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Authors: Dr. Robin Stern

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Instead, we listened to the testimony of these survivors, letting them be the real authorities on their own grieving and healing processes. We have applied psychological insights when it seemed necessary and translated them for the layperson, more out of an instinct to share ideas than an attempt to justify what is evident: Human beings are both undeniably fragile
and
astoundingly resilient.
Grief, like any other emotional process, is as unique as a fingerprint. In the pages that follow, you will get a sense of where the contemporary thinking is on grief, having moved away from old ideas. One of the things that we were so struck by as we immersed ourselves in these stories—researching, interviewing, writing, discussing, revising, and most important, listening to the voices and stories of 9/11 survivors—was that the public dialogue on loss has been severely limited. If you ask the average person what they know about grief, they will usually throw out the phrase “stages of grief.” Either knowingly or not, many of us reference the influential theory of Elisabeth Kübler-Ross, in which she posited that there were five distinct stages of grief that each person must go through. But the latest research on loss proves that Kübler-Ross's once ground-breaking theory was inadequate to describe the full range of grief reactions. The average person's journey through grief is far less uniform—more like a roller coaster than a ski lift.
Sigmund Freud, the father of psychoanalysis, made his own lasting impression on the public psyche when it comes to loss. Freud posited his foundational theory of grieving in his 1917 essay, “Mourning and Melancholia,” in which he attempted to distinguish between healthy grieving and melancholia, a state of ongoing depression. He argued that one must do “mourning work,” responding to the “call of reality” until she can “renounce the object by declaring its death” (the object being the lost loved one). The melancholic mourner, in contrast, becomes destructively attached to a lost loved one, unable to “kill” him or her off in one's own mind.
As you'll see in the coming pages, the individuals who lost loved ones in the attacks of September 11th, did not so much work through their grief—suggesting a finite amount of sadness, eventually depleted to nothing—as open up to it, acknowledge it, integrate it. No mourner chose to cease thinking about their beloved, so much as shift the nature of the relationship—from in the flesh to in the mind and heart. A mother, lost, is no longer a source of homemade soup and a good, long dinner conversation, but she still influences her son in a daily, sacred way. A fiancé, dead so young and suddenly, can no longer caress the bare shoulder of his love, but the memory of his tenderness can still make her feel loved.
We know, then, what grief is not—direct, contained, predictable. What it
is
, well, that's still being explored by some of psychology's finest thinkers and researchers. In this book, you will see the grief process wax and wane in the lives of real, relatable people. This storied approach is critical, as the science around grief continues to tie itself up in knots about how to describe the widely variant types of sadness that affect the grieving human. Dr. Kathy Shear of Columbia University describes the emotional experience of grief as akin to the physical experience of inflammation: “We don't think of natural grief as an illness, primarily because there's so much baggage associated with illness. But some very prominent thinkers and researchers have, in fact, said that we should consider grief similar to inflammation, a natural healing response to injury.” In this case, of course, the injury is the loss, and one's emotional defenses, like the immune system, rise up to process and heal the psyche.
Joan Didion, acclaimed memoirist, took great comfort in a different metaphor for grief's all-consuming hold on a widow's consciousness: waves. In her engrossing account of her husband's death and what came after,
The Year of Magical Thinking
, she references Dr. Michael Lindemann's work. The chief of psychiatry at Massachusetts General Hospital, he defines grief as “sensations of somatic distress occurring in waves lasting from twenty minutes to an hour at a time.”
Dr. George Bonanno, also of Columbia University, has studied grief and trauma over two decades and in a variety of contexts, many of them with parallels to September 11th. He believes that waves like the ones Lindemann describes are an accurate depiction of a state that comes and goes, rather than sticking around in some unceasing, uniform way. Additionally, he argues that there are four potential trajectories of grief: “resilience, recovery, chronic dysfunction, and delayed grief or trauma.”
The notion of “delayed grief” is a highly contested one. Some well-respected experts in the field, Shear among the most vocal, have argued that about 10 percent of bereaved people experience
complicated grief
, marked by the presence of prolonged feelings of disbelief and anger, a sense of emptiness, suicidal thoughts, and estrangement from other people. In fact, according to the
Canadian Medical Association Journal
, the next edition of the
Diagnostic and Statistical Manual of Mental Disorders
—the
DSM-5
, scheduled for publication in 2013—is likely to contain a new entry called “bereavement-related disorder,” which will attempt to describe and classify grief that goes on and on.
Dr. Leeat Granek, a Toronto-based psychologist, worries that such an inclusion pathologizes grief, rather than seeing it as a normal part of the human experience: “Many of the mental illnesses in the DSM are social constructions that are based on the cultural zeitgeist at the moment. We already live in a culture that is intolerant of grief and loss in general. The message is often, ‘You need to move on, you need to see someone.'” Granek is leading a bourgeoning movement advocating for the reconceptualization of grief, particularly in the North American context, where is has been misunderstood and neglected for too long. The cultural context within which grief emerges is key in understanding how we process. The brave eight who are featured in this book all mourned their losses in the United States, but each has very particular cultural scripts within that commonality.
Understanding grief, in all its manifestations and cultural mores, is not just beneficial for our own inevitable experiences of loss, but so that we might support others through theirs. Megan O'Rourke reflected on her grief process following her own mother's death in a series for Slate.com, which evolved into her book,
The Long Goodbye
. She explains, “I am not surprised to find that it is a lonely life: After all, the person who brought me into the world is gone. But it is more than that. I feel not just that I am, but that the world around me is deeply unprepared to deal with grief.”
She goes on to detail the well-intentioned yet unsatisfying emails that she got from friends and colleagues following her mother's death. They echoed one another, sympathetic, yet inadequate: “At least she's no longer suffering.” O'Rourke was crushed by the lack of wise support. She is not alone. So many of us have felt abandoned during times of great suffering, left to the fumbling condolences of a world that is both uninformed about grief and also afraid of what it indicates: that we all love and lose, that we all will die. It's imperative that we become more aware of the complex truths about grief, and in turn, more skillful in comforting one another, so that we, too, may one day receive the same substantial support in return.
This is also not just a book about grief. It is, first and foremost, a book about resilience. It is about that miraculous process by which people whose lives have been shattered in an instant, manage to find the strength to pick up the pieces and put them back together again—not in the same way as before, but in a new, reintegrated form.
Resilience is often assumed to be a personality trait, something you are either lucky to be born with, or doomed to be born without, but it is actually more accurately thought of as a process. A resilient person essentially draws on inner resources and calls on community support in order to move forward after disappointment, failure, or trauma. Research confirms that the presence of resilience is encouraged or discouraged by the communities and environments of which we find ourselves a part. When difficult things happen to us—divorce, illness, death, job loss, etc.—we are able to weather those changes based on a unique combination of our own hard-wiring and psychological resources in consort with the protective factors that our families and communities, social policies, and schools create for us.
Resilience has been a widely discussed topic as of late, identified by educators, mental health professionals, and researchers as one of the key ingredients to living a long, happy life. Bonanno, among others, has found that resilience, rather than some rarified quality, is actually quite common, and that there are “multiple, unexpected pathways” to get there. In fact, resilience researchers warn, what might sometimes look like a short-term decline in mental health can actually be a sign of the human psyche rallying its resources for ultimate recovery.
Hardship does have the capacity to make us hardier. A recent study in
The Journal of Personality and Social Psychology
, for example, found that some of those who have experienced multiple stressful events in life become more robust—picking themselves up and integrating their lessons faster than those who haven't experienced many losses or life changes. Resilience, it turns out, can be like a muscle, growing stronger with use.
Another recent study, this one aptly titled “That Which Doesn't Kill Us Can Make Us Stronger (and More Satisfied with Life)” and appearing in the journal
Psychology & Health
, found that identifying oneself as a “survivor” is actually positively correlated with life satisfaction. In other words, those who have been through hell and made it out feel like life is a bit more heavenly than those who never have to struggle through such darkness.
In this book, we look at the ways in which these resilient people took their grief and remolded it, bringing new meaning into their lives. They mourned, and continue to do so in various ways, but also carried on as an affirmation of life's preciousness and the heart's capacity for renewal.
But they didn't do it alone. So often, the eight survivors featured in this book were and still are deeply supported by caring communities—both informal and formal. Their families, friends, and extended networks stand as testament to the healing power of simple and profound presence and love. One hand held after the next, one hug given and received after the next, one sad or angry sentiment articulated and heard after the next. In Bishop Stephen Paul Bouman's moving book,
Grace All Around Us: Embracing God's Promise in Tragedy and Loss
, he relays relying on the powerful wisdom of a South African bishop post-9/11: “In our culture, when tragedy happens, we don't all visit at once. We come a few at a time so that each time the person in sorrow has to answer the door and tell the story again of what happened and shed the tears. As the story is told again and again, healing can begin.”
The survivors' caregivers, therapists, support groups, and spiritual mentors also show up in these pages—people whose commitment to their work and engagement with the people they care for is deeply moving, particularly in the face of such destruction. Disaster, as a subject, has been around, at least in the American context, since we first took stock of what was lost—so many lives, rigid social roles, a sense of abundance—following World War II. The idea of disaster mental health, more specifically, was first put on the conceptual map with Erikson's 1976 book,
Everything in Its Path: Destruction of Community in the Buffalo Creek Flood
, in which he asked, “What is ‘disaster,' anyway?” and then answered in a way that reads as eerily prescient when considering our subject, an event that wouldn't take place for twenty-five years yet: “a sharp and furious eruption of some kind that splinters the silence for one terrible moment and then goes away.” Erikson, like us, centered the voices of the victims of that tragedy, arguing that they deserved a more researched and skilled response from professionals in the mental health field.
Great caregivers, psychologists, sociologists, and the like have heeded his call ever since, creating institutes, field guides, journals, and coalitions in order to constantly perfect our capacity to respond in moments of crisis to those who need it most. As Laura van Dernoot Lipsky, author of
Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others
, writes, “Many of us who do frontline work to ease trauma and bring about social and environmental change understand that bearing witness, amplifying the story, and taking right action are our most important tasks. But how do we witness, and what is right action?” These questions, like all of the wisest inquiries, are unanswerable, to some extent. And yet, those whose life work is located in the trenches of human suffering continue to explore ever more skillful ways of helping healing along.
It's not just about the individual professional's capacity, of course, but also about the capacity to coordinate a response among professionals working in a variety of realms. An unprecedented partnership was forged following September 11th between two very different organizations: Disaster Psychiatry Outreach and New York Disaster Interfaith Services. They were able to work together to acknowledge that healing the whole victim is not just about emotion, nor is it just about spirit, but about the combination of the two.
In a critical, co-edited new book,
Creating Spiritual and Psychological Resilience: Integrating Care in Disaster Relief Work
, Grant H. Brenner, Daniel H. Bush, and Joshua Moses write: “These partnerships have the potential to help societies harness the transformational capacities disasters hold for resilience—for how we might redress chronic, long-simmering ills in new ways, comfort the bereaved, rebuild with the survivors, and perhaps even help people better situations they were in prior to disasters.” Indeed, Dr. April Naturale, who directed the disaster mental health response called Project Liberty, found that many of the people her organization served reported that they never would have sought mental health services prior to September 11th, but felt that the experience had deeply enriched their lives in many different areas.
BOOK: Project Rebirth
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