Grief from an unexpected, tragic or too-early death is devastating. And all too often, loved ones don’t know how to deal with someone else’s deep, uncomfortable and “unfixable” sadness. Memoirist Amy Lin talks about the trauma of suddenly losing her husband with grief researcher and author Dr. Joanne Cacciatore. They help us understand what Dr. Cacciatore calls "the gift-curse of fully inhabited grief" and how we can better support our grieving friends and loved ones.
Grief from an unexpected, tragic or too-early death is devastating. And all too often, loved ones don’t know how to deal with someone else’s deep, uncomfortable and “unfixable” sadness. Memoirist Amy Lin talks about the trauma of suddenly losing her husband with grief researcher and author Dr. Joanne Cacciatore. They help us understand what Dr. Cacciatore calls "the gift-curse of fully inhabited grief," and how we can better support our grieving friends and loved ones.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine:Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic today is grief after traumatic sudden loss. Our books are “Here After” by Amy Lin and “Bearing the Unbearable: Love, Loss, and the Heartbreaking Path of Grief” by Dr. Joanne Cacciatore.
I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine. I am so excited about my guest today. Amy Lin is a writer who lives in Calgary. Her work has been published in “Ploughshares” and she writes the Substack “At The Bottom Of Everything.” “Here After” is her first book. Amy, welcome to the show.
Amy Lin: Thank you so much for having me. I'm so grateful.
Dr. Denise Millstine: Dr. Joanne Cacciatore, often referred to as Dr. Jo, is a professor at the Arizona State University and the director of the graduate Certificate in Trauma and Bereavement program. She's also the founder of the MISS Foundation and creator of the Selah Carefarm. She's the author of the award-winning bestseller “Bearing the Unbearable: Love, Loss, and the Heartbreaking Path of Grief” and a bereaved Mom since the death of her daughter in 1994. Joanne, thank you for being here.
Dr. Joanne Cacciatore: I really appreciate the opportunity to talk about something so heartfelt and painful, but important.
Dr. Denise Millstine: Thank you for that. “Here After” is a memoir. It's told in short reflections on a time in Amy's life when she fell deeply in love, navigated early marriage, then tragically, shockingly lost her young husband while he was out running. Amy reflects on her grief while then unexpectedly navigating her own serious health challenges.
Okay, you both know how “Read. Talk. Grow.”works. We discuss books that portray health topics in an effort to better understand health experiences through story. And in this case, we're talking about traumatic grief. Amy, what a beautiful, reflective work you have shared with the world. For our listeners who have yet to read the book, will you tell them about Kurtis?
Amy Lin: Yeah. It's such an honor to speak about a man who, you know, he loved living so much. I can't fathom how he had so little time to do it. He was somebody who carried his own sun with him everywhere that he went. And he moved through the world with this kind of extraordinary awareness of what it meant to be waking up for another day. And it's really radical to live with somebody who offers that kind of newness to the day.
It's, gosh, I haven't talked about Kurtis personally in a while. And he liked things exactly as they were. You know, if you went to the ice cream store, he either ordered the favorite of the person serving him, or he ordered vanilla. So much of him lives in “Here After,” as evidenced by my emotions right now, I find it hard outside of the book to think about who he was, because it's like staring directly at the sun. But I'm so moved when I think about him. I think that's who he was. He moved people.
Dr. Denise Millstine: And you have to, with sharing this and your journey and your experience with the world and knowing there are so many people who navigate traumatic loss. Which, Joanne, that is your area of academic study and professionalism. Can you talk about what traumatic loss means, what that encapsulates?
Dr. Joanne Cacciatore: Yeah. Well, in the literature, but also in my work for 30 years with grievers, traumatic bereavement differs from non-traumatic bereavement in the way that it's generally recognized as unnatural deaths. Deaths that happen before their time, deaths that include violence. If I were to catalyze it, it would be early deaths, the deaths of younger people. You know, we don't expect even 50-year-olds to die nowadays, and suicide and homicide and also the deaths of children at any age.
And so that's sort of how we understand it when we're looking at the data between natural deaths and unnatural deaths. For example, it's not necessarily just the relationship, Denise. It's also the nature of the deaths.
So I worked with two bereaved moms at one point in the past, and both of them lost their grandmother. One of them lost their grandmother to hospice. She was in her late 80s. Her death was a good death. You know, they had lavender diffusers in the room and they were playing her favorite music. And the family was there and they were singing, and the lights toward dimmed. And it was a peaceful death. So it was a good death. And there's grief there, for sure, but it's not traumatic. It doesn't have the edge of trauma.
Whereas the other woman I was working with, who was also a brave mom, but her grandmother died at the same time, but her grandmother was about the same age, but lived independently in a community for 55 and older and played tennis once a week and did all the things, and someone went in to rob her and ended up murdering her. That's traumatic, because you don't expect even your grandmother to be murdered.
It is about the cause of death, but it's the relationship to the person who died. But it's also about, and the age, but it's also about the cause of death and the circumstances of death. Everything is contextual, even though things like the DSM tries to contextualize things, as wise and prudent clinicians, we have to always consider context.
Dr. Denise Millstine: Dr. Cacciatore is referring to the structure by which we categorize as mental health conditions, particularly in referencing the DSM. And clearly having a young husband like Kurtis, who Amy is sending off for running a half marathon in the days of COVID. So, of course, this is a time when these types of running events were done on your own and coordinated but not this big gathering. We all remember 2020 well and had every reason to believe that he would return. Because he was healthy enough to run a half marathon, didn't have any health conditions and I think within your definition of traumatic, that is the type of unexpected loss.
Dr. Joanne Cacciatore: I can feel the grief, but I can feel the love. And I love the way you describe him. You know that he carried the sun with him. I mean, that it's just, it's just beautiful. It's just really touching.
Amy Lin: Thank you. That's so kind of. I appreciate you saying that. I mean, I think something that's lost on the living, if they are lucky, is that when we enter a relationship with someone, when we love them, when we really love them. If you are very, very lucky, you do not realize then that you're really entering into the promise that if they die that you will grieve them.
Because grief really is love's final form. And I think especially when you're young. And we know that young widowhood is defined anywhere, in the 50s and down. We know that they'll die, but it's this abstract thing until they do. And then the realities of what love asks of us after people pass. The ways in which we are asked to grieve them. I think it's so often not discussed. That the weight of love is the weight of grief, and people want to hide their grief. Often because they're asked to professionally, personally, socially, which then means that they're asked to hide how much they loved that person. I really appreciate you saying that to me, because it gives me an opportunity to show you who he was, but also who he was to me, and I'm grateful for that.
Dr. Joanne Cacciatore: Yeah. And, Amy, you said something that's really important there. And that is that people, grievers are asked to hide.
Amy Lin: Yes.
Dr. Joanne Cacciatore: Shame is an emotion of hiding and shame as Viktor Frankl said in “Man's Search for Meaning,” shame does not promote transfiguration or transformation after trauma. Shame promotes hiding. And we ask people, not just implicitly but explicitly, to hide their grief all the time because it's too painful. And I call it a form of emotional colonization. Where we're telling people, you can't have this even though it belongs to you. You know, your love for Kurtis and your grief for Kurtis belong to you and Kurtis. And no one has the right, in my opinion, to come along and say, gosh, Amy, don't you think you're doing this a bit long? Or don't you think it's time to move on? Or isn't it time for you to date again? Or, you know, all of the intimations, explicit intimations and implicit intimations that we get from society.
And there's actually some data about this. It's called social constraints. And the research. And one of the things they found was that social constraints predicted poor psychological and physical health outcomes in bereavement. This is very important. So the pressure from society to move on, to be okay, and to suppress grief and to hide, actually is making us physically sick.
Amy Lin: I'm so glad that you are speaking so clearly on it. It's actually rare in some of my conversations to hear someone name it so explicitly. I do think that people come, for the most part, from a tender place of wanting to relieve you of pain when they excuse it. There is so much small talk in grief when people approach it.
I cannot begin to list the amount of people that I have seen, known for years, that either have never acknowledged that Kurtis died, which is shocking to me. Or tend to elide or entire really glaze, over the realities of death. So there is a lot of, “You look really good.” “You're still so young.” There is notably one woman who told me, “Well, at least you're so pretty.”
Dr. Joanne Cacciatore: Wow. Wow.
Amy Lin: And this was in a professional context. I want to be clear. She knows me professionally. Yes. I have been able to gracefully having, you know, Kurtis has been dead just a little over four years. I've had four years of practice to gracefully move through these situations that are inelegant, to say the least. And that was one that stopped me in my tracks. I really didn't know what to say. This is what the woman reached for in the reality that she was going to have to acknowledge that my husband had died. She reached for what I looked like.
Dr. Joanne Cacciatore: Right.
Amy Lin: And people, they're lost. They're not…I don't think people are trying to be cruel, but they are not providing, as you say, a space for people to be as they are. And when people internalize that and the shame, as you say that comes to that, I think it not only makes them ill, but it misshapes them. It bends them out of the form that grief is forcing upon them. Really, grief has entirely rearranged my internal architecture, and I find it incredibly difficult to be in spaces where people are not only, not creating room for that new architecture, but actually thrusting an entirely different architecture upon me. I'm grateful for you saying that.
Dr. Joanne Cacciatore: Yeah. And I mean, I think this is part of the problem is the external schemata for certain people gets internalized and that's where the shame comes.
Amy Lin: Exactly.
Dr. Joanne Cacciatore: I don't want to let the bigger systems off the hook here either, because much of the attitude about grief as this pathological thing for which we need to eradicate all emotions around it. I think much of that comes from societal attitudes that come from these larger systems that are sending these messages constantly. And then people get this attitude where schools don't know how to handle for example, it's mothers. It's going to be Mother's Day next month and it's April and they're making cards for Mother's Day. But this little third grader, his mom died in a car accident. And the teachers, this is a true story. The teachers took him out, pulled him out of class, and had him go to the principal's office so his feelings didn't get hurt.
And I'm like, that is not right. I mean, we need better. Of course we need better pedagogical models. And of course, the medical system, the psychiatric system also sends these messages that if your grief hasn't abated, if you're still yearning for the person after one year, then you have something called prolonged grief disorder. Oftentimes, capital D, Depression is conflated with grief because so many of the symptoms look alike. And this is why individuals in society think, oh, well, we need to move on.
I've actually had people reach out to me saying, I need to send my daughter-in-law to you because she has this disorder that I read about because her baby died six months ago and she can't go to a baby shower. And I'm like, let's be real here.
It's a little bit like asking someone who has had both legs amputated to get up and run a marathon next week. It's unfair. People need time to adapt, especially when the loss is traumatic and we want to rush people back to functioning. We're so concerned about functioning and productivity that we have lost all sense of compassion and community care.
Dr. Denise Millstine: Amy, shortly after Kurtis's death, you develop a serious medical condition. Initially with life-threatening blood clots in several places in your body, requiring intensive hospital care, blood thinners, even surgical procedures. This must have been overwhelming on top of your loss and within the context of your grief. It's lucky, I hope you don't mind me using that word, that your father recognized that something serious was happening and really urged you to seek hospital care and evaluation, which was probably lifesaving. Can you tell our listeners about that?
Amy Lin: Thank you for asking. Yes. My father, who is a doctor. His quick action and his knowledge of what was really happening to me unequivocally saved my life. I believe that. He was the one who drove me to E.R. And I was convinced, I was convinced that I had torn a muscle in my groin. And I actually was wearing a hospital binder on my ribs because I was in so much rib pain. And I was sure, again, I was convinced, that I had torn my intercostals from crying. And so I had a binder on just because I couldn't breathe, because I was in so much pain.
And again, the widowhood effect is here. Am I a medical professional? I am not. And here I am diagnosing myself with all kinds of reasons why I am in so much physical pain. And it was my father who is a medical professional, who brought me to E.R. in the middle of Covid. We were in a Covid overflow tent. It was incredibly stressful for everybody there, for the medical professionals, for the people who are waiting for care on an incredibly taxed medical system. And I didn't think we should be there. I thought we were taking a seat from somebody who really needed it.
When I was seen, and for this I am so grateful for the Canadian medical system, a cascading rapid intervention began. Because it became very clear very quickly that I not only had very severe vein thrombosis in what I thought was my torn groin, but I also had a pulmonary embolism, which was the cause of my rib pain. And I would be ultimately in hospital for ten days. At least half of that, was in intensive care.
I would have two thrombectomies to try to clear the DVT from my leg, which was extensive. I was on three, three anticoagulants to try to clear the clots in my lungs, one of which was described to me as Drano for your veins. And they ran continuously, even during my thrombectomies, because of the concern that the physicians were warranted in having.
And I would leave the hospital, I was allowed to leave the hospital only after I could prove that I could walk with the aid of a walker. Unbeknownst to me in these days. Behind the scenes, doctors are speaking to my family about calling my kin, my siblings and preparing them for a very sad conversation.
Which is so difficult because Kurtis had just died ten days ago. We were already having sad conversations. And I was in the midst. And I write about this in the hospital of suddenly confronting two parts of my brain. The survival part of my brain, which was telling me to try to live, the relational part of my brain. I could see my parents desperately wanting me to live. And then the part of my brain that was grieving. That was telling me, however illogically, that this was a sign that it was time to go. Because Kurtis had gone. And a part of me really believed my health had failed because Kurtis had called me onward, and that I all had to do was answer the call.
I don't believe that grief is the reason that my health failed. I believe that I had what medical professionals have termed to me, an unlucky constellation of events. But I do believe that grief is the reason that I hesitated, and I did hesitate for a couple of days. I ultimately had to provide consent for the thrombectomies, for the medication, because I wasn't sure. But I am grateful, as I said, to my family and particularly my father, who ultimately saved my life. And you know what a gift to give somebody, to give anyone. To love them enough that you want them to live.
I now live in the world as someone who, you know I have a stent, because I have a very rare syndrome called May-Thurner syndrome, which essentially creates a clotting space in my body, in the most simplified of terms.
And I have, you know, I take daily medication and I have to wear a compression stocking. Well I should wear it all the time, but really, I do wear it when I fly. And I have to think about my health in ways that I truthfully was lucky not to think about it before. So I don't just think, something about my grief experience, I don't just think about the mortality of my beloveds. I really think about my own mortality. Having been confronted with the realities of mortality on all levels, because Covid was happening, so I was seeing a global mortality, and I was experiencing personal mortality, and I was experiencing a beloved mortality. And that, it has woven into my experience in a way that, you know, has made it difficult.
And I, I have had a lot of support, and I'm grateful for it because I don't, I truly do not believe that I would have made it without the support on the emotional side, but also on the medical side, starting with my father and then from the hospital. The Canadian medical system is as nimble as it promises in an emergency, and I'm really grateful for that.
Dr. Denise Millstine: I think something that can be under-recognized is some of the physical symptoms of grief, and it can be really hard, particularly for women when we have physical symptoms that we are inclined to write them off to, we've been crying too much, or I must be tired because I can't breathe, because I'm tired because of everything that I'm carrying.
And so I find it particularly important that you've shared the components of your own health journey in “Here After,” as a reminder to people who are reading your book, that your own life goes on and your physical health goes on, and if there are symptoms or concerning things happening to your body, to please seek care, particularly in this case with a blood clot, which can be so dangerous, so fast. So thank you, Amy, for sharing that with us.
Amy Lin: Yeah. Women, we're I think we're socialized, honestly when we experience pain, to dismiss it simply as a part of the female experience. And we do such a disservice to ourselves when we ignore what pain is trying to tell us. One of the most horrifying things, when I look back, is that I took a massage gun to my leg.
Dr. Denise Millstine: Listeners, do not, do not, do not do that.
Amy Lin: Do not do that. When you have a blood clot, destabilizing the site is awful. I took a massage gun to my leg for at least an hour because I was convinced that I had a sore muscle. And in reality, I had so many blood clots that they showed them to me after my thrombectomies because of the extent of them. My father cannot, we didn't even tell him for like two years. He still can't hear it.
Dr. Denise Millstine: Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine: So Amy's book, I'll just restate, is written in these very short essays, very short reflections. Really. It's such a beautiful book. Listeners need to at least put their hands on it and see how gorgeous it is and just feel its creation.
But, at the risk of causing more wrath, Joanne. There's a short portion where she talks about a grief counselor. Right Amy, gave you a packet of information to tell you what normal grief was. To tell you what the predictable stages are. That it would last 4 to 6 months and if it went longer than that, it would be considered prolonged and complicated. This is a health professional, as you've written about it Amy. And so the question I asked for you, or I'd written previously for you, Joanne, is at the risk of hearing your wrath, would you react?
And I can see that I've made your blood boil even more, but I wanted to recognize the power of your writing, Amy. Because you bring these things to the surface. You bring these things to your readers, in a way that is really reflective and honest about how you were treated. There are times and examples in the book where people approach you and recognize that they don't know what to do. And I just want to offer some space for that, because I think sometimes people hear, oh, it's wrong to say these things to somebody who's grieving. And sometimes the response to that is more retraction.
And there's a moment where you're talking about walking with your friend Kate, and she says to you, I sometimes forget how much pain you're in. And you say, I am. I'm in crippling pain. And I just thought it was so lovely to recognize that, she could be honest with how sometimes she forgets how you seem normal, you seem okay. And then she sees this evidence that really, the pain is so deep and so crippling. Would you just comment on that, Amy?
Amy Lin: Absolutely. Thank you. I'm glad you brought up the grief counselor. The one that boils my blood is the psychiatrist. So often people ask me, increasingly now when things happen, what to do or what to say, which I'm really grateful for. I'm grateful. I'm an educator by training, so I'm always grateful to help people. But my answer is always the same and it comes from that root exactly about my friend Kate offered me and truthfully continues to offer me, which is honesty and a space to actually be as I am.
I appreciate it so much, and I do appreciate it so much when people approach me honestly and with space offered. Where they don't try to fill it, they say, I don't know what to say, and most of the times, if they're honest, they'll say the next true thing, which is, it's awful.
And then it allows me to say, it is awful. Because that is the awful truth of being alive, is that the people we love are going to die, and we don't want to walk around confronting that all the time. But the grieving do. The grieving are entirely broken apart every day by the weight of the beloved's absence. They have no choice but to look at what the absence means. And they have no choice every day but to decide if today is another day where they live with the absence. And living in the chasm of absence is a constant threat to staying alive. Or it certainly is for me.
And when people allow me, even for a moment, to place in the center between us what is always at the center of my existing, which is that I choose every day to live in the knowledge of death and the pain that it will cause the people that love me. I'm grateful for that. Because for a moment, it allows me to place in the community what I carry often alone.
And my friend Kate offered that to me. She was honest about forgetting. Well, of course she does. Her husband is alive. Both of her parents are alive, so she has two children that are still alive. May they live forever. And then she allowed me to say what was true for me, which is that my beloveds are not alive. Some of them are, and I hope that they are that way for a very long time. But I think daily, truthfully about the time when that will not be true. Because I know what the cost is of loving people.
And I think when we offer that to grievers of all kinds. I'm thinking particularly if a woman who came to me at a book event and said, I don't have the same grief issue, I have decades of infertility. But she said, this is my pain. So grief exists in all of these places, and we think of the most tender thing, the most radical thing we can do for people, is to allow people to place them between us.
My house burned down in the summer.
Dr. Denise Millstine: No.
Amy Lin: I don’t know you If you guys know that. On the day of my wedding to my beautiful, wonderful second husband, my house burned out. And in the very long half year of restoring. We just moved in like two days ago, that’s why I was not great on my emails.In fact, I had a whole team of people here, picking out every single thing I've ever owned, including the possessions of Kurtis’s that I have treasured and still have. And one of the men saw my book and he kind of leafed through it, and he looked at me and he said, is this your writing? And I said, yeah, my first husband died in 2020, very suddenly. And I'm very open about this. And he looked at me and immediately his beautiful green eyes, and they filled, totally filled with tears. And I said, oh, did you know someone who died? And he said, my son died 21 years ago. Immediately I started crying and he was already crying. And I said, well that must feel like it was yesterday. And he said, yeah, some days it does. And we took a moment, both of us, and we thought about our yesterday. Which for me was four years ago. For him, it was 20 years ago. And we both got on with our lives because that's what we have to do. But it was really moving moment for two people who, up until four seconds ago, up until he saw the book, had no idea that we carry the same kind of pain. And I appreciate it when we offer people that. Boy, we give them something of themselves back. And a lot of “Here After” is about that, about trying to give people a chance, a place to get a part of their lives back in public. Sorry, that was very long.
Dr. Denise Millstine: It was beautiful and speaks to the power of books and being seen and using that as a way to see each other in different ways. I feel like, Joanne, you have a lot to respond to there.
Dr. Joanne Cacciatore: Well, I mean, what strikes me so much, Amy, about what you're sharing is how, this is an unfixable loss. When loss is catastrophic, there's no fixing. And even when it's not, I mean, we shouldn't really try to fix people. It's not our job to fix people. It's our job to love people.
We actually conducted a study, a team, some of my colleagues and I conducted a study, because we were looking at. There's a lot of studies out there on grief support and the benefits of grief support. For example, even if you're looking at, quote, prolonged grief, quote, disorder. The one thing that they got right, for those of you who are medically minded, the one thing on the checklist that they did get right is avoidance, and it's a one item on the list. And yes, avoidance is problematic because we never habituate to the loss.
I proposed something many years ago called the emotional muscles of grief theory. And that is that as time passes, if we keep lifting, practicing, lifting the weight of grief, we build emotional muscles like, much like a regular weight. If we pick up a 10-pound barbell and never pick it up again because it's too heavy, then we can never pick it up. But if we keep picking it up every day and we keep practicing with it and working with it, then we build the emotional muscle. And it's the same thing psychologically and emotionally with grief. So my proposition there is that this idea that, we turn away from grief as a society and so we never give people a chance to practice lifting the weight of grief.
So in this study, one of the things I wanted to see was when it comes to social support, how do grievers define what good support looks like? Cause we know that people talk about social support a lot, but from the experts themselves, in a Thomas Kuhn-ian way, what do they want as grief support? The first thing we found was that emotional support and emotional acts of caring were the two by far most salient themes in the data. So those were the actions. And that means remembering the person, turning, turning toward the grievers, saying their name, asking questions about them, sharing memories about them, not being afraid. Right. Acting in love, not fear.
But beyond that, we asked about the actor. So who was providing the best social support? And this is the part where it gets very interesting. Because we asked about every human group who would have contact with grieving people. We asked about family, friends, neighbors, colleagues at work, therapists and counselors, psychiatrists, medical staff, crisis workers, spiritual leaders. Oh gosh. We asked about every human group you can imagine, support groups.
Right before we launched the survey, I was talking to, I had a grad student, a PhD student I was working with, and I said, you know, I'm going to add one more category of actors. And I added animals.
Amy Lin: Hhhhhmmm
Dr. Joanne Cacciatore: And most every human group ranked at less than 50% satisfaction. In fact, a number of them including social workers. And I happened to be in the school of social work, ranked at about 30% satisfaction. Which is grim, really grim. So, support groups came in at about 67%, which is better. Animals came in at 89%.
Amy Lin: Oh.
Dr. Joanne Cacciatore: Without words at all and I think it's the words that get human beings in trouble. I think it's our propensity to want to fix someone who's hurting. When the stories about the animals that came through were like my dog, I would cry every single day for my husband who died, and my dog would just come up and lay her head on my lap. And so the animals turned toward people who were in pain, while humans turned away, or they tried to change them.
We got stories from people who said, like, even my best friend and I love my best friend, but my best friend would come over and I because I'd be crying and I call her and I'd say, I'm really sad tonight. I really miss my daughter, and my best friend would come over and try to get me to go to the bar to have a drink to cheer me up. They don't want to stay in that place, whereas animals without words at all are just willing to stay there, sit and stay. It was amazing to me. I ran the data several times because I was just in awe at this finding. And it really moved me and also really upset me. It was a robust sample. I think we had 1200 participants. So it was a nice robust sample and it's a little disappointing. I'm a little disappointed in our species, to be honest.
Dr. Denise Millstine: Well, and in the book we see Amy develop a relationship with MoMA, her new dog that she and Kurtis had decided to get when the dog became available. And as I read it, Amy, it seemed like you pretty much forgot. And then you were, received the message that this new dog has arrived. Do you still want the dog?
And I love how you talk about one of your friends or maybe it was your therapist said, I'm so glad to see you looking to the future. But you didn't know if you could love another being with what you had in reserve, but you did. But I think that's an important aspect of this to do. You want to tell the listeners and, about MoMA.
Amy Lin: Of course. MoMA is a wonderful angelic dog who arrived in my inbox nine months after Kurtis had died, which is not very long at all. And it was in the height of COVID and my own health was still. This was before I got my stent inserted. I still really struggling to actually just be mobile. So there were a lot of reasons why a dog was a bad idea.
But I talk about this in the book as well. I feel a little bit of that widowhood effect that I talk about. Which for those unfamiliar, is the clinical term for the fact that people who have experienced out-of-time or young loss, tend to experience tragedy at a much higher rate than their peers. And tragedy here, are things that might seem random, but are in fact not. This would include things like heart attacks, cancer, getting struck by lightning, traumatic car accidents, all of these things that we think of as the chaos of the universe actually happened in far greater number to people who have been widowed very young, which is called the widowhood effect. It being someone who has experienced loss when you were very young literally puts your life at greater risk.
And when I think about MoMA, which is at first does not seem like a life-threatening decision. I do see the widowhood effect in play here, because a person who is not being rearranged by grief at nine months would logically, you know, with the decision part of their brain that frontal part of their brain. Would have looked at their reasons and said, OK, it's the middle of COVID, how am I going to train this dog? I can't go anywhere. There are no classes. I don't have a home. I was still living with my family at that time. They would have thought, I'm not mobile. I'm facing like a stent insertion and a kind of surgery that I need to have in the next few months. I'm on a medical disability leave, so we don't have assured income. I have never actually raised a puppy before and might not have the emotional and physical resources to do so now, including financial resources.
There's all of these things that the frontal lobe would we start raising in a person not experiencing intense grief. That would very logically, as I have just laid it out, any computer, you feed that data and it goes, do not get this dog. And I got this email and I didn't even take five minutes, to think about it. I immediately wrote back because I thought, oh, this is the dog Kurtis and I were supposed to get. And in the world of grief for me, especially at nine months, anything that Kurtis had touched, anything that he still lived in, anything that still embodied, decisions that he had made, anything that brought him back into the land of the living, I was there. It didn't matter what it was. Oh, he picked a dog with me a year ago that I forgot about. But that decision is now manifesting now. A piece of Kurtis lives in that decision, in this dog. I just thought, oh, of course I'm going to accept this puppy. Of course I am going to bring this dog into my home.
And so I made this totally illogical decision to adopt this puppy. And it was a nightmare because she was a puppy. But it was incredible because it was the first moment. And I would say, I would argue in the book that it is the first moment you see anything beyond the love of Kurtis. You see wiggle through the pain, which is there and the disbelief at the way people treated me, which is there. And the love of Kurtis. You see this other small strand named MoMA and she is small. She's only 10 pounds, full grown. And I start to love this dog.
And even now we have another dog, my husband and I. I had to call my mother and I said, I'm can’t remember, young dog's being this much work. I said, was MoMA this much work, like she's an angel. She's had never done anything wrong in her beautiful, lovely life. And my mother is like, yes, she was a nightmare. But she's like, you were offline. I don't remember it. Thank God my parents were there. I think this dog would have just starved. I don't even remember feeding her. I don't remember how we trained her because I think my parents truthfully really helped me. And MoMA is such a joy.
To your point about the people and their animals. I remember when I moved into this home a year after Kurtis had died, and I was. I'd never lived alone before. Never. And I was so alone in this house. And I would walk these empty, echoing rooms, and I would think about how I was so alone. And always because of the kind of breed that MoMA is. She’s Havanese, they have to be with you all times. I would get through half of that thought, and two seconds later I hear the sound of MoMA. It pushes back on the loneliness, the presence of dogs, but also of people, if we're willing to sit there. It does so much to alleviate that why of grief, which is that we're alone because we're not. There's so many people in pain.
And if we can, I'm going to actually, Joanne, co-opt that language. When people speak to me, if we can sit and stay with the people in pain, we do that same work for them and we just have to sit and stay with what they offer us. That's our work. And that is, of course the beautiful work of dogs, of which I am a huge fan. I have two.
Dr. Joanne Cacciatore: Doing this work for 30 years with people who have had catastrophic loss. Loneliness is one of the core, sort of emotional experiences of people.
Amy Lin: Absolutely.
Dr. Joanne Cacciatore: And what's really interesting is a lot of them talk about feeling lonely because other people turn away from them and avert their gaze. They, you know, in a metaphorical way, they they turn away.
Amy Lin: Sometimes literally. I've had people cross the street to avoid speaking to me.
Dr. Joanne Cacciatore: 100%. I hear those stories all the time. What's really interesting to me, going back to the prolonged grief disorder checklist, one of the items on the checklist is I feel lonely.
Amy Lin: Yeah.
Dr. Joanne Cacciatore: So if you answer yes to that, you have a higher likelihood of being diagnosed with prolonged grief disorder. And my point about that is why are we blaming grievers for the way society treats grievers? It's akin to blaming victims. And this is why I think we need more grief education out there. Because when we don't understand something that feels very scary as human beings, we tend to avoid it.
I certainly don't want to jump out of an airplane, even with a parachute, without proper training. And yet, even in graduate school, like even in social work, there's no requirement for social workers to get grief education. Which is mind blowing to me, considering social workers do the vast majority of counseling and therapy in America. And yet there's no mandate for this training.
So I think the whole way society is set up really puts grieving people and people who are in pain, deep emotional pain, at a significant disadvantage for being ostracized and further made to feel lonely.
Amy Lin: And I think in particular, it's important to note that when we speak about these communities that are often turning away, I think we're often speaking about communities that are not the queer community, communities that are not people of color, because you know, within black communities, within queer communities, within other you know, my father is Chinese, within Chinese cultural understandings, there are totally different ways of integrating the realities of death, of which are pervasive throughout experience into those lived experiences. So primarily, I often find the discomfort. It's a white discomfort. There's a cultural lack of framework that other cultures, that other groups of people, they have the framework. They have to have the framework, the realities of their lives, of their survival rely upon integrating grief into their lived experience. Because this is their lived experience.
Dr. Joanne Cacciatore: Yeah, yeah, yeah. And intergenerational too. Right, Amy?
Amy Lin: Intergenerational, exactly, precisely. And I think that's important to acknowledge that there are models where grief is woven in, where we can create systems of support for people, where they aren't experiencing that loneliness. But it is, it requires an entire systemic mind change and an opening of perspective and a welcoming of this full symphony of the emotional experience. And that's where I think, particularly in North America, at the educational level, at the governmental level, at the personal level, I see people struggle to remain expansive to what they can experience emotionally.
I often say to people, when you yourself limit the grief or the sorrow or the loss that you're feeling, when you reach for ways to compress it or control it, or even try to place that control on other people, you limit how much people can love you, and you limit how much you can offer others. And when you when you look away, you miss so much of what you can experience.
I live and I don't hide this, in incredible pain, but it seems inconceivable to me to live any other way. Because in any other way, where I limit or I try to control the sadness, I really feel that I limit, not only how much I can hold when other people share with me, but I also limit how much of Kurtis I can offer people.
That's what the book is about. It's about ensuring that what Kurtis offered me, this expansiveness and this doesn't come to me naturally. I'm a closed person. I'm a limited person in a lot of ways, and Kurtis offered me expansion, and when I offer it to myself, when I offer it to other people, I live in the legacy of what Kurtis allowed me to do, and I wish that we lived in it together. But it's an honor to learn how Kurtis loved me and to offer that to other people. And that is the abundance of “Here After.” I live in the richness that this book offers to me because people offered me their beloved, and it has made me more tender.
Dr. Joanne Cacciatore: That's really beautifully said. That is the gift curse of fully inhabited grief.
Amy Lin: Yes.
Dr. Joanne Cacciatore: Is that by choosing to live in a place of what I call fully inhabited grief, we live more honest lives. The bottom comes down. Yeah, the bottom drops out.
Amy Lin: Yep.
Dr. Joanne Cacciatore: But also the top blows open.
Amy Lin: Yes.
Dr. Joanne Cacciatore: And everything has more color and more texture and is more real. And I wouldn't have it any other way either. Amy, I'm right there with you.
Dr. Denise Millstine: This has been such a beautiful conversation, and I hear a call to action for more understanding and education around grief. And both of you have put books into the world that are easily accessible to people who want to deepen their knowledge, their understanding, and their ability to be empathic in traumatic grief. Those books are “Here After”by Amy Lin and “Bearing the Unbearable” by Dr. Joanne Cacciatore.
I want to thank you both for being here with me and having this honest conversation about this difficult topic.
Amy Lin: Thank you so much.
Dr. Joanne Cacciatore: Thank you.
Dr. Denise Millstine: “Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard-Pasque and our recording engineer is Rick Andresen.
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