Grief is the most available, untapped, emotional resource for personal transformation.
—Lyn Prashant

One of my favorite professional endeavors is teaching a class on the somatic aspects of grief. I present my Degriefing work at the University of California Berkeley, the Mayo Clinic, as well as at hospices, hospitals, and clinics. I often start my presentation by reading my article “Grief and Degrief” (Massage & Bodywork, December/January 2002, page 52) which refers to, and was written in response to, the September 11, 2001, attacks in New York City. Seminar participants usually feel restimulated immediately; the correlated bodily reactions that previously occurred in their system now arise anew.

I teach by this example, referencing their own somatic reactivity from an event that imprinted itself in their collective and personal consciousness. As I remember my own experiences on September 11, 2001, my somatic symptoms also return immediately—my throat tightens, my belly contracts, my breathing becomes a bit rapid and shallow, a sense of not enough air in the room provokes the need to take deeper breaths, and copious visual images flood my memory.
Massage therapists, bodyworkers, and their clients are no different. Every client is a potential trigger for your own trauma issues; equally important is the restimulation that might happen to clients as they take refuge on your table.

Grief and Loss

Grief is the body’s response to loss—any loss. Fresh grief can restimulate the feelings of previously unresolved, long-forgotten grief. The changes grief brings upon us can be both significant and subtle, impacting our physical, emotional, mental, and spiritual states. As bodyworkers, it is necessary to understand the effect grief has on ourselves and our clients, somatic and otherwise.
Whether simple or complex, fresh or unresolved, grief can create a deluge of symptoms, including fatigue, insomnia, pain, gastrointestinal disorders, chest pressure, palpitations, stomach pains, headaches, backaches, panic attacks, increased anxiety, and depression, among others. Thorough evaluation is required to identify and differentiate the roots from the manifestations of actual illness.

Today’s quick-fix healthcare system typically doesn’t recognize or address grief-related problems. The well-trained talk counselor, however, can provide supportive verbal communication techniques, nurturing emotional attention, recommendations and referrals for appropriate integrative therapies (supporting the implementation of important somatic treatments), as well as embody the personal presence needed to assist clients in coping with grief in a healthy, self-supporting way. Just as we maintain referral relationships with chiropractors and nutritionists, massage therapists and bodyworkers should also have a short list of talk therapists to which they can refer.

In our own experience, our hierarchy of losses is determined by our own assessment of what has meaning to us and the familiarity with which we relate to persons, places, or things that have been lost. Stephen Levine, author of Who Dies? An Investigation of Conscious Living & Conscious Dying, told me some years ago, “We can only be available to another in their grief to the extent that we know our own.”¹

For massage professionals, I encourage the understanding of two essential points:

1. Degriefing skills are those that somatic healthcare professionals can learn to help clients.

2. It is imperative we first examine our own losses, because our own individual legacy and the impact of our personal story of loss affects us as we live day by day.
By taking responsibility for our reactionary behavior, we can become more astute listeners and therefore be more present and confident to serve our clients’ healing processes.

My rule of thumb with grieving clients is that it is okay to cry with them, just not more than them. For example, when my beloved sister, Donna, died, I needed to restrict my acceptance of new clients with breast cancer for about nine months. I found that the similarity of the symptoms and the familiar story brought my personal pain to the surface so quickly that I wanted to save or rescue those with the same affliction. Every time I talked about Donna, it threw me into an emotional rollercoaster, provoking a subsequent temporary upsurge of grief (STUG). I knew that I needed personal healing first, and attending to clients came next. I recognized that without some distance from the saga of this particular cancer, I was less effective.

In his book, Waking the Tiger: Healing Trauma, Peter Levine talks of the phenomenon that bodyworkers see every day. Previous trauma stored in the body gets reactivated by fresh trauma. He says the effect is cumulative, but that traumatic restimulation becomes an opportunity for transformation because all the issues are swirling around and available for process. On the physiological level, Levine writes, “Each successive experience of freezing and refreezing is identical to the original experience, but with one important difference. With each episode of freezing, the amount of energy summoned to deal with the situation increases due to the cumulative effects of the refreezing.”²

For psychologists and psychiatrists, the Diagnostic Statistics Manual gives the official definition of trauma as “that which is outside the range of usual human experience, and that would be markedly distressing to almost anyone.”³ Levine goes on to explain that the “healing of trauma depends upon the recognition of its symptoms. Because traumatic symptoms are largely the result of primitive responses, they are often difficult to recognize.”⁴

When we are in service to those traumatized or grief-stricken, we empathetically feel the effects of the trauma clients are experiencing. As bodyworkers, our bodies cannot perceive the difference between our own or another’s suffering. When we therapeutically put our hands on another, we put our bodies through the vicarious effects of their trauma. And, when losses/traumas combine, they develop a quotient that is exponentially more powerful than the sum of the parts. One loss plus another is not equal to two—it is the exponential effect. As bodyworkers, we must take care of our own bodies while holding space for empathy.

The New Normalcy

In her book, The September 11 Syndrome, stress expert and psychologist Harriet Braiker describes how to help average people deal with the “new normalcy” in which we face fear and uncertainty as the grim reality of our daily lives.⁵ Since that day, the emotional climate we live with exacerbates the depth of our feelings and affects everyone. What we learned beforehand in massage school needs to be revised and updated to accommodate a client population living and dying in this new emotional climate.

Dr. Kathleen Nader, author of “Terrorism: September 11, 2001—Trauma, Grief, and Recovery,” explains that terrorism has affected those who were previously traumatized in a number of ways. It may have amplified or awakened traumatic emotions, such as fear, anger, rage, depression, helplessness, anxiety, hypervigilance, fatigue, heightened startle response, distrust, poor concentration, stress, arousal, and horror.⁶

As a consequence of physiological (increased pulse, elevated adrenal cortex hormones) and psychological (fear, rage) phenomena during traumatic events, multiple impressions register or imprint themselves with intensity and may become interlinked.⁷,⁸They include sensory impressions (touch, sights, sounds, smells), accompanied by a strong desire to fight, intervene, flee, hide, or rescue. “Traumatically imprinted thoughts and images often repeat themselves until they are properly processed or become suppressed, remaining influential in life,” Nader writes. Either initially or over time unresolved aspects, episodes, or emotions from traumatic experiences may translate into repeated complexes of behavior and emotions that affect the quality of life, according to Nader.⁹

S. Eth and R. Pynoos write that bereavement after traumatic loss is more complicated than simple bereavement.¹⁰ Nader says the combination of trauma and grief may affect the bereavement process in a number of ways: symptoms common to both grief and trauma may intensify; thoughts of the deceased/event may lead to traumatic recollections (images, sights, sounds, smells, or emotions related to the event); trauma symptoms may hinder or complicate issues of bereavement, such as grief, dream work, the relationship of the deceased, issues of identification, the processing of anger and rage; and posttraumatic sense of estrangement or aloneness may interfere with healing interactions.¹¹

A 9/11 Case Study

While giving a seminar in California, I began demonstrating how the Degriefing process is a valuable way to transform grief, allowing us to keep our grief quotient manageable and non-injurious to the mind and the body. A young man from the audience approached me and said he was suffering tremendously. He had spent four months volunteering as a bodyworker in Manhattan and had not been able to successfully return to his former job and life, nor cope with or release the effect of the experience he had after 9/11. He had gone to help those in New York City—to learn, to serve, and to be of help. He was now back in California praying to make peace with the personal sense of despair he felt after returning from the intense experience.
He told me he felt isolated and unimportant since he had returned to California, and that his life was boring and petty, meaningless compared to all he saw in New York. He felt guilty he didn’t do more and was ashamed the experience of the trauma (first-hand) had eluded him. He judged himself to be of less worth.

In her article, “Healing from Shame Associated with Traumatic Events,” Angie Panos writes that shame is a debilitating emotion that piggybacks on top of trauma. Shame complicates the healing and recovery process from trauma on many levels, including psychologically and spiritually. She recommends a listener (counselor) who will show some acceptance, support, and nonjudgment. In Degriefing work, the foundation is that “above all, grieving people need to be heard.”¹²

This California-based bodyworker said he could not sleep or eat and now cried easily. He felt estranged from his wife and daughter since they knew almost nothing of what his experience had been. His friends’ words fell short and felt condescending, and his own words failed to communicate the violence in both nighttime dreams and waking moments. He was experiencing despair, disconnection, and futility. He wanted to return to New York City, and yet knew he was not capable of doing so. He cried during the days and took sleeping pills at night. He was terrorized by his dreams. Some suggested he had posttraumatic stress disorder (PTSD). Others suggested he had secondary traumatic stress disorder (STSD) empathy exhaustion leading to compassion fatigue, or emotional burnout. With his permission I interviewed him in front of the seminar of his peers and with his courage he received support from the group; it became a teaching within a teaching. He was exactly the type of client we were preparing to serve, and he was right there as one of us.
Although I could do a certain amount of counseling on the phone with this individual, I was very clear that finding a local massage therapist who was proficient in issues of grief and trauma was absolutely recommended. His somatic feelings were those that could be lived with, and yet with time and no proper focus, those feelings began to seriously complicate his life; if prolonged, they could certainly impair his sense of well-being.

The Grief Timeline

Each one of us copes differently with loss and Degriefing work is designed to accommodate each individual client’s particular personality, needs, and tendencies. Degriefing is a body-mind process incorporating the use of both traditional and integrative therapeutic modalities to transform this copious internal resource called grief. Bodyworkers and massage therapists can be key in the transformation process.

In her book, The Wheel of Life, Elisabeth K¸bler-Ross writes about the difference between resolution and resignation in regards to working with (and transforming) the effects of loss. She explains that to resolve our issues of loss and grief, we need to experience the wide range of emotions, including the tears and laughter, before making resolution possible. To deny the depth of our feelings, what we can hope to accomplish is a state of resignation, at best.¹³ This is where the use of Degriefing tools for normalization is imperative to accomplish the service of sitting with and listening to the bereaved. In the first session, I ask individuals to fill out an intake form, bring in photographs, and tell me their story. The conversations are often disjointed and out of chronological sequence, because grief shatters and scatters linear thinking. I practice the art of holding space and non-interruption, using both compassionate listening skills and active listening. Grieving people need to be heard, not preached to, given platitudes, nor told how to be different. I normalize their experience by hearing them, asking skillful questions about how they are feeling in their body, and inquiring about their families, support network, and community.

I often use a combination of soothing music, Tibetan bowls, therapeutic oils, and perhaps teach simple yoga asanas. The bodywork happens after the clients have verbally expressed enough information that I can sense where they are holding emotion in their bodies. I direct them to use nostril breathing, drink plenty of water, and take time for a hot, meditative bath. I educate clients according to their comprehensive abilities each session.

In Degriefing terms, grief is the body-mind reaction to loss—any loss. Therefore, it is imperative we name our losses. In doing so, we can transform them into fuel, rather than accepting the physical burden of carrying them as part of our ever-increasing emotional minefield. Before we have the ability to change anything, we must identify what we are working with and acknowledge our losses.
Part of this process also means giving grieving people, above all, the time to be heard. As we listen to the stories of our clients and hear their personal language (e.g., “I feel I’m carrying the weight of the world on my shoulders,” “my head is stuck in the sand,” “I can’t see straight”), we can observe this might be an opportunity to assist in the physical restructuring of their personal armor by doing bodywork on their neck, back, and shoulders. In Degriefing terminology, these are referred to as somatic colloquialisms.

A major component of the Degriefing process is creating a grief timeline that allows clients to recall and document grief in their lives, according to chronology. It is a powerful and effective tool that can be used to identify residual grief that might still be interfering with their essential sense of well-being. By drawing a timeline and dividing it into five-year increments, we can easily allow ourselves to examine life in segments, keeping the possible overwhelm of this exercise to a minimum. Information regarding the losses in one’s life can be viewed graphically outside the body while monitoring the somatic reaction that’s registering inside the body. The lesson is that losses have emotional, physical, and physiological components that are in fact connected to a particular incident. While assessing the degrees of grief being felt by the client, this skillful process helps ascertain where to start the conversation regarding primary and secondary losses.

Accumulated, unresolved grief, always combines with and exacerbates fresh grief. Powering through one’s life can fool an individual into believing that the little losses were no big deal. Yet, when viewing the whole tapestry of the events of our lives, these memories can restimulate feelings, depicting the impacts these losses truly had on our lives. Any remembered event and corresponding emotion felt, in conjunction with a viewed loss, can have tremendous value in the timeline exercise. No memory is too old or insignificant in the examination of our grief. Pictures can be used to deepen detail and memory and intensify the effectiveness of this tool.

In Degriefing, each treatment approach is an individualized combination of integrative therapies, created specific to the needs and previous experiences of the client. These are a handful of checkpoints in a Degriefing session. I always begin by breathing deeply. I closely listen to clients’ stories, hearing the language used, including the use of somatic colloquialisms. I closely watch facial expressions, habits, mannerisms, and body language. Assisting their communication is just as important as practicing the art of non-interruption, all the while observing their behavior as they talk about events on the timeline. Since grief shatters and scatters linear thinking and expression, grieving people often speak out of sequence. I encourage streams of thought to emerge from the individual, and with active listening, I paraphrase their words back to them using their own language.

Explaining the bereavement process and defining the functioning of primary and secondary losses helps clients begin to see the effect it’s had on their lives. Depending on their familiarity with integrative therapies, I might start to talk about which type of massage they could benefit from and with what frequency, as well as any aromatherapy applications that might help them in their process. I encourage clients to keep a journal of the changes in their chaotic, unfamiliar lives and assess what issues and emotions they are carrying in their bodies (as the barometer for their emotional reality). Most of this first hands-on session is intended to establish trust in a safe connection.

It’s important to show clients how to use the timeline to get the memories of all their losses flooding to consciousness, because fresh grief restimulates past, unresolved grief. Then acknowledge the effect of loss on their lives—mind, body, and spirit—and suggest there is a reframing opportunity available for creating a new relationship to their own lives. Above all else, listen to and hear them no matter how many times they repeat the story.

Honor Yourself with Self-Care

When there is a collective disruption of lives, such as with the September 11 attacks, and trauma, confusion, loss, and grief follows, the bereavement process can be used as an opportunity to focus on oneself and explore one’s own personal truth. The impact that loss has on the individual and surrounding family members has a ripple, domino, exponential, wide-reaching cumulative effect.
We had climactic and planetary catastrophes challenging the human condition in 2005. We have become a global society affected by each other’s problems. We live in duality. We are both practitioner and student, parent and child.

As healthcare professionals, we must find a way to honor ourselves with adequate self-care and fierce devotion to remain healthy and stay in balance with the concept of personal well-being and honor our individual processes. Degriefing helps practitioners clear their space so they can be more available for others; then it teaches them the tools for transforming grief to clients. All we truly have is the knowing that the body doesn’t lie, it represents our measure, our barometers of the truth. We have the choice to name our losses and face them and the uncertainty of life with dignity and awareness. More than ever before we have an opportunity, in the midst of all this distress and chaos, to order our personal universes and learn to honor and care deeply for ourselves.

My late husband’s mother asks me why I don’t do “happy work.” I find my passion for Degriefing work infinitely challenging, and I regularly witness the joy of working with individuals who’ve learned to transform their grief. It’s one of the deepest pleasures of my existence. There is no end to grief, and we can allow that entity to overwhelm us and restructure the course of our incarnation, or we can grab the sludge of it and build blocks that demand a restructuring of our lives.

The events of September 11 taught us in the most dramatic and unexpected way of the uncertainty of life. It challenged all our hopes and dreams, our sense of being, and who and what we can trust. We must embrace the possibility that these deep and difficult paths of analysis offer grist for our personal mills. And like pulverized grains to bake our bread, it is all transformable.

Lyn Prashant, CT, CMT, MA, massage teacher, yoga instructor, and certified thanatologist, is the founder of Degriefing, a body-mind modality to unlock and transform grief. With more than twenty-two years in the field, Prashant is also involved in the International School of Degriefing, establishing a bilingual hospice and health spa dedicated to the transformation of grief. Featured on ABC radio, Prashant is also a grief counselor trained at John F. Kennedy University’s Graduate School of Professional Psychology. For more information, visit her website at www.degriefing.com, or call 415-457-2272.

Notes

1. Stephen Levine, personal communication, 1984.
2. P. Levine, Waking the Tiger: Healing Trauma (Berkeley: North Atlantic Books, 1997), 105.
3. Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), 4rd ed. (Washington, D.C.: American Psychiatric Association, 1987).
4. P. Levine, Waking the Tiger.
5. H. Braiker, The September 11 Syndrome (London: McGraw-Hill, 2002).
6. Kathleen Nader, “Terrorism: September 11, 2001: Trauma, Grief and Recovery,” Gift From Within, www.giftfromwithin.org/html/firstaid.html (accessed May 31, 2006).
7. Ibid.
8. L.C. Terr, “Childhood Traumas,” American Journal of Psychiatry (1991): 148.
9. Kathleen Nader, “Terrorism.”
10. S. Eth and R. Pynoos, Post-Traumatic Stress Disorder in Children (Washington, D.C.: American Psychiatric Press, 1985).
11. Kathleen Nader, “Terrorism.”
12. Angie Panos, “Healing from Shame Associated with Traumatic Events,” Gift From Within, www.giftfromwithin.org/html/healing.html (accessed May 31, 2006).
13. E. K¸bler-Ross, The Wheel of Life (New York City: Touchstone, 1997), 161.