Julia Samuel, psychotherapist and author on bereavement and grief

Julia Samuel, psychotherapist and author on bereavement and grief

We spoke to eminent psychotherapist and author Julia Samuel to learn more about her approach to grief and bereavement.

A conversation with Julia Samuel

We spoke to Julia Samuel for episode 21 of the Art of Dying Well podcast. The context of the conversation was thinking about grief and bereavement particularly during the month of November. Julia spoke to James Abbott in October 2020 during the Covid-19 pandemic. Listen to the Art of Dying podcast episode 21.

Q. I’m really pleased to say I’m speaking to psychotherapist, author and speaker Julia Samuel. I’ve been reading your books (Grief Works, This Too Shall Pass), and one simple phrase you mention very early on, stuck with me throughout, that life is change, something we’re not always great at managing. And I think particularly so in these times with Covid-19. Death, of course, is change too, and I wonder why we’re so hard on ourselves in terms of how we cope with this very human process?

A. “I think it’s a combination of things. I think particularly in modern life, where we have so much speed and sense of efficacy with our smartphones and digital life, that it gives us a false sense of our own agency in our mortality. That we ought to be able to fast-track or have a sort of super amazing app inside ourselves to adjust to bad news, to change, and that somehow we’re doing it wrong if we’re not coping well.

“And really pain is the agent of change, depending on how big the change is, if it’s a mild one, it’ll be mild discomfort. If it’s a huge change, like the death of someone significant in your life, that will be equalled by the amount of pain in your life. Because when we’re puttering along and everything is comfortable, we have no desire or need to change. So it is only the signals of pain in our bodies that force us to face this new reality – whatever it is that we didn’t choose – that forces us to adapt.

“But we are wired to adapt. And it’s the things that we do to support us as we adapt that enable us to go through that process. And the things that we do to block it, to block the pain are often the things that do us harm over time, through our lives.”

Q. I think you’re absolutely right that we’re wired to adapt, which is why Covid-19 in a situation of isolation is so difficult, because we are human, we are relational. And some of those things which we might find difficult – being at the bedside accompanying someone who’s dying – are all the more difficult because it might be through a screen or with that sort of disconnect. So we’re wired up to be connected and yet we’re disconnected. How do you think that’s affecting not only the journey of accompanying, but the journey of bereavement? 

A. “I think social distancing are the chilliest two words in our lexicon right now because when we look at bereavement, whether it’s a living loss, which most people are experiencing through Covid-19, or a loss from death, a bereavement, it’s the love and connection to others and the support that we get at the time, and after the loss, that predicts our outcomes.

“Because when love dies or when something big happens, we’re wired to socially connect, we’re evolutionarily wired to be in a tribe and connect and support each other. People need people. We need them in good times and we really need them in bad times. So I think not physically being with each other – people are talking about being bodiless and not having touch – I think that does have a physiological impact which raises our fear levels.

“And then when our fear levels are higher, there’s more cortisol, we go into fight or flight. We can go into a loop of feeling more frightened, getting more cut off, then doing bad behaviours, not being able to think properly. And then, of course, it lowers our immune system because we’re on a kind of alert all the time.

“On the other hand, the fact that we do have technology; so I can see people’s faces, I can still work online, I can see my children in different countries, we can have access to webinars and information in a way that was unthinkable even 10 years ago, there is connection, it just is a very different connection. And if it’s the only connection – if you live alone and have to shield if you’re vulnerable – it is certainly better than nothing. But I think there’s going to be a price to be paid in mental health throughout the world for people who don’t have connection to other people, physical connection.”

Q. Yes, absolutely, and then there’s the grieving process – no one necessarily likes funerals, but nonetheless it is a ritual that helps us cope, helps us say a final goodbye – it’s a mechanism we’ve got used to as a final farewell. And now that is obviously seriously restricted. So is this making our grieving process that much harder at the moment?

A. “Oh it makes it much harder. I think how somebody dies – and most Covid-19 deaths are sudden and unexpected – I don’t think you can measure one death as worse than another death, I don’t think there is a hierarchy, but with a sudden and unexpected death, what we talk about is that you have ‘grief with the volume turned up’. So all the normal kind of feelings of grief, of fear, of shock, of sadness, of despair, a fury, all of those are intensified with a sudden death. And many were witnessed on Zoom, with not being present.

“And then, of course, all the rituals that you’d have, of people coming round, of having a memorial where all the people that love the person that died and you gathered together, all of that has either been stopped or very depleted. And so most of the people that I talk to, they feel that their grief has been suspended, that it’s sort of on hold.

“The first task of mourning is to face the reality of the loss, and if that reality – where you haven’t sat beside the person, you haven’t held their hand, you haven’t had the opportunity to say that you love them to say goodbye – but you’ve seen it on a nurse’s iPad, it’s sort of like watching it on telly. It is totally surreal.

“I think people are more likely to be traumatized because they’ll have the looping images of what they saw, but none of the comfort of having been there. And one of the big aspects of grief that derails a grieving process are regrets; the things that you didn’t know; the things that you didn’t see; the opportunities you couldn’t have and can never go back and put right. And of course the opportunity for that with a sudden death, when you’re not present, is much, much greater.

“The majority of the deaths have been in the older population, where there’s been many in couples that have long, long marriages, of decades long. The partner, the surviving partner – because they’re older and more vulnerable – they can’t have family members with them, so they’re on their own after, say, a 50-year marriage. Watching it on Zoom, I mean, that is completely crazy-making. I spoke to one person who watched her husband die on Zoom and then had a Zoom funeral. With a 50-year marriage, the psychological craziness of what that does to you, and how you find a way of coming to terms with that and supporting yourself through it, is unimaginable.

Q. What, can you say to that particular person, who’s experienced that massive disconnection after decades of marriage? I mean, I have no idea, I’m not a trained psychotherapist, but what can you say to somebody like that? 

A. “I think there’s a number of things. First of all is to acknowledge how devastating that is, how shocking, how traumatizing. To stay and be with them in this sort of surreal place by acknowledging it, allows them to recognize they’re not doing it wrong, or making a fuss –  that generation particularly feel like ‘I should be okay’, they’re quite a stoic generation.

“And then let them tell you what they are feeling, what they are experiencing, what they are having difficulty with, finding words to describe what’s going on inside. The thing about grief is that it’s invisible, for example if that person walked down the street now, because we don’t wear mourning clothes, nobody would know. I always think we should wear a little black ribbon so that people are nicer to you in the shops and on trains and tubes.

“Finding words to connect with what’s inchoate and invisible in their bodies, and voicing that and being heard and acknowledged, is the beginning process of facing the reality of the loss, and as you face the reality you feel the pain of it, and as you feel the pain of it you incrementally, moment by moment, adjust. And then in that process of adjusting you kind of find a way of accommodating the loss – over a long period of time. I do that, and then I help them have ideas for themselves of creating rituals that in some way represent the funeral – whether it’s lighting a candle at six in the evening, playing a piece of music, reading a prayer or a poem, maybe it might be writing a letter to the person that has died. So it’s about developing rituals.

“Funerals are incredibly important because they represent a ritual that is familiar in the kind of alien place of grief, where you feel completely lost, we kind of know what the deal is, we know that there’s a coffin, and we know that people gather together, and there’s prayers or poems if it’s a humanistic one, and so I get them to try and think of rituals that they can have in the day for themselves. Maybe they might walk to their local spiritual place, whether it’s a church or a synagogue or a mosque, and so that they can develop habits that represent and honour the person that has died, so that becomes part of their day.

“And then the very big thing over time is that when the person dies your future ends as you imagined it, and you have to grieve the loss, but of course the love never does, the relationship continues and that person is in you for the rest of your life. So what I develop with clients is touchstones to memory, things that connect them to the person that’s died, so is it wearing something of theirs, a scarf if it’s a woman, a watch or a handkerchief, or something that smells of them maybe, making their favourite recipe, their favourite cottage pie or Thai curry whatever that is.

“Walking and talking is incredibly therapeutic, so having a neighbour or a family member who can come with you, and it can be a short walk round the block, or a longer one into a green space is even better. The thing with walking is that you’re in rhythm together and you can look at the floor and have time for space, you can look up at the sky and think about them and it’s incredibly therapeutic, so it’s finding ways of remembering, that over time and with those other things really makes a difference.”

Q. November is traditionally a month of remembrance, but what about those people locked in their grief, where remembrance is almost impossible as they feel so bereft that maybe that type of thing, while clearly therapeutic, clearly helpful, is too painful, how do you get over that barrier for those who say that memory is too hard for me?

A. “For the person where it’s way too hot, much, much too painful, if I was talking to them it’s likely they’ll have trauma, so that the traumatic memory overrides your ability to connect and you have to block it, you have to shut it down. What we do with trauma is that we try and block it and then it comes up again, and we try and block it, and it’s triggered by sight, sound, touch and smell, but it can get into an incredibly complex cycle that then kind of feeds on itself. So, in those cases, the most effective treatment for trauma is EMDR – Eye Movement Desensitising Reprocessing – it’s a terrible word to describe a treatment, but it’s the best evidenced treatment, and it’s much less about talking, it links your traumatic memory to the rest of your brain, the left side or the right side, through bilateral movements, or online I do it with butterfly hugs / tapping. Single event trauma, you can take two sessions and it drains the distress out of their bodies, and then they can begin to kind of deal with the long haul of grieving, but you can’t fully grieve until you’ve dealt with the distress. ”

Q. It’s fascinating isn’t it, because our brains are programmed – we’re so used to walking down the wide highway of ingrained behaviour, that taking the harder path for us sometimes, the narrow one, is hard, you’ve almost got to re-programme how you address these things. 

A. “Yes, I talk about this in Grief Works as the paradox of grief. There are so many paradoxes; it’s by allowing yourself to feel the pain that over time that you heal, and it’s by looking at the reality, by facing what’s happened, that you can over time integrate and remember the person that’s died. It’s by allowing yourself to both feel the pain, but also to have hope and plans, that allows you to feel the pain, so that you can’t stay in it all the time. Some people very much feel that they need to show the person that’s died that they’re suffering because that kind of represents for them the value of how important they were – that somehow they feel guilty, or are doing it wrong if they smile, if they laugh, if they go and have a cup of coffee where they don’t think about the person – people feel very guilty. But actually it’s by giving yourself a break from the grief that paradoxically allows you then to go back and do the work. Most aspects of grieving are paradoxical, but the thing you need is the support.

Q. Yes, absolutely and we’ll talk a bit about support and a bereavement toolkit, if we can put that into words. I know you have your Eight Pillars of Strength in the latest book, which is fascinating, and I can see how death, dying, bereavement are all a big change in life, so I can see how they’d apply. How would you apply your Eight Pillars to dying and bereavement?

A. “So, the Eight Pillars I devised for when a devastating loss happens, whether it’s by death or a life/living loss; divorce or a health diagnosis, we kind of go off-kilter, we feel like the ground beneath our feet has been taken away, and we feel very scared. And so I devised the Eight Pillars as an architectural structure to hold us steady, of attitudes, ways of being and behaviours, that hold you steady when everything feels so shaky.

“The first one is your relationship to yourself, so when you’re suffering, one of the cruel aspects of all grief is that we often turn on ourselves, like ‘I’m doing this wrong, I’m an idiot’, guilt is the most painful companion of grief. We kind of feel that we’ve failed the person that died, and we go on a Sherlock Holmes kind of ruminating loop of what if, and why didn’t we, and all of that.

“So the first task, in a way, for yourself is to be self compassionate, to be aware of what I call your ‘shitty committee’, not to tack and turn on yourself but to be as kind as you would to anybody else. Be gentle with yourself and kind of turn down the volume on the criticism, and turn up just small habits of ‘I’m doing OK, this is tough’ and self-soothing.

“And then the other one from Grief Works is the relationship to the person that’s died, so it’s very much how you feel the pain of it, but how you continue the relationship, how that lives on in you after they’ve died and how you figure that out for yourself.

“And then the other one is to find a way of experiencing and express the pain. And for living losses it’s how to manage your emotions, so we want our feelings to match our thoughts but they very rarely do. We want to get there fast, one of the first things everybody says to me is ‘how long am I going to feel this bad?’ And my answer is normally, longer than you want, and it does change over time, but you know as everybody is beginning to understand grief isn’t something you get over, it’s something that you find a way of adapting to and living with, that you accommodate it, you let it change you, and to let it change you, you have to find a way of expressing what your feelings are and for some people that could be gardening, for some it could be painting, others it could be seeing a therapist, it could be having a various playlist of different songs for your moods, and kind of moving in relation to them, like ‘I’m furious’ or ‘I’m sad’ or writing letters to the person that’s died, you need to find a way to manage and express what you’re feeling.

“And then all the other ones are things like exercise, so grief is very embodied, and there’s a connection between our mind and body, that’s very true trauma, like the body remembers, the body holds the score. And people feel grief in their bodies, they often feel it in their chest, or they feel like their heart is being squeezed. Men often rub their legs, they want to run, and we feel scared, so grief often feels like fear.

“So taking exercise reduces the cortisol in your body, whether it’s a fast walk, whether it’s going on a rowing machine, whether it’s kick boxing, cycling… Whatever it is, if you get your heart rate up, just for 15 minutes a day – you do not have to do this like a marathon – it lowers the cortisol and raises your oxytocin, which then also raises your capacity to connect to other people, to let people in.

“We have a kind of bad design as human beings, that when we’re really miserable and unhappy, when we’re really grieving, we shut down with the pain, because of the cortisol in our bodies and we repel people and we send off signals of pain that goes into their bodies, which, they kind of want to support us but they often get overwhelmed by it, or can’t fix it, and so they run. Whereas if you exercise you lower the cortisol and then you’re more open to receive other people’s connection to you, their affection, warmth, and then you feel safer again. Everybody has to find their own kind of toolbox.”

Q. I wanted to touch a bit on grief before death actually, because I’m thinking a bit about my own situation. My brother died having had cystic fibrosis since birth, so his death was a long time coming, but then starting a grieving process – and I’m sure I think that’s what I did – before the person dies is a little bit confusing isn’t it, and you might not even know that you’ve started grieving? What do you say to people who find themselves in that rather confusing state?

A. “That’s a very good point. I believe that grief starts at the point of diagnosis. So the moment you and your parents were told that your brother had cystic fibrosis, that was their first step, that his life, his outcomes, his potential, was limited. He wasn’t going to have a long life in a way that they’d hoped for or expected, and so that is a loss, it’s a loss of the expectation, it’s a loss of the dream.

“There are basics that you have to allow yourself to feel the loss and acknowledge it, but I think what’s complex about diagnosis and pre-bereavement is that there’s a lot of co-protection. So that parents would’ve wanted to protect you and your brother from the sadness they felt. He probably wanted to protect all of you as well, but actually when you protect each other there’s a gap of connection and understanding, then everyone can feel quite alone with it. You may have felt this; with people with sick siblings there’s a lot often of conflicting feelings, like they feel a bit scared, they feel angry that their sibling is getting all the attention, they feel it often that they have a kind of burden of responsibility to be OK, to be happy, to perform, to have the success that two brothers would’ve had, but only in yourself, and many other things, but often it’s the negative things that kind of go underground because you feel you’re bad.

“Children learn how to grieve from observing the adults around them, so that if parents could role model: ‘I feel angry and sad’, and ‘I feel OK’, and ‘I want us to have a good time’, all of those things we can do in families where there’s open communication – where you can talk about difficult things, as much as you can talk about the good things – there’s more trust and there’s more wellbeing basically.”

Q. I wanted to go back to remembrance and memory one final time. And again through personal experience, through looking at others, sometimes people create a sort of shrine don’t they? It might be leaving a bedroom untouched, certainly of a younger person, because it’s so painful they don’t want to disrupt anything as was, in a sense. With parents who struggle with that level of grief, where their remembrance is almost a mausoleum, it’s a difficult one. How do you get someone to a healthy sense of remembrance and memory?

“There really isn’t a right or wrong way to grieve. Whatever coping mechanisms people find – if it’s creating a shrine, never going into the bedroom – I don’t think it’s any of our business to march in and say you’re not doing this right, you have to get on with your life, move forward and redecorate the room.

“But, and there is of course a but, when I think about people finding a way of living with grief, it is by allowing themselves to not only feel the pain of the loss, but to trust and to dare to live again and love again. That you miss and feel the pain of the person that’s died, and you let yourself engage – this is a few years down the line, this is by no means immediately, over time, longer than people want – you do accommodate the loss and find a way of living with it, and investing in life again.

“So it maybe part of that, so a way of allowing yourself to do that would be having a shrine that you go to regularly, that doesn’t block you from having pleasure in your life, letting yourself love, letting yourself engage with life and feel connected with yourself living and those around you, living. If someone had blocked all their openness to loving and living, and was only connecting to the person that died, then that’s complex grief, and that needs quite a lot of serious intervention and work, because of course, like all these things the longer you do it, the more entrenched it gets and the worse your outcomes are. Because then people tend to not do the things that help them, they tend to stop going out, taking exercise, they don’t eat so well, and then there’s a kind of spiral.

“Yes, and of course we acknowledge that not every grief journey is the same, they’re all different, I think I read that there are some 44 different types of grief, there’s probably more than that in fact. No journey is the same, no easy way of doing it. In this time of the pandemic, of separation, isolation and anxiety, what services and support is out there for people that you could direct people to?

“There are many organisations that offer support. If people go to my website and go to the What Help section it has the Eight Pillars of Strength, but it also has a list of organisations. So it would for instance have CRUSE, which is the biggest bereavement organisation, or BACP, which is the biggest counselling organisation, where you can get a therapist, but many others. And I do really encourage people, I mean there are many ways of supporting yourself and therapy is by no means the only one, but the sooner you get the support that you need the better your outcome is likely to be. So don’t try to, in old fashioned terms, have a stiff upper lip and be brave, get the support you need to manage the difficulty that you’re facing, whatever it is.”

Q. One final thing I did want to say is that you must be heartened by the fact that we’ve recently had the Good Grief Festival with thousands of people interested. In these times that is a very, very positive thing, that level of interest.  Whereas before talking about death, dying and grief was quite taboo, people just wanted to box that off, and they weren’t comfortable at all with it, but now many, many thousands taking part, high profile speakers, people sharing their stories, and of course you spoke at the festival yourself, you must be very, very heartened by the fact that this is now a conversation that people are having?

A. “I really am, there are certainly unexpected consequences of Covid-19 and I think one of them is that we’re being forced to face our mortality. I mean we always know it, but in some way we have a kind of magical thinking that if I don’t think about it it’s not going to happen to me. But I think the pandemic has forced us to recognise that we can all get ill and that we can all die, and that has opened conversations within families, within friendships groups, particularly with young people I think, where they’ve then gone to seek information.

“I think that people are looking for community, they’re looking for ‘my people’, so for example if you have had a sibling that’s died there are groups for that; for every type of death or personality, there’s information and content. And I think one of the things that people are beginning to realise is that if you face the fact that you’re mortal you actually engage in life more fully, and that life and death are completely interconnected, and how you live your life influences a lot how you die, so that if you have those conversations, if you do your ethical will, if you talk to people about what you want them to remember, what are the important values that you have.

“Some people talk about heaven is where you’re still remembered by someone, so where we don’t have the institution of religion so much but actually having a spiritual belief that while you’re still in the memory of someone that cares about you, that’s a place that you live on, whatever your spiritual belief is, is very meaningful.

“And I think we’re looking for meaning, and we’re looking for connection, and really talking about death is the most direct place that we can do that. Life and death, love and loss, you know are two sides of the same coin, and the more we face that, I think the better we’ll do.”

Listen to the Art of Dying podcast episode 21.

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