Sunday, March 31, 2013

Medicalising Grief

I'd like to share a fascinating and critical documentary from the BBC, Medicalising Grief, available to hear online only the next 7 days here

A thought provoking and honest discussion of grief, depression, and the DSM-5 featuring Drs. Jerome Wakefield of NYU, Allen Frances of Duke (emeritus), Gary Greenberg, psychotherapist, Lisa Cosgrove of Harvard, Trish Hill of University of Nebraska-Lincoln, Joanne Cacciatore of Arizona State University, Dana Merkling of MISS Foundation. On a personal note, this comes in the midst of a very painful, traumatic loss of my own.  I was unaware this would be aired today, so I dedicate my own participation in this documentary to the memory of my friend "T" and her grieving children.

I would highly recommend this program for consumers and clinicians alike.  Our gratitude to Matthew Hill, Gemma Newby, and the BBC for their courage in shedding light on this very important topic.

"The Diagnostic and Statistical Manual of Mental Disorders - or DSM - is a book full of lists of symptoms, strange sounding names, codes and guidelines. It's also a book that changes lives. Its champions say it is simply a system of classification, a diagnostic tool. Its critics claim it is more - it decides what is and isn't a disease and that every time a new version is published an increasing number of people are labelled mentally ill.

And for every diagnosis in the DSM, there is a corresponding medical treatment waiting in the wings.
In May 2013, the American Psychiatric Association will publish the latest edition of their DSM and it is likely to cause tension within the American psychiatric establishment.

But why is this medical-looking manual causing such controversy?

Where some say the previous DSM was responsible for pathologising childhood, critics of the new edition will medicalise grief.

Are the intense feelings most people experience after the death of a loved one misery or melancholia? That is the ongoing debate, the result of which will have an impact on millions of people and our understanding of a fundamental human reaction.

In a post-Prozac world, when normal becomes abnormal, medication generally follows. An estimated 8 to 10 million people lose a loved one every year and something like a third to a half of them suffer depressive symptoms for up to a month afterward. How much does the pharmaceutical industry stand to benefit if an extra 5 million people a year are prescribed anti-depressants?

Matthew Hill investigates the DSM, its decisions over what is and is not a mental illness, and the people behind it."

Thursday, March 28, 2013

All Ten Miles: Losing a daughter. A mom. A friend.

M looked into my eyes and she knew. Still, I had to tell her. She curled into my lap, knees to her chest, in the back of the car saying "No, no, no, oh my god, no" over and over again. She couldn't catch her breath, and neither could I.  I held her as her tears soaked through my shirt and dripped down my belly. I was silently weeping as I held her. She was like a baby again, all 18 years of her rounded into me, all ten miles to her house to say goodbye to her mom.


I met T 10 years ago when she moved across the street. We became fast friends, as they say, sharing holidays together and late nights talking about philosophy, kindness, love, and compassion. In fact, at one point, I almost had her at vegetarianism. "Nah," she said, "I decided it would be an excuse to eat too much junk food."  T brought sunshine into the room with her, and she loved her three children very much. She was almost always happy and optimistic.  A good friend to many, she loved her girl nights with a glass of Chardonnay. Sedona was her favorite place in Arizona and she even volunteered to help the MISS Foundation on a number of occasions. She made the best silly faces for pictures... she always made me laugh. And when she and her former husband filed for divorce, they were graceful, gentle, and cooperative, and they remained close friends for years. I deeply admired the way they cared for one another through the grief of that divorce. In October of 2011, when we had our barefoot walkabout (barefoot hike) she bravely took off her shoes to walk in memory of her sister, a beloved baby, who died 40 years earlier.

Over the course of 10 years, I'd see T through many difficult days and nights, some of them the normal struggles of being a  newly single mom- some of them related to her own existential questioning. Nothing unusual or extraordinary, just very real and very human. When I recently moved from the neighborhood, she'd come visit me in Sedona where we'd hike and sit, quietly, on the majestic red rocks. And on occasion, when I was running early headed into town, we'd meet up at the ol' neighborhood Starbucks where we'd share her triumphs and struggles (she often teased calling me a "friend-a-pist" and "ther-a-friend").

She'd been seeking a spiritual path the past year or so. I'd given her a recommended reading list on mindfulness and self-compassion, and she was so excited about opening her heart to the numinous. The last time I saw her, she was healthy, happy, and doing well tolerating the normal ups and downs of life.

But about five weeks ago, life became tough for her.  I gave her some names and numbers of some local therapists for some "real" therapy. She was self-employed and couldn't afford insurance, so she was concerned about the cost. I stressed to her the importance of getting help from someone she could see every week in a therapeutic relationship. When we hung up the phone, she seemed hopeful, and we committed to reconnecting for our Starbucks meeting in a few weeks.  I texted her a few weeks ago but she was out of town so couldn't meet for coffee. I texted her again last Friday:

I said, "Hey T-mama, hows about java this am?"

She said, "So sorry Jojo, I don't feel well at all. Another time?"

I said, "Oh, no good sickies?"

She said, "Yeah."

I said, "No problem, feel better xo"

That was my last contact with T.

What I didn't know was that a few weeks earlier she was out of state where she'd seen a physician who prescribed multiple psychiatric medications to stabilize her.

But what I learned yesterday was that she seems to have destabilized. Our other friends said that when she returned from out of state, she spiraled downward into a vortex of strange and highly uncharacteristic behaviors:  social withdrawal - very unusual for T because she was very attached to and reliant upon her small circle of friends, anhedonia, fear, anxiety, akathisia, and even deeper into despair. She was even fearful to see her children. Her former husband said he'd never seen her like this in their many years together.

The descriptions of her behavior do not reflect the friend I've known over the past decade.

On Tuesday at 4:30pm, I got a disturbing call from her former husband. I heard the message. I remember exactly where I was standing. I shook my head. I replayed the message. It was hard to hear. I walked outside and played it again. "What? What? What?" Over and over in my head.

I called him back and rushed out the door to the streets of the old neighborhood where so many wonderful memories had been held all these years. I pulled up to T's house. AR van. Investigators. Cops. He ran over to me and we held each other and cried. We waited until after midnight in the cold desert air, not dressed for such conditions, floating in and out of our bodies. It was nothing short of a nightmare. And the children- they didn't know yet. They are so young, oh so young to lose their mother, only 12, 13, and 18. Our hearts were breaking right there on the streets of the old neighborhood.

We made a conjoint decision to tell M, the eldest child, first. But her former husband wasn't allowed to leave the scene.  So D and I went to pick her up, telling her something happened. And ten miles of that drive was nothing short of excruciating. Her beautiful daughter, her flower, folded up into my arms, quivering. It brings me to tears again now as I type this.

M is brave, like her mother. She asked if she could wait to see her mom leave into the van. I asked, "Are you sure you want to do that sweetie?" She insisted. So we waited hours until they wheeled T out on the gurney, covered in a thick black blanket. M put her head gently on her mama's body and my arms held this precious grieving child as she sobbed. They were patient with us as M wept for quite awhile. When she was ready, she took a deep breath, put her head into my chest, and cried more as they put T into the van.

We went back to her former husband's house very late where we then had to tell her younger children. Words can't describe it here, so I wont even try. None of us in that house slept all night. The meeting with the funeral home is today, at one of the few places where we'd entrust T.  And I saw her parents, children, siblings, and her closest friends mourn and weep and anguish over this huge, irremediable loss...

What words are there for something like this? We are left with many, many more questions than answers. This is not T. In the many years we've all known her, she had never been like this. And so I have very strong feelings about all of this, including anger. She did not take her own life: T would not. She was killed by broken medical, mental health, and insurance systems that fail to provide real support and aid to those who are suffering.

But that is for another time. The time for tears is now. And this, writing her story, is the beginning of my own therapy, my own way to remember and honor her through all the pain. Wherever she is, she's with her beloved big sister now.

T, thank you for hiking barefoot with me. I miss you already. We all miss you already. We will do our best to take good care of your babies.

Thank you to T's family for asking me and allowing me the tragic privilege to tell her story.

*Please note:  I will be taking a few days. If you call or email, please be patient with response time. Thank you*

Thursday, March 7, 2013

My Medical Utopia

In my Utopia. 

Add Doctor: "Tell me about your life. How are you doing?" Puts prescription pad away and engages in deep, empathic listening. 

Oh, and yes, in my utopia, the doctor also meditates twice a day, avoids processed foods, eats organic, spends more time in nature, and doesn't watch TV.  In addition to that, this same doctor is comfortable approaching the suffering of another, is aware of his or her own emotional reactions to death and grief, and is willing to take the time to just sit with an open heart and listen.

What are the chances that if the medical system operated this way, we'd save lives, hearts, money, and time?


The soul still sings in the darkness telling of the beauty she found there; and daring us not to think that because she passed through such tortures of anguish, doubt, dread, and horror, as has been said, she ran any the more danger of being lost in the night. Nay, in the darkness did she, rather, find herself.

--St. John, Dark Night of the Soul

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