Where is the Spiritual in Grief?

I am saddened by the absence of a spiritual dimension to the debate about grief and depression. I have colleagues whose focus on grief is solely on people’s capacity to cope and adjust. I know of very few (except ministers, spiritual directors and rabbis) who validate one real source of depression as the loss of meaning or a violation of values and beliefs. How often have you heard people say “ I will do anything” in order to achieve a particular goal? Such a statement, if rigorously followed, can mean giving up one’s own values as less important than the goal itself. Is not depression an inevitable spiritual outcome of such a Faustian bargain?

Without the spiritual, the capacity to connect to resources beyond oneself, grief and depression are indistinguishable.

What is a “will to live” if not something intangible that keeps you going in spite of reality?

What is it that gets you through the crucibles of losing essential connections, through crushing loneliness, betrayal or pain, of facing one’s own death?

Where do people crushed by the biochemistry of unremitting depression find the courage to not only stay alive, but to be creative as well?

How do you become “psychologically hardy”, able to handle with resilience high amounts of stress and loss?

How do you forgive yourself for losing your way? For example, could you embrace the murderer of one of your children, as you’ll discover later in this book that Linda White, among others, has done? The answer lies beyond the rational, logical models of psychopathology, coping and adjustment. Often, you will have to reach limits as individuals before such spirituality is recognized as necessary. A witness' sacred trust is to hold hope in times of darkness, to (e.g.) silently and unobtrusively hold the belief in the transgenerational significance of the unfolding story.

Consider the work of David Doefler in some of the most challenging places to find forgivness and rise to the occassion:

During a week long intensive course on restorative justice, held during a steamy June in a medieval castle –cathedral surrounded by New York City, I witnessed on videotape a sacred, intimate interchange between two human beings that was as loving an experience as I have ever seen. Nothing about it was sexual. There was no physical contact, only hands touching bullet proof glass that separated the two as they parted after over four hours. They would only see each other one more time—as he apologized to each of the victims of his double homicide moments before his execution.

Prior to witnessing on videotape only a hour of the four hours, I could not have imagined that two human beings, on their very best day of their lives, could share with the depth, honesty, forgiveness and loving care that these two did. How extraordinary it was to see the mother of one of the murdered girls take her wounds to the man who had killed her daughter—and for both to then find healing.

This seemingly miraculous interchange happened because of careful preparation, coming out of the vision of a spiritual man steeped in the philosophy of restorative justice. It came in spite of the cynicism, doubts, obstacles and the presence of a system of retributive justice that demanded the murderer pay for his crimes with his life, that every family member of the woman thought her to be crazy to be desirous of meeting with him in the first place. He was a monster; he had no right to any relief of conscience, responsibility or accountability she might give him. He deserved to die, and his death was the only justice they could feel. How could she do this?

Did the depth of this experience happen because she pulled her punches, denied the destruction of lives physically, emotionally and spiritually that had happened? No. Did it happen because he apologized and asked for forgivness? No. Did it change any outcome? He still died two weeks later. She was even further distanced from her family, able subsequently to realize all of its dysfunctions that had accrued over the previous twelve years of hell following the murder.

But the lives of both had been transformed. Strapped to the gurney, straining to face individually every one of the vicims of his horrendous crime, he apologized. One of them, the boyfriend who had been severely injured in the attack, had asserted many times there was no way he would ever forgive this monster, was eager for his death, even questioned his sincerity. He burst into tears, placed his hand on the window and said “I forgive you.” These were the last words Jonathan, the condemned man heard uttered as he turned, signaled the execution to begin by starting to sing “Silent Night”. He never finished the third line of the first stanza.

Life was no piece of cake for Paula afterwards. The intimacy of those moments were not matched anywhere in her life save with the mediator, David Doefler, and those who walked with her through that time. Still, she had a sense of peace that could not have come any other way. She could now grieve his death as well as that of her daughter. She could grieve all the broken lives in her family. Love replaced hate. Forgiveness was more than an expectation from her religion; it was now a reality forged in the most challenging of life circumstances.

Both Paula and Jonathon had expanded their consciousness of the possibilities in human interchange. A deeply loving exchange had happened between two people bound together by the despicable acts of one of them requiring the stretching of every emotion, the grace of their common religion, the holding of hope for them by David, who believed them capable of creating this sacred experience of conciliation.

My consciousness was also expanded just by watching this event. It was an act of love I had never considered possible before. There were moments in watching it that I felt embarrassed to be there while something so personal was taking place. I have been stretched in my consciousness before; indeed, if I had not been I would not hav e been there this day, would not have participated or felt the rightness of this training in rstorative justice, would not have been open to facing my own shadow that had led me to be so destructive in injuring my own children in the process of divorcing their mom. Even so, my universe expanded with this experience. There was reason for optimism in a world crazed by 9/11 terror, by rewarded corporate greed, by preemptive wars, by collapsing health care and justice systems. The world was not going to change. My personal life was not going to require any less effort to keep it alive and vibrant.

But the potential for any human encounter to be redemptive, loving, forgiving had increased dramatically for me. The belief in the ability of the human spirit to revive after being broken was affirmed. I could once again see that holding hope for others in the darkest of times even if it only was rewarded one time, was worth all of what was necessary on my part to make that happen.

Sharing in a history, life experience or a story is basic to validation because it works from the premise that what is being experienced is worth remembering and is real. As witnesses, we give significance to a loss, success, transition, and decision or to a time of forgiveness, good-byes, last wishes or finishing business. We may be the only one who knows what happened and its importance.

Some of the most significant losses are those of our witnesses. Parents and grandparents, aunts and uncles for example, were there when significant events of childhood took place. When we remember someone at the time of a funeral or anniversary, we are giving voice to that role of witness. Eventually, it is the witnessing of life itself that can be an expression of the grief and joy of a lifetime of witnessing.

Having witnessed another's life can also create meaning. People often do not know the significance of their own lives, while others may. For example, witnessing the life of another directly or indirectly can resonate with aspects of our own, inspire or caution we to do things we otherwise might not have.

Spiritual Depression

Depression can be spiritual, the result of feeling hopeless, unforgivable, worthless or living a life story that lacks integrity or is a source of unbearable shame.

As someone who deals with depression and feels health care professionals overdiagnose it, I want to make a case for spiritual depression, how it can be seen in arrested spiritual development, and how it holds hope as it has evolved over the past thirty-five years.

Depression is disconnection. It is disconnection from the past. It is disconnection from each other. It is disconnection from everybody else’s issues but our own. It is disconnection from hope, forgiveness, joy and love. Ultimately depression is a disconnection from self.

How does such disconnection take place? Are good people ever broken in such ways? I think it can happen to anyone, depending on circumstances and choices. In fact, the more successful, powerful, wealthy or famous one is, the more likely it is for losses to be spiritual rather than material in nature—and the more difficult to avoid spiritual depression as a result.

Many people have little in their growing up that prepares them for “having it too good.” Most of us dream of how wonderful that would be, but never really consider what temptations and abuses can result.

Consider the disdain with which people who have grown up with wealth have for the nouveau riche.

Or how about the fascination we have with the famous, the new aristocracy whose exploits—usually their failings—are highlighted in the most popular magazines.

Think of the 18 year old soldier, placed in harm’s way with the most powerful weapons known in human history, in a moment of panic does something that kills another—not an enemy, but a civilian, a buddy?

Wonder about the doctor, as an intern given responsibilities for human life beyond his or her current competencies, exhausted by 100 hour plus weeks, who makes a mistakes that costs someone their life?

In some instances, such as those faced by the soldier and the doctor, these circumstances were deliberately created as rites of passage. Rites of passage have two significantly different spiritual outcomes. They can be tests of people’s capacity to endure extremes and hardships, a test of resolve or courage. What is often necessary is the letting go of old assumptions and beliefs that do not apply to new circumstances, and finding internal resources never previously discovered. Such a letting go and internal discovery is inherent in both grieving and the creative process. Successful negotiating of the challenges admits one to a group who value people being empowered, capable of rising to the occasion.

Rites of passage can also be designed to break down the individual’s integrity and spirit. It is literally the application by cultures and societies of the “survival of the fittest” principle. The challenges posed are meant to destroy links to the past, to create a reliance on the family or group that replaces self-reliance or old values. In this case, rites of passage are often designed deliberately to force the individual to do something that destroys their capacity to trust their internal values because the violation is so profound. Thus, the Mafia or street gang initiates a new member by having them murder someone; the training program demands one dehumanize the people in their control or care.

In the first instance, rites of passage create spiritual hardiness that allows the initiate to withstand challenges to their integrity. In the latter, they create spiritual depression, substituting loyalty to a cult, guru or profession for a connection to one’s integrity.

Unfortunately, both parenting and professional training can result in either type of rite of passage. After many years of doing therapy, chiefly with educated people and other health care professionals, I have seen many people whose families have used power and abuse as ways to destroy individual’s will and damaged their capacities to believe in themselves. After many years in medical and graduate education, I have seen more instances of the training process being used to break spirits than to challenge growth. Why else, for instance, would ninety percent of medical students oppose the way medical internships are designed, with over 100 hours a week, with responsibilities for life and death in their totally inexperienced and incompetent hands, with the same conditions created that are designed to break the spirit of prisoners of war? Why else, a year later, would those same individuals almost universally say every doctor must go through that type of experience?

Certainly I have seen some physicians come through the growing up and training experiences and be stronger for it, But I have seen more who have not. It is the principle reason, I believe, physicians themselves are among the highest in depression, why they often self medicate to the point of abuse and self destruction, It is also the reason that depression is overdiagnosed in the health care professions, and why positive approaches to health and healing, often represented in the alternative or complementary therapies are met with their cynicism and open hostility. It is the nature of depression to see growth and forgiveness as unattainable and even dangerous, for they threaten to break the bond of loyalty and secrecy that has been substituted for integrity. Spiritual depression doesn’t respond to antidepressants. Psychotherapy is avoided for it can point out where the break took place, and how it became justified later through a loss of empathy and compassion.

What is missing in the lives of people who suffer from spiritual depression is a combination of the capacity to rise to the occasion, gratitude for what is positive and the ability to invest sufficiently in relationships to see them through to forgiveness. When people lack access to what has been called this “best self,” they also lack what it takes to let go of past hurts and deep wounds.

Some people who are spiritually depressed actually find it easier to cope with everyday life by accepting that they're a “victim” of depression. It's easy to justify not trying: You can then ignore or shun those who have injured you; you can self-medicate with drugs and keeping very busy. Life is full of inequities and injustices, so why bother? In many instances, you may have experienced legitimate sorrows that “broke” you—you were raped, got fired, your husband or wife left you, your dream of becoming a doctor was thwarted, or, ironically, fulfilled—but if you’ve become adept at proving the world is a lousy place to live in and never have the energy to free yourself from your loss, it may be because you're spiritually depressed.

Spiritual depression can lead many to perpetuate their suffering and to inflict it on others. I believe the source of much of what is intergenerational revenge in the forms of holy wars, ethnic cleansing, unending conflicts between Catholics and Protestants in Northern Ireland, between Jew and Arab in the Middle East, to mention only a few, results from this spiritual depression. It’s also at the root of incest and child abuse as well.

One reason people seek professional help is that they fear the loss of meaning and direction of their lives. They may even say, “I am a broken person,” as though life has no meaning any longer, as Mark did when the consequences of his actions became too much for him:

Mark was in his late thirties when he started seeing me. A successful businessman with a lovely wife and two boys, Mark and his wife had overcome numerous challenges over the years, accomplishing everything they had wanted to with a lot of hard work. Mark had recently had a brief affair that he had terminated, but “Suzie is still all I yearn for,” he confessed. “She was like a soul mate for me. I can't do that to my wife and family, but there's got to be more to life than this.”

Mark had everything that money could buy, except a sense of real connection. He saw in Suzie, with whom he'd had the affair, what was missing in himselfa sense of meaning in his life. As we talked over the weeks, it became clear that Mark had made moral compromises along the way in order to get to where he wasthings he could never admit to his wife, he thought, for how could she forgive him? His story wasn't so much broken as it was hiddenand a source of shame.

Mark's depression wasn't one that responds well to antidepressants. Thinking differently wouldn't change much either. Clearly he wasn't suffering from physical problems or a lack of support. His money and successthings that society uses to measure the “good life”weren't enough. Mark's depression came from within his spirituality.

That’s mild compared to what some people do from a place of depression. Others abuse depressed people, and many pass it on. The anger and frustration of depression is often unacknowledged and unexplored. Often it isn’t even owned—“I wasn’t myself,” “he deserved it,” “it’s for your own good,” “don’t tell me I’m angry—you don’t know what anger is . . .” are common externalizations of responsibility for taking it out on somebody else. When a depressed person has power over others, they create in others the way they feel. An eye for an eye mentality is one expression of depression.

When the depressed person is your boss, partner, counselor or doctor, you could be in for abuse—paradoxically, frequently at the times when you are beginning to feel better. The hardest times for depressed people is when others are going to places you cannot go—into restitution, restoration, forgiveness, happiness, joy or savoring accomplishments. That’s why the suicide rate is so high around holidays, times of celebration and the beginning of spring.

A life story that lacks integrity, meaning or the potential for forgiveness, whose persistent themes lack a sense of grace, courage, continuity, direction, or access to powers beyond the self, can also result in spiritual depression. Common to all spiritually depressed individuals is the sense that their story isn't either not worth telling or must be hidden, that they are worthless, despicable or unforgivable. They believe they are not included in a healing community, and don't deserve to have one. It's hard for them to identify what it would take to give their story meaning, for the path they have taken has been devoid of remorse or guilt for so long they aren't sure how to regain or restore themselves to wholeness. That was the very painful fate of my friend Jana, whose quiet demeanor hid a tortured secreta lack of grief and forgiveness:

Jana was a lovely woman who lived in her husband's shadow. Karl was a well-known pediatrician, adored by many people. Jana was a librarian and led a quiet life.

Early in their marriage, they'd had two children. When the youngest, Marie, was four, she'd contracted a virus. Karl was away at a medical conference. He wasn't able to get home until the next day. By then Marie had died.

Karl and Jana were unable to cope with their loss together. Jana was angry that Karl wasn't home at the time of Marie's death, though she never expressed it. She withdrew from caring for their son, Boris, and left it to Karl to do the parenting, along with a housekeeper. Karl poured himself into his work, developing a special practice treating children with leukemia, at that time an almost certain terminal condition.

Thirty-five years had passed when I met Karl at a conference in Denmark, where I was living and working at the time. During the conference, we took several long walks together in the woods by the lake. As Karl told me of his daughter's death, he began opening to the grief he had kept bottled for so long.

In the year that followed, I visited Karl and Jana many times and Karl and I conducted numerous workshops together for the staff of his oncology ward at the hospital. Karl was learning to be playful and to share his tears with colleagues who respected him.

In their home, Jana fixed wonderful meals but rarely spoke unless Karl or I addressed her directly. She was very shy and reluctant to share her thoughts. We spent long hours listening to music, both classical and new age. I persuaded Jana to try to do some Tai chi to “Pachabel's Canon.” Although she was stiff and awkward, she loved it.

Slowly, Jana began to blossom. She began taking courses on Tai chi. She went to a women's support group. She mentioned Marie's death occasionally in the women's support group, only noting that it had happenedand that Karl had not been there.

One day, after being away for several months, I called. Karl answered the phone. In his quiet way, he said it wasn't a good time for me to come to visitJana wasn't feeling well. This pattern continued for several months. I persisted with Karl, and he finally admitted that Jana was severely depressed.

She had been at a Tai chi workshop when, looking at everyone else, she suddenly felt out of place. “It's too late for me,” she told herself. “I don't deserve to be here.”

Over the next several years, Jana had the full range of treatment for depressiondrugs, therapy, even electroconvulsive treatments. Except for a few days here and there, the depression wouldn't lift. She did admit how angry she was about what had happened at the time of Marie's death, but she couldn't seem to get past it. “I don't deserve to be angry at him,” she would say. “Look at what he's done with his lifeand what I've done with mine.”

In the meantime, I moved back to the United States. I saw Jana once, but it was clear she was not reachable by my friendship.

Four years passed and then I received a letter from Karl. In it he told me that Jana had committed suicide six months before. Life had held no meaning for her, he said.

“Hers was a long and painful terminal illness,” Karl shared with me as we visited her grave six months later. “I knew it would happen someday. She was suffering so much. She could never find someone to trust with her grief. She felt that her life had little meaning once she reached retirement age and could 'only' look back at her years as a librarian. She compared herself to me and to you and found herself wanting.”

Jana had waited a long time to deal with her daughter's deathtoo long, it seems. By her mid-sixties, as she began to emerge from her shell, depression set inand the internal and external resources she had weren't sufficient to help her, in spite of a genuinely loving husband and the best of available treatment.

It's hard to know in retrospect what would have helped and when unexpressed grief becomes depression. Had Karl dealt with Marie's death? He had not talked openly about it until some thirty years later with me, yet he had previously found ways to deal with his grief through his work with dying children. His life, his workhis storyhad meaning in light of his loss. Even after experiencing Jana’s five-year depression, he could grieve her death and her depression, knowing that he had done what he could, that his life still had meaning. Karl, now in his eighties, has remarried and volunteers his time at a local hospice program. He remains a good friend, as playful and loving as ever.

What is missing in the lives of people like Jana who suffer from spiritual depression is a combination of the capacity to rise to the occasion and the ability to invest sufficiently in relationships to see them through to forgiveness. When people lack access to what has been called this “best self,” they also lack what it takes to let go of past hurts and deep wounds. Jana couldn't forgive herself or Karl, and when she saw him able to do that, it pushed her deeper into her despair. Her story was broken, and she ended it tragically.

It requires extraordinary circumstances and extraordinary people of the Nelson Mandela, Mahatma Gandhi and Martin Luther King stature to help people restore their integrity and break the cycle of spiritual depression that knows only revenge and infliction of suffering as its outcome. Asia is one such extraordinary person:

From the age of six, my father incested me. It was a family secret, and I knew it would create incredible chaos if I ever dealt with it. But I knew I had to and over the years, I have confronted him several times about what he did to me. At first he denied it and I was a family outcast. I had to deal with it on my own, and I did, getting into therapy, finding my own spiritual path.

My father is a miserable, unhappy man. He has no friends. He is so negative. But he has admitted now what he did, at least a little. I has helped me enormously to have him open to talking about it. As much as I hate what he did I do love him.

I want to explore with him what it would take for him to forgive himself for what he did to me. I have already forgiven him, but I know that isn’t enough. That forgiveness is what he needs to get back his integrity, which I know now is the center of his depression.

Asia, in confronting her father and in staying connected with him, held his hope that there might be a way to restore his integrity and break through his spiritual depression. Because of the trauma of her childhood, she had found a spiritual path to her best self that she could share with her father.

Asia’s father clearly had broken with his sense of integrity as a father. All too often the taking on of something new, life’s gains of fame, fortune and power pose greater threats to the loss of integrity resulting in depression that hardship and adversity do.

A recent survey, for example, showed that when asked “how much is enough?” many people would respond with specifics—enough to pay off the mortgage, send the kids to college, retire early, and take a vacation. Another study examined what the ideal income level would be—when what you want or need and can productively use without spending more time taking care of possessions than enjoying them. While it was a lot more than what most of us make—perhaps $200,000, it was a lot less than what some make and continue to seek.

The most common response, according to the earlier survey, of the richest 10 percent of the population was “twice as much as what I have”. Stunningly, these richest people had lost a connection between what they have and what it could do for them. They have lost their sense of integrity about money—it was no longer functional, nor could it ever be satisfied.

You might get enough money together to send the kids to college, and have a real sense of accomplishment, but if “enough” meant “twice as much” then there is no end point, never really a way to measure “enough”. Greed has robbed these people of their integrity—and in many instances, their capacity to enjoy and meaningfully use what they do have. The result is the “Midas Touch” type of depression.

There are also types of losses that are greater challenges spiritually than others. Divorce is one example, and something that often sets apart people who have lost a spouse by divorce from those who have lost theirs through death. The process of divorcing is often aided by lawyers whose mission is to “get what they can in settlement” whether it is a “fair” settlement or in the best interest of all parties involved, including children. It can also be fueled by a deep sense of hurt, abandonment and betrayal. In many instances affairs, which represent violations of marital vows, are involved. So is abuse that may be physical, sexual and emotional.

Many of us, for I include myself in this, who have gone through divorce can look back at some aspect of what we did in the process and admit we violated our sense of integrity. We let our ego, anger, lust, greed or desire for revenge get the best of us. We deliberately hurt someone we loved and even innocent bystanders such as our children. And we became so ashamed of it that we never told a soul, often compounded the spiritual crime by justifying what we did or burying it.

It’s a critical loss often associated with mid-life to realize you can be destructive and act in ways that don’t fit your self-image. Those who grieve such a loss often admit the folly, deceit and destructiveness in what they did and seek forgiveness. Some spend the rest of their lives making sure that whatever pushed their shadow to the fore never has a chance to do so again. Some reconcile with those they injured or betrayed, and their relationships are even stronger. Some accept the specific harm that was done and find ways to restore wholeness.

If you cannot admit you have broken with your sense of integrity, you are deeply vulnerable to spiritual depression. Perhaps you believe you have done the unforgivable—you have acted with greed, hidden evidence of dishonesty, been cruel and destructive. You cannot bear to face the shame of what you have done, not just once but for years, even a lifetime. If faced with the harm you have done, you are not sure you could survive the guilt. For some what was done was “not being yourself” and dismissed as simply the function of being drunk, drugged, seduced, angry, psychotic or under too much pressure. The loss of integrity could also blend with a loss of honesty in which what happened is not even admitted. It becomes a very long road back to wholeness and to connection when integrity is lost.

Without a connection to your best self, you can probably handle everyday issues but not the challenges which would mean putting aside the more base aspects of yourself: The petty jealousies, the righteousness that comes from being unforgiving, the using of ends to justify means.

Those who are spiritually depressed often have life stories characterized more by unblinking loyalty and secrecy than by loving and forgiving. They demand perfection from themselves and others. Inevitably they fall short and lose their sense of integrity as a result, able to rationalize even the dastardliest of deeds as “not being themselves”. They then find themselves to be more rigidly rational than courageously compassionate, more self-absorbed than empathetic, more willing to be a “victim of circumstance” than “master of their own fate.”

If this is true for you, pray that there is an Asia in your life. Seek courageous friends who will give you the guts for the long journey back to wholeness and health. Find someone to intervene and help you to find new ways to imbue your life story with episodes that have meaning, bravery, and purpose. Admit you have done harm and seek ways to restore and forgive. Open to the grace that it will take for others to welcome you back and to forgive your transgressions. Find someone who believes you can regain your integrity, let go of the futile and inhuman pursuit of perfection and accept having feet of clay and find ways to be forgiving and forgiving. That can seem a superhuman task, and for some it is.

Another way out of spiritual depression is to admit that what is happening is beyond your control — that only that Higher Power, transformed consciousness or something else beyond you can change what needs to be changed. Alcoholics Anonymous, among other support groups and twelve step programs, uses this surrender as a basic step back toward integrity. Then it becomes a matter of finding the right kind of help, which we'll discuss in Chapters Five and Six.

Otherwise, even if your “suicide” is not an active process, it may be a passive one like Asia’s dad’s. It might take many years to accomplish “spiritual suicide” through self-neglect, stressful living, self-fulfilling prophecies, deliberate criminal behavior that invites discovery and punishment, ongoing destructiveness, alienation, boredom and unnecessary risks. Spiritually depressed people can live very long lives—a fate worse than death itself.