State of Mind

I’m a Psychologist. After My Brother’s Suicide, I Realized I Had Completely Misunderstood Grief.

A man hangs by his knees from the flying trapeze.
Photo illustration by Slate. Photo by Getty Images Plus.

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Dad’s prognosis wasn’t good. Sitting vigil beside his hospice bed, my family and I watched the cancer take over. As my dad became sicker, my brother Dave got sicker, too. His depression and alcohol addiction worsened; he moved in and out of treatment. He mysteriously deteriorated alongside my dad.

When Dad died, Dave’s mental illness turned fatal. My little brother died by suicide, six months to the day after we lost our dad.

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I knew Dave was gone when I saw the series of missed calls from my mom. I knew before she spoke. I fell to the ground, my body overcome by memories of Dave as a child on the slide at the park, in his punk phase with dyed hair. I felt dizzy, trapped on a demented carnival ride. When I regained the ability to stand, I turned the full power of my brain toward blaming myself—a trained mental health professional—for my own brother’s death by suicide.

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Sometimes, I don’t think I should be a psychologist anymore.

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

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Before my own grief, I was skilled at compartmentalizing myself for emotionally complex conversations with patients about the abuse they’d suffered or the guilt of surviving war. But when I sought my own grief therapy, I found that much of what I’d done as a professional turned out to be wrong for me as a patient. I realized we—all of us, but especially mental health care practitioners—have been getting grief wrong.

Too often, therapy treats any loss—divorce, unemployment, death—like an internal challenge that unfolds in a predictable order. Many of my clients expect to fight through stages, from shock to acceptance, like levels in a video game. Fifty years ago, Elisabeth Kübler-Ross mapped out five stages of grief, first thought to be sequential, which have since left permanent impressions in popular culture (even though as a set of steps, it’s been largely debunked).

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I’m so thankful to Kübler-Ross for her early studies, but I made mistakes under this thinking, overly focused on language and cognition, largely ignoring the body. I’ll confess that I too saw grief as linear, expecting an intense emotional reaction to happen early, then subside naturally with time. If it didn’t follow this process, grief became a problem or a disorder to treat. Prolonged effects often include acute loneliness, which can also be misunderstood. Traditional therapy, which I assumed was correct, was based on this idea: People get stuck in grief because they are lonely, having lost a person close to them. Treatments focused mostly on the relationship with the person who died. I wasn’t prepared for a crisis of community involving people who are still alive.

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Everything changed after my own loss.

In my early grief, the term heartache became literal. Going to work and parenting my children became physical challenges. I ached. Even years later, unexpected triggers can still reopen the wound. I no longer believe the pain will subside entirely. I now know I will live with grief, in some form, for the rest of my life. Talk therapy helped, but it wasn’t enough.

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What did help was physical; I found healing in movement, throwing myself into a hobby I’d only dabbled in before, circus arts. Spinning on silks and flying on the trapeze freed my mind from overthinking.

And I realized I needed to repair my relationships with the living.

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

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

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

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In my quest to work through this, I worked with a highly trained therapist using MDMA, an amphetamine-like compound. This is a treatment protocol that could be approved by the FDA as early as 2023. (I had to travel outside the U.S.) It’s not yet mainstream, but it’s not fringe science, either. Psychedelic therapy eased the anxiety of my big questions. I didn’t get answers, but I felt at peace. (There’s a research team at Johns Hopkins that has been treating terminally ill patients with psychedelic-supported psychotherapy for many years. They’ve found that this kind of intervention significantly relieved existential anxiety and depression in people confronting the end of their lives.)

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

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We know now that grief lives in the body. Mary-Frances O’Conner found that grief changes our brains, disrupting pattern recognition. Years of memories suggest our lost loved ones might walk through the front door at any moment. We grieve while waiting for a new reality to form. He’s never coming back. I believe you can help build that reality, carving new neural pathways and muscle memories—a new pattern.

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Now, I encourage patients to incorporate movement and hobbies into therapy in a way that brings joy. One client, a photographer, takes a photo walk every day as part of her healing. Another, an avid skier, took a sabbatical from work to become a ski instructor. Clients tell me these tangible assignments are an immense relief. Nothing is simple while grieving but physical activity is achievable and empowering—a welcome relief from the existential questions and searing emotional pain that come with loss. Movement engages different aspects of the brain, distracting from critical thinking and shifting focus to spatial reasoning. Diversifying neural connections fosters resilience and promotes healing from the inside out.

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

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

I also encourage my clients to take on the big, existential questions in a way that suits their journey. A spiritual process might also mean prayer, meditation, mindfulness or a writing exercise. It might mean reading philosophy to explore various worldviews or working with a clergyperson or spiritual director. And I’m now a staunch advocate for psychedelic-assisted therapy.

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I’m not the same psychologist I used to be. I had to forgive myself. First, as a therapist, for not “saving” Dave from an illness as grave as our father’s cancer. And as a grieving sister, for not “recovering” quickly, or not at all. You don’t recover from grief. You integrate it. It doesn’t leave you. It gets absorbed into you until it’s part of what makes you whole.

​​If you need to talk, or if you or someone you know is experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call or text 988 to reach the Suicide & Crisis Lifeline.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

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