S2E8 Grief

Grief occurs when we have experienced the loss of someone we love, and it is one of the most intense baseline emotions we may encounter. In this episode, Dr. Rubin and Dr. Pete discuss the stages of grief as originally defined by Dr. Elizabeth Kubler-Ross, the differences between grief, sadness and depression, and how honoring our emotion of grief can serve to connect us to those we love and have lost. Tune in to learn more about how to mindfully experience this difficult aspect of human struggle.




Nikki: So, today we're going to talk about grief, we do a lot of sometimes lighter episodes and find episodes, that we also want to make space on this podcast to talk about some of the more difficult things. And given the recent death toll in the United States from COVID, right, past 500,000 lives loss this year already, you know, we really thought it was appropriate to start this conversation so, hi Pete.

Pete: Hey, yeah, because, there's no one that has not experienced grief. I mean, I guess maybe if you're like a kid or something.

Nikki: Well, I was going to say maybe there are some people that haven't experienced it yet.

Pete: Yeah.

Nikki: Though, there isn't a human walking this earth. And actually, you know, I'll say animals as well. Animals grieve.

Pete: We love those videos.

Nikki: We do. We do. And there aren't any animals, living beings, humans that won't experience it. Maybe it's the best way to say it.

Pete: Yeah. Because it's just a common experience to life and so, yeah, that's the suffering that we all experienced. But yeah, so not the funniest topic, but a common experiences that we all have. And while we are focusing on behaviorism, and we don't want to focus entirely on like world issues or the pandemic in particular. It's clearly with over 500 alone, just in the US.

Nikki: Just in the US alone, yeah.

Pete: For our listeners abroad thinking that the total across the globe is much higher and so this is maybe for some people to face grief in a different way. Now, the other thing about this that hopefully we'll get to is that we're grieving in a much different way and during a pandemic, too.

Nikki: Yeah, because, there's a lot of similar experiences that we're having. And of course, like, the degree of grief that someone's experiencing in this particular context is going to vary. But maybe we could start by defining grief here because I think sometimes there's a bit of confusion around like, what is grief, for example, versus depression? Or what is grief versus sadness? Because they're obviously all kind of cousins of one another and they're different emotions. So I guess I would ask you…

Pete: Well, I know you like my definition.

Nikki: I do.

Pete: I’ll give you a Merriam Webster, if you want one.

Nikki: Okay, please. Let's do it.

Pete: Deep employment distress caused by or as if by bereavement.

Nikki: Okay.

Pete: That's a lot of like, wordiness.

Nikki: It's a lot of words. I like word that's a lot of wordiness.

Pete: That's a lot of deep sorrow, especially that's caused by someone's death.

Nikki: Yes, though, it could be you know, I think it's important to say like, we can also experience grief in response to a breakup, right?

Pete: That’s right, loss.

Nikki: It's immense loss,

Pete: Immense loss, deep sorrow may be caused by loss. That would be our definition?

Nikki: Yeah, that's what I would say. And this is something I talk about in therapy a lot. I'll say the distinction with like, sadness and depression, right? Is that depression is it's hidden, but always says it's like, it's clinical. Like there's heaviness, there's like lethargy, there's sometimes we actually don't feel sad when we feel depressed, right? We feel like numb or flat.

Pete: We'll see more about that, because some listeners are going to be confused by that.

Nikki: Yeah, and Pete and I never discussed, we definitely need to do an episode specifically on depression. But depression is, you can feel sad when you're depressed, though it's, I would say it's like it's very grief is physical too but depression is very physical, like, you'll know you're not motivated. Your sleep is impacted, there is like a flatness that comes along with it. There's a disconnection to, to living, like you don't get joy or pleasure out of things that you usually have interest in, right?

Pete: [inaudible 04:16] that word that like…

Nikki: Say that word for folks.

Pete: [inaudible 04:21] that five cent word that we call like in psychology that I never knew before I got to psychology. Did you as a literature major know that word?

Nikki: I did not.

Pete: Well, when we teach students it's just an A in front that's like, I guess just from Latin just means that it's removed. So like a motivation or anhedonia, anhedonia is a loss of pleasure in activities that you do to otherwise feel pleasure motivation is a lack of motivation, all parts of the depression makeup.

Nikki: Yeah.

Pete: And just before you keep going, like the DSM, I think one of the things that we also try to highlight and that I say is that depression is a symptom, you know, and you know, it's Not always, it's not really it's not the diagnosis. And because there's so much that goes into the experience of depression, so we have like major depression, major depressive disorder, depressive disorder, things like that. But the act of depression, and I think this is the thing about behaviorism is that we all experience these symptoms differently.

Nikki: Yeah, absolutely. There's going to be common threads, and then there's going to be different manifestations of symptoms and emotional expression.

Pete: Absolutely.

Nikki: And then I think last, it's important. Lastly, it's important to distinguish between sadness, which is sadness is the most common emotion, right? Like, we can feel sadness for all kinds of reasons. And I often get asked the question by patients, like, “why would evolution select for sadness?” because we talk a lot about like evolution, selecting further reason I say, well, because if we couldn't feel sad about anything, and tie into grief, that would mean that nothing means anything to us. That the potential to lose something to not get what you want to be disappointed in, that could be like a job or relationship. You know, I don't know, just something that you imagined was going to turn out a certain way. If you had no potential to feel sad about that. That means you don't care about anything. Right?

Pete: Exactly, yeah.

Nikki: And would you add anything to any of those definitions?

Pete: No, I think it's, they are the universal emotions. Did you say sadness was the most common?

Nikki: I was saying between depression and grief, right? So like, in these cousins, right, they all kind of exist under a similar umbrella. Sadness is something we feel lots of times, but it's like grief is unique.

Pete: Well, yeah, grief is unique and that's what we'll get to the stages of grief. And how grief is the process of this really, like significant loss basic emotions, because that's what I thought was key. You need to feel sadness, so when people come to me, and they're like, “Oh, I'm really sad, or I'm anxious.” It's like, good.

Nikki: Yeah.

Pete: Because it's an emotion. So I'm glad you're feeling let's just learn how to feel it. So the universal emotions are typically defined and if anyone's seen inside out you will recognize the characters.

Nikki: Something I assigned for homework many times [inaudible 07:06] to watch that.

Pete: Yes, indeed. So disgust, sadness, happiness, fear, anger, surprise. And so sadness It just it's a part of the common experience. That's a lot of another theme in which we address here on when east meets west.

Nikki: Yeah, absolutely. And so this is going to be a thread across any emotion is that grief is something we also want to allow ourselves to feel. I'm always really clear with people that I say grief is probably one of the most intense baseline emotions that we can experience, right.

Pete: Yeah.   

Nikki: So other emotions, like anxiety or sadness or joy, they can become intense, when we engage them, they can become dysregulated. Grief, when it shows up it is extremely intense.

Pete: Yeah. It was complex grief so it's complicated.

Nikki: Yeah, complicated grief. Which, like I would say, that's when grief starts to take on sort of like a, it's related to trauma basically, it can take on a more, there's sort of like a different treatment for that and we could do another episode about it.

Pete: Yeah cliffhanger.

Nikki: Yeah. Cliffhanger. So getting back to grief here and maybe this would be an important time too, I'm sure people are thinking as we're talking like, oh, I've heard of like the five stages of grief. So hopefully, listeners have heard of this before. So, there was a doctor named Dr. Elisabeth Kubler Ross, who she's the one that developed the stages of grief and her landmark book, which is called on death and dying. And she initially had a theory that there was a linear five step process to grieving and the stages she outlined for denial, anger, bargaining, depression and acceptance. So, a lot of times when I’m working people are…

Pete: I'm sorry; I didn't realize that she presented them as linear.

Nikki: Yeah, and I think that makes sense, right, because we talk a lot about this on this podcast, like we assume as humans that things follow a linear process.

Pete: I don’t know. I got rid of that a long time ago.

Nikki: And that's part of I think, obviously your Zen practice, right, but we know how the brain is wired we make that assumption that things follow in that way.

Pete: Well let me just explain that because linear, for listener that just to think about even what it means for to be linear. That meant that Dr. Covey Ross was saying that you would initially feel denial, you would then feel anger, you would then bargain before feeling depression and then acceptance. So it's suggested that you follow those that in a very discreet way.

Nikki: Yeah, and this is affected like Pete’s getting right at the punch line here is like, what we found is obviously, nothing is linear that those, we don't necessarily follow that pattern that I say to people. Those are all potential aspects of grief, you may experience all of them, you may experience some, you may follow that order and maybe a different order.

Pete: Let me ask you a question just live us in our preparation, so there was research by psychologists that then found that it was not in that linear way that she had originally presented it.

Nikki: This is where I need to recall a little better, I read that once it's like, I've read that I read that one somewhere and there have been other clinicians that have like proposed other theories. So to say like, it's not linear and I think like, you know, anybody listening that has experienced grief in their life would might kind of go ‘Yeah,’ like, I didn't follow that pattern. I know, for my own self that I've experienced grief; I've experienced some of those aspects, but not all of them and certainly not in that order. I don't know about how about for you, Pete?

Pete: Yeah, I mean, the reason I asked that it was not to put us on the spot but also just to realize that like, I feel like I've always taught it as a fluid thing. But I think whenever I think of any developmental process within psychology; I have always conceptualized it as fluid. So if I think of identity development, any of the constructs that psychologists have tried to manualized or operationalize, I think I've always seen them as fluid and I don't know if that's my Zen. So that's why I was more asking is like, I'm not sure if I've read it, I was trained that way, or if it was just my Zen, so sometimes, hey, listeners, I got confused.

Nikki: We certainly don't know everything.

Pete: I don’t know where some of my stuff comes from sometimes.

Nikki: No, it's also sometimes we learn things so long ago.

Pete: Yeah.  We get that old?

Nikki: Well, I think that partially it’s years and I think that is also just actually our training as psychologists that we recognize that emotions and again, grief is an emotion. It's, again, to reiterate one of the most intense emotions we can experience at baseline. Emotions are not linear processes they don't follow a perfect pattern.

Pete: Well actually, Dr. Kubler Ross was 1969 that book was published.

Nikki: I didn't realize that long ago.

Pete: Yeah, it's really helpful to kind of conceptualize even just from that. I mean, again, foresight, you know, she had some really incredible foresight there for sure.

Nikki: So Pete, I'm wondering, because I think this is a really important piece here, because I definitely want to touch a little bit on some spirituality aspects of this, because this can often come up with grieving in the process. How does Zen Buddhism conceptualize grief? Or how is grief maybe approached from that lens?

Pete: Well I think what we would actually just focus on loss and non-attachment I don't know. So this would be interesting for a scholar really, like, I wonder if in Sanskrit, or some of these traditional languages if there's a translation of grief. And my guess that my assumption is that there might not be.

Nikki: Interesting.

Pete: Because spiritually speaking, there is not a grieving process, per se, because the practice is about non attachment. Where like, so loss is meant to be a peaceful transition to your next life.

Nikki: That's very interesting. And I think this is what sometimes can get confusing for those that are new to the concept of non-attachment because I think sometimes that can be interpreted as not feeling.

Pete: No, it's actually more of an acceptance of the sadness and let's calls it grief for this.

Nikki: Yeah, grief.

Pete: [inaudible 13:40] because it is universal. So they'll embrace that you're feeling sadness, depression, grief, we'll sort of use it in that way, from the loss. The goal is to really adjust to the new life without that loved one and you do so in a peaceful transfer, like a peaceful in a calm way. So you know, I'm thinking, and I remember like, when I started studying Buddhism and an aunt of mine had passed, and I remember going to the funeral. And I was like, feeling very celebratory of her life. Like, that was sort of the approach I was taking and then as like, the coffin was rolled up and my mom was crying. I was like, Oh shit, I feel crying coming on and I was like, wait, why am I going to cry?

Nikki: Right, because now you’re trying to, you know, thinking back to our episode on toxic positivity last season, right? Like that. You were attached this idea of like, I don't want to feel the grief, I just want to feel good, right, I just want to celebrate her.

Pete: and there's a one of the stories of the Buddha about this was like, and this is tough, a woman who lost her child came to the Buddha and begged the Buddha to bring her child back. And the Buddha asked a woman to bring a mustard seed from a house where no one had ever died. So it's that thing for people think like so the Buddha said, bring me back a mustard seed from a house where no one has ever died.

Nikki: That’s impossible.

Pete: And of course she cannot find a household and so that idea is like the pain of death is universal and that's the universality of dying.

Nikki: Yeah, and I have to say, we've touched on this in previous episodes, you know, Eastern practices are much more skillful at bringing that into our conceptualization of being alive. Right, that like, part of being alive is that, again, like impermanence and we'll all die at some point, that's going to happen. And I think, from a Western perspective, and I'm going to be honest, I think even in psychology, you know, even from cognitive behavioral therapy standpoint, we can get really focused on like, let's get better, right. Like let’s improve our [inaudible 15:50]

Pete: Well, that’s what I was thinking about the DSM, because I think the DSM allows for six months of bereavement.

Nikki: I think they've changed in DSM five but that's a great point. It's like it used to be.

Pete: Is it 12 months now?

Nikki: I don't remember. It's like, pathologies right?

Pete: Correct. If you grieve more than six months from someone that you really love, you're now pathological.

Nikki: right.

Pete: No.

Nikki: Yeah. So it's like, there's such a fear of this emotion and I think, you know, both from a third wave CBT perspective, which, of course, we've borrowed lots from Zen Buddhism, it's this allowing of that experience. And not allowing our fear of loss, like the fear that we're going to someday not have that person, like not allowing that to stop us from being present in our lives and connecting with other people. Because that's something I don't know, I think of a friend of mine, it just breaks my heart. I think there's a person I know who's experienced a lot of loss in their life, and this person has a very hard time allowing themselves to connect deeply with other people, because they're so afraid of losing them. And so in the short term, right, it's like that feels safer and yet this person then doesn't get to feel the depth of love that they could.

Pete: Yeah. And you have to be able to be open and you're what's that is saying? It's better to have love than to not have love at all.

Nikki: But I think a lot of people say in the in the moment, like no, because what if I lose them?

Pete: I know, that's what my mom didn't get another dog.

Nikki: Yeah.

Pete: Mom if you’re listening.  And I challenge her, I said, Well, is it better to like, not have the tragedy of losing a dog versus owning one and being able to experience a love for the X amount of years that you have them? And that's a values decision?

Nikki: Well it is. What I think again, if we come back to just the intensity of the experience of grief when we're going through it, a lot of people can judge that as like, I this isn't worth it. I mean, I've heard that from people before. I mean is that something that's called compensation? I mean, that's something obviously I also challenged, but I understand it, they're like, I can't feel this way.

Pete: Yeah. I mean it's fearful. And I'm reminded, just to bring in some Eastern stuff to think about a really good friend of mine, when he lost his mom and in a Baptist Church. So sort of thinking about it was really, really intense, you know, the ceremony, just lots of screaming, and non judgement of the emotion.

Nikki: Right, just like allowing what's coming.

Pete: Just whatever came, coming.

Nikki: Yeah.

Pete: Just throw yourself on the floor and does whatever you need to do you know, and mean, and like, having studied some of the Buddhist stuff, which is like, well do it peacefully and calm and accept. And sometimes in some Buddhist traditions, depending on where they are in the world, they would have ceremonies and the ceremonies might just put the body on top of a mountain and let the vultures come eat it, because then you're feeding in the cycle of life. And so there you are watching a loved one to be eaten by birds, like that's in some Tibetan literature.

Nikki: Wow.

Pete: That's amazing. You know, and we have teachings of reincarnation, and Buddhists often will do cremation because they don't believe that their body is theirs, they believe that their body is just a vehicle and that it's just borrowed for this life.

Nikki: Right, and yet of course, that gets into, you know, like concept of like souls, and who we are. We’re going to end here in a couple moments but there are two things I just want to add about that. I want to go back to what you're saying about like the screaming and the sounds that they were making. You know, there's something very primal about grief, right? And I'm reminded of two things I've read about animals like; they hit me so hard when I think about it.

Pete: No crying.

Nikki: I probably will, so the first was I had read this beautiful article in The New York Times a while ago about actually this man in New York who takes care of birds when their owners pass because birds can live like 30, 40, 50 years. And the birds grieve and they whale and it's like, you know, and again, I always talk about like humans for some narcissistic, right? We think that grief is unique to us like no, so that's one and then the second is, and this is also just very beautiful that elephants you know, which are a matriarchal society, they have funeral funerals for their dead.

Pete: Yeah.

Nikki: And one thing that they do is they gather around the bones of the deceased elephant and they all touch the body.

Pete: Isn't that amazing?

Nikki: Oh, it's like, and I think like, the point that I am making is like, we need grief because it keeps the connections to those that we love, right? That I often say to people like love and connection always has on another side, like an underbelly, right. Like when those that we love are walking this earth, the underbelly is fear, like; we can't love somebody without feeling fear that we're going to lose them at some point.

Pete: That's right.

Nikki: And then once they do pass, and you know, whatever tradition you believe in, even if you're an atheist, then there's grief with the love, but the love and connection isn't severed by death, right?

Pete: Yeah, it remains.

Nikki: It remains. Yeah, you know, but I think that's a difficult concept for people to connect with, because they're so afraid of the feeling.

Pete: Yeah. And that's why some people are going to think it's weird that I said celebratory of my aunt's life. And really, it's one of the things I say to a lot of people in my personal life is just celebrating the person's memories. And that works for me, but that could also be part of the positive toxicity and really trying to find. And I think the key here is just doing what works for you, identifying that there are these stages of grief, notice them, label them, and then you're going to like ebb and flow through all of them. And that is fluid and how you go through the process.

Nikki: Yeah, and I'll end with something a friend of mine has told me that I believe it comes from the book ‘Through the Looking Glass,’ which is concept that sure he says I find it very helpful personally, that grief is like a brick that we carry with us. And at first, it's very heavy and over time we get used to it, but it's with us always. And that brick that we carry with us is what connects us to those that we've loved and lost.

Nikki: This has been When East Meets West. I'm Dr. Nikki Rubin.

Pete: And I'm Dr. Pete Economou. Be present. Be brave. This has been When East Meets West all material is based on opinion and educational training of doctors Pete Economou and Nikki Rubin.

Nikki: Content is for informational and educational purposes only.