A Piece of My Mind > The Sound of Silence

A Piece of My Mind
The Sound of Silence—When There Are No Words
Melissa Red Hoffman, MD, ND
JAMA. 2019;322(2):117-118.

In this narrative medicine essay, a surgeon and palliative care physician describes the isolating silence that she felt … and how that lingering silence has come to guide her when sitting with patients, when there are no words.

Melanie Kaye/Kantrowitz writes in her poem “Kaddish,” a tribute to her dead father:
“if I were to mourn properly
I would not be done.”



The Journey Of Losing A Soulmate To Cancer with Carla Malden
October 5, 2016 by New Dimensions

When you lose someone, well-meaning people give you books full of supposedly uplifting platitudes: “time heals all wounds;” “there is a purpose to this;” “you will find closure.” But, as non-religious baby-boomer Carla Malden says, she found them useless. She shares the highs and lows, sparing nothing in her truth-telling. You will be inspired by her candor and clarity as she speaks about her experience of living through the debilitating disease and death of her husband and work partner. She likens this time in her life to being strapped in a roller coaster that you never bought a ticket for, “You can do nothing but hold on. There are weeks where you are plummeting and weeks where you feel hopeful and things are on the rise.” This conversation explores the zigzagging emotions of living with a loved one who is battling a life threatening illness, as well as moving into widowhood.


A Buddhist Ritual

Adopting A Buddhist Ritual To Mourn Miscarriage
August 15, 2015

When parents lose a child, there are rituals to mark their grief — holding funerals, sitting shiva, bringing casseroles. But when that loss happens before birth, it often isn’t marked. Sometimes, it’s barely even mentioned. It’s different in Japan, which has a traditional Buddhist ceremony that some Americans are adopting as their own.


After Miscarriage, Missing The Luxury Of Grieving
August 19, 2011

Less and less willing to sit with our emotions

How Medicalizing Grief Turns Into Dollars
Forbes. February 21, 2012

grief, once excluded from the definition of depression, is now included within it.
This means that people grieving over the death of a loved one could theoretically go to their psychiatrist and be prescribed pills to treat the “condition.”

The Lancet beautifully outlines why the medicalization of grief is misguided for so many reasons.
Antidepressants don’t do anything to the moods of non-depressed people, they point out, so there’s little likelihood that they would work to reduce grief.
Arthur Kleinman, a medical anthropologist, says that since the APA wants to allow for treatment of the normal grieving process, it had to first yank it from Normalcy and plunk it down in the realm of Abnormal, or worse, “make it over into a disease—ie, depression.”

the DSM continues to shorten the normal grieving processes.
The DSM-III considered grief for up to one year acceptable, the DSM-IV only two months.
No other culture, Kleinman says, considers two months a normal amount of time to grieve. They must be shaking their heads at us silly Americans and our strange attitude towards grief. Cultures across the globe vary hugely in what’s considered a normal timeframe to grieve, some devoting the remainder of the lifespan to mourning the loss of a loved one.

a fundamental difference between grief and clinical depression: grief, in many ways, makes sense, as there is direct cause for the feelings of sadness, loss, sleeplessness, and lack of concentration.

Would you want to take a medication if it would help lighten the pain of grief?
Or is it better to experience it, work through it, and wait for it to lift in its own time?
There is undoubtedly a place where grief becomes depression when it does not lighten for a long time.
But considering it a symptom of depression from day one seems like a damaging way to define it.

see also:


CRAZYWISE: A Traditional Approach to Mental Illness
Phil Borges
Jan 2, 2016

When a young person experiences a frightening break from reality, Western experts usually label it a “first-episode psychosis”, while many psychologists and cultures define it as a “spiritual awakening.

Is Emotional Pain Necessary?

Is Emotional Pain Necessary?
August 02, 2010

bereavement exclusion

As Holly Prigerson, a researcher at Harvard University who studies bereavement says, “What underlies a lot of this discussion is: Is it harmful to interrupt a normal grief process by medicating?” Medicalizing Our Experiences But for some people, the real issue raised by the bereavement exclusion is philosophical — or maybe the better word is existential. Dr. Allen Frances, the famous psychiatrist and a former editor of the DSM, says that more and more, psychiatry is medicalizing our experiences. That is, it is turning emotions that are perfectly normal into something pathological. “Over the course of time, we’ve become looser in applying the term ‘mental disorder’ to the expectable aches and pains and sufferings of everyday life,” Frances says. “And always, we think about a medication treatment for each and every problem.” From Frances’ perspective, if you can’t feel intense emotional pain in the wake of the death of your child without it being categorized as a mental disorder, then when in the course of human experience are you allowed to feel intense emotional pain for more than two weeks?

see also:

The Power of Mindfulness: What You Practice Grows Stronger
Shauna Shapiro
cortical thickening
I’m not good enough


In Defense of Sadness: Happiness Is Overrated
February 14, 2008
depressive realism
[2nd part is better]

you can’t measure suffering

8:10 todos aquellos síntomas de despersonalización, de disociación, de embotamiento emocional que lo hemos dicho, pero de mucho retraimiento, que la persona se encierra en sí misma y no es capaz de salir de ahí, personas que por ejemplo padres o madres que no son capaces de cuidar de sus hijos, y ya no de cuidar a sus hijos sino de cuidar de ellos mismos, personas que dejan de comer, personas que dejan de llevar una vida … no normal porque ya hemos visto que esto es un proceso, que se tiene que ir normalizando nuestra vida, pero que vemos como que paran. Que dejan de vivir.
V3_5 Patrones básicos de reacción de los adultos tras los incidentes críticos

7:30 …a la vida normal lo mas pronto posible
V3_6 Factores protectores y de riesgo en emergencias cotidianas en adultos

Primeros Auxilios Psicológicos
Universidad Autónoma de Barcelona.

Oliver Sacks, Exploring How Hallucinations Happen

Oliver Sacks, Exploring How Hallucinations Happen (46 min)
November 06, 2012

I did in fact have that experience again, but when I had it the second time, it was not with a drug, it was with music, and I think music can take one to the heights in a way comparable with drugs.

Every culture has found chemical means of transcendence; e.g. ayahuasca

11:00 indigo was my favorite hallucination

a sleeping medication called chloral hydrate … I want to say goodbye. I’ve gone mad. … delirium tremens, not induced by alcohol withdrawal but by chloral withdrawal.

28 Lilliputian hallucination … elfs

31 the bereavement hallucinations – which are common; something like 40 or 50 percent of bereaved people get them occasionally – are often felt as very comfortable, comforting, and they may help them through the mourning process, and when one has mourned fully, they disappear.

32:30 intense emotion of any sort can produce an hallucination.

Charles Bonnet Syndrome

Exclusive First Read: ‘Hallucinations,’ By Oliver Sacks  (41 min)
October 24, 2012


Oliver Sacks: Hallucinations (35 min)
Talk of the Nation
November 09, 2012

A Community of One: Social Cognition and Auditory Verbal Hallucinations
Vaughan Bell
PLoS Biol, 2013, 11(12): e1001723. (December 03)