The Imposition of Black Grief

— Prolonged grief is normal—and even necessary.

By Nneka M. Okona

When the pandemic dawned on our shores in early 2020, I neither panicked nor despaired. There was something eerily familiar about how quiet and still the world suddenly felt—how we were all living in a groundless, uncertain reality.

I’d had countless experiences with personal losses in recent years, so I knew how isolating grief could feel. Though this time, we were all sitting in a darkened room, the heaviness of loss wrapped around us like a cloak and bonding us together in more ways than one.

Over time, we’ve developed the language to describe this shared experience—collective grief. This mourning is neither an individual expression nor an experience, but can be felt as an entity that impacts a group of people all at once. For Black people, collective grief has a particular shape, feeling, and shade.

Three Black people embrace while overlooking the silver casket of Conrad Coleman Jr., which is sitting above the burial plot, adorned with flowers.
Friends and family attend Conrad Coleman Jr.’s burial service in Rye, New York. Early in the pandemic, Black Americans were not only disproportionately more likely to contract COVID-19, but also more likely to lose a family member or friend to the disease.

For Black people in the United States, grief and loss are intertwined with our very being. Our ancestors knew the trauma of loss intimately; many of us, myself included, are descendants of those enslaved. The institution of chattel slavery throughout this country—not just in the Southern states—depended upon breaking up families in order to use our Black bodies for labor. We lost so much then. Though we’re generations removed from it now, those losses remain within us, embedded in our consciousness and our psyche, lying dormant in our bodies.

As a result, Black people have experienced the pandemic differently, beginning with the fact that we were disproportionately impacted by this deadly virus. And we have grieved deeply as a result. I released my debut book, Self-Care for Grief, on Aug. 3, 2021. I began writing it in September 2020 when life still felt uncertain, but I wanted to give readers a soft place to land as they grieved. I wanted to remind people that they can grieve in their own way and that there aren’t any rules for how that should look. But that was hard to do knowing the state of the world outside my front door. The seasons were changing, which meant another spike in COVID-19 cases, hospitalizations, and deaths. The hope of a vaccine seemed like a pipe dream at best.

While official messaging encouraged everyone to continue being cautious, many Black people knew this to mean that, once again, we had to save ourselves. Misinformation was high. There wasn’t consistent or accurate reporting about how many people had contracted COVID-19. Guidance on how to protect ourselves—with masks, wiping down groceries, keeping a 6-foot distance—varied depending on the day. We had to bind together to get through, something Black people have always done. If we were going to survive, we needed to grieve, process, and make meaning of our losses. We inherently knew these things, even if many of us couldn’t recognize them at the time.

Grief requires tenderness. Demands it, even. As Black people, being rough or careless with our grief is more of the same indoctrination from Western culture and society. Trying to survive in this capitalistic society teaches us that we should not value stillness or rest. And racism always gives us a reason to be aggrieved and to fight for our humanity to be acknowledged and validated. Honoring our losses—and the grief that follows—means bowing to stillness. It then becomes necessary to have the courage to look at our grief and recognize it for what it is—not a nuisance to be gotten over as quickly as possible, but a force that will forever change us. Grief calls us to bend, to evolve, to integrate the losses that we’re reeling from.

Loss encompasses more than the death of a loved one. We may need to grieve former states of being, old routines, a neighborhood or city we moved away from, a dream we have outgrown or had to let go of, a sense of safety or inner peace, or the end of a relationship with someone who is still alive. The list is nearly as endless as the ways that we can honor our grief.

Marcia Howard, a community member and activist in Minneapolis, Minnesota, straightens mock tombstones in November 2022 in the Say Their Names Cemetery, an art installation that sits in a grassy park one block north of the George Floyd Memorial. Names visible on the tombstones include Philando Castile, George Floyd, Tank Blanding, and more.
Marcia Howard, a community member and activist in Minneapolis, Minnesota, straightens tombstones in November 2022 in the Say Their Names Cemetery, an art installation that sits one block north of the George Floyd memorial. The installation began with 100 names of Black lives cut short by police violence, and grew as the community requested more to add.

A Black Story of Grief

In modern times, there are new things to grieve. Rather than only hearing about the violence of white-supremacist police brutality on news stations or seeing it splattered on the front page of the newspaper each morning, we have the ability to witness it happening in real time via social media. We now have more awareness and more investment in taking a stand against racial injustice, but seeing these old wounds with even older origins so often, so graphically, comes at a cost.

The murder of George Floyd in Minneapolis on the evening of May 25, 2020, was a catalyst for the anger bubbling underneath the surface for most Black Americans to emerge with power and force. We were so tired of soldiering on even when little losses constantly surrounded us; of having to be OK with the unwarranted deaths of our brothers, sisters, cousins, aunts, uncles, mothers, and fathers. We were so tired that “tired” no longer sufficed; we needed another word to encapsulate the full breadth of all it means to hold, all it means to live as a Black person. We wanted to feel safe and to not fall prey to the potential lethality of driving while Black, walking while Black, eating while Black, traveling while Black.

We wanted Blackness in this country to stop equating to a death sentence.

Living with this knowledge is not only heavy but tortuous. It impacts mental health, the ability to build and maintain interpersonal relationships, holding onto employment and performing well. As much as one might think it’s possible to compartmentalize how structural and systemic racism affects Black people, that’s not the case. Robert T. Carter, professor emeritus of psychology and education at Teachers College of Columbia University, pioneered research on the relationship between racial trauma and mental health.

In a 2007 study, Carter found that, as a result of racial discrimination, Black people can develop racial trauma profound enough to be considered a psychological trauma comparable to PTSD, according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). “Racism can and does create damage to one’s psyche and personality in the same way that being subjected to community violence, being held captive, or being psychologically tortured can create emotional damage,” Carter writes.

Though Carter was one of the first to codify the mental health impacts of racism, five years earlier, psychiatrist and psychoanalyst Hugh F. Butts used the term “racial trauma” to ground further research, study, and understanding in the topic. In a 2002 article, Butts notes that “responses to racial discrimination by African-Americans are often not viewed as severe enough to indicate that these blacks may have post-traumatic stress disorder.”

PTSD from racial trauma can cause hypervigilance, depression, anxiety, and chronic stress, which forces our nervous systems to roar into overdrive.

And yet, more than two decades later, it’s reported that 71% of Black Americans experience some form of racial discrimination in their lives. This number seems low, especially considering how racial trauma actively changes us and the way we live. PTSD from racial trauma can cause hypervigilance, depression, anxiety, and chronic stress, which forces our nervous systems to roar into overdrive. New research from the University of Arizona takes this one step further. In a study published in April 2022, researchers Da’Mere T. Wilson and Mary-Frances O’Connor explored grief and bereavement implicit in the racial trauma Black people live with.

Wilson and O’Connor assert that solely associating grief with the loss of a loved one makes the definition “too narrow in scope.” Per the study, “This lack of representation, plus the prevalent universalist research framework in psychology, has led to a lack of understanding of how the specific contextual factors of living as a Black person, in a Western country like the United States, may differentially impact the experience of grief.” Like Carter, the two also research how grief and loss can catalyze political and social action. They illustrate that the racial trauma, grief, loss, and bereavement that follow are interconnected in an interdependent web.

So, how can we care for ourselves in a world that doesn’t recognize our pain and suffering—and doesn’t want us to be well?

A day after the hate crime and mass shooting at Tops Market, Latisha Rogers is comforted by the community and support of True Bethel Baptist Church in Buffalo, New York, on Sunday, May 15, 2022.
A day after the hate crime and mass shooting at Tops Market, Latisha Rogers is comforted by the community and support of True Bethel Baptist Church in Buffalo, New York, on Sunday, May 15, 2022. Rogers, a Tops assistant office manager, was not only present at the mass shooting, but she called 911 to report the gunman, only to be admonished by the operator for whispering.

How We Rebuild

Black Americans have created moving rituals to help us honor and process those losses. We are a communal people. The strength of the village, not just the heteronormative and very white nuclear family model, is what we lean upon.

When someone dies, Black Americans gather at funeral homes, at churches, at banquet halls. We gather in love. We cry, we eat, we honor their lives. Yet, during much of the pandemic, these beautiful grief rituals have been disrupted. Instead we had to grieve alone in our homes, isolated from our communities, behind a computer screen. Zoom funerals became the norm, shaky cell phones and iPads capturing our grief in unprecedented ways. Within the grief space, there are Black folks meeting the evolving needs of their communities. Breathworker and grief guide Naomi Edmondson lost her grandmother, whom she considered a mother figure, in 2019. “When I lost her, in a way I lost the center of my universe,” she says. “Then having to handle that loss with COVID and the grief surrounding the pandemic, there were so many layers of grief that I was dealing with.”

As a result, Edmondson created a virtual space called Black Folks Grieve as a safe container for both herself and others who look like her to discuss their losses and grief. Every Monday evening, she facilitates a sharing circle for anyone who signs up via her website. “Before I started the group, I was looking for places where I could be in and not only feel like my grief was validated, but I didn’t have to do this intense labor to explain myself,” she says. “The last thing you want to have to do is the work of trying to make someone understand where you’re coming from.”

Fellow grief guide Alica Forneret came into the grief space after unexpectedly losing her mother in October 2016. Submerged in grief, Forneret channeled all she was feeling into Instagram missives about every aspect of grief. She also began consulting with companies on bereavement policies designed to make it easier for employees to cope with grief in the workplace. “How people treat you and your pain, the processing of pain, and your vocalization of that pain, I have found is the most interesting to talk to people about,” Forneret says. “The difference between me showing up to work every day in June of last year and everyone else is very different. The way that we are supported and need care is very different too.”

Now, she sees her work evolving. She’s working on her first book and is building a nonprofit called Pause that will help Black people formalize (and, in some cases, professionalize) their grief work to support those who need it most. Edmondson and Forneret are part of a legion of Black people—many of them Black women—revolutionizing how grief can be tended to. There’s Oceana Sawyer, a former transition guide, who uses Patreon to offer conversations and grief circles about honoring death as a rite of passage. She went from talking about grief on an individual level, before summer 2020, to now talking about collective grief.

She says she started looking at Resmaa Menakem’s work on somatic abolitionism and applying it to grief. “That led me to a deep exploration around how bodies, specifically bodies of the African Diaspora, are metabolizing grief alongside all the other losses that we incur on a daily basis.” This newfound curiosity fueled an expansion of Sawyer’s offerings: In addition to the virtual death cafes she’s led for Black and Brown people, she’s also hosted joy-mapping workshops on Afrofuturism, womanism, the end of the world, and more.

In the realm of academia, Kami Fletcher, associate professor of American and African American history at Albright College, refers to herself as a death scholar. She found her way into death studies during graduate school when her chair told her about an opportunity to act as a researcher for Mount Auburn Cemetery, Baltimore’s oldest African American burial ground. She spent years researching and writing about Mount Auburn and says, “It helped me to learn a lot about cemeteries, the records [that] this space keeps, and what that means to people who are supposed to be invisible in history.”

“I don’t think I realized that folks were using death studies—death, dying, bereavement, and grief—to mobilize and organize in really interesting ways,” she says. In 2018, she co-founded the nonprofit Collective for Radical Death Studies with the implicit aim to decolonize death studies and radicalize death practice. Death work, the Collective’s website states, is anti-racism work. It provides resources and information on death studies, death practices, and deathways, such as the Radical Death Studies Canon, which spans topics ranging from queer death and capitalism to colonialism and genocide. “Our mission is to decolonize death studies, and for us [that] really means to decenter whiteness,” Fletcher says.

There’s also author and end-of-life caregiver Breeshia Wade, who recently penned Grieving While Black: An Antiracist Take on Oppression and Sorrow, about living with racial trauma. And Sundari Malcolm, who hosts the BIPOC Dinner Party, an organization created with the goal of bringing people around (virtual) tables to talk about grief. Of course, there are countless others. The wide-ranging approaches to facing our grief and sitting with it, according to Forneret, is truly something to behold. It’s also something that gives her hope. “The diversity of people doing this work, the different ways they approach their work, and the complexities are so different and deep,” Forneret says. “It feels so rooted. And that’s why I want to support the people in our community.”

Complete Article HERE!

Why Prolonged Grief Shouldn’t Be Considered a Mental Illness

—Especially During a Pandemic

By Stefanie Lyn Kaufman-Mthimkhulu

It is August 2018. We are at a cemetery in New Jersey where some of my ancestors are buried. My father finds his parent’s grave, and places two stones on an ever-growing pile of rocks. I never met them in this life. When I place my stones, I am thinking about how sickness and weakened immune systems embeded themselves in the genes of Jewish people, Black people, and other descendents of genocide and trauma. I think about showing up in the mental health system as a kid—mainly due to the consequences of unmitigated trauma and distress—and being told there was something wrong with me.

As we shift to my aunt’s grave, I watch as my father prepares to recite the mourner’s Kaddish—the prayer for the dead. He does not need to read from a book. He has been reciting these words for 45 years. These are the words that formed the backbone of how he marks time: one more year with his parents gone.

My father holds his hand over his sister’s name on her stone, and sobs as he recites the words. In this moment, I am proud of my father, and yet I have never been more devastated. In this moment, I understand exactly why grief hugged him like a tight blanket and never let him go. In this moment, I am angry for the ways his grief stole time, energy, and attention from me and from my family. In this moment, I see the trauma like an umbilical cord, a blood-red string from his belly to mine. I imagine myself severing this stranglehold of trauma that has us both sinking in the same boat, drowning in the same sea. I love you, Dad. I want healing for you. I want healing for me, too.

In a culture that so often defines mental health by our ability to produce, function, work, minimally impact others, and appear as “normal” as possible, however, there is no space for grief. This makes the addition of prolonged grief disorder to the newly updated DSM, short for the Diagnostic and Statistical Manual of Mental Disorders (aka the “bible of psychiatry”), even more disturbing and misguided.

Many of us have been conditioned to believe that a mental illness is just like diabetes—a disease that needs to be managed and treated with medication. But my lived experience, my work in the mental health and disability justice world for over a decade, the wisdom of my community members, and research paints a different picture: Social, political, and economic factors are critical in getting at the root of mental distress and suffering.

When we think of the myriad of ways marginalized people are denied dignity, humanity, and justice—how long is the “right” amount of time to grieve? Not one loss, but many? Generations? Thousands? Millions? In one way, I imagine it, grief that doesn’t go away is a justified response in a world that doesn’t allow us to stop, to rest, or be present. Prolonged grief, like madness, is an act of resistance.

Getting to the root cause of grief

To say that we are ill if we cannot get up and get on with life in the face of a neverending onslaught of trauma, oppression, loss, distress, and chaos is deeply misguided. Even a trauma-informed shift from “what is wrong with you”to“what has happened to you” doesn’t feel right. It doesn’t feel complete enough because this is not just about me.

Grief that doesn’t go away is a justified response in a world that doesn’t allow us to stop, to rest, or be present.

I need to ask bigger and deeper questions that get at my roots: What happened to my family? Who were they before capitalism, colonialism, and the invention of whiteness (the greatest sources of distress, suffering, and grief on Earth)? Who did they become becauseof this violence? What have I (and my soul) lost while upholding these same values? My grief work and healing work lives here. It is ancestral work. For me, my healing will not be found in a therapist’s chair. I know I need to start with my family.

I was a senior in college when my aunt died suddenly and unexpectedly. In many ways, her death led me back home—to my Judaism, to (one of) my culture(s), and to my ancestral practices. Her funeral was handled in an Orthodox fashion, and for seven days, we sat shiva. I learned that my people know grief. They knew grief deeply. So deeply that there is an entire process laid out for our mourning. We do not cook or clean. Instead, we receive. We sit, talk, listen, laugh, and eat. We sing our songs and read our prayers. Divesting from the individualistic values that white supremacy enforces allowed me to lean into the magic of rituals and my community. It gave me a container for my mourning as a lifelong process that I did not have to navigate alone.

I did not put my grief down. We dance with each other, early in the morning and late at night, and it isn’t always pretty. I hear my aunt’s voice in my head, and I talk to her all of the time. I bring her into every room I can and I see her in my dreams. If I am psychotic, I am glad to be because we love each other, still. We know each other, still. When I told my partner, Thabiso Mthimkhulu, (who is a brilliant Afro-Indigenous ancestral healer) about this new diagnosis, he laughed and said, “Grief is a ritual we have the honor of engaging in with ancestors that walk alongside us. It is not something to bury, like we do with the flesh and bones our souls are protected by.”

My issue is with an institution, a medical establishment, that believes and upholds the myth that six months is “the correct timeline” for grieving.

Make no mistake: I want us all to heal. I want us all to have access to what we need (whether that is therapy, a somatic healer, pills, herbs, time away from your life, childcare, more money, etc.). If this label, prolonged grief disorder, allows you to access something that brings you comfort, or ease, or relief (and if you made an informed choice), then use the tools you have access to. My issue does not exist here.

My issue is with an institution, a medical establishment, that believes and upholds the myth that six months is “the correct timeline” for grieving, which is the metric the DSM uses to determine what constitutes prolonged grieving. An institution that would rather dig its heels into apathology-based understanding of mental distress, than ask itself why we even need diagnostic codes to get care and support in the first place? My issue is with a country that sees no irony in medicalizing grief when millions of people all over the world have died alone, away from loved ones, in cages, cells, and hospital beds; in corners and on floors (or if they’re lucky), with loved ones saying goodbye through an iPad.

During the pandemic, families and communities have been unable to engage in cultural or religious grief and mourning practices, including funeral and burial practices that have deep ancestral and spiritual meaning. These wounds of the spirit and soul will have profound impacts on us, including prolonged mental distress or grief that doesn’t go away in six months. Why should it? Grief is sacred. Grief is an honor.

When we have the space to grieve

What becomes possible when we have the space to grieve? What rituals and practices can we tap into to sustain our spirits? Poet Malkia Devich Cyril describes grief as “every response to loss.”

When my maternal grandmother was dying, I sat sifting through her photo albums, making collages, smelling her sweaters, trying on her skirts, and immersing myself in her world. I painted her a birdhouse using her brushes and supplies, just like she had painted birdhouses. I placed it on the window sill of her hospice bedroom (the place she took her last breath in), and hung one of her paintings on the wall. Now, her art fills the walls of my home and lives on my left arm as a tattoo. Her clothes fill my closet. Her Josephine necklace sits on my neck. The small memories, items, movements and moments—this is how I process. It is how I make sense and remember. Because if I don’t, I worry what I will pass down to my daughter. Grief will demand to make its presence known. It will find somewhere to live, and I don’t want it to be inside of her.

These days, I have the honor to work with healers, herbalists, bodyworkers, and care workers who are justice-oriented, and hold space for the full range of what I hold in my bodymind without requiring a diagnosis or label. They know that healing has no timeline, and let me lead the way. Five years later my grief is a palpable heartbeat that courses through me. Let me have it. Let me die with it. My grief tells me I loved. I lived. I had.

Complete Article HERE!

The US Civil War drastically reshaped how Americans deal with death

– Will the pandemic?

An art installation by Suzanne Brennan Firstenberg in remembrance of Americans who have died of COVID-19, near the Washington Monument in Washington, D.C.


More than 1 million people living in the United States have died of COVID-19 during the past two years.

The numbers paint a clear picture of devastation, though they can’t capture the individual and familial pain of losing loved ones – which will no doubt transform many more millions of Americans’ lives.

The impact of this mass death on American society as a whole is less clear, especially since the pandemic is not over. While there have been a few moments of public remembrance – 700,000 white flags placed on the National Mall, and President Joe Biden’s brief words noting the “one million empty chairs around the dinner table” – the country is only beginning to grapple with the shared grief of so many deaths.

Instead, there is public discord surrounding those who died. In a country divided over basic facts about the virus, deaths have been exploited for political purposes, or wrapped into conspiracy theories.

As a scholar of religion who has studied the history of death in America, I am quite preoccupied with how the country makes sense of, honors and remembers the COVID-19 dead. The magnitude of death today immediately brings to my mind the event that killed the second-highest number of Americans: the Civil War.

My first book, “The Sacred Remains,” looked at the conflict’s impact on Americans’ attitudes toward death, during another period of extreme division and overwhelming loss of life.

Preserving the dead

Roughly 750,000 people died in the Civil War, or 2.5% of the country’s population at the time – the equivalent of 7 million Americans dying today.

The unprecedented death toll had profound consequences on American cultures of death for generations, particularly through the emergence of the funeral industry.

Throughout the 19th century, most Americans died, and had their bodies tended to, at home. Last moments with the corpse were with loved ones, who were responsible for washing and preparing it for the final rituals before burial, generally in local churchyards.

But the Civil War provided an opportunity for a game-changing development. Embalming was an innovative method of preserving bodies that allowed some Northern families to have their war dead retrieved from the mostly Southern battlefields and brought back to be buried in Northern soil.

The display of President Abraham Lincoln’s embalmed body after his assassination was a pivotal moment in this transformation. His corpse was transported on a train from Washington, D.C., to Springfield, Illinois, with frequent stops in many Northern cities where it was put on display for grieving Americans.

A black and white illustration shows a line of people paying respects at a funeral.
A drawing depicts Americans viewing Abraham Lincoln’s body at City Hall in New York City in 1865.

As embalming became more common, it helped legitimize a new class of professional experts: funeral directors, whose homes became a mix of business, mortality, religion and their own domestic life. By the early 20th century, this new business had established a fairly standard American way of death, centered on the viewing of an embalmed body to bring a community together.

Americans’ relationship to their dead would never be the same. The intimacies the living had with the dead before the Civil War gradually disappeared, as funeral homes managed the care of more and more bodies.


One of my intellectual heroes, sociologist Robert Hertz, wrote a famous essay about death and society in 1907. He argued that social groups represent themselves as immortal, capable of overcoming the death of any member. The community’s survival depends greatly on transcending death, so it transforms the dead into sacred symbols of group identity and social cohesion.

Hertz’s studies focused on death in small societies in Borneo. Yet his exploration of the relationship between the death of the individual and the life of the social group is pertinent now, in the context of the pandemic – as it was in the aftermath of the Civil War.

The victorious Union turned dead soldiers into symbols of the nation. Their deaths were seen as sacred sacrifices to preserve the country. For religion scholars, this is a clear example of American civil religion. In the U.S., civil religion is a patriotic culture that sees America as a sacred, exceptional country, built on shared ideals, myths and traditions.

But the Northern victors did not “control the narrative,” as we say these days. Indeed, a very striking and still-present counternarrative soon developed among the vanquished Confederates after the war. The losers built an alternative civil religious culture, what historians refer to as “the religion of the Lost Cause.”

Women in white dresses and skirts stand in front of a war monument in a black and white photograph.
Daughters of the Confederacy unveil the ‘Southern Cross’ monument at Arlington, Va., in 1917.

For many white Southerners, the battlefield dead did not signal God had abandoned their cause but rather illuminated his support for values associated with the Confederacy – values the United States is still grappling with today. They saw the loss as a temporary setback, but believed that ultimate victory would come if they maintained some form of Southern cultural purity based on notions of racial, regional and religious superiority.

Looking ahead

The politicization of death is not uncommon in American history, particularly during times of profound social crisis. And since the start of the pandemic, the same has happened with COVID-19 victims.

Death during a pandemic is obviously different from death during a civil war. In both cases, however, it is difficult for a divided country to experience unity in the face of an enormous loss of life and to agree on what those deaths mean for the nation.

Unique aspects of the pandemic make national mourning, and united healing, even more complicated. For example, the virus has not taken an equal toll across the country. The death toll shows significant disparities among different economic and racial groups. And the need to prevent contagion has intensified the physical separation between the living and the dead, making some meaningful rites of mourning difficult or impossible.

Many communities have made efforts to commemorate the pain of the pandemic, such as through Dia de los Muertos, a Mexican holiday honoring those who have died. But there have been minimal efforts to help make sense of the deaths on a national level: to rally around a compelling public narrative about the tremendous loss of life and grief. It remains to be seen if Americans will eventually incorporate the losses into a unifying civil religion, or only use them to reinforce polarization.

One million dead and counting will certainly require more efforts, more reflection and more soul-searching to help American society overcome and indeed draw strength from this unimaginable number.

Complete Article HERE!

Coming to terms with a patient death

By Ben Pilkington

Death, of course, is a part of life for everybody. And for doctors, death comes with the territory of being a healer. Despite enduring more exposure to death than most, physicians still experience strong and lasting emotional reactions to it, including intense feelings about their own professional responsibility and competence.

COVID-19 brought this burden on doctors and other healthcare workers into sharp focus. Healthcare workers are dealing with mass mortality at a time when patients need more help than ever, but fewer resources are available to treat them.

This article examines how patients’ deaths affect their physicians, and how deaths from once-in-a-generation catastrophes like COVID-19 have complicated these encounters. We look at the stigma surrounding doctors and their emotions, and how such attitudes jeopardize healthy coping. Finally, we explore strategies that doctors can use to deal with patient death.

How do patient deaths affect physicians?

Even the most experienced physicians can have difficulty coping when a patient dies. Despite this—and despite the fact that physicians are confronted with death more than the average person—there is scant research examining how exposure to death affects them.

Available literature suggests that more exposure to patient death is strongly linked with more work-related stress, according to an article published in BMC Medical Education. Stress caused by the death of a patient at work can lead to burnout, which data suggests affects nearly half of all doctors treating terminally ill patients. To make matters worse, a high level of stress negatively impacts the quality of patient care, note the authors of a study published in BMJ Supportive and Palliative Care.

Sometimes, doctors feel the effects of a patient’s death long after it occurs. Feelings of numbness, guilt, and stress after a patient dies are common in the short term, but when surveyed, 61% of physicians reported that the most memorable patient death they witnessed continued to be a source of emotional distress for them in the long term, noted the BMC authors.

Patient deaths in the emergency department (ED) can be especially tough for doctors to deal with. There is typically no established patient-doctor relationship and death can occur suddenly, even in young and otherwise healthy patients, leading to more distress and emotional trauma for the healthcare workers tasked with preventing death from occurring, the authors added.

This takes its toll. According to a survey cited in the BMC article, 28% of ED doctors have considered quitting and 32% have thought about changing professions.

COVID-19 made it harder to cope with patient deaths

Dealing with medical emergencies means ED doctors are typically exposed to more sudden deaths than other physicians. But with the outbreak of COVID-19, doctors were confronted with unprecedented levels of patient death alongside increased demand for healthcare services, fewer resources per patient, and less time to do their jobs.

Together, these stressors are sometimes referred to as “cumulative grief,” a phenomenon that data from the US Department of Health and Human Services (HSS) suggests negatively impacts physicians’ health and the care they provide.

“Under normal circumstances, healthcare workers have more time to grieve and manage stress following the death of a patient. With increased deaths, the behavioral health impact of grief and the risk of burnout increase. This can result in compassion fatigue, low morale, exhaustion, burnout, and errors that could harm patient care,” according to the HHS report. You can read more about compassion fatigue and burnout here.

Systemic attitudes toward physician grief

Physicians recognize the need to help a patient’s bereaved family members and friends cope with death—breaking bad news is part of the job. But there is no standard advice for physicians who need that same support.

Traditional medical culture hasn’t looked kindly upon doctors’ emotional responses to death, notes psychologist, speaker, and author Elaine Kasket of London Metropolitan University, in a blogpost with BoardVitals.

“It is socially ingrained through medical school, and the cultures in both the UK and US medical establishments see a physician’s emotional response to death as a sign of weakness and even incompetence,” she said. “It feeds into this popular image of the physician as some kind of superhuman ultimate rescuer of human life; unable to do his or her job if they give in to or even acknowledge their emotions.”

Confronting this issue requires a fundamental change in the medical community’s perspective and policy. “There needs to be a sea change in medical culture to make support available,” she said, “and for it not to be stigmatized, to help physicians cope with grief, depression, despair or sadness.”

Strategies for coping with patient death

Out of necessity, and often in the place of a glaring absence of strategies in their training, physicians often develop their own ways of coping with their patients’ deaths. Sometimes, these coping mechanisms are unhealthy, such as when a doctor dons a morbid sense of humor (although some researchers maintain humor is healthy), tries to become numb to death, or externalizes the problem, as with alcohol abuse or overeating, according to the BoardVitals blogpost. Click here to read more about the drinking habits of doctors and the pandemic.

According to an article published in the Journal of Graduate Medical Education, oncologists at Memorial Sloan Kettering Cancer Center in NYC responded to the dearth of resources for physicians coping with death by introducing their own method, known as “Patient Death Debriefing Sessions.” Introducing these short sessions gave resident oncologists and other members of the treatment team a practical way to address their emotional needs after a patient died.

Patient death debriefing sessions were less than 10 minutes long, held within 24 to 28 hours of the death, consistently held after each patient death, and led by the attending physician. The sessions focused on residents’ emotional reactions to patient deaths, guided by a pocket card tool.

Memorial Sloan Kettering residents reported finding these sessions to be helpful and educational.

There is no shortage of techniques available—including yoga, mindfulness, exercise, and healthy hobbies—to help physicians relieve some of the stress and personal grief they feel when a patient dies. Read about some of those techniques here. And, of course, any physician needing support can lean on family members and friends, reach out to a counselor, and/or find a grief support group.

Just as important, however, is that doctors must give themselves permission to grieve—and society and the medical establishment can help take pressure off physicians by realizing they may need to grieve in the face of death, like any other human being.

Complete Article HERE!

A New Take on Death and Dying

In “The Future of the Corpse,” co-editors Karla Rothstein and Christina Staudt review the spectrum of death and offer ideas for change.

Christina Staudt, left, and Karla Rothstein are co-editors of “The Future of the Corpse.”

By Eve Glasberg

Around the globe, roughly 165,000 people die every day. The Neanderthals were the first human species to bury their dead, entombing them with stone tools, animal bones, and other artifacts in shallow graves.

The Future of the Corpse: Changing Ecologies of Death and Disposition, edited by architect and GSAPP Professor Karla Rothstein, founder and director of the GSAPP DeathLAB, and Christina Staudt, co-chair of the Columbia University Seminar on Death, reviews the spectrum of death.

American society today is in a pivotal period for reimagining end-of-life care, funerary services, human disposition methods, memorializing, and mourning. The book’s editors and contributors outline the past, present, and future of death care rituals, pointing to promising new practices and projects that better integrate the dying and dead with the living, and create positive change that supports sustainable stewardship of the environment.

Rothstein and Staudt discuss the book with Columbia News, as well as what it was like to collaborate on the volume, and who they would invite to a joint party.

Q. What was the impetus behind this book?

Karla Rothstein: After discovering my graduate architectural design studio syllabi online a decade ago, Christina invited me to present to and then join the University Seminar on Death. In 2016 the seminar and GSAPP DeathLAB jointly organized a daylong colloquium—Designing for Life and Death—which brought academics and industry stakeholders together to probe New York City’s relationship with death, corpse disposition, and the potential for new forms and civic-sacred space. This book contains chapters by many of the colloquium’s interdisciplinary panelists, sharing their expertise on the complex and evolving aspects of dying, death, and remembrance.

Christina Staudt: The colloquium produced so many substantive and thoughtful ideas that we felt compelled to bring the content to a larger audience in a comprehensive volume on postmortem issues.

Q. What are some of the innovative projects and practices in the book that better integrate the dying and dead with the living, and create positive change supporting sustainable stewardship of the environment?

KR: Many cemeteries across the globe are facing dire limits on burial space. Cemeteries are cultural assets and provide crucial open space in dense cities, but the American expectation of a burial plot in perpetuity for each individual is at odds with the density and spatial limits of urbanity. The resource consumption of prevailing casketing and cremation practices are also considered wasteful by those prioritizing ecological impact.

Cemeteries can serve their current communities through new, sustainable forms of corpse disposition that engage the body biologically, and contribute to enduring civic-sacred spaces supporting grief and remembrance. We and others are developing mortuary options that are gentle on the earth while also remaining proximate to where we live.

CS: A growing rejection of embalmment and resource-intensive coffins among environmentally conscious families parallels a movement toward direct disposition—i.e., the body is moved from the deathbed directly to the burial site. More time is spent with the deceased at the site of death—where the family washes and cares for the body—rather than having the corpse whisked away to a funeral home. Individualized rituals and services that reflect the character of the deceased, often planned in advance with family and loved ones, occur by the deathbed and the place of final disposition. Advocates of green burial are leading the way.

Q. How has COVID accelerated and highlighted the need to address the changing death-care landscape?

KR: Never before in our lifetimes has death been so present. Society has a desperate need for spaces of healing—from the traumas of COVID, as well as other forms of grief and grievances, including confronting and repairing racial, environmental, and economic injustices. Civil and dignified contexts are crucial to societal care. A sense of community and ritual are important scaffolds around life’s transitions, and we need options and practices commensurate with current individual values and planetary priorities. Relative to just a decade ago, the public interest and willingness to engage in discussions of death and disposition are truly remarkable.

CS: The sheer volume of pandemic fatalities alone would have forced healthcare industries and the funerary complex (funeral directors, crematories, and cemeteries) to retool their practices, but the necessity to isolate because of COVID has been a stronger impetus to change. Telemedicine, deathbed goodbyes on Facebook, Zoom funeral planning, livestreaming and recording of funerary services, and online memorializing have all advanced exponentially, and are here to stay.

The social inequities of the pandemic, with much higher death rates for the poor and minorities, has added urgency to our need to address systemic change.

Q. What was it like to produce a book together?

KR: We both have high standards, and we’ve earned each other’s trust and respect. We have different styles: We’re both pragmatic idealists, but Christina is perhaps more straightforward, and I sometimes tend toward the poetic. We complement one another well.

CS: The collaborative process was pleasantly smooth. Karla and I hardly ever disagreed. Rather than feeling I was compromising my position in discussions about the book, I found that our dialogues gave me new insights and expanded perspectives.

Q. Have you read any books lately that you would recommend, and why?

CS: In Notes on Grief, Chimamanda Ngozi Adichie shares her experience after the death of her father during the pandemic. She allows her pain and reactions to emerge on the page with compelling power. Her suffering, questioning, search for meaning, and desire to honor her deceased father touch on themes common in bereavement—the bodily sensation of grief, the failure and support of rituals, the need for time and space alone and for community. Her dual project of memorializing and finding a way to live with grief is a gift to the reader.

KR: I would add Elizabeth Kolbert’s recently published Under a White Sky. I haven’t read it yet, but it’s a continuation of her excellent research and writing on the impacts we humans have wrought on the planet, and I reference her earlier The Sixth Extinction regularly. Taking responsibility for the consequences connected to our actions is a timeless ethical imperative.

Q. You’re both hosting a dinner party. Which three academics or scholars, dead or alive, would you invite, and why?

CS: With no restrictions to the invitation list, I will aim high: It would be a treat to reunite the Dalai Lama and Archbishop Desmond Tutu, so they can continue their charming lunch banter, recounted in their The Book of Joy— Lasting Happiness in a Changing World. As a foil to these two “mischievous” (as they describe themselves in the book), male faith leaders, I will invite a female atheist who can match their wit, perhaps the Barnard graduate Zora Neale Hurston, or maybe the early women’s rights leader, Ernestine Rose, said to possess “a rare sense of humor.”

We may end up touching on postmortem issues directly, but no matter where the talk leads, mortality remains foundational to human life and is never fully absent.

KR: My days are overflowing with teaching, research, and the building projects of my architecture practice, so I would be thrilled to participate in this exceptional evening!

Complete Article HERE!

How the Absence of a Funeral Makes Death So Much Harder For the Living

Olivia Claire Friedman on Trying to Mourn Without Ritual

Rippingille, Edward Villiers; The Funeral Procession of William Canynge (c.1399-1474), to St Mary Redcliffe, Bristol, 1474

By Olivia Clare Friedman

In January 2021, I lost one of my very favorite people. Frances was seventy years old when she died. Her death wasn’t COVID-related. I’d known her since I was twelve. She was in her thirties then. She was divorced—had been for years, her ex-husband lived in another state, I never met him. And she had no children. I was the closest thing to her child. I was her daughter, she said.

Because of the pandemic, her funeral was put off. I’d just turned in a draft of my novel Here Lies, set in a dystopian future in which the government cremates the bodies of the deceased and then keeps the ashes. A young woman named Alma tries to re-claim the ashes of her mother. All the while, Alma must find her way through grief and mourning.

Just after I’d finished the novel, Frances was gone. I found myself inside the cloud of grief, trying to sort through it and finding no answers. I became a mourner-in-waiting. For Frances, we had no funeral. Family members didn’t want to risk a gathering, and I knew, in pandemic times, this was the right approach. Frances wished to be cremated, and so she was. When the time is right, we’ll have a celebration of life, a friend of Frances’s said. Maybe something on a boat. We’ll scatter her ashes. Since then, we haven’t made plans.

My mourning feels suspended in time. Something inside me is holding its breath.

I found myself inside the cloud of grief, trying to sort through it and finding no answers.When I cried for Frances, I cried by myself. I didn’t want to upset my baby or my husband, so I shut the door to our bedroom and wept. But my husband understood. He lost his father to cancer ten years ago. He says he felt like his life broke in half. There was everything before his father’s death, and everything after.

Even though I’d closed the door, my baby could hear me crying. My husband said she asked for me, pointed to the door. Later, when I thought I was done crying, I’d go and do something else, like prepare for teaching or take care of laundry, and the grief would circle back, coming up all over again. That is the difficult part, when the grief returns without a warning. Grief that bubbles months later, years later—that’s the grief that lands a surprise blow.

My sadness has no order. It can be hard to see a trajectory, a way out, just as it has been hard to see a trajectory to the virus, a real sense of an ending. Of course, in writing, we try to find an arc, a shape to things. Right now, Frances’s death hasn’t had a shape. She was here, and she is gone, and there hasn’t been a funeral or ritual to mourn her.

In the middle of the pandemic, this was a heartshatteringly common story—deaths and no ritual to mourn. I wonder too about others who have felt relief. Not everyone wants a ritual for their grieving. Some won’t want to mourn at all, or they won’t want to go to a funeral, maybe because they were estranged from the deceased, or they don’t want to travel, or they’re too raw-hearted, or just ambivalent. There are those stories too.

My mourning feels suspended in time. Something inside me is holding its breath.The decision about what happens to our bodies after death is one of the most personal choices we make. Traditional burial, cremation, a green or natural burial…we choose. It’s a choice that might be rooted in family wishes, religious expectations, cultural traditions, personal preference, or all of these. Still, we choose. We can also not choose. Even the decision to choose—that decision is ours.

We already know that rituals of mourning are part of the heart of most cultures and traditions. I think about luxurious rituals, brimming with people and songs. I think of opulent funerals and horse-drawn carriages and the blasts of trumpets. I think of the Terracotta Army, a massive assembly of terracotta sculptures of thousands of soldiers, chariots, and horses buried in the tomb of Qin Shi Huang, the first Emperor of China. I think of the many sounds of New Orleans’ “funerals with music,” what were called jazz funerals, and second lines. I think of photos I’ve seen of massive funeral pyres. Of long processions of cars I’ve driven by on local roads, or images of funeral crowds overwhelming cathedrals, people pouring out of the doors.

There is also quiet mourning, silent mourning. During some periods in British culture, the length of mourning was expected to be nine months. Wearing all black, of course, visibly signaled your mourning state to everyone around you. Nine months—the period of gestation! And I think of Dickens’ Oliver Twist going to live with the undertaker. Oliver has “an expression of melancholy in his face,” the undertaker says, so he decides Oliver would make “a delightful mute,” staying silent and wearing all black, walking alongside the coffin at children’s funerals.

I think about solo mourning. Recently, I was discussing the subject of funeral rites with a friend, and he brought up Antigone. Antigone is the Greek mythological figure, the daughter of Oedipus, whose story concerns the burial of her brother. Because of the nature of her brother’s death, his burial is punishable by death, King Creon says. Even mourning him is punishable by death. But Antigone can’t abide this. She still buries her brother on her own.

The decision about what happens to our bodies after death is one of the most personal choices we make.Even with a ritual to mourn Frances, a part of me would always feel suspended, like I was holding something in. But a funeral, a celebration of life, can give mourning a location, its own spot on the map of grief.

Grieving can make you feel selfish and ridiculous and angsty and tangled. One loss summons previous loss. With Frances’ death, a string was pulled. My grief brought up past deaths. I thought of the deaths of my grandmothers, great and great-great, from years back. One died of cancer, another grandmother died of natural causes. All of the grieving gets knotted together.

Frances’s obituary was longer than other obituaries I’ve read. The act of reading it was a kind of ritual, because it captured her so well, the experience of knowing her. She loved animals close to the way she loved people. She was one of the most generous souls you ever met, and she was also very candid and keen. She lived with an illness almost all her life. She lost her parents at a young age. At the end of the obituary were the names of loved ones, family and friends, in Frances’s life. And seeing that, everyone’s names together, made me feel like we were all standing there, physically somehow, in print but side by side. In ink—and I do believe in the power of ink—we had a kind of ritual mourning for Frances.

I have my own rituals to mourn her. They’re simple, seemingly small, but to me they’re not small at all. I look out the window more than I used to. I look at the sky more than I used to. Are these rituals? Yes, I’ll call them that. And if I wanted to, I know I could have my own made-up ritual. I could light a candle and sing. I’m not sure what the words would be. My crying too is mourning, a ritual of mourning. Going outside in my yard by myself to cry or just to think alone—yes, I’m coming to understand, all this is a ritual too.

A funeral, a celebration of life, can give mourning a location, its own spot on the map of grief.In February, one month after Frances’s death, a small gray cat started coming to our door. This was significant—Frances had adopted many cats, maybe thirty-something. She stopped counting; she was embarrassed; her house was overrun. As soon as you walked in through her front door, you’d smell cat pee. She had cat beds in rows on top of her own bed. One time I saw a tomcat pee on an electric socket, and the whole thing started sparking.

So this little striped gray cat kept coming around our door, and of course my husband and I fed her, and of course she wouldn’t leave.

I waited to name her, because I knew when I did, that’d be it. And anyway, when I did start to think of names, it was torturous to find the right one. How about Lady Grey? “No, not that,” my British mother-in-law said. Other ideas were the names I’d wished I had when I was a kid—Fiona, Michelle, Serena. I thought about her face, her expression and eyes. I’d try out one name, and then I’d scratch that and decide to start over. We left her nameless for months. Then one day, I went all in. I finally decided on a name.

Annie is wild and scrappy. Her tail is three-quarters gone. She leaves mushed-up mice and lizards on our welcome mat, dead voles with pink claws in the air. These are her gifts. She’s been with us for months. We’re used to her now, but I’m not used to Frances gone, and sometimes I have to remind myself: She’s not here. I don’t know if we’ll gather with her ashes, but here comes the gray cat when I open the front door, ready for breakfast. Here she is—rolling in dirt, sniffing the air.

Complete Article HERE!

I look at death every day – let’s change the way we talk about it


As a forensic pathologist, the dead of all ages, shapes and sizes have been the focus of my career. Numerous times a day, for the past 40 years, I have looked closely and directly at death, knowing that, for many – probably most – of the people I examine, the start of their final day had been completely normal. Death had come swiftly and unexpectedly. So, as I dress each morning, I often wonder where I will be at the end of my day. At home? Or in a mortuary, being slid into a fridge on a shiny tray?

In medical circles, we had been expecting a global pandemic for several decades. The HIV/Aids pandemic of the 80s was a sombre milestone, resulting in about 36 million deaths worldwide, but I never anticipated that the first pandemic of the 21st century would develop from a virus in China. I had expected it to come from a lethal reorganisation of the DNA of the influenza virus – as happened in 1918, when “Spanish” flu killed at least 50 million people worldwide, and in the subsequent, less lethal, influenza pandemics: 2 million died in the 1957 flu pandemic and 1 million each in 1968 and 1977. The last notable flu pandemic was swine flu, in 2009, which resulted in about 500,000 deaths. A serious influenza pandemic is about 50 years overdue.

Death had become a subject to be avoided or glossed over. Our lack of experience often meant it felt overwhelming

I know that I am unusual in having had such a longstanding personal insight into death and the fundamentally precarious nature of our lives. Many of us have never seen a dead body, even of a close relative. In our westernised, urban society, the tradition of paying your respects to the body in an open coffin in the parlour is now rare. This offered the opportunity to recognise the normality of death: to look it in the face; to consider your responses; to remember your own impermanence

By the start of this century, it seemed to me that death had become a subject generally to be avoided, glossed over, obfuscated and (if at all possible) simply ignored, at least until one was faced with it personally. Now, the lack of this experience often means it feels overwhelming.

Before Covid, I noticed how our language was becoming increasingly euphemistic. The noun is “death”, the verb is “die”, but these words were seldom heard. Dying had become “passing” – and the focus was usually on “easing that passing”, to sanitise and smooth it and manage death in a way that diverted distress. I felt I was seeing a significant disconnect develop between the profound, human process of grieving, with its incumbent pain, stress and sadness, and the emollient aims of the death industry. It was a disconnect that was welcomed by so many.

The pandemic challenged this approach in almost every respect. Suddenly, death and the consequences of death were the focus, day after day, of every news report. The facts were raw and painful, the words stark. The noun was “death”, the verb was “die”. These people had not “passed”. Covid, I hate your harvest, but I thank you for rewilding such endangered language.

As the pandemic continued, interviews with families became the modern equivalent of the wake beside the coffin in the parlour. Where once there was little or no desire to see the body after death, now the denial of contact, at the end of life and afterwards, was traumatizing.

I hope one positive to come out of our new reality is a change in society’s approach to death. It is still too early to tell – and perhaps I never will be able to tell, since I am inside the taboo, looking out. But, from my perspective, I would say that a new willingness to engage with death would be a healthy change.

I have been lucky. Few of my close family have contracted Covid; none have died from it or even been hospitalized. However, during the course of the pandemic, three of my friends have died: two from natural disease – one suddenly, one slowly and painfully – and one from an accident. Covid has killed many, but, even in the depths of a pandemic, I was reminded that people continue to die of other causes – and that these causes also kill millions.

Let us face up to the inescapable fact that humans die. Until then, life is for living.

Complete Article HERE!