How my brother’s suicide changed my practice as a psychologist.

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Dad’s prognosis was not good. Sitting next to his hospice bed, my family and I watched the cancer take over. As my dad got sicker, my brother Dave got sicker too. His depression and alcohol addiction worsened; he went in and out of treatment. He mysteriously deteriorated alongside my father.

When Dad died, Dave’s mental illness became fatal. My little brother died by suicide, six months to the day after the loss of our father.

I knew Dave was gone when I saw my mom’s series of missed calls. I knew that before she spoke. I fell to the floor, my body overwhelmed with memories of Dave as a kid on the park slide, in his punk phase with dyed hair. I felt dizzy, trapped in a demented carnival ride. When I regained the ability to stand, I used all of my brain power to blame myself – a trained mental health professional – for my own brother’s death by suicide.

Sometimes I think I shouldn’t be a psychologist anymore.

It’s my job to help people who are feeling hopeless. Why couldn’t I “save” my little brother? I had read all the books and passed all the tests, but my stupid doctorate. did nothing to help me with the person I desperately wanted to help. My ego wants to be reassured that I am not a failure. Can I still be competent at my job and also be part of the tragedy of Dave’s death?

Before my own grief, I was good at compartmentalizing myself in emotionally complex conversations with patients about the abuse they had suffered or the guilt of surviving war. But when I sought out my own grief therapy, I discovered that much of what I had done as a professional had turned out to be bad for me as a patient. I realized that we – all of us, but especially mental health practitioners – were cheated with grief.

Too often, therapy treats any loss – divorce, unemployment, death – as an internal challenge that unfolds in a predictable order. Many of my clients expect to fight through stages from shock to acceptance, like levels in a video game. Fifty years ago, Elisabeth Kübler-Ross mapped out five stages of mourning, at first thought to be sequential, which have since left permanent imprints in popular culture (although as stages they have been largely debunked). ).

I’m so grateful to Kübler-Ross for his early studies, but I made mistakes in that thinking, too focused on language and cognition, largely ignoring the body. I confess that I, too, viewed grief as linear, expecting an intense emotional reaction to occur early on and then wane naturally over time. If he didn’t follow this process, the grief became a problem or a disorder to be dealt with. Prolonged effects often include acute loneliness, which can also be misunderstood. Traditional therapy, which I assumed was correct, was based on this idea: people are stuck in grief because they are alone, after losing someone close. Treatments focused primarily on the relationship with the deceased person. I was unprepared for a community crisis involving people still alive.

Everything changed after my own loss.

In my first mourning, the term sorrow has become literal. Going to work and raising my children have become physical challenges. I hurt myself. Even years later, unexpected triggers can still reopen the wound. I no longer believe that the pain will subside completely. I know now that I will live in grief, in one form or another, for the rest of my life. Talk therapy helped, but it wasn’t enough.

What helped was physical; I found healing in movement, throwing myself into a hobby I had only done before, circus arts. Spinning on silk and flying on the trapeze freed me from overthinking.

And I realized that I needed to mend my relationships with the living.

While my father was sick, my husband, Rob, managed the children’s schedules. I flew to hospitals out of state, visiting my dad, then my brother. Rob and I were married, living parallel lives in the same house. When Dad and Dave died, Rob thought I was finally “back”. I had just lost my family and, strangely, my part-time job as a nurse’s aide. I had spent months mopping up blood, figuratively and sometimes literally. I didn’t know how to be “back”.

I was deeply ashamed of my messy family that Rob had married into. Grief is often accompanied by the shame of not being on it now, which is isolating, especially if significant other people or children are grieving very differently. Rob and I needed couples therapy to learn how to support each other. We needed new tools and a new language.

My grief was also a spiritual crisis. Because Dave died by suicide, ideas about fate, power, choice, and free will consumed me. Growing up in the church, I struggled with the idea of ​​heaven and the presence of God.

In my quest to solve this problem, I worked with a highly trained therapist using MDMA, an amphetamine-like compound. This is a treatment protocol that could be approved by the FDA as early as 2023. (I had to travel outside of the US) It’s not mainstream yet, but it’s not a marginal science. Psychedelic therapy eased the anxiety of my big questions. I had no answers, but I felt at peace. (There is a research team at John’s Hopkins that has been treating terminally ill patients with psychedelic psychotherapy for many years. They have found that this type of intervention significantly relieves existential anxiety and depression in people dealing with the end of their life.)

Three years later, I am still re-examining my practice, unlearning much of what I studied in graduate school. I let go of the theoretical frameworks that once dictated my clinical actions and conceptualizations. I have a deeper understanding of how grief lives in the body and seeps into every relationship. Instead of just asking what’s going on inside youI also ask, what’s going on around you? What’s going on in your body?

We now know that grief lives in the body. Mary Frances O’Conner discovered that grief alters our brains, disrupting pattern recognition. Years of memories suggest that our lost loved ones could walk through the front door at any moment. We cry as we wait for a new reality to form. He will never come back. I believe you can help build this reality, by creating new neural pathways and new muscle memories – a new template.

Now I encourage patients to incorporate movement and recreation into therapy in a way that brings joy. A client, a photographer, takes a photo walk every day as part of her recovery. Another, an avid skier, took a year off to become a ski instructor. Clients tell me that these tangible assignments are a huge relief. Nothing is simple during grief, but physical activity is achievable and empowering – a welcome relief from the existential questions and searing emotional pain that comes with loss. The movement engages different aspects of the brain, distracting attention from critical thinking and shifting attention to spatial reasoning. Diversifying neural connections promotes resilience and promotes healing from within.

Surviving friends and family are an essential part of my conversations with new clients. We get stuck in our grief, not just because we miss loved ones, but because the loss makes it difficult to preserve relationships. In couples or family therapy, it is helpful to discuss how different approaches to grief can affect your dynamics. One person can be stoic, another expressive. One wants to talk about the dead person, the other can barely form the name in his mouth.

These conversations relieve shame, normalize grief, and build bridges between our past relationships and how they will be in the future. Therapy is not accessible or desirable for everyone, but you can also gain a strong sense of community in bereavement groups, religious groups, and volunteer organizations. One thing is certain: Heartache cannot be appeased in isolation.

I also encourage my clients to approach big existential questions in a way that suits their journey. A spiritual process can also mean prayer, meditation, mindfulness or a writing exercise. This may mean reading philosophy to explore various worldviews or working with a member of the clergy or spiritual director. And I am now a strong advocate for psychedelic-assisted therapy.

I am no longer the same psychologist that I was. I had to forgive myself. First, as a therapist, for not having “saved” Dave from an illness as serious as our father’s cancer. And as a grieving sister, not to “recover” quickly, or at all. You do not recover from a bereavement. You integrate it. It does not leave you. It’s absorbed into you until it’s part of what makes you together.

​​If you need to talk, or if you or someone you know is having suicidal thoughts, text Crisis text line at 741-741 or call or text 988 to reach the Suicide and crisis lifeline.

State of Mind is a partnership between Slate and Arizona State University that offers practical insight into our mental health system and how to improve it.

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