Tuesday, November 18, 2014

7 Suggestions for Grieving During the Holidays

The decorations seems to go up earlier and earlier every year. This time it was even before Halloween. The whole world seems to want to tell us to be happy this time of year.

A lot of people I know hate this time of year.

If you've suffered a loss recently, or even several years ago, you know what I mean. It's just not the same. Even if Thanksgiving, Hanukkah, Christmas and New Years' didn't feel like big deals to you before, they may seem to feel dreadful now. This is the time of year when schools close, businesses shut down, and people take vacations.

All to be together.

But after grief, it's often now when the absence of a loved one is silently screaming into your heart louder than before. That empty space, that vacuum, that sudden panic that something is terribly wrong. It all seems to come back in the run up to the holiday season.

By now, you may have learned that controlling these emotions is often unrealistic. The approach I've come to appreciate as more helpful than trying to control feelings is to instead manage the stress that this time of year and these very heavy emotions can bring. The research on stress management is therefore perhaps more relevant than theories about grief. Unlike grief, we don't consider stress to come in stages. It's a relentless presence in all of our lives, more so in the non-linear pain of grief.

So how to manage during the holidays? The following might help:

1) Keep in mind that you're not suffering alone. The holidays are difficult for millions of people around the world, even though it's not addressed in television advertising and marketing. You are not alone in your pain, although the pain can feel terribly lonely. Even if your loss happened a long time ago, the holidays have a unique way of dredging up lost memories and the intensity of grief. You're not moving backwards, grief is circular. It often feels like it's running laps around milestone dates like birthdays and holidays.

2) Choose the people you want to be around. Choose helpful people, if you can. Perhaps your place of worship reaches out to people during the holidays. Try it out. If you find you really have no one around during the holidays, think of alternative plans you can make. Chinese restaurants are usually open, and there's less likelihood of running into families doing their Christmas shopping there. Try not to stay home in the confines of your pain.

3) Exercise. Grief is stressful. Work out the stress. I live in south Florida, where it's very pleasant this time of year. Chances are though that going for a walk is not realistic where you life. You might have to join a gym. You probably don't want to be walking around an indoor shopping mall with all the families, couples and Christmas carols playing. Bring headphones to the gym and walk on the treadmill or around their track. It burns off the stress in your body and gets you out of the house. Try and exercise in some form at least a few times a week. Research indicates that several months of moderate cardio exercise 30 minutes 3-4 times a week can be as effective as an anti-depressant, even in people with less than optimal health.

4) Eat as well as you can. Stress makes your body crave sweets and fat. Grief is stressful. There's tons of sugary snacks around during the holidays. It's a very dangerous combination! Try and eat as healthy as you can. You don't have to juice or become vegan, but do try to eat as many fresh fruits and vegetables instead of packaged snacks. The last thing you need with intense grief is cycling through sugar crashes.

5) Be mindful of addictive behaviors such as alcohol, smoking, or gambling. There's a reason people do these self-destructive behaviors: they feel good. Why do they feel good when we know they're not good for you? Fundamentally, they give you a sense of control. Grief is the consequence of total lack of control. None of us can control someone else's life span or even our own. Many people find an addiction gives them a sense of control, even if it comes at the expense of well-being. Try not to fall into this trap. Besides, alcohol is technically a depressant, smoking ruins your quality of life before killing you and gambling is expensive. None of these sound like good coping skills because they aren't. If you've benefiting from AA or NA in the past, the holidays are a good time to attend regular meetings.

6) Start meditating. A steady combination of regular meditation and exercise can completely transform how you experience stress. You can learn how to meditate here in some of my books. Nurture your spirit, even if your religious beliefs have been shaken or destroyed.

7) If you can't do it on your own, seek help. Reach out. Get into therapy. If you don't like your therapist, shop around. Try out different support groups till you find the right fit. There's no shame in taking psychiatric medication to get through this time of year if you need it. Grief is sometimes so intense, so outside of what we can easily manage, you should leave no stone unturned in seeking help.

I like to think of these challenging times of year as an athletic event. Instead of physical sports, the holidays are Olympic events that can stretch the limits of your emotional and spiritual endurance. You can't control whether or not you'll experience grief, but you can manage the stress of the holidays by approaching them with he attitude of an endurance athlete. That means developing regular training routines incorporating the above guidelines.

I wish you peace and freedom from suffering.

Thursday, September 25, 2014

Stalking Resilience (trigger warning)

Ten years ago I got an email from my friend, Dave. A man of few spoken words, he asked me to check out his latest piece of writing. "Intense is all I can say" was the only clue as to what was about to unfold. At the time the working title was "The Killer Inside Me". Over time, it became known as "Stalking the Bogeyman" (trigger warning).

I read it with frozen attention. Words unfolded, revealing a history I couldn't imagine. My friend. He had this history I couldn't fathom. He had kept it in a vault all these years, and we never knew.

This happens to other people. This stuff is in the papers. Not to anyone I know.

Not my friend.

My friend couldn't have possibly gone through this.

Dave wasn't lying, it was definitely intense. I don't know if that was his intention, but it's hard to write about intense events without being intense. The intensity remained, but at some point it took on a different quality. Under the pressure cooker of a secrecy first imposed by his rapist, the desire to kill to protect other potential victims, direct and indirect, grew all consuming. When the lid was unexpectedly removed, the secrecy was gone, and with it the possibility of the perfect crime.

The traumatic event of his childhood was in black-and-white for all to see. The people Dave sought to protect the most with his secret-- his parents-- stayed by his side. He wasn't in trouble. He wasn't going to be shamed. And he wasn't going to be punished for talking about it. The imposed secrecy wasn't a magic spell, but exposed instead as a cheap magic trick. There was nothing to back it up.

With the very public story came-- what? Healing? Resilience? Is that the Hollywood ending we're all hoping for? He wrote this story, it became an episode of This American Life (trigger warning), now it's an off-Broadway show... so that means it's all good, right? All's well that ends well?

I don't know.

Over the last 15 years or so, I've spent a lot of time with people who are dying and grieving. My career has given me time to reflect over the course of what have been thousands of grief and death trajectories exactly what we're prepared for as a society.

We are not prepared for trauma.

We are not prepared for our loved ones to be in pain.

We are certainly not prepared for complicated emotions.

We like tidiness. We like things to be clean. We like to think pain has stages that we can grow out of and get over.

We really like anti-bacterial soap. But our lives are full of contagions, full of germs, things unseen that can be very threatening.

We think of resilience as clean. As closure. It's a goal, an endpoint. We get there, everything is fine. We move on, we don't hold on. That's a sign of healing, right?


We assume people we know are not in pain. Surely, they don't have any secrets, any hidden pain. They're functioning so they're okay.


We aren't prepared for the reality of trauma, pain and grief. It's an injustice to those we care about, maybe some day ourselves, to assume that resilience must mean you've "moved on", or gotten over stuff. More than likely, the stuff we go through becomes a part of us.

We don't have a template for this.

Resilience can't be measured by how happy you are. It's not required you have "closure".

Sometimes resilience just means you've endured and survived.

Sometimes resilience means you stop hiding your pain.

Sometimes resilience just means you share your story so there's less secrecy around all our suffering.

Sunday, August 24, 2014

Meditation: The Inside Scoop

The most common reason people give to be unable to meditate is to say "I can't turn my mind off". For some reason, there's this assumption that meditation requires the supernatural ability to clear the mind in order to be performed. This is absolute rubbish.

Everything we do requires practice. If the prerequisite or goal of meditation practice was to empty the mind, the best meditation teachers would be those who could perform lobotomies. I can assure you this isn't the case.

I've maintained a daily meditation practice for about 18 years. I thought I'd share with you all some of what happens when I sit down to meditate to assure you that a quiet mind is in no way a requirement for a meditation practice. The following took place in an idyllic location while on vacation in Catalunya a couple of weeks ago. I sat down one afternoon while everyone else in the house was gone to watch my breath. I assumed the meditation posture, and focused my mind on counting my exhalations, one at a time, while allowing my mind to unfurl.

"What a beautiful spot. I can't believe how blue the sea and sky are. I should have sat down to meditate a while ago.

It reminds me of what I thought of earlier, once you decide to sit down to meditate, everything outside of the sitting session is resistance. How long have I had this meditation practice? I used to say 16 years, but I think it's 18. Wow. Mind still very much on.

This spot is high up. I'm pretty sure it will survive the ice caps melting. Who knows how many feet that will be. I hope it's gradual, although that one researcher said it's more likely to be sudden and catastrophic. Those methane reserves in Siberia are being released, that's really bad. It will all come down to timing. I hope we're all together when it happens. I can't imagine the drive out of south Florida. What will I take? Glad I backed up the hard drive and put it in a Ziploc in my office. That's going to be a crazy traffic jam. We'll have to head north. I hope I can get a job in another state easily. I wonder if the flood will bring down the global economic system.

Wow, that's the most uncomfortable tangent. I hate that topic. Government is so broken. Taken over by demonic forces. Ancient forces that brought down Rome, too. So evil the way the way they're treating the earth.

Why all the judgement? Meditation is about love, after all. Ok, let's think about love. Let's send love to the politicians and greedy oil executives.

Wow, what a nice spot to sit. I can't believe how relaxing this is. Seems like a bubble while the rest of the world turns to shit. So many dead in Gaza, Syria.

Breath tight. Release the belly. There. The most helpful thing is always to release the belly. Got to remember that. Love the chattering parts of the mind. How many parts of my mind are there? Wait, who's keeping track? Is that part of the mind, too, or something outside of it. Does mind emerge? I'm really appreciating that emergent hypothesis. I wonder if I can incorporate that into the Toronto workshop somehow. The slides are all done. Those used to make me so much more nervous.

The run this morning was awesome. I wish we had mountains and trails in Florida like that. Makes me miss living in California. I don't think my Achilles' tendon can take two runs a day, but I would love to if I could. I wish I had run more in my late twenties. Grad school sucked for that stuff.

Soften the belly.

Oh wait, that was a shimmering moment. Love that. Let's do it again.

Nope. But that was nice.

Ah, it happened again.

Hmmm. I hit my goal. But I want to keep going. Ok, another 49 breaths. I hope I have time. Is there anything else I should be doing?

Oh, nevermind, this is nice. 'The Buddha's enlightenment is vast, it encompasses all experience'. He's been here, each moment is a footprint of his enlightenment.

If only people knew how much chatter remains, even with meditation practice, they'd be less intimidated. I should totally blog out this session. "

So what's your experience like?

Monday, August 18, 2014

Seven Tips for Professional Caregivers

This past weekend I was in Toronto as part of a series on Contemplative End of Life Care put on by the good folks at the Institute of Traditional Medicine. My area of focus was grief, specifically the approach I use and have highlighted in my books. It occurred to me that I've been taking care of the dying and grieving for over 15 years. I feel like I just got started and nowhere near burned out. I was asked several times in different ways what's worked for me in being able to sustain high intensity mental health care.

When I'm discussing end-of-life care and grief therapy with other professionals, I like to point out that we need to tap our own inner resources of compassion in order to be able to help others. To do this, we have to build up these inner resources in the first place.

The way to do this is fairly straightforward to describe, but harder for many to put into practice. We'd much rather take care of someone else than ourselves. If we listened to half the advice we give others about how to take care of themselves, we'd be twice as healthy.

What works? In 2014, there's very little mystery in answering this question. Here's the list, again, culled from decades of health and well-being research (done by others) and my own personal experience: 

1) Treat yourself as a whole person. This means balance different aspects of your life-- body, mind, spirit.

2) Eat right. What's that mean? Science is telling us more and more how important it is to eat plants, use common sense portions and avoid processed foods. For me, this means going to the grocery story to buy ingredients rather than meals to re-heat.

3) Exercise. If you can do an hour a day most days of the week, wonderful. If not, 20-30 minutes 3-4 times a week of moderate cardio exercise is a good goal.

4) Meditate. This doesn't mean read about meditation or enjoy spending time in your garden or playing with your pet. It means cultivate a daily sitting practice. It's the purest way I know of to nurture heart and spirit.

5) Create a community. If you work in health care, start talking about self-care. Give hugs to tired colleagues. Spread the word that we matter. You don't want to become the nagging missionary, but better yet, let the changes you're making be their own example. People will notice you're doing something different. If you work as a solo practitioner, reach out on social media or try to arrange meetups in or near your community to find like-minded people that can help you feel connected. The key to preventing burnout is feeling that you're part of a bigger whole, a tribe of fellow caregivers moving in the same direction with the same priorities. Don't wait for a community to form spontaneously, change the system to be one you like.

6) Limit your reliance on alcohol, television and other drugs. We joke a lot in health care about happy hours. But there's no evidence to suggest people who drink regularly are more emotionally resilient or spiritually centered than those who drink very little or not at all.

7) Don't be afraid to grow into your potential. Many of us started out working as professional caregivers with mentors or teachers we looked up to. Mentors aren't born, they're made out of experience. Don't be afraid to make changes in how you work and how you live so you can become an expert at what you do. Remember the gratitude of others as a guide to keep you going. What helped your patients the most? Keep doing that.

We are blessed to do what we do for a living, but chances are no one has taught us how to be in it for the long run. Health care providers who are balanced and healthy can provide better care for others. My goal in caring for others is to be able to do it for as long as I can and stay healthy in the process. I hope you can, too.

Sunday, July 20, 2014

Filling the World with Compassion

Pictures coming out of Gaza and the news of MH17 being shot out of the sky has made this a very difficult week to be a human. Our world seems to be run by people obsessed with power, and we are subject to their whims. So quickly, we become mobilized to take sides-- the one we are on is legitimate, righteous and those other people are wrong, even evil.
But does this actually help the situation?
I'm inclined to believe that it only perpetuates the horrors we feel overwhelmed by. I recall reading years ago, I don't know the exact source or context, a quote by Mahatma Gandhi. In it, he says something to the effect of "the purpose of non-violence is the genuine wish to improve your enemy, not destroy him."
Improve your enemy.
This is not the Art of War, it's the Art of Compassion.
Sure, some say this is naive, it's not how the world works.
Oh really?
I think it's the only what it can work.
It's impossible to think of a single geo-political conflict currently raging without having to first go back dozens, hundreds, even thousands of years. Taking sides seems to not be a very effective solution.
The alternative-- compassion-- will never be supported by power. Dominance requires a group mentality that preys on our most primal herding instincts. Compassion is equalizing, decentralizing. It threatens power consolidation.
Does this mean we should throw flowers at Hamas, or give group hugs to the IDF?
No. What it means is that we should all try and practice compassion wherever we are.
Try and be nice to the person who brings you your food or who comes to fix your cable TV.
Smile at the next person who is helping you in a store.
Be courteous driving in rush-hour traffic. 
Reach out to that person you've been meaning to check in on.
When compassion in every day life become second-nature, it becomes reinforced in how we see the world. We cringe when our leaders ask us to turn it off in nationalist double-speak.
 Maybe, just maybe, each of these individual acts of compassion can gradually fill the bucket that seems so empty in our world today.