Dr. Ann Masten from the University of Minnesota wrote in the journal American Psychologist (2001) about resilience as “ordinary magic.” That is, given normal protective factors, most children will be able to cope, recover, and be fine after witnessing or experiencing a traumatic event.

Some children and adolescents may develop symptoms following a disaster, especially if they have experienced traumatic events earlier such as losses or other difficult situations. The symptoms related to trauma may appear as difficult behaviors or emotions shown at home or school. It is important for parents to know that children’s behaviors and emotions can become dysregulated, where they demonstrate more aggressive or withdrawn behaviors such as sadness or anger, and even “numbing” or little emotion as a way of coping with trauma.

Some of the “red flag” behaviors of concern when seen in children of different ages include:

• For children under 5 years of age: returning to earlier behaviors such as thumbsucking, bedwetting, fear of darkness, separation anxiety or excessive clinging
• For 6-11-year-olds: disruptive behaviors, extreme withdrawal, inability to pay attention, sleep problems and nightmares, school problems, psychosomatic complaints
  including stomachaches and headaches or changes in usual behaviors
• For 12-17-year-olds: sleep problems and nightmares, school problems including changes in performance and truancy, risk-taking behavior, problems with peers, changes in usual behaviors, psychosomatic complaints including stomachaches and headaches, depression or suicidal thoughts

Parents need to be able to recognize these “red flag” behaviors and identify when their child may be experiencing so much distress that he needs help. Parents may also need help in providing support to their child after traumatic events that may also traumatize the parents. Brief support and being able to talk to someone who can be more objective may be helpful to both parents and child after a traumatic event.

When they experience traumatic events, children can be protected most by support from their parents or trusted caregivers, being able to talk to them and have them listen, and if they are younger, being able to play freely. Younger children often play out what they have seen or experienced which, at times, may be difficult and upsetting for parents to observe but is important in helping the child recover from the event.

Returning to routines is also very important for children after they’ve experienced trauma, even if the routines are different from what they experienced before the traumatic event. If the children are older, then being able to go to school and be with friends will help in their recovery. Life needs to be predictable for children (and adults) and traumatic experiences disrupt that predictability. Reinstating routines help make life predictable again.

Guidelines for Parents to Help Their Child Cope with Trauma Include

1. Offer to listen to your child and help her, but don’t overwhelm her if she is not ready to talk. Don’t pressure your child to think or talk about what has happened beyond her willingness and readiness to do so. Children need answers to their questions that are age-appropriate and truthful, but it is not in their best interest to be flooded with more information than they ask for or need.

2. Talk about what has happened or is happening but in tolerable doses. It is wise to respect your child’s need to break off the discussion and to respect his wish to not talk further about the trauma for a while. He or you can ask to talk again at another time.

3. Do not underestimate a young child’s awareness or understanding of what has happened or may be happening. Answer your young child’s questions about injury or death truthfully, but in language she can understand without offering her
more than is necessary for her to hear.

Different age groups have different needs. For example, very young children need to be protected from exposure to too much television or other media; they are likely to have either seen or heard too much already.

Children need to be helped not only with their anxiety and confusion, but also with their anger. They may react to the traumatic event with anger and need to learn ways to express their feelings in healthy ways. Here are a few age-appropriate, healthy ways to help children express their confusion or anger about a traumatic event:

• It is often helpful for young children to have the opportunity to draw pictures of what has happened, perhaps depending on the traumatic event, including rescue vehicles coming to aid. Children who are a little older may want to play out the event with toys.

• Older children may find it helpful to use heroic action figures for their play or toy soldiers or military equipment to show danger as well as rescue.
• School-age children may want to use these less verbal forms of expression but they also might be able to be more direct and verbal about their feelings and concerns; they are more likely to also talk to teachers, relatives, and other adults in addition to parents.
• Teenagers may find it helpful to talk as part of a small group of peers their own age rather than talk by themselves. After disasters, teenagers can play a major role in helping others in recovery work at school and in their community and also help younger children. It is important to recognize and support prosocial activities for teenagers, which can also decrease the likelihood of higher-risk behaviors.

As I shared with one parent whose young child was very upset after experiencing a traumatic event that would impact both of their lives for some time, “Life will return to normal, however, after trauma, it may be a ‘new normal.’”

Flipped car photo available from Shutterstock

The Lonely Screams, by Sean Seepersad, presents a curated collection of essays contributed to Seepersad’s website, Web of Loneliness. The stories are often wrenching and sad, and Seepersad follows each essay with his thoughts about the origin of and solution to the writer’s loneliness.  Aside from his clinical and academic interest in the subject, Seepersad has a personal interest; the final chapter is his own essay about his experiences of loneliness.

Two-thirds of the contributors to this book are women, and most describe feeling lonely for as long as they can remember. The contributors tell personal stories of loss, betrayal, childhood bullying, parental abuse and abandonment, romantic relationships gone awry, and of opportunities missed or simply not available in their lives. Most writers try to understand why they experience chronic loneliness, and they often point to events from their childhood that set the pattern in motion. Jack, for instance, writes “From my earliest memories I have always felt alone and not totally accepted. I have learned that when I was a baby, out of frustration my mother would hit me to stop me crying.” He concludes his essay hopelessly: “Loneliness kills potential. I can see no future for myself. I will give myself a few years, though. I would not ever kill myself, no matter how much of a failure I become.” In his analysis, Seepersad comments on Jack’s resignation and notes that Jack responded to his childhood loneliness by becoming a chameleon, “changing himself to fit the world around him,” and this kind of separation results in the loss of the hurt child within. Seepersad’s solution for Jack is to “get in touch with his true self, realize his true desires, and pursue his own dreams.”

The Web of Loneliness project is not set up with a rigorous experimental design, run within the auspices of a university lab; it’s a website, and anyone who wishes to contribute his or her story is welcome to do so. Contributors frequently comment on their gratitude for being heard, for being able to give voice to the experience of loneliness. At the end of each essay in the book, a URL is provided so the reader can go online and leave comments about the essays, and read comments others have left.

Although the stories were indeed sad, and sometimes difficult to read, they were actually stories of a great many more conditions than loneliness. Many writers were clearly experiencing profound clinical depression, and some experienced suicidality. Of course, depression and loneliness make sorrowful bedfellows, and each contributes to the other in a dynamic way. I wanted Seepersad to focus the book more closely on loneliness. With a public website inviting contributions, I wondered why he chose the particular essays he selected for this book.

My greatest disappointment with this book was in Seepersad’s commentary after each essay. He structured his response in two directions: what he saw as the origin of the individual’s loneliness, and his advice to the writer. Without exception, both halves were shallower than I expected. Seepersad is a clinical psychologist, and I’d anticipated reading more insightful commentary about the origins, and less glib advice.

Additionally, his thoughts about the origins are often contradictory. For one writer, who sought close relationships despite expressing a concern about intimacy, Seepersad wondered why she sought relationships, if she was afraid of intimacy? To a later essay, he commented that the need for belonging is a basic human need, like hunger.  As a psychologist with access to (if not familiarity with) the literature, he could have presented a more in-depth examination of the conflict between a basic human need, like belonging, and the anxiety associated with fear of intimacy. Such an explanation needn’t be heavily academic — given the book’s audience, which is probably people who feel lonely, he could have presented more complex information in an accessible way.

With a stated goal of offering each writer advice about what they might do to change their circumstances, Seepersad takes on a big job, especially for a slim book of this type. The answers are certainly complex, given the lifelong patterns these lonely people describe, but Seepersad resorts to an essentially light, hand-waving response, as he offered at the end of Pat’s story: “If you are suffering from this inner loneliness as well, it may well mean you need to undergo your own deep, transformational process as well.” With such a shallow answer (pointing to an enormous and difficult task), he would have been better off formulating a different structure for his responses to the essays. Had he organized his responses with a tighter focus on illuminating the source of each writer’s loneliness, he could have gone into greater depth and made his contribution more valuable.

In the end, reading this book felt like reading a public website, and I did not come away with a greater understanding of “the complex world of the lonely,” as the book’s subtitle promised. Seepersad has access to such rich material, I hope his next effort takes the questions a little more seriously.

The Lonely Screams: Understanding the Complex World of the Lonely
By Sean S. Seepersad
CreateSpace: May 18, 2011
Paperback, 186 pages
$8.99

Wait a minute, how can anything positive come from being shot by a stranger in the chest with a .38 caliber pistol?  Well, as Pennington points out, he was lucky. He didn’t die. The bullet missed his heart. In the ambulance to the hospital, he focused on breathing, relaxing, reassuring himself, and thinking positively.

Subsequently he realized that a series of very fortunate coincidences prevented him from being killed, which left him enlightened: “Why should I be in a miserable situation and be unhappy? Being in a miserable situation is bad enough.”

As Pennington points out, life is inevitably sad and full of unexpected tragedies. So rather than wallowing in misery, why not look for whatever good you can find and turn misfortune into benefit?

That is the general premise of this book and one that provokes knee-jerk cynicism as it brings to mind the many trite phrases mothers harped at us for years: look for a silver lining; look at the glass as half full; make lemons out of lemonade.  Yeah, yeah, all of these truisms were pretty annoying as a kid, but as you approach the age when your mother uttered these phrases, you’re hit by the truth: Mom was right.

In this very short, quick-read book, Pennington tells eight personal stories of experiences that could have shattered his physical, financial, and mental health. Yet he never let misfortune drag him down. He not only beat his problems, but pushed past all of the hurt and disappointment to better himself.  Each of these stories ends with a sort of parable—a lesson that readers can apply to their daily lives. 

Pennington strategically leaves his wife’s illness to the very end, because, as he admits, it is the hardest lesson. “I know it sounds insensitive and selfish for me to say this,” he writes. “But I have no doubt that I am a better man because of what I learned by living through the illness that took her life.” His wife, Claire, suffered from multiple sclerosis, and in light of her suffering, he came to realize that his problems were minuscule. In caring for her, Pennington learned to give freely and without expectations.

“If we can respond to others’ needs without expecting a reward in return, it is possible for us to receive a gift for our giving,” he writes. “We may find ourselves feeling an increased sense of usefulness or pride in a job well done.” It’s the Golden Rule.  As Mother might have said, Do unto others as you wish they’d do unto you. What gives this and other old homilies some relevance is that Pennington has actually lived through some fairly horrible times and recovered by using these principles.

On the other hand, it’s worth noting that Pennington was an executive coach and motivational speaker long before he wrote this book. In fact, immediately after he was shot (which occurred early in his career), he thought, this would make a great “signature story”–a story to spice up his lectures and grab the crowd’s attention. 

For this reason and more, this book largely feels as if Pennington packaged his lecture notes as another point of sale in the back of the lecture hall. The bullet points, the call-out boxes, the bold-faced lessons are dead giveaways. 

However, just because you know this, does it diminish Pennington’s overarching lesson? Well, I don’t think so. The author helps readers put tragedies and so-called tragedies into perspective and gives readers strategies to build a better life. “Whatever your next step might be, it doesn’t have to be earth shattering,” he writes. “It may not produce a dramatic change right away. But if you don’t take it, you will have missed new opportunities that you would not have discovered otherwise.”  Pennington’s words do seem wise—and if Mother were listening, she’d no doubt give a self-satisfied nod in agreement.

Find the Upside of the Down Times
By Dr. Rob Pennington
Resource International: May 20, 2011
Paperback, 125 pages
$17.95

Of course, we did go on, as people do. But that year our conversation was more subdued than usual because we were all so aware of the empty chair at our table; the absence that couldn’t be denied.

As the years have gone by, the loss has become less painful. Now our memories of David and others who’ve passed out of our lives are laced with humor and nostalgia. The chairs are empty. But the relationships with the people who once occupied them continue on in our shared memories and stories.

Negotiating through the first holiday season following a death is seldom uncomplicated. Although the traditions that evolve in subsequent years may be fine in their own way, holidays without our loved one will never be quite the same. The holidays after a recent death highlight the absence and often throw people into confusion. Grieving people know they should “move on” – whatever that means – but aren’t at all sure they want to and don’t know how. Those who care about the person in mourning want to be helpful but are equally confused about how to do it. It’s a situation that is poignantly human.

For those of you who have lost a loved one within the past year, thinking about the empty chair at the holiday table may intensify grief in all its complex manifestations: sadness, anger, resentment, and maybe even guilt about the loss and, yes, joy and sweetness and gratitude that the person was in your life. For those who care about the grieving person, it can be difficult to know how best to honor the memory without contributing to pain.

Grief counselors generally agree on some basic guidelines that can help you manage a personal loss or help you support those in mourning during the holiday season.

If you are the grieving person:

• Allow yourself the right to grieve. American culture has a tough time with death. For some reason, there is pressure to get on with life within a year after a loss. That expectation is unrealistic and unfair. Most people take three to five years to fully accept the loss of someone they loved. If someone dear to you died during this past year, remind yourself that it’s normal and healthy to want to bow out of some of the events of the winter holidays that emphasize family and togetherness when you are feeling alone in a new and painful way.

• Take care of yourself. Discipline yourself to get enough sleep, to eat right, and to follow your normal routines – especially if you don’t feel like it. You’ll be better able to make good decisions about what makes sense for you to do over the holiday season.
• Plan ahead. Do you want to be alone or will being with those who love you ease the pain? Really think about it. Sometimes being alone makes the aloneness much too hard to bear. Sometimes being in a crowd is overwhelming. Only you know what is best for you. Talk to key family members and ask them to support you in whichever decision you make.
• Rethink hosting the party. If yours is the usual gathering place, think about whether you want to do it this year. Some people like getting lost in the details of planning and managing a dinner for twelve. But if you are one of those who finds it just too hard to make a party when in mourning, know that it’s okay to be “selfish” in times like these and to beg off. People who love you will understand. Those who don’t aren’t worth worrying about. At the very least, ask for help and accept all offers to spread the responsibilities around.
• Give people permission to share stories. Many people have the idea that the best way to help someone in grief is to avoid talking about the person who has passed. Most of the time, they are mistaken. When we stop talking about someone is when they are really lost to the family. Let people know that as hard as it is that the person is no longer with us, it’s important to remember the good times, to laugh about funny things they did or said, and to acknowledge that he or she is missed.
• Do things a little differently. For some people, doing the usual traditions and celebrations makes the loved one’s absence all the more painful. Think about whether doing things a bit differently or going to a different place would be helpful.

If you are a family member or friend of someone who is grieving:

• Allow the person the right to grieve. Everyone does it differently. Some people want to withdraw from the world and work through their sadness alone. At the other end of the spectrum are those who manage by carrying on as usual and tempering the pain through the distraction of people and parties. Carefully consider what your loved one needs, not what you would do in the situation.

• Take care. If you notice that your family member or friend isn’t eating, getting enough sleep, or functioning well at home and work, don’t ignore it. These are signs that the person is possibly getting clinically depressed. Invite the person to a meal. Talk to her about the importance of maintaining routines. If her inability to take care of herself is prolonged, do what you can to get her to a counselor.
• Plan ahead. Ask the person in mourning what he wants to have happen at family events. How would he like to acknowledge the loss and at the same time keep the holiday going for everyone? Some families literally set an empty place at the table and take a moment to share anecdotes about the person who has passed away. Others make a toast to the memories. Still others offer a prayer. Talk together about what will feel best for everyone involved.
• Offer help. If the grieving person is the one who usually hosts family gatherings, see if someone else can offer to do it this year. If she wants to keep up the tradition, get as many family members as possible to help with the shopping, cooking, cleaning, decorating, and whatever else needs to be done.
• Talk to the grieving person about the loss. Listen without judgment. Resist giving advice. Just be there. Understand that grief comes and goes in intensity and frequency for quite awhile. It is by talking and listening that we all integrate sadness and gradually move on.
• Try out a new activity that was never shared by the person who is gone. It’s helpful to do some things that aren’t shadowed by the fact that the last time we did them, the deceased person shared it. If people like the new ideas, they can become part of the family tradition. Or not. Leave that decision for next year.

Time does indeed heal most things. But everyone has his or her own sense of timing. If this is your first holiday season since the loss of a loved one, give yourself permission to feel what you need to feel and do what you need to do to get through it. Find ways to honor the memory of your loved one and to accept the support and care of those who love you.

If you are a friend or family member of someone who is grieving, give them support, love, and concrete assistance. By talking about their loved one and by listening to their stories and feelings, you help reassure them that the sadness may fade but our relationships with people we love never really end.

Katy required a 7-hour brain surgery while fully awake, so she could respond to questions from the surgeons. During the surgery, which involved temporary removal of her skull, her head was nailed into an MRI. She could hear and smell the drilling into her skull. There was risk of paralysis with surgery, but definitive risk of paralysis, or death, without it. If the operation were successful, however, she would be OK.

As Katy told the story of the discovery of the tumor and its implications to her friends and family, a common response was, “Wow — you’re really lucky!” Hmm… only 7 in 100,000 people get a brain tumor like this and it happened to her. Is that really being “lucky?”

What they really meant was, “Oh my God, what if you hadn’t had the concussion and didn’t discover the tumor in time?” Yes, it could have been worse. She could have been robbed of the chance to have surgery and possible cure.

But how is it that upon hearing such a story the word “lucky” comes to mind? Why do people say this? It’s not uncommon for people to respond to tragedies in this way, even sometimes their own.

The reasons aren’t that different from those behind comments made to the grief-stricken that their deceased loved one is “better off.” Mostly, such responses are unconsciously designed to make the person saying them more comfortable, but can invalidate the pain of the one who’s suffering. It’s uncomfortable to talk about frightening and painful things, or to imagine ourselves in the shoes of someone with such a scary fate.

People often avoid and isolate those who are grieving or have terminal illnesses, either literally or emotionally. They don’t know what to say or how to act — staying far enough away to preclude being able to really relate. They change the topic to the luck of it all or steer clear of talking about the elephant in the room. We need to keep a comfortable distance from another’s tragic fate and the reality that it could happen to us. It helps to remove ourselves and focus on the interesting coincidence, the positive, and how things could have been worse.

Gratitude can foster resilience to better help weather life’s misfortunes.

It’s one thing, however, to cope with our own tragedies by focusing on the silver lining and maintaining a positive perspective. Focusing on the positive can be adaptive as a way to feel hope and not sink into despair, giving us time to adjust. Similarly, gratitude, achieved from within through genuine, hard-earned acceptance and perspective can foster resilience to weather misfortune.

But when someone we care about is suffering tragedy or ill fate, understanding their subjective experience by listening carefully and following their lead can inform our sense of how to respond in a way that would be comforting to them. Some people do need to avoid facing painful realities at times and feel better when others join with them in this way. In that situation, however, an optimistic perspective is truly an empathic response that emerges from sensing where the other person is, rather than from one’s own anxiety or helplessness. Warning signs that you may be at risk for imposing your own discomfort onto your friend or loved one, rather than being with them include feeling anxious to do something and make things better, or feeling awkward and wanting to get away.

Though it may be a well-kept secret, many people going through such tragedies privately talk of feeling isolated emotionally. Sensing that those around them feel uncomfortable, they are forced to protect family and friends from having uncomfortable feelings. They are left with nowhere to turn. Being a true friend is to have courage to step into your loved one’s shoes so they don’t feel alone or have to take care of you. Before you tell someone stricken by tragedy how lucky they are, take a moment to consider whether you would want to trade places so you could be the “lucky” one.

Regardless, loss is something that we work with often in counseling. One thing we can be certain of is that loss is universal and comes in many shapes and sizes.

What Is Complicated Grief?

Grief can look different depending on the individual doing the grieving. There is no set or “normal” time period for grieving, or fixed way of grieving for that matter. Each of us grieves as a result of the unique, subjective, contexts from which we come. According to Walsh-Burke (2006), traditionally, grief can be described as “the emotional, psychological, and physical reactions to loss” (p. 29).

According to Walsh-Burke (2006), complicated, problematic grieving can be characterized as “prolonged distress after the loss has occurred” (p. 49). Often, this type of grief will persist regardless of the amount of support that the individual receives from others (Walsh-Burke, 2006). Individuals with this type of problem will often have difficulty with their everyday functioning due to their grief. For example, making it through an entire school day or work day can be difficult for them; focusing on tasks that they once did with ease can become impaired; relationships can suffer; feelings of hopelessness can ensue; and depression can result.

How Our Thinking Influences How We Feel

I am a practitioner of cognitive-behavioral therapy. I cannot tell you how many times how, after experiencing a loss and meeting with me for counseling, many of my clients have said to me: “Tyler, I understand that you are saying that I can change how I think about this loss, but how else am I supposed to feel about it?” This can be a problem-inducing belief: the belief that it is possible to feel only sadness after a loss. Many of my clients believe that they should feel sad or depressed after a loss because it is the “proper” or “correct” thing to do. By no means would I ever hope for a client to be happy with losing a job, pet, or loved one, but I do believe that we can alleviate problematic thinking that contributes to feelings of hopelessness and despair, thus easing an individual’s pain.

When a client’s grief becomes complicated, their underlying belief is that it is wrong to go on with living their lives, or to be happy at all for that matter, after experiencing a loss. Essentially, they believe: “I must continue to react to this situation with sadness. Doing anything else would make me a bad person;” “How can I be happy after losing my job? That would not be normal. How can I move on when I am this depressed?;” “I regret…;” or “I can’t be happy after my children have left the nest. I no longer have a purpose.” These types of responses come in many shapes and sizes and are often colored by an individual’s unique, subjective experiences and thought processes. Are these the types of responses that people you know have had after a loss? Maybe you have even had some thoughts like this yourself during your time of grieving.

If you’re still young, you might wonder what could possibly be better about getting older.  Lustbader gives one of the major advantages as self-acceptance.  We move from our youth where we are “trying to figure out what we are good at” to a point where we know what we’re good at and may therefore find it easier to make decisions, to learn new things, and to take risks.  Since time is limited, we may become more courageous and thus become “true to ourselves.”   In her persistently optimistic way, she even discusses the advantages of physical deterioration because as we encounter physical limitations, they “jar…us into prizing that which we can still do.”  Aging can be difficult, but Lustbader reframes the negative aspects of aging, helping the reader to view aging in a more positive way.  To those who fear aging, this is a relief.

Aging involves many losses, not just physical ones.  How does one handle the grief that comes with having lived for many years?  In the essay Loss, Lustbader states that “inside all of us is a great pool of grief that keeps enlarging as each fresh loss is added to the others….Grieving does not get easier, but we acquire the skills to bear it and the wisdom to accede to its rhythms.”  She says that we become more resilient as we age since “we become increasingly confident that we will be able to bear whatever befalls us.”  It becomes easier to go through the grieving process because we have an idea of how long it will take and we know that we will make it through.

Although Lustbader feels that many of our relationships may improve with age, her optimism doesn’t mask reality.  She gives the example of siblings who no longer speak to one another.  As she puts it, “nothing is guaranteed between siblings–neither friendliness nor allegiance.”  The process of aging can, however, heal old wounds.  Lustbader says that relationships between couples can improve because couples who’ve been together a long time learn how to “resolve their conflicts more easily and leave less of a hurt residue.”

In her essay about stories, she stresses the importance of finding the “right kind of listener”–someone who takes the time to listen and who doesn’t interrupt.  This essay might be a useful one to share with the less patient listeners in your life.  The young may not value the telling of stories, but it is so important that our stories be heard that a stranger may become the best audience.  Why is storytelling important?  If our stories are painful, telling them can help us heal.  As Lustbader puts it, “Turning an onerous event into a story changes it into something we can bear.”

One of the greatest fears we have about aging is becoming dependent on others because of lessened physical ability.  Lustbader discusses the value of learning to accept help from others.  She gives the case of a woman who was going blind, so she gave away her books to friends, keeping only a few.  Some of her friends began weekly visits where they read to her.  By sharing the books with her friends in this new way, the accommodation made for her disability brought both her friends and her new joy.

From the first essay, I kept thinking of people I wanted to give a copy of this book to.  An essay about how difficult the twenties are compared to later life would be perfect for my daughter or a young male colleague;  Lustbader’s writing about gratitude and acceptance would be valuable for my mother.  It took me longer to read the book because I found so many quotations that were applicable to my life or that of others. 

The book is not only beautifully written, but because the perspective is so useful, I found myself wanting to lead a group of senior citizens in a discussion group about the book.  Each essay could provide a focus for healthy group discussions. What would a group of seniors feel about this quotation, from the essay on giving and receiving: 

“Life improves when we attend to our interdependence… Those who do not miss a chance to make life easier for someone else wake up each day with eagerness and have less fear about their own future.”

How would a group feel about her statement that “we must move through difficulty rather than try to get around it if we wish to be strengthened by life experience”?  Does life really get better as we age?  After reading Wendy Lustbader’s book, I’m inclined to agree with her that, in many ways, the answer is “Yes.”

Life Gets Better: The Unexpected Pleasures of Growing Older 
by Wendy Lustbader
Hardcover: Tarcher
256 pages, $16.77

In Resilience: How Your Inner Strength Can Set You Free from the Past, Cyrulnik speaks of those he has worked with who grew up as orphans, were abused or forced to fight in wars and who later transformed their lives through resilience to emerge as remarkable individuals.

Cyrulnik discusses studies done in neuroscience, psychology, and genetics supporting the idea that resilience — the positive capacity of people to cope with stress and adversity — can provide the basis through which people subject to childhood trauma can later become socially integrated and highly successful. As Cyrulnik says in providing a definition, “To put it more simply, resilience is a sweater knitted from developmental, emotional, and social strands of wool. That is why it is more helpful to describe the history of a resilient personality.  We can then try to understand how it dodges the strokes of fate and still contrives to use solid supports in order to knit itself.” 

He later writes, “The purpose of this book was simply to say that there is such a thing as resilience.  Resilience has a form, and there is a price to be paid.”  Resilience: How Your Inner Strength Can Set You Free from the Past is a heart-opening, brilliant work of hope and understanding.  The book is written for all of us, because, as Cyrulnik says, “… we are all resilient and because none of us has the good fortune to avoid pain completely.”

Psychological resilience, the dynamic process that individuals exhibit positive behavioral adaptation when they encounter significant adversity, trauma, tragedy, threats or even significant sources of stress, has had research findings published since 1973. What is outstanding in Cyrulnik’s Resilience, and used as criteria in measuring it, is both his revelation of otherwise uncovered statistics and his many personal stories describing resilient individuals.

Cyrulnik begins his introduction with, “Misfortunes are never wonderful. But when an ordeal does come, do we have to succumb to it? And if we fight it, what weapons do we have?” Cyrulnik points out that resilient children, undergoing trauma, often begin to use an internal defense mechanism at an early age.  This may involve the splitting of the ego into a socially acceptable and a more hidden, unspeakable side that, while held secret, nonetheless reveals itself in roundabout ways. The hidden side spurs the development of the imagination and abstraction.

Cyrulnik describes this splitting:

“Abstraction forces us to discover the general laws that allow us to defeat or avoid our enemies, whereas the absence of danger induces intellectual numbness.” 

But splitting, while arising with the development of dreams and abstraction, also suffers the cost of keeping the individual from being whole, with all of the resulting, often chronic stress.  Healing comes usually long after childhood, when the individual can later “knit” his or her own personal story meaningfully into the social and cultural story of the given place and time.

Cyrulnik explains, “Any memory is a dialogue between what our environment has implanted deep within us and what we want to reveal about ourselves to others. A story is a verbal representation that recounts a series of significant events. Telling our story creates a coherent feeling of selfhood.  It reconciles the two parts of the divided ego. The socially acceptable ego can at last tolerate the secret ego that cannot be talked about. The subject can at last talk about himself and express himself as a totality.”

In his conclusion he writes, “This is how resilience is knitted. Resilience is not just something we find inside ourselves or in our environment.  It is something we find midway between the two, because our individual development is always linked to our social development.”

Resilience does more than fulfill the purpose Cyrulnik stated for writing his book, which is simply to state that resilience exists. Cyrulnik shows that ”… the feeling of selfhood, which is shaped by the gaze of others, can be reshaped and reworked by representations, actions, commitments, and narratives.” While resilience is a defense mechanism, it is more conscious and more malleable than other defense mechanisms and can thus be shaped and reworked to bring us happiness.

It is through retelling our own personal stories that we reshape our feeling of selfhood and develop our own resilience.  Resilience reconciles the two parts of the divided ego, until the subject can at last speak of herself as a totality.  Cyrulnik’s masterful retelling and examination of stories shows us that not only may tragic circumstances not destroy us but can in fact be the basis from which we may blossom.

Resilience: How Your Inner Strength Can Set You Free from the Past
By Boris Cyrulnik
Tarcher: February 17, 2011
Paperback, 320 pages
$14.95

The book is divided into three parts. In the first section, O’Rourke takes the reader on an emotional tour of her mother’s diagnosis, doctor’s appointments, treatment and finally, to her mother’s death. Within this, the author reflects upon different aspects and events in her life, especially of happy moments with her mother and family. In this section, as well as within the other chapters of the book, she revisits her relationship with the mother she had pre-cancer and the mother she had post-diagnosis, with tests, radiation, chemotherapy and experimental treatments. Leading up to her mother’s death the reader experiences the author’s own anger, disbelief and avoidance of the fact that her mother is going to die. Sometimes O’Rourke is angry and not particularly likeable; sometimes she is sympathetic and grateful. But this pattern mimics grief, which is not always so clean-cut. While the reader knows that O’Rourke’s mother dies, the style, the sentiment and the rawness with which O’Rourke writes of her mother’s death moved me, as a reader, to tears.

In the second and third parts of the book the author focuses on her search for answers and an understanding of her grief, of how she relates, or doesn’t relate, to the rest of the world — to her peers, friends and former partners — of how she now moves through the world differently, for something to adequately explain her pain and for a ritual in which to mourn.  On this quest, she reads book after book on religious traditions, mores and customs on grief and mourning, finding information, but nothing completely satisfying. Within her memoir, she also searches through many literary and scholarly works in an attempt to relate to her findings.

One of the earliest “consolations” and theories with which she relates is that of Colin Murray Parkes. He states that one “searches (illogically) for a loved one after death.” What resonated with O’Rourke’s experiences was that many people go through a period of searching for the dead person in objects, animals and the environment; O’Rourke finds herself searching for her mother in nature, in the trees, and specifically in the wind. The author likens the need to find her mother in things to having to say the person is dead, but not having to believe it. She describes being self-conscious about her grief, about her desire to talk about her mother, of feeling off-balance, insecure and longing for a sense of connection. As illustrated in the book the author describes the lack of discussion about her loss among friends and family as taboo, as if not talking about the loss will somehow change things, and because of this she becomes distant and resentful.

Another concept that the author mentions is Elisabeth Kubler-Ross’s theory on the five stages of grief: denial, anger, bargaining, depression and acceptance. Ross’s theory is that the bereaved move through these five stages, in order, as part of the grieving process. In her opinion and based upon her experiences, O’Rourke believes they are not stages, but states, that do not progress in sequence, but rather in a “messy process.” It appears to me as a reader that in her search for answers the author is looking for one answer to everything, yet she finds small concepts with which she can relate to for some things. She explores the mono- and polytheistic religions as a means of drawing out meaningful mourning rituals which ultimately, leaves her craving something to call her own and to guide her through her own loss.

In examining her own death, O’Rourke again turns to religion, philosophy, history and other literary texts to see how death was viewed and to draw conclusions about understanding of her own mortality. Historically, she discovers that at one point, to the Romanticists, death was something of beauty, something shared by the community and that, while feared, something that people once looked forward to. It is through this reverence of death that a fear of death also grew. In her research she comes to somewhat of a conclusion as to why this is: that death and dying was once part of a community process; the members all practiced rituals together and assisted the bereaved.

Also compelling is her discussion of present-day society’s handling of grief, how it has become a private, lonely, silent passage unlike the rituals of the past. O’Rourke is not religious, but she admits to an “intuition of God,” an attraction to spirituality, and concedes near the end of her book that she did feel the interconnectedness of things and that there is something out there. “If the condition of grief is nearly universal, its transactions are exquisitely personal.”

The closest thing to which she can ascribe her experience is through Virginia Woolf’s memoir, Moments of Being:

From this I reach what I might call a philosophy; at any rate it is a

constant idea of mine; that behind the cotton wool is a hidden

pattern; that we- I mean all human beings- are connected with this;

that the whole world is a work of art; that we are parts of the work

of art. … Certainly and emphatically there is no God; we are the

words; we are the music; we are the thing itself. And I see this

when I have a shock. … There is a pattern hid behind the cotton

wool.

O’Rourke writes exquisitely of her intellectual and emotional experience with grief. While reading and knowing that her grandmother, her mother Barbara’s mother, is still alive, I wondered what her grandmother must be experiencing while watching her daughter die. It is not until the very end of the memoir that this is explored.

Throughout this book the author searches for relief in ritual form and it is here, when O’Rourke describes the spreading of her mother’s ashes, that she realizes the family has created its own rituals for dealing with the loss. With passion, humor and sometimes despair, she confronts the grieving process.

Having read this book, and at times feeling like part of the family, I felt more comfortable and compelled to talk with my friend who suddenly and unexpectedly lost her mother. Through the author’s descriptions of feeling lost, as an “outsider” and as if she were carrying around a secret, I promised myself that I would do whatever I could to help my friend not feel so alone and isolated. While O’Rourke gives insight into what the bereaved may be feeling, grief differs with each individual regardless of what psychologists may have concluded.

This book is passionate and raw as well as poetic and I highly recommend this to anyone regardless of whether they have lost someone close to them.

The Long Goodbye: A Memoir
By Meghan O’Rourke
Riverhead Books: April 14, 2011
Hardcover, 320 pages
$25.95

Jill Bialosky tells the story of her sister Kim Bialosky’s suicide. She shares events of Kim’s life, Kim’s diary entries and conversations she had with her sister before she took her own life. As the author is telling the story of her sister’s suicide, she also takes the reader along a journey to find answers on what leads some people to take their own lives. The book starts out with the author telling the reader how her younger sister took her own life.

On April 13, 1990, Jill Bialosky’s younger sister, Kim called to wish her a happy birthday. Two days later, after a night out with her girlfriends, Kim took her own life, asphyxiating herself with carbon monoxide in her mother’s garage. A local boy who took care of her mother’s yard found her body.

Aching to understand why and how her sister lost the will to live, Bialosky interweaves family history, literature (Shakespeare, Dante, Melville, and Plath appear frequently), medical writings, and Kim’s own journals. The very nature of suicide, the author notes, is as elusive as the great whale Moby Dick, and her writing reflects that slipperiness, circling in and out of memories and emotions.

The portrait Bialosky presents of Kim is a vivid one: a sweet little girl surrounded by adoring older sisters, a sensitive teenager longing for her absentee father, and finally, a broken young woman who, as she wrote in her devastating suicide note, got ”tired of being lonely.” There are times when Bialosky’s pain is almost unbearable (shortly after Kim’s death, she lost two babies), but she’s never maudlin. She writes so gracefully and bravely that what you’re left with in the end is an overwhelming sense of love.

Jill Bialosky also tells of her sister’s use of alcohol and drugs and an abusive boyfriend. (Five years later the boyfriend committed suicide as well). As Kim strove to find answers to a happy life, she was also struggling to help her mother cope with depression and loneliness. Jill and her other sisters repeatedly attempted to counsel Kim to leave their hometown and change her life for the better. However, Kim never managed to escape and only dug herself deeper into emotional pain.

As Bialosky researches suicide, she provides feedback from several professionals, statistics from psychiatric journals and facts about suicide attempts. The author’s purpose here is to let the reader know that not only is she sharing her and her family’s personal experience, but also trying to give the reader information from various publications. Jill Bialosky studies family genetics (her mother’s depression), environmental factors (absent father), and emotional support (Kim not seeking professional help). With all the information that Bialosky includes in her memoir, I was fascinated by some of the connections she makes with her sister’s suicide. Would Kim have taken her own life if she saw more of her father, if her mother had not suffered from depression, and if she had sought help? It is hard to say; however, the author makes some very convincing arguments.

One of the ways Jill Bialosky chose to cope was to attend different bereavement groups. She shares other people’s personal experiences with dealing with a loved one who commits suicide. She is very detailed about the surroundings in the meeting rooms, stories shared by others and what her conclusions are from attending these meetings. It is simple: “There are no answers,” she says. “We only say we are sorry. Sometimes it is all we can do. But it is something. It is not nothing.” (Bialosky, pg. 234)

Throughout this book I feel like Kim is speaking directly to me. With her stories, personal diary entries and the conversations with her sisters, the author convinces the readers that no matter how others feel about suicide, we must understand that when a loved one takes his or her own life, they should be forgiven and their memories should be cherished. We can always look for clues or watch for warning signs coming from someone who is contemplating suicide and take action. However, when someone has decided to take his or her life, one can only hope that they have the tools to cope at that moment.

From personal experiences, I can understand those moments when someone might decide that they can no longer cope with personal emotional pain. However, with strong emotional support a person can seek help at those low moments in their lives.

I found this book to be educational, thought-provoking and very emotionally deep. I highly recommend this to anyone who wants to understand human nature.

History of a Suicide: My Sister’s Unfinished Life
By Jill Bialosky
Atria Books: February 15, 2011
Hardcover, 272 pages
$24

Elisabeth Kübler-Ross, author of On Death and Dying, published in 1969, identified five stages of grief:  denial, anger, bargaining, depression, and acceptance.  Okun and Nowinski associate those stages with “traditional grief.”  However, because of modern medicine’s increasing ability to prolong life in the face of impending death, a “new grief” has been born as the terminally ill and their families are now living with death for longer periods of time.  In what the authors refer to as a template or road map, Saying Goodbye leads these families through five stages of the new grief:  crisis, unity, upheaval, resolution, and renewal.  They believe that while there will be “no hard-and-fast boundaries separating these stages,” it is likely you will be “dealing with issues associated with more than one stage at any given time.”

Beginning with the diagnosis of a terminal illness, what is then experienced is largely dependent on how the patient responds to the diagnosis, family members’ relationship to that person, and the roles each family member has assumed in the past and may in fact still play.  Family dynamics is the evidentiary thread of continuity in Saying Goodbye as to how well the diagnosis is or is not dealt with, and how positions of responsibility within the family for different aspects of the ill person’s healthcare and legal matters are decided and managed.  If healthcare directives and legal documentation such as DNRs (do not resuscitate), powers of attorney, etc., are not already in place, families can find themselves in a highly emotional environment that is not conducive to making decisions clearly.

Life has meaning.  Crises are normal.  Crises create opportunities.  We can survive.  Death has meaning. In a chapter on resiliency, these attitudes are indicative of a resilient family, one that may be better equipped to face the challenges that come with a terminal illness.  A fragile family, in contrast, may find it difficult to even consider them to be something in which strength can be found.  While certainly beneficial to both kinds of families, it seems that Saying Goodbye may be most helpful to those whose delicate family dynamics might hinder or even prohibit sound decision-making.

Because they are based on personal experiences, what may be an especially invaluable resource for families are the many stories of individuals that are shared throughout the book.  In some cases, very specific personal reflections on what they wish they had known or done are also presented and may be the most telling of what a family member goes through.  These perspectives both from patients and family members may cause readers to reflect on their own situations as they pertain to quality and end-of-life plans.  If you have not already done so, you may even find yourself thinking very seriously about addressing these things now while failing health is not an issue.  Owing in part to the family therapy approach of Saying Goodbye, there is a great deal of information contained within its pages that can help to bring families closer on numerous levels and perhaps help them communicate more effectively regardless of whether a terminal illness is involved.

The end of the book provides several pages of websites for coping with the issues surrounding terminal illness and include general topics, grief and support, hospice, funerals, medical issues, specific diseases, counseling and therapy, services for veterans, and legal issues.  Although there will be many times when research and reading may not be on a family’s priority list of things to do, those to whom the diagnosis of a terminal illness has been delivered may want to invest in copies of this book as one of the first resources they can access for insight and direction.  Better yet, the physician who shoulders the unenviable task of delivering that news may want to do so with a copy of Saying Goodbye in hand, thereby providing the family with a head start in navigating the family, medical, and legal twists and turns they will inevitably encounter.

Saying Goodbye:  How Families Can Find Renewal Through Loss
Berkley Books
336 pages
Hardcover, $17.79

In the first of three sections, O’Rourke recounts her mother’s colon cancer diagnosis, her deterioration and eventual death on Christmas Day, 2008. Growing up in a tight-knit family with two younger brothers, O’Rourke had a very close relationship with her mother, which changes and grows deeper as she tries to support her through the disease.

The bulk of the book focuses on how O’Rourke tries to deal with her overwhelming grief (and to an extent her family’s) and how our culture mourns (or lack thereof). She also shares tender childhood memories and various slices from her life as she adjusts to life without her mom.

To help her make sense of her grief, O’Rourke turns to grief literature and research. She draws on everything from Shakespeare’s Hamlet to Tennyson’s memorial for his close friend Arthur Hallam to Emily Dickinson’s “I Measure Every Grief I Meet.”

She also dispels the myth of Elisabeth Kübler-Ross’s five stages and shares interesting research findings, which help readers better understand grief and how it functions. For instance, she cites Erich Lindemann’s study, the first-ever systematic survey on grief, which revealed grief’s physiological symptoms. Lindemann defined grief as:

“sensations of somatic distress reoccurring in waves lasting from twenty minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an empty feeling in the abdomen, lack of muscular power, and an intensive subjective distress.”

O’Rourke then adds:

The experience is, as Lindemann notes, brutally physiological. It literally takes your breath away. Its physicality is also what makes grief so hard to communicate to anyone who hasn’t experienced it.

She also notes how grief washes over us in waves.

Some researchers say grief comes in waves, welling up and dominating one’s emotional life, then subsiding, only to recur—an experience I recognized as my own. As George A. Bonnano, a clinical psychologist at Columbia University, has written, “When we look more closely at the emotional experiences of bereaved people over time, the level of fluctuation is nothing short of spectacular.” This oscillation, he theorizes, offers relief from the stress grief creates. That made sense. I thought of one of the lines from Lewis’s A Grief Observed: “Sorrow…turns out to be not a state but a process,” he wrote. “It needs not a map but a history.”

I lost my father almost two years ago and my grandmother five years ago—devastating losses that I, too, feel in waves. I was particularly struck by the feeling that O’Rourke was writing my story, my thoughts, my anxieties. That she deeply understood my pain and, to an extent, the wounds I carry. I found comfort and solace in her ability to capture grief with such honesty and vulnerability, as I think others will.

Not surprisingly, The Long Goodbye is at times a difficult book to digest. There are many heart-wrenching parts, particularly when O’Rourke is describing her mother’s decline and passing. These are hard to read without getting emotional yourself.

What will no doubt also resonate with readers are O’Rourke’s insights on grief and mourning. Even if you haven’t experienced grief yourself, her passages will help you better grasp it. For instance, she writes of the fresh pain that her mother’s passing will bring throughout her life:

The moment when I flash upon my mother’s smile and face and realize she is dead, I experience the same lurch, the same confusion, the same sense of impossibility. A year ago collapses into yesterday in these moments. Periodically for the rest of my life, my mother’s death will seem like it took place yesterday.

In another passage, she writes about time’s inability to truly heal, contradictory to the common belief in our culture:

People kept saying to me, “It gets better at a year, doesn’t it?” Or, “I hear it gets better at a year.” It did. It got “better” in that I could go on for days without thinking too much about the fact that someone I still loved as dearly as I ever did was dead. But to expect grief to heal is to imagine that it is possible to stop loving, to reconcile yourself to the fact that the lost one is somewhere else. So heal isn’t the right word. I love C.S. Lewis’s metaphor: A loss is like an amputation. If the blood doesn’t stop gushing soon after the operation, then you will die. To survive means, by definition, that the blood has stopped. But the amputation is still there.

O’Rourke also captures the difficulty of experiencing first events without your loved one, when their absence is especially sharp and sad.

…Now, in Montauk, when the reek of saltwater and fish hit me, a wave of understanding swelled: My mother no longer exists.

…Grief requires acquainting yourself with the world again and again: each “first” causes a break that must be reset. I knew, already, that the next time I visited the ocean, I would not be gutted like this. In this sense, my mother’s death was not a single event, but a whole series of events—the first Easter without her; the first wedding anniversary without her; the first time Eamon, who has epilepsy, had a seizure and she was not here to calmly take charge. The lesson lay in the empty chair at the dinner table. It was learned night after night, day after day.

And so you always feel suspense, a queer dread—you never know what occasion will break the loss freshly open.

Losing a loved one often means losing your footing in the world. It means navigating a whole new world. Even more so, losing a parent (or close caregiver) can feel like you’ve lost a sense of security and protection. It requires that you figure out your new role in a world without them. O’Rourke grapples with this as well. After losing her mother, she feels a deep sense of “aloneness,” of being “motherless.” She also starts taking on the role of caretaker and worrier in her family (“Part of my new role is to worry.”).

While The Long Goodbye focuses on O’Rourke’s experience with loss, her stunning memoir deals with universal themes and struggles. It is an insightful, thoughtful, raw and beautiful read, where the author lets readers into her heart. As she mourns her beloved mother and processes her grief, readers may very well do the same with their own painful losses.

For the last handful of years, Britain and the United States have done quiet experiments with a new form of therapy for veterans suffering from combat stress, using a resource neither nation lacks along their coasts: surf.

“Ocean therapy,” or surf therapy, will surprise longtime surfers mainly because of the official-sounding name; the idea that an ocean and a surfboard can be good for the body and mind is otherwise not very new.

But recent studies have tried to quantify just what happens in the water.

The United Kingdom’s National Health Service is still conducting trials in Cornwall, where waves wash in from the Atlantic, to determine whether “surf therapy” deserves taxpayer support. The idea caused outrage at the Daily Mail, where outrage is a business model.

“It’s important that the NHS uses its funds for medicine and equipment rather than watersports,” a British taxpayers’ advocate, Fiona McEvoy, told the Mail late last year. National Health defended the trials on the grounds that they were cheap — £250, or about $400 per person — and aimed at saving money on demand for antidepressants and other drug therapies.

But the U.S. Marines Corps has also worked “ocean therapy” into its post-traumatic stress disorder treatment regime. Until recently, Lt. Col. Greg Martin commanded the so-called Wounded Warrior Battalion West at Camp Pendleton. “Anything a guy really enjoys” will ease combat stress, he says, “but there’s nothing like surfing to touch the mind, the body and the spirit all at the same time. And that’s our approach in the Marine Corps, we have a whole-Marine focus, so it’s not just the medical side.”

The nonprofit Jimmy Miller Memorial Foundation developed the program of ocean therapy that the Marines use; the foundation sends therapists and surf instructors to Camp Pendleton every two or three weeks.

One reason it works, says Jim Miller, father of Jimmy and founding member of the board, is that surfing can wear out a vet so much that he sleeps. Miller tells a story about one Marine who turned up for a surf lesson with a number of problems, including insomnia. “This guy couldn’t sleep more than three or four hours a night, and he was on heavy medication,” Miller said. “But after his first session in the water, he slept for eight hours — without drugs.”

Carly Rogers, the occupational therapist who developed the program for the Jimmy Miller Foundation, says surf lessons in the water and group therapy afterward on the sand are meant to shape other parts of a patient’s life. “By achieving this goal [of learning to surf],” she says, “in this dynamic environment where they’re broken down to nothing [in the ocean], they’ll learn to be self-sufficient in other areas.”

Her program is based on Mihaly Csikszentmihalyi’s flow theory, which argues that a person learning to be “in the zone” — a joyful, focused, un-self-conscious state — can learn to be happy. And a microbiologist in Munich, Ulrike Schmidt, who runs the lab at the Max Planck Institute, isn’t surprised. She’s studied minute physical changes caused by post-traumatic stress, and she says it makes sense that surfing might help change the chemistry and structure of a veteran’s brain. “We already know that moving your body is fundamentally good for healing,” she says. “And there’s evidence that through movement and physical effort you can encourage metabolic processes in the brain.”

Which is not quite how the vets themselves describe it. For them, the intense focus and strenuous work in the water tends to take their minds off whatever haunts them.

“In combat,” one L.A.-area vet named Louis Scott explained to me, “you look to your left and you look to your right, and you’re always worried about your brother. In the surf, you look to your left and you look to your right,” he said, “and you’re out there with your brothers. And yet you’re havin’ fun.”

Photo courtesy of Wiki Commons.

Distraught and shaken after Anne-Marie’s passing, Sankovitch plunges herself into life, promising to live for both herself and her beloved sister. She writes:

I was scared of living a life not worth living. Why did I deserve to live when my sister had died? I was responsible now for two lives, my sister’s and my own, and damn, I’d better live well. I had to live hard and live fully. I was going to live double if my sister couldn’t live at all. I was going to live double because I had to die, too, one day, and I didn’t want to miss anything. I set myself to a faster and faster speed. I drove myself through action and plans and trips and activities. I wanted to make my parents smile again and keep my kids from thinking about death. I wanted to love Jack and walk for miles with Natasha. I had to make up for everything that everyone around me lost when Anne-Marie died.

But after three years of full-speed-ahead living, Sankovitch realizes “I couldn’t get away from the sorrow.” So she turns to books for comfort—something she’s done her entire life as an ardent reader. And even more so, she turns to books for answers to the gnawing questions: “…of why I deserved to live. And of how I should live.”

She starts the first book on her 46th birthday and decides to read the books that “I would have shared with Anne-Marie if I could have, ones that we would have talked about, argued over and some we would have agreed upon.” (Interestingly, in several of the books Sankovitch selects, she sees Anne-Marie in the strong, resilient characters.) She also starts a website called ReadAllDay.org to publish her daily reviews. (Yes, in addition to reading a book a day, she also reviews it!)

Sankovitch hopes that her year of reading will become an “escape back into life.” She searches these books for meaning and lessons on loss, life and healing. She also makes connections between the books and her own life, including memories of Anne-Marie and her childhood, past loves and even the tragedies her parents experienced in war-torn Europe. (These are especially stirring.) These memories are essentially sprinkled throughout the book, and appear more like anecdotes than a structured memoir.

Sankovitch writes eloquently about the life lessons she gleans from her many books. For instance:

The Emigrants is not a happy book, but it is a book absolutely resounding with life. If I put my finger on any page of the book, I felt the pulsing heartbeat of the lives Sebald recorded. It is the heartbeat he gave back to them, making them real for me. “Remembrance” for me means remembering someone with love or with respect. Remembrance is acknowledging that a life was lived. Sebald’s book is remembrance of four lives.

I was in my forties, reading in my purple chair. My father was in his eighties, and my sister was in the ocean, her ashes scattered there by all of us in swimsuits under a blue sky. And only now am I grasping the importance of looking backward. Of remembrance. My father finally wrote out his memories for a reason. I took on a year of reading books for a reason. Because words are witness to life: they record what has happened, and they make it all real. Words create the stories that become history and become unforgettable. Even fiction portrays truth: good fiction is truth. Stories about lives remembered bring us backward while allowing us to move forward.

She also writes beautifully about the joy of books. One of my favorite passages:

Books are experience, the words of authors proving the solace of love, the fulfillment of family, the torment of war, and the wisdom of memory. Joy and tears, pleasure and pain: everything came to me while I read in my purple chair. I had never sat so still, and yet experienced so much.

Tolstoy and the Purple Chair is filled with poignant parts — like the ones above — but some sections do feel slow, tedious and as though they skim the surface of Sankovitch’s life without delving deeper. As mentioned above, because the memoir is a collection of memories, it feels as though the reader is getting slices from her life instead of a full course meal. Some sections also read cliché and even saccharine. Plus, the book is repetitive: Sankovitch brings up the same insights throughout, so the book probably could’ve been shorter.

How you feel about the book may depend on your expectations: Don’t expect to read a complex or deep memoir or a book solely celebrating books. Tolstoy and the Purple Chair is basically a blend. With the focus on healing from her sister’s passing, Sankovitch mixes memories with lessons and wise words from her many books.

But while the book has its limits, it offers timeless wisdom, is uplifting and has a powerful message: “The only balm to sorrow is memory; the only salve for the pain of losing someone to death is acknowledging the life that existed before.” It will no doubt become a salve for sorrow to the many readers who’ve lost loved ones.

One great resource is the Grief Support Services of the Samaritans of Boston. They recently conducted an interview with Dr. Jack Jordan on the topic of grieving a loved one who has committed suicide. Dr. Jordan is a licensed psychologist in private practice in Pawtucket, Rhode Island, and Wellesley, Massachusetts, where he specializes in working with loss and bereavement. He is coeditor of the 2011 book Grief After Suicide (Routledge) and the Clinical Consultant for Grief Support Services of the Samaritans of Boston (www.samaritanshope.org), where he is helping to develop innovative outreach and support programs for suicide survivors. I have obtained permission to reprint the interview here, specifically for Psych Central readers.

Q. Your book notes that “suicide survivors” can include people who are not on close terms with the deceased. Can you explain?

A. Immediate kin are the most likely to be affected, but it’s not just them. It could be a next-door neighbor who saw the person every day. Or a subway train driver could be traumatized after someone jumps in front of a train. Or a high-school student may have had no personal relationship with another student who died by suicide, but may have somehow identified with that person. In general, a survivor is anyone who felt responsible for the death or for not preventing it, or who was deeply and negatively impacted by the death.

Q. How is grief after suicide different from other kinds of grief?

A. It depends on what aspects of grief you’re talking about. After any type of death, there is a yearning for the deceased. After sudden death, there is shock or disbelief; people have trouble accepting the reality of the death. After a sudden, unexpected, violent death (such as a homicide or suicide), people focus on the horror or trauma of the death. There is a preoccupation with, “What did my loved one go through during their final moments?” But with suicide, there is a whole struggle with, “Did they know what they were doing? Why did they choose this? Didn’t they know how much this would hurt me?”

Q. How does the stigma that’s associated with suicide affect suicide survivors?

A. Many societies have ostracized, shunned, or punished the family of the person who died by suicide. In the developed world, that’s beginning to be replaced by social ambiguity. As mental illness becomes increasingly destigmatized, people may not condemn someone who died by suicide, but suicide creates much social awkwardness. Many people hold back because they don’t know what to say to someone who has lost a loved one to suicide. For example, they may wonder if it’s okay to mention the person’s name or use the word suicide. Also, survivors can self-stigmatize because of their own guilt and shame. So it becomes a vicious cycle. People don’t know what to say or do, so they avoid the “elephant in the room.”

Q. Your book discusses research suggesting that support groups for suicide survivors may be particularly helpful. Why do you think that is?

A. There has not been much research on suicide survivors, and most of it has involved people in support groups, so it’s a self-selected sample. That being said, I’ve found in my own research and practice that contact with other survivors can be very helpful. It counteracts a sense of stigma and isolation. Participants learn from each other about coping skills. And people may have a better chance of getting an empathic response than they would in their usual social networks. A woman who has lost a child to suicide may find that talking to another mother offers more comfort than talking to her own husband. There’s also a role modeling effect: New survivors need some inspiration or hope that they can survive this tragedy.

Q. Your book profiles several programs that support survivors, both here in the United States and around the world. What common threads do you see in these programs?

A. In the United States, most support groups are led by survivors. In Europe and Australia, they are more professionally led. All involve bringing survivors together to talk to each other. Many provide information about psychiatric diseases, suicide, and grief. Cutting-edge programs are reaching out proactively to new survivors: First responders such as emergency medical technicians and firefighters may have brochures about support services, and funeral directors and clergy people may know about such services. And new programs being developed include teams of trained volunteer survivors who will visit with new survivors in their homes, rather than survivors having to make an appointment with a therapist or find a group to attend.

Q. Many people might think that working with suicide survivors would be depressing. What keeps you going?

A. I see people get better. The people I work with have had something terrible happen to them, but they also have a lot of resilience, which is inspiring. In addition, I have a strong sense of my own spirituality. When I was younger, I considered going into the ministry, and I see my work as a type of ministry. Suicide raises profound religious and philosophical issues, and I feel like I’m working at the spiritual edge of life. Walking with people at this very difficult time in their life, and seeing that help make a difference in the healing process of many survivors, is very personally satisfying to me.