Does My Pain Count?

Kate Bowler:        Hi, I’m Kate Bowler, and this is Everything Happens.

Look, the world loves us when we are good, better, best. But this is a podcast for when you want to stop feeling guilty that you’re not living your best life now. We’re not always having an eat, pray, love experience. I used to have my own delusion of living my best life now. I’m a Duke professor, wine and cheese enthusiast, wife and mom, Instagram gold. Then I was diagnosed with Stage 4 cancer. That was four years ago and I’m still here. And now I get it. Life is a chronic condition. The self-help and wellness industry will try to tell you that you can always fix your life. Eat this and you won’t get sick. Lose this weight, and you’ll never be lonely. Believe with your whole heart and God will provide. Keep this attitude and the money is yours. But I’m here to look into your gorgeous eyes and say, hey, there are some things you can fix and some things you can’t. And it’s OK that life isn’t always better. We can find beauty and meaning and truth, but there’s no cure to being human. So let’s be friends on that journey. Let’s be human together.

K.B.:          Not long ago, I recorded a podcast episode with my friend Dr. Ari Johnson, who has played a huge part in improving maternal health care in Mali. Yes, he saves babies, but he kept saying that we can grow and grow in our capacity to love. We can even learn to love people we’ve never met. Love is a muscle. He was saying. And we can get stronger and stronger. Well, that got me thinking of other people who I really admire for that strength, the ability to grow stronger and stronger in virtues that we will need to get through this hard time. So I reached out to author and psychotherapist Lori Gottlieb. You might know her from her New York Times bestseller, “Maybe You Should Talk To Someone” and her weekly Dear Therapist column for The Atlantic. I’ve been so struck by Lori’s incredible capacity for deep and compassionate listening. She is strong in exactly the way I think we all need right now. And I knew she would have so much to offer us as we bear each other’s stories in a season of sorrow. Lori, I’m so grateful you took the time to talk with me today.

Lori Gottlieb:      Oh, and thank you so much. I’m so glad to have this conversation with you.

K.B.:          I’m sorry to dive into all the intensity when we were like just getting to know each other, but you seem to perfectly understand the moment we’re in. It feels like we’re just swimming in grief. And for people who may not know your work, just give us a little introduction. How have you become so practiced in the hard work of grief?

L.G.:               Well, I think that we all deal with loss in our lives. And I think that we’re afraid to call it that because we feel like there’s this hierarchy of grief or loss. Right? Somebody has a miscarriage, but they didn’t lose their eight year old child. Somebody has a breakup, but they didn’t have a divorce. And so for the first week, maybe people will be there and be supportive. And then they kind of forget about it like it didn’t happen. Or they think, well, you’ll get over that quickly, because on the hierarchy, it’s you know, it doesn’t really it’s not really up there. They have these silent losses and they feel like it didn’t you know, they didn’t get the support around it. And so they start to tell themselves that they’re not grieving, that it’s not a loss, and they feel really alone in what they’re feeling. And so I think that the more that we can have compassion for people and meet them where they are in whatever their loss is, instead of saying to ourselves, well, you think you have it bad, what about me or what about so-and-so? I think that we will all feel not only more compassion for ourselves and more compassion for other people.

K.B.:               Yeah, that’s so true. I can just think of the number of times I’ve thought when I told somebody that maybe actually my secret question was like, does my pain count? Like, what about this? Does this count? Cause it sure. It sure hurts.

L.G:           Yeah. And I think there’s a difference between showing up and sharing a part of yourself and complaining. So I think that people are worried that they’re going to appear like they’re complaining about something that feels trivial to other people. But I think that behind every loss is something deeper so an example might be like I was writing about in the book, I was treating this woman who was a newlywed and she came back from her honeymoon and she got diagnosed with cancer and ultimately became terminal cancer. And I would go from sessions with her to somebody who would come in and say something like, “Why do I always have to initiate sex with my husband?” But I think that what was really important for me to hold on to was it wasn’t so much about comparing those losses. It was about what’s underneath that loss? So underneath that is we can all understand the depth of what it feels like when we feel rejected by someone we love. That’s incredibly painful.

K.B.:               Yeah, that’s right.

L.G.:               It’s not just, I always say that when people are talking to me in therapy, I’m listening to the music under the lyrics. The lyrics might be: I can’t believe that I always have to initiate sex. But the music is what’s the underlying struggle or pattern that this person is trying to talk to me about?

K.B.:               Yeah, that’s lovely. And this like deep desire to be met there instead of just maybe words that we think we’re saying.

L.G.:               Yeah, we have this expression in therapy: feeling felt. Everybody wants to feel felt.

K.B.:               I like that. As someone who’s always felt like I was a bit much. I really like that. That sounds exactly right.

L.G.:               It doesn’t mean that, you know, the person who’s listening to you and the person who’s helping you to feel felt. It doesn’t mean that they agree with your version of the story. Right? So a lot of people will come in and they’ll tell me about why everyone and everything else out there is problematic. And by the way, it’s not that there aren’t difficult people in the world. We had this when I was training. A supervisor had said to me, when I was doing my internship, she said, “Before diagnosing someone with depression, make sure they aren’t surrounded by assholes”.

L.G.:               So, it’s not it’s not that that’s not true. But I think that, you know, we’re all unreliable narrators and some people will tell you their version of the story. You don’t have to agree with their version of the story. And this is especially true now when we’re sort of, you know, under the same roof with our families and our partners, and whoever it might be. You don’t have to agree with their version of the story. You don’t have to feel what they’re feeling, but you have to be able to step into their shoes and imagine what their experience is like. It doesn’t have to match your experience, but you have to be able to enter their world.

K.B.:               Especially too, like when we’re questioning whether were allowed our feelings like. One thing it seems so obvious to both of us right now is everyone’s looking around and saying, “I feel afraid, am I allowed to be afraid?” And just needing somebody else to help provide some of this bigger narration for our stories that we’re not always able to do for ourselves.

L.G.:               That’s right. And I think that, interestingly, a lot of people are also afraid because I think a lot of people are seeing that other people are feeling anxious. So you’re right. There are some people who feel like, well, I don’t have it as bad as somebody else. You know, I think that there sort of acceptable things you can feel anxious about and you could feel anxious about somebody getting sick. You can feel anxious about job loss or financial loss. But it’s not OK to feel anxious about maybe your loss of, you know, like for our kids, for example, they’re not seeing their friends, you know. So a lot of parents, what they do is they try to say, well, you know, you’re gonna see your friends soon or, you know, hey, let’s go play a board game or, you know, instead of saying, yeah, I know, it’s really hard not to see your friends right now. Yeah. So we you know, we do that in non COVID times too. We do that with our kids, especially where they come to us with a feeling like “I’m angry” and we say “Really? over that?” Or we say, “you’re so sensitive”. They say, “I’m sad”. And we say, “Oh, don’t be sad. Hey, look, a balloon!”

L.G.:               Right?

L.G.:               And that’s because we don’t we don’t want them to feel pain. The thing is, they’re going to feel it anyway, just as we try to distract them from from whatever they’re feeling. Those feelings don’t go away. What helps them is to feel like, yes, someone sees me. I see you. I hear you. I understand, you. And so during the Coronavirus, one thing that I’m saying is that people are afraid to feel joy. Because they feel like, well, it isn’t OK. I can’t enjoy this moment that I’m having reading to my child right now. I can’t enjoy this moment of taking a hot bath. I can’t enjoy the fact that I have some extra time to facetime with my friend because everybody else is going through all of these horrible things or even,even if you are going through these horrible things, we can’t hold the both and. And I think that we need to get really good at holding the both and. Like, I am so happy to see my son more than I usually do because he’s at home doing remote learning. And I’m horrified by the circumstances under which I’m having to see him more.

K.B.:               Yeah, I really like that. Yeah.

K.B.:               And, you know, it reminds me of the the woman that you mentioned with with what became terminal cancer. All right. I thought the way that you talked about her and her in your book so beautifully and tenderly, it seemed like she was really able to to allow herself like a much wider range of human experience in, in the darkest season of her life. And that that actually like opened up new possibilities of living for her.

L.G.:               I think that sometimes cancer patients are like people think, oh, they’re such a saint, they’re so brave. They’re so, you know, all these things and truth is, I’m not brave like I. When I used to go get my shots as a kid, I would like, you know, I couldn’t even tolerate that. You know, she was like, I’m not brave at all, but what choice do I have? She’s like I’m so scared. Why? Why is one saying that I’m brave. I’m freaking out. And and I think that she was just so real. And so that’s why she came to me, because I was not somebody that was part of her cancer team. And I was so inexperienced. And I was worried that I would screw it up for her because she was only going to get one chance at doing this. She wanted me to be with her until she died. And we didn’t know how long that was going to be. It could have been a year, could’ve been five years, could’ve been ten years. But I made that commitment to her. But I told her before I made that commitment. I said, you know, I don’t really know how to do this. And I mean, I didn’t use those words, but I wanted her I wanted her to say, like, maybe you should go to somebody who really has done this before.

L.G.:               And what she said was, you know, that whole the affirmations and the pink ribbons and the optimism, that’s not that works for some people. But that’s not the approach for me. I need someone outside of that for this experience that I want to have. I learned so much from her about how to live. Her sessions compared to the sessions that I had around her. You know, people said, well, isn’t it depressing? You know, when she comes in and she tells you all these things? And I said, no, her sessions are rife with vitality. You know, like like I felt so alive in those sessions with her. She was so real. She was not sugarcoating anything. She was so, you know, the range of emotions from anger to despair to joy to discovery. Everything was in there.

K.B.:               Yeah. I think, I think people imagine that like in order to live beautifully, they have to have an unlimited horizon. And when we see something like that with a limited horizon, their ability to act meaningfully and honestly inside of that is is like such a joy and a privilege to watch up close.

L.G.:               Yeah, I think it really brings things into focus. And one of the things that we talked about was why does somebody need a diagnosis of cancer to live that way?

K.B.:               I was so struck by when you attended her funeral because of the boundaries around the patient therapist relationship, you weren’t able to disclose how close you really were. We carry each other’s stories without always having a way of being able to speak about them. It just made me wonder how have you managed the weight of knowing without always being able to tell?

L.G.:               That is something that I think is really unique to what I do because I have these very deep, rich relationships with my patients that other than my consultation group and they can’t even know the person’s name, they, you know, nobody gets to hear about them. And so when I was at her funeral, she had wanted me to be there. That was very, you know, is something that we had discussed very explicitly. And her husband reiterated that after she died and made sure that she had actually had an email prepared before she died, that he was to deploy to me. So I received the email with the invitation and she had a note that was kind of like an inside joke between us reiterating that I had made her this promise and that I better be there and that she would know. Even though she was dead, whether I was there. So I better make it to the funeral. And so I did. But of course, you know, I went I was in the back and everybody was telling all these stories about her. It was so interesting to me because I knew her in a specific context, but everybody else had lived all of these experiences with her, some of which I had heard about. Now I got to see the real people involved in them, which was really interesting for me. Somebody said to me, well, you know, how did you know her? And I was really caught off guard because I didn’t expect to be engaged in conversation with anybody. And I said she was a friend. And I realized she was. She had become a friend.

K.B.:               I’ve always wish there was like a word for that. Like, like Storyful or something like the idea of being like filled up with all the people that we love or we listen to that we are we are carrying with us. And I wonder if just right now we’re all holding so much suffering in what we hear on the news and friends and people, we find ourselves thinking about at 2:00 AM, and wondered, since you’re very practiced in the art of being Storyful, can you offer some advice to listeners who might feel like they’re just a bit too full of reality?

L.G.:               I want to broaden the definition of reality because I think that people are saying reality is what we see on the news all the time and nothing else is real. What’s real is cooking a meal and enjoying it right now. What’s real is what’s equally real is playing a game with your kid, reading a good book, having a really deep conversation with a friend, virtually. That’s all reality, too. So I really think it’s important to distinguish between as we talk about our anxiety, productive anxiety and unproductive anxiety. Productive anxiety is being reasonably worried about something so that it motivates you to take action. So we are all reasonably worried about the Coronavirus, that we are social distancing, sheltering in place, washing our hands a million times a day, trying in my case, failing not to touch my face. You know, we’re taking those precautions because we’re worried. We should be. But then there’s unproductive anxiety, which is excessive rumination about something in the future that hasn’t happened yet and may never happen. And we call that catastrophizing. Futurizing or catastrophizing. Future tripping. So when we talk about what is reality, you can spend your whole day reading Coronavirus stories and watching the news and doing all that. But it’s not going to be productive anxiety because you’re already doing everything you need to do. So if you check the news once a day and you make sure you’re still, you know, the news changes to make sure that you’re doing what you need to be doing. That’s all you need. And then there’s the reality of here we are. We are sitting here having this conversation that is real. Here we are having a dance party in our house that is real.

KB:            That’s so good Lori, that you’re widening the scope of like the experiences, because it’s it’s also those experiences that are going to carry us to be able to to do hard work, if that’s what we need to do.

L.G.           Well, yeah, it reminds me, as we were talking about cancer. It reminds me of a different cancer patient that I had, and she was saying that when she had cancer, people were afraid to joke around her or to be joyful around her. People were like walking on eggshells around her because they felt like they always had to be very like doom and gloom around her are just very serious around her. You know, they couldn’t relate to her as a normal person who happens to have an answer.

K.B.:               But how are you really?

L.G.:               Right. Right. Exactly. And so she was saying it’s not like I’m going to forget that I have cancer. You know, like, don’t worry. Like, I won’t forget about it. It’s there. I don’t forget. I. I’m not having these, like, little brain farts where I pretend I don’t have cancer. But but that’s where the both and comes in. And I’m also like sometimes I’m on Twitter and I’m really enjoying it or sometimes like I’m taking a walk or I’m laughing with a friend or someone makes a really inappropriate joke, not about cancer, but like, you know, just in general, like like I’m still alive. Like I want to binge watch a TV show and talk about it. And we can talk about something that feels really different from the cancer.

K.B.:               Yeah. You know, I when I got sick, I did start getting really hooked on absurdity as a way to sort of like cut through the noise of tragedy. So I had like, how do you like a recreation of gingerbread houses out of like a mega church, gingerbread houses that I would make kind of like gumdrops and whatever or I threw a lot of parties. Lately, I love my friends and I love what people are doing to just celebrate the absurd.

K.B.:               I have a friend who’s doing Taylor Swift brackets. We have to sort of have the songs compete and then one at the end they’ll,they’ll have a dinner party and those costumes for her video or, you know, they’re putting together like choirs online or when one person flings out the window open every morning and just screams whatever is on her mind. And I I love it because I think you’re right. It gives us it like it gives us the whole range of being a person again when we get flattened and flattened.

L.G.:               Right. What’s underneath all of these jokes is like, hey, this is my experience. Are you experiencing it, too? It connects us. And I think what we want to hear when we’re experiencing something that really makes us feel uncertain and kind of scared is we want to hear me, too.

K.B.:               Yeah. That’s right. That’s right. I get a lot of mail from people who have lost they’ve just lost so much and they’re not able to to grieve in the way that they need to grieve. You recently wrote so movingly about grieving the loss of your dad, and he sounds like he was a really incredible person.

L.G.:               Yeah. Three weeks ago, my father died and I was very, very close with him, as was my son. And so, you know, I think a lot of people are going through this where somebody dies, and it wasn’t related to the Coronavirus. And so there’s what we talked about earlier, that sort of hierarchy of grief, where you feel like he was eighty five and he had congestive heart failure and he was at home and he died around his family. We didn’t expect him to die that early. We thought it was very surprising when he died. But at the same time, because everybody you know, so many people are grieving the loss of people who have died from the Coronavirus. There’s so many people going through that. You almost feel like, well, I can’t really talk about this because I got to have my time with him. I got to grieve in advance. I got to say my goodbyes to him. He and I in the months before he was dying, he helped me through my grief. We talked a lot about what it would be like for me not to have him in my life anymore in the same way that, you know, I will carry him with me, but I won’t be able to talk to him every day like I always did. And one thing that he said to me was he said, I can’t take away your pain. That as much as I want to, there is nothing that I can do to take away your pain. You will have to feel this pain. And he said it in the context of, I asked him how he managed after his parents died. And he told me that, you know, the pain is always going to be there in different ways and that he knew that I was resilient and that he knew that I would know that I would carry him with me and that, you know, that. But he said that the pain was an indication, an indication of how much I was loved and and got to love him.

K.B.:               That you’d be marked by that love. Oh, that’s so beautiful, Lori.

L.G.:               Yeah, he was. He was an incredibly emotionally generous person. What was so strange about going through this during this time was we couldn’t have a funeral with with all of the people he loved and who loved him. When we got back from burying him, we went to my mother’s house and on the doorstep was this gigantic box of paper towels that he had ordered for my mother so that she in her 80s would not have to go out during the Coronavirus and risk getting sick.

K.B.:               Stop, awe.

L.G.:               It was surreal and beautiful at the same time. And that’s that’s a coronavirus death right there. Right? He was so worried that she would get sick and then and then we couldn’t. You know, I’m Jewish and we have this tradition where we sit Shiva for seven days. And that means that your house is open for seven days and people come in at any time and they everybody brings you meals and they hug you and they sit with you and they share memories and stories. And it’s it’s part of the grieving ritual. And we got none of that. So, you know, I mean, facetime does not does not do it the same way of presence of a physical presence with somebody.

K.B.:               You read my mind. That is exactly what I was thinking, that we have lost the gift of presence. That’s right. And like that that was like that’s I mean, I’m just thinking of like when I was in the hospital and stuff, but like having people just reach out and touch me, like we lose so much when we lose touch and food and the ability just to surround when when words fail us.

L.G.:               There’s something about being in the same physical space with another person where you’re a few feet away from one another. That you hear the same sounds in the room, you see the same lighting. You hear the person breathe in a different way. And there’s an energy and a vibe to being in the same physical space that you don’t get when it’s mediated by a screen and you’re in different physical locations.

K.B.:          Yeah. Yeah.

L.G.:               There’s a patient in the book that I write about named Rita and she is this older woman and she’s very, very alone. And she told me at one point that the only reason that she gets pedicures is so that someone will touch her so that she could a foot massage and someone will physically touch her skin. It’s so important we call that lack of touch. There’s a term for it: skin hunger.

K.B.:               We have we do. We hunger for it. And like we feel remade sometimes like or confirmed. Like it just seals in what we needed to know.

L.G.:               It also it physiologically regulates us, so it  actually helps us with our anxiety because physiologically we have a response to touch that calms our nervous system down.

K.B.:          So then when we’re so limited in this way, like what are some basic skills from your practices that that maybe regular people can can learn right now if they want to be if they want to like recreate some of the better parts of that gift of presence?

L.G.:               Yeah, well, first of all, just speaking to parents. In order to be present for your kids, you need to be present for yourself. It’s really important that you take care of yourself and that you don’t put pressure on yourself to recreate normalcy right now. That you can, there are certain things that we need to have in terms of routine and structure that are helpful, like the day before. Like a night before. When you go to bed, say, here’s one or two things that I want to accomplish tomorrow. And other than that, there are some basic things that I need to do. Like I need to make sure that I go to sleep on time and I wake up at my regular time. I need to make my bed, which is funny. Making your bed really changes things for you. I need to take a shower and I need to put on clothes.

K.B.:          Yes. All of this.

L.G.:               Right. All those things. And then I need to eat my meals at regular times. I need to eat breakfast at breakfast time. I need to eat lunch at lunchtime. And then you take dinner at dinnertime. So that gives us some kind of backbone for our script, for our schedule, for our routine. And it makes us feel a little bit human, right? But beyond that, what are the one or two things that you need to get done? And make it really manageable. So for our kid, people are fretting over things like how much screen time should they have and are they, should I be doing their algebra class with them? Right. And you know, you know what? What’s gonna happen? Are their brains gonna turn to mush? And they don’t realize that kids are learning so much right now about resilience, about adaptability and flexibility, about community and how to create community. And they’re being so creative in how they’re doing it. They’re learning about pitching in and what it means to help with the cooking and help with the dishes and help clean up. They’re learning about the broader community. You know, maybe we are healthy. But this thing that we’re doing by staying in place is helping that neighbor across the street. And can we give her a call, by the way? And can we put dinner on the doorstep of, you know, that person who lives alone? You know, what can we do for our community, too? And I think that having that broader sense of purpose and meaning is something that kids really relate to and get excited about.

K.B.:               Yeah, yeah, you’re right. We’ve been kicked off the middle class achievement super train in so many ways to like a deeper way of learning to be like part of this ecology and live inside of it. Lori, you are a delight. Thank you so much for your gifts of compassion and attentiveness. I just want to soak it all in. Thanks for helping us stay awake in a world that is in a lot of pain right now.

L.G.:               Oh, thank you so much. And thank you for doing this podcast. You know, it helps so many people.

K.B.:          Thanks friend.

K.B.:               I loved what Lori said about redefining reality rght now. Reality is not only the hardest parts of our days in the news and the devastation of the world, reality is also making dinner with someone or laughing at something dumb or wanting to reach out and hold someone’s hand because you ache to be touched. We are so many things all at once. But when we face down pain, loss and uncertainty, it feels like we should only be one thing talking about one thing facing that one thing head on. I heard in Lori’s great advice a call to pay attention to our humanity, our small needs, our desires to be known and to have a regular bedtime. So let’s sink back into our humanity and find a rhythm, because it’s only when we manage the day we have not the one we wish for, or fear that we can do the good and hard work of living our gorgeous lives. And hey, if you are on the frontlines of suffering right now and self-care is absolutely impossible, we love you. We’re praying for you. We should rally around you and give you any extra that we have if we are sheltered. And if you’re sheltered right now and you feel like you can’t hear your kid complain about what cereal is in the house for one more second. We love you. We are still praying for you. And you still get to ask for help and friendship and what the deal is with Tiger King. We are horrifyingly and wonderfully human today. So let’s do it again tomorrow.

K.B.:               This podcast wouldn’t be possible without the generosity of the Lilly Endowment. Huge thank you to my team, Jessica Richie, Keith Weston, Harriet Putman and JJ Dickinson.

K.B.:          So fun fact about the podcast world. Your reviews matter. Would you mind taking a minute to write a review on Apple podcasts? It would mean so much. This is Everything Happens with me, Kate Bowler.