbing is all that the Old Mighty really does hear. In other words, He's sick of words. And who can blame Him? We are all talk, are we not?

Which is why talk therapies, especially rational therapies tend to work, but it's also why we need them to talk out our many obsessions.

But there IS such a thing as too many tears, if not for this holiday.

The story goes that a woman could not stop crying for the loss of her husband. She was irreconcilable. Her family brought her to the holiest rabbi in town who told her that she shouldn't be sad. Her tears went to good use. The Old Mighty gathered all of her tears in a cup, every one of them, and when a terrible calamity threatened destruction to the world, he used her tears to avert the tragedy. This calmed her down.

She could stop crying.

So sometimes it's good to cry, and sometimes it's best to stop. I used to tell my kids what my mother told me, advice I hope they will tell my grandchildren, that they should squirt out a few tears now and then, maybe every day.

I still tell my patients this. But this doesn't apply to people who can't stop crying, like the woman in the parable. So without a rabbi to tell you the importance of your tears, how do you stop?

Therapy's an interesting process.

Sometimes it helps to look over your life and find the things that you forgot to cry for or weren't mature enough to cry for or had been taught that you shouldn't cry for, but you should have cried for when they happened. You should have cried at the time but you didn't.


So for example, some little kids, upon the loss of a parent are told that it's okay, they'll be well cared for and they need not cry. They're told they should buck up at the funeral. Be a man, be adult. Be strong. Kids grow up thinking this is the way we're supposed to be all of the time. Strong.

Then they wonder why, having stored up so many tears, when they find themselves at a vulnerable place in life, that the floodgates let loose and they feel as if they're drowning in their own tears. I tell these patients they have to mourn those old losses.

They're not all deaths, either, these losses. You know how to list your losses. Loss of innocence, loss of love, loss of functioning, loss of health, loss, loss, loss. Talking about losses puts those tears into place.

Stoicism can be a problem. Stoicism helps when you get rejection letters, and it's never good to feel sorry for yourself, really, so stoicism has it's place. But holding back feelings as a general approach to life can definitely be a set up for problems.

Therefore it is nice to know that most cultures build in ways other than stoicism to handle Big Losses. (We'll talk about the smaller, annoying losses as they pop up in other posts. Let's talk about the big losses here).

The psych literature tells us that Jews handle death nicely, so it's convenient that I'm Jewish. Maybe there are some universal truths for everyone in our customs and laws.

Let's start with a funeral. I'll go back to Aunt C's funeral. You last read about her when I visited her in the hospital. It made me feel so good, connecting with Aunt C, even though I knew she was heading towards hospice. Anyway, she passed away soon after that post.

In our culture, at the funeral service people lclose to the person who passed away talk to an assembly of friends and relatives (like in most cultures I think). My aunt had eight eulogies, one more beautiful than the next. One of my aunt's children, cousin Bobbie, said to me, Mom would have loved the service. She would have loved what we said, and she would have loved that the day was sunny and everyone came out to say goodbye.

At the funeral everyone is supposed to ask forgiveness from the mais, the person who passed away. So that's therapeutic for the community of mourners, too.

Then there's the shiva. If you're a mourner, a first degree relative or spouse, you stay home from work for seven days so that people in the community can visit you and you can talk about the life that's lost. People cry, sure, but it's hard for them to cry non-stop when there are so many visitors.

It's not a law that a mourner has to cry. You can tell who's in mourning because the males don't shave that first week and everyone in mourning tears their shirt before the funeral and wears it all week long. Crying during shiva isn't a requirement. It doesn't have to be.

So when my cousin's mom passed away, her sister, my mom, sat shiva with her two only other living sibs and my cousin Bobbie and her two sibs.

I cooked. The community cooked. Jews are all about food, at the end of the day. Food is life.

My cousin Bobbie had an incredible relationship with my aunt. They really were best friends. Now that the formal ritual is over, the funeral, the seven days, the month, she's into the year of grieving for a parent. In that year you don't buy new clothes or go to movies or concerts. I am quite sure my cousin cries often for her mother, expecting, when she picks up a ringing phone to hear my aunt's voice.

It's very surreal, you know. One day you can talk on the phone to someone, and the next day you can't. I'm sure my cousin picks up the phone to call her mother, starts dialing, pauses and puts the receiver back into the cradle.

Now that we're a couple of months past the shiva, she's probably crying a lot. She's supposed to stop after the year is up.

Because there is this prescribed grieving, at the end of the year a person does feel that the job is done. They can stop crying. Not for good, of course not. But the person who has passed away has been accorded respect, and a mourner feels he or she has truly mourned.

Immediate losses are hard for most people, especially that first year, and tears come often if we let them, whereas once they're a thing of the past, it's harder to remember, harder to grieve.

Which is why this holiday, Tisha B'Av is so hard for most people to wrap their heads around. It requires reflection, memory, a very long memory. For Holocaust survivors the loss still feels immediate. For the rest of us, it's harder.

But what do we do about it when crying is getting old already? That's the problem for most people. People who come to see me usually don't have to make themselves cry. They can't stop crying. And, depending upon the person and the context, too much crying can make one sick, not better.

Which is why the docs are forever telling you, Take these medicines. Happy is better. (My motto, by the way). I can't say, Take these medicines because I'm not a medical doctor.

But for the record, if a medical doctor recommends medication, I'll support that decision. And legally, therapy docs have to tell you to get a med eval, a medical evaluation to see if you need medication if you can't stop crying.

So consider that. And sure, get therapy. Grieve the past losses. There is an endpoint to the grief and suffering in any one person's past. Clean out some of it with a caring professional.

There aren't enough rabbis in the world, certainly, to take care of all of those tears.

Copyright 2007, therapydoc

How to Talk to a Widower--Grieving and Drugging

Maybe it's not terribly intellectual and it reads like a comic book without the depth, but I loved a book I wasn't supposed to be reading.

It's not what you think.

I have a friend who reads advance copies professionally. Anyway, I happened to be hanging around her house and the book happened to be on her coffee table and she happened to be on the phone, and you know these books take about five minutes from cover to cover . . .

Actually, I took it home.

Have I blogged yet about grieving and drugging? No, I don't think so. I know I've talked quite a bit about grieving, facing end of life, that sort of thing, and I've surely talked about drugging and alcohol, America's favorite drug.

So put them together and you have the subject of Jonathan Tropper's upcoming book, How to Talk to a Widower. The sticker on the cover said it was due for release in July in hardcover (Delacorte Press).

If it's out, pick it up or get it at the library, because despite what I said about comic book depth, the stuff on how to talk to someone who has lost someone tragically is wonderful. I've never read anything close to it and if I weren't so against plagiarism I'd have copied those chapters just to keep them for myself. I'd make copies for patients.

You should just go ahead and buy the book if you want to improve your communication skills exponentially (most of us do). I haven't read Mr. Tropper's others but intend to.

How to Be a Widower is a laugh out loud fast read. It surpasses all the chick lit novels I've ever read. Seriously, that's an exaggeration, but I've read quite a few between the dry research intro books I'm making myself go over to be ready to teach in September (we'll talk about that another day).

This book is as dead-on as you'll ever get for depicting emotions following the loss of a spouse. Jonathan Safron Foer's Extremely Loud and Incredibly Close does that for kids who have lost parents. Foer's book is unbelievably, extremely, incredibly good, cover to cover. Nothing chicky or prurient, nothing shallow or silly about it.

Still. I could swear Mr. Tropper lost his wife having read this book. That or he's one of the cloth, a therapy doc who has talked to people who have lost their better half. Neither is true. He teaches writing at Manhattanville College.

His advice is great, but honestly, I feel I'd ruin the book if I told you more about it than that.

But I will tell you about the Jewish custom of sitting shiva, which is unbelievably sublime and therapeutic. People who visit mourners the first seven days following a funeral are supposed to behave in certain ways.

The mourner is sitting on a low chair and isn't supposed to fix meals or do any work. Visitors and friends take care of him. Briefly and most generally, it goes like this:

1. You're not supposed to speak to a mourner unless the mourner speaks first, addresses you specifically or looks your way with a certain acknowledgment of your presence.

2. You're not supposed to talk about yourself. At all.

3. If you do talk, it should be to ask the mourner about the person he or she lost--if anything. Even that can be very intrusive.

3. You can offer the mourner something to eat of drink.

4. Mainly, almost anything you say to someone who is mourning can and probably will be shallow and inappropriate, so try not to say much more than perhaps pass on a happy memory of the deceased. And even then, only if it seems the right time.

5. Never interrupt the mourner if he or she is speaking.

A very nice thing about Tropper's book is that he shows how a person who has lost someone can change dramatically within a year. It also shows how abusing alcohol can slow down the grieving process even though it feels really, really good at the time. The alcohol abuse makes the loss even worse.

So for me? Two thumbs up on this book. Thanks Mr. Tropper. Sure, I'll try another advance copy any day if you're offering.

Copyright 2007, therapydoc